This article is from the November 2004 The Mexico
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Medical Treatment in Mexico
by David Alexander
Photos by Lynne Doyle
David Alexander has written and published the AIM -Adventures in Mexico newsletter for most of the past seventeen years. A former resident of southern California, he now lives with his wife in Tepic, Nayarit. More information on the letter and a listing of past issues can be found at www.Mexico-Newsletter.com
Luck changes lives. In 1975 I came to Mexico on vacation and met a young Mexican lady who worked in a bank. Severely smitten, I courted her during frequent visits and within six months we were married. We went to live in my house in San Diego. However, life in the U.S. