Memories of Mexicali


As I get ready to leave Mexicali, I am posting several old postcards of the city.  Today’s post is more reflective of the many changes going on now – but we’ll be back to our usual topics soon..

this one is just a few years old

I’m sure that my regular readers can tell that parting is ‘such bittersweet sorrow’.. How could it not be  – when I have met such wonderful people, learned so much and made some great friends?

Mexicali – Av..Revolucion – circa 1960’s

At the same time, I am excited about moving forward – school, studying in Bogotá, and working on my research.

Governmental Palace (now part of UABC) circa 1960’s

Hard to leave the hospital in particular.  I went back there yesterday and got to see some of the people who were so welcoming, starting on my very first day.  (When I was still struggling – particularly with the regional accent here – which differs from the Spanish I was used to hearing.)

Av. Lopez Mateos

It was great to be back in the operating room with Dr. Ochoa.  With classes in Nashville, and my homework assignments, I hadn’t seen him for a couple of weeks.

I know I will miss him most of all even if I am embarrassed to admit it.  He will always rank up there as one of the world’s great “bosses”; he was great to be around; day after day after day- which is not something you can say about most people.   I know I’ve talked about what a good (and patient!) professor he has been, but this last month, when we’ve been collaborating on the book, has changed the dynamic a bit.  He’ll still always be ‘my professor’ and a surgical colleague – but now that we have worked together in a different capacity – he is more of a friend too.  (I’ve actually called him by his first name a couple of times, which is a hard thing for me to do..)

I think, too, that is was a little-bit eye-opening for him to be more involved on the writing (and researching) side of things.  I hope he enjoyed it as much as I have.  (He should – he did all the research on Mexicali’s nightlife.. )

and Joanna – who has become one of my best friends.. (Not just my best friend in Mexicali – but someone I consider a really close friend – anytime, anywhere..)  It just seems like we connect and communicate on that level that only really close friends ever do.. Despite different backgrounds, I feel like I’ve known her my whole life..  So it’s hard to say “see you later” to Joanna.. (“See you later” is so much better than goodbye, don’t you think?)

So of course, as you can imagine – I spent my last day at the hospital – in the place I love the most: the operating room.

Dr. Rivera (left) and Dr. Ochoa

I’m going to miss my ‘movie star’ surgeon too – Dr. Rivera has been great about being in all my pictures and film clips..  He’s a nice young resident – (still grounded)  and I think he’s be a great surgeon when he finishes his training..  He’s interested in surgical oncology – so we might be writing about him again in a few years..

 

Kim Kardashian: Better call your lawyers..


As I mentioned previously – the ‘unauthorized’ use of celebrity images is pretty common around here.  We talked about this before in conjunction to Kim Kardashian and Rhianna – and today, while driving around Mexicali taking pictures for a section of the book on architecture, we saw yet another example of this.  (Sorry, Kim – we were in traffic, and seeing it was unexpected, so the photo is blurry – and I know, my window is filthy) – but it’s undeniably you hawking clothing up on a sign outside a clothing store on Blvd Anahuac..  Just thought you should know..

Kim Kardashian hawking cheap clothing in Mexico

In other news – spent the day trying to find the elusive “casa de Louis Vuitton” which is a house of the outskirts of Mexicali painted brown with symbols to look like a Louis Vuitton bag.  I know the house is still there – yesterday one of the people who lived near the house was lamenting being a neighbor – but the address and directions were far from correct..

I did get some more great photos of Mexicali.. including one of the fancy car dealerships down here.. (I like to remind people that Mexicali has one of the highest standards of living, and income in all of Baja)..  There is a growing middle-class here (and just like most of us), they like nice things..  It’s another side of the road photos since I wasn’t planning on taking pictures of car dealerships..

Mercedes Benz dealership

A lot more photos but I haven’t gotten around to sorting of all them yet..More architectural adventures tomorrow..

 

 

 

as the mercury soars..


into the 110’s (and higher) it’s been an interesting week in Mexicali.  I’ve definitely entered new territory in my book writing venture.  In the last books, I basically didn’t see the forest for the trees – meaning that even as I raced around, and enjoyed the cities I was living in – I didn’t include any of the information about the cities themselves.. Just the surgeons, and surgery.

In retrospect – I think that was a mistake.  While I know the beautiful multifaceted Bogotá, my readers don’t.  At the time, I didn’t want to duplicate the efforts of the many talented travel writers out there.  But on consideration – living in a city is so much different from visiting one.   It takes months to see and fully appreciate the nuance of many locations – especially cities..  Anyone can talk about the historic church built in 19 whatever, but it takes time and familiarity to see the beauty of Mexicali’s Graceland, or the changing canvas of the UABC museum.  It takes time to collect the stories that bring the city to life.  So now, I am trying to do that – in a small fashion with everything I’ve collected since coming here in March.

