Las buenas y las malas: Or how Clinica Reina Sofia tried to kill my dad

Posted on December 21, 2023 by K Eckland

Long time readers know that I have spent the last 13 years of my life evaluating, writing about and promoting medical care in Colombia. In addition to this blog, I have written multiple papers. presentations and books about my experiences and direct observations of care in the various facilities in Bogota, Colombia. The majority of experiences have been excellent.

I have been bringing clients here several years, including my own mother – who had a life-saving TAVR for critical aortic stenosis in 2019 at Fundacion Cardioinfantil. If she hadn’t had that procedure then, she would be most assuredly dead now. Instead, she is a vibrant 84 (almost 85) year old female who continues to run several miles every day, participate in a multitude of exercises (aerobics, zumba, dance etc.) and sports (pickleball, running group).

Of course, when you are taking about something as vast and varied as health care, it’s never going to to be 100% all of the time, for every condition at every clinic, office or hospital. As part of the process of writing a book about healthcare and surgery in Bogota, I have spent literally thousands of hours in hospitals and hundreds of hours in the operating rooms around the city. I have interviewed hundreds of doctors and staff members. Some of these experiences have been so-so, some have been below average, and a very few have been bad.. Our recent experience at Reina Sofia on Calle 127 falls into the incredibly bad category. It was so bad and potentially life-threatening that it almost sounds like farce. Until it’s your dad. And the nurses that are ignoring the patient are ignoring your dad as he experiences crushing chest pain.. The clueless ER doctor is just irritated by your very existence because she wants to get back to chatting on What’s App – and continues to talk down to you. (I am fluent in medical spanish – and cardiology/ cardiothoracic surgery) and that seemed to anger her.)

When the nurse performing your dad’s EKG gets angry when your bradycardic, pale and dizzy dad doesn’t get his shirt back on fast enough so that he can dump you back in the waiting room and he can go on his break. Then when the cardiac enzymes are positive, they move you to the observation area and never check on him again. I had to check his chest pain/ vital signs/ everything while we wait, futilely for someone to help us.

Nevermind oxygen saturations in the mid 80’s.. Seems like the plot of a bad 1980’s movie – as you realize that they are ignoring you, because you are a crappy old gringo, and that they would rather and leave….

Until you have to call a friend to help you leave the hospital so you take your family member to another hospital because the staff keeps ignoring you – and telling you “wait ten more minutes” hour after hour.. Until the so-called specialist rattles off a prepared speech, and doesn’t seem to listen when you dad explains that he still has chest pain (after receiving only tylenol in the ER). It was a devastating experience – and a terrible learning experience.

I freely admit it was my mistake. I initially wanted to go directly to Clinica Shaio when my mom called me – but after thinking about the distance – I made the (wrong) clinical decision that if my father’s clinical status looked poor – that I shouldn’t risk the trip – and should take him to the closest well regarded facility. Clinica Reina Sofia is just minutes from my house, and my dad looked eminently bad. So much so that I rode in the backseat of the car with him in case he needed CPR on the way.

But I trusted that ER staff would know how to manage a common and basic emergency condition like this. After all – it’s part of basic life support classes – you know, the classes that lifeguards and babysitters take. That assumption almost cost my dad his life. It’s particularly hard for me because I have been to Reina Sofia before (in the operating rooms, etc.) and the care was pretty good – good enough that I took my dad there in the middle of the night. Maybe they (Reina Sofia) do know how to treat this very common emergency condition. Maybe they know that time is the essence. Most likely they do. Which means that they just don’t care. Because they certainly didn’t care about my dad. They just wanted him to sit down and shut up.

As I write this, I am waiting for the cardiologist to tell me about my dad’s cardiac catheterization – here at Clinica Shaio, where the care has been wonderful and immediate!

Lost post 2014: Juan Valdez

Posted on November 4, 2023 by K Eckland

**I recently found a hidden folder with several drafts from 2014 – 2018 that were never published. I decided to revisit and update these posts while I am working a nursing assignment in the Northeast, USA**

For everyone who is wondering: Does this post mean that I am headed to the cafetero (coffee region) of Colombia? Sadly, no – that journey will have to wait for a future trip (Oct 2023) to Colombia. Instead – it’s time to talk about the ubiquitous “I must be in Colombia” Juan Valdez. He’s kind of like the North American Marboro Man – except his product won’t kill us. (Equally addictive in my opinion, but oh so deliciously!)

Most people think it’s just a brand name for the Colombian version of Starbucks but that’s just one of it’s latest incantations. The symbol of Juan Valdez, harvesting coffee beans, has been around a lot longer (since 1958), and represents more than just upscale marketing of an almost universally used product.

When I originally wrote those words, almost 8 years ago – I was thinking about Juan Valdez as the eternal symbol of Colombia – and how as a symbol it has a bit of a double edged sword, as it gives rise to the idea that ALL Colombians are “campesinos” or rural farmers, instead of doctors, lawyers, judges, designers etc.

This can lead into dangerous territory because of the long and tortured history between campesinos and paramilitaries in Colombia. This has been particularly bad for the small independent (and usually poor) farmer in the southern regions of Colombia, where the FARC and other groups still hold considerable power. I was going to write more about this imagery as well as some of the more sophisticated imagery regarding Colombia and Coffee. But that was before I bought my own tiny finca – and began to learn about coffee agriculture.

Now that we are knee deep in classes and books on growing coffee, sustainable and nonchemical practices – it all seems a lot different. But the idea of the uneducated peasant farmer still robs Colombia’s people of the dignity that they deserve. They may not have a college degree in all of this – but the agriculture and economy around coffee growing is pretty complicated/ and sophisticated.

There’s more than varieties of coffee, there are differences in caffeine content based on altitude. We are still preparing the finca for a spring planting (March – April) of an Arabica bean variety popular in our region of Colombia. That means ensuring that we have adequate shade coverage for the plants – which receive a calculated amount of sun-shade for the best bean development. Our coffee will be shaded by plantains – and avocados. (There are some other scattered fruit trees, but we concentrated these for the best shade coverage).

Coffee beans develop and have to be harvested every two weeks. That’s still a manual process. Once the beans have been picked – industrial or large fincas can move on to large scale or mechanized means of preparing the beans to eventually be ready for your coffee cup.

But we are small – and the coffee beans are for our personal use (and some select friends) so it’s all going to be manual production on our farm. We will be doing it the same way that small farmers have been doing it for hundreds of years; drying the beans, sorting and shucking the outer skin, and then taking our small quantity of beans to the Coffee Growers Association and the larger farms to have them carefully roast the beans to our desired roast. It’s time-consuming, and it’s hard work – and that’s why I think I am so drawn to it.

Since we are just starting out – don’t head out to the farm to visit just yet – it takes a minimum of three years for plants to mature enough to provide beans suitable to coffee. (Good thing because we still have so much to learn!) That sounds like a long time, but then I remember that I’ve been writing this blog since 2010, back when I visited Bogota for the first time. (I was supposed to stay a few weeks and then head to San Pedro Sula for a Spanish program.) San Pedro Sula never happened – and the Spanish program has been me, basically winging it – watching a lot of Netflix in Spanish and having (mostly) only Spanish-speaking friends. (A little English always sneaks in – usually folks wanting to practice).

Additional links and information

Juan Valdez official site: site with information on Juan Valdez and Colombian coffee.

Flavors of Bogota: this is a coffee company that offers courses/ classes for Baristas, and potential coffee shop owners (or anyone who wants to sell coffee, in any form). The people who run the website, Karen and Peter are pretty interesting too. She teaches about coffee at one of the local universities.

Termales Los Volcanes

Posted on October 29, 2023 by K Eckland

It’s taking longer than I thought to find the video clips I have about driving in Colombia.. so we will defer that topic for now. Instead, let’s talk about something less death-defying and much more relaxing.. Hot springs!

I know I mentioned in my post about Santa Rosa de Cabal – how much I love hot springs.. Or maybe I mentioned it when I went to to Sulfur pools in Tocaima way back in 2010, but that would have been the earliest days of the blog.. I adored the hot springs in Paipa – but those too, I might not have mentioned since it was a client trip.

Anyway – I love hot springs! I love bathtubs, jacuzzis, swimming pools – all things water. It was so important that it was one of the determining factors when it came to purchasing my house in North Bogota. Was there a bathtub / was the bathroom large enough to install one? Now, the tub at my house isn’t some massive spa tub that uses hundreds of gallons of water. It’s just a regular old tub, but I sure do love it – especially when I can’t sleep, or the damp chill during the rainy season sets into my joints. Now the tub at my rental property is the supersized luxury type, but honestly, I’ve never used it – or the golden toilet.

*the bathtub at the Elvis Presley Graceland penthouse*

So if you’ve never been to the ‘termales’ or the hot springs but you enjoy a hot bath – just think of a swimming pool of nice, hot volcanically heated water, usually in a beautiful outdoor location. I’ve recently made it my personal goal to visit as many Colombian hot springs as possible. I read somewhere that Cundinamarca has 42 different hot springs alone, and that Colombia has 130+. I won’t get to all of them – and I don’t need to. (I can’t image enjoying hot springs in 100 degree weather, which rules out several). But with just a few days left before I head back to the United States for a month, we decided to start working on that top ten list I posted recently.

A mid-week day trip was perfect, so we decided to pick a location close to Bogota. We decided to go to Termales Los Volcanes in Macheta, Cundinamarca. Minimal traffic to navigate to get out of the city since it was a Tuesday, low weekday prices and no crowds at the springs.

We arrived early in the morning, around 730 am, while the weather was still cool and refreshing. We had a nice breakfast before jumping in the deliciously warm springs. There are two big pools, one much warmer than the other, and two smaller pools.

The hot springs are set against the lush green background, with a waterfall, cobblestone paths and lots of flowers. There is a small hotel on site, along with a restaurant, snack shop and spa. Since we were on a day trip, we didn’t need the hotel, but we checked it out anyway. Weekday rates start at 315,000 COP and include breakfast as well as hot springs entry. Weekend rates start at 415,000 COP.

Since we were just day trippers, it cost us 35,000 COP each to get in. The hot springs are open from 7 am to 11 pm most days. We enjoyed the pools for quite a few hours, along with breakfast, snacks, lunch, massages in the spa, and quick dunks in the icy waterfall before we headed back to the city. It was a lovely day – and even lovelier because Andres and I got to spent it together. (We do a lot of family activities with his parents, cousins, uncles etc., but we don’t always get to spend time together.) He’s a great co-pilot, co-conspirator and partner-in-crime for our adventures. We have a lot of very different interests but he’s definitely game for my hot springs challenge.

I got a bit of a sunburn despite lots of sunscreen – so I’d advise wearing a rashguard, like Andres did. Otherwise, it the entire day was a bit of joy..

Cali, Cali, Cali and the best AirBnB in Cali!

Posted on October 25, 2023 by K Eckland

Montenegro, Salento, Santa Rosa de Cabal and now, Cali, Colombia. We passed thru multiple states, ate lots of different things, took lots of pictures, hiked in the mountains, climbed lots of stairs and enjoyed the famous hot springs on our way to the grand city of Cali, Colombia.

So…. Cali is hot.. Not warm, but hot. Maybe not to everyone (I saw locals wearing sweaters and jackets) but it’s the kind of hot that makes me grouchy and miserable – and I know this! I’ve had plenty of miserable trips to sunny beach locations (and other places that heat seekers flock to – and I know what heat does to me). Add heat = instant bitch.

It was also the surprise visit for Andres and his daughter’s shared birthday weekend.

So I couldn’t let the heat get to me. I found a charming Airbnb home with a small swimming pool. The hosts were absolutely delightful, so I posted the link above, if you are planning a trip to Cali. It was in a nice neighborhood (but not a lot of stores or restaurants to walk to) right on the river. It was the perfect solution – we basically lived in the pool for much of the weekend. His daughter loved it, we had a good time, and I didn’t become a heat enraged monster.

House we rented in Cali, in private cul-de-sac
lovely elegant split level
Dining room and kitchen opened out to the pool/ BBQ area
BBQ area
living room
master bedroom
master bedroom
view from master bedroom

I don’t usually feature someone else’s rental on the blog – but this house made all the difference. It was spacious – charming.. We barbecued, we swam, we slept in the hammock by the pool. This house made all the difference for me – (and certainly for people who had to travel with me!)

But we didn’t stay in the house the entire time. We took a morning stroll down to the Parque de los Gatos and other Cali landmarks. Of course, I did manage to bow out of one afternoon adventure in the heat – to hang out by the pool and read a book. It was lovely! I also used the time to sneak out and get ice cream for the birthday folks..

I enjoyed the heck out of the pool.. I even stayed home to read a book by the pool while everyone else went out one afternoon
the Pool
BBQ birthday
Parque de los Gatos

I probably should talk about Cali and salsa dancing.. or salsa music, drink champus or the many other things that make Cali famous and noteworthy.

But I didn’t go and experience any of those things on this visit. (This is my second visit to Cali.)

Here’s an easy Recipe for Champus. It’s a tasty nonalcoholic drink made with tropical fruits. Lots of people say they drink it at room temperature, but we usually have it chilled.

At the end of our weekend, we returned to Bogota.. I drove for a good bit of the way – but I really don’t like driving in Bogota, so we switched off at Ibague, where we stopped for lunch, and to wait out traffic with some friends. (You don’t want to drive thru/ near Bogota during peak time – it can take 3 to 4 hours to cross the city if caught in peak traffic.) On one of my future posts – we are going to talk about Driving in Colombia. I know I mentioned that I received my driver’s license and motorcycle license this year but driving in Colombia particularly in the city of Bogota is worthy of a special note.

The thermal hot springs of Santa Rosa de Cabal and the ruins of La Posada Alemana

Posted on October 10, 2023 by K Eckland

Just outside of Salento is the burnt remains of several large buildings on a large estate. That estate is the former hotel of the infamous Carlos Lehder, narco-trafficer and one-time ally of Pablo Escobar. La Posada Alemana was inspired by Carlos’ father ,Kurt Wilhelm Lehder, and the small Pensión Alemana he had owned. The senior Senor Lehder was no saint either, as a german immigrant who had moved to Colombia in 1928, he maintained strong ties to the fatherland. He is believed to have strong pro-Nazi sentiments, and to have helped the Nazi’s gather intelligence, using his hotel for meetings.

I don’t write a tremendous amount about Escobar and such, mainly because I feel like the topic has been talked to death, from Cocaine Cowboys, to Narcos and El Patron de Mal and every other quasi-documentary out there.

But since we were literally passing the burned out ruins, I felt compelled to stop and take a few pictures.

But our next destination was pretty amazing! I had actually seen it on a youtube channel. (There are a couple of great channels for information on tourism destinations in Colombia. My personal favorite is FNDCol. They have a great series on all the different states in Colombia. Another good one is FonturCol. Both pf these channels are in Spanish, but you don’t need English to appreciate the view.

This video is where we went – the thermal baths at Santa Rosa de Cabal, in the Colombian state of Risaralda.

We went on a misty, then rainy day – which ended up being perfect. The hot thermal baths (there are several pools), the chilly waterfall and cold rain on your face made for an extraordinary combination. We also took advantage of the deep tissue massages, and the adjacent restaurant and coffee bar.

For starters, there’s the view..

Then, the thermal baths themselves.. The water is deliciously hot. The waterfall provides for refreshing cool water along with several cascading showers.

There are flowers, and greenery everywhere.

We spent most of the day at the thermal baths – I could have stayed forever, honestly. And you almost can, since the falls are open until 11 pm at night on weekdays and 2 am on the weekend. Several locals advised us that nighttime visits were the best for couples, and a romantic date. Magical! But we left before that – to try the famous sausages of Santa Rosal at a charming roadside restaurant.

Lakeside cabin at roadside restaurant
Cabins
The famous sausage of Santa Rosa de Cabal
one of the many rabbits that make their home outside the roadside restaurant
The tree house and lookout point at the roadside restaurant

It was a cute restaurant, with a coverage main restaurant, a small snack shop and several little cabins for private meals. They also have a massive tree outback, with stairs that lead upwards to a lookout point. It was too misty that day for much of a view, but the famous chorizos were quite tasty.

After a late lunch, we returned to the town of Santa Rosa de Cabal (the hot springs are outside of town, a couple miles away). The town itself was underwhelming, but my impression may have been dampened by the grey rainy weather, so I will have to come back one day and give it another chance (happy to do as long as I can visit the springs again.) Of course, I might just end up staying at the folksy cabins just outside the springs – and skip the town entirely.

On our next post – we make our way to the sulty city of Cali, the Colombian capitol of Salsa dancing.

I’ve made it my personal goal to see (and experience) as many thermal baths in Colombia as possible (Paipa was fantastic too!) so I am going to include this link to 10 different thermal baths near Bogota for similar minded people to enjoy..

The charming and colorful town of Salento

Posted on October 5, 2023 by K Eckland

The trip has gone better than expected so far. In the last decade of so, I have developed a very poor heat tolerance – which makes traveling difficult sometimes. I feel overheated on a sunny day 70 degree day in Bogota (I have several fans installed at my house to the complete horror of my friends and neighbors.) Sometimes, I am sweating and overheating when my friends are putting on sweaters.. It’s kind of frustrating to deal with – but now I travel with my own fan, and ice packs. So, I was worried about traveling to the Eje Cafetero, because some areas are fairly warm, like Pereira but Andres was careful to plan most of our trip in the cooler areas. Not as cool as Manizales, which is my general comfort zone, but quite pleasant so far in our journey.

Salento is quite close to Valle de Cocora, and during our stay, the weather was cool, with rain overnight. Salento is one of those picture postcard towns, that as much as it’s a touristy place, it still manages to be charming, which was a pleasant surprise. (I am sure volume of tourists plays a big part – we were there during the week, just prior to school vacations (semana de receso) so while there were other tourists around, there weren’t any lines, nothing was crowded, merchants were pleasant, friendly and not at all pushy.

I like color – it’s one of my signatures in both interior design and fashion. I strongly believe that we should “live life in color” and I despite that all white cold, institutional look that is so popular these days. Same thing for grey, and beige schemes – which predominate in Bogota design. My own house in Bogota is a riot of color, and a color scheme that changes on a whim.

Salento is the same, rich with color – in the bright fashion of the coast, and the Caribbean versus the painted ladies of San Francisco. The other nice thing is that it isn’t just one or two streets – it’s the majority of the town.

colorful homes and businesses in Salento

We stayed at a lovely apartment hotel that was close to the center of town. We were able to walk everywhere. The apartment was well-appointed, and we could make our own breakfast in the morning. Our host, Mario was very nice and happy to accommodate our plans.

After we got settled, we walked downtown – and to the Mirador, which is a point above Salento that allows you to see the entire city below – once you climb the steps to get there. (There’s a less strenuous path to the Mirador, but I needed the exercise).

It’s 256 fairly steep steps, (less than half the steps of La Piedra del Penol, and only a quarter of the climb up Monserrate but it’s enough to make you breath pretty hard.

I found the actual city view a little underwhelming, but maybe I’ve been spoiled by all the beautiful Bogota vistas..

But once you reach the top, there is a trail that leads to another view point – and this one is breathtaking. Instead of city scapes, it’s a panaramic view of the valley and the mountains that surround Salento.

I could take a million pictures and probably never do it justice.. So here’s a couple more.. Just click on the image if you want to see the whole thing.

The older I get, the more I am awed by nature. It’s funny how that happens. Sometimes, I think that we need to see a lot of ugly to truly appreciate the beauty in the world.

On the way back, we did a little bit of shopping to celebrate Andres birthday – and so I could take pictures of some of the crafts. (I know, it’s in almost all my Colombia posts – but the different kind of artisanal art and indigenous and traditional craft here is so beautiful. I don’t need to buy it – because how many mochillas, bags, hats and other things does a person need? Then again – I do try to support local craft by buying it whenever I need a gift because why would you buy someone mass market crap when there is a plethora of beautiful handmade items that actually mean something out there.

(Not this time – this time Andres actually picked out the beautiful leather bag he wanted – and I’ll get a picture of it tomorrow.) But there is such a variety of so many lovely things, that I just can’t help but take pictures of it when they let me..

After that, we took some more pictures – found a nice restaurant before heading back to the hotel to sleep..

Tomorrow – Santa Rosa de Cabal and the thermal springs..

A surprise visit – to Eje Cafetero and Cali

Posted on October 4, 2023 by K Eckland

It’s been a bit since I’ve posted here, but the adventures continue. I spent some time in Pacho, Cundinamarca finishing up a manuscript for my second full length novel. Now that it’s done – I am in the tedious process of getting it edited and finding an illustrator.. Now, I am not the great American novelist and I have absolutely no illusions that I will find any mainstream sales success (no publicist, no large publishing house) but I have always believed that if you put in the time and effort to do something, finish it…

But, it was a relief to finally finish the book – and not have all the characters in my head all the time. That being said – there is always so much to do.. But we are taking a week to smell the roses and enjoy ourselves.. It’s a surprise visit for my significant other to see her daughter on her birthday. She lives in Cali – and she will be delighted to see her dad.

Since I’ve never been to the Cafetero or Coffee Region of Colombia, we decided to take a tour of it on our way to see her.

We left Bogota around 3:30 am.. We live in North Bogota, and our journey takes us south, so we have to cross the entire city first. (There isn’t a bypass though politicians have been promising one for the last 40 years.) By 4:30 we encountered traffic.. (If you haven’t been here – Bogota has a massive traffic problem – brought about by limited public transportation, a huge population of people who work on one side of Bogota and live on the other) and well, an exploding population, with a road system designed for a much smaller city. (In the 1990’s Bogota’s population was around 3 million, now in 2023 – we have close to that in Venezuelan immigrants with a total population of around 11 million).

But soon enough, we were on the open road.. Our first stop was Ibague in the Colombia state of Tolima. Culinary-wise, Tolima is best known for some of my favorites, Tamal tolimese and Lechona (stuffed roasted pig). (The links will take you to some older posts on these tasty Colombian dishes).

We stopped for some breakfast and a quick visit with family. (His, not mine, though I like to think of his large immediate family as mine). It was starting to get hot there by about 930 so I was glad when we hit the road again..

Now if you’ve never driven in Colombia – distances are very very deceiving. I recently got my Colombian driver’s license which requires you to take the full driving course to learn the Codigo de Transito, and clock your behind the wheel hours. Funny enough, I was rear ended while driving in the student car, which has massive green labels saying “student driver – keep back” – but that’s a story for another time.

The maximum speed limit in the country is 80 kilometers – but most of the time, you never get near it.. In the cities, the limiting factor is usually traffic – but in other areas, it’s the state of the roads themselves. There is always road construction. With a rainy and a dry season, you also get periodic flooding in some places.. Much of Colombia is high in the Andes mountains – with winding mountain roads – usually one lane in each direction. Add a couple of fuel trucker, semis (18 wheelers) and a whole bunch of motorcycles and cyclists – with people passing said fuel trucks, cyclists over double lines, on blind curves and all, you end up with an average speed of around 30 to 50 kilometers an hour.. (that’s less than 30 miles an hour for people like myself who weren’t raised on the metric system.) Sometimes it feels painfully slow.. But on highway 40 – it can feel dangerously fast..

*That time estimate is complete fiction..*

Unfortunately, due to the narrow roads, curves and such – I didn’t get many pictures of our drive – and it’s an unbelievably breathtakingly gorgeous drive.. You climb higher and higher in the mountains (which is delightfully refreshing with cool temperatures) with such a picturesque landscape, dotted here and there with fincas and small farms – but otherwise endless green trees, plants, grass and a wide open blue sky..

We continued on after a brief stop in Cajamarca (photo above) to Montenegro, where we spent the night. There are some cool things to see in Montenegro but we decided to relax a bit after getting up so early.

Sampled some coffee, walked around the plaza and swam in the pool. My companions were lights out asleep by about 730 that night. The next morning we headed off to the Valle de Cocora. If you’ve ever seen the kid’s animated movie. Encanto – it’s set in this part of Colombia..

*I love maps.. absolutely fascinate me, so of course – plenty of them in this post..*

The Valle de Cocora is part of the Los Nevados National Park and is located just outside of Salento. It’s famous for the large collection of Quindo Wax Palms, which are the tallest palm trees in the world. These palms are also part of the national identity of Colombia.

As part of the Nevados Mountain range, the palms are located at an elevation higher than Denver.. What does that mean, you ask? It means blissfully cool weather.. and lots of misty low clouds that drift in and out.

Today was the day that I realized that I am not a horse lover.. Not a horse hater either.. Wouldn’t want to knowingly eat one – and I used to get upset when they would sanction killing the wild mustangs when I lived in Nevada.

But I was never that pre-teen girl that was doing paint-by-number horse paints, or reading Black Beauty a million times (am I dating myself or what), and dreaming of owning a horse.. but I love animals in general, mainly feline varieties. Our neighbor used to graze horses in our yard when I was little in Virginia, and I have ridden before.. But not – horse crazy.

Ha.. So we decided to go on a “nice” horseback tour. I immediately felt uncomfortable, but hey – get back in the saddle right.. But it progressed to a freak out – and I ended up dismounting and walking (which is fine – I love a good walk/ hike). But it still surprised the heck out of me. I always feel like I am fearless.. Ha. Seabiscuit proved me so so wrong today..

Andres and his mom had a lovely time horseback riding.. Once my pulse went back to normal, and my feet were on level ground – I had a great time too..

We had a lovely lunch at a cute restaurant. The area is known for it’s fish (trout) dishes, so we each had a different trout preparation and shared..

Enjoying a little Club Colombia
High up in the Valle de Cocora
Andres mom enjoying trucha with mushrooms
Valle de Cocora is filled with amusements, tours, shops and selfie stations
Trucha with cerviche
Trucha with garlic butter
the classic Eje Cafetero jeep
Horse tack at the stables

Then it was time to set off for Salento.. But that’s another post.

Additional Links about destinations in this post:

Cocora Valley Jetsetter’s Guide

Visiting the place that inspired Encanto

Town hopping in the Cafetero

National Coffee Park in Montenegro

New podcast: Kristin in Colombia

Posted on July 16, 2023 by K Eckland

Readers, friends, colleagues and even family often ask, “Why Colombia?” They aren’t asking about the logistical reasons I’ve presented in previous posts. They are asking an entirely different question. They are asking why I’ve uprooted my life, to start again – on the road to citizenship in Bogota, Colombia.

I could have continued to visit and live in Colombia periodically, and post my stories, pictures and adventures. Especially after I realized that all of my academic efforts in the field of surgical tourism wouldn’t amount to much, despite years of effort.

But I didn’t. I moved here – lock, stock and barrel as they say. I sold my house in Memphis, Tennessee, packed up or sold all of my belongings and re-settled my live in South America. I have no regrets – and I would do it again. In fact, I only wish that I had taken the leap earlier.

I decided to start a podcast called Kristin in Colombia to talk about this, and all the other experiences and adventures in my life – as a middle-aged woman starting a new life in a new Country, with a new culture, language and everything else it entails. I just finished the first episode, and it’s a little rough technically speaking. I am not a public speaker, nor a sound editor.. But bear with me as I get a little more experience – and enjoy the ride.

https://podcasters.spotify.com/pod/show/kristin-eckland/episodes/A-most-unusual-origin-story-or-how-did-I-get-here-e270kkm

Reason # 1 – and Holidays in Colombia

Posted on December 25, 2021 by K Eckland

Over the years, people have asked me the same question repeatedly. “Why, Colombia?” Different people have asked me this question for different reasons, about different things. Sometimes it’s Colombian people – government officials, surgeons and others, and they are asking in relation to my work in medical travel.

Sometimes, it’s my fellow North Americans asking for the same reason. Sometimes, it’s my co-workers in the USA, who want to know why I spend so much time here. Sometimes, it’s Colombians for the same reason. Sometimes, it’s just people who are curious.. There are many many reasons, and I won’t talk about them all today.. But..

The #1 reason I love Colombia, live in Colombia and promote Colombia and Colombian culture is: The People!

Obviously, people are unique, and there are good and bad people etc.. everywhere. But I have found my Colombian friends, acquaintances, neighbors, and even many many strangers to be some of the nicest, and kindest people I have encountered. I would have never been able to write the books, if that hadn’t have been the case. Before smart phones (and related technology), and speaking very minimal Spanish, I was able to navigate, research and write several books about this country, all due to the countless times absolute strangers helped me out, whether I was lost in the far part of town, needed to complete a task complicated by complex instructions, or just needed additional information. There was always someone that volunteered to help. Many of these people went on to become close friends, or colleagues. But sometimes, it was just a stranger on the bus who was giving me directions to where I needed to go.

Of course, there are nice and helpful people in the United States – I always tell people, that in general, “gringos” are friendly and welcoming to strangers. And the rest of the world, has no shortage of nice people either. But it’s more than that – here there is a sense of family and inclusion that we seem to have lost in the United States. When I was a child, during the holidays, families (like mine) always invited visitors, strangers, single people etc. to join us – and celebrate with us. But much of that sense of inclusion has diminished over the last several decades.

Where my parents would invite people to picnic with us at one of our soccer games, etc. my generation is more closed off – our immediate nuclear family becames a secret club. Instead of saying, “I can’t do lunch because of my child’s X activity, but would you like to sit in the stands with me so we can catch up?” people have become exclusionary – and often times, pretty darn proud of it. It becomes almost a badge of honor among young adults to start excluding even very close friends once you marry and had children.

It’s more like, “Look at how special I am – I have a spouse, and kids, [and thus don’t have time for you].” I am not the first to remark on this phenomena, there has been miles of articles, books and literature written about it. It ties in with the helicopter parenting and other childrearing trends that are more prevalent in North America. This anti-social, narcissistic trend probably isn’t entirely absent in Colombia – but it’s not common. So, in Colombia, at least, your friends with kids are still your friends and vice versa..

Thus, for someone like me – who likes to travel (and likes to travel alone) and live a very independent life – being able to maintain friendships with people, and being able to include them in my life and theirs, despite their childbearing status is important. (I love my friends, and even though I don’t have kids of my own, I enjoy being around children, especially when they get to that fun pre-teen age).

But during the holidays, these trends tend to be enhanced, which is why they talk about the depression and risk of suicide during the holidays – in the USA – because we have a lot of lonely people being left out of a lot of socializing for superficial reasons (like divorce, widowhood, or single status) even before the pandemic turned our world upside down.

But let me give you a recent example (just one of many many experiences I have had) and tell you about my Christmas – because maybe it’s better to just talk about actual events – instead of sociology theories..

Of course, let me acknowledge, that the Holidays in Colombia are a very special time anyway.. It’s not about a bunch of presents under the tree or buying a lot of stuff you don’t really need. Colombia is a Catholic nation – and religion is definitely part of it – but not overwhelmingly so. (I am not terribly religious – and none of it makes me uncomfortable here – which means something; when you consider that many times at home in the USA – I can’t get through a business meeting without someone feeling the need to invoke Jesus, repeatedly, in a lengthy and aggressive manner, whether or not it’s appropriate.)

Christmas, New Year’s and the Holiday season is a time to celebrate – with friends and family. It’s a time for homemade cooking, exchanging hugs, stories and spending time together. It’s gotten more complicated recently – but this year, everyone was vaccinated – and boosted – and several of us remained masked too (with doors and windows open for extra ventilation).

This year, 2021, my neighbors, the Gonzalez family invited me to join with their big, boisterous, lovely and sweet family for Christmas. I moved here in the middle of the pandemic – with strict lockdown rules in place – so I didn’t really know my neighbors well – only enough to share greetings in passing. We had exchanged holiday greetings and neighborly gifts (they gave me a lovely anchete (gift basket), and then they invited me to spend time with their family.

Look at this lovely anchete, filled with great things..

Side Note:

I learned a long time, when I first came to Colombia – to say yes to these opportunities. (When I was new to Colombia, I would often say no because I didn’t want to be “a bother”, or inconvenience anyone. I thought saying yes was bad manners – so sometimes, I turned down invitations to do things that I really wanted to do because I thought people were just inviting me to be nice – and again, I didn’t want to inconvenience them…. and then a nice Colombian girl I knew explained that by turning down invitations, people got the impression that I wasn’t interested in what they had to offer..

So I got over my uncomfortableness at feeling like I was “putting people out” and started saying Yes.. To just about everything… and it has made a heck of a difference – and I’ve had some amazing experiences and gotten to know some wonderful people).

So off we went to his brother’s house.. Both John and his brother were born in the atlantic coast of Colombia, even though they have spent most of their lives here in Bogota. So, in a salute to their costeno heritage, they were cooking some delicious cuts of meat – using a smoking technique called al trapo..

Don’t worry, while I may have been too busy enjoying myself and talking to everyone to take pictures of all the members of the Gonzalez family – I did manage to get lots of food pictures..

My neighbor is one of five siblings – and three still live in Bogota. He and his wife, Brenda have six grown children, who all live nearby.. So it was a fun gathering of some very nice people, who all love each other a lot. Mr. Gonzalez brother, Richard was doing the honors cooking the meat with one of Mr. Gonzalez’s sons.

So first you dampen a piece of linen or loosely woven cotton cloth in wine.. Red wine, preferably, but any wine will do. It just needs to be moist, not dripping.

Once the cloth has been moistened with wine, sprinkle coarse salt and some pepper on the cloth. Then place the meat in the center of the cloth. Roll the meat in the cloth, adding additional salt and pepper between layers.

Meat rolled in wine soaked cloth and tied with string

Then the meat roll is placed directly into the fire (on a wire rack over the flames)

Cook the meat for 20 to 30 minutes. When the roll is removed, it will look crusty and burnt, but it will be juicy and delicious inside. Cut the fabric and the strings.

After the covering has been removed, let the meat rest for five minutes before slicing and serving.

There was a bevy of other delicious things to eat.. I took pictures of some of my favorites

There was a delicious mango salad, with lettuce, pineapple pieces, mango chunks, and raisins. I don’t know what the dressing was – but it was delicous and mild enough not to overpower the delicate flavors in the salad.

Besides enjoying all the delicious food and drink, we had a lovely time. John and Brenda’s kids are a lively, good-natured bunch.. I wish I would have gotten more pictures at the time..

At midnight,, everyone including the sweet little grandkids gathering in the living room to watch the little ones open a few presents.

the grandbabies, enjoying some desserts..

Then we played some games, chatted and the adults enchanged secret friend gifts.. (They did charades during the gift exchange, so you had to guess who the gift was going to..) Danced a little bit – enjoyed some jokes.. and then it was time to go home..

All and all a lovely time, with a charming family, celebrating Christmas here in Colombia..

In Capitol City

Posted on August 27, 2015 by K Eckland

Long time readers know that I am addicted to the capital city of Colombia. So there was no way that I wasn’t going to take a few days to head over to Bogotá the moment I had a chance. I just got back – and before I head off on my adventure to La Macarena tomorrow, I thought I’d post an update.

Charlie’s Place

8D y 106-84

Usaquen

Since I was just stopping in for a few days, I decided to forgo renting my usual apartment. It’s a good thing I did or I would have missed out on getting to know the folks over at Charlie’s Place, a boutique hotel and spa in Usaquen.

It’s probably not for everyone – people who want to be in the middle of the tourist areas of Bogotá should stick to La Candeleria. Business travels on large expense accounts can head to the big-name chains. But for people like me, who want to be in the north side of Bogotá, around Barrio Chico and Usaquen, Charlie’s Place is ideal.

With just 22 rooms, the hotel is very cozy and accommodating. The manager, Wilson, is a Minnesota native and is delightfully charming and easy-going. The rest of the staff including Daniela and Javier are equally polite, friendly and helpful. (There’s a reason Charlie’s Place is consistently rated as excellent by Trip Advisor for the last several years.) The best part is that the rates are fair and the service is excellent.

Once I was comfortably settled, it was time to get back out and enjoy the brisk weather. (The weather is one of the reasons I love this city!) My first stop was over at SaludCoop where the doctors and nurses were nice enough to answer some questions about the ongoing healthcare crisis.

The Colombian Public Health Care Crisis

Right now, the public health system, EPS and SaludCoop are going broke. Basically, much of the money paid in by members of the health care cooperative has disappeared (been embezzled), leaving hospitals with bare cupboards. Hospital staff are feeling the pinch as payroll arrives late, in diminished amounts, or in some cases, not at all. (There are rumors that the money was funneled into the purchase of luxury apartments, fancy vacations and the like). There have been some protests and work stoppages by health care workers, but unfortunately, the local unions have been unwilling to support their efforts.

