Senderismo in Santander


In the months since I discussed Andres’ pathology reports with his mom, he’s started chemotherapy.. I met and lost a charming, attractive man named Danny. The days have marched on.. and Finally, it was the end of May – and time for the long awaited, anticipated trip to Santander to celebrate Andres’ mom’s birthday. It was a three day hiking tour with Explorando Ando, a local travel / tourism group that specializes in hiking/ walking trips.

The bus picked me up from calle 170 at midnight along with two other members of the hiking group. We were the last people to be picked up as the bus passed through Bogota. Then we headed out on the highway. At 4:30 am, we stopped in the town of Barbosa to switch to a smaller, traditional “Chiva” bus.

(It was an amazing trip – filled with friendly and fun people, breath-takingly beautiful scenery and lots of activity, but my favorite part was riding on top of the Chiva!!)

Riding on the top of the chiva in Florian, Santander

Once we got to Florian, we had a hearty breakfast before heading out on our first hike – to the first waterfall.. We had to hike through the finca of a local man, but for a small fee – he was happy to have our group pass through. He had oranges, water and free standing bathrooms for us to use.

The waterfalls were really spectacular. There is no way to really describe it otherwise… They were so immense, photos just don’t capture it. It’s an incredible sensation; looking up at this enormous waterfall and realizing just how tiny and insignificant we are in the scale of things.

(Click on the photos to see the whole image)

Sometimes feeling tiny isn’t a bad thing – it was the first time in a long time that I didn’t think about all the things that having been going on this last year.. (Long time readers know that it’s been a bumpy road this last year). This trip was the first time that I didn’t cry for a couple of days.. That I didn’t wake up with that sad heavy feeling in my chest.. I needed that.. And more importantly, I think my traveling companions, especially, Flor – needed that – to be able to get away from Bogota, and away from the sadness that envelopes us..

The second day of the hike is when we went to the the biggest of the waterfalls.

The last and final day – was the day we went to two different waterfalls, where we were able to swim, and play under the falls.

One of the really nice thing was that even though we were just a group of five (Maria Eugenia, Natalia, Flor, Amanda and I), it felt like one big class trip.. Everyone there was excited, with friendly attitudes and an adeventurous spirit.. Some people were younger than me, some people were older.. People in their 20’s and in their 70’s. The hikes were long enough and difficult enough to be challenging without being too difficult for the average person. I felt sore for a couple days after the trip – but it was the good kind of sore..

Maria Eugenia, Me, Flor, Amanda and Natalia

I don’t get to see Natalia nearly enough – she lives in Madrid, which is a city outside of Bogota…But she’s always good for some fun.. She’s the one who packed Coronitas, which are little baby cans of Corona beer to celebrate our climb on the biggest hike of the trip..

Enjoying a coronita after an all day hike and an 9 km uphill climb.. Worth it!

That was kind of a crazy day – because it started out a little drizzly, which felt good.. But as we were climbing back up to return, the fog rolled in and it was complete. Just after we reached the summit, the fog pretty much obliterated any kind of landscape. (The people trailing behind us were completely invisible to us in the dense fog.)

Now if only I could do this every week…

Thanks to the folks in the group for editing and sharing this video with me..

Birthday in Boyaca, part 1


Been catching up on my writing.. Haven’t written as much as I would like to recently but for good reasons.. After a difficult year – last year, I had vowed to enjoy myself and embrace life again. I’ve always been someone with “ganas a vivir” and I had lost that joyful spirit. This year, I have been doing my best to reclaim that spirit and my sense of who I am. One of the things that had really hurt me last year when I turned 50 – in the midst of all this turmoil was the lack of celebration. Not of me, per se, but the celebration of life, of living, of exploring, of the great privilege of being able to experience joy, wonder, pleasure and laughter.. I have that back – and I am going to hold on to it fiercely.. Whether that means embracing my “epoca de estupidezes, boadas y locuras” by doing all the things I want to – putting myself and my wants first for a while, or just by lighting fireworks – and being true to my redneck rural roots, then that’s what I am going to do.

For my birthday, we decided to take a three day trip through Boyaca. it’s nothing life shattering, but Boyaca is one of my favorite states in Colombia. It’s green, green, green and the rolling hills remind me of my beloved Virginias.. Most of the places we went, I have been to before – but this time, it wasn;t on a tour bus. It was the two of us trying to re-connect and remember the love and friendship we had before it all went so very, very wrong. It’s not a reconciliation, because some things can’t be undone – but it’s a re-definition of our relationship. Maybe it seems weird that we would go on this journey together after everything – but my life isn’t tradicional in any sense of the word, anyway. I mean, I am an American living in Colombia, so my life isn’t going to look like most people’s anyway.

We work together, we lunch together most afternoons. I bring special supplements back in my suitcase when I come back home from my trips back to the USA, and I accompany him to most of his medical appointments. I am the one that interprets what the doctors say into something resembling common dialect for the family. I sit with him during the long chemotherapy sessions and I like to think that we have developed a deep friendship. I am probably deluding myself, but that’s how it is.

So we set off from Pacho for our first destination: Raquiria.

Raquiria is a tourist town known for it’s ceramics and craft work. Raquiria is one of my favorite places for silly reasons, I suppose. It’s a town filled with light and color, so it’s a place I like to photograph.

We stayed at a cute little airbnb, and he indulged me in one of my pet hobbies – portrait photography. I love taking photographs of just about anything, nature, architecture, events, but taking photographs of people is what I really really love. I love the challenge of trying to capture the essence of the person in a still photograph. Years ago, he used to patiently sit and pose for hours while I practiced. He was one of my favorite models. Today, he indulges me for 30 minutes. It’s just the start of a great day.

This is my favorite of all the photos.. He looks a little older than the Andres I know, but he looks good.

Here’s one of me..

We drove thru Sudamarchan – so of course, we stopped for the famous sausages..

Villa de Leyva

On our way to Villa de Leyva, he stopped the car suddenly at a dusty looking road, with a big grin on his face. Soon, I had one too! Go-karts!

We started out clean – he drove – carefully avoiding mud and small puddles after recent rains.. But of course, as soon as he turned over the wheel to me – into every puddle I could find! Very quickly, the go-kart was covered in filth, and so were we! It was a lot of fun..

Villa de Leyva is one of those heritage towns – a colonial Spanish town with a large central plaza.. People don’t come to Villa de Leyva for Go-Karts.. They go there for the history and the charm. So we did those things too.. There was a wedding at the church in the central plaza, with the bride arriving in a horse drawn carriage.

This is going to be a two part post – with all the pictures and such.. Next post – Mongui (home of the soccer ball).

Lost post 2014: Juan Valdez


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

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

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

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

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

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

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

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

Photo by Livier Garcia on Pexels.com

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

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

Additional links and information

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

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

Termales Los Volcanes


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

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

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

the bathtub at the Elvis Presley Graceland penthouse

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

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

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

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

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

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

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


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

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

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

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

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

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

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

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

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

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

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


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

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

Ruins of La Posada Alemana

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

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

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

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

For starters, there’s the view..