I am not Frommer’s.. I am more like his awkward, quirky little cousin. I don’t have the manpower or the resources to talk about the hundreds of restaurants here (more than 100 Chinese restaurants alone!) but I can tell you some of my favorite places; for a casual lunch with friends, or a night on the town.  I can’t give exhaustive listings on all there is to see and do in this thriving city, but I can show you the heart of it.  I can tell you about the things that make Mexicali more than just spot in the hard-baked earth; the things that make this city real, and make it a fascinating place to be.  I can make your stay; whether just a few days, weeks or months; interesting and informative.

It’s been a fascinating and amazing journey to discover these ‘pockets of life’ and living history – and now that I am outside my realm (of medicine and surgery) one that would have been impossible without the numerous people who have embraced me, and shared their wisdom.  (It’s becoming quite the list – and I’ll share it with you all soon.)

But I certainly hope that my future readers enjoy the journey as much as I have.

How’s the book coming?


I was in the United States most of last week (at my reunion) but I didn’t stop working.  While a reunion may not seem like the most ideal situation for a medical writer – it’s actually a great opportunity to talk to people and get their opinions about health care, medicine and surgery.  After the first few minutes of catching up – talk naturally turns to everyday life, and for many of us – ‘everyday life’ involves worrying about the health of our families.. Also, many of my classmates – and old friends have been some of my biggest supporters of the blog (and my other work) so it was good to get some critical feedback.

Bret Harte class reunion

The book is coming along – almost continuous writing at this point.  While I (always!) want more interviews with more surgeons, I am now at the point where I am filling in some gaps  – talking about the city of Mexicali itself.  So I am visiting museums, archives, and talking to residents about Mexicali so I can provide a more complete picture to readers.  Right now, I would really like some information about 1920’s -30’s Mexicali – I can find a lot of interesting stuff about Tijuana, but Mexicali is proving more elusive.

It’s a bit of a change from my usual research – finding out about decades old scandals (even local haunted houses), visiting restaurants and nightclubs, but it’s been a lot of fun., even if it seems frivolous or silly at times.  I hope readers enjoy this glimpse into Mexicali’s rich history as much as I have.

Finished the cover – which to me, is critical at this point.  (I use the cover to inspire me when it comes to the less than thrilling stage of copy editing) so I am posting an image here.

cover for the new book

Meeting with an architect later this week – to learn about, and write about some of the variety of styles here in Mexicali.  (There is such a surprising array – I thought it would be nice for readers to have a chance to know a bit more.)

Now there’s one house I’ve dubbed “Mexicali’s Graceland.”  I don’t know why Graceland comes to mind every time I go past this home (it looks nothing like Elvis’ home in Memphis) but the term has stuck.  I am hoping to get some of the history on this house because it just looks like a place where even the walls have stories to tell.

The pictures aren’t the most flattering – but I’ll post one so you can tell me what you think.  (It’s actually far more lovely in person – with the contrast between the pink walls and the white scrollwork, as well as some of the more classic design features.) I guess my imagination tends to run away with me – with images of grandeur and elegant ladies sipping champagne in the marbled halls of the past – but then – most of my usual writing is technical in nature, so I have few outlets for my creativity.

Mexicali’s Graceland

Meeting with my co-writer today to go back to the archives..

In the operating room with Dr. Enrique Davalos Ruiz, Neurosurgeon


Dr. Enrique Davalos Ruiz, Neurosurgeon

Spent the morning in the operating room with Dr. Davalos.  As we discussed in a previous post, Dr. Davalos is one of just a few neurosurgeons here in Mexico to specialize in both adult and pediatric neurosurgery procedures.  He performs a wide range of procedures such surgery for cerebral tumors, spinal bifida, hydrocephalus, trauma, spinal surgery and epilepsy.  But one of the procedures he is best-known for here in Mexicali is the surgical repair of craniosynostosis.  However, if you’ve ever watched this intricate procedure – ‘repair’ really isn’t the word that comes to mind to describe the procedure.  ‘Rebuild’ is much more appropriate.

Craniosynostosis is a congenital cranial deformity caused by the premature fusion of the cranial sutures.  (These sutures allow for the babies head to be slightly compressed during natural childbirth).  Many new moms can attest that their neonate’s head was temporarily ‘squashed’ looking at birth, but normalize over the first few days as the bones relax into their natural position.  In normal development, these sutures (or ridges where the bones come together) are not yet fused  – and fuse over the first few months of life.

When the bones that comprise the skull fuse early, it can result in a significant cranial abnormality.  (Luckily, in most cases of [primary] craniosynostosis – the patient’s brain functions normally despite this.)

To treat this surgically, Dr. Davalos had to essentially rebuild part of the skull (the coronal sections of the parietal and frontal bones).   He did this by removing and reshaping the skull in separate sections and then rejoining the pieces to conform to a more natural shape.  (As a someone who sews, it reminded me of lacing a corset to get curved shaping).   In a child of this age – the bones should fuse/ heal within approximately six weeks – with no long term limitations for activities.

Sterility was maintained during the case, and everything proceeded in a rapid and appropriate fashion.  Anesthesia was proficient during the case, with excellent hemodynamic stability and oxygenation.

Dr. Davalos beveling a portion of the skull

Dr. Enrique Davalos Ruiz, MD

Pediatric and Adult Neurosurgery specialist

Calle B No 248

entre Av. Reforma and Obregon

Zona Centro

Mexicali, B. C.

In the OR with Dr. Ramos & Talking with Dr. Enrique Davalos Ruiz, Neurosurgeon


Interesting day today – as I travelled across a wide range of specialties in just a few short blocks.  I started out this afternoon in thoracic surgery with the good doc seeing patients in clinic, then off to IMSS to watch a Whipple procedure (pancreatoduodenectomy) with Dr. Gabriel Ramos.   (The Whipple procedure would be the ‘open heart’ surgery of the general/ oncology surgery specialty – it’s a complex, complicated and involved procedure – so, naturally, I loved every minute of it!)

Dr. Gabriel Ramos & Dr. Maria Rivera

Some of you will recognize the absolutely delightful Dr. Maria Rivera from one of our pictures last week (on facebook) – in which she was an absolute stunner.

Not an everyday photo – but then that case was pretty breathtaking too – (when I finish writing about it, I will post a link.)

Dr. Elias Garcia Flores, who I met briefly last week was there too.. (Of course, I didn’t recognize him since he had a mask on this time.)

Unfortunately, I couldn’t stay because I had a previous appointment to interview Dr. Enrique Davalos Ruiz, a local neurosurgeon.  He turned out to very charming and interesting..

He’s the only neurosurgeon specializing in pediatric and adult neurosurgeon for all of Baja California and Sonora.  (I’ll write more about him soon – I am hoping to head to the operating room with him next week.) He’s pretty busy working at IMSS and Hospital General de Mexicali, in addition to private practice but he didn’t seem to mind taking time to talk to me.

Mexicali book: New co-author


As much as I have adored working with my previous co-author, Dr. Albert Klein, PharmD on two previous editions – it just wasn’t practical for this title.  He’s now living and working in North Carolina, whereas – I don’t know when (and if) I’ll be returning to my beloved southern Virginia, which makes this sort of collaboration more difficult.  Also, Dr. Klein, (by the nature of his background) is more of an expert on Colombian history, culture and Bogotá life than the rest of Latin America.  (I always feel that the best way to get a glimpse of life is through the eyes of those who have lived it.)

But I do want to sincerely thank Albert for everything – (without him, I might not have been brave enough to publish at all!)  It’s been a pleasure working with him – both on the books and in the hospital, so hopefully we can collaborate again in the future (Medellin, perhaps?)

In the meantime, I have a new co-author for the latest book, the ‘mini-gem’ guide to Mexicali.  While it’s a more breezy style book compared to my other offerings, I still feel very fortunate to have enlisted some local assistance for the sections on culture, Mexicali life and local color.  The input has been invaluable for me during the writing process – and will prove to be the same for readers, (I hope!)

I am also hoping to get a few additional contributors for other sections of the book to talk about issues in their respective areas of expertise.  (It may be free but that doesn’t mean it shouldn’t be a quality product and a good read.)   It’s not a done deal – and it may be difficult due to everyone’s busy schedules etc – but I am hoping it all comes together.

Once I get all of the specifics nailed down  – I’ll post more about it here.

The rest of the book is going well – I am probably about 75% complete (and then the dreaded editing process!!)  Depending on how horrible editing is – and time limitations – determines whether or not the Mexicali book becomes a e-book.  (I find the e-book conversion process endlessly frustrating, particularly for a die-hard fan of footnotes like myself.)

In the operating room with Dr. Martin Juzaino


This post is a little overdue since I was out of town for a few days.. I missed the 115 degree temps and I missed Mexicali too..

Dr. Juzaino (left) and Dr. Rivera

Usually, I go to surgery after I’ve spoken to the surgeon, and talked to them for a while but in this case – I had heard of Dr. Juzaino (after all – he practices at Hospital General de Mexicali) but couldn’t find a way to contact him – he’s not in the yellow pages, and no one seemed to have his number..

So I just hung out and waited for him when I saw his name on the surgery schedule. He was supernice, and invited me to stay and watch his femoral – popliteal bypass surgery.  Case went beautifully – leg fully revascularized at the end of the case.   Patient was awake during the case but appeared very comfortable.

intern during surgery

There was a beautiful intern in the surgery – her face was just luminous so I couldn’t resist taking a picture.  Unfortunately, I didn’t get her name, and no one recognizes her because of the mask – so I am hoping some one from the OR recognizes her here.. I’d like to send her a copy of the picture.. (and get permission to post it..)

Saw Lupita Dominguez – who in the role of nursing instructor that day.  She is always so delightful – I need to get a picture of her with out the mask so all of you can see her -besides being an outstanding nurse, and nursing instructor,  she is just the friendliest, sweetest person with cute freckles to boot.. (I am very envious of people with freckles..)

On another note entirely, here’s some more information about the ethical implications of transplant tourism for my interested readers as follow up to my Examiner.com article.  It’s a video of lectures by one of the leading ethicists and transplant surgeons, Dr. Delmonico.. (yes, like the steak.)

Mexicali and Medical Tourism


As I mentioned in a post earlier this week, the New York Times article  by Jennifer Medina has really gotten Mexicali officials to sit up and take notice.  The NYT article was just one part of a ‘medical tourism plan’ outlined by the mayor of Mexicali and other government officials.

turismo medico

city of Mexicali

Right now the outline consists of several points:

1. Guide to medical services – they have published a book with the names and addresses of surgeons interested in participating in medical tourism.

2. Transportation – mainly by automobile and buses.  The medical tourism lane at the border was part of this.

3. A plan for a 32 block medical tourism zone.

A good start, and it shows forethought – but as I listened to their outline it prompted my own (humble) suggestions:

1. Medical guide – make this a ‘real’ guide not a phone book of surgeons and providers offering their services.  It should be comprehensive, and offer more than just names and addresses, ideally written as an independent review.. But then take the risk that maybe everything, and every service won’t come out shining..   (Admittedly, this is something I understand the best).

2. Transportation – consider approaching Volaris or another carrier to offer direct flights once or twice a week from Las Vegas, Dallas and Los Angeles.  Right now there are no direct flights from Mexicali to the United States.  By offering direct flights – Mexicali could be much more competitive with both Tijuana and Las Vegas (which is pursuing its own medical tourism strategy to make Las Vegas a medical tourism destination.)  This would play to Mexicali’s two biggest strengths:

1.  It’s proximity to the United States

2.  It’s reputation as a ‘safe’ destination in comparison to Tijuana and other border cities which have their own medical tourism ideas..

It would also open up Mexicali to a much wider market since both Dallas and Los Angeles is a hub for several American carriers serving Canada and the USA.

2. Consider changing the 32 block ‘medical tourism zone’ into one large facility offering dedicated service lines.  While all the small private hospitals in Mexicali will hate this idea – instead of fighting over patients, they would have the advantage of having one large facility with pooled resources.

This would also address the weaknesses of medical tourism in Mexicali: Right now each facility has five (or two) ICU beds, and just 10 or so post-operative beds.  It would also eliminate some of the waste caused by the costly duplication of services – since each hospital currently struggles to offer CT scans, cath facilities and other costly equipment.  As part of a long-range plan – this would better enable the providers and facilities in Mexicali to seek outside accreditation/ and certification of programs and service lines, which in turn would attract more patients.

In the meantime, participating hospitals could convert to specialty facilities (ie. an orthopedic hospital, and plastic surgery center etc.) while the new facility is being built.  This would also reduce the stress on doctors traveling all over town to see just one or two patients at each facility.. If medical tourism really gets going here – these doctors are going to need as much time as they can get; caring for patients..

The centralized large hospital would also enable people like Dr. Vasquez to really get his cardiac surgery program off the ground.  More specialized ancillary services like physical and rehabilitative services would also be pooled and would improve the quality of services in the city, for everyone, including the people of Mexicali who also suffer from the lack of large, comprehensive facilities.   This also brings me to my next point –

3.  Since the city and government of Mexicali is involved in the project – there needs to be a clear and comprehensive plan about how the revenue from this project is going to serve the people of Mexicali.  After all – their tax dollars are helping to fund this ingress into medical tourism, so they need to get something out of it.. Like a PET scanner or some other service that doesn’t currently exist in Mexicali.