Unfortunately, the government seems apathetic to the concerns of the healthcare workers and their patients. The Minister of Health, Alejandro Gaviria went so far as to say that the health care crisis was a “lie” in a recent press conference, following up on his previous twitter (June 2015) and blog comments (Feb 2015), even going so far as quoting Christopher Hitchens in his defense of the health care system. Of course, no where in his statement does he talk about healthcare workers going without pay or operating rooms without suture. But he’s not alone in his apathy.

Most of the local politicians couldn’t even be bothered to show up to a legislative session on the issue. Only 9 members of the House of representatives (out of 166) attended.

This financial travesty has wide-spread implications beyond just the public health sector (of hospitals and clinics throughout Colombia). Many of the private facilities also rely on payments from the healthcare cooperative. (Imagine if medicare went broke through criminal mismanagement – it would affect a lot more that general and county hospitals). In many cases, these hospitals are forced to write off millions of dollars of nonpayment from the health cooperative. In fact, one of the largest hospitals in Cali (a city of 2.5 million people) will be forced to shut it;s doors, mainly due to losses incurred from nonpayment by EPS and SaludCoop. So it’s a huge mess that will probably only get worse without government intervention.

On the flip side of the Colombian Health Care Crisis and the declining peso (over 3200 pesos to the dollar this week) – Hospital Santa Fe de Bogotá appears to be thriving.

Santa Fe de Bogota’s new emergency department

Yesterday evening I had the pleasure of a guided tour of the new Emergency department at Santa fe de Bogota with the current Chief of the Emergency Department (and trauma surgeon), Dr. Francisco Holguin.

Fans of the Bogota book know that I spent quite a bit of time at Santa Fe de Bogotá in the past – and that it is one the highest ranked facilities in all of Latin America, so it was fantastic to see all of the improvements. (The ER was still under construction the last few times I was there). The first thing I can say – It’s big! Big, spacious, brightly lit and airy (especially for an ER). The is good work flow with several large workspaces for the doctors and nurses, instead of the typical traffic jams that occur in older facilities. It’s on the same floor as diagnostics (CT scan, radiology), the operating rooms and the intensive care units which means that critically ill and injured patients can be rapidly transported to where ever the need to go.

The spacious department now has 56 beds with an overflow unit for critically ill patients. Several specialists are on-call, in the ER and available 24 hours including orthopedics, trauma and internal medicine. Downstairs from the main ER is the fast track – for all of the non-life-threatening general medicine problems.

After spending two days interviewing and talking to people about the SaludCoop problems and EPS – it was nice to leave Bogotá on such a nice note.

Heading South!

Posted on July 18, 2015 by K Eckland

It’s been a long hiatus as I’ve replenished Latin American Surgery’s coffers on a couple assignments over the last several months, but I will be back in the Southern hemisphere later this summer, and I am sure we will have a lot to talk about..

It’s an unfortunate reality that travel and travel writing costs money. That, coupled with the long hours required in my “day job” mean that I do less writing and researching for the blogs than I’d like. I was able to keep pace initially, but there was a point where it became a question of getting some sleep so I could work and pay my mortgage (and buy groceries) or continuing to churn pages for the blog.

on the runway at Colombia Moda 2104

After spending a lot of my resources working on a thoracic project this Spring over at the sister site, thoracics.org and working – it’s nice to be back here at Latin American Surgery.com

I’m going back to Medellin soon – and I look forward to taking all my readers with me. (I wanted to travel to a couple other areas, but frankly, couldn’t afford it). I won’t be attending Colombia Moda this year – but there is always someone to interview, health topics to talk about, cultural events explore or people and places to photograph.

I have a couple if ideas for some interesting articles, but we’ll have to wait to see how these ideas come together.. I hope it will be worth the wait..

Crazy days!

Posted on August 3, 2014 by K Eckland

It’s been a couple crazy, busy days here in Medellin. I have a bit of a backlog of posts – from a day learning to finger crochet in a group crochet class, the festival of flowers, a visit to Clinica Medellin Occidente and the ALAT conference. It will take me a little while to post everything before heading home in just a few short days.

The ALAT conference was fantastic. In addition to numerous wonderful, learned speakers from all over Latin America, it was a great chance to connect with innovative thoracic surgeons from practices all around the world. We also re-connected with surgeons we’ve interviewed in the past – to hear what they have been doing since my last visit.

One of these surgeons was Dr. Andres Jimenez at Fundacion Santa Fe de Bogotá (SFdeB). As astute readers of the Bogotá books may remember, our encounters haven’t always been as collegial as they could have been. However, he did grant me an interview, and permit my ingress into the operating room. To my surprise, I found that while he was a hesitant interviewee, he was also a promising young surgeon.

With that in mind, I re-connected with Dr. Jimenez briefly to ask about the program. Dr. Jimenez reports that they have started a lung transplant program and recently performed his first lung transplant at SFdeB.

Dr. Carlos Carvajal (right)

Dr. Carlos Carvajal, who was a thoracic surgery fellow when we first interviewed him – is now a practicing thoracic surgeon at Hospital Santa Clara in downtown Bogotá.

Dr. Ricardo Buitrago continues his work in robotic surgery at Clinica de Marly. Caught up with Dr. Luis Torres, the young and charming thoracic surgeon from Clinica Palermo.

But the biggest surprise at all – was the twinkling brown eyes of Dr. Cristian Anuz Martinez. (The twinkling brown eyes above a surgical mask are all I remembered from my 2012 trip to the operating room with Dr. Frnando Bello in Santa Cruz, Bolivia).

with Dr. Cristian Anuz Martinez

We spent some time over coffee talking about the current state of cardiothoracic surgery in Bolivia, his private practice and his colleagues.

The conference itself was phenomenal – the amount and range of topics covered – from sleep medicine, tuberculosis, critical care medicine and pulmonology in addition to thoracic surgery.

The Festival of Flowers

The festival of flowers, one of the largest events in Medellin also started August 1st. The event which is expected to draw 19,000 visitors to Medellin this year – celebrates the floral industry of Antioquia with ten days of events. The events are staggered through out the city and include musical concerts, singing contests, parades, flora displays, children’s events and arts.

Festival of Flowers displays in Plaza Mayor

Tomorrow: Clinica de Medellin – Second time is the charm!

Days of Summer

Posted on June 15, 2014 by K Eckland

A cautionary tale for my on-line friends in another botched surgery case in Florida.

Let the buyer beware:

In the most recent case, four individuals have been arrested for impersonating surgeons and operating an unlicensed surgery clinic. According to the media reports, only one of the four people charged is a licensed physician, nurse or other trained healthcare provider – but that didn’t stop them from performing major operations such as liposuction and abdominoplasty procedures on their unknowing patients. While Dr. William Marrocco* was the doctor on record for the clinic – patients report that he wasn’t the one operating!

Unlike many of the ‘chop shops” we’ve written about that take place in garages, motels and private ‘parties’, in this scenario, unwary consumers were duped by a savvy group of criminals who had owned and operated the “Health and Beauty Cosmetic Surgery” clinic in downtown West Palm Beach.

*The good doctor Marrocco remains a legally licensed doctor in the state of Florida – though interestingly enough – he does not have prescriptive privileges. One the Florida Department of Health website, Dr. Marrocco (whose secondary address corresponds with the clinic address) reports active licenses in Virginia, Pennsylvania, Michigan, Indiana and Nebraska.

But let’s check it out… so I did my own preliminary online search –

Virginia: No records found. No active or past licensees (expired in the last five years) found. So he may have had one – but not recently.

Pennsylvania: William Charles Marrocco held a license in Pennsylvania for a brief two-year period between 1998 to 2000. This includes his period of medical residency training at Temple University Hospital.

Michigan: Three expired licenses – one for student status (resident) and one as a pharmacist.

Indiana: Dr. Marrocco was a licensed plastic surgeon in the state of Indiana from 2000 to 2011 and has a notation “reinstatement pending‘. Maybe Dr. Marracco is planning on heading back to Indiana – where his license remains unblemished – despite the scandal surrounding the 2003 death of his wife after he performed liposuction on her). License # 01052282A

Nebraska: Expired, license #2909, educational license permit (training) affiliated with Indiana University

Jorge Nayib Alarcon Zambrano – (one of the individuals charged) is listed as a member of the Colombian Society of Plastic Surgeons – from Cali, Colombia. So he may be a trained surgeon, just not a very good one (and not licensed in the United States).

Licensing isn’t everything..

Kind of goes to show some of the pitfalls of relying on licensing boards for consumer protection. Dr. William Marrocco was a licensed plastic surgeon, but that’s little consolation for many patients at that West Palm Beach clinic.

In fairness to Dr. William Marrocco, Jorge Alarcon and the other individuals in the case – they have been charged with multiple counts, but have not been convicted of any crime. Until that time, they remain innocent until proven guilty.

Apologies to my loyal readers for the long lapse in posts but my plate has been pretty full. But I will be finishing my latest assignment in a few weeks and starting a couple of new projects for the summer months.

I applied for and received a new assignment from Examiner.com to expand my focus to include more than just health topics. Now I will be able to write more articles focusing on life and culture in Latin America.

Colombia Moda 2014

To kick-start my new assignment, I have applied to attend Colombia Moda 2014.

(official image from Colombia Moda / Inexmoda)

As many of you already know, I was able to attend last year – and got a fascinating glimpse into the fashion industry and the future of both fashion and consumerism.

Last year’s speakers were promoting the concept of “re-shoring” and changing from the traditional ‘seasonal’ lines and collections to an ongoing, evolving fashion line with new designs and items being designed, developed and sold to the public in shorter mini cycles.

This year – I’ll be able to cover all of this – along with interviews with individual designers, fashion lines and the Colombian fashion and textile industry. (Last year, my articles were focused on the role between fashion and plastic surgery).

Fashion is so intrinsic to Colombian life, and many parts of Latin America, so I am really excited about it. It plays such an important role in the economic, social and an even personal lives of many Colombians.

I won’t have an assistant this year – but I am getting a new lens for the event (I will be journalist/ photographer for the event).

After Colombia Moda, I will be flipping back and forth between writing about culture and my ‘usual’ medicine and health storylines.

I will be staying in Colombia for several weeks as well as covering the Latin American Association of Thoracics (ALAT) conference at the end of July. It’s one of the biggest international conferences in thoracic medicine/ surgery with many of the legends of thoracic surgery planning to be in attendance.

In August, I’ll be heading across the globe to interview the head of an innovative surgical program.

I’ll be checking in along the way – and posting photos, interviews and articles as I go.

End of the road

Posted on April 26, 2014 by K Eckland

I know many people were not thrilled about my latest post, “What I don’t like about Colombia,” but I felt it was a fair question (posed by a reader) and it deserved an honest answer. Whitewashing my opinions / experiences and perspectives or painting a pretty picture does a disservice to this beautiful country and its people.

Colombia, like any country – has its beauty, its strengths, its joys and its share of problems. Ignoring issues because they may appear less than favorable undermines my integrity and the integrity of my work.

So I apologize if I have offended anyone, particularly any of the wonderful people who have graciously extended hospitality and friendship to me. That was not my intention. But I cannot apologize for sharing my perspectives as an outsider looking in.

As my time here in Cartagena and Sincelejo comes to a close – I hope that my readers, colleagues and friends can appreciate my experiences for what they are, my experiences.

Last week in Sincelejo

My last week in Sincelejo was a bittersweet one. Sweet because we had two coronary cases but bitter because it was sad knowing this was the last time I would see everyone.

Anita, Patricia and Estebes

These three ladies have made all the difference in my operating room experiences here, and I am grateful for that. I have really enjoyed getting to know them – and I feel sad at the thought that I may never see them again.

Raquel (right) and Anita, the instrumentadors

I am really going to miss Patricia and her perpetually sunny nature, easy smiles and ready laughter. She was so sweet to introduce me to her son so I would have an escort and companion if I wanted to go out dancing.

Patricia and Estebes, circulating nurses

I will miss Estebes, who always seems to go out of her way to help me. She is always there to adjust the light, offer a stool or anything else that might make it easier for me while I am peering into one of the dark tunnels of someone’s leg.

with Estebes

Anita, too, has wonderful. I feel like we have also had some fun, working at the ‘back’ of the table. I’ve tried not to be in her way – and to actually be somewhat helpful. (I’ve probably failed at this – but she has been very sweet and has never made me feel unwelcome.) She’s also extremely knowledgeable about surgery so it’s good to have her there. It’s hard to feel nervous with Anita watching over me. Or when I need a third hand – she is always there – even while managing everything at the top of the table too.

Tuesday

We arrived in Sincelejo this morning for surgery this afternoon. I did a fitting with Dr. Barbosa and his new headlamp apparatus so I could fit the final piece of Velcro. It’s not the prettiest thing in the world, but it’s functional and fully washable. (The previous headlamp anchor is an uncovered foam that crumbles with washing). I added a border to the old one as well, and repaired it the best I could, so he would be able to swap them out as needed. I hope he liked it – despite its ‘ugly duckling’ appearance. I thought it would be a nice gesture since he has done so much for me – and I don’t know how to say “Thank You.”

Dr. Barbosa models his new headgear.

The patient only needs one small segment of vein – so Dr. Barbosa decided it would be a good time for me to learn open saphenectomy. (I think I have convinced him on the soundness of my theory of learning the principles of saphenectomy, especially with my argument on the need to know for emergency cases.)

performing a saphenectomy

It was amazingly fast and essentially a bloodless field. Since everything is open before you, it is easy to ligate and clip all of the collaterals. I was surprised by how quickly I was able to free the vein. Closure didn’t take much longer than normal because even though it was an ‘open saphenectomy’ since it was only one graft it wasn’t that long of an incision.

I am glad I had an opportunity to try it because it certainly gave me more confidence than I would have had if I was expected to learn it during an emergency case. I also felt it gave me a better feel for the anatomy – because it’s all laid out in front of you. (It doesn’t matter how much you read or study a textbook – people are ‘never’ completely textbook, and ‘real’ anatomy looks different from the pretty drawing in my Grey’s Anatomy, especially when you are peering down a dark tunnel tract.)

Wednesday

The patient from yesterday is doing well. The morning chest x-ray showed significant atelectasis but the patient was hemodynamically stable and without other complications. I reviewed post-operative teaching (pulmonary toileting, ambulation) with the patient and explained that due to underlying COPD, he needed to be more aggressive in pulmonary toileting, and post- operative exercises.

Just a nurse? I don’t think so…. But you are only a doctor.

Today a doctor attempted to insult me by stating, “You aren’t a doctor.” (Don’t worry, dear readers – it wasn’t Dr. B – I think he ‘gets” me.) It made me want to laugh out loud but I managed to restrain myself since I was scrubbed in at the time. Of course I’m not a doctor – and thank the lord that I am a nurse! I never have and never will want to be anything else!

I feel sorry for someone so limited that they can’t see all that is missing from their life because they are “just a doctor.” They are just a doctor, but I am fortunate enough to be a nurse! I get to be everything that they can’t. For him, the people who come to us for help are just patients – part of an endless cycle of work, a means to pay the bills, buy a big house and have the status that being a doctor brings.

But for me, well, I am not usually overly religious in my speech but there is no other way to describe it but to say, I am blessed. I do feel it’s a ‘calling’ of sorts. I am blessed with the opportunity to care for these people, each one unique; with their own hopes, dreams and rich histories. I have the privilege of being one of the people alongside the family and friends who cares for them. I am lucky enough to be invited to share in that care. The patients may leave the hospital, but they never leave my heart.

I am so much more than just a nurse to my patients; I am a teacher, a friend, a source of comfort and compassion during a life-changing experience. I am the one who holds their hands when they are frightened – and the person who brings a smile to their face when they think they will never smile again.

Just a nurse?

I am a little bit social worker, a tiny little angel, a physical therapist, a cheerleader and friend, and even to many, their favorite ‘doctor’. Often, I am the one they feel comfortable talking to – I am the one they bring their questions and concerns to. Usually, I am the one they trust – to tell them to truth and to assist them on their journey back to health. And, that sir, is a privilege you may never know.

To my surgeons, I am the extra right hand they didn’t know they needed. I am always where I am needed – often behind the scenes, taking care of small issues so the surgeon can continue to do the things he needs to do – namely operate. I am someone to bounce ideas off of – someone to teach (and wants to learn). I am the very best resident a surgeon will ever have.

To the other doctors (who may have limited experience with cardiac surgery patients), the ones who are willing to admit it – I am an advisor, a teacher and a trusted colleague.

To my nursing colleagues – I am a mentor, a teacher and someone willing to listen to their concerns. I know their jobs and I know their intrinsic value. I know their talents – even if you don’t. I never shrug off a nurse’s concerns, and that has saved lives. If the nurse caring for the patient comes to me and says, “I don’t know what it is but something isn’t right,” than I know that something isn’t right. And together, we figure it out and make it better. I know that these nurses, the ones you dismiss – they have hopes and dreams too – and they take pride in excelling in their job. If they don’t know something, it’s not for a lack of trying – it’s for want of a mentor.

Ever Luis, one of my favorite floor nurses

And yet – there is still more to this nurse – I am an investigator, a researcher and a bit of a detective. But you sir, are only a doctor.

In today’s case, the patient needed two grafts. Dr. B started the initial incisions (I was off by a centimeter yesterday on my initial incision, so I think he lost confidence in my skills – I was worried about avoiding the patients more superficial varices.) I am a little afraid of jumping in too quickly and harming the patient – so I am cautious in making my initial incisions – but once that’s done, I feel like I am in familiar territory. I looked at my case log after the surgery – and it seems incredible for me that I’ve only had eight cases because it feels like I’ve been doing it for longer – parts of the procedure feel almost automatic now. I wish it was 25 or 3o cases but the service just isn’t that busy. I knew that would be the case when I came here – so I am grateful for the eight cases. Eight is still more than none, and none is how many cases I was getting back at home. (It’s that tired cliché – everyone wants someone with experience but no one wants to give a person a chance to get experience.)

