Talking with Dr. Gustavo Gaspar Blanco, plastic surgeon

Posted on September 6, 2013 by K Eckland

Dr. Gustavo Gaspar Blanco, plastic surgeon

Dr. Gustavo Gaspar Blanco is a plastic surgeon in Mexicali (Baja California) Mexico. He is well-known throughout Baja and Northern Mexico for his gluteal augmentation techniques using gluteal implants. While this is one of the procedures he is most famous for, he also performs the complete range of body, facial plastic surgery procedures, and post-bariatric reconstructive surgery.

It was an engaging series of interviews as Dr. Gaspar is extremely knowledgeable and passionate about his craft. “Plastic surgery is different from other specialties, it is an art. The surgeon needs to have an eye for beauty and symmetry in addition to surgical skill.”

To read more about Dr. Gaspar in the operating room.

Gluteal Implants versus Fat Grafting

There are multiple methods of gluteal augmentation (or buttock enhancement). Dr. Gaspar performs both fat grafting and gluteal implantation procedures. He prefers gluteal implantation for patients who are very thin (and have limited fat tissue available for grafting) or for patients who want longer-lasting, more noticeable enhancements. (With all fat injection procedures, a portion of the fat is re-absorbed).

He recommends fat grafting procedures to patients who want a more subtle shaping, particularly as part of a body sculpting plan in conjunction to liposuction.

Breast Implants and attention to detail

Like most plastic surgeons, breast augmentation is one of the more popular procedures among his patients. The vast majority of his patients receive silicone implants (by patient request), and Dr. Gaspar reports improved patient satisfaction with appearance and feel with silicone versus saline implants. He uses Mentor and Natrelle brand implants, and is very familiar with these products. In fact, he reports that he has visited the factories that create breast implants in Ireland and Costa Rica. He says he visited these factories due to his own curiosity and questions about breast implants**.

Once he arrived, he found that each implant is made by a time-consuming one at a time process versus a vast assembly line as he had envisioned. He was able to see the quality of the different types of implants during the manufacturing process. These implants, which range from $800.00 to $1200.00 a piece, go through several stages of preparation before being completed and processed for shipping. He also watched much of the testing process which he found very interesting in light of the history of controversy and concern over previous silicone implant leakage in the United States (during the 1960’s – 1970’s).

Another aspect of breast augmentation that Dr. Gaspar discusses during my visits is the breast implantation technique itself. While there are several techniques, in general, he uses the over-the-muscle technique for the majority of breast implantation procedures. He explains why, and demonstrates with one of his patients (who had the under-the-muscle technique with another surgeon, and now presents for revision).

“While the under-the-muscle technique remains very popular with many surgeons, the results are often less than optimal. Due to the position of the muscle itself, and normal body movements (of the shoulders/ arms), this technique can cause unattractive rippling and dimpling of the breast. In active women, it can actually displace the implant downward from pressure caused by normal muscle movements during daily activities. This may permanently damage, displace or even rupture the implant.”

Instead, he reserves the under-the-muscle implant for specific cases, like post-mastectomy reconstruction. In these patients (particularly after radiation to the chest), the skin around the original mastectomy incision is permanently weakened, so these patients need the additional support of the underlying muscle to prevent further skin damage.

Not just about outcomes

While his clients, from all over North America, are familiar with his plastic surgery results, few of them are aware of his deep commitment to maintaining the highest ethical and medical standards while pursing excellence in surgery.

Commitment to ethical care of patients crosses language barriers

While Dr. Gaspar is primarily Spanish-speaking, his commitment to ethical practice is crystal clear in any language. He explains these ethical principles while offering general guidelines for patients that I will share here (the principles are his, the writing style is my own).

Advice for patients seeking plastic surgery

Be appropriate:

– Patients need to be appropriate candidates for surgery:

Around fifty percent all of the people who walk into the office are not appropriate candidates for plastic surgery, for a variety of reasons. Dr. Gaspar feels very strongly about this saying, “Unnecessary or inappropriate surgery is abusive.”

– Plastic surgery is not a weight-loss procedure. Liposuction/ Abdominoplasty is not a weight loss procedure. Plastic surgery can refine, but not remake the physique. Obese or overweight patients should lose weight prior to considering refining techniques like abdominoplasty which can be used to remove excess or sagging skin after large-scale weight loss.

fat removed during liposuction procedure

– Have surgery for appropriate reasons. Plastic surgery will not make someone love you. It won’t fix troubled relationships, serious depression or illness. Plastic surgery, when approached with realistic expectations (#3) can improve self-esteem and self-confidence.

– Realistic expectations – just as plastic surgery won’t result in a 25 pound weight loss, or bring back a wayward spouse, it can’t turn back the clock completely, or radically remake someone’s appearance. There is a limit to what procedures can do; for the majority people, no amount of surgery is going to make them into supermodels.

– Know the limitations

Not only are there limits to what surgery itself can do, there are limits to the amounts of procedures that people should have, particularly during one session. “Marathon/ Extreme Makeovers” make for exciting television but are a dangerous practice.

Stay Safe:

Just as patients should avoid marathon or multi-hour, multiple procedure surgeries, patients should stay safe.

– Avoid office procedures

As Dr. Gaspar says, “The safest place for patients is in the operating room.” With the exception of Botox, all plastic surgery procedures should be performing the operating room, not the doctor’s office. This is because the operating room is a sterile, well-prepared environment with adequate supplies and support staff. There are monitors to help surgeons detect the development of potential problems, life-saving drugs and resuscitation (rescue) equipment on hand. Should a patient stop breathing, start bleeding or develop a life-threatening allergic reaction (among other things), the operating room (and operating room staff) are well prepared to take care of the patient.

Communicate with your surgeon –

Give your surgeon all the details s/he needs to keep you safe, and have a successful surgery. Talk about more than the surgeries you are interested in –

– bring a list of all of your medications

– know a detailed history including all past medical problems/ conditions and surgeries.

If you had heart surgery ten years ago – that’s relevant, even if you feel fine now. Have a history of previous blood transfusions/ radiation therapy/ medication reactions? Be sure to tell the doctor all about it.

Even if you aren’t sure if it matters, “My sister had a blood clot after liposuction” – go ahead and mention it.. It might just be a critical piece of information such as a family predisposition to thromboembolism (like the example above).

Lastly

Surgical complications are a part of surgery. All surgeons have them – and having a surgical complication in and of itself is no indication of the quality or skill of the surgeon. Complications can occur for a variety of reasons.

However, how efficiently and effectively the surgeon treats that complication is a good indicator of skill, experience and expertise.

As part of this, Dr. Gaspar stresses that medical tourism patients need to prepare to stay until they have reached an adequate stage of recovery. This prevents the development of complications and allows the surgeon to rapidly treat a problem if it develops; before it become more serious.

“There is no set time limit for my patients after surgery, everyone is different. But none of my patients can go [return home] until I give my approval.” This philosophy applies to more than just medical tourists from far off destinations. It also applies to any patients have large procedures and their hospitalizations. While many surgeons race to discharge clients as same-day surgery patients, Dr. Gaspar has no hesitation in keeping a patient hospitalized if he has any concerns regarding their recovery. “Hospitals are the best places for my patients, if I am concerned about their recovery.”