4. Don’t forget the rest of Baja – there are an awful lot of retirees and such living in southern Baja – so make sure they know about what your city has to offer.  These people need hip replacements, heart surgery and a whole spectrum of services that are very limited in their geographic area.  Give them a reason to come to Mexicali instead of Ensenada or Tijuana by courting their business.

If anyone from Mexicali reads this post – I hope they can see my suggestions, in the spirit that they are given.  Mexicali has a lot of opportunity here, and the potential to be a great place for a wide range of medical tourism – not just bariatrics and plastic surgery, but they need more comprehensive, and long-range strategies to put their plans into action.

Today was a great example of how much the city has accomplished by working together – with a little more work, and a lot of vision – Mexicali could really go far, and provide great services to more than just a bunch of gringos..

Meet Lupita Dominguez, surgical nurse


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.

Wrapping up and saying “Thanks!”


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].

Mexicali: the city by the fence


Back in Mexicali after a week away at the nurse practitioner conference in Florida – and I am surprised by how much I missed the city.

a view of the city

To be sure, it lacks the glamour and sophistication of Bogotá, Medellin or Buenos Aires.  It doesn’t have the 500 years of history or Caribbean flavor that makes Cartagena such a vibrant city.  Yet – despite this, Mexicali remains the city by the fence – and the city that makes me want to stay on the Mexican side of the border.

Maybe it’s the casual friendliness of the city that grabs me, and embraces me.  The lack of pretension, the very earthiness of the barren,hard packed dirt and dusty surroundings draw me in – with the hidden pockets of Mexicali that beg to be explored.  Every brightly lit taco stand, the mom and pop establishments, and the upscale neighborhoods tucked away in tree-lined streets..

So, today after clinic, and rounds – we left the hospital and explored Mexicali – looking for photos to represent the Mexicali that I am coming to know, and which are often unseen by weekend tourists.

the main artery, which criss-cross the city

Having the good doc as a tour guide was an unexpected bonus – he knows the city so well, and was able to give background and insight into all of our destinations. Despite being from Sonora, he attended school here – making Mexicali very much his home.

as the capital of Baja California, there are numerous excellent educational facilities

I find taking city photos one of the more difficult aspects of writing.. Monuments aren’t all that exciting, and often the most interesting parts of cities aren’t the most photogenic ones..

This is one of Mexicali’s better known landmarks – the stadium used for bullfights.  The Mexicali sign is actually made of mirrored tile which glistens in the sun..

Mexicali landmark: Bullfighting stadium

We stopped by the Military base, because I have been fascinated by the military presence during the preparations for the elections – soldiers guard the electoral offices to prevent any sort of voting shenanigans.  (I’ll try to get a picture of the soldiers soon)

The good doctor laughs when I ask about military efforts and involvement abroad.  (Just because I’m not aware of the Mexican military overseas doesn’t mean they aren’t UN peacekeepers.. )  So I ask my questions about it and it is several minutes before he can stop laughing enough to even answer the question.  Funny, maybe.  But then – when you think of it kind of nice.  Mexico doesn’t attempt to police the world, and that’s okay..

“No, there’s no navy,” he laughs.. (Actually, there is a navy – which is also involved in trying to fight drug trafficking and gang activity).  But it’s nice that it’s apparently low-key enough that it doesn’t dominate the public’s attention.

Military base in Mexicali

Their primary function is more like our national guard – fighting against unrest (and now – narco-trafficking) at home.  Safeguarding elections and the general populace.  Keeping the border safe (yes – safe from all the violence endemic to satisfying the American thirst for drugs, and the underground importation of American weaponry).  I feel a little nervous taking pictures of the base, but no one seems to notice or approach me.  (My first attempts were semi-surreptitiously, but then, with encouragement, I got a little bolder.)

Today is the last day that the political candidates are allowed to campaign before the election, so we passed supporters for PRI (Enrique Pena) and PAN (Vasquez Mota).  I didn’t see anyone out there for AMLO or Quadri, but maybe they just weren’t as well represented.  After this – the candidates have to lay low for a few days so Mexican citizens can ‘reflect’ prior to the elections on Sunday.  That’s kind of a cool concept too – no endless barrage of media like the mega-campaigns at home.

Of course, I wish we could have a real workable multi-party system, so it’s not always a ‘lesser of two evils’ situation at home.  Maybe if we weren’t limited by having just two choices and two main parties – we might have more ‘shades of grey’ instead of all this extremism at both ends of the spectrum.. But it’s interesting to watch here, all the same, and I am glad that I have been here to experience it.