I am still hoping that future employers will take my willingness and eagerness to train into consideration and offer me a chance even though I am a locum tenens provider. I have just been burned too many times in permanent positions to risk taking another one in hopes that they will fulfill their promises to train me.

Thursday

No surgery today but a full clinic! It was a good day in clinic because I got to see all the post-operative patients from our previous surgeries, and it was just a bit heart wrenching. But then again, I am always a big sap for my patients.

All the patients seemed so happy to see me – and I was so happy to see all of them too!

Everyone looked really good, and I was impressed by their questions and attentiveness during the appointments. My patients knew all of their medications by name, and were eager to discuss this and other post-operative instructions they received at the time of discharge. (Usually it seems like people forget a lot of what we talk about in the hospital – but I think my horrible gringa accent sticks in their minds).

The only disappointing aspect, was seeing one of our patients (who had been really fragile pre-operatively) amble in. She looked great – and said she felt pretty good, (other than the usual sternal soreness) but one of her leg incisions had partially dehisced. (Luckily it was a very small skip incision and the patient had been fastidious about cleaning it as directed). The wound was very clean, with no signs of infection. It was healing well by secondary intention but I was disappointed in myself that the wound closure didn’t hold up.

After clinic – we headed back home. All the while, I was thinking of how I will miss Sincelejo. I will miss my friends, my patients and Clinica Santa Maria. I will miss the chance to work with Dr. Barbosa – who was always such a great teacher, even if we didn’t always see eye-to-eye. Most of all, I will miss Iris, who has been my best friend, confident and colleague during this journey. I will miss working with her – I honestly think that between the two of us, we could be a force to change the world (or at least cardiac surgery) for the better.

From the bottom of my heart, I sincerely say, Thank you Iris, Thank you Dr. Barbosa, Thank you, Estebes, Anita and Patricia – and thank you Dr. Salgua for having me here among all of us – and making me part of the team. I will miss you all.

Dr. Salgua Feris

San Jacinto and taking the long way home

Posted on April 11, 2014 by K Eckland

As we left Sincelejo to return to Cartagena, I noticed that we made an unexpected turn away from our usual route. This was confirmed as we passed the fitness center on the other side of town and headed towards Corozal.

The department of Sucre as outlined in RED

“Ah, this will be my adventure today,” I said to myself. Sure enough – I kept quiet and enjoyed the change of scenery as we drove away from Sincelejo into a mountainous area that reminded me of my high school years in Angels Camp – Murphy’s area of California (Sierra Nevada foothills).

The terrain was dotted with trees interspersed with dry straw-colored grasses. Cattle grazed in pastures on either side of the small, winding two-lane highway.

As we drove through Corozal, I ventured to voice my suspicions. The good doctor laughed and confirmed that it was, indeed an ‘adventure’ designed for me – since he and Iris knew of my love of Colombian countryside.

the apple is just there for scale

First stop on our tour was for the famed avocados. (Indeed – these famous avocados have been the source of much amusement among the cardiac surgery team due to a previous episode involving a “bait and switch” by another team member (who ‘stole’ a bag of these avocados from the good doctor, and left behind a small bag of more ordinary avocados in their place.)

woven fabric made on traditional looms

We then passed into Bolivar –

Our next stop was San Jacinto, which is a town that is locally known for their artisanal crafts. (The Sucre – Bolivar regions are noted for many of their textile crafts. Some of the techniques date to the pre-Colombian era).

Having Iris as my tour guide was wonderful. As a certified artisanal artist of traditional Colombian crafts, Iris was able to give me a detailed explanation of each of the different types of craft making – including information about regional differences in weaving designs, colors used, and other traditional items.

(For more information about the processes used in this craft work, click here.)

Since I am in the midst of (very slowly) learning how to crochet one of the traditional Colombian bags – I can certainly appreciate the amount of time and skill that goes into crafting each of these individual items. There is no assembly line, factory floor or Made in China” labels here. (Yes, I looked).

As the road wound its way back to the fork where we usually take the other branch) we stop at our usual coffee shop. There we were greeted by a Palenque resident selling baked goods.

We bought a sweet, round ball of a popcorn(ish) treat called Alegra which contains corn with coconut and panela. She then came and sat with us and attempted to teach us to speak a few words of Palenque.

After our brief respite, we continued to the main highway to Cartagena and proceeded home. It took a little longer, but to me – it was well-worth it. Thank you, Iris and Dr. Barbosa for my unexpected surprise!

Sincelejo Diaries, part 2

Posted on April 5, 2014 by K Eckland

Tuesday – We drove back from Cartagena this morning before heading to surgery in the afternoon for a bypass grafting case. For the first half of the way, I sat in the back and enjoyed looking out the window. It’s amazing how dry parts of Bolivar are.

The drought has been responsible for the deaths of over 20,000 farm animals here in Colombia. The small lakes are disappearing, from my first trip to Sincelejo to my most recent visit just a few weeks later. The trees and bushes besides the roadways are completely coated with layers of dust from passing vehicles. It gets greener as we pass into Sucre, but it’s a sad reminder of the devastating effects of climate change.

After stopping for breakfast along the way, where we met up with Dr. Melano, Iris went with Dr. Melano and I stayed with Dr. Barbosa. We talked about music mostly. At one point, a former patient from several years ago called, just to say hello. The patient had recently heard that Dr. Barbosa now had a surgery program in Sucre. (The patient had previously traveled to Cartagena from a small town in Sucre for surgery.)

Once we got to Sincelejo, we headed to the hospital to see our patient before surgery and go over any last-minute questions or concerns.

(Of course) I was worried about finding vein but we easily found good quality conduit. Dr. Salgua has been very nice about helping me with the saphenectomies. The team teases me because I have a difficult time pronouncing her name. We have a kind of system: While I finish closing the leg, she moves up the table to assist the surgeon in starting the grafts. Then when I finish wrapping the leg, I stay at the back of the table with the instrumentadora, learning the Spanish names for all the instruments. Once the chest is closed, she does a layer of fascia and I close the skin incision.

It’s a little crowded sometimes with the new instrumentadora learning the essentials of cardiac surgery, but the atmosphere at the back of the table is a lot different from the climate at the top. (Dr. B is always calm, pleasant and entertaining – but Dr. Salgua is almost completely silent the whole time). I am a lot quieter than my “out of OR self” when I am across the table from the surgeon too..

Wednesday – Another coronary case, on a fragile-ish patient (multiple co-morbidities including chronic kidney disease etc). It was a long case and I was a little worried the whole time but the patient did well. (I always worry about the frail patients).

I did okay too – performing a saphenectomy with Dr. Barbosa. The patient had a vein stripping procedure previously (on one leg only) so I wanted to be sure to get a good segment of vein on the remaining vein. I think Dr. Barbosa was worried about the quality of the conduit (because he kind of hovered – and didn’t relax until we started harvesting it.)

Skip harvesting

I wish I would have more opportunities to perform a traditional saphenectomy (one very long incision). I assisted on one several years ago – and I think if I had a chance to do a couple more, I would feel more comfortable skip harvesting. Of course, a headlamp would also help. (It’s kind of dark looking down the skip ‘tunnels’). Then once I’ve mastered skip harvesting, I think it’s just another small jump to endo-harvesting with a scope. I know a lot of people never bother learn to skip harvest, but I feel more comfortable building on the principles of open procedures first. I might need them in an emergency case which is kind of why I wished I had more open saphenectomy experience.

Thursday – Saw three patients in the clinic today. However, on reviewing the patient records and an intra-office echocardiogram, one of the patients definitely doesn’t need surgery at this point. (Asymptomatic with only moderate valvular disease). We were happy to let him know he didn’t need surgery even if that means fewer cases.

Two surgeries today. The first case was a bypass case for a patient with severe coronary disease and unstable angina. Dr. Salgua and I did the harvest. I think Dr. Barbosa is a little nervous about handing over the reins to me for harvest because he keeps a pretty close eye on me while I am doing it. But then again, it might be because I am a little overly cautious and hesitant at this point. If I didn’t have Dr. Salgua to look over my shoulder and encourage me onward, I’d put clips on everything and proceed at a snail’s pace to make sure I do it right. But since it’s still my first week, maybe I shouldn’t be so hard on myself.

On the other hand, he must think my suturing is pretty good, because he just trusts me to do it correctly.

The second case was a patient from last week, who developed a large (symptomatic) pleural effusion and cardiac effusion (no tamponade or hemodynamic instability) which is a pretty common surgical complication. The case proceeded well – I placed the chest tube, with Dr. Barbosa supervising. Dr. Barbosa performed the cardiac window portion of the procedure.

Sadly, one of our patients from last week died today. It was a fragile patient to begin with, and even though surgery proceeded well, the patient could never tolerate extubation and had to be re-intubated twice after initially doing well. From there, the patient continued to deteriorate.

Friday

Today we had a beautiful aortic valve surgery. This has always been one of my favorite cardiac procedures. Somehow its elegant in the way the new valve slides down the carefully coördinated sutures. (I don’t have pictures from this case – since I was first assisting – but I will post some from a previous case – so you can see what I mean).

Dr. Salgua worked an overnight shift, so I was at the top of the table – (and yes, noticeably quieter than normal.) I was surprised at how fast it seemed to go – but maybe that’s because everything went so smoothly. Or maybe because we’ve done a lot of coronaries lately, which is a much more tedious and time-consuming process.

Iris and I are working on a patient education process – as a way to improve the continuum of care for patients (particularly after discharge). I really enjoy working with Iris because I feel like we are always on the same page when it comes to patient care.

While it’s been a tiring week for the crew – I am, as always! exhilarated and happy to be here in Sincelejo. Just knowing it’s the end of another week (and I am that much closer to going home) has me feeling a little sad. But I guess I can’t stay forever, and I sure don’t want to take advantage of all the kindnesses that have been extended to me.

That being said:

At the end of every surgery, every day and every week in Sincelejo – I am grateful. Grateful to Dr. Barbosa for being such a willing and patient teacher – grateful to the operating room crew (especially Iris Castro and Dr. Salgua) and particularly grateful to all the kind and generous patients I have met and helped take care of*.

The medical mission

This week I had another inquiry about ‘medical missions’. I know people mean well when they ask about medical missions, or when they participate in these types of activities but…

Long time readers know my philosophy on this – don’t go overseas so you can pat yourself on the back over the ‘great deeds’ you performed ‘helping the poor’. It’s patronizing to the destination country and its inhabitants – and generally not very useful anyway. An awful lot of volunteers with real skills and talents go to waste on these so-called mission trips when their skills might be better served (in less exciting or glamorous ways) in free clinics in our own country.

But it does give everyone involved a chance to brag about how selfless and noble they have been; traveling thousands of miles, sleeping somewhere without 24/7 wi-fi (and who knows what other hardships).

Instead, change your orientation – and maybe challenge that assumption that everything you’ve learned about medicine, health care and taking care of people is better and superior. Open your eyes and be willing to learn what others have to teach you instead.

* I always opt for full disclosure and transparency with the patients. I introduce myself and explain that I am a studying with Dr. Barbosa, what my credentials and experience is to give them the opportunity to ‘opt out’.

Sundays in Cartagena

Posted on March 30, 2014 by K Eckland

El Centro

Sundays in Cartagena are a bit different from Bogotá or Medellin. As a major tourist destination, Cartagena never really slows down the way other cities do in Colombia. In Bogotá, my neighborhood (Chico) was essentially deserted on Sundays. The only signs of life were on the streets closed for pedestrian walking. La Candeleria and Usaquen were the destinations of choice for Bogotanos who chose to stay in the city.

Instead the activities change – instead of business, the weekends are for boat trips to the Islands of Santa Rosario, long leisurely lunches, wandering around El Centro and looking at arts and native crafts, and walking along the beach. Tourists stroll along Bocagrande window shopping at designer storefronts, eating ice cream. The hotels host popular events in Castillogrande, and restaurants and bars feature the sports of the day, to standing room only crowds.

So today, after sleeping in a bit, Iris and I headed to El Centro for another leisurely stroll around El Centro. Sunday mornings are a nice time for this – the streets are still pretty quiet and not yet packed with tourists. (That comes later in the day.)

As we wandered down the tree-lined streets, I can’t help put take photos, even if I’ve photographed these same areas many times before. Somehow, every time I encounter the colorful buildings with the beautiful blossoms on the curving cobblestone streets, I am enchanted all over again.

After walking around the neighborhood and making our way up the wall, we headed to the nearest Juan Valdez..

After our leisurely coffee, we walked back home to escape the heat of the day. Now I am heading back out – to the beach.

The Sincelejo Diaries

Posted on March 30, 2014 by K Eckland

Sincelejo from the balcony

Since I have very limited wi-fi while in Sincelejo, I have been keeping a diary of my time on the cardiac surgery service of Dr. Cristian Barbosa. But then again, maybe I should explain why I am here.

I came to Colombia to learn how to perform skip harvesting saphenectomies with Dr. Barbosa. As I mentioned previously, we’ve kept in contact since we first met, and he was gracious enough to offer to teach me.

Before I ever left Virginia, it took a lot of paperwork and diplomacy, but we were able to secure administrative permissions for me to study sapheneous vein harvesting with Dr. Barbosa at the hospital in Sincelejo. While this isn’t medical tourism, I thought my readers might enjoy hearing about daily life as part of Dr. Barbosa’s cardiac surgery service.

Cardiac Surgery in Sucre, Colombia

outside the operating room

While the cardiac surgery program is located in Hospital Santa Maria, Dr. Barbosa and his team often travel to nearby hospitals and clinics to see new consultations. This program is the only program in the state of Sucre and patients come from all parts of the state.

Many of the patients come from tiny pueblos of a few hundred (or thousand people). Many others come from impoverished backgrounds. (Colombia has a tiered health care system with a national health care plan for people from lower socio-economic classes, kind of similar to the Medicaid concept.)

We arrive in Sincelejo on Monday, March 24^th in the evening. We have a busy day tomorrow and the doctor wants to get started early (without facing the 3 hour drive in the morning.)

En Familia

In Sincelejo, we live en familia, in a large airy apartment with big windows that overlook much of Sincelejo. There are four of us here, the surgeon, the anesthesiologist (who is Director of the program), the perfusionist and myself. Iris and I share a large room with a private balcony. Meals are shared and we usually travel as a group to the hospital and on errands.

After our arrival Monday evening, the doctor, the perfusionist and I head to the largest grocery store and shopping center in town. We shop as a family, picking out fruit, arepa corn flour, coffee and other essentials. We then head to the food court. (They are treating me to Corral, due to my proclaimed love of Corral’s famed hamburgers).

It sounds like it could be uncomfortable – this domestic scene with my boss and the cardiac surgery team, but surprisingly it isn’t. Iris, the perfusionist (and my roommate both here and in Cartagena) always says they are a “cardiac surgery family,” and it feels that way – in a comforting, cozy way.

I joke and call Dr. Barbosa, “Papa” as he is the natural father figure of the group, and somehow it feels appropriate.

‘Papa’ of our cardiac surgery team

25 March 2014 – Tuesday

Today we travelled to Corozal to see two consultations in the intensive care unit. Then we returned to Sincelejo to see another patient at another hospital, Maria Reina. We eat lunch at the apartment, en familia . Afterwards, we go back to the office to see patients before heading off to surgery. (We had to delay surgery for several hours because the patient decided to eat breakfast. I guess s/he was hungry too).

Finally after this delay (to prevent anesthesia complications), we head to the operating room. There are the typical delays while the patient is being prepped and prepared. This gives me a chance to get to know the rest of the crew, Anita (the instrumentador or surgical tech) who runs the operating room table, Raquel, an experienced instrumentador who is training to work in the cardiac suite, and the two circulating nurses, Patricia and Estebes.

Raquel (right) and Anita, the instrumentadors

The circulating nurses are responsible for taking care of all the duties that fall outside of the sterile field, like fetching additional supplies, medications or instruments. They also control the environment by regulating the temperature, and adjust the electronic machinery (like the electrocautery unit, or the sternal saw) according to the surgeon’s immediate needs and specifications.

Patricia and Estebes, circulating nurses

Dr. Salgua is the medical doctor who works in the office, seeing patients and assessing their medical (nonsurgical needs.) For the last year, she has also worked as Dr. Barbosa’s First Assistant in Surgery. If there is any chance for friction in the operating room, most likely it will come from her. I am cautiously nice but optimistic when I realize she is fairly quiet, and not overly aggressive. (I relax, but just a bit. I am still nervous about how the team will take to me, even though the common Oops! “accidental” needle stick scenario seems unlikely here.

Dr. Salgua

Everyone is very friendly and welcoming and even before starting the actual surgery, I am breathing easier and starting to think that maybe I could belong here, with this group.

The surgery went well (valve replacement and annuloplasty). After the surgery, we transport the patient to the intensive care unit and give report to the doctors and nursing waiting to assume care of the patient.

Note: patient did well and went home on POD # 3 on 3/28/2014.

26 March 2014 – Wednesday

More surgery today, but still no coronaries (and thus no saphenectomies). It was a great day in the operating room – I closed the sternal incision.. (BTW, surgery went beautifully). I am already starting to feel more at home with the operating room staff, and I feel like they don’t mind having me around. Dr. Salgua has been very kind in assisting me during procedures, which is a relief. She still stays pretty quiet during the cases, but I think maybe sometimes she is a bit nervous too.

with the team

After transferring the patient to the ICU, our second visit to the patient from yesterday finds her over in the general surgery ward. (This morning she had been sitting up in a chair in the ICU when we arrived.) She looks good and states she is sore, but otherwise fine.

The cardiac catheterization lab calls; there are four cath films they want us to review, and patients to discuss regarding surgery. The patients themselves are resting in the recovery area after the cath procedure, so our administrative assistant, Paola makes appointments for each of them and instructs them to bring their families, medications and any questions.

The most interesting part of the cath lab is who is doing the caths. It’s a nurse, while the cardiologist sits behind the protective radiation shielded glass enclosure viewing the films and calling out for additional views. I wonder if the nurse knows that in the United States, a similar position would pay over 100,000 dollars. But this is one of the things that I see a lot of her in Colombia and in Mexico. Well trained nurses being essentially nurse practitioners (making diagnoses, treating disease, performing invasive procedures) but without the status or the compensation.

My roommate and I talk about this disparity sometimes. She’s a master’s trained nurse herself, so it makes for some very interesting discourse and insights. (She doesn’t like to have her picture taken, so I haven’t.)

