the price is perfecto

Felipe, over at The Zapata Tales, has some strong opinions about what he likes (and does not like) about Mexico.


Mexican medical care, he likes.


Me, too.


While I was prone on the gurney awaiting surgery, I had little to occupy my mind.  So, I thought about what any red-blooded American thinks about under similar circumstances.  What is this going to cost me?


I do not have health insurance.  There is no need to go into the reasons I chose this course, other than to say I do not expect other people to pay for my food and housing, why should they pay for my medical bills?


If I had the same injury in Oregon, I would probably pay around 16 to 25 thousand dollars just for the surgery.  Or so I guessed, based on my litigation experience. 


Two days in the hospital would cost maybe an additional three grand.  So, maybe $28,000.  (My sources indicate my guess is within the margin of error.)


When I was getting ready to leave, my angel flew in with a credit card slip for my signature.  I knew that Mexican medical charges are reasonable.  I have had treatments during the last year down here.


So, imagine my surprise when I looked down at the credit slip to see -- $60,611.11!


It took me a moment to remember I was in Mexico.  The bill was in pesos, not dollars.


In US dollars, that seemingly large bill dwindles to just under $4,500.


For the price of a cruise, I was treated as royalty for two days, had my bones photographed, and was given a reconstructed right ankle -- along with some rather stylish bandaging.  All at free market prices. 


80% less than the same care in The States.


If I had chosen a hospital that did not cater to upscale expatriates and upper middle class Mexicans, the bill would have been much less.


In truth, I would have preferred the cruise.  I undoubtedly chose the wrong door while visiting Monty Hall.



Of course, I will get to do some of my own price comparisons when I return to Oregon in just over two weeks.  That should be an interesting experience.  I had best reload my credit card.


When the doctor released me, he asked me to see him in two weeks to have my dressings changed.  I intend to do that at the start of next week.


I may then have a better idea how long I am going to be spending on crutches.


There must be another adventure waiting out there.

room with a vista

My surgery was exactly what I would expect from medical services in a high-quality hospital in The States.


My hospital room was what I would expect from a Milan boutique hotel.


Comfort.  Clean lines.  Able bilingual staff willing to please.


From what I could see on my floor, each room was private with a nifty adjustable bed right out of the Sharper Image catalog.  A pullout sofa for family members to spend their days and nights with the patient.  A private well-appointed bathroom. 


And a view of the sea front -- or of the buildings between the hospital and the sea.
 

Let me get one point out of the way.  Several of you have been asking if I have much pain.  The answer is: very little.


From the moment I received the epidural, I have felt only a slight irritation around my ankle.  Even after my recent two falls.  And for that I am thankful.  For the lack of pain, that is.  Not for the falls.


During my overnight recovery the doctor thought ahead to install a syringe filled with a strong pain killer in my back -- just in case I was in severe pain.  I am pleased to report no one needed to push the plunger.


But the moment the nurse put me to bed, I was bored.  My book (Masters and Commanders: How Four Titans Won the War in the West, 1941-1945 -- a good read) was in the truck -- a mile or two away.  My computer was in my hotel room -- just across the street from the hospital, but it may as well have been on the moon.


So, I took out the reporter's note pad I carry with me, and started jotting down memories of the day.  In between moments where I would simply pass into sleep.


In the middle of the night, it hit me.  My hotel room!  I was scheduled to check out at noon. 


When I woke up that morning, I watched the hours tick over.  I had two problems: (1) checking out of the hotel and (2) getting my computer to give a valid credit card number to the cashier and to start contacting friends to figure out my escape plan.


And then an angel* appeared.  She was part of the hospital staff that ensures all paperwork is completed -- especially payment information.  For me, she was the equivalent of a Milanese concierge.


I explained my dilemma.  If I could reserve another night at the hotel, that would give all of us time to work out the financial and transportation issues.


She checked.  Every room was filled for semana santa.  I was a veritable Mary and Joseph.  No room at the inn.  (OK.  Wrong story.  But same book.)


She then offered to check me out of the hotel and to bring my computer and luggage to me.


When the computer arrived, I started contacting friends to see if I could put together a plan to escape the hospital's gravitational pull.  And you all know how that part of the story turned out -- with the intervention of my friend, Lou.