About Dr. Gustavo Gaspar Blanco, MD

Plastic and reconstructive surgeon

Av. Madero 1290 y Calle E

Plaza de Espana, suite 17 (second floor)

Mexicali, B.C

Tele: (686) 552 – 9266

If calling from the USA: 1 (877) 268 4868

Email: gustavo@drgaspar.com

Dr. Gaspar attended medical school at the Universidad Autonoma de Guadalajara. He completed both his general surgery residency and plastic surgery fellowship in Mexico City at the Hospital de Especialidades Centro Medico La Raza.

He is a board certified plastic surgeon by the Mexican Society of Plastic and Reconstructive Surgery, license number #601. He has been performing plastic surgery for over 20 years. Surgeons from areas all over Mexico train with Dr. Gaspar to learn his gluteal implantation techniques.

** He has also visited the facilities in Germany where the Botulism toxin is prepared for cosmetic/ and medical use.

Spending the day with Dr. Gabriel Ramos, Oncology Surgeon

Posted on September 1, 2013 by K Eckland

Spent the day in the operating rooms with one of my favorite Mexican surgeons, Dr. Gabriel Ramos Orozco. Dr. Ramos is an oncology surgeon with offices in Mexicali (Baja California) and his hometown of San Luis Rio del Colorado in Sonora, Mexico.

Dr. Gabriel Ramos Orozco, Oncology Surgeon

In the operating room with Dr. Gabriel Ramos

We spent the day in his hometown – first at the Hospital Santa Margarita, where he performed a laparoscopic cholecystectomy, and then in his offices seeing patients.

In the operating room – photos edited to preserve patient privacy

Hospital Santa Marta

The hospital itself was a small intimate clinic. The operating rooms were small but well-equipped. We were joined by Dr. Campa, an excellent anesthesiologist and another general surgeon. While the anesthesia equipment was dated, all of the equipment was functional. At one point, the sensors for cardiac monitoring and oxymetry readings malfunctioned but within seconds a backup monitor was attached. (This is a frequent occurrence in most hospitals around the world and the USA because the sensors that connect to the patient with gel are cheap disposable and somewhat fragile.)

There were several monitors dedicated to laparoscopy with good display quality. The operating rooms had ample light and functioned well. Overall the clinic was very clean.

The surgery itself proceeded in classic fashion. The patient was positioned appropriately and safely before being prepped and draped in sterile fashion. Since the surgery itself was of short duration, anti-embolic / DVT prophylaxis was not required but was still applied. (Note: in Mexico, these stockings are of limited utility – and for more lengthy procedures, TEDS or electronic squeezing devices are usually applied.)

The surgery itself was under an hour, with no bleeding or other complications. The patient was then transferred to the post-operative care area for monitored recovery from general anesthesia.

Dr. Ramos performs laparoscopic surgery

In the clinic

It was an interesting day – because he sees a diverse mix of patients. As a general surgeon, he also operates for many of the classic indications, so there were several patients who saw Dr. Ramos for post-operative visits after appendectomies, cholecystomies (gallbladder removal) and the like. There was also a mix of patients with more serious conditions like colon, testicular and breast cancers. His patients were a cross section of people, from the United States and Mexico alike.

International patients

Some of these patients came for the lower cost of treatment here in Mexico, but others came due to the dearth of specialty physicians like oncology surgeons in places like Yuma and Las Vegas. Many of these international patients spoke Spanish, or brought translators with them since Dr. Ramos is primarily Spanish speaking.

Since D. Ramos is not well-known outside of Mexico, many of these patients were referred by word-of-mouth, by former patients, friends and family.

Then it was back to the hospital twice to visit his patient post-operative. She was resting comfortably and doing well. It is this level of service that draws patients to his clinic both here and in central Mexicali.

This winter, Dr. Ramos returns to school so to speak – as he will be spending several months in Barcelona, Spain and Colombia learning new techniques such as uni-port laparoscopy. He will then be able to offer these state-of-the-art treatments to his patients back here at home; whether these patients come from northern Mexico or other parts of the globe.

Highly Recommended: Excellent surgeon with well-coordinated team. However, patients requiring more extensive surgery (large tumor surgeries/ cytoreductive surgery) should request Dr. Ramos perform surgery in the larger Mexicali facilities for better access to advanced and specialized support services like hemodialysis etc. for sicker/ higher risk patients.

However, the level of care was appropriate at this facility for this procedure, which is rated as low-risk. (i.e. generally healthy patient, with straight-forward procedure)

Reasons to write about medical tourism: #146, a cautionary tale

Posted on August 15, 2012 by K Eckland

As I mentioned in several previous posts, there are numerous reasons why I write about medical tourism, and protection of the consumer is first and foremost.

Several months ago, I was told an exceedingly disturbing tale of patient abuse at the hands of a plastic surgeon here in Mexicali, MX where I am writing my latest book. I’ve internally debated publishing information about it – not because I think the patient isn’t credible (the patient is exceedingly credible) but due to the lack of verifiable documentation and evidence related to this story. Then again, this is exactly the reason that this American patient was so hesitant to come forward. Ultimately, I feel that by failing to publish this account, I would be further victimizing this patient, and failing to warn consumers of the potential dangers. It is of the utmost regret that I do not have conclusive proof to bring to the authorities (and readers) to prevent this surgeon from ever operating again. This patient isn’t being vindictive, or seeking a payout – it’s the furthest thing from her mind. Her only motivation is the pain, disfigurement and indignities that she has suffered, and a hope of preventing this from happening to another medical tourist.

“I wanted to go to the police, to the medical board, to someone, but how can I prove it?” the patient asks, agonizing over the episode which occurred more than a year ago.

Yet, she is still haunted by it – and the story itself is a harrowing account of abuse of patient trust – and so it should be presented here. Given the lack of verifiable documentation, I have omitted the name of the surgeon involved, but suffice to say, he is a popular surgeon in Mexicali, and one that I have intentionally omitted from my latest book.

The patient, who happens to be a bilingual health care provider came to Mexicali for liposuction and rhinoplasty. While telling the story, she is embarrassed by this – as if her supposed vanity is to blame for what occurred. It is another reason she was reluctant to report it to the police – for fear that she would be told that she deserved it.

Her surgery was botched from the beginning and almost cost her life. A simple cosmetic procedure has profoundly damaged her physically and psychologically. She has scars; both physical and emotional that testify to much of the trauma that occurred.

She presented for surgery that fateful morning with no sense that anything was amiss; the surgeon has an excellent reputation and she had investigated his credentials; he is in fact, a licensed plastic surgeon. Previous patient testimonials were glowing with no hint of any problems.

The first indication there was a problem came with the initiation of the procedure. After being given a mild paralytic, she remained conscious and aware during the procedure. She remembers vividly being intubated by the anesthesiologist who appeared not to notice her distress. “I could hear the heart monitor going crazy but they all ignored it.”

“There were several flashes, and that’s when I realized that the surgeon was taking pictures of me, naked, intubated and helpless.”

She continued, “I know that many plastic surgeons take pictures for before and after photos, but no one ever asked me about it. Also, in most clinics – they take the pictures while the patient is still awake before going into the operating room.”

“I finally lost consciousness and woke up in the recovery room. I sensed right away that something was wrong – I had horrible pain on the left side of my abdomen and chest, and bandages on the left side of my abdomen but nothing on the right, or my face.” [the patient had been scheduled for bilateral liposuction of the abdomen and rhinoplasty.]

Then the PACU nurse delivered devastating news; the procedure had been abandoned mid-way – with the liposuction performed on the left only, because she had gone into respiratory arrest during the procedure. The nurse also whispered confidentially, that she was “lucky” because the surgeon and one of his staff members had been noticeably intoxicated on their arrival to the operating room, and had left immediately before the procedure [presumably] to “do some more cocaine.”

Later, when the anesthesiologist arrived, the patient questioned him gently; about her intubation experience, the abrupt discontinuation of her surgery – and as to what had happened. “Nothing happened”, she was told repeatedly. “Everything went absolutely fine.” When she insisted, asking why her surgery did not match what was initially planned – the anesthesiologist left.

When the surgeon finally arrived, he was equally uncommunicative. In answer to her questions; “Did anything happen during my surgery?” he gave repeated denials and assurances that ‘everything was fine.’ He also denied taking any photographs.

When she asked why, then, did she only have half the procedure completed, he answered, angrily, “because I changed my mind,” before stalking out.

When her family came to help her dress and leave the surgical center, there were even more surprises, a series of rounded, purplish marks on her chest. “My mom asked if they were hickeys, and when I looked in the mirror – that’s exactly what they looked like.” Being familiar with surgery, and medicine, I interrupted to ask if they could be from the electrodes, CPR or anything else. “I don’t know” she answered, “but they sure don’t look like any of the marks I’ve seen on other patients before.”

These marks along with a fateful encounter as she was leaving the clinic are what haunt her to this day. As she was leaving with her family, a young man was chuckling and staring at her as she walked past. She looked over at him, and he started laughing, saying, “I recognize your face, [and your body] from the photos passed around the hospital.” The photos that no one will admit to taking.

Even now – she has evidence of the botched procedure – one side of her abdomen has is lumpy and uneven with furrowed tunnels (an attempt at liposculturing, she thinks). When comparing it to the side that was untreated – she begins to lament the folly of her procedure – and yet again, to blame herself.

“I wish I had never done it. Now I have to see this everyday. I am afraid to ever have surgery again (to fix it).”

At the end of the interview, she is in tears, and she leans over and whispers in my ear: the surgeon’s name.

“I wish I could prove it,” she says. “This should never happen to anyone else.” She states that when she went back to talk to the original nurse (from the recovery room), the nurse was no longer there – so her only collaborating witness is gone. While her family saw the results – they were told the same story she was, that the surgery preceded normally, and that the surgeon ‘changed his mind’ in the middle of surgery. Repeated calls to the surgeon for more information have gone unanswered.

I wish she could prove it too – the ensure that everyone knew the name of this heartless surgeon – to prevent anyone else from becoming a victim. But even without the name, it’s a strong reason for me to continue doing what I do now.

[Readers should note that while this occurred in Mexico – unfortunately events such as this have occurred around the world. In the 1990’s there was a widespread scandal as a notable plastic surgeon attempted to sell photos to a tabloid of Michael Jackson, Liz Taylor (among others) that were taken without their knowledge during plastic surgery procedures.]

Update: There is a new scandal at John Hopkins in the wake of the February suicide of one of their popular OB/GYNs who is believed to have taken pictures of his patients secretly, using a mini – camera hidden in a pen.

“Likely Suicide of Johns Hopkins Ob/Gyn Tied to Secret Photos” article by Robert Lowes, Medscape, February 2013.

Meet Lupita Dominguez, surgical nurse

Posted on July 5, 2012 by K Eckland

Had an amazing day yesterday – one of those days that reminds you how much we can do in medicine when we all work together. I am hoping to write it up as a case study – if not – I will tell you more about it here. (The patient was exceedingly gracious when I asked permission.)

But this morning, I was back in the operating room with Dr. Cuauhtemoc Vasquez. (If he is tired of me – he sure doesn’t let on..)

I finally had the opportunity to get some of the pictures I’ve been trying to get on every visit to his OR – to show readers the heart, and the pulse of cardiac surgery..

There’s a running joke in Mexicali – if you need help in the operating room, any operating room, in any of the hospitals in the city; just holler for Lupita because she’s always there.

Introducing Lupita Dominguez, surgical nurse

All kidding aside on the popularity of the name “Lupita” among operating room personnel, there is just one Lupita that I would like to talk about today, Lupita Dominguez, who is Dr. Vasquez’s surgical nurse. In the months, and the numerous occasions that I have been a guest in Dr. Vasquez’s operating room, I’ve had the opportunity to observe and appreciate the hard-working Lupita.

Lupita Dominguez with Dr. Vasquez

Teacher, Coordinator and Mind-Reader

Most people don’t know it – but Lupita has the hardest job in the operating room, and probably (in Mexico) the most poorly paid. They say a good scrub nurse has the instrument in the surgeon’s hand before he knows he needs it – and from what I’ve seen, that’s Lupita. She’s here an hour earlier than the rest of the surgical team, getting everything ready, and she’ll be here after everyone else escorts the patient to the intensive care unit.

Here she is, a blur of motion as she takes care of everyone at the operating room table

As I watch again today, she is ‘running the table’ and anticipating the needs of not just one demanding cardiac surgeon, and an additional surgeon, but also one surgical intern, and another student. With all of these people crowded at the table, she still has to follow the surgery, anticipate everyone’s needs and keep track of all the instruments and supplies in use. In the midst of this maelström, the scrub nurse has to ensure that everyone else maintains sterility while preventing surgical instruments from being knocked to the floor, or otherwise misplaced (a difficult task at times).

Here she is demonstrating how to correctly load the needle, and pass sharp instruments

She’s forever in motion which has made taking the few photos of her a difficult endeavor; She’s shaving ice for cardioplegia, while listening to the circulator, adjusting the OR lights, and gently guiding the apprentices. She’s so gentle in her teaching methods that the student doesn’t even realize she’s being led, and relaxes enough to learn. This is no easy task, particularly since it’s just the beginning of the July, and while bright-eyed, pleasant and enthusiastic, the new surgical resident is inexperienced. Her own student nurse, is two parts shy, but helpful enough that near the end of the case, (and the first time since I’ve known her), Lupita actually stops for a moment and flashes me a wave when she sees the camera faced in her direction. I’m surprised, but I manage to capture it.

a very rare moment – Lupita takes a millisecond to say hello

She is endlessly busy, but ever uncomplaining – even when a scheduled surgery takes an unexpected turn and extends to twelve or even fourteen hours. Bladder straining perhaps, baby-sitter calling, but Lupita never complains. She’s not unique in that – scrub nurses around the world endure long hours, tired feet and legs, hungry bellies, full bladders, and aching backs as they complete their days in the operating room. But she does it with good nature and grace.

Lupita assisting Dr. Vasquez during surgery

The surgical nurse

In the United States, this important job has been lost to nursing, a casualty of the ongoing shortage. Positions such as scrub nurse and others like it have been frequently replaced with technicians who require less training and thus, less compensation that nurses. Maybe the nursing profession doesn’t mourn the loss; but I do.

as you can see – here she is, ‘behind the scenes’ so to speak..

But in Mexico, and many other locations, this position remains the exclusive domain of the nurse. Nurses such as Lupita, spend three years studying general nursing in college, before completing an (optional) additional year of training for a specialty such as the operating room. After completing this training, these nurses spend yet another year in public service.

The idea of the public service requirement is honorable yet almost ironic (to me) at times, since the majority of nurses in Mexico will spent their careers in public facilities, and by definition (in my mind at least), nursing is an occupation almost entirely devoted to the service and care of others.

Working conditions vary but some constants

Depending on the country, the culture, and the facility; conditions may vary; nurses may get short breaks, or be relieved during particularly long cases. The only constant is the cold, and the hard floors, and rickety stepstools[1]. While the nurses here tell me that the workday is only seven hours long – I’ve been in the operating room with these ladies before, and watched a supposed ‘seven-hour’ day stretch to fifteen. But it is just part of being a nurse.

[Usually I tell people when I am writing about them – but on this instance – there was never an opportunity.. but she (and all the nurses in the OR with Dr. Vasquez) certainly deserve mention.]

[1] Temperatures are set lower in cardiac surgery rooms. Why the stepstools always seem rickety, I have no idea.

Dr. Marco Sarinana and Dr. Joel Ramos,Bariatric surgeons

Posted on July 3, 2012 by K Eckland

Busy day yesterday – spent the morning shift with Jose Luis Barron over at Mexicali General.. Then raced over to Hospital de la Familia for a couple of general and bariatric cases.

The first case was with the ever charming Drs. Horatio Ham, and Rafael Abril (who we’ve talked about before.) with the always competent Dr. Campa as the anesthesiologist. (Seriously – Dr. Campa always does an excellent job.)

Then as we prepared to enter the second case – the director of the hospital asked if I would like to meet Dr. Marco Sarinana G. and his partner, Dr. Joel Ramos.. well, of course.. (Dr. Sarinana’s name has a tilde over the first n – but try coaxing that out this antique keyboard..)

So off to the operating room with these three fellows. (This isn’t my usual protocol for interviewing surgeons, etc. but sometimes it works out this way.) Their practice is called Mexicali Obesity Solutions.

Dr. Marco Sarinana and Dr. Joel Ramos, Bariatric surgeons

Dr. Alejandro Ballesteros was the anesthesiologist for the case – and everything proceeded nicely.

After that – it was evening, and time to write everything down!

Today should be another great day – heading to IMSS with Dr. Gabriel Ramos for a big case..

Wrapping up and saying “Thanks!”

Posted on July 1, 2012 by K Eckland

It’s a busy Sunday in Mexicali – presidential elections are today, so I am going to try to get some pictures of the nearest polling station later.. In the meantime, I am spending the day catching up on my writing..

a polling station in Mexicali

Lots to write about – just haven’t had the time.. Friday morning was the intern graduation which marks the end of their intern year – as they advance in their residencies.. Didn’t get a lot of pictures since I was at the back of the room, and frankly, unwilling to butt ahead of proud parents to get good pics.. This was their day, not mine and I was pleased that I was invited.

I did get a couple of good pictures of my ‘hermanito’ Lalo and Gloria after the event. (I’ve adopted Lalo as my ‘kid’ brother.. Not sure how he feels about – but he’s pretty easy-going so he probably just thinks it’s a silly gringa thing, and probably it is..)

Dr. ‘Lalo” Gutierrez with his parents

Lalo’s parents were sitting in the row ahead of me, so of course, I introduced myself and said hello.. (They were probably a little bewildered by this middle-aged gringa talking about their son in atrocious Spanish) but I figured they might be curious about the same gringa that posts pictures of Lalo on the internet.. I also feel that it’s important to take time and tell people the ‘good things’ in life. (Like what a great person their son has turned out to be..)

Same thing for Gloria.. She is such a hard-worker, and yet, always willing to help out.. “Gloria can you help me walk this patient?” It’s not even her patient, (and a lot of people would say – it’s not our jobs to walk patients) but the patient needs to get out of bed – I am here, and I need some help (with IV poles, pleurovacs, etc.) and Gloria never hesitates.. that to me – is the hallmark of an excellent provider, that the patient comes first .. She still has several years to go, but I have confidence in her.

She throws herself into her rotations.. When she was on thoracics, she wanted to learn.. and she didn’t mind learning from a nurse (which is HUGE here, in my experience.)

Dr. Gloria Ayala (right) and her mother

She wasn’t sure that her mom would be able to be there – (she works long hours as a cook for a baseball team) but luckily she made it!

Met a pediatric cardiologist and his wife, a pediatrician.. Amazing because the first thing they said is, “We want nurse practitioners in our NICU,” so maybe NPs in Mexico will become a reality.. Heard there is an NP from San Francisco over at Hospital Hispano Americano but haven’t had the pleasure of meeting her. (I’d love to exchange notes with her.)

I spent the remainder of the day in the operating room of Dr. Ernesto Romero Fonseca, an orthopedic surgeon specializing in trauma. I don’t know what it is about Orthopedics, but the docs are always so “laid back”, and just so darn pleasant to be around. Dr. Romero and his resident are no exception.

[“Laid back” is probably the wrong term – there is nothing casual about his approach to surgery but I haven’t had my second cup of coffee yet, so my vocabulary is a bit limited.. ] Once I finish editing ‘patient bits’ I’ll post a photo..

Then it was off to clinic with the Professor.

Saturday, I spent the day in the operating room with Dr. Vasquez at Hospital de la Familia. He teased me about the colors of the surgical drapes,(green at Hospital de la Familia), so I guess he liked my article about the impact of color on medical photography. (Though, truthfully, I take photos of surgeons, not operations..)

Since the NYT article* came out a few days ago – things have changed here in Mexicali. People don’t seem to think the book is such a far-fetched idea anymore. I’m hopeful this means I’ll get more response from some of the doctors. (Right now, for every 15 I contact – I might get two replies, and one interview..)

Planning for my last day with the Professor – makes me sad because I’ve had such a great time, (and learned a tremendous amount) but it has been wonderful. Besides, I will be starting classes soon – and will be moving to my next location (and another great professor.)

Professor Ochoa and Dr. Vasquez

But I do have to say – that he has been a great professor, and I think, a good friend. He let me steer my education at times (hey – can I learn more about X..) but always kept me studying, reading and writing. He took time away from his regular life, and his other duties as a professor of other students (residents, interns etc.) to read my assignments, make suggestions and corrections when necessary. and lastly, he tolerated a lot with good grace and humor. Atrocious Spanish, (probably) some outlandish ideas and attitudes about patient care (I am a nurse, after all), a lot of chatter (one of my patient care things), endless questions… especially, “donde estas?” when I was lost – again.