We finish seeing patients and head home. The doctors head off for a siesta. Dr. Barbosa has been up since before five for his daily exercise before surgery.

As for me – after some scouting of the immediate areas around the hospital and the apartment, I went on my motorcycle tour. It was great fun but I got an important reminder of the perils of motorcycles just a few days later.

Note: After and uneventful surgery (defect repair), patient recuperated quickly, and was discharged 3/29/2014.

27 March 2014 – Thurday

The week is really flying by. I’ve been having fun with the operating room team. They are a great group. Everyone has been extremely nice and welcoming. (You can never be sure how your presence is going to be tolerated or change the existing dynamic.) Dr. Melano and I have a couple of animated discussions over current practices, literature and recent meta-analyses. It’s an enjoyable discourse even though my vocabulary often fails me. I hear myself making grammatic mistakes and repeated errors in Spanish but it seems with some much going on (reviewing my anatomy, practicing my suture ties, assisting in the operating room and trying to keep up on my writing )- I just can’t seem to remember as much as I should in Spanish. I inwardly cringe when I substitute ‘conocer’ for ‘saber’ yet again, but the word is out of my mouth in reply to a question before I can corect myself.

Dr. Salgua assists Dr. Barbosa

I sit out this surgery (still no coronaries) and spend some time taking pictures to document my experiences here. I got a couple of shots that I really like, including one of Dr. Barbosa, Dr. Salgua and Raquel.

one of my favorite pictures from that day

Note: Patient discharged home 3/29/2014.

28 March 2014 Friday (and coronaries!)

Today is my big day – and I am excited and a little scared too. I got up at five this morning and went with Dr. Barbosa to the exercise park, so I would have a place to walk while he played tennis. It helped me get ready for the day, and I got to see where Dr. Barbosa uses up all of his pent-up aggression. He turns it into a power slam. (I don’t know tennis terms, but whatever swing he was doing – it must be responsible for his tranquil overall demeanor.)

After breakfast, we head to the hospital. We check on our hospitalized patients before going to see today’s surgical patient in pre-op.

Our patient is a bit fragile-looking so (of course!) I worry about her and how she will do with surgery. I also worry that I might not sew straight, now that it’s time for me to get to work.

Some of my previous OR “lessons” have been brutal, including several at a troubled facility that sent me running away from cardiac surgery (of all kinds) for several months*. This is what fuels my anxiety. (I am not anxious by nature).

But here in Sucre, in this OR, this experience is nothing of the sort – Dr. Barbosa is an excellent teacher. I don’t know why it’s a surprise. He’s always been a bit of a Clark Kent of the operating room; pleasant, calm and methodical.** This is just the same. In his soft burring voice he goes over the procedure with Dr. Salgua and I. The he oversees our attempts, gently encouraging and coaxing. It is yet again, a comfortable experience, instead of a traumatizing, horrible one.

a pretty great teacher

I don’t have any pictures which would show my twinkling eyes which are the main indication of my happy grin beneath my mask as I finished closing the last leg incision.

We wrap the leg when we finish and move up to the ‘top’ of the operating room table. (I’ve learned that the top and the bottom of the operating room table are two very different places.)

I close the chest incision – surgery is over. We transfer the patient to the ICU. She remains a little fragile but has no immediate problems.

After making sure the patient is stable, the team heads over to Clinica Maria Reina. We have received a call that a trauma patient is being placed on ECMO (to support his lungs) after developing a fat embolism. We are standing by to help, as needed.

As I look around, and talk to the staff, I find that there are three patients in the small ICU, all young men in their twenties, all intubated with critical injuries, all due to motorcycle accidents. One patient, just barely an adult has lost a limb as well. He is awake and hitting the siderails with his remaining hand to capture the nurse’s attention. She holds his hand and speaks soft to him and he calms down. Watching this, along with the patient struggling to survive as doctors rush to connect ECMO is a sobering reminder of how devastating my joyride could have been.

The patient is connected to ECMO without incident. As a weary unit, all four of us return home.

The view from my private dance floor..

Everyone is exhausted – but I am exhilarated! I just want to dance – so I do, by myself, on the balcony with my phone blaring out some music. Later that evening, we go out for dinner to celebrate a successful week. I am still in a joyous dancing mood which probably drives my companions a little crazy but it’s been such a great day.. so when we return home, I dance some more.

March 29th, 2014 – Saturday

In the morning after my dancing spree – Dr. Barbosa and I walk down to the hospital. Our fragile patient from yesterday is doing okay, and our other two patients are ready to go home. I review discharge instructions with each patient, and hope that I am not mangling my Spanish too badly. But they seem to understand me, so maybe I am doing alright. The doctor is nearby, writing prescriptions, to clarify anything I have trouble explaining.

One patient asks about getting out of a chair without using his arms (and stressing the sternal incision) so I demonstrate my favorite technique, and together we practice.

After we finish, we head back to the apartment to eat breakfast, finish packing and head back to Cartagena. Dr. Melano is staying behind (along with Dr. Salgua, who lives in Sincelejo) to check on our remaining patient.

The ride back is pleasant, but I start to feel some of the fatigue from all of the excitement of the week. I also feel a little sad to be leaving our little cardiac ‘family’ for a few days, which is probably crazy considering how much time we’ve all spent together. I guess it’s because I know it’s just temporary.

Iris and I head back to ‘our’ Cartagena apartment where the neighborhood cat, Ximena is waiting for us.

Now we will relax, write and get ready for the return trip on Tuesday.

* A deliberate elbow to the face was just the beginning of a series of humiliations at a previous facility.

**Pulling on his superman cape when needed.

The Road to Sincelejo

Posted on March 21, 2014 by K Eckland

The Road to Sincelejo

For me, the road to Sincelejo has been in the making for a long time. Since meeting Dr. Cristian Barbosa, cardiac surgeon in February 2010, I have wanted to know more about his work. I first meet Dr. Barbosa on my initial trip to Cartagena de Indias when I (literally) accosted him in a hallway in Hospital Bocagrande. At that time he was the chief of cardiovascular surgery of the now defunct cardiac surgery program at Hospital Bocagrande. He was minding his own business, walking down the hallway. As he passed, I read the title on his lab coat, “Cirguia Cardiovascular.”

Back on 2010, my Spanish was even worse than it is now – just forgotten bits of high school Spanish. But that didn’t deter me on my mission. I had entered the hospital under stealth (okay, not really, but I was just a ‘gringa’ wandering around without authorization) to meet and talk to surgeons, so I wasn’t about to let this opportunity pass by.

with Dr. Hector Pulido (left) and Dr. Barbosa in Cartagena (2010) after a chance encounter in a hallway,

Of course, since my Spanish was limited – I didn’t know how to express all the normal social graces in these sort of situations. Instead, I said, “please stop” as it was the first phrase that came to mind. He did, and we managed to exchange enough conversation for me to explain who I was, and what I would like to know. Despite my lack of manners, and random appearance, he didn’t seem to mind. A visiting cardiac surgery nurse, “por supuesto!” (of course!)

I knew I was successful when he then asked, “Do you want to go to the cath lab and review today’s films with me?” The rest is now history, on the pages of this blog, multiple articles and the Cartagena book.

Sometimes, the language of surgery is universal – which is what makes all of this possible.

in the operating room with Dr. Barbosa in 2010.

Since that first meeting, Dr. Barbosa and I have both improved our language skills (his English, my Spanish) and we’ve kept in contact. We’ve caught up with each at various conferences and meetings. Therefore, I was saddened to hear of the closure of the cardiac surgery program at Hospital Bocagrande due to financial difficulties*.

Cardiac Care

I was excited when Dr. Barbosa told me about his new position in Sincelejo (Sucre) a few years ago, providing cardiac surgery services to the local community. The program called Cardiac Care provides cardiac surgery services to a populace that would otherwise have to travel several hours (to Barranquilla or another large city).

When Dr. Barbosa invited to come join his team in Sincelejo, it took some re-arranging and re-scheduling to do – but it was an opportunity I just couldn’t miss.

The program remains small and relatively unknown even among Sincelejo residents. For this reason, Dr. Barbosa and his team (cardiac anesthesiologist, Dr. Sebastian Melano and nurse perfusionist, Sra. Iris Castro) all live in Cartagena but maintain another apartment in Sincelejo. When they have surgery scheduled, they stay in Sincelejo for several days to perform surgery and oversee the patient’s recovery.

Road trip

On Thursday, I took my first trip with the group to Sincelejo to see several patients (post-operative patients and new consultations).

Dr. Barbosa and his cardiac anesthesiologist see patients at the Clinic in Sincelejo

This trip itself was very interesting. Sucre is a region (state) of Colombia that is entirely new for me. Even though the trip is just 125 km from Cartagena, it’s a journey into a new landscape of rolling hills (Mountains de Maria) and takes over three hours.

Leaving Cartagena, we pass through the various areas of the city. We pass through barrio Manga, past several hospitals including Hospital San Juan de Dios, and toll stops. As we pass through the industrial areas of the city, the massive oil refinery expansion project dominates the landscape. Evidence of other ongoing construction and expansion outside city limits is also present.

Like most roads outside cities, we pass through several security checkpoints.

As we leave Bolivar we pass several palm plantations, where palm oil is produced. (Alas, no palm wine – one of my favorites)**.

Like Texas with hills

March is the tail end of the ‘drought season’ of this tropical locale so much of the landscape is brown, and barren appearing (think of Texas, with hills.) This year has been particularly dry with several wildfires due to the effects of the El Niño weather systems. This year, they tell me is even worse than previous El Niño years. A comparison to Texas is appropriate since this part of Sucre is mainly farms with livestock (horses, chickens etc.) and cattle grazing. For this reason, Sucre is well-known to Colombians for both its beef and the richness of the local cheese.

Along the way, we pass several small settlements of tiny houses along with the fincas (working farms) of the wealthy. Some of the homes are poured concrete with concrete floors and painted in gay colors, others are hard-packed manure with dirt floors.

one the modest dwellings roadside in Sucre

As part of a promise made to improve the infrastructure of Colombia during President Juan Manuel Santos’ famous “five points” most of the roadways are either newly paved or in the process of being paved and expanded.

During the drive, my companions give me the history of the various settlements.

Palenque

One the first settlements we pass while still in the state of Bolivar is the town of Palenque. Palenque is known for being the first settlement of escaped/ free Africans in Colombia. (As one of the main ports for the slavery trade, Cartagena – escaping slaves would make their way to small settlements to live as free members of society.)

Palenque is known for adhering to mainly of the African traditions of their ancestors, as female residents wear traditional dress. Residents speak a distinct dialect of a creole based, Spanish language mix also called Palenque.

photo courtesty of Proexport Colombia. Photo by Juan guFo.

photo courtesy of Proexport Colombia. Photo by Juan guFo.

A decade makes a difference – The Red Zone

Just ten years ago, this simple journey would have been venturing into dangerous territory***. Guerillas and paramilitary groups controlled the area, and terrorized residents and travelers alike. No where does the history of conflict in Colombia become more real than in the tiny town of Chinulito. This town was one of the first casualties of paramilitary activity in the area. Over 300 families had to flee the area for their very lives. Many more were killed. (For a bit of eye-opening, remember that while we often think of these massacres as a thing of the past, the violence is ongoing in parts of Colombia, and this incidence occurred in 2000, not 1970).

It wasn’t until 2008, that 56 of these former residents were able to return, under the protective watch of the Colombian military and police. The military presence is significantly heavier than any of the other areas I’ve been to.

Soon we enter the town of Sincelejo and head to the office to see patients.

Not a puebla

Despite being considered a somewhat rural area by more cosmopolitan coastal residents of Barranquilla and Cartagena, Sincelejo is no small puebla. The city, which is the capital of Sucre, has a population exceeding 200,000. The city has a long history and was initially inhabited by native peoples prior to Spanish exploration, and subsequent “discovered” in the 16th century. The city was formally founded in 1535 in the name of San Francisco de Asís de Sincelejo. (We will talk more about the city in future posts since I’ll be spending considerable time here.)

*Cardiac surgery services lines are particularly expensive to maintain in comparison to other hospital services.

** Apparently, I am not alone in my appreciation of this type of wine, which is widely considered among locals as the Colombian equivalent of “bum wines” like Thunderbird, Ripple, MD 20/20 or other cheap drinks favored by alcoholics.

*** If you are thinking of doing something like venturing solo into the Red Zones, particularly if unaccompanied by Colombians, please read this article, “Backpacking in a red zone.”

Cuidad Delirio and the spirit of Colombia

Posted on March 16, 2014 by K Eckland

This is Colombia!

One the reasons I have so many posts on local culture (in addition to medical tourism) is due to the fact that I struggle to impart the sentiments, the spirit, and the very essence of the destinations.

Viva Colombia!

The first time I came to Colombia, as we landed the JetBlue airline crew broadcast the song, Viva Colombia! and all the other passengers burst into cheers.. I guess it was that initial experience that has always stayed with me.

No, this isn’t the Spirit of Colombia.

Most of my writing is technically based so it is a huge challenge to attempt to draft essays that actually speak to the character of the people, the richness of the cultures.

there is more to Colombia than this..

But without these things, I think readers have a hard time separating the reputations of many of these places (for crime, or violence for example) from the people. The news media are so filled with negativity, and one limited perception or view of everything: Colombia is drugs and war, Mexico is violence and gangs, the United States is consumerism and spending, that it’s impossible for people to see, or read anything without this pervasive opinion poisoning our perceptions.

this is Colombia.. futbol

Now and then comes the occasional piece that takes a closer look – and I try to share those here.

and this..

I also try to include the often whimsical, charming or sweet details that give a better picture of what it is to be here. What it’s like as a foreigner wandering the streets – seeing everyday life.. Not just sickness and health in the corridors of hospitals and clinics. But the everyday lives and special occasions of the people I meet.

For example, one of the things that really, for me kind of captures the spirit and the pride of the people of Colombia is the twice daily broadcasts of the National Anthem of Colombia..

Cuidad Delirio

Another was the delightful film, “Cuidad Delirio” that I saw last night at the film festival in Cartagena. The film, which was made in Cali and directed by Chus Gutierrez is pure eye candy.

My response to the film was almost visceral.. I don’t usually like this type of film – the silly romantic stories.. But the film just captured the essence of Cali (and Colombia) so beautifully. The colors, the music, the liveliness.. In short, the film did in about 90 minutes what I have spent years trying to do – share the “feel” and some of the daily joy of life here*.

* I know skeptics are rolling their eyes – despite the many problems cause by socio-economic disparities and chronic warfare, many people here have a “Joie de vivre” that is unmistakable. It is this sentiment that brings me to Colombia, over and over.

The photographers of ColombiaModa 2013

Posted on July 24, 2013 by K Eckland

As a nurse, and a writer who mainly covers medicine and surgery – I was a bit nervous when I embarked on the Colombia Moda project. However, with fashion and beauty playing such a large role in Medellin (and other cities in Colombia), I thought it would be a huge mistake not to cover this event.

the other end of the runway (Matt Rines)

So far – it’s been wonderful – and my fellow writers and photographers have been particularly so. I was worried with my lack of fashion photography background/ experience that the other prensa (press) at the event would be daunting, or intimidating.

friendly Colombian photographers help the newbies

friendly Colombian photographer, Stevin Ortega helps the newby

But they haven’t been – they have been friendly, nice and amazingly helpful. Before the first runway – there they were – scooting over so my additional photographer (Matt Rines) and I would have a good view of the runway – and giving us tips on using the best camera setting to capture images in this sort of setting.

Colombian photographer, Federico Rios before the show

Watching the professional photographers is a little awe-inspiring.. Since we are sitting shoulder-to-shoulder (and even closer sometimes!), I can see their photos almost at the moment the shot is taken (on the digital display), and these guys are just amazing! The clarity, the vision (to see that it’s going to be a good shot) is just phenomenal. I was actually sucking in my breath – a couple times as I glanced at some of my neighbors photos while we waited for the next model to come out..

with Juan Bouhot and Juan Estaban (Colombian press) – waiting for the runway to start

International Press but little American representation

The majority of the journalists are from Colombia (InFashion, Caracol, El Colombiano and just about every Colombian magazine/ paper you can think of) but I have seen journalists from Panama, Bolivia, Argentina, Chile and even Australia. Matt and I haven’t seen any other press from the United States yet – but somehow that doesn’t surprise me. (When I was pitching this story to two different news outlets – both said that readers weren’t interested in stories about Colombia.)

But for my readers here – I’d like to get closer, and get some more stories about the people who shoot the photos.

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More than Colombian News

But this isn’t a story about Colombia, really. It’s more of a story about fashion, beauty and all that goes with. Fashion is international – and this event certainly proves that. One of the big focuses this year – is trying to “reshore” the clothing construction industry as one of this year’s lecturers from the Fashion Institute of Technology (FIT) explained.

It’s no longer cheaper, or easier to have clothing made in Bangladesh, India or China.. And that (previous) cheapness came with other complications – like long wait times, and a lot of bureaucratic headaches for designers and retailers.. Relocating these industries to the Americas is a boon for everyone. Especially now that designers and retailers are changing their selling models – to embrace 7 or more lines a year “short lines” versus the traditional 2 to 4 lines. But we’ll talk about that later – it’s almost time for the next runway to start!

Ipanema runway model (K. Eckland)

If you want to see more images by some of the photographers I have met:

LookatU – Paolo Trujillo

Julian Carvajal – (I was peeking over his shoulder at times – he’s a fantastic photographer).

Style Street – fashion + photography

Estudio 8A – photographer, Jorge Ochoa from Argentina

Succo –

John Drews – highlights some of the work of Medellin-based John Erick Velasquez M.

What the runway looks like from behind the lens

As for me – I am working on several articles for other outlets – so I will post more information, and links when they are done. For the time being, you can follow my Colombia Moda twitter feed: K. Eckland for up-to-date photos and news.

Stories from the front

Posted on July 16, 2013 by K Eckland

Security on a street corner in an upscale Bogota neighborhood

Stories from the Front

Anyone want to hear about the summer I spent living with a group of young journalists, in a South American country in the midst of a civil war? Oh, wait – that’s this summer – and it’s not as dramatic as all that. While everything I said in the first sentence is factually correct; it’s also horribly misleading.