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

There are flowers, and greenery everywhere.

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

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

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

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

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

Is it safe to fly after surgery?


Long haul flights are a health risk for everyone

While the risks of prolonged immobility and pulmonary embolism with long distance travel are well-known, many potential patients are unaware of the increased risks of thromboembolism after surgery.

Increased risks in specialized populations

People with a personal or family history of previous blood clots (PE or DVT), women on oral contraceptives, and patients who have undergone orthopedic surgery are some of the people at greatest risk.

Increased risk after surgery + Long trips

The heightened risk of thromboembolism or blood clots may persist for weeks after surgery.  When combined with long-haul flights, the risk increases exponentially.

In fact, these risks are one of the reasons I began investigating medical tourism options in the Americas – as an alternative to 18 hour flights to Asia and India.

Want to reduce your risk – Follow the instructions in your in-flight magazine

Guidelines and airline in-flight magazines promote the practice of in-flight exercise to reduce this risk – but few have investigated the risks of thromboembolism in post-surgical patients by modes of transportation: car travel versus air travel.

airplane3

But, is it safe to fly after surgery?

This spring, Dr. Stephen Cassivi, a thoracic surgeon at the world-famous Mayo Clinic in Minnesota tried to answer that question with a presentation of data at the  the annual meeting of the American Association for Thoracic Surgery.

This question takes on additional significance when talking about patients who have had lung surgeries.  Some of these patients require oxygen in the post-operative period, and the effects of changes in altitude* (while widely speculated about) with air travel, have never been studied in this population.

Now, Dr. Cassivi and his research team, say yes – it is safe.  Mayo Clinic is home t0 one of the most robust medical travel services in the United States for both domestic and international medical tourists.

After following hundreds of patients post-operatively and comparing their mode of transportation  – Dr. Cassivi concludes that the risks posed by automobile travel and air travel after surgery are about the same.

Additional reading

For more information on deep vein thrombosis, pulmonary embolism and safe travel, read my examiner article here.

AATS poster presentation abstract:

Safety of Air Travel in the Immediate Postoperative Period Following Anatomic Pulmonary Resection
*Stephen D. Cassivi, Karlyn E. Pierson, Bettie J. Lechtenberg, *Mark S. Allen, Dennis A. Wigle, *Francis C. Nichols, III, K. Robert Shen, *Claude Deschamps
Mayo Clinic, Rochester, MN

Schwarz T, Siegert G, Oettler W, et al. Venous Thrombosis After Long-haul Flights.  Arch Intern Med. 2003;163(22):2759-2764. doi:10.1001/archinte.163.22.2759 .  This is some of the definitive work that discussed the risk of long flights with blood clots in the traveling population due to prolonged immobility.

*Most flights are pressurized to an altitude of around 8,000 feet – which is the same level as Bogotá, Colombia.  This is higher than Flagstaff, AZ, Lake Tahoe, Nevada, Denver, Colorado or Mexico City, D.F.  – all of which are locations where some visitors feel physical effects from the altitude (headaches, fatigue, dyspnea, or air hunger.  In extreme (and rare) cases, people can develop cerebral edema or other life-threatening complications at these altitudes**.

** Severe effects like cerebral edema are much more common at extreme altitudes such as the Base Camp of Mt. Everest but have occurred in susceptible individuals at lower levels.

Punta Pacifica, Hospital San Tomas and Centro Medico Paitilla


**Due to some unforeseen changes in my itinerary, I can only provide just a brief overview of some of the facilities in Panama City, which falls far short of my usual.**

Centro Medico Paitillo (CMP)

Balboa Ave. and 53rd Street

Website: http://centromedicopaitilla.com/

Founded in 1975, CMP has grown to become the largest private facility, though  Punta Pacifica appears to rapidly approaching on their heels.  They have several well-established international health insurance programs and the hallways were well populated with English-speaking visitors and patients.  The hospital has community outreach and health promotion classes as well as a 64 slice CT scanner, MRI and other diagnostic capabilities.

Website is attractive, and well-designed with English and Spanish versions.

Clinica Hospital San Fernando

Via Espana Las Sabanas

Website: http://www.hospitalsanfernando.com

There are two facilities for Hospital San Fernando; a Panama City facility and another facility in Coronado. The Panama city facility is one of two Panamanian facilities accredited by Joint Commission International.  This is a private facility designed to entice foreign visitors and upwardly mobile Panamanians.

Website with English language version that includes price quotes for International travelers. Website is well-designed and easy to navigate.

I have not visited or viewed this facility

Hospital Punta Pacifica

Boulevard Pacífica y Vía Punta Darién
Ciudad de Panamá

Website: http://www.hospitalpuntapacifica.com/

Webpage with English and Spanish versions, and has been designed for international travellers. However, the overall quality of the website is poor. Information has been poorly laid out and is often mischaracterized. For example, visitors to the site who are seeking information about individual physicians are transferred to a poorly typed resume-style pdf. Physician specialties are mislabeled; with cardiologists listed as surgeons, which may cause confusion for potential patients.

Hospital Punta Pacifica was accredited by Joint Commission International in September of 2011. Hospital Punta Pacifica’s main claim to fame, as it were, is that it is John Hopkins International branded facility.  As such, it is aggressively marketed as a medical tourism destination.

It is located in downtown Panama City, just a kilometer from the CMP (Centro Medico Paitilla).

Victoria 001

Hospital Santo Tomas

Calle 34 Este y Avenida Balboa

Website: http://hospitalsantotomas.gob.pa/

Hospital San Tomas is the oldest public hospital in Panama. Originally started as a small facility for impoverished women in September of 1702, the hospital has grown over the last 300 years to become the largest hospital in the country. The hospital now offers multiple service lines including surgical specialties such as thoracic surgery, plastic surgery and general surgery, among others.  The campus includes separate facilities (Maternity hospital, children’s hospital), a blood bank and Cancer center.

Blue Cross Blue Shield of Panama – one of the international arms of the Blue Cross Blue Shield insurance company, and just one of the many insurances accepted at most Panamanian facilities.

What’s this about free insurance for tourists to Panama?

In one of their more effective (and dramatic) public relations gestures, the Panamanian government widely advertises “Free  medical insurance for the visitors”.  This catastrophic policy covers all visitors during the first thirty days of their stay for accidents and injuries (up to $7000.00) that may occur during a stay in Panama.  Visitors just need to show their passports on arrival to one of the participating medical facilities.

The policy also covers up to $500.00 of dental expenses, and economy class air tickets for return home for family members (in case of a death of a tourist) and repatriation of the deceased.  (This may sound like a grisly benefit but from previous discussions with tourists in various locations – this can be quite costly.)

*Just so you know – it doesn’t cover chronic conditions or pregnancy, so visitors can’t come here and expect to have free care for non-emergent problems (ie, elective hip replacement and the like.)

Anthony Bourdain does Colombia


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

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

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

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

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

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

Going home..


After a whirlwind three months that included trips to Chile, Bolivia and different cities in Colombia, I am getting ready to come home in a few days.  As always, leaving Bogotá is bittersweet.  I miss my friends, and my family but I will also miss the city and all of the nice people I’ve met here.