So as I wrap up my studies to spend the last few weeks concentrating on the book, and getting the last interviews, I want to thank Dr. Carlos Ochoa for his endless patience, and for giving me this opportunity. I also want to thank all the interns (now residents) for welcoming me on rounds, the great doctors at Hospital General.. Thanks to Dr. Ivan for always welcoming me to the ER, and Dr. Joanna for welcoming me to her hospital. All these people didn’t have to be so nice – but they were, and I appreciate it.

* Not my article [ I wish it were – since I have a lot to say on the topic].

Saturday in Mexicali

Posted on June 17, 2012 by K Eckland

After all our serious discussions about TAVI this week, we’ve moved on to some more casual topics.. It’s a sunny, quiet Saturday in Mexicali – so we spent the day enjoying some of what the city has to offer..

First we stopped by the Betty diner for lunch – a Betty Boop themed 50’s diner that we stumbled across the other day.

Betty Diner

Av. Honduras #123

Esq. on Bogotá

Col. Cuauhtemoc Sur

Mexicali, B.C

(near the Plazita)

Open 8am to 9am – closed Mondays..

Betty Boop restaurant

I’m not usually a ‘food poster’ – so I don’t usually post pictures of food – but since we are talking about a restaurant, I’ll break some of (my) rules.. It’s a casual place – with a mix of Mexican and American style food.

with the requisite chips and salsa..

The owner, Francisco Padillo was there – and he was very nice, along with all of the servers. I made my husband order his meal in his (worse than mine) remedial Spanish. He also paid in dollars – with no eye rolls and/or sighs from the staff..

the smiling staff at the Betty diner

All and all – it was a nice lunch.

Since, I was acting like a preadolescent girl, my husband (continued to) indulge me – and we headed over the Hello Kitty store just down the street – in the Plazita..

The Hello Kitty store

(Really – who can resist Hello Kitty! – she’s just so darn cute!)

After that – we were off to do some of our regular errands..

Spending the weekend with Dr. Vasquez, and medical photography

Posted on June 10, 2012 by K Eckland

For internet searches for medical photography – all of my images are free for your use, but please give proper credit for my work, ie. “Photo by K. Eckland”. For commercial uses, contact me, (so that I can contact the subjects of my work).

Please note that patient privacy is protected – and patient permission is obtained prior to photographs. For the most part – I photograph surgeons – not patients, or surgery.

Spent much of the weekend in the operating room with Dr. C. Vasquez, cardiac surgeon at two different facilities, and the differences couldn’t be more apparent – and perhaps not what one might expect. Much of it comes from perspective; as a person behind the lens, I see the scene differently than others might.

harvesting the radial artery

In fact, this prompted me to write an article on the subject of medical photography, complete with a slide show to illustrate the effects of color on surgical photographs. I’ve also re-posted much of the article here (see below). Once you see the photos from today, you’ll understand the article.

the beige operating room

The case today went beautifully, with the patient extubated in the operating room.

Dr. Vasquez, and Lupita, scrub nurse

While we were there – had an unexpected surprise! Dr. Gutierrez ‘Lalo’ showed up. I have been trying to get him into the cardiac OR since he confessed his interest in cardiac surgery. It was great to see him – and I like encouraging him in his educational goals. (I kind of miss being a mentor, and preceptor to students..)

Lalo peeks over the curtain..

Dr. Gutierrez (Lalo) in the cardiac OR

Medical Photography

Medical photography is many ways is more art, and luck that skill – at least for people like me who never set out to be medical photographers in the first place. It was a natural development prompted by dire necessity during the early days of interviewing surgeons and medical writing. I am still learning, and hopefully improving.

But as I said before, much of it is luck, and timing, particularly in this field, where the subjects are always in motion and a slight movement of the hand tying the suture knot can result in either a breath-taking shot or an utter failure to capture the moment.

The most dramatic and vivid photographs often come at mundane moments, or unexpected situations. In medical photography, where the subject matter combines with a dramatic interplay of color, light and shadow to illustrate some of life’s most pivotal moments such as birth, death and life-saving operations – it is surprising how important the background elements are.

Here in Mexicali, I have been taking photographs of different surgeons for several weeks at different facilities across the city. But, almost unanimously, all of the photographs, regardless of subject at Hospital Almater are lackluster and uninspiring. Contrast this with the glorious photos from the public facilities such as Hospital General de Mexicali, and Issstecali.

The culprit is immediately apparent, and it demonstrates how such carefully planned such as aesthetics and interior design can have unintended consequences. The very studied, casual beigeness used to communicate upscale living in the more public parts of the hospital are destroying the esthetics of the operating room services they are selling. Whereas, the older facilities, which have continued the use of traditional colored drapes and materials do not have the problem.

Historically, surgical drapes were green for a very specific reason. As the complementary color to red, it was believed to be a method of combating eye fatigue for surgeons looking at the red, bloody surgical fields for hours at a time. Over the years, operating room apparel and drapes evolved away from this soft green to a more vivid blue, know as ‘ceil’. The reasons for this change are probably more related to manufacturing that medicine, and since that evolution, surgical drapes now come in a variety of colors – hence the color matching here, of the paint, the tile, the patients, the operating room and the surgeons itself. Somewhere, an interior decorator is filled with gleeful satisfaction – but I can only muster up a groan; knowing I will be here again and that most of my photos will be unusable.

While the consequences of poor medical photographs may seem trivial to anyone but myself (and my interviewees) at this junction – it runs far deeper than that. With the advent of the internet, and the complicated legalities of getty and other corporate images, small, independent photographers such as myself are gaining wider exposure than ever before. Alas! – much of it is uncredited, but several of my more popular images are downloaded thousands of times per week, to grace slideshows, powerpoint presentations and other illustrations for discussions of anything from medicine and surgery to travel, technology and even risk assessment. In an era of branding, and logo recognition, places like Hospital Almater are certainly missing out.

In other news/ happenings: Upcoming elections!**

Finally found someone to talk to and explain some of the issues in Mexican politics – but he hates Quadri, and doesn’t really explain any of it except to say ‘He’s corrupt..” (From my understanding, ‘corrupt’ is an understatement, and that all of the parties are corrupt – and it’s pretty well understood by everyone involved – so of course, if I hear something like that – please explain.. explain..) It’s not like I am capable of voting anyway, but I’d sure like to hear perspectives..

It looks like I’m not the only one who is a little leary of pretty boy pena’s party’s dubious history. His numbers have fallen in recent polls in advance of tonight’s televised debates. (Let’s hope these debates are better than the last.)

My personal “favorite”, Quadri is still trailing in the dust, but it looks like Lopez has a chance to take the election from Pena (much like it was ‘taken’ from him in 2006 with his narrow defeat.. Lopez is a socialist which is hard for Americans like me to understand – but then again, it’s not my country, and the levels of inequity here are certainly wider than at home – so maybe someone like Lopez can bring some much needed support to the lower classes.