My angel then arranged to let me stay at the hotel for another night -- at rates far less than my imagined Milan boutique hotel.


Everyone complains about hospital food.  My four meals were a nice balance between fruit, vegetables, and protein.  Well-presented and far better tasting than most restaurants I have encountered in Mexico.  That is not to denigrate Mexican restaurants; it is to compliment the hospital.


But that does raise the question of price.


A great topic for tomorrow.

* - There is more to that term than meets the eye.  If you want to hear a more personal story, let me know.  This post is probably not the place for it.

adventures in surgery

As I wrote on Saturday, I have had little personal experience with hospitals.


That is no longer true.  I am now a scarred veteran.


When we arrived at the hospital, two orderlies rushed a wheel chair out to the van.  As it turned out, that was probably not the best approach.


As long as I was prone, no pressure was on my foot.  As soon as it dangled, though, it hurt.  A lot.  A quick look at the x-ray at the top of the post shows why.


Like all hospitals,San Javier wants to be certain whoever comes through the front door can pay for services when they exit.  I do not have health insurance.  That caused a bit of a stir.  In fact, the stir was still under wsay the next day.


But only a slight one.  After realizing I had a credit card number, an orderly rushed me off to x-ray where it became apparent I had not suffered a mere foot displacement.


X-rays in hand, I was off to the emergency room to be examined by the doctor on duty.  She took one look at the x-ray and contacted an orthopedist -- telling me he was on the way.


I have heard "on the way" a lot in my 61 years.  In hospital parlance, it can mean almost anything.  In what seemed to be almost germanic efficiency, there he was.  A short, elderly man who could have played the role of my grandfather -- if I were still the 20-year old I attempt to be.


In perfect English, he told me I had fractured my right tibia at the head and had separated my ankle bones.  There was no possibility of simply re-setting it.  I needed surgery.  And I needed it now.


I asked him to brief my friends, who were still awaiting word in the admission area.  He did.


Then, much to my surprise, he allowed all three of them into the emergency room.  They were interested in what was going to happen, but their ship was about to leave.


I wished them bon voyage, and then I was -- alone.  In a city where I knew no one.  In a culture that is based on the assumption that family members will be present to assist hospitalized patients.


That is when the hospital staff performed admirably.  In a mixture of Spanish and English, I let them know the information they needed to know (sometimes repeating the same information to several staff members), and they told me what was about to happen.


The anesthesiologist did not give me a general anesthetic.  Instead, he gave me an epidural that numbed me from the waist down.


During the surgery, I drifted in and out of sleep.   When I was awake, I watched the surgery on my foot.  The staff attempted to pull the sheet up to obstruct my view, but I saw quite a bit.  And wish I had seen more.


To me, the surgery seemed brief.  But it took over two hours to install the screws and pins that will help my old bones to mend.


Tomorrow I will show you my hospital room.  Or, at least, I will write about it.

what lies beneath

There will be a break in the hospital tale to share a little safety tip with you.


Everywhere I have lived has had its share of things that creep and crawl.  However, the two places I have lived in Mexico have been well-situated to afford some up-close and personal experiences.


Saturday offered another.


I was trying to open a jar of chipotle salsa.  Mexican food manufacturers must seal their jars using zero atmosphere.  The lids will usually not budge without using all of the tricks I learned from my father to open recalcitrant jars.


I had tapped.  I had twisted.  I had put the lid under hot water.


The next step was the dish cloth as a friction piece.  Without looking, I picked up the dish cloth -- and something fell in the sink.  Something that did not like being disturbed.


It may appear small, but that centipede is about two inches long.  And he was not pleased to be out and about.  At least, not in the sink.


Rather than dispatch him, I grabbed my camera.  And once again proved thart I need to learn how to use my closeup function.  But you get the drift from the photograph.


I thought about picking him up to release him.  Then I remembered being told that these little beauties have a venom that rivals a scorpion sting.  True?  I have no idea.  but I was not going to offer up my hand as a testing lab.


Begging his pardon, I took two dinner knives (awaiting washing) and divided him into three equal parts.  And each part started running for cover.  That is some nervous system.