I am posting a map of Colombia, so even though I’ve taken several trips – you can see that I haven’t really explored the country at all. (I’ve posted little push pins on the areas I have visited.)  I excluded Facativa and some of the closer towns since they are really just suburbs of Bogotá, and it would just clutter the map.

Map of Colombia, courtesy of Google Earth

As you can see – I haven’t explored the southern part of Colombia, or the pacific coast at all.  My Atlantic adventures have been confined to Cartagena.  So, I guess this means, I still have a lot of work cut out for me on my next visit(s).

map showing central Colombia

But I hope that readers have enjoyed reading about my travels, the people I’ve met and the things I’ve seen.  Now – I know this is a medical/ surgery blog but since much of the surgery I write about is in this part of the world, I think that including some of my experiences is relevant/ interesting for people who read the blog.  Once I get back home, I’ll post some more articles on medical quality control and standards – and more of my usual dry fare.

Dr. Alberto Martinez, Sports Medicine/ Orthopedic surgeon


Dr. Martinez (right) in the operating room

(Out of respect for patient privacy – I’ve done my best to crop the patient ‘bits’ from the photo.)

Spent some time last week with Dr. Alberto Martinez of Med-Sports Orthopedic Clinic here in Bogotá.  Dr. Martinez specializes in arthroscopic surgery of the hips, knees and shoulders.   As we talked about before, shoulder surgery is its own subspecialty in orthopedics due to the increased complexity of this joint.

We talked a bit about hip arthroscopy,which is still a relatively new procedure in orthopedics and the fact that one two surgeons in Bogota are currently performing this procedure.

Arthroscopy is the orthopedic minimally invasive counterpart to general surgery’s laparoscopy or thoracic surgery’s thoracoscopy.  It involves insertion of a camera and several tools through small (1 cm) incisions in the skin.  Arthroscopy itself has been used in orthopedics for many years but it is just now making inroads in hip procedures.

I’ll be publishing an upcoming article based on my observations over at ColombiaReports.com

For more information

Rath E, Tsvieli O, Levy O. (2012).  Hip arthroscopy: an emerging technique and indications.  Isr Med Assoc J. 2012 Mar;14(3):170-4.

Haviv B, O’Donnell J. (2010). The incidence of total hip arthroplasty after hip arthroscopy in osteoarthritic patients.  Sports Med Arthrosc Rehabil Ther Technol. 2010 Jul 29;2:18

The authors found that 16% of patients in their study eventually required hip replacement after hip arthroscopy during seven years follow-up.

Nord RM, Meislin RJ. (2010).  Hip arthroscopy in adults.  Bull NYU Hosp Jt Dis. 2010;68(2):97-102. Review.

Afternoon at the finca, and a day at the market


We spent Saturday exploring Lerida and cruising around.

Ready for adventure

We stopped at several roadside stops to buy some local fruit before heading off to La Gaviota, a local finca owned by a Brazilian woman.

buying papayas

We bought some delicious sugar mangos, along with some sweet papayas and mandarins.

enjoying sugar mangos

La Gaviota, a finca in Tolima

Now, there are two kinds of fincas in Colombia; working fincas and pure vacation fincas.  A working finca is usually a farm or an orchard – often owned by a city resident but managed locally.  This allows people who live and work in Bogota to have a get-away place that also brings in income.

one of the lakes at La Gaviota

Some of these fincas have been in peoples’ families for generations and produce much of the fruit and livestock products (dairy, meat etc) that are sold in Colombia.

Other fincas are pure recreational homes, and as such, are primarily owned by wealthier Colombians though this is not always the case.  Fincas vary from modest cabin style affairs to elaborate, ornate mansions with swimming pools, tennis courts and private fully stocked ponds.  Since most working people can’t stay at their finca very often, many owners rent out their fincas part-time.  Such was the case with the lovely La Gaviota.

the pool, surrounded by fruit trees

The entire property has been planted with fruits and trees native to Brazil and the staff encourages visitors to sample the many exotic varieties.

Yaca, a fruit native to Brazil

There is a swimming pool, and several lakes stocked with fish.  There is also a hotel, and a restaurant, where they will prepare your fresh catch.  Like many of the numerous fincas that dot the landscape here, they welcome travelers and offer services at reasonable rates.  So we spent the sunny afternoon at the pool.

The next day, we went to the market in Lerida.   We bought some more ‘tipica’ or traditional Tolidense food called lechona from a very nice young man who helps his grandmother.

young man selling lechona

While I vary from vegetarianism to veganism in the states, I never hesitate to try another delicious typical dish when I am traveling – and it was marvelous; warm, savory and flavorful.

There are several variations of lechona, which is stuffed pork but the Tolidense version uses a base of garbanzo beans for the stuffing and comes with a sweet-flavored bread stuffing called insulso on the side.

lechona

The grandmother, also invited us to come to her house where she had other tolidense specialities for sale, including tolidense tamales.

with grandmother

There were other vendors selling panela which is popular sugar product here in Colombia, (and other latin American countries.)  It’s a staple, a form of unrefined sugar produced at the local sugar cane factories in the region.  (I particularly like panela in my coffee and tea.)

panela

We met and purchased several tamales from another vendor in the market, a very nice woman who was very happy to pose for the camera.  I am ashamed to say that I forgot to write her name in my little notebook because my hands were full with all of our great purchases.

homemade tamales

in Lerida


in the mountains on the way to Tolima

Most Americans have limited exposure to Colombia, and Colombian life.  Other than media reports about drugs and violence, the majority of people’s opinions about the country have been formed by one quintessential little film of the mid-80’s…

“Romancing the Stone” – yeah, that’s right – the silly little romantic comedy with Kathleen Turner and Michael Douglas.  “Is this the bus to Cartagena?” is a line I’ve heard many, many times from people asking questions about my experiences here.

In general, like most things, Colombia is nothing like the movies.  Especially this one, since it was filmed in Veracruz, Mexico.

just outside Lerida at Sunset

But Lerida is that Colombia – the hot, humid, tropical Colombia that people think of after watching that movie.  It isn’t jungle-like here, of course,(that’s further south) but it’s an ancient city with stone buildings and some cobblestone streets interspersed among newer construction; but Lerida has the unrelenting heat and steaminess that people generally picture (and fail to find in Bogota.)  My guide tells me that the city wasn’t quite so hot – until most of the trees were removed when the streets were paved.  It makes sense since the neighboring cities (with thick tree-lined streets) are noticeably cooler.

It’s an interesting city – and more than just miles away from Bogotá – more like decades.  Life is a bit more traditional here, but that may be just the heat, and the ancient appearance of much of the buildings contributing to that perception.  Lerida was first ‘discovered’ in 1538 by Spanish conquistador Sebastián de Belalcazar who was amazed by the richness of the land, but it wasn’t officially ‘founded’ until 1777, which actually makes it technically one of the younger towns.  But as you wander the town, you see that people are still living in many of the original buildings – updated and modernized, of course.  But the original architecture with high ceiling and spacious rooms offers the advantages of cooler temperatures despite relentless sun.