I hope I don’t alienate readers at home with my talk of politics – after all, I am not really a political animal, so ignore my musings, if you like..

In other news – it’s a bit frustrating when you have spent several months here – only that have the New York Times swoop down.. and all the doors that were closed to you (That’s you, Omar Dipp) suddenly burst open since they are a major news agency.  Of course, they had the mandatory patient testimonial,  – it was just the usual “medical tourism lite” style story that so often dominate the news.   Didn’t you just love the “nurses warm your hand…”  more like advertising than real journalism, but whatever..  (In fairness – I write a lot of “news lite” articles myself for outlets like Examiner.com which actually prefer this style, but those are usually 400 word pieces – and I’m not at the NYT, so of course, I am envious..

But it’s good for Mexicali – and all the hard-working doctors I’ve met here..  They certainly deserve the exposure!

Hopefully readers who want the real scoop on operating room conditions, doctors , etc.  will still know where to come for in-depth information..

Saturday in Mexicali


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..

Overseas Radio Follow-up


As a follow-up for all the overseasradio.com radio listeners (and all my loyal readers) I have posted some additional information on the topics covered during the radio program with Ilene Little from Traveling for Health.com including contact information for several of the physicians mentioned.

in the Operating Room at New Bocagrande Hospital

Thoracic Surgery

Esophageal cancer – during the segment we highlighted the importance of seeking surgical treatment for esophageal cancer at a high-volume center.  One of the centers we mentioned was the University of Pennsylvania Medical Center in Pittsburgh, PA – and the work of Dr. Benny Weksler, MD.

Dr. Benny Weksler*, MD

Hillman Cancer Center

5115 Centre Avenue

Pittsburgh, PA 15232

Phone: (412) 648-6271

He is an Associate Professor in Cardiothoracic Surgery and Chief of Thoracic Surgery at UPMC and the UPMC Cancer Center.  (For more information on Dr. Weksler, esophageal cancer, and issues in thoracic surgery – see my sister site, Cirugia de Torax.org)

(To schedule an appointment via UPMC on-line click here).

We also briefly mentioned Dr. Daniela Molena*, MD at John Hopkins in Baltimore, Maryland.

The Johns Hopkins Hospital

600 N. Wolfe Street

Baltimore, MD 21287

Phone: 410-614-3891

Appointment Phone: 410-933-1233

(The link above will take readers to the John Hopkins site where they can also make an appointment.)

* I would like to note that I have not observed either of these physicians (Weksler or Molena) in the operating room.

We also talked about several of the thoracic surgeons that I have interviewed and observed numerous times, including both Dr. Rafael Beltran, MD & Dr. Ricardo Buitrago, MD at the National Cancer Institute in Bogotá, Colombia.  These guys are doing some pretty amazing work, on a daily basis – including surgery and research on the treatment of some very aggressive cancers.

in the operating room with Dr. Rafael Beltran

Dr. Rafael Beltran is the Director of the Thoracic Surgery division, and has published several papers on tracheal surgery.   He’s an amazing surgeon, but primarily speaks Spanish, but his colleague Dr. Buitrago (equally excellent) is fully fluent in English.

Now the National Institute website is in Spanish, but Dr. Buitrago is happy to help, and both he and Dr. Beltran welcome overseas patients.

Dr. Buitrago recently introduced RATS (robot assisted thoracic surgery) to the city of Bogotá.

Now, I’ve written about these two surgeons several times (including two books) after spending a lot of time with both of them during the months I lived and researched surgery in Bogotá, so I have included some links here to the on-line journal I kept while researching the Bogotá book.  It’s not as precise, detailed or as lengthy as the book content (more like a diary of my schedule while working on the book), but I thought readers might enjoy it.

In the Operating Room with Dr. Beltran

There are a lot of other great surgeons on the Bogotá website, and in the Bogotá book – even if they didn’t get mentioned on the show, so take a look around, if you are interested.

in the operating room with Dr. Ricardo Buitrago

Contact information:

Dr. Ricardo Buitrago, MD 

Email: buitago77us@yahoo.com

please put “medical tourist” or “overseas patient for thoracic surgery” in the subject line.