I live in an exciting, wealthy cosmopolitan city where the murmurs of FARC and continuing peace talks garner little notice – unless, of course, you are living in the corporate offices of Colombia Reports. But otherwise, paramilitaries are not a big part of my daily life with the exception of the occasional amputee in the park.

(This is not to minimize the horrors faced by the populace for the last fifty years, but to avoid over-sensationalizing daily life here.)

lost his leg due to a landmine

Daily concerns

A bigger concern is a more basic one – for any woman alone in any major city, particularly as a traveler navigating a foreign city, and foreign language: the usual safety concerns to avoid being victimized. So, I worry more about being mugged for my purse than being kidnapped and held by gangs or para-military groups. Living here is like living in Chicago, Detroit, and Washington D.C in that respect. But that’s not always what people want to hear.

Flashy Headlines

Big headlines attract readers, but substance and content are what’s really important. So instead of trading in on ‘war stories’ with my readers, I try to bring portraits of daily life in Colombia and other parts of Latin America. It’s not as flashy; and exciting – but it’s worthwhile reading all the same. So with that in mind, I hope you enjoy reading about the lives of some of the people I encounter in my travels.

In the operating room with Dr. Luis Botero, plastic surgeon

Posted on July 15, 2013 by K Eckland

Please note that some of the images in this article have been edited to preserve patient privacy.

Today, Dr. Luis Botero has invited me to observe surgery at IQ Interquirofanos in the Poblado section of Medellin. He is performing full-body liposuction and fat grafting of the buttocks.

Dr. Luis Botero, in the operating room

The facility: IQ Interquirofanos

Interquirofanos is located on the second floor

IQ Interquirofanos is an ambulatory surgery center located on the second floor of the Intermedica Building across the street from the Clinica de Medellin (sede Poblado). The close proximity of this clinic to a hospital is an important consideration for patients in case of a medical emergency.

The anesthesiologists estimate that 90% of the procedures performed here are cosmetic surgeries but surgeons also perform gynecology, and some orthopedic procedures at this facility.

The are seven operating rooms that are well-lit, and feature modern and functional equipment including hemodynamic monitoring, anesthesia / ventilatory equipment/ medications. There are crash carts available for the operating rooms and the patient recovery areas.

There are fourteen monitored recovery room beds, while the facility currently plans for expansion. Next door, an additional three floors are being built along with six more operating rooms.

Sterile processing is located within the facility with several large sterilization units. There is also a pharmacy on-site. The pharmacy dispenses prosthetics such as breast implants in addition to medications.

The only breast prosthetics offered at this facility are Mentor (Johnson & Johnson) and Natrelle brand silicone implants (Allergan). In light of the problems with PIP implants in the past – it is important for patients to ensure their implants are FDA approved, like Mentor implants.

In the past seven years, over 31,000 procedures have been performed at Interquirofanos. The nurses tell me that during the week, there are usually 30 to 35 surgeries a day, and around 15 procedures on Saturdays.

Prior to heading to the Operating Room:

Prior to surgery, patients undergo a full consultation with Dr. Botero and further medical evaluation (as needed). Patients are also instructed to avoid aspirin, ibuprofen and all antiplatets (clopidogrel, prasugrel, etc) and anti-coagulants (warfarin, dabigatran, etc.) for several days. Patients should not resume these medications until approved by their surgeon.

Complication Insurance

All patients are required to purchase complication insurance. This insurance costs between 75.00 and 120.00 dollars and covers the cost of any treatment needed (in the first 30 days) for post-operative complications for amounts ranging from 15,000 dollars to 30,000 dollars, depending on the policy. All of his clients who undergo surgery at IQ Interquirofanos are encouraged to buy a policy from Pan American Life de Colombia as part of the policies for patient safety at this facility. International patients may also be interested in purchasing a policy from ISPAS, which covers any visits to an ISPAS-affiliated surgeon in their home country.

Today’s Procedures: Liposuction & Fat Grafting

Liposuction – Liposuction (lipoplasty or lipectomy) accounts for 50% of all plastic surgery procedures. First the surgeon makes several very small slits in the skin. Then a saline – lidocaine solution is infiltrated in to the fat (adipose) tissue that is to removed. This solution serves several purposes – the solution helps emulsify the fat for removal while the lidocaine-epinephrine additives help provide post-operative analgesic and limit intra-operative bleeding. After the solution dwells (sits in the tissue) for ten to twenty minutes, the surgeon can begin the liposuction procedure. For this procedure, instruments are introduced to the area beneath the skin and above the muscle layer.

During this procedure, the surgeon introduces different canulas (long hollow tubes). These tubes are used to break up the adipose tissue and remove the fat using an attached suctioning canister. To break up the fat, the surgeon uses a back and forth motion. During this process – one hand is on the canula. The other hand remains on the patient to guide the canulas and prevent inadvertent injury to the patient.

fat being removed by liposuction

Due to the nature of this procedure, extensive bruising and swelling after this procedure is normal. Swelling may last up to a month. Patients will need to wear support garments (such as a girdle) after this procedure for several weeks.

Types of liposuction:

In recent years, surgeons have developed different techniques and specialized canulas to address specific purposes during surgery.

Standard liposuction canulas come in a variety of lengths and bore sizes (the bore size is the size of the hole at the end of the canister for the suction removal of fat tissue.) Some of these canulas have serrated bores for easier fat removal.

Ultrasound-assisted liposuction uses the canulas to deliver sound waves to help break up fat tissue. These canulas are designed for patients who have had repeated liposuction. This is needed to break up adhesions (scar tissue) that forms after the initial procedure during the healing process.

Laser liposuction is another type of liposuction aimed at specifically improving skin contraction. This is important in older patients or in patients who have excessive loose skin due to recent weight loss or post-pregnancy. However, for very large amounts of loose skin or poor skin tone in areas such as the abdomen, a larger procedure such as abdominoplasty may be needed.

During laser liposuction, a small wire laser is placed inside a canula to deliver a specific amount of heat energy to the area (around 40 degrees centrigrade). The application of heat is believed to stimulate collagen production (for skin tightening). Bleeding is reduced because of the cautery effect of the heat – but post-operative pain is increased due to increased inflammatory effects. There is also a risk of burn trauma during this procedure.

There have been several other liposuction techniques that have gone in and out of fashion, and many of the variations mentioned are often referred to by trademark names such as “Vaser”, “SmartLipo”, “SlimLipo” which can be confusing for people seeking information on these procedures.

Fat Grafting

Fat from liposuction procedure to be used for buttock augmentation

Fat grafting is a procedure used in combination with liposuction. With this procedure, fat that was removed during liposuction is relocated to another area of the body such as the buttocks, hands or face.

In this patient, Dr. Botero injects the fat using a large bore needle deep into the gluteal muscles to prevent a sloppy, or dimpled appearance. Injecting into the muscle tissue also helps to preserve the longevity of the procedure. However, care must be taken to prevent fat embolism*, a rare but potentially fatal complication – where globules of fat enter the bloodstream. To prevent this complication, Dr. Botero carefully confirms the placement of his needle in the muscle tissue before injecting.

Results are immediately appreciable.

fat being injected for buttock augmentation. (Photo edited for patient privacy).

The Surgery:

Patient was appropriately marked prior to the procedure. The patient was correctly prepped, drapped and positioned to prevent injury or infection. Ted hose and sequential stockings were applied to lessen the risk of developing deep vein thrombosis. Pre-operative procedures were performed according to internationally recognized standards.

Sterility was maintained during the case. Dr. Botero appeared knowledgeable and skilled regarding the techniques and procedures performed.

His instrumentadora (First assistant), Liliana Moreno was extremely knowledgeable and able to anticipate Dr. Botero’s needs.

Circulating nurse: Anais Perez maintained accurate and up-to-date intra-operative records during the case. Ms. Perez was readily available to obtain instruments and supplies as needed.

Overall – the team worked well together and communicated effectively before, during and after the case.

Anesthesia was managed by Dr. Julio Arango. He was using an anesthesia technique called “controlled hypotension”. (Since readers have heard me rail about uncontrolled hypotension in the past – I will write another post on this topic soon.)

Controlled Hypotension

However, as the name inplies – controlled hypotension is a tightly regulated process, where blood pressure is lowered to a very specific range. This range is just slightly lower than normal (Systolic BP of around 80) – and the anesthesiologist is in constant attendance. This is very different from cases with profound hypotension which is ignored due to an anesthesia provider being distracted – or completely absent.

With hypotensive anesthesia – blood pressure is maintained with a MAP (or mean) of 50 – 60mmHg with a HR of 50 – 60. This reduces the incidence of bleeding.

However, this technique is not safe for everyone. Only young healthy patients are good candidates for this anesthesia technique. Basically, if you have any stiffening of your arteries due to age (40+), smoking, cholesterol or family history – this technique is NOT for you. People with high blood pressure, any degree of kidney disease, heart disease, peripheral vascular disease or diabetes are not good candidates for this type of anesthesia. People with these kinds of medical conditions do not tolerate even mild hypotension very well, and are at increased risk of serious complications such as renal injury/ failure or cardiovascular complications such as a heart attack or stroke. Particularly since this is an elective procedure – this is something to discuss with your surgeon and anesthesiologist before surgery.

The patient today is young (low 20’s), physically fit, active with no medical conditions so this anesthesia poses little risk during this procedure. Also the surgery itself is fairly short – which is important. Long/ marathon surgeries such as ‘mega-makeovers‘ are not ideal for this type of anesthesia.

Dr. Julio Arrango keeps a close eye on his patient

Dr. Julio Arango keeps a close eye on his patient

However, Dr. Arango does an excellent job during this procedure, which is performed under general anesthesia. After intubating the patient, he maintained a close eye on vital signs and oxygenation. The patient is hemodynamically stable with no desaturations or hypoxia during the case. Dr. Arango remains alert and attentive during the case, and remains present for the entire surgery. Following surgery, anesthesia was lightened, and the patient was extubated prior to transfer to the recovery room.

He also demonstrated excellent knowledge of international protocols regarding DVT/ Travel risk, WHO safety protocols and intra-operative management.

Surgical apgar score: 9 (however, there is a point lost due to MAP of 50 – 60 as discussed above).

Results of the surgery were cosmetically pleasing.

Post -operative care:

Prior to discharge from the ambulatory care center after recovery from anesthesia the patient (and family) receives discharge instructions from the nurses.

The patient also receives prescriptions for several medications including:

1. Oral antibiotics for a five-day course**. Dr. Botero uses this duration for fat grafting cases only.

2. Non-narcotic analgesia (pain medications).

3. Lyrica ( a gabapentin-like compound) to prevent neuralgias during the healing period.

The patient will wear a support garment for several weeks. She is to call Dr. Botero to report any problems such as unrelieved pain, drainage or fever.

Note: after some surgeries like abdominoplasty, patients also receive DVT prophylaxis with either Arixtra or enoxaparin (Lovenox).

Follow-up appointments:

Dr. Botero will see her for her first follow-up visit in two days (surgery was on a Saturday). He will see twice a week the first week, and then weekly for three weeks (and additionally as needed.)

* Fat embolism is a risk with any liposuction procedure.

**This is contrary to American recommendations as per the National Surgical Care Improvement Project (SCIP) which recommends discontinuation within the first 24 hours to prevent the development of antibiotic resistance.

San Vicente at Rionegro: Hospital at the top of the hill

Posted on July 11, 2013 by K Eckland

After interviewing Dr. Andres Franco, Chief of Cardiac Surgery over at Clinica Medellin, he invited me to tour San Vicente Fundacion’s Centros Especializados in Rionegro, Antioquia.

San Vicente Fundacion Centros Especializados in Rionegro, Antioquia

Rionegro is about 45 minutes from downtown Medellin but just a few miles from Jose Marie Cordoba airport (the international airport for Medellin.) This makes this hospital well-positioned for domestic and international tourists.

San Vicente Fundacion

Vereda la Convencion, via Aeropuerto – Llanogrande, kilometre 2,3

Rionegro, Colombia

Tele: (574) 444 8717

Website: http://www.sanvicentefundacion.com

We’ve briefly mentioned the 100 million dollar facility in the past, as it was one of the first hospitals in Latin America to receive a “green” designation (Leed silver certification) for sustainability, water conservation, energy use, material and resource use, innovation and indoor environmental qualities. To see San Vicente’s individual scores in each of these catagories, click here. It was interesting to have the opportunity to see the facility for myself.

My guide for the visit was Ms. Flor Cifuentes, the chief nurse for cardiovascular surgery. In addition to answering all of my questions and showing me around the facility, we talked about nursing. We were joined by Ms. Sandra Milena Velasquez, who is the care coordinator for the facility.

Nursing care at San Vicente

The three of us spent much of the morning talking about their vision of nursing at San Vicente. Both nurses see the role of specialty nursing as being critical to the success of the facility, and the care of the patients.

I think they are interested in my viewpoint as both an outsider and as a nurse practitioner, a position that isn’t recognized in Colombia. We all kind of sigh over this – as it’s apparent in any facility that nurses here have extensive education (usually five to six years for “Jefes” and often function in advanced roles (particularly in the operating room.)

Enf. Flor Cifuentes

Eco-friendly and patient friendly design

While four stories are visible to casual visitors, there are an additional four floors beneath the facility. The subterranean floors are part of the eco-friendly design.

The hospital is beautiful, and surrounded by the lush greenery that characterizes the hills of Colombia. There are several gardens stocked with aromatic plants as a sort of “tranquility space” for patients and families.

At 2600 meters (8,500 ft), Rionegro falls into one of the top ten hospitals for altitude (along with facilities in Bogota, Quito, Ecuador and La Paz, Bolivia).

The above ground areas are filled with light, with large windows. Many of the patient rooms, including the ICU room have a ‘family space’ for family members to spend time with their loved ones.

The equipment was state-of-the -art. The cardiac operating room was large, well-stocked. There is a computerized system for everything from climate control to lighting, to cameras and monitors. Touch screens abound. Nitric oxide connections exist in all of the operating rooms. A cell-saver rested in the corner next to the bypass machine (heart-lung machine) in an antechamber of the cath lab, just waiting to be called into service.

One of the operating rooms has been converted into an angiography suite (cardiac catheterizations, peripheral vascular procedures and neurology interventions) with a second room being constructed nearby.

There is a helicopter pad on the roof for more urgent arrivals.

Phase II

Evidence of ongoing construction was rampant – as the hospital begins a second stage of construction; for a Cancer Center, a Neurosciences center, a trauma center, plastic surgery center (plastic, maxiofacial and esthetics), Women’s Health, Neo-natal care and a Psychiatric care center. It’s a pretty ambitious endeavor which will also add 400 beds to the facility. (Currently, the Rionegro facility has 145 general beds, 14 ICU beds, 20 specialty beds and 20 ER beds.)

“Ghost Hospital”

Unfortunately, for investors – the two-year old facility was essentially empty. Among healthcare professionals, many refer to the facility as a “ghost hospital” due to the low occupancy rates since it’s opening.

Only one of the five operating rooms was in use during my visit. The pre and post operative areas were empty. So was the four ambulatory procedure areas.

The ICU was half-full at best (4 to 5 patients). The only area that showed evidence of life was one of the ‘regular’ patient floors. Amazingly, even the emergency room was empty.

Hopefully, this is just growing pains for the hospital, which is the newest part of the well-established San Vicente Health System.

The San Vicente de Paul Health System

The Rionegro facility is part of the larger San Vicente de Paul Hospital System. The San Vicente hospital in downtown Medellin has a long history of patient care and community service. (The film below talks about the San Vicente Hospital System – but it’s a couple of years old, so the Rionegro facility was still in the development stage.)

Chapel on the main campus of San Vicente de Paul in downtown Medellin

San Vicente : Rionegro has several advertisements on YouTube about their facility, and is part of the San Vicente channel on YouTube. The majority of it is in Spanish but there are a few English language offerings.

For one of ads featuring the Rionegro facility, (Spanish version) – click here. The hospital gave me a CD-ROM containing the English version, so a friend is uploading it to YouTube so I can show it here.

Medellin Plastic Surgeons: Aristizobal Aramburo thru Gomez Botero

Posted on July 8, 2013 by K Eckland

Medellensa (or women from Medellin) are considered some of the most beautiful women in the world. However, they often have had some help. Plastic surgery is wildly popular in Medellin, Colombia and much of Latin America, and standards of beauty are based on a voluptuous physique with large breasts, small waist and an (often) exaggerated caboose. Actress Sofia Vergara, of Barranquilla is a classic example of Colombian beauty ideals, which have spread into popularity to the United States. Many North Americans and Europeans seeking this look come to Medellin for the city’s famed plastic surgeons.

Of the 650 members of the Colombian Society of Plastic, Aesthetic and Reconstructive Surgery, 98 members are located in the Medellin area. Using this directory, I attempted to contact surgeons for interviews. When e-mail addresses were not available, I contacted surgeons thru the Colombian Society website, when that option was available*. If the surgeons listed a website, contact was also attempted via website.

Alphabetical listing – compilation is ongoing as I continue efforts to contact and interview plastic surgeons in the city.

Luis Fernando Aristizobal Aramburo

Calle 7 #39-290 Office # 1216 Cl Medellin

Medellin

Tele: 266 9823

Email: aristi01@epm.net.co

Emailed 7/4/2013, no reply.

Joaquin Aristizabal

No email or internet contact information available

Edgar Alonso Becerra Torres

Calle 6 Sur #43 – 200

Office # 1001

Sector Poblado

Medellin

Tele: 268 – 1132

Email: consultorio1001@une.net.co

Website: esteticaedgarbecerra.com

Emailed 7/4, and used contact form at site, no reply.

Carlos Alberto Betancourt Madrid

No contact information provided

Juan David Betancourt Perra

Calle 7 #39- 197 Torre Intermedica

Piso 13, Office # 1816

Medellin

Tele: 352 – 0264

Email: plasticjdb1@une.net.co

Website: www.plasticjdb.com

Emailed 7/4, no reply. Met in person at the Clinica Interquirofanos 7/13/2013.

Specializes in post-bariatric surgery procedures. Interviewed August 2013. To read the interview, click here.

Rafael Ivan Botero Botero

Clinica Las Vegas Fase II

Office # 370

Medellin

Tele: 311 9167

No email provided.