As a mentioned in a previous post about Cali – motorcycles are the preferred method of travel in the warmer climes; relatively inexpensive, and good on gas – you see motorcycles just about everywhere you look; with entire families on bikes.

family on motorcycle in Lerida

Women in high heels, babies pressed between bodies, toddlers riding up front, even women riding ‘side-saddle’.

Coming from a society where motorcycles are used more as a statement than a viable mode of transportation; it takes a minute to adjust to the scene of so many bikes – it’s not a convention, they aren’t ‘bikers’, it’s just another day of running errands and going to work.

line of motorcycles

For more posts about my visits to Medellin, click here.

Road to Lerida, part 1


Had a wonderful Thanksgiving with some delightful friends yesterday.

I went to the operating room this morning with Dr. Alberto Martinez – but we will save that for later.

This post is for my good friend, Steven Morrisroe who always tells me to devote more posts to ‘everyday life’.  He’s been a big supporter of my work – so Steven – I hope you enjoy this.

Gee.. it doesn’t look that far..

The road to Lerida – part I

The most effective and efficient way to travel in Colombia is by plane; flying to Medellin or Cali is an exercise in ease – by the time the coffee carts comes around (yes, Colombian airlines take care of their passengers), it’s time to sit up your seats and prepare to land.

Not really going to Siberia (been there, done that!)

But the roads are notorious for being poorly designed exercises in endurance and frustration.  It’s something Santos has pledged to address – outlining a massive overhaul of Colombia’s infrastructure, which is desperately needed.  Despite being one of the major roads to this part of the interior of Colombia – it’s a two-lane road, hugging a hill on one side, and a dramatic cliff for the other for the majority of the journey.  While mom-and-pop restaurants and mini-markets dot the roadside, along with tiny houses and laundry lines – this is a heavily trafficked major route for the transport of goods across the country.  There are produce trucks, heavily laden pickups, buses, even several car haulers with brand-new Japanese cars all crowded together with more tanker trucks than I’ve ever seen in my life*.  At one point, I looked out the window at the road ahead and it was all semi-trucks as far as the eye could see in both directions.  It makes this little road as crowded as peak traffic in Bogotá.

this picture is actually from Honda, when traffic finally thinned out..

So much so that what should be a swift and picturesque journey becomes a six-hour crawl as the speedometer stays markedly fixed at less than 30 km/h (yes, that’s kilometers).  The only exceptions being quick bursts of pulse-raising, dare-devil maneuvers as we attempt to pass another in a seemingly continuous line of tanker trucks as we head into another blind and narrow hairpin curve.

passing, but you can’t see the motor cycle passing us..

We settle back into the agonizing crawl, behind more semis.  The line only broken when we attempt such feats as the double pass – passing a tanker truck on the far left as it attempts to pass a slower moving, more heavily laden truck. But at least, it breaks up the monotony and frustration of breathing diesel fumes and enduring the smell of hydraulic breaks being tested by the continuous grade.

this is actually a truck wash hugging the cliff

But don’t get the wrong idea – it’s still a beautiful journey and I am enjoying it immensely.  I just want you to be able to picture the chaos and flurry of activity amidst the serene surroundings.

Once you pass just outside of Bogotá – you are in the country.  Most of the trip is up and over a mountain pass – with a breathtaking view of what must be the Grand Canyon of all valleys.. It’s astounding lovely, but I was unable to get a photo of the massive verdant green valley with rivers and lakes scattered below.  It looks so much like West Virginia, that I have to remind myself where I am more than once.

Where am I?? (Answer: just past Honda)

After twisting and turning for hours – we emerge in the valley below and arrive in the city of Honda..

*My tour guide informs me that the reason there are so many tanker trucks is that despite having ample oil reserves, Colombia does not have a single oil refinery, so all the oil produced travels on this very road to be exported to the USA for refining.

Bogota’s castle


Some of you may notice that I have temporarily changed my header – to show Bogotá’s castle.  I found it the other day as I wandered some of the carerras.  (Residents of Bogotá know that once you get into the single digit carerras – all logic and inference regarding standard directions goes out the window.)  Once you cross Carerra Septima (Cra. 7) the lovely city layout that makes Bogotá such an easy place to navigate changes into a labyrinth of twisting, winding streets reminiscent of San Francisco..

It’s part of what makes the city so interesting – and at times (such as yesterday, when I was making my way to an appointment) – a bit frustrating.  Just when you think you ‘know’ the city – you stumble upon something completely different from what you were expecting..

Not what I was expecting

The castle which is located at Cra 3 – 74 was the brainchild of Dr. Juan Osorio Morales and is called Castillo Mono Osorio.   While it has the appearance of antiquity, it’s actually only about 100 years old.

Bogotá’s castle

The creator, a local eccentric – was  Colombian cultural attaché to Brussels.   Upon his return to Bogotá, he spent the next twenty years creating the castle which later served as home to his own personal theater troupe.

Like the work of many unconventional artists, after his death the castle fell into disrepair until it was rescued in recent years by one of his descendents and repaired to its current state.

It currently houses several stores including a banquet space, a gift shop and a pharmacy.  Best of all – there is currently space for let.  A new, whimsical office, anyone?

Checking in at Santa Fe de Bogota


After a year and a half – it was time to stop in at Santa Fe de Bogotá and see what was new.

Dr. Roosevelt Farjardo, MD (general surgeon) has been instrumental in implementing some of these new and exciting changes such as the ‘Virtual Hospital’ that I will be writing about (soon).  He was very nice about taking time to update me on some of his new programs at part of the Center for innovation in education and health.  Telemedicine is just the tip of the iceberg as far as some of the cool things they are doing.

Unfortunately, the same can’t be said of the International Patient Center  – or rather – I can’t report anything other than the fact that Ana Maria Gonzalez (the previous director) has left for a position in the United States and that Dr. Carolina Munoz has taken her place.

I was hoping to get some statistics and report back about some of the specialty programs for overseas travelers – but Alas!  I am unable to bring this information to you.  I waited over 70 minutes after my scheduled appointment with Dr. Munoz – and despite several calls from her staff, she never showed up and never attempted to reschedule.

I wish I could say this is an isolated incident – but I am afraid this is more like a clash of “cultures”.  I say this because I met with Dr. Munoz  previously; during the writing of the book (when she was the Director of the International Patient Center at rival Fundacion Cardioinfantil.)

At that time, (if I remember correctly, she introduced herself as a cardiac surgeon who had retired to “spend more time with her children.”)

Of course, my obvious question – was “oh, and how many children do you have?**”

I thought we were making polite conversation – because at the time, I was less familiar with Colombian customs, culture etc.   In reality, she was reminding me of her elevated stature in comparison to mine (as ‘just a nurse’).  Dense as I was – it became obvious as the interview progressed – as she made sure that I knew that she had replaced her rival (Ms. Ana Maria Gonzalez – RN) who had also worked at Fundacion Cardioinfantil in the past.  I’m sure she resented having to answer questions about the Executive Health Program and other aspects of their medical tourism program from someone she found to be inferior to herself.  (She made that pretty clear at that initial interview back in 2011).

