Sunday, January 8, 2012

Healthcare in the Baja

One aspect of Living Loreto that (thankfully) I have not had personal experience with is the healthcare system, but I know that this topic is one of significant interest to many people who now live here, or are considering spending more time here in the future.  That is why, when a friend of mine suffered a nasty broken bone near her hip after fall, I asked her to consider sharing the experience of her treatment and recovery with the readers of Living Loreto.

What follows is her story, and while like any major health procedure conducted anywhere it has not all been “fun and games” I am pleased to say that when I saw Jane earlier this week she is continuing to mend and should be off her crutches hopefully by the end of the month.  I want to thank her for contributing this first person account about an important aspect of life: 

Health Care Options In Baja

Have surgery in Baja? Not exactly the first place you might think of when faced with the prospect of a major procedure. Most of us living here have heard a horror story or two about health care experiences and so hopefully I can debunk a few myths as well as provide a little information, although by no means do I have all the answers.

As I write this I am recovering from surgery for a broken hip. At first I thought maybe I had jammed my leg after a fall down two tile stairs, and so I iced it and waited a couple of days before getting an X-ray here at the hospital in Loreto. However, when that showed that the bone was broken I knew I had to get to La Paz “muy pronto”, because the necessary surgery was going to be beyond the capability of the local Hospital.

Consulting La Paz phonebook I was surprised with the number of Orthopedic specialists listed and narrowed it down to two; OrtoMedix and a Dr. Luis Vargas, where I scheduled an appointment for the following day and I also scheduled an appointment with Dr. Mondragon, an orthopedist that I had previously seen about a knee injury. Both doctors seemed very professional and competent but I decided to go with Dr .Vargas for several reasons, mainly because he proposed a surgical procedure that I felt was more appropriate for my kind of fracture.

After his examination and consulting my X-Rays, Dr. Vargas wanted to operate immediately but I felt I needed to go back home to Loreto and get organized. I was going to be spending one night in the hospital, then a couple nights in a local motel with daily check ups. So, my husband and I drove back to Loreto to have my pre-op lab work done and get packed and organized, before returning to La Paz in a few days for my operation.

The facility I had my surgery in is known by several names: Central de Especialidades Medicas, Fidepaz, and “that little purple Hospital”. It is a private hospital and the access to the surgical facilities and the overnight stay were included in the fee the Surgeon quoted me for the procedure, which also included the anesthesiologist fees as well.  Fidepaz, as I will call it, is far nicer than most medical centers in the United States. First of all, it is a small facility, (important to me because it meant potentially less exposure to germs), and each patient gets their own private room. There are no set visiting hours and they encourage a family member to spend the night by providing a really nice couch in the room.

Like most medical specialists with high levels of education, my surgeon, Dr. Vargas spoke fluent English as did my anesthesiologist, who also had a great sense of humor. He played retro 80’s music in the OR and, because I had had a spinal tap and was semi-conscious through the surgery, he gave me updates on the progress of the operation.

Although the doctors all speak English, the nurses do not - at all! My Spanish is terrible and I had difficulty even communicating that I needed another pillow. Hospital food is usually a challenge and that’s true in Mexico as well.  I thought the food was, well, weird and couldn’t eat it but that didn’t stop my husband Greg from taking care of that aspect on my behalf.

About 3 or 4 hours after the surgery, the effects of my spinal started wearing off and boy was I in for a surprise! At my pre-op, the doc explained that my surgery really wouldn’t involve a lot of pain and that thinking ahead about it would only make it worse. I should have clarified this. As I eventually learned, he is anti-medication. After no sleep that night due to agonizing pain, I finally got a small shot of something around 5am to help me sleep. When the Dr. came in at 9 we had quite the conversation about my pain management!

While I agreed with him that American Docs tend to overmedicate most of the time, surgery isn’t one of those times, and a five inch incision that included drilling through my bone and putting two long screws into my hip bone was indeed major surgery. He said morphine and opiates were for the dying, which seemed appropriate to me as I was wishing I was dead at that moment. He finally gave up four (four!) pills of some kind to get me home and in bed. Lesson learned. I would definitely have surgery down here again, but not before the surgeon and I had an understanding about pain management!

For general medical care here in Loreto, we are fortunate to have a handful of competent English speaking doctors. Most charge approximately $200 pesos ($15.00 US) per office visit. One doctor, Dr. Gerald Ramos, has in-office X-Ray and ultrasound equipment. However medical services here are limited, our local hospital is comparable to a walk-in clinic in most places in North America and it is necessary to go to larger cities like Constitution (2 hours drive) and La Paz (4 hours) to see a specialist and receive more than first aid treatment.

As I understand it, Mexico’s medical system has a number of tiers, not unlike that of the United States. At the top of the pyramid, receiving the best care in the best private facilities are those who have private Mexican health insurance, (some US insurance may be accepted) or, are like ourselves, are “self-insured” and pay directly for the procedure, (the cost of which, in this case, was a small fraction of what it would have been in the US).

Government employees have their own hospitals, under the ISSTE system that provides a variety of subsidized social services. These hospitals are located in Constitution and La Paz and I’m told they are on par with the Seguro Social Hospitals and clinics. The Seguro program is a government health insurance plan that provides basic coverage for most paid employees and can also be purchased by American and Canadians for approximately $300USD/yr. My private doctor in Loreto works two days a week at the Seguro clinic here and I believe that may be a requirement for the local doctors. I know several people who have been very satisfied with Seguros services, and this is also a way to obtain referrals to see top notch doctors in La Paz.

Last of all, there are the general hospitals in Constitution and La Paz for the general population without some form of insurance or personal resources. Briefly, you would not want to end up here, by North American standards they are crowded and unsanitary.

While I have heard there are some specialists in near-by Constitution, I prefer to go to the much larger city of La Paz (population over 200,000) and have relied mostly on word of mouth for referrals to Doctors I have seen there. For example, a consultation with a dermatologist will run you $500 pesos ($40.00 US) for a head to toe skin check. The biopsy I had done on a precancerous lesion left less scarring than one that I had done in the States by a Facial Plastic Surgeon! Most of these Doctors speak English, some even having American training or credentials. However, rarely do their office staff speak English, but you can usually get by with “Spanglish”.  

It’s been a slow recovery and I still have sleepless nights but after two months it’s getting easier. I’ll be on crutches until the end of January, which can’t come soon enough. Like many things here in the Baja, I learned by experiencing it and will be a more informed patient if something else happens and I need medical services again. 


Thanks to Jane for the story about her experiences with the medical system here in the Baja, being better informed about the options and realities of something as potentially important as healthcare is certainly an important part of “Living Loreto”.