Not every tale has a moral.  But this one does.


Look before touching folded items.  Many an enemy can hide within.


At least, I did not have a new hospital tale to add to the one i have interrupted.

one for the road

I know next to nothing about hospitals.


At least from personal experience.


I was born in one.  At 4, my skull fracture was treated in the same hospital.  In high school, my tonsils were removed in another.


But I know a bit about medical care.  Two decades of poring over other people's medical records for litigation, tours of hospitals, and deposing doctors has taught me something.


Or I thought it had.

Just like a play, being a member of the audience and being a member of the cast are two different experiences.  Too different.


When I broke my ankle, one of the first questions the guides asked was where I wanted to be taken.  There I was -- a stranger in town, not knowing anyone.


The question would have stumped me had I not seen a hospital the night before while looking for my lost bank cards.


San Javier Marina Hospital had the look of one of those boutique hospitals that spring up next to high rise condominiums in tony neighborhoods.  The type of place where you could leave a good portion of your children's inheritance.


It had three advantages for me: location, location, location.  Just like the old real estate joke.


It was across the street from my hotel.  It was one block from the cruise ship dock (for my friends).  And it was about a mile or two away from the disco where I parked my truck when we went ziplining.


The guides loaded me into the van -- after my rather melodramatic parting speech.  And down the hill we started.  To the hospital.


But, this is Mexico.  We were all part of a tour that included a free tequila tasting.


OK.  We were part of a tour that had an agreement with a tequila distributor to ensure that the zipline tourists stopped at the tequila store for a shot -- and the marketing opportunity to take home a genuine bottle of local tequila.


The driver asked if anyone wanted to stop.  Hands shot up like a Russian election.  They then asked if I objected.  Of course, I said: go right ahead.  My foot was not hurting too much.


But it did bring back a memory.  In the early 1970s, a group of us regularly skied Mt. Hood.  We were in our 20s, and knew no danger.


While hotdogging on a jump and somersault, my friend Leo gashed the back of his head with his ski.


The ski patrol gave him first aid and told us to get him to a hospital near our homes as soon as possible.  So, off we went on our mission of mercy.


One of our ski traditions was to stop at a burger drive-in for dinner at a small town at the base of the mountain.  And, being young people of a pre-postmodern era, we honored tradition -- especially those dealing with food.


Leo was fine with it.  His girlfriend (now his wife) was not.


But we got him to the hospital.  And we are all still friends.


So, Theresa -- I guess Karma has had its say in the great stopping for refreshment lottery.


Tomorrow, I will tell you a bit about the surgery.  I will warn those of you of an empathic nature, eyes may be averted.


For the rest of you, that is merely a come-on.

highs and lows

Today has been a rather odd day -- literally filled with ups and downs.

Yesterday I related the tale (back to school) of our church's donation of a classroom to the primary school in Villa Pinal.

Today was the dedication ceremony for the building.  Lou stopped by on his motor bike to drive me over to the ceremony in my truck.  We had planned on driving to Manzanillo later in the day.

One of the more obvious traditions that Spain left to its colony Mexico is pomp and circumstance.  If there is a ceremony, it will be as formal as the circumstances allow.

This one was no exception.  Not only were the school officials there, the local political figures also showed up.  With plenty of formal introductions and conversation.

I have seen the exact same behavior during my years in Great Britain while attending military functions.  There is no familiar first-name American back-slapping.  It is all about titles and station.

And, of course, the scheduled starting time slipped past with no concern.  There was formal socializing to be conducted.

Even in this small village, the chairs were decorated for the dignitaries with a formal table cloth for the refreshments.  We were even greeted by white-gloved children in uniforms.  I almost felt as if I could be the King of Spain's third cousin.

At the appointed time, the children lined up in formal rows and a color guard presented the Mexican bandera -- along with the long version of the Mexican national anthem: Himno Nacional Mexicano.  A rather rousing tune, rendered with the gusto and tunelessness of children.


A young girl then led all of us in the pledge of allegiance to the Mexican flag.


I did not see one postmodern hesitation by anyone.  Everyone saluted in the stiff right arm Roman salute, and recited the pledge from the heart.