I mean, a lot of what we take for granted in the USA doesn’t exist here, like a decent free public school education. (Okay – I know critics will argue about the value of an inner city education – but we still provide a free elementary & secondary school education to all our citizens.) So socialism for the purpose of providing basic services in all areas of Mexico seems pretty reasonable. (It would help if I could read some primary source stuff – without using translation software, so I would have a better idea of the specifics of AMLO’s ideas.)

I did ask my friend about the student demonstrations for Yo Soy 132. I guess as an American growing up after the 1960’s – we tend to not too make much of a big deal over student demonstrators – after all – we have the ‘Occupy’ movements going on right now in our own/ other countries – but he was telling me that this is pretty uncommon in Mexico.

** No, I’m not really into politics but I feel like it’s important to try and understand as much as possible about the places (countries) where I am residing.

Mexico on my mind….and the city by the fence

Posted on May 26, 2012 by K Eckland

Actually, it is on my mind quite a bit these days, as you can imagine. But that’s also the title of the new website where I will be contributing to articles about life, and health care in Mexicali. It’s a website designed for Americans and other extranjeros living in Mexico, so I thought it was the perfect place for some of my articles on medical emergencies and medical services.

I think that if you are an ex-pat living in a different country/ culture/ etc. even if you’ve been here for a while – if you become ill, it’s a little more frightening and confusing than it might be in your old hometown. So, hopefully the addition of a fellow gringa to help navigate the system, so to speak, is more comforting and helpful to readers..

Of course, many of the readers of the site are living in different areas of the country, so this is also a chance for me to speak up and promote Mexicali – and after being here for a couple of months – I really think that Mexicali is often judged harshly.

Sure, I don’t want it to become the next Cabo San Lucas – where Spanish is drowned out by drunken teenagers hollering, puking and carrying on in English, and Mexican culture has been submerged beneath a sea of tacky shops, Starbucks, and the homogenous effect of chain restaurants and fast food. But I also think that when people skip over Mexicali, they are missing a chance to see an interesting side of Mexico – a side that is often downplayed to tourists unless you are heading to Mexico City.

But first – let’s be sure to say what Mexicali isn’t. It isn’t a quaint seaside resort, or charming village. It also isn’t a crime-infested border city, as we’ve talked about before.

If you are looking for cute, charming and rural – this isn’t the place for you.

But that’s not to say that Mexicali is without its own considerable charms. It is first and foremost – a city of industry. While this contributes to wide areas of industrial blight (factories and their by-products aren’t particularly attractive) – it also means that there is a significant sector of skilled labor and a higher overall standard of living. Some of this industry is medical, but much of it is more traditional – factories and companies who came here to take advantage of NAFTA. Frito-Lay is here, Modelo brewing is here, as well as several juice distributors and machineries. But there is also Intuitive Surgical – the makers of the DaVinci Robot, a two million dollar piece of extremely sophisticated medical technology.

street art in Mexicali

It is also the capital of Baja California, so there is a large contingent of government offices here too, along with the Universities and educational facilities of higher learning.

But most importantly, it is a city of people. These people are the true heart of ‘Mexican culture’, in a very real sense. I am fortunate that as a student, in my daily activities – I get to encounter these people on a day-to-day basis – and the people of Mexicali have proven to be as friendly and welcoming as any city I’ve ever lived. Despite the close proximity to the border, this is the real Mexico – and it hasn’t been diluted. Spanish remains predominant, and real working class citizens populate the streets and buildings as opposed to the more touristy destinations where everything has been ‘Americanized’ for our comfort.

Want to learn Spanish? Then come here. You will get to practice every day. People will help you, correct your grammar, offer you the occasional missing word – and they do it with patience and a smile, but they will expect you to speak Spanish all the same.

The charm is here – on the quiet, upscale streets in the different barrios of the city, in the music emanating from well-kept homes, in the kitchens of mom and pop restaurants serving native dishes, and in the way that residents still welcome outsiders like myself.

They have pride in their city, their way of life and take pains to encourage me to sample it – pieces of their culture, whether as part of traditional festivities for a national holiday, or a bite of food from a street vendor or even just directions to the best [blank] in town.

an art museum in Mexicali

It also has its own identity, distinct from larger Mexico. Some of this comes from dealing with the heat – 120 degree days in the summer are not uncommon – on these dry, sun-baked and parched streets.. Some of it comes from the unique make-up of this city – which boasts a shared heritage with a large Chinese community who fled the states after building the railroads. So, yeah – they probably have the best Chinese food in Mexico too.

So hopefully, as I write about the doctors, and hospitals of Mexicali, visitors to the city will see the other charms that make me appreciate this place a little more every day.

Mexicali book update

Posted on May 8, 2012 by K Eckland

The service is quiet so I am spending the day writing and working on the Mexicali book. For new readers, I would like to explain that the Mexicali book is a little different from my previous offerings. This is not an exhaustive compilation of surgeons and facilities in Mexicali, as frankly, I do not have the time or resources to accomplish such a task at this point in time.

Like all my books, it is a labor of love, but differs in that it highlights some of the best, and worst of Mexicali and medical tourism in this city. So instead of interviewing and observing hundreds of surgeons, it highlights the limited number of physicians who agreed to participate in this project.

As such, no plans are being made to market this book commercially. Instead, I plan to offer it as a free pdf download for interested readers. I will also be offering a full color soft-bound edition (at cost) for people interested in the many full color photographs of surgeons and surgery in Mexicali. I will be placing the soft-bound edition on Amazon.com for interested persons. Unfortunately, the cost of producing such a book (color photos) in limited runs is fairly expensive, so I apologize in advance to readers – but as I said – it’s a labor of love, and I won’t make a dime off of it. I can only hope that if readers enjoy this book, they will consider purchasing one of my longer, more detailed books on medical tourism (such as the Bogotá book.)

More information will be forthcoming as I get further and further towards completion of this project.

New series of articles

Posted on May 5, 2012 by K Eckland

I’ll be writing a new series of articles for the Examiner.com based on my experiences, interviews and observations here in Mexicali, MX and Calexico, California. While the focus will be on serving the needs of the Calexico community (particularly now that there is a fast pass lane for medical travelers), I hope that all of my loyal readers will continue to support my work.

I have already published my first three articles – and have added a new navigation section (on the side of this blog) for interested readers.

As part of this, I wrote a story about the good doctor and all of the work he is doing – including one of our recent ‘house calls’ to San Luis, in Sonora, Mexico. It was probably one of the more difficult articles to write; due to space limitations and trying to present information in an objective fashion. (It’s hard to present all the evidence to support your conclusions in just a few hundred words; ie. He’s a good doctor because he does X, Y, and Z and follows H protocol according the P.” Makes for wordy reading and not really what the Examiner is looking for.

Too bad, since readers over at Examiner.com haven’t had the chance to know that if the opposite is true (a less than stellar physician or treatment – that I have absolutely no reservations about presenting the evidence and stating the facts about that either..)

Don’t worry, though – I will continue to provide that level of detail here at Cartagena Surgery – where the only limitations are my ability to type, and the (sometimes) faulty keys of my aging laptop.