Contacted via Society website on 7/4

Lists fluency in English and Spanish.

Luis Fernando Botero Guiterrez

Cra. 25A # 1-31 Parque emp. El Tesoro

Office # 907

Medellin

Tele: 448 – 6030

Email: luchobot@gmail.com

Emailed 7/4, responded immediately.

Lists English and French in addition to Spanish. Following correspondence, I interviewed Dr. Botero at his office. The interview with Dr. Botero can be seen here. You can read about my visit to the operating room here.

Juan Botero Londono

No contact information provided

Jenny Carvajal Pareja

Calle 2 Sur #46 – 55

Office 266 Fase II

Medellin

Tele: 444 – 1312

No email provided

Contacted via society site 7/4*

J. Mario Castillon Montoya

Clinica Medellin Fundadores

Office #1003

Medellin

Tele: 511-6634

No email provided

Contacted via society site 7/4*

Diego Alberto Castillon Munoz

Calle 54 # 46 – 27 (Clinica Medellin)

Office # 1003

Medellin

Tele: 511 -6634

Email: dacastillon@une.net.co

Emailed 7/4, no reply

Reports on the society website that he speaks English and French in addition to native Spanish. Shares office with Mario Castillon.

Oscar de Jesus Chica Gutierrez

Calle 2 Sur #46 – 55

Office 235

Medellin

Tele: 311 – 6344

Email: oscarchica1@hotmail.com

Emailed 7/4, no reply.

Camilo Correo Herrera

No contact information provided.

John Emiro Cortes Barbosa

Calle 33 # 74E – 80 Cl. Medellin

Tele: 250 – 3941

Cell: 315 – 343 – 6898

Email: jamanta@hotmail.com

Emailed 7/4

Speaks English.

Jose Ivan Cortes Hernandez

Calle 38A # 80 – 72 Apto. 216

Cuidadela Laureles

Medellin

Tele: 412 5803

No email ontact provided.

David Ricardo Delgado Anaya

No contact information available

Ruy Rodrigo Diaz

Calle 32 # 72 – 28 Clinica Las Americas

Medellin

Tele: 345 – 9159

Email: rdiaz@epm.net.co

Emailed 7/4. Interviewed July 18, 2013. To read more about the interview, click here.

Jenny Maricela Diaz Cortes

Cra. 48B # 15 Sur 35

Aguacatala 2

Medellin

Tele: 321 0539

Cell: 317 639 7501

No email. Contacted on 7/4 using society form*.

Gonzalo Diaz Palmett

Calle 2 Sur # 46 – 55

Office # 450

Medellin

Tele: 268 – 0158

Email: sdiaz@une.net.co

Emailed 7/4,no reply.

Andres Diaz Romero

Diag 75B # 2A – 80

Office # 421

Torre Medica Clinica Las Americas

Medellin

Tele: 345-9159

Email: cplastica@hotmail.com

Emailed 7/4 no reply received.

Clemencia Duque Vera

Diag 75B # 2A – 80

Office # 419

Torre Medica Clinica Las Americas

Medellin

Tele: 345-9159

Email: duqueclemencia@hotmail.com

Emailed 7/4, no reply received.

Alberto Echeverry Arango

Diag 75B # 2A – 80

Office # 422

Torre Medica Clinica Las Americas

Medellin

Tele: 345 – 9160

Email: albertoecheverry@yahoo.com

Emailed 7/4, no reply.

William Echeverry Duran

Calle 1A Sur # 43A – 49

Office # 206, Edificio Colmena

Medellin

Tele: 311 – 0555

No email. Attempted contact via society site on 7/4*.

Francisco Fabian Eraso Lopez

Cra. 45 # 1 – 191

Torre 1 Apto 1607

Torres Patio Bonito

Medellin

No telephone, no email provided

Attempted contact via society site on 7/4*

Julio Cesar Eusse Llanos

Calle 7 # 39 – 197

Office # 908

Medellin

Tele: 444-5464

No email. Attempted contact via society form 7/4*

Sabrina Gallego Gonima

Calle 2 Sur #46 – 55 Fase I

Office # 528

Medellin

Tele: 311 – 6780

Email: sgallegog@gmail.com

Emailed 7/4, no reply.

Lists English and French in addition to Spanish.

Monica Maria Garcia Gutierrez

Calle 33 # 42B – 06

Office 1220

Torre Sur San Diego

Medellin

Tele: 262 – 3915

Email: monicamg@une.net.co

Emailed 7/8.

Rodrigo Gaviria Obregon

Carrera 25B $ 16A Sur – 211

Biofarma

Medellin

Tele: 317 1626

Email: Rodrigo.gaviria@biofarma.com.co

Email bounced.

Julio Alberto Giraldo Mesa

Carrera 25A # 1 -31

Office 716

Parque emp. El Tesoro

Medellin

Tele: 317 4478

Cell: 311 333 4061

No email listed, emailed through society website on 7/8*.

Profile states he speaks English and Portuguese in addition to Spanish.

Lists plastic surgery education at Hospital Barata Riverio – Rio de Janiero, Brazil.

Martha Elena Gomez Botero

Calle 2 Sur # 46 -55

Clinica Las Vegas

Medellin

Tele: 268-3818

Email: megomezbotero@hotmail.com

Emailed 7/8.

Dr. Gomez specializes in maxiofacial surgery and hand surgery.

** the website email form for the Colombian society of plastic surgeons does not appear to be working. I have contacted the society regarding this issue.

View from the mall

Posted on July 6, 2013 by K Eckland

If you want to understand and to really know life in Medellin, than you need to see the richness and complexities of life here. It’s simplistic to say that life here is more than black and white. It isn’t varieties of grey either.. There are so many levels, and sublevels and little pockets / slices of life here. Every barrio has its own personality; community, strengths and weaknesses.

Never has that been more apparent than during my visit to El Tesoro yesterday to interview Dr. Botero. Even so, I would be selling the city short if I pretended that I truly understood Medellin in my brief time here. My friend, Adriaan has lived here since 2008 and he would be the first person to admit – that it takes much of that time just to scratch beneath the surface.

One of the reasons I write about Colombian life so frequently, in addition to medical issues is to better understand life here – and to share that with my readers. It’s not just another language, or another Latin American country. Superficial differences are great for picture postcards and brief visits – but if you spend any real time here, or want to have lasting business relationships or friendships with people here, than you have to dig deeper (not just into Colombia, but in yourself).

One of the lessons has to do to with what we bring to other countries. A lecturer at the Global Health Conference in Duke one year explained it best. He went on a ‘medical mission’ to Mongolia.. And he thought he should teach them American principles of surgery. But when he got there he talked to the surgeons there and realized they didn’t want or need this. They wanted to learn more about laparoscopic surgery. So he changed his project entirely, and taught laparoscopic surgery. (Notably, he was the only speaker at this three-day conference who listened – and taught what the hosts wanted to learn.)

This is not a medical mission, it’s the anti-thesis to what I do. But I still have to listen, and to consider Colombians and Colombia as a big part of what I do. I am not an imperialist, and I am not a big multi-national organization. But if I am going to encourage people to see Colombia as a viable option to affordable surgery, then I need to consider the Colombians that will be impacted by this.

I have to take time to make sure that my efforts don’t undermine the needs of Colombian citizens – that they don’t lose access to health care providers in favor of the ‘wealthy gringos’ with cold hard cash in hand. I have to try to encourage others in this industry to do the same; to work within the existing framework to try to ensure services for all.

This means that I tend to steer clear of facilities created only for ‘rich gringos’ and send people to the excellent public and private facilities that also serve Colombian citizens. This prevents the diversion of resources away from the very people who live here and rely on these services for everyday life. It means sending people to Fundacion Cardioinfantil, Clinica San Rafael or the National Cancer Institute for the wonderful doctors who work there, instead of the ‘Medical Cities” that are popping up almost daily. That way, these excellent providers continue to serve their communities and the money from medical tourism enriches these same communities instead of the pockets of a very few. These facilities then add services – for everyone. There are enough excellent facilities here that it’s an easy choice – but people traveling to other countries like Thailand and India need to think about this. These countries already suffer from a “brain drain” as their most talented health care providers flock to the ultra-expensive and ultra-elite facilities for wealthy travelers (and leave their own citizens out in the cold.)

There is talk of building several of these tourist hospitals in the coastal cities (Cartagena, Barranquilla and Santa Marta) and I hope it doesn’t come to pass. It would change, and damage this country which I have come to love so much.

This is also why I steer clear of transplant tourism – which is inherently unfair.

Being in Colombia has changed me, because it makes me question a lot of the things that I held as ‘facts’ merely due to my upbringing and geographic orientation. But I feel this is essential for becoming a more intelligent and informed person and citizen of the world. Sometimes it is just noticing the obvious – like the view from the mall at El Tesoro.. Sometimes its taking a minute to talk to the vendors in the park; to listen to their dreams, hopes, worries as well as get their perspectives on life, global and local events. But sometimes its just being here.

Checking in with Dr. Hector Pulido at Clinica General del Norte

Posted on July 3, 2013 by K Eckland

After spending some time in my old neighborhood in Bogotá visiting friends and family over the holiday weekend – it was time for a quick trip to Barranquilla for another reunion, of sorts. Dr. Hector Pulido, the Chief of Surgery at the Clinica General del Norte (and a long-time friend) invited me to Barranquilla to take a look around..

with Dr. Hector Pulido (left) and Dr. Barbosa in Cartagena (2010).

The City of Barranquilla: Colombia’s Golden Gate

Barranquilla is the capital of the Colombian state (province) of Atlantico, and is the largest city within Atlantico. Barranquilla is the fourth largest city within Colombia – after Bogotá, Medellin and Cali. While population estimates vary greatly, the generally published estimate is around 1.6 to 2.4 million people*. Much of Barranquilla’s historical importance is related to its position as the major port of Colombia. This is reflected in Barranquilla’s continued growth and reputation today.

Barranquilla: More than Shakira and Carnival

While Barranquilla is widely considered to be Cartagena’s ugly big sister; it is also the coastal region’s more serious, intellectual and industrial side. Excluding the internationally famous Carnival; among the Colombian coastal cities of Barranquilla, Cartagena and Santa Marta; Cartagena is viewed as being for play, Santa Marta for relaxation… But Barranquilla is viewed as the city where the work gets done..

That impression; of business-like efficiency and competency certainly held true during my tour of the main facility of the rapidly expanding Clinica General del Norte health system.

Clinica General del Norte

The Clinica General del Norte facility on Calle 70 is the main facility of the nine hospital network. (There are 4 hospitals in Barranquilla itself, with several other hospitals in Cartagena and other coastal areas.) The Calle 70 facility is also the biggest with 464 beds, and an anticipated addition of 300 beds in the works.

Care of the critically ill

Clinica General del Norte has 100 intensive care beds, with a dedicated coronary /cardiac intensive care, a burn unit, pediatric intensive care and a 24 bed neo-natal unit. They also have an intensive care unit for patients requiring hepatic dialysis for patients with liver failure. This last unit is of particular interest – since it is where Dr. Hector Pulido, as a general surgeon specializing in Liver, Biliary, Pancreatic Surgery and Transplant) cares for many of his more critically ill patients after surgery.

But no real chance to observe Dr. Pulido at work – at least, not today.. Just a quick whirl around the facility, accompanied by Yolanda Basto de Hossman, and Dra. Maria del Carmen – to the 14 operating rooms to check out the cardiac surgery room along with the updated and modern equipment, to the neo-natal unit to talk to the Chief of Pediatrics, and see babies as young as 20 weeks gestation.

MRI/ CT scan and Angiography facilities

Dr. Pulido encourages them to show me everything (everything! he says) – so they do; the dual angiography suites, the 64 slice CT scanner with 3D reconstruction, to MRI – meeting and talking to staff along the way. No PET/ CT yet but it’s on the way – they say – which will make this the only facility on the coast with such diagnostic capabilities. (They are building the structure to contain it as part of the new building being constructed in front of the existing facility).

But, of course, for me – it’s not enough.. I need to talk to the surgeons, spend some time with them; observing and talking to their patients – getting the feel and the rhythm of their practice.. I need to watch them in the operating room, and to know them – before I can be completely satisfied.

So even now, as Victor takes me back to the airport, I am thinking, questioning, planning.. “Are the rents very expensive near here?”, I ask. “No” he says as he drives through the nearby small streets with gaily painted houses.. Well, then I think I have my answer.

Sunset in on the air field as I prepare to leave Barranquilla

Links for more information:.

City of Barranquilla – government website

Official Colombia Travel page: Barranquilla

El Heraldo – news of the Colombian coast

Clinica General del Norte

*Local residents estimate the population at almost 4 million people in the metropolitan area

Sunday in La Candelaria

Posted on July 1, 2013 by K Eckland

I am visiting Bogotá this week, before heading back to Medellin..

Bogotá is one of those cities that climbs into your heart – despite initial misgivings; too big, too cold, often rainy; becomes gloriously interesting and wonderfully cool..

I was armed with just a camera phone, so my friend, Camila Togni assisted in my photo-taking endeavors..

Sidewalk in downtown Bogota

Despite its large size – the city manages to be hospitable and friendly to visitors – and I missed my Bogotá “home”. So I headed back for just a few days to check in and enjoy all the things that make me love this unlikely city so much..

While Barrio Chico (where I live) is pretty quiet – La Candelaria is always quite a bit more lively.

I normally tend to avoid the Candelaria area because of the ever-present crowds of people, which is a shame because there are a lot of interesting places to visit and some beautiful architecture in this part of town.

Alvaro Palacio & Claro Lozano in front of the Cathedral de Bogota

But this weekend is the celebration por el nino del 20 de julio (and the ORs are closed) so when my friends invited me to go downtown with them – it was an opportunity not to be missed!

First we headed to the Iglesia de nino de 20 de Julio since this what the holiday weekend was all about.. It’s a huge church – a campus, actually – and it was packed with people.

Iglesia de nino del 20 de Julio

Even though it was crowded, it was a lovely service – and the church itself is quite pretty.

el nino de 20 de Julio

The church has a lovely glass dome and several stained-glass windows with religious scenes.

The church is so large, the domed area actually isn’t part of the central church, but an overflow area with a jumbo screen television so worshippers can see the priest conducting the service in the main chamber.

You can see the crowd milling in the foreground of this photo.

the crowd at the church

After the service, we wandered around the large flea market just a street away from the church before heading to lunch at a famous but tiny, and old restaurant called, “La Puerto Falso.”

While the rest of my party had their famous tamals, I was up for a bit of a culinary adventure, so I had a soup called Changua.

Colombian Tamal

While the description of a soup made of milk, eggs, bread, mild local cheese and cilantro didn’t sound that entices – it was actually quite good and is part of Bogotá regional cuisine.

Links for additional information about sightseeing in Bogota

More information about La Candelaria

Virtual tourist – La Candelaria

Video of LA Candelaria

Cathedral de Bogota

Most guides are going to send you to the Museo de Oro “The Gold Museum” but that’s not my favorite..

Museo de la Policia – probably my favorite of all the museums, thus far, in Colombia. It’s free – guides welcome you in from the street – and you can see the bloodied, bullet-ridden jacket of Pablo Escobar, from his last moments on a rooftop in Medellin. (It’s considered rude to ask about Pablo Escobar in general conversation) but if you hold any fascination about how a rural boy from an impoverished background managed to hold Colombia hostage, and gain international infamy – it’s a must. The guides also offered free candy, and played a game of ‘rana’ with us. (The are guides for multiple languages).

International Tango festival

Posted on June 23, 2013 by K Eckland

There’s always something going on here in Medellin, so I am keeping busy even when I’m not in the operating room.

Dressed and ready to tango!

This week – it’s the 6th Festival Internacional de Tango..

the crowd at the Botanical Gardens enjoys a free show during the International Tango Festival

While salsa dancing is a Colombian original (from Cali), the Argentine tango is alive and well here in Medellin. At this week’s festival, several musicians and dancers from Medellin are being showcased for their skills – along with Buenos Aires legends.. Local schoolchildren are also participating in a series of concerts and dance demonstrations. It’s quite a bit of fun – and showcases some of the things the city of Medellin really excels at.

After attending a Tango performance last weekend, and numerous other public events and outings – one of the things that it really noticeable is how well the city manages these events.

Fun and family friendly

There has been no trash or litter, no displays of public drunkenness (despite the fact that there is plenty of alcohol at these events), and no disturbances at any of our outings (and several were free).

Roaming the city

During the weekend, we roam the city – taking pictures, enjoying the endlessly lovely weather – and riding on the metro (train). The trains are affordable, quick (and if you avoid peak traveling times during the week) not too overly crowded.

above ground metro train

Universidad Station

Several parks and museums are located close to the Universidad Station including the Planetarium, Parque Explora (for kids) and the Botanical Gardens.

the planetarium

The Botanical Gardens

The ‘Joaquin Antonio Uribe’ Botanical Gardens were a delightfully relaxing place to spend a gorgeously sunny Sunday afternoon in the midst of the city, but away from the hustle and bustle of El Centro (where I live).

Admission is free.

There was live music to listen to, plenty of flowers, and wildlife to enjoy (iguanas roam the grounds), and assortment of snacks (ice cream, juice drinks, and other regional treats).

Iguanas roam the park

But the park isn’t just there to enjoy nature.. It’s a great place to people watch.. Also the people of Medellin are very kind and friendly, so they are happy to talk – even to gringas with bad Spanish, like myself.

using his camera to meet girls

We watched this photographer use his camera to meet girls as he roamed the park..

A group of young people singing…

Then we met a lovely princess..

and a local vendor selling gum in the park..

lost his leg due to a landmine

This very nice gentleman is a reminder that as sunny and lovely as Medellin is – there is still an ongoing war to remember.. One that has devastated thousands of young men, and displaced millions of people.

jumping rope

Wholesome

As a visitor (and temporary resident) of Medellin – the wholesomeness of the park is enchanting.. It’s a reminder of one of the reasons, I do enjoy Colombia so very much.. Just like my “Sundays in Bogotá” – the city slows down during the weekends, and people spent time with their loved ones.. No gameboys in evidence, and phones used mainly to take pictures.. It’s a gracious illusion that reminds me of my own childhood in a small town..