Mexicans love their flag.  They love their country.

Seven-year old Antonio then stepped forward and read a letter (that was almost as large as he is) to the representatives of San Patricio by the Sea -- telling us how much the children appreciated the classroom, and what it means to the community.


Antonio has the makings of a community leader.  He read solemnly and deliberately.  But there was nothing mechanical or teleprompted about his message.


He said what he meant -- and meant what he said.  (If that is not too Seussical.)


The ribbon on the front of the building was cut.  Our pastor said a prayer.  And the ceremony was over.


At that point, all formality disappeared as we chatted and ate an incredible fruit salad along with cookies.  For this community, it was the equivalent of champagne and caviar.  And far more appreciated.


Lou and I, along with another friend who required an x-ray, then headed south to Manzanillo.  It was nice to be a passenger and see the landscape that zooms past me on my weekly drives.


I had two tasks: pick up my mail and buy a few groceries.  After buying some gasoline for the truck, my pre-injury peso supply was exhausted.  I will now ration out the few dollars I have over the next three-week period before I head north.  I certainly hope my transmission holds up that long.


On the way out of town, we stopped for lunch.  Where I managed to get down three of the five steps in the restaurant without incident.  The fourth tripped me up.


Fortunately, I did not fall all the way to the ground with my crutches, but I did hit the step hard with my bandaged foot.  Hard enough that I felt the splint move.


The surgeon asked me to see him two weeks post-surgery in Puerto Vallarta.  Unfortunately, he is not associated with any of our local doctors.  But I may stop by to see my local doctor on Friday.  Just to be certain there is nothing I need to do now.  It would not be good (to indulge in understatement) to have the healing process go bad at this stage.


I am now back at the house.  My foot is propped up as I write.  Hoping I can avoid any further drama with this injury.

back to school

Mexico is not a poor country.

Its gross national product places it as either the 13th or 14th wealthiest nation in the world. Above South Korea and Australia. Mexico easily falls within the category of middle income nation.

Central Americans sneak across Mexico's border to seek work. The greener pastures syndrome is not limited to Mexicans looking north.

But those numbers are a bit deceptive. What that gross national product figure is split over Mexico's large population, the per capita figure puts Mexico around 69. About the same as the average Russian or Pole.


There are poor people in Mexico. Lots of them. Some very poor. And where there is need you will find expatriate Canadians and Americans reaching for their wallets.

The church I attend is no exception. I started attending San Patricio by the Sea in 2007 on a house search trip to La Manzanilla. When I made the permanent move south last year, it became my church home.

San Patricio by the Sea is one of those bodies that takes Christ's commands to "love your neighbor" and "feed the hungry" very seriously.

The church's primary community service project this year was the construction of a new classroom for the primary school in Villa Pinal, a small village on a dirt road almost a mile from the main highway. It would not be an insult to refer to it as a poor farming community. Dirt poor.

Working one's way out of dirt poor is the same throughout the world. Skills like critical thinking, reading, writing, and ciphering must be acquired.

Villa Pinal's primary school was simply not equipped to provide its children the ladder to get out.

The school's sole classroom was a partially open air palapa with a barely functional blackboard and ramshackle desks. The size limited the number of children who could attend. Those who could not were forced to walk two miles to the nearest school -- along a dangerous highway. And because they were not there, increased funding went elsewhere, as well.

If you would like to see what the building looked like, you can see it at the San Patricio by the Sea site.

A local charity (Ayuda los Niños Costalegre) donated money to construct two classrooms. Our church donated money to construct a third -- which has just been completed. When I saw it earlier in the month, the finishing touches were being added. It will be officially accepted by the school on Thursday.

The miracle of all this is not merely that children will now be able to avoid the dangerous daily walk to the neighboring school. Though they will.

Nor that the students can now have a comfortable environment for their education. Though they will.

Nor that enough students may be attracted to the school that public funding will be increased. Though it probably will.

The true miracle is those who have been blessed with resources have shared much with those who have little.

I have personally been blessed with that same open-handed approach from my friends in the church.

Now we can pray that the children will use the gift as best they can to find a better future for themselves -- and for Villa Pinal.