Mexico’s Private Medicine

February 26, 2009




From Puerto Escondido Mexican Hwy 131, pueblo in Oaxaca mountains.


After the post on Mexico’s social medicine system, I thought it would be a good idea to report on the private medical system. However, we’re getting to know it first hand as Bruce has encountered unexpected health problems. Two weeks ago he had neck pain that progressed to shoulder pain and the inability to raise his left arm. He has strength in forearm and biceps but is unable to raise the left arm from the shoulder. My concern was a herniated disc so we consulted with an orthopedic physician in Puerto who diagnosed him with a rotator cuff tear…to my relief. Bruce was doubtful as there was no precipitating cause….although he claims it was the neck massage I gave him. The neck pain started to get worse as well as limited range of motion. In sum, with several anti-inflammatory meds this all became so painful and limiting we are now in Oaxaca city for in depth appropriate testing and medical care (not available in Puerto).



We stopped for fresh squeezed orange juice on the way to Oaxaca.


We arrived 5 days ago and have consulted another orthopedic physician who ordered neck xrays and an MRI of his shoulder. He does have a partial rotator cuff tear and nerve root compression (pinched nerve). Fortunately, the recommended treatment is a conservative approach which is usually successful but will take time. Over the last 5 days he received a cortisone injection in the most inflamed portion of his shoulder and another one in the neck at the facet of the culprit nerve root. Thus far, he has some relief from the pain and improvement in raising his arm. He starts physical therapy on Monday and training for proper neck and shoulder exercises which we can do on our own.
With the running around we have to do we're exploring more of Oaxaca city. We're finding it more beautiful that our previous visit. Plus, Oaxaca is known for some of the most flavorful food in the Americas...possibly el mundo.


Under the circumstances the experience has been pleasant. The appointment with Dr. Bernardo Herrera Juarez was made on Sunday night when we arrived. He met us at his office at 11am on Monday, had the MRI and xray on Tuesday, he saw us again to review the studies on Wednesday. Shoulder and neck injections were done on Monday and Wednesday, respectively.

Costs in Pesos: Appt w/ortho in Puerto 530
Appt w/ortho in Oaxaca 500 x 2 visits=1000 pesos
Meds 366
Taxis 285
Xray 500
MRI 2700 (MRIs are around $1800-3500USDs in the states)
Total cost: 5381 pesos ($365 USDs)

Other than the pain, limited range of motion, and inability to get comfortable, the worst part is lack of sleep. In Mexico only certain physicians can write a prescription for Ambien, a well known sleeping aid not prescribed frequently here and known as a controlled substance. In the US just about any MD or PA can prescribe this medication, however to buy most US prescribed antibiotics, anti-inflammatory meds no prescription is needed.

Bruce has concluded that as the body arrives in it's 6th decade of life that muscular conditioning is important to maintain sound structural physical health. Spending too much time on the computer for the last 20 years, and driving around the countryside the last 7 months has done little to keep the shoulders and neck stong. Hence, from here on out a basic physical routine will be established to prevent further problems.

Mexico’s Social Medicine

February 16, 2009

Photo left: Pancho Villa center, taken at restaurant in nearby village.

Yes, even our 2nd world neighbor (or 3rd depending where you are in Mexico) has socialized medicine. Although, the competence of the physicians is equal to US physicians, testing and treatment for those using social medicine clinics have limitations. I’ve been working at a local clinic over the last few weeks and the following is my experience and observation.

The clinic is simplistic and rudimentary. The building has no air conditioning, although some rooms have window units, they don’t run them. The 4 consultation rooms have fans or open windows and all have bad lighting. The clinic houses a one-room-four-bed hospital, a room for D&Cs, an ultrasonography room, and pharmacy. The exam tables and cabinets are old, some with rust, but functional. The doctors provide their own tools (otoscope, Doppler, etc). 1970’s typewriters are used for legible documentation and charts are in order of family last name. There are no HIPPA rules, consents to sign and individual family member’s charts are kept in one folder.



