Sunday, December 23, 2012

Christmas Visitors bring Healthcare Challenge

This is the first Holiday Season I have spent here in Loreto since my very first Christmas in 2005, just a month after taking possession of the newly finished casa.  This year I am also hosting my Sister Janice and Brother-in-Law Tom, here for a visit from Calgary, who arrived last week. 

On the first day they arrived, at the end of a fairly late night of catching up with each other, my Sister reported that on her way to bed she noticed a cascade of “sparkly flashes” of light in one eye, but thought nothing of it, putting it down to the late hour and the fatigue of air travel – and perhaps overindulgence in the welcoming beverages!

However, the next morning she awoke with cloudy vision in that eye and a large black “floater” in the bottom corner of her vision – and the realization that this might be something serious that required some action.  After conversation over breakfast it was decided that the first course of action should be for Janice to call her Optometrist in Calgary and ask him for his opinion.  Connecting over Skype (voice over internet phone service) she was able to speak with her Calgary Doctor and, after questioning her about her symptoms, he concluded that it was likely caused by one of two conditions; a condition called PVD (posterior vitreous detachment ), which was a non-threatening condition that would resolve itself eventually and did not require any urgent attention – or, alternatively it could be a tear or detachment of the retina which was potentially a very serious situation and would require  immediate treatment by laser stapling to prevent further retinal detachment and potential blindness!  

Faced with these serious options, our first priority was obviously to find someone who could determine which of them we were facing, before we could decide what, if any, further action was going to be required.  To that end, I decided the first step was to call one of my Loretano friends, Cecilia, who has lived off and on in Loreto for years and is fluently bi-lingual, and I thought could be helpful in this situation. 

I wanted to get in touch with a Dr. Gill, who owns one of the three Optical offices in Loreto, and was by reputation by far the most qualified, and the only Optometrist in town, as the other two were Opticians, qualified to fill optometric prescriptions and to fit glasses. I had visited Dr. Gill’s Office several times earlier this Fall to order a new pair of lenses for my own glasses, but had always found the Office closed.

So, when I called Cecilia that morning I was hoping she could help me get in touch with Dr. Gill and arrange an appointment for him to examine my Sister’s eye and determine if, and how serious a situation we were dealing with.  When Cecilia answered her cell phone my first question was “Are you in Loreto”, to which she replied, “No, I’m in La Paz, how can I help you?”

After I explained the situation, Cecilia said she would get in touch with her Mother, who lives in Loreto, and ask her to try get in touch with Dr. Gill for me, and Cecilia would try to call me back in 10 or 15 minutes.  When she got back to me called back it was to say that her Mother had not been able to get an answer on Dr. Gill’s cell and so she was going over to his house to see if he was at home – another advantage of living in a small town!  Sometime later I got another call back from Cecilia, her Mother had determined that there was no one home at Dr. Gill’s and furthermore, she had asked around and found out that he was away from Loreto and was not due to return until February.   

Definitely time for “Plan B”!  After confirming with Cecilia that Dr. Gill was the only qualified person here to evaluate my Sister’s situation, we quickly came to the conclusion that our best option was probably going to be found in La Paz, which is where the biggest and best Hospitals are – and, (coincidentally?) where Cecilia was. 

So it was left that she would make inquiries and identify who she thought would be the best available specialist we could get an appointment with as soon as possible, hopefully by the afternoon of the following day, as La Paz was a 4 hour drive from Loreto and it was already getting on for late morning, probably too late to make the trip and be there in time to see anyone that day.  While we were waiting to hear back from Cecilia, my Sister was becoming more familiar with the symptoms in her eye and was noticing that the “black spot” was thinning out and moving from the bottom to the top of her eye, which we took to be a good sign – inconsistent with our most serious concern of retinal damage, which presents as a firmly closing black shutter across the field of vision.

In the meantime, I wanted to see if I could find some medical assistance locally that might be able to shed further light (pardon the pun) on the situation.  After speaking to several people in the community I got some useful input from Cynthia (who runs the Wine Cellar here with her husband Will), first of all, she had met a new General Practitioner Doctor in Loreto who spoke fluent English and had recently opened a small Clinic, half-days in Loreto. Secondly, she said she had recently seen a “thread” on a Yahoo Group; “La Paz Gringos”, dealing with someone who was looking for medical assistance with a retinal detachment and the thread contained some referral information to resources in La Paz which she copied and forwarded to me.

While we were still waiting to hear further from Cecilia, we headed into town to the new Medical Clinic, located on the ground floor of the Santa Fe Hotel, which I had been told was open Monday through Friday from 4:00 to 8:00 pm.  We walked into the small waiting area of the Office and were immediately greeted by Dr. Angel Alaniz (cell 613-104-2077) who was alone in his office, and invited Janice into his examination room, where she described her symptoms and he asked her questions and gave her answers in flawless English and conducted a basic examination of her eyes. 