So I guess it is no surprise that she didn’t bother to show up to our appointment this week – which is a shame, as I had looked forward to finding out more about the evolving International Patient Center at Santa Fe de Bogotá.

Luckily for me – there was another nurse there, Sandra Salazar – who could give me some basics.   She was delightful, helpful and dreadfully embarrassed about the whole thing.  She was even able to give me a list of some of the American insurance companies they have worked with in the past.  I had lots of questions about the HIPEC program, which she couldn’t answer – but she outlined the entire medical tourist process – and answered a lot of other questions.  She showed me how they streamline the process for their international patients, and the process for medical and surgical evaluations.

Now, there’s some good news for readers:  You aren’t nurses.  You are paying customers – so I am sure that Dr. Carolina Munoz will put aside any of her personal feelings (whatever they are) towards foreigners and will make time for you.

**The answer as none – as she is not married, and was not planning to be married in the foreseeable future.

Now when I am talking about culture – I am not strictly talking Colombia – America.  I am talking about Doctor – Nurse relations.  Watch some old Turner Classic Movies sometime and you will see what I mean..

Now I debated writing about this, but after talking with some other non-Colombians here in Bogotá, I felt it was important to pass it along because it illustrates quite a few things about my work:

1.  It’s not as easy as it looks (I spend a huge amount of time waiting..)

2.  Cultural differences can cause a lot of problems – so be prepared to be tolerant.

3.  If there is a chance that patients may get poor service – I want to know about it!  (And part of readers need to know about – is my experiences.)

New venture with Colombia Reports


While I have written several books about surgery and surgeons in Colombia, much of this information I’ve obtained from my research has been consigned to sitting on the shelves of various bookstores.

But, now with the help of Colombia Reports, I am hoping to change that.  As I mentioned in a previous post, Colombia Reports.com and it’s founder, Adriaan Alsema have been amazingly supportive of my work, ever since they printed my first article on Cartagena in 2010.

Since returning to Colombia, I have kept in touch with Colombia Reports while we discussed ways to bring more of my research and work to the public.  Colombia Reports is a perfect platform – because it serves a community of English-speaking (reading) individuals who are interested in/ and living in Colombia.   With this in mind, Colombia Reports has created a new Health & Beauty section which will carry some of my interviews and evaluations.

It is an ideal partnership for me; it allows me to bring my information to the people who need it – and continue to do my work as an objective, and unbiased reviewer.  We haven’t figured out all of the details yet – but I want to encourage all of my faithful readers to show Colombia Reports the same dedication that you’ve shown my tiny little blog, so that our ‘experiment’ in medical tourism reporting becomes a viable and continued part of Colombia Reports.

This is more important to me that ever – just yesterday as I was revisiting a surgeon I interviewed in the past (for a new updated article), I heard a tragic story that just broke my heart about a patient that was recently harmed by Dr. Alfredo Hoyos.  While I was unable to obtain documents regarding this incident – this is not the first time that this has happened.

Previous accusations of medical malpractice against this surgeon have been published in Colombian news outlets including this story from back in 2002.

The accusations are from Marbelle, a Colombian artist regarding the intra-operative death of her mother, Maria Isabeth Cardona Restrepo (aka Yolanda) during liposuction.  These accusations were published in Bocas – which is part of El Tiempo, a popular Colombian newspaper, in which the singer alleges that Dr. Hoyos was unprepared, and did not have the proper equipment on hand to treat her mother when she went into cardiac arrest during the surgery.

story about the death of one of Dr. Alfredo Hoyos' patients.

story about the death of one of Dr. Alfredo Hoyos’ patients.

Kristin 002 Kristin 003 Kristin 004

Now – as many of you remember, I interviewed Dr. Alfredo Hoyos back in 2011, and followed him to the operating room, giving me first hand knowledge of his surgical practices.

Readers of the book know he received harsh criticism for both failure to adhere to standard practices of sterility and patient intra-operative safety (among other things.)  I also called him out for claiming false credentials from several plastic surgery associations – and notified those agencies of those claims..   In the book, readers were strongly advised not to see Dr. Hoyos or his associates for care.

But – as I mentioned, my book is sitting lonely on a shelf, here in Bogotá – and in the warehouses of Amazon.com and other retailers.. So, people like that patient – didn’t have the critical information that they needed..

This is where Colombia Reports – and I hope to change all that.   So in the coming weeks, I am re-visiting some of surgeons we talked to in 2011, and interviewing  more (new) surgeons, more operating room visits..

The people of Bogota


I’m actually out of the city for a few days – but during my long flight, I reflected on some of the reasons I enjoy this city so much.

Why do I enjoy Bogotá so much?

Well, the people, of course!  Now, I know that people are shaking their heads – but for a small-town girl like me,  a cosmopolitan city like Bogotá is very exciting indeed.   So many festivals, events, galleries and museums**.

But it’s the people who are the heart of the city – and what really brings it alive.   Just this week, I had the opportunity to rub shoulders with and talk to a Colombian film director, a geo-petroleum engineer, a civil rights (labor) attorney  and one of the executives of Caracol.   It’s just that kind of town – like Washington D.C. but down-to-earth and accessible.  [Now, my little eight-year-old friend, Flavia has met President Santos just walking on the street one day, but I haven’t.]  But there are still wonderful opportunities to meet and talk to interesting people who I might not cross paths with in my ‘normal’ life in the hospital.

For example, I found myself sitting next to the film director, Andres Barrientos at a birthday party for a mutual friend. (Of course, the guests at the party were a like a small UN delegation – but less protocol and more fun;  it included Colombians,  two delightful ladies from Venezuelan, a British gentleman, and the guest of honor – another American like myself –except for her beautiful Argentinean Spanish.)  These are all just people and friends I have made wandering around the city..

Of course – talking about the ‘extranjeros’ or foreigners living in Bogotá is an entirely different topic – and one we will get around to one of these days.  But as I chatted with the very normal, very nice Mr. Barrientos (and he politely refrained from laughing at the ridiculousness of my YouTube efforts), it made me consider how many film producers I met in Danville, Virginia, Mexicali, Mexico or Reno, Nevada during my various moves.  (The cumulative answer is: Zero.)  And why would I – on the streets of my small southern town?  But Bogotá is a different matter entirely – it is a global city, with its tenacles on the pulse of Colombia, Latin America and the world.

Global positioning and perspectives

Talking with labor attorneys and several petroleum company officers just brings home some of the amazing lack of insight we (as North Americans) have on some many issues affecting the rest of the world – and our roles within this context.

While Americans are often accused of being willfully ignorant – this just isn’t true.  The reality is that: we are intentionally blinded as citizens to much of the outside world.  I mean, I make a continuous, specific concerted effort to find English language information about issues facing Latin America (for this blog) and it is exceedingly difficult.

What we do see on CNN, BBC and our nightly news and read has already been translated (and censored) for our consumption.  As a result – if it isn’t a  sensationalized report about a bomb going off somewhere – or a huge drug seizure, then there just isn’t much information available – whether we are talking about our southern neighbor, Mexico, the economic powerhouse of Brazil, Colombia, Peru, Chile or any of another dozen countries.