4-bed-one-room hospital for deliveries, IV rehydration, other temporary admittable ailments.

No appointments are taken so patients show up first thing in the morning and patiently wait for their name(s) to be called. The doctors see 15 to 25 patients in the morning and then break from 1-4, typical siesta time. One doctor comes in from 2-6 to cover the siesta time frame. At 4pm more patients come in and it’s basically the same process. We’re usually done with patients by 6pm. The clinic is staffed 24/7 as patients may have to be admitted at any time.


Photo right: This pressure cooker is actually their autoclave (for sterilization of equipment). They use the same type sheet paper to wrap the instruments as used for plates at taco stands.

Patients do not pay for any services or medications. One great thing about this system is all family planning contraceptive modalities are free, including condoms. They cover monthly injections, IUD, intradermal implants, OCPs and vasectomies (infrequently requested at this time). Also, all vaccines and well-child-checks are covered. Contraception is really taking off here despite the strong Catholic beliefs embedded by the Spaniards 500 years ago.


Photo left: Notes are typed out on old typewriters. Roll of TP is personal stock of doctors. In this public facility TP is a luxury.

On the flip side of family planning is the prenatal care. It’s common place to see several 15- 18 year-olds expecting their 1st, 2nd or 3rd child. However, we are seeing women in their late twenties coming in with their first pregnancy as well. All services are free and babies are delivered in the clinic hospital or cesarean in Pochutla 45 minutes away. If all goes well for vaginal deliveries, patients are sent home 5-8 hours later.

There is a fair amount of diabetes here. Unfortunately, I’ve heard Mexico has the highest per capita consumption of cola drinks – bad for the teeth and health. The testing they use is a fasting blood sugar to diagnose. They may occasionally order glucose tolerance tests but they do not use the hemoglobin A1C test which is routinely used in the US. Medications for diabetes are limited to less than 5 choices for type 2 diabetes. They do have insulin for type 1 diabetics. There are no dietitian classes and I have not seen patient education literature given. They’re told to watch their diet and take their medication and come back monthly until controlled. Kidney function is monitored by lab work and baseline ophthalmologist consults are not recommended unless there is a problem.

Treatment room, note red trash can is similar to biohazard. Osha doesn't visit Mexico.

Treatment for other common ailments such as arthritis and back pain monthly anti-inflammatory intramuscular (shot in the arm or buttocks) injections are given and x-rays ordered if strongly indicated. For psoriasis, patients are told to use creams. Their formulary does not have any cortisone creams…a must in the derm world. I recommend patients purchase cortisone creams from the private pharmacies around town, if they can afford it. Typical skin conditions are scabies, your garden variety fungal infections, lower extremity ulcers and stasis dermatitis. The clinic is treating 3 cases of leprosy I have not yet seen.
One disease absent thus far is attention deficit disorder (aka ADD) or it’s “hyperactive” cohort, ADHD. The family unit is VERY close, children work with their parents, help around the house, go to school, go to family and church events, etc. They wear school uniforms and are spic and span walking to school. There are no “nursing” or “retirement” facilities here. Families take care of their elders.

Outside conference room/kitchen. Doctora Veronica and Doctor Hugo take a break.

Private physicians are available to anyone who can pay cash the day of service. The cost of a specialist consult: dermatologist is 325 pesos and 530 for an orthopedic surgeon, 25 and 39 USDs respectively. There are private hospitals, laboratories and imaging facilities also available.




As a side note about dentistry, dental tourism is on the rise here in Mexico. An acquaintance informed us he needed serious dental work and was quoted 5800USD/tooth in the US. Here an English speaking Harvard-trained dentist will do the work for 1200USD/tooth....substantial savings.

Southern Canada

Feb 7, 2009

Puerto Escondido is a haven for Canadians. Their vacations last 4 months compared to the extended two week vacation for US citizens. They put together an annual Blues Fest which is underway almost every Wednesday and Saturday night from January until the end of February. Many build their homes and stay year-round or just for the winter. What makes this place so attractive are the beaches, the small clean tourist strips, great restaurants, excellent seafood, the markets, the deeply embedded Mexican presence, the small town atmosphere and the picture perfect setting as the city sits around the bay.