We talked about Dr. Carlos Ochoa, MD – the thoracic surgeon I am currently studying with here in Mexicali, MX.  I’ve posted all sorts of interviews and stories about working with him – here at Cartagena Surgery under the “Mexicali tab” and over at Cirugia de Torax.org as well.  (Full disclosure – I assisted Dr. Ochoa in writing some of the English content of his site.)

out from behind the camera with Dr. Ayala (left) and Dr. Carlos Ochoa

He is easily reached – either through the website, www.drcarlosochoa.com or by email at drcarlosochoa@yahoo.com.mx

HIPEC / Treatment for Advanced Abdominal Cancers

I don’t think I even got to mention Dr. Fernando Arias’ name on the program, but we did talk about HIPEC or intra-operative chemotherapy, so I have posted some links to give everyone a little more information about both.

HIPEC archives at Bogotá Surgery.org – listing of articles about HIPEC, and Dr. Arias.  (I recommend starting from oldest to most recent.)

Dr. Fernando Arias

Oncologic Surgeon at the Fundacion Santa Fe de Bogotá in Bogotá, Colombia.  You can either email him directly at farias00@hotmail.com or contact the International Patient Center at the hospital.  (The international patient center will help you arrange all of your appointments, travel, etc.)

Fundacion Santa Fe de Bogota

   www.fsfb.org.co

Ms. Ana Maria Gonzalez Rojas, RN

Chief of the International Services Department

Calle 119 No 7- 75

Bogota, Colombia

Tele: 603 0303 ext. 5895

ana.gonzalez@fsfb.org.co  or info@fsfb.org.co

Now – one thing I would like to caution people is that email communications are treated very differently in Mexico and Colombia, meaning that you may not get a response for a day or two.  (They treat it more like we treat regular postal mail.  If something is really important, people tend to use the phone/ text.)

Of course, I should probably include a link to the books over on Amazon.com – and remind readers that while the Mexicali ‘mini-book’ isn’t finished yet – when it is – I’ll have it available on-line for free pdf downloads.

Spending the weekend with Dr. Vasquez, and medical photography


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.

This week in Mexicali Surgery


No – I haven’t changed the name of the blog, just reflecting the nature of my current assignment.  Spending some time in Interventional Cardiology this week as part of a story I am writing about chest pain emergencies for Mexico on my mind.com.  Today, I checked out the cath lab at Hispano Americano Hospital.  It’s a bit crowded, but all the equipment is brand-spanking new, and practically sparkling.  (Don’t worry – I have photos to prove it!)

Nurses in the cath lab at Hospital Hispano Americano

Dr. Fernando Monge was kind of enough to give me a guided tour.  While we were there he (assisted by Dr. Raul Aguilera) placed a stent in a patient with recurrent angina.  A doctor from the ER also stopped by to have him review a couple EKGs..  I’ll post a link when the full story is done.

Also stopped in to talk to Dr. Jose Antonio Olivares Felix, MD, a general surgeon who reports to me that he is doing single port laparoscopy – so of course, that got me interested.  Hoping to set a date to go to the operating room.

I’ll be spending all of tomorrow in the company of Dr. Marnes Molina, MD to learn more about some of the other stuff he’s doing in urology (and hopefully grab a picture of that green laser!)

Dr. Gabriel Ramos, Oncology Surgeon


Dr. Gabriel Ramos, Oncologic Surgeon

Been a busy week  – (Yea!) but now that it is the weekend, I have a chance to post some more pictures and talk about my day in the operating room with Dr. Gabriel Omar Ramos Orozco. 

Despite living in a neighboring apartment, interviewing Dr. Ramos proved to be more difficult than anticipated.  But after several weeks, I was able to catch up with the busy surgeon.

Outside of the operating room, he is a brash, young surgeon with an off-beat charm and quirky sense of humor.  But inside the operating room, as he removes a large tumor with several cancerous implants, Dr. Gabriel Ramos Orozco is all business.

It’s different for me, as the interviewer to have this perspective.  As much as I enjoy him as a friendly neighbor – it’s the serious surgeon that I prefer.  It’s a side of him that is unexpected, and what finally wins me over.

Originally from San Luis Rio Colorado in the neighboring state of Sonora, Dr. Ramos now calls Mexicali home.  Like most surgeons here, he has a staff position at a public hospital separate from his private practice.  It is here at IMSS (Instituto Mexicano del Seguro Social) where Dr. Ramos operates on several patients during part of the extended interview.

Operating room nurses at IMSS

During the cases, the patients received a combination of epidural analgesia and conscious sedation.  While the anesthesiologist was not particularly involved or attentive to the patients during the cases, there was no intra-operative hypotension/ alterations in hemodynamic status or prolonged hypoxia.

Dr. Ramos reviewed patient films and medical charts prior to the procedures.  Patients were prepped, positioned and draped appropriately.  Surgical sterility was maintained during the cases.  The first case is a fairly straight forward laparoscopic case – and everything proceeds rapidly, in an uncomplicated fashion.  45 minutes later, and the procedure is over – and Dr. Ramos is typing his operative note.