But when you live somewhere like Bogotá – you become more globally informed just by meeting and interacting with all of your fellow Bogotá residents – from UN representatives, other foreign nationals on down to your every day taxi driver.  (Always talk to the taxi drivers – they are usually exceedingly nice, have a wealth of information and different perspectives on everything from affordable healthcare, the American presidential elections, the environment and Latin American economic policies.  You will be surprised what you will learn.)

That’s just something I can’t get on Main Street, Danville, Virginia..

**Speaking of which – they are offering my book for sale at the Festival de Librarias in Parque 93 this weekend.

Sunday in Usaquen


Sunday streets open for pedestrians

Since I am always talking about Sundays in Bogotá – I thought I would post some photos..

Today we walked along the streets (Carrera Septima) to enjoy the sunshine in Usaquen.

Streets closed to auto traffic to allow Bogotanos to enjoy the city, walking, on bikes, skates, skateboards – and strollers as families enjoy the sun.

We walked to the marketplace and enjoyed the park.  (One of things I particularly love is that when you go to the park – kids are playing soccer, not with their iPhones..  (of course they have iPhones- they just put them aside for a few hours.)

Flavia in park,, kids playing in background

Teaching Flavia some basic gymnastics today – cartwheels, handstands and such..

in the park

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

vintage rides in Usaquen

This guy was minding his own business – but he just looked cool (James Dean style)..

 

 

you can see the tips of the marketplace stalls (white tent tops)

 

Thoracic surgery and sympathectomy


Clinica Palermo,

Dr. Luis Torres, thoracic surgeon

I went back to see Dr. Luis Torres, thoracic surgeon and spent the day in the operating room with him for a couple of cases.   He is a very pleasant, and friendly surgeon that I interviewed last week.  Dr. Torres just recently returned to Bogotá after training in Rio de Janeiro for the last several years at the Universidade de Estado de Rio de Janeiro.  He completed both his general surgery residency and thoracic surgery residency in Rio after graduating from the University de la Sabana in Chia, Colombia.  (He is fluent in Spanish and Portuguese).

I spent some time out in Chia last year with the Dean of the medical school (and thoracic surgeon, Dr. Camilo Osorio).

The first case was a sympathectomy for hyperhidrosis.  I’ve written more about the surgical procedure over at Examiner.com, and I will be posting more information about the procedure – potential candidates and alternative treatments over at the sister site.

 

The second case was more traditional thoracic surgery – a wedge resection for lung biopsy in a patient with lung nodules.  **

In both instances, cases were reviewed prior to surgery, (films reviewed when applicable – ie. second case) and visibly posted in the operating room.  Patients were sterilely prepped, draped and positioned with surgeon present.  Anesthesia was in attendance for both procedures – and hemodynamic instability/ desaturations (if present) were rapidly attended/ addressed / corrected.

Dr. Torres utilized a dual-port technique for the sympathectomy, making 1 cm incisions, and using 5mm ports.  Each side (bilateral procedure) was treated rapidly – with the entire procedure from initial skin incision and application of final bandaids taking just 35 minutes.

Dr. Torres, performing VATS

The second case, proceeded equally smoothly, and without complications.  There was no significant bleeding, hypoxia or other problems in either case.  Surgical sterility was maintained.

** Both patients were exceedingly gracious and gave permission for me to present their cases, photographs etc.

Just as the second case ended – Dr. Ricardo Buitrago arrived – and performed a sympathectomy on one of his patients – using a single-port approach.  (I am currently working on a short YouTube film demonstrating both of these techniques.)

New International Terminal to open October 18th


Returned to Bogotá after a conference, and I am happy to report that the massive airport construction project at Bogotá Airport (El Dorado International Airport) is almost finished.  The first flight from the new terminal will be on October 17th – with full operations commencing in the new terminal on October 18th, 2012.

As one of the busiest airports in Latin America – and a hub for Avianca, Copa, LAN, Satena and EasyFly – (offering 6,000 flights per week on Avianca alone) this new terminal will ease congestion and improve traveler comfort..  I am flying out again later this month – so I will update everyone on all the details soon.

Want to wait in style?  Check out the VIP lounges.

Bogota revisited


Finishing my first week in the doctoral nursing program before heading back to Bogotá in mid-September.  (I’ll be keeping in touch with my professors via Skype, Scopia and a variety of on-line media.)

I am exciting to be coming back to a city that I have come to know and love!  In fact, my only regret is that I didn’t devote enough pages of the book to the city itself.  At the time, I rationalized that people who were interested in the city would be able to find plenty of information in the existing travel guides (and I am not a traditional travel writer) – so I devoted myself wholeheartedly to medical tourism, hospitals and surgery.  But as time has passed – I regret not sharing the city more with readers, since after living there for almost six months (and traveling all over the city daily), I certainly became intimately familiar with much of it.

So, readers will be happy to hear that I haven’t made that mistake with my latest book on Mexicali, MX – but I am just happy to be going back to Bogotá, a city that truly has captured my heart..

It’s insidious, you know.  The things that I initially didn’t like (like the ‘eternal autumn’ weather) become some of the very things that make me enjoy the city so much.   Bogotá is a city that has to be ‘known’ to really be appreciated.  If you don’t scratch beneath the surface of this vibrant, amazing place, then you really won’t see (and love) the city.

For example; that cool, mild weather, that had me groaning the first few weeks also made it possible for me to spend much of my time outdoors – exploring the city, walking miles everyday.  Spend a week sweltering in Cartagena (or Mexicali, in August, for that matter) and you will see what I mean.

The food that seemed plain and unspiced at first, became something to savor.  All of the exotic and tangy fruits, and ‘real’ food taste – unmasked by heavy additives let me appreciate how wholesome and unaltered it really was.  It made me appreciate the subtlety and complexities of the meals I was enjoying.  (If you drown everything in ketchup or hot sauce – what are you really tasting?)

So, in just a few weeks – I will be back in this wonderful, charming, whirlwind place that has claimed a little corner of my heart.

Why read Bogota and other hidden gem titles?


 

As readers of my sister site, Cartagena Surgery know, I am currently hard at work on my third title in the ‘Hidden Gem’ series – with the latest offering on Mexicali, Mexico.  But I continue to get comments from readers, friends, and everyone else asking, “Why bother?”

Why bother reading Hidden Gem?

People should read these titles because we can’t assume that all medical providers have been vetted, or that all medical facilities meet acceptable criteria for safe care.  It is a dangerous assumption to expect that ‘someone’ else has already done the research. [lest you think this could only happen in Sri Lanka, be forewarned.  With new legislation, the critical doctor shortage in the USA will only worsen.]

Medical tourism has the potential to connect consumers with excellent providers around the world.  It may be part of a solution to the long waits that many patients are experiencing when seeking (sometimes urgent) surgical care.  It also offers an opportunity to fight the runaway health care costs in the United States.

But..

But it also has the potential, if unchecked, unvetted, unverified and left unregulated to cause great harm.