As with anything there are downsides. The main highway that links this elongated city has been under construction for more than 6 months and it’s anticipated not to be completed for another year…..that’s the consistent story I get from the taxi drivers. One’s car takes a beating on this main road. Those year-longers that live here state that sometimes to get something done it may take a while and even though you’re given a time frame, don’t count on it. Manana means “not today”. I’m told by Canadians that they adjust better to these delays than US citizens. However, if you go to a Mexicans’ place of business (their “taller”) they take care of the service pronto…..at least that’s our experience.
All this taken into consideration, for a winter haven, it’s a nice place to be.

Still Here Puerto...

January 24, 2009

Yeah, we are still here…more than a month now. We’ve grown pretty attached to this city. The beach is the best, the weather perfect, the city has everything you need and as always the Mexicans are very friendly and happy.

Pestel is made from one solid wood block.













This is the finca's mini hydroelectric plant: an automobile alternater hooked to a water wheel run by gravity-fed water.





Thursday we travelled with our friend Tami about an hour and a half north to the coffee plantation Finca (farm) de Nieves(snow). Gustavo was our guide on this beautiful 800 acre farm named for the white flowers that bloom on the coffee plants in spring. For my friends who think pushing a pencil is tough work, the plants are grown on steep hillsides which make for some tough picking by the Mexican workers. It was difficult just walking up the hillsides.




Finca farm is self-sufficient with it's own water source.



Wild horses showed up on finca during our hike.



As for the rest of the week Pat spent time at a local clinic, took spanish classes and played tennis. I just lazed out at the beach with the boogie board, played a little tennis and watched the market.

We have also been watching more DVDs than we ever did in the states. The city has many vendors that sell first run videos that are obviously pirated for 25 pesos(about $2). This week I wanted to see the new James Bond flick. I walked into the store and asked for a James Bond movie. At first the senora was bewildered then she lit up and said "Ah, cero cero siete". We watch them on our laptop out on the balcony under the stars. You gotta love Mexico.


Interesting insects: Golden ant and a nest of what we call "Grand Daddy Long-legs".....looks like a horses' tail.







Yes, 10s of thousands of spiders!

Another week slips by in Puerto.

January 15, 2009

Mexican tarantula takes siesta on trail.

My advancement in Spanish is coming along well. I found an English-speaking Spanish teacher and what a difference it has made in my progress. However, disappointment has come along in the medical volunteer scene. I’ve been in contact with a local that works with an NPO and places volunteers at clinics in the area. She informed me after the holidays she can put me with a physician at a local clinic and would be in contact with me. Since our return and several attempts at contacting her I have not heard a word. Interesting and hard to understand as dermatology providers are the busiest and one of the most in-demand specialists in the US. It’s disappointing that I’m not able to use my Spanish as much as I would like, use my medical skills and learn more about the practice of medicine here in Oaxaca. I guess there are worse things.

Meanwhile, our van has taken some wear and tear and is in need of repairs. The brake problem was the master-cylinder which was replaced by expert mechanics. Two days later Bruce made a return visit to change out our leaking water pump. The mechanics that worked on the van were top-notch guys; however, Bruce bemoans the fact that he is not able to work on his “own stuff”. He loves nothing more than to get his hands greasy and without the proper equipment to do the work, he’s at the mercy of local mechanics.

Enough complaining though, our days start with a walk on the beach just before sun up, then a leisurely fruit breakfast, by 11am we’re either reading, going to the market or just lounging around. By 1 or 2pm we take a nap, play tennis in the late afternoon, and have an early dinner, then watch a movie on our laptop on the terrace under the stars. Movie watching has always been a rarity for us, so we have a lot of catching up to do. By 830pm we’re ready for bed.

Trail goes between farming property in ancient riverbed.