Colombia ranked 11th in the world for plastic surgery: who says so??

Posted on June 16, 2013 by K Eckland

No, not the World Health Organization (WHO), but another entity entirely, ISAPS.

Plastic surgeons in Mexico gather for a demonstration of techniques for breast reconstruction. Mexico is currently ranked #5 for number of plastic surgeries

International Society of Aesthetic Plastic Surgery (ISAPS) recently published survey data ranking Colombia at 11th for volume according to the most recent statistics (2011) available. 211,879 total procedures were reported. Colombia currently ranks #27th globally in population with a 2013 estimated population of 47 million. Considering the modest population size of Colombia this statistic may reflect both Colombian cultural expectations and the growing trend of medical tourism.

Countries that perform the most cosmetic surgery procedures***:

1. United States: 1,094,146

2. Brazil: 905,124

3. China: 415,140

These top three nations also represent a total population of 1.86 billion people. Brazil, in particular is also widely known as the medical tourism destination of choice for plastic surgery.

Plastic surgery in Colombia

Of the 211, 879 procedures, 65,075 or 30.7% were breast enhancement procedures. Liposuction accounted for 23% of all cosmetic surgical procedures.

Dr. Reyes, a plastic surgeon in Bogota, Colombia operates on a patient

Questionable study results due to lack of participation

However, the accuracy of the data collected by a joint American – Brazilian team is questionable given the low percentage of participation by licensed member surgeons. Out of 20,000 eligible ISAPS member surgeons, only 996 participated in the organization’s survey. Additionally, of the .04 percent of surgeons reporting their surgical practices, 43% (431 surgeons) were based in the United States. Of the remaining 565 surgeons represented the remainder of the worldwide plastic surgery community, 172 of these participants were from Brazil. The final statistics provided for each country are based on estimates extrapolated from a representative sample from survey responses received.

Are the results any surprise, given the players? But then again, maybe these results will encourage more Latin American surgeons (and surgeons in other countries) to participate more fully in the academic activities of their specialty societies.

*Mexico was also in the top five with 299,835 procedures.

***As an interesting aside, the island nation of Japan ranked fourth.

In the operating room with Dr. Wilfredy Castaño Ruiz

Posted on June 14, 2013 by K Eckland

I am still working on several posts – but in the meantime, I wanted to post some photos from my visit to the operating room with Dr. Wilfredy Castaño Ruiz, one of the thoracic surgeons at Hospital General de Medellin.

Readers may notice that some of the content of my observations of the operating room have changed.. In reality, the reports haven’t changed – I have just chosen to share more of the information that I usually reserve for the books since I probably won’t get time for a “Medellin book”. So, if you are squeamish, or if you don’t want to know – quit reading right about now…

It was a surprise to meet Dr. Wilfredy Castaño Ruiz because it turns out we’ve already met. He was one of the fellows I encountered during one of my early interviews in Bogota, with Dr. Juan Carlos Garzon Ramirez at Fundacion Cardioinfantil.

Since then (which was actually back in the early spring of 2011), Dr. Castaño has completed his fellowship and come to Medellin.

Dr. Wilfredy Castaño Ruiz, thoracic surgeon at Hospital General de Medellin

Yesterday, I joined him in the operating room to observe a VATS decortication. The case went beautifully.

Dra. Elaine Suarez Gomez, an anesthesiologist who specializes in cardiothoracic anesthesia managed the patient’s anesthesia during the case. (This is important because anesthesia is more complicated in thoracic surgery because of such factors as double lumen intubation and selective uni-lung ventilation during surgery).

Anesthesia was well-managed during the case, with continuous hemodynamic monitoring. There was no hypotension (low blood pressure) during the case, or hemodynamic instability. Pulse oxymetry was maintained at 98% or above for the entire case. Surgical Apgar: 8 (due to blood loss**)

Monitors at HGM are large and easily seen from all areas of the OR

Dr. Wilfredy Castaño Ruiz was assisted by Luz Marcela Echaverria Cifuentes, (RN, first assist*). The circulating nurse was a very nice fellow named Mauricio Lotero Lopez.

Enf. Luz Echaverria assists Dr. Wilfredy Castaño Ruiz during surgery.

*”Registered nurse” is not terminology common to Colombia, but this is the equivalent position in Colombia, which requires about six years of training.)

** In this particular case, the surgical apgar of 8 is misleading. The anesthesia was excellent, and the surgery proceeded very well. However, due to the nature of surgical decortication (for a loculated pleural effusion/ empyema) there is always some bleeding as the thick, infected material is pulled from the lung’s surface. This bleeding was not excessive for this type of surgery, nor was it life-threatening in nature.

Hospital General de Medellin

Posted on June 14, 2013 by K Eckland

I spent the day yesterday at Hospital General de Medellin, and I am going back today for another visit. I’ll be revising and updating this post as I go along. I spend most of the day with Dr. Luis Fernando Meza Valencia and Dra. Elaine Suarez Gomez, but we will talk more about these two doctors in another post.

Hospital General de Medellin

Carrera 48 No 30-102

Medellin

574) 384 7475

Emergencies: : 018000411124 / (574) 262 17 43

Hospital General de Medellin

Quite frankly, it is the nicest public facility I have ever been in, anywhere. The entire facility (and I was peeking in corners and closets) was spotless – and that included the operating rooms.

It’s the main trauma center for Medellin, and the largest public facility with a large well-coordinated ER. (The ER was quiet and orderly during my visit – despite being about half-full.

The hospital is well-equipped with 3 mixed ICUs, a step-down unit, a large neonatal ward and NICU, pediatric ICU along with multiple wards for medical patients. There are nine operating rooms, including a dedicated cardiac operating room (quirofano #1), and a separate cath lab with OR capabilities (for endovascular and hybrid procedures.)

Attached to the hospital is the ‘Consulta Externa’ where the doctors see their patients, along with a non-invasive cardiology clinic (echocardiograms, stress tests and the like, and laboratory. I have certainly missed several departments – as I passed auditoriums and several other departments during my visit, but all of the major elements are included above.

They do not have a PET scanner at Hospital General de Medellin (but given the expense of this machinery, there are only a few PET scanners in Colombia. There are only two in Bogotá – one at the Fundacion Santa Fe de Bogotá, and one at the National Cancer Institute.)

There is no international patient division or department, but the website has a full English version, many of the physicians speak English (about half of the physicians I met), and they are very welcoming.

Mural at Hospital General de Medellin

The hospital, while busy was not as hectic or crowded as some of the other facilities I have seen in the past. I’ll be at Hospital General for multiple visits, so I will have plenty of opportunities to see if that changes.

High-risk Obstetrics Program

During my visit – Dr. Carlos Garcia, the Chief of Surgery was talking about the new obstetrics outpatient monitoring program along with several other services that are fairly uncommon for publicly funded hospital facilities.

I only received the basics of the OB program (because OB is not really my area of expertise) but as Dr. Garcia explained – it’s an out-patient monitoring program for high-risk obstetrics patients. Patients are equipped with fetal monitors so that they can be in their own homes during much of their gestational period, instead of confined to the hospital. The monitors are reviewed continuously by the staff at Hospital General – and if there are any serious abnormalities or evidence of fetal distress, not only is the patient contacted – but an ambulance is automatically sent to bring in the patient for urgent/ emergent evaluation and treatment.

Medellin, my beautiful friend..

Posted on June 10, 2013 by K Eckland

I don’t know how it always happens.. I set out on one kind of expedition and (frequently) it turns into something else. So we have it.. I was planning to write extensively on Panama City, but looky, looky – here I am again, living in the fantastic, tragic beauty of Medellin.

As I wrote once before, Medellin is a city of great loveliness, but somehow Bogotá always blinded me to Medellin’s charms.. But it’s time to give Medellin a fair shake, so here I am..

Anthony Bourdain does Colombia

Posted on April 29, 2013 by K Eckland

It’s not his first visit – he’s done several other programs highlighting Colombia, but tonight’s episode on his new CNN show, “Parts Unknown” is definitely his best. It’s the first time I think he actually ‘got it’ and was really able to convey a real sense of Colombia to his viewers.

While his previous shows were primarily about food, and local food culture – his episodes on Colombian cuisine were always very wide from the mark.. Sure, he had the names of dishes and such – but he didn’t really bring home the feel of Colombia and it’s people.

http://www.youtube.com/watch?v=qNiF0R1QJpk&feature=share&list=SP6XRrncXkMaVZxpButSnMywWvtINMmjXv

Or that Colombian food isn’t really about intense spices, it’s about the intense and rich flavors that comes from the rich textures of the foods themselves – without overpowering curries or heavy sauces..

Better quality, fresher ingredients and a wide variety make for richer flavors

Medical Tourist death under inquest

Posted on February 24, 2013 by K Eckland

Was it a medical mistake/ an accident of fate / or…. was it the Cocaine? An inquest is held on the intra-operative death of an Irish medical tourist..

In a recent inquest, the wife of an Irish tourist who died while undergoing liposuction with a well-known Colombian plastic surgeon talked about her husband and his decision to pursue plastic surgery with Dr. Ricardo Lancheros Pedraza.

In a published story by Gareth Naughton of the Irish Independent, the wife of Pierre Christian Lawlor detailed her husband’s decision to undergo cosmetic surgery with the Bogotá surgeon due to unhappiness with his physique.

During her testimony, she also conceded that her husband had taken cocaine in the days and hours immediately prior to surgery – despite being advised specifically to refrain from smoking, alcohol or taking medications.

In a story published in Irish Central – Ms. Andrea Galeano, the Venezuelan-borne wife of Mr. Farrell reported that her husband had taken cocaine on several occasions after arriving in Bogotá for his surgical procedure.

Mr. Farrell is believed to have died from intra-operative myocardial infarction (heart attack during surgery).

Additional Information

This Daily Mail article from 2012 describes how the use of cocaine can cause heart attacks, and sudden cardiac death.

Medical News Today article

Scholarly articles:

Finkel JB, Marhefka GD. (2011). Rethinking cocaine-associated chest pain and acute coronary syndromes. Mayo Clin Proc. 2011 Dec;86(12):1198-207. doi: 10.4065/mcp.2011.0338.

Schwartz BG, Rezkalla S, Kloner RA. (2010). Cardiovascular effects of cocaine.

Circulation. 2010 Dec 14;122(24):2558-69. doi: 10.1161/CIRCULATIONAHA.110.940569. Review.

Images of Colombia

Posted on February 20, 2013 by K Eckland

While I am back here in the United States, I wanted to share many of the images I’ve gathered and collected during my most recent visit to Colombia.. Some of these images will be familiar to long-term readers from various posts about my trips to Lerida, visits to the finca, and day-to-day encounters with different and interesting people in Colombia.

I hope you enjoy!

People and Places in the nation of Colombia

on a Techo por mi pais building project – in south Bogota

students from the local beauty school, south Bogota

everything gets recycled – these panels are used for roofing

kids playing in South Bogota

Techo family

the finished house

the best model for a novice photographer..

a ranch hand at a working finca outside Bogota

My friend, the photographer, documenting Colombian life

sunset in the mountains above Bogota

one of my favorite models – at a finca

a view of Bogota at night

vacation finca

buying fruit at the side of the road

ruins of Armero, site of volcano tragedy

a vacation finca

in Lerida

street in Lerida

ruins at Armero

in Tolima

training school for police pilots

Church in Mariquita

the bogota castle

Not what I was expecting

working on the mural

Bogota mural artist

Bogota cityscape

a work in progress

a homeless woman rests against a construction barrier of one of the newest Bogota high rises

The Hotel B3 on Carrera 15

lazy Sunday in Usaquen

Usaquen

vintage rides in Usaquen

A girl offering puppies in the park (with parents, not pictured)

German Encino and his wife at one of my favorite casual restaurants

Church in the Valley outside of Bogota

The tram to Monserrate

Panorama of Bogota from Monserrate

enjoying sugar mangos

panela

young man selling lechona in Tolima

Camila

in one of the poorer neighborhoods in Bogota

south Bogota

street art

at the local market

Colombia Civil Defense

man making jewelery

‘Paint the car’ charity event

Happy Anniversary…

Posted on February 10, 2013 by K Eckland

As my long-time readers know – I am a huge fan of Adriaan Alsema, a Dutch-borne journalist in Medellin, Colombia. He is the founder/ creator/ and genius behind Colombia Reports.com – the English language news source for all things Colombiano.

Mr. Alsema, Editor-in-chief, Colombia Reports

It’s the fifth anniversary of Colombia Reports – so I wanted to wish Adriaan a Happy Anniversary..

Know before you go: Medical tourism and patient safety

Posted on January 17, 2013 by K Eckland

The file download for the latest radio program, “Know before you go” with Ilene Little is available. It’s from the Christmas broadcast with Dr. Freddy Sanabria.

Image courtesy of Ilene Little

(I am on the periphery of the show – introducing Dr. Sanabria and talking about safety guidelines and intra-operative safety protocols. (Same stuff I talk about here – just a different medium.)

Dr. Sanabria, plastic surgeon

Dr. Sanabria joined us to talk about his experiences, and his clinic in Bogotá, as well as his ongoing projects and patient safety protocols. It was nice to be able to share some of my observations from my visits to his operating room.

Click here to connect to the Radio show archives

Dr. Alejandro Jadad and Jose Vergara

Posted on January 12, 2013 by K Eckland

Much thanks to Jose Vergara for sending me a link to an article on Dr. Alejandro Jadad. Jose Vergara, aka Frankie Jazz, as some readers may remember, is a Cartagena native and talented artist in his own right.

Frankie Jazz/ Jose Vergara

We try to keep up with each other – so he knows all about my interest in Colombian medicine and surgery, and I love his new album (so I try not to gush and be too much of a groupie when I hear from him) but he recently sent me a link to one of his more recent projects. The Voxxi article by Silvia Casablanca is pretty interesting, so I wanted to share it with readers.

For starters – Jose Vergara is the photographer for the article..

Dr. Alejandro Jadad, MD, PhD

But it’s the life of Dr. Alejandro Jadad that is so inspiring.. Dr. Jadad is a Colombian anesthesiologist, textbook author and founder of the Centre for Global eHealth Innovation in Toronto, Canada (among other things). He has been credited with being one of the major innovators in the fields of clinical research, medicine and information technology.

While at Oxford, as a research fellow in Anesthesiology, he developed a validation tool (the Jadad scale) to critically evaluate and analyze clinical research studies. This is an important tool to distinguish the quality (and value) of individual research studies – or how much weight a study (and its findings) should have. We talk about the importance of objective scales and measures quite a bit here at Bogotá Surgery, and the Jadad scale is one of the best known and most widely used scales for clinical research.

Clinical research is how surgeons know whether a patient has a better chance for survival with surgery or chemotherapy/ radiation, for example.

So as you can imagine – having a tool like this is particularly vital when talking about clinical medicine / or health research where the findings of research studies are used to guide and determine medical decisions – aka the medical treatments for people like in our example above.

As the Casablanca article points out – Dr. Jadad didn’t stop with writing textbooks and creating the Jadad scale. After completing his fellowship in the United Kingdom, he moved to Ontario, Canada to continue his research at McMaster University. Since then, he has continued to innovate and create tools to help both clinicians and the public. One of the ways he helps clinicians is by further creating and refining tools to evaluate medical research.

He has also been a major creator and contributor to the development of internet and computer based applications to connect doctors and their patients. His efforts are based on more that the patient – provider dyad, and are part of a larger, global framework for reforming and transforming healthcare.

More about Dr. Alejandro Jadad, MD, PhD

Casablanca, Silvia (2013, January). Dr. Alejandro Jadad: Redefining health and making it global. Voxxi [on-line article].

(Canadian) Pioneers for Change

“Making Longer Life Worth Living“, lecture by Dr. Jedad at Singularity webblog as part of the ‘Singularity University lecture’ series.

More about Jose Vergara / Frankie Jazz

Frankie Jazz – wikipedia page

Vimeo page

Let Me Take My Way – which is one of my personal favorites…

Techo por mi pais with Team Sanabria

Posted on December 8, 2012 by K Eckland

Just a week ago, I was ankle-deep in mud in the southern-most reaches of Bogotá, with ‘Team Sanabria’ as they completed another house as part of “Techo por mi pais”, which is an organization very similar to Habitat for Humanity.

A couple of weekends each year, they donate their time (and hard labor) to build homes for many of Bogotá’s poorest residents.

It’s arduous work – which is more difficult given the frequent rain and adverse weather conditions in the hills above Bogotá.

I wrote a short story about their efforts over at Examiner.com – but I wasn’t able to include all of the pictures, so I wanted to post some of them here.

Juan Jesus’ grandson stands in the doorway of his modest home

The family they were building the house for on this occasion was exceedingly sweet, gracious – and willing to wade into the muck with the rest of the team.

The organization, is much bigger than just Team Sanabria, so all in all – about fifty houses were built that weekend.

Volunteers carrying supplies to another site

laying foundation for Juan Jesus’ new house

It costs about 1500 dollars to construct one of the basic 3 meter X 6 meter homes.

Here the foundation, and flooring has been completed – and they are getting the walls into place.

Luckily, the rain didn’t start again until most of the walls were completed.

It was an excellent chance to see a side of Bogota that most visitors never to get see – and to meet many of the residents of the neighborhood, so I was very glad they invited me to join them.

a group of beauty school students stop by to check on the progress.

It also gave me a chance to get some other pictures of the neighborhood – of things we don’t often think about when we see or hear about poorer neighborhoods (or slums).

Like the rose bushes that residents plant to brighten and beautify their homes.

well kept home with flowers

Or the full herb garden, Juan Jesus’ neighbor planted (and shared with us) in her immaculately kept and fenced yard.

I think sometimes, the overwhelming poverty makes it hard for outsiders to notice the little spots of beauty in places like this. But it gives me hope – and it shows the resilience of human nature.

I think it’s also important right now, while our own country is hurting too.. With all of the divisions and politics – particularly in the aftermath of the elections, sometimes we forget to put a face on the people who are living in more marginal circumstances – due to unemployment, etc.

We hear so much about fraud, waste and abuse of social programs that we forget about the real people who desperately need these services. Now, I am not some hippie advocating for radical political change.

I am just a nurse, trying to find the people who sometimes get forgotten in the middle of all this.

kids in the barrio