The ‘Art of Medicine’ with Dr. Jose Mayagoitia Witron, MD, FACS

Posted on May 2, 2012 by K Eckland

I should be finishing my readings in preparation for clinic this afternoon, but after reading most of the day yesterday (it was an international holiday for people living outside the USA), I guess I am entitled to spend some time writing.

Besides, I spent an illuminating morning with Dr. Jose Mayagoitia Witron, MD, FACS over at Mexicali General Hospital. While he was telling me what he doesn’t do: (no uniport laparoscopic surgery, and not a huge amount of bariatric surgery), what I observed told a very different story.

Dr. Mayagoitia, MD, FACS

I didn’t follow Dr. Mayagoitia to the operating room. Instead – I accompanied him to a teaching session with his medical students, who presented case studies – and I observed Dr. Mayagoitia instructing his students in the ‘Art of Medicine’. This skill is fast becoming a lost one in today’s emphasis on the science of diagnostics, and laboratory testing. But not here, not today – and not with Dr. Mayagoitia.

He believes strongly in the physical examination and all of the wealth of information that it provides. He also believes it is an underutilized tool to connect doctors with their patients. As he explains, too often doctors become too busy ordering tests – which separates the doctors from their patients – instead of listening to ‘the person in the bed’. (My terminology not his). So during his students case presentations – the emphasis is on the story (the clinical history), the patient’s life (background, social settings, diet, habits) and the clinical physical examination. Students aren’t allowed to talk about, or ask questions about diagnostic results such as radiographs or serum analysis until the story and the physical findings have been throughly discussed and examined in detail.

Even then – he challenges them – to use more than their eyes – to engage their brains, and their other senses.. “What about the description of this surgical scar? Does it seem a little large for an appendectomy?” he asks.. “What about it’s location?’ he challenges**..

“What about the differentials? What other diagnoses should we consider? he asks. “I know you think the diagnosis is obvious – but give me some alternatives,” he coaxes. “What else could be going on? Tell me why you don’t think that it’s X” he asks – making the students review and explore the other possible causes for this patient’s abdominal pain. “Could it be Z?” he asks.. “Why not? What else would we see?” he states in reply to a student’s mumbled answer..

Then, only then, do we review the labs, and the films – the more tangible aspects of the practice of medicine. Those results that students can see easily, (maybe too easily) and tempt them into abandoning the ‘art’ of medicine and patient care. But he doesn’t allow it – and quickly steers the conversation back to the displayed pathology to this pathophysiology and symptomatology of the patient in question.

As someone who still struggles with the physical skill of percussion – this entry into the art of medicine hits home. It is an art, and a woefully underappreciated one.

** Please note – these quotes are my best approximation from my translations during the case presentation, and may miss nuances.

About Dr. Jose Mayagoitia Witron

Dr. Mayagoitia is more than a clinical instructor – he is a respected professor of surgery at the Universidad Autonoma Baja California (UABC) and has been teaching medical students for over 20 years. He also teaches surgical residents and has been doing so for over fifteen years. He gives lectures daily at the University, in addition to his busy schedule as the Supervising Surgeon for the Intensive Care Unit at Mexicali General, and private surgical practice (with evening clinic hours).

He speaks in clear, unaccented English (my southern accent is thicker than any accent he might possess) which may be as a result of his fellowship training in San Diego. He completed his general surgery residency right here at Mexicali General after attending UABC).

He remains active in the research community as a supervisor for resident research projects including two ongoing projects worthy of note: a new study looking at the treatment of open abdomens, (from massive trauma, infection, etc.) and a study looking at the early initiation of enteral feedings versus delayed (72 hours or greater) in surgical intensive care patients.

He, along with his wife, Gisela Ponce y Ponce de León, MD, PhD (a family medicine physician and instructor at the UABC nursing school) recently presented a paper on obesity research in Barcelona, Spain.

He does all of this in addition to a steady diet of general surgery (cholecystectomies, appendectomies, bowel surgery (such as resections) and the occasional bariatric surgery. As one of the lead surgeons at a major trauma hospital** – he also sees a considerable amount of emergency and trauma cases.

He reports that on the last – bariatric surgery, he has mixed feelings. While it has become a popular staple for the treatment of obesity and obesity-related complications – he questions it’s role in a society that steadfastedly ignores the causes. “I wonder if we will look back one day and realize that we [surgery] did a real disservice to our patients by doing so much of this.” So, while he does perform some bariatric procedures, he is very selective in his patients. “It’s not a quick -fix, and they are going to be dealing with this [changes from bariatric surgery] for the rest of their lives so they [patients] need to understand that it’s a lifelong endeavor.” When he does perform bariatric procedures, he prefers the gastric sleeve, which he believes is more effective [than lap-band, and smaller procedures] but less devastating in terms of complications and dramatic life alterations.

Dr. Jose Mayagoitia Witron, MD, FACS

General surgeon, Fellow in the American College of Surgeons

Edificio Azahares

Av. Reforma 1061 – 6

Mexicali, B. C.

Tele: 686 552 2400

** He reports that Mexicali General, as a public facility, sees about 80% of all traumas in the area.

Blue Cross/ Blue Shield of Mexicali & Dr. Cuauhtemoc Vasquez Jimenez

Posted on May 1, 2012 by K Eckland

Note: I owe Dr. Vasquez a much more detailed article – which I am currently writing – but after our intellectually stimulating talk the other day, my mind headed off in it’s own direction..

Had a great sit down lunch and a fascinating talk with Dr. Vasquez. As per usual – our discussion was lively, (a bit more lively than usual) which really got my gears turning. Dr. Vasquez is a talented surgeon – but he could be even better with just a little ‘help’. No – I am not trying to sell him a nurse practitioner – instead I am trying to sell Mexicali, and a comprehensive cardiac surgery program to the communities on both sides of the border.. Mexicali really could be the ‘land of opportunity’ for medical care – if motivated people and corporations got involved.

During lunch, Dr. Vasquez was explaining that there is no real ‘heart hospital’ or cardiac surgery program, per se in Mexicali – he just operates where ever his patients prefer. In the past that has included Mexicali General, Issstecali (the public hospitals) as well as the tiny but more upscale private facilities such as Hospital Alamater, and Hospital de la Familia..

Not such a big deal if you are a plastic surgeon doing a nip/tuck here and there, or some outpatient procedures – okay even for general surgeons – hernia repairs and such – but less than ideal for a cardiac surgeon – who is less of a ‘lone wolf’ due to the nature and scale of cardiac surgery procedures..

Cardiac surgery differs from other specialties in its reliance on a cohesive, well-trained and experienced group – not one surgeon – but a whole team of people to look out for the patients; Before, During & After surgery.. That team approach [which includes perfusionists, cardiac anesthesiologists (more specialized than regular anesthesia), operating room personnel, cardiology interventionalists and specialty training cardiac surgery intensive care nurses] is not easily transported from facility to facility.

just a couple members of the cardiac surgery team

That’s just the people involved; it doesn’t even touch on all the specialty equipment; such as the bypass pump itself, echocardiogram equipment, Impella/ IABP (intra-aortic balloon pump), ECMO or other equipment for the critically ill – or even just the infrastructure needed to support a heart team – like a pharmacy division that knows that ‘right now’ in the cardiac OR means five minutes ago, or a blood bank with an adequate stock of platelets, FFP and a wide range of other blood products..