Following this, he invited Tom and myself into the Office and explained to all of us that, while his brief examination was not in any way thorough or decisive, he had not seen anything alarming, but he assured us that Janice should see a specialist as soon as possible.  In the meantime, he prescribed some drops that might help if there was any infection that could be a cause or result of the condition.  For this advice and his immediate consultation, and over half an hour of consultation, the charge was merely 100 Pesos – or about $7.00 US! 

(I can highly recommend Dr. Alaniz and plan to contact him again, any time I need the services of a Doctor here locally.  He spends his mornings on call at the Villa del Palmar Resort south of Loreto Bay, and weekday afternoons in his Clinic in town, and is available for emergencies on his cell at anytime – an important new health resource for the English speaking community here in Loreto!)

Later that evening, I received a call from Cecilia; after canvassing her friends in La Paz she had identified a Doctor Fausto Ortiz who was an “Oftalmologo Cirujano de Retina y Vitreo” which I roughly translate as an Ophthalmologist Eye Surgeon – exactly the man we needed to see!  His Office in La Paz was adjacent to the FIDEPAZ Hospital (which was featured in a Guest Blog from January of this year “Healthcare in the Baja”) and he could see us for an examination appointment almost immediately, at 6:15 pm the following day! Try to get into a highly qualified specialists´ office on a day´s notice in Calgary!

Of course, we accepted the appointment with enthusiasm, with many thanks to Cecilia for having found Dr. Ortiz and made the appointment for us.  We quickly made plans to leave here just after noon the next day for the approximately 4-hour drive to La Paz, made reservations to spend the night there after the appointment and to meet Cecilia and her boyfriend for dinner.

The drive to La Paz was uneventful, although my Sister was intimidated by the narrow road, yawning cliffs, and the twists and turns of Mexico Highway #1, which I have become used to driving over the years.  We located the Hospital, painted bright purple, and located on the main road entering La Paz, just past the Walmart, and then we proceeded on into the center of town where we had reservations at the 7 Crowns Hotel on the Malacon where I had stayed on previous visits.

After checking in to this scrupulously clean, comfortable business-class hotel, we headed back to the Hospital, arriving half an hour early for our appointment in Dr. Ortiz’s Office, in the wing across the parking lot from the main entrance.  After a short wait he saw Janice before the appointment time and after discussing her symptoms and giving a quick preliminary exam, he put anesthetic and dilating drops in her eye and told her (in excellent English) to wait fifteen minutes  for her pupil to dilate before he did a more thorough examination.

He then called me and my Brother-in-law into the examining room; as he explained, “this is an important conversation and you all need to listen!”  The examination was extensive and lasted for perhaps ten minutes, with a similar sequence of intense lights and ¨Look up; look down; look left; look right¨ that she was familiar with in her Calgary Optometrist´s examination.

When he finished, and we were all nervously repositioned in front of his desk again, he beamed at us with a wide smile, and said, ¨There is NOTHING wrong with your eye!¨

He had found no damage to her retina and diagnosed that she had experienced a very common condition which affects 60% of people over 60 and 90% of those in their 90´s.  This, he explained, was very similar to what happens in an egg when the egg white (vitreous fluid) is reduced in volume over time and then can eventually draw the enclosing membrane slightly away from the egg shell (retina).  This is seen as the sparkling light show she had experienced. When the membrane pulls away, there can be a tiny droplet of blood released into the vitreous fluid, which creates the “floater” she had seen, which will diminish over time and eventually disappear.

In other words he assured us that there was no damage and there would be no lasting consequences and no treatment required, but he also, advised having her vision checked again when she returns home, and see a Doctor as soon as possible if she has a recurrence of the “sparkly” lights, the symptom of the separation, in case there is retinal damage the next time.  For almost an hour in total of his time, including a thorough explanation of the specifics of the condition to Janice, her husband Tom and myself, including showing us numerous illustrations in one of his medical reference books – the total charge was one thousand pesos, or about $75.00 US. 

Needless to say we were all very relieved and happy with the diagnosis as we headed off to meet Cecilia and her friend at a great local Italian restaurant, where we thanked her again in person and went on to enjoy an interesting evening of conversation together over good food and wine.  The next day, after stroll along the La Paz Malacon and a little early Christmas shopping we headed back to Loreto in the afternoon, arriving here just before sunset around 5:00 pm. 

And so, all’s well that ends well with our Medical “adventure”, but what I will take away from this experience is the way that I was able to reach out to my friends here, and with their care and help, find the very specialized person we needed to see - and be in his office 300 km away getting exactly the care we needed within 36 hours of the event, a sequence I think would be difficult, if not impossible, to duplicate in as timely a manner where my Sister came from back in Canada ,in a city of a million people.            

Finding that sort of friendly support, and accessing that quality of medical care, in that short a period of time, and at such low cost – this experience has given me an even greater appreciation for “Living Loreto”.

Felize Navidad y Felize Año Nuevo de Loreto!