Another reason to read Hidden Gem is to find out more about the surgeons themselves, their training, and many of the new, and innovative practices in the realm of surgery. Often the best doctors don’t advertise or ‘toot’ their own horn, so you won’t find them advertised in the pages of your in-flight magazine as “One of the best doctors in XXX” even if they are.  (Many people don’t realize those segments are paid advertisements, either.)

Why bother writing Hidden Gem?

Because ‘someone’ needs to.

I am that ‘someone’ who does the fieldwork to find out the answers for you.  I can never assume that it’s been done before, by someone else.  I have to start from ‘scratch’ for every book, for every provider and every hospital.

I also believe that the public should know, and want to know more about the people we entrust to take care of us during serious illness or surgery.  We should know who isn’t practicing according to accepted or current standards and evidence – and we should know who has/ and is offering the latest cutting edge (but safe and proven) therapies.

 

Read more about the doctor shortages:

NYT article on worsening doctor shortage  (and one of the proposed solutions is a loosening of rules governing the training and credentials of doctors from overseas – coming to practice in the USA).

Hospital ranks and measures: Medical Tourism edition?


It looks like Consumer Reports is the newest group to add their two cent’s worth about hospital safety, and hospital safety ratings.  The magazine has compiled their own listing and ratings for over 1,100 American hospitals.  Surprisingly, just 158 received sixty or greater points (out of a 100 possible.)  This comes on the heels of the most recent release of the LeapFrog results.  (Leapfrog is controversial within American healthcare due to the unequal weight it gives to many of its criterion.  For example, it is heavily weighed in favor of very large institutions versus small facilities with similar outcomes.)

Consumer Reports has a history providing consumers with independent evaluations and critiques of market products from cars to toasters since it’s inception in the 1930’s.  It’s advent into healthcare is welcome, as the USA embraces new challenges with ObamaCare, mandated EMRs, and pay-for-performance.

While there is no perfect system, it remains critical to measure outcomes and performances on both an individual (physician) and facility wide scale.  That’s why I say; the more scales, scoring systems and measures used to evaluate these issues – the better chance we have to accurately capture this information.

But – with all of the increased scrutiny of American hospitals, can more further investigation into the practices and safety at facilities promoting medical tourism overseas be far behind?

Now it looks like James Goldberg, a bioengineer that we talked about before, is going to be doing just that.  Mr. Goldberg, who is also an author of the topic of medical tourism safety recently announced that his firm will begin offering consulting services to consumers interested in knowing more about medical tourism – and making educated decisions to find the most qualified doctors and hospitals when traveling for care.  He may be one of the first to address this in the medical tourism industry, but you can bet that he won’t be the last..

If so, the winners in the international edition will be the providers and facilities that embrace transparency and accountability from the very beginning.

New series of articles


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.

UK surgeons add their voices to speak out against Medical Tourism


As we’ve written before, local plastic surgeons are fighting the loss of income from medical tourism.  In the UK, where 1 in 20 patients (in one poll) have used medical tourism, are adding to the dissentThis isn’t the first time British plastic surgeons have spoken out against medical tourism – in fact, British physicians were the first ones to publish commentaries against the practice of traveling overseas for surgery in professional journals.   Last year, they released a statement condeming this practice.

Now, these surgeons are speaking out in the popular press.  The irony is, while these statements are primarily aimed at people travelling to India – as readers of our sister site know, they just as easily could apply to the United States (and our large contingent of ‘phony docs.’

But how much of this is real?  and how much of this is hype to boost their own sagging practices?  It’s hard to know since much of the ‘data’ is based on polls of UK plastic surgeons.

In related news, Las Vegas has started a new task force to weed out phony/ fake doctors operating in the hispanic community after several highly publicized incidents – including several deaths.

More stories from Cartagena Surgery:

How to investigate a potential surgeon

Busting a fake clinic in Los Angeles

Unqualified Arizona doc heads to trial after several patient deaths

The ‘fix a flat’ doc

The original fix a flat doc story

Follow cartagena surgery for more stories..

Looks like Panama may bite off more than they can chew..


In a recently published story, the government of Panama is now offering medical  insurance for all tourists to Panama for free.  This insurance is not  ‘Complication Insurance’ which is offered by private surgeons in Colombia and other countries for patients traveling specifically for medical tourism.  Complication insurance covers all possible medical complications resulting from medical procedures at the designated clinic or destination..

No – Panama is taking the European and socialized medicine approach and is offering general medical coverage for ALL short-term travelers to Panama.  (The long-term exclusion is a wise move given the numbers of Americans and other overseas residents who make Panama their retirement home.)  This insurance resembles typical travel policies in that it covers injuries, accidents and other medical situations that may occur while on vacation..  I just hope the Panamanian government hasn’t underestimated its tourists and their injury/ illness potential.

Now readers – don’t get any wild ideas.. This is not the time to stress that ‘trick knee’ while hiking to visit the Naso-Teribes..

Meanwhile, Costa Rica is making a pitch for more corporate clients such as Pepsi-Cola.  These multi-national corporations can potentially bring hundreds of millions of healthcare dollars by diverting their employees to medical tourism destination such as Costa Rica.  (Like Colombia – Costa Rica is an ideal destination for North Americans due to proximity, quality and diversity of services available.)

Now available in the Kindle Lending Library!


Now you can read Bogotá! for free in the Kindle lending library..  (I hope this inspires some generosity among critics for impoverished medical writers – leave some positive feedback about the book!!)

 

 

The future of medical tourism: the glass ceiling


The International Medical Travel Journal has a new article that questions the notions that ‘the sky is the limit’ in the medical tourism industry.  This article discusses the belief that many investors have that as long as there is a new shiny facility, medical tourists will flock..  In reality, the market for medical tourism is fairly narrow, particularly for American medical tourists – who are the ones most likely to open their wallets and pay cold hard cash for surgical procedures overseas.  (That’s because medical care in many other countries is less expensive for residents – so why travel and pay cash for something you can get at home for relatively little expense (even if it requires waiting.) Many of these Americans are uncomfortable or unwilling to travel to more exotic locations – as Dubai has found out first hand.

Of course, plastic surgery and other elective procedures are a little different.)  But most Europeans, Canadians etc.  aren’t going to have to fork over 100,000 for heart surgery (or be uninsured) so the pool is limited.

The other class of medical tourist – the wealthy residents of countries that may not have elite services is also a mixed bag,  Many of these patients are going to elect to go to ‘big name’ American facilities despite the cost – for a specific level of care.  They may seek out specialized procedures that are unavailable or even illegal in their home countries – but that market is smaller than most of us realize.

It’s a good article that brings a dose of reality to the concept of medical tourism as a ‘cash cow’ route to easy and limitless cash.  Medical tourism is not for everyone, as investors are finding out.

HIPEC: the latest research results


If you remember, previous New York Times articles questioned the efficacy of hyperthermic chemotherapy given during cytoreductive surgery.  We promised to investigate, and return with more results to this question.

Recently several articles have been published on the topic, including this one – in the journal of Clinical Oncology.  This narrative by Maurie Markman talks about the quick dismissal of HIPEC by many oncologists, particularly for larger tumors – and he questions the wisdom of this approach in light of recent research results.