Dr. Gabriel Ramos in the operating room

But the second case is not – and Dr. Ramos knows it going in..

The case is an extensive tumor resection, where Dr. Ramos painstakingly removes several areas of implants (or tumor tissue that has spread throughout the abdomen, separate from the original tumor).

The difference between being able to surgical remove all of the sites and being unable to remove all of the gross disease is the difference between a possible surgical ‘cure’ and a ‘de-bulking’ procedure, Dr. Ramos explains.  As always, when entering these surgeries, Dr. Ramos and his team do everything possible to go for surgical eradication of disease.  The patient will still need adjunctive therapy (chemotherapy) to treat any microscopic cancer cells, but the prognosis is better than in cases where gross disease is left behind*.  During this surgery, after extended exploration – it looks like Dr. Ramos was able to get everything.

“It’s not pretty,” he admits, “but in these types of cases, aesthetics are the last priority,” [behind removing all the tumor].  Despite that – the aesthetics after this large surgery are not as worrisome as one might have imagined.

The patient will have a large abdominal scar – but nothing that differs from most surgical scars in the pre-laparoscopy era.  [I admit I may be jaded in this respect after seeing so many surgeries] – It is several inches long, but there are no obvious defects, the scar is straight and neatly aligned at the conclusion of the case – and the umbilicus “belly-button” was spared.

after the successful removal of a large tumor

As I walk out of the hospital into the 95 degree heat at 11 o’clock at night – I admit surprise and revise my opinion of Dr. Ramos – he is better than I expected, (he is more than just the kid next door), and he deserves credit for such.

*This may happen due to the location of metastatic lesions – not all lesions are surgically removable.  (Tumor tissue may attach to major blood vessels such as the abdominal aorta, or other tissue that cannot be removed without seriously compromising the patient.)  In those cases, surgeons try to remove as much disease as possible – called ‘de-bulking’ knowing that they will have to leave tumor behind.

Dr. Ramos, HIPEC and Radio Broadcasts


Finally caught up with the busy Dr. Gabriel Ramos, MD, oncologic surgeon and spent several hours with him in the operating room at IMSS (the social security hospital) for a couple of cases on Wednesday..  I’ll be writing more about him soon.

Dr. Gabriel Ramos, Oncologic Surgeon

Yesterday was a full day with clinics here and San Luis.  Also – more homework, so I have to get some studying in before heading back in this afternoon.

On the radio with Cartagena Surgery:

Recorded my very first radio interview with Ilene Little at Traveling 4 Health..  I hope I don’t sound too bad (when I get nervous, I laugh..)  It’s not a pre-determined format, so I didn’t know the questions until she asked them – which makes it more interesting, but I sound less polished as I search my brain for names, dates, places etc.  Trying to remember the name of the researchers who published a paper in 1998, 2008, or 1978 is daunting when you worry about ‘dead air’.. I was so nervous I was even forgetting my abbreviations.  I hope it comes across better to listeners.

We talked about the books, what I do (and how I am surviving on savings to do it).  We also talked about some of the great doctors I’ve interviewed, treatments such as HIPEC as well as some of the quackery and false hope being peddled by people with a lot to gain.. I kind of wish HIPEC and quackery weren’t in the same segment.  Since it was off the cuff – I didn’t have all of my medical references and literature to talk about to distinguish the two (so if you are here looking for information on HIPEC – search around the site – I have links to on-going studies, and research going back over a decade, both here at BogotaSurgery.org .  Of course, the crucial difference between the two is:

HIPEC is a new treatment, but there is NO assurance of success – in fact, some patients die from the treatment itself.

– There is a body of scientific literature on HIPEC for advanced abdominal cancers (ovarian, uterine, etc)

Quakery or pseudo-science can be a bit trickery.  Maybe they take an existing or  promising treatment (like therapies for stroke, Parkinson’s etc.) and apply it to something else – like treatment of serious cancers.  (Yes – people will find papers written about the ‘treatment’, but these papers may not meet scientific rigor, or may not be about the condition or treatment that they are receiving.)  They also promise miracles and cures.

In medicine, even the very best doctors and surgeons can’t promise these things – because medicine itself isn’t an exact science, and different people respond to the same treatments differently – ie. one patient may have complications and another patient doesn’t.

Lastly  – we just touched on it – but I think it’s an important concept – is patient self-determination.  That no matter what I, or anyone writes, does or says – people always have the right to determine their own medical treatment.

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


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.