Nursing donkey on trail, Bruce kept his distance.

River crossings are safe this time of year. They are too swollen to cross during rainy season in August, September and October.

To break up the monotony Tami took us out on a hike to Manialtepec hot springs. Fifteen miles west of Puerto on Hwy 200 we drove to San Jose de Manialtepec, a small pueblo where we parked our car and walk about 3 miles to a hot springs. Millie, Tami’s Golden Retriever gladly accompanied us. To get to the hot springs we have to make 5 shallow river crossings. The spring’s hot water was collected in a cement pond that we all sat in once acclimated to the temperature, which I’m guessing was 110F. The small spring bubbled from under large rocks and had the common sulfur aroma. It was a refreshing stop. We snacked, relaxed, and watched butterflies and birds.
Hot springs dipping reservoir.

Hot springs runoff.

Flat Stanley joins Tami in Puerto and on all her excursions. Visiting shrine at hot springs.

On our way back we stopped by a Manialtepec lagoon restaurant for fresh seafood. One of the wonders of Mexico is the cost of fresh seafood. An expensive dinner out in the US; a common meal for Mexicans. We three had fresh shrimp (large ones!) and some sort of bass made Mexican style, quesadillas, home-made tortillas and totopas (chips), various salsas and three beers for $20USDs (230 pesos) including tip.

Restaurant shows off alligator carcass along kayaks.

Bruce and Millie enjoy ride home.

Back in Puerto, Oaxaca

January 7, 2009
Mexican street dogs taking their siesta.

Bruce and I have been south of the border for over 3 months now and have never encountered trouble finding a place to stay…with the exception of Tulum on the Yucatan. We were told that Puerto and the Mexican beach towns fill up during the holidays, something we’ve never seen……..there’s a first time for everything. That’s what we love about the van; we are never without a home. Away from Puerto we slept in the van but now that we’re back we’d like to find an apartment or similar to rent for the next month or two. Turns out January and February are the busiest months for rentals. Canadians love this town and for some reason can no longer tolerate the minus 50 degrees in their native land. They’ve even put together a blues fest for the months of January and February. The gringo scene includes representatives from most first world countries (Brits, Aussies, French, even met a couple of Greeks) and this season few US citizens. These gringos really know how to take a vacation; they come down for a month or four at a time.

Fortunately for us, my new-found tennis buddy manages a suites residence and was able accommodate us until the end of the month. Good thing because two days after arriving her place was completely full. Casa Mar is a paradise on the south end of Zicatela beach. It's a 12 suite compound with a tropical courtyard, pool, wireless internet, all have fully equiped kitchens and are within a couple of hundred yards from the beach. Although we have to drive to the market, the quietness is a nice trade-off. We will have to find another place at the end of January, move back into the van, or move on down the road.

Meanwhile, Bruce is back to trading and watchingthe market and I’m working on my Spanish and am to meet with someone next week regarding medical volunteering. There are “local laws” to foreigners volunteering in Oaxaca, so I must go through the proper channels. Might as well enjoy the chronically warm weather, play tennis, study Spanish and eat some of the best food in all of Mexico.
Ms. Millie, the irresistable house dog.

January 1, 2009

We celebrated New Years Eve camped on a beach somewhere between Zihuatenajo and Manzinillo. A perfect way to end 2008 and start 2009.

The last time we drove along this coastal road we couldn't wait to get into the highlands. It was so hot and muggy we could barely stand it. Now, it's dry, the temperature has dropped and its comfortable. Also, the roadwork going on in October has been completed making our drive easier.

We left Puerto on the 29th, Bruce and I considered staying but felt the urge to get on the road and move on......plus, our landlord had the place rented out from 12/29 till the end of March. We enjoyed Puerto and figured if we missed it we can always come back.....well 3 days and 500 miles out we decided to return. Now we know what Taz felt like when she chased her tail. We'll see about finding a place for the next couple of months.

January 1, 2009 Tizupan, Michoacan Mexico