In fact, several large new American studies – including one at Case Western are examining the use of HIPEC, particularly in gynecological cancers like ovarian and uterine cancers which carry a dismal prognosis.

American Hospitals are finally jumping on the HIPEC bandwagon…

Detroit hospital offering HIPEC

Atlanta docs, robots and HIPEC

This last link isn’t really news – it’s a press release, but since it’s on a surgical oncologist (Dr. Wilbur Bowne) who was an early American adopter of HIPEC, I thought readers might be interested.

Previous Bogota Surgery posts on HIPEC

HIPEC: The basics

Bogota Surgeons stay ahead of the curve

The Future is Now: HIPEC

Looks like it’s about time to check in with our favorite surgical oncologist, and HIPEC expert, Dr. Fernando Arias..

Check back soon for more..

Colombian life: an outsider looking in..


There’s a great blog here on WordPress that I wanted to recommend to anyone interested in Bogota – and all things Colombian.  The blog is called The Wanderlust Chronicles and it follows the life, and adventures of Kate – a young teacher / translator (who reminds me a bit of myself).  I do have to say – that as I ‘cruised’ around the site, reading her posts – tears almost came to my eyes, and I became wistful for all the things I loved and enjoyed about my time in Colombia.

For everyone else –

It’s a great reference for all of you who want a bit of a different vantage point (nonmedical) on the beauty of Colombia and Colombian culture.  I hope you enjoy!

Medical Tourism Forecast for 2012


Where is Medical Tourism & Travel headed for 2012?   Predictions vary according to sources, but all sources expect the medical travel phenomenon to continue, unabated.

Maria Lenhart at the Medical Travel Report (a private travel company blog) estimates 35% growth over the next year, based on Deloitte statistics.

Where are they going?  According to Depak Datta of the Medical Tourism Corporation – for the most part, people are staying fairly close to home..  Meaning that people from the United States and Canada favor locations in the Western Hemisphere over Thailand, India and other destinations popular with Europeans, Africans and Asians..

Domestic medical tourism remains a popular option with American corporations who are sending their employees to large, well-known facilities within the United States.

In fact, large American healthcare institutions often have the most to gain from medical tourism via international affiliations with institutions in South America, India,  and Asia.  John Hopkins, Cleveland Clinic, Duke, Harvard and several other well-known top-tier American medical giants have branding agreements and other lesser affiliations with hospitals and clinics across the globe.

In the midst of this growth, concerns over patient safety and quality of care should remain at the forefront (in all facilities – domestic and international.) But until more potential customers demand (or even display any interest) in quality, and safety issues – the industry is not going to go out of its way to provide this information.

Colombian government steps up..


In a surprising but admirable move, the Colombian government has announced that it will pay for the removal of PIP implants.    As we discussed at our sister site, Cartagena Surgery, recent disclosures that the French company knew their breast implants were defective as far back as 2005 has sent shock waves of outrage through the medical community.  Further disclosures that the implants contained substandard construction grade materials (not medical grade) and fuel additives which contributed to the exceedingly high rupture rate (7% versus an average rate of 1% for all other implants) has important health implications for women world-wide.

In the wake of this scandal, hundreds of thousands of women across the globe, particularly women in Latin America where the implants were heavily marketed, have been panicking and storming physicians’ offices for answers.

(In a related post at our sister site – we reassured readers who received implants in 2011 by some if the surgeons profiled here..

With the French government advising over 30,000 french recipients of these implants to have them removed promptly, this goodwill gesture by the Colombian government should go far to reassure and calm Colombian women.

Update: 14 Jan 2012

Medpage Today just published a nice comprehensive article on the Poly-Implant Prostheses (PIP) implant controversy.  It’s a good story for people playing catch up on this story – and wondering if they may be affected by this news.

2011 in review: State of the Blog


Thank you to everyone for making Bogotá Surgery.org a phenomenal success!  Surprisingly – this annual report shows a few less views than our own counters – but we are thrilled all the same..  Here’s hoping for more and greater successes in 2012!

Here’s an excerpt:

The concert hall at the Syndey Opera House holds 2,700 people. This blog was viewed about 9,700 times in 2011. If it were a concert at Sydney Opera House, it would take about 4 sold-out performances for that many people to see it.

Click here to see the complete report.

Feliz Navidad and Happy Holidays, my friends!


Click here to see a photo array (presented by Colombia Reports) showing the lights of Christmas time..

You can find more information about Christmas, Carnival and other festivals year-round in Bogotá at this webpage here.

Wishing all of my readers and friends a happy holidays and a healthy new year!

The Motley Fool & Medical tourism


The Motley Fool takes on medical tourism.  For you aren’t familiar with this site, it’s a very popular financial blog with stories on the economy, popular stock picks, predicted trends and investment strategies for retirement planning.  I am only passing familiar with the site myself since I come from a family of economists, but you can imagine my surprise (and delight!) to see medical tourism given serious consideration and discussion on their blog.

It’s about time that people talk about medical tourism in a fair and realistic fashion.   It tends to be sensationalized in extremes either fantastic! amazing! awesome! extreme plastic surgery makeover style or devastating.  graphic. and disturbing horror stories.

But this is a more rational and balanced discussion of health care and medical tourism – by the numbers, so to speak.. and it’s about time.

Por la navidad…


Perdoname porque mi espanol es un poco malo pero me gustaria dar vosotros una regalos por la navidad. Por todos mis amigos quien de leimos en espanol :

Ahora, en Smashwords.com – es un promocion por este libro – Bogota! una guia de quirofano. Este descuento es 25% cuando usas codigo TA47T.

Ir a Smashwords rapido! porque este promocion es corte – solomente desde ahora a 17 de enero.

I apologize to all my Spanish readers – my written Spanish is even worse than my spoken words.  (Luckily, I hired an excellent translator, Sra. Ochoa for the spanish edition of the book.)  Happy Holidays, and here’s wishing we all enjoy the best of health in 2012.

Bogota receives high marks from the Boston Globe


Ivy Hughes at the Boston Globe recently discovered the charms and attractions of this fair city in a feature article published  today.  She reviews some of the most popular sites and scenes of the city, while dispelling many of the myths surrounding Colombia and enjoying the Transmileno experience..

In other city news, Colombia Reports just published a new story on the development of a new plastic surgery center – catering to the needs of medical tourists.

I also wanted to thank everyone – we recently reached over 10,000 visits – in just the few short months since we started this site..

Hopefully, in the future, I’ll be able to afford to make this, (and the sister sites) ad free for less distractions..

Bogota’s LBGT community, tolerance and gender reassignment surgery


Here’s the link to a nice story published on Off2Colombia as part of a press release for the city of Bogotá.  It’s a nice article (and video) that shows the diversity of this beautiful city.  As someone who lived in Bogotá for several months – I have to say that everything about this story is very true – and people in Bogotá are very friendly, warm and welcoming to EVERYONE.

Just another interesting facet of this lovely, fascinating and teeming city in the Andes..