We haven’t even gotten into such things such as a hydrid operating rooms and 24/7 caths labs – all the things you need for urgent/ emergent cases, endovascular interventions – things a city the size of Mexicali should really have..

But all of those things take money – and commitment, and I’m just not sure that the city of Mexicali is ready to commit to supporting Dr. Vasquez (and the 20 – something cases he’s done this year..) It also takes vision..

This is where a company/ corporation could come in and really change things – not just for Dr. Vasquez – and Mexicali – but for California..

It came to me again while I was in the operating room with Dr. Vasquez – watching him do what he does best – which is sometimes when I do what I do best.. (I have some of my best ideas in the operating room – where I tend to be a bit quieter.. More thinking, less talking)..

Dr. Vasquez, doing what he does best..

As I am watching Dr. Vasquez – I starting thinking about all the different cardiac surgery programs I’ve been to: visited, worked in – trained in.. About half of these programs were small – several were tiny, single surgeon programs a lot like his.. (You only need one great surgeon.. It’s all the other niceties that make or break a program..)

All of the American programs had the advantages of all the equipment / specialty trained staff that money could buy***

[I know what you are thinking – “well – but isn’t it all of these ‘niceties’ that make everything cost so darn much?” No – actually it’s not – which is how the Cardioinfantils, and Santa Fe de Bogotas can still make a profit offering world-class services at Colombian prices…]

The cost of American programs are inflated due to the cost of defensive medicine practices (and lawyers), and the costs of medications/ equipment in the United States****

the possibilities are endless – when I spend quality time in the operating room (thinking!)

Well – there is plenty of money in Calexico, California** and not a hospital in sight – just a one room ‘urgent care center’. The closest facility is in El Centro, California – and while it boasts a daVinci robot, and a (part-time?) heart surgeon (based out of La Mesa, California – 100 + miles away)– patients usually end up being transferred to San Diego for surgery.

Of course, in addition to all of the distance – there is also all of the expense.. So what’s a hard-working, blue-collar guy from Calexico with severe CAD going to do? It seems the easiest and most logical thing – would be to walk/ drive/ head across the street to Mexicali.. (If only Kaiser Permanente or Blue Cross California would step up and spearhead this project – we could have the best of both worlds – for residents of both cities..

A fully staffed, well-funded, well-designed, cohesive heart program in ONE medium- sized Mexicali facility – without the exorbitant costs of an American program (from defensive medicine practices, and outlandish American salaries.) Not only that – but as a side benefit, there are NO drug shortages here..

How many ‘cross-border’ cases would it take to bring a profit to the investors? I don’t know – but I’m sure once word got out – people would come from all over Southern California and Arizona – as well as Mexicali, other parts of Baja, and even places in Sonora like San Luis – which is closer to Mexicali than Hermasillo.. Then Dr. Vasquez could continue to do what he does so well – operate – but on a larger scale, without worrying about resources, or having to bring a suitcase full of equipment to the OR.

The Mexican – American International Cardiac Health Initiative?

But then – this article isn’t really about the ‘Mexican- American cross-border cardiac health initiative’ –

It is about a young, kind cardiac surgeon – with a vision of his own.

That vision brought Dr. Vasquez from his home in Guadalajara (the second largest city in Mexico) to one of my favorite places, Mexicali after graduating from the Universidad Autonomica in Guadalajara, and completing much of his training in Mexico (D.F.). After finishing his training – Dr. Vasquez was more than ready to take on the world – and Mexicali as it’s first full-time cardiac surgeon.

Mexicali’s finest: Dr. Vasquez, (cardiac surgeon) Dr. Campa(anesthesia) and Dr. Ochoa (thoracic surgeon

Since arriving here almost two years ago – that’s exactly what he’s done.. Little by little, and case by case – he has begun building his practice; doing a wide range of cardiovascular procedures including coronary bypass surgery (CABG), valve replacement procedures, repair of the great vessels (aneurysm/ dissections), congenital repairs, and pulmonary thrombolectomies..

Dr. Vasquez, Mexicali’s cardiac surgeon

Dr. Cuauhtemoc Vasquez Jimenez, MD

Cardiac Surgeon

Calle B No. 248 entre Obregon y Reforma

Col. Centro, Mexicali, B. C.

Email: drcvasquez@hotmail.com

Tele: (686) 553 – 4714 (appointments)

Notes:

*The Imperial Valley paper reports that Calexico makes 3 million dollars a day off of Mexicali residents who cross the border to shop.

***In all the programs I visited – there are a couple of things that we (in the United States do well.. Heart surgery is one of those things..)

**** Yes – they charge us more in Calexico for the same exact equipment made in India and sold everywhere else in the world..

In the operating room with Dr. Cuauhtemoc Vasquez, Cardiac Surgeon

Posted on April 28, 2012 by K Eckland

Had a great day in the operating room with Dr. Cuauhtemoc Vasquez, MD the promising young heart surgeon I told you about several months ago. I have some absolutely breathtaking photos of the case – but I want to double-check with the patient before posting anything potentially revealing in such a public forum.

Todays’ surgery was at one of the public hospitals in Mexicali – and while technology was sometimes in short supply – talent sure wasn’t. I was frankly surprised at the level of skill and finesse Dr. Vasquez displayed given the fact that he is so early in his career.

Dr. Cuauhtemoc Vasquez, Cardiac surgeon

He’s also just an all-around pleasant and charming person. I know from previous encounters that he’s well-spoken, interesting, engaging and an excellent conversationalist – We didn’t talk at length on this occasion – because honestly, I really don’t like to be distracting during cases – especially since much of the discussion was in an English-heavy Spanglish.. (He is fluent in English but we both tend to slip in and out of Spanish. I mainly slip out when I start thinking in English and come across a concept that I am not sure about explaining or asking about in Spanish.**

But don’t worry – I am planning on seeing him next week – where I can hopefully lure him to lunch/ coffee or something so we have a more lengthy discussion – so I can give you all the details in a more formal fashion in a future post.

As a crazy side note – finally got that ‘great’ picture of the good doctor.. Oh, the irony – not during a thoracic case but while he was assisting Dr. Vasquez – (the good doctor is board-certified cardiothoracic surgeon, after all..) I didn’t post it here because there are some ‘patient bits’ in the photo..

**I know this can be frustrating from my experiences with my professor – but it’s also frustrating when: a. a question gets misinterpreted as a statement (because of my poor grammar) or b. misconstrued completely – which still happens pretty frequently. Luckily, people around here are awfully nice, and tend to give me the benefit of a doubt.

Also – I need to post this photo of one of my favorite operating room nurses – Lupita. (Lupita along with Carmen and Marisol) have been an absolute delight to be around even of those very first anxious days..

Lupita, operating room nurse.. Doesn’t hurt that she’s as cute as a button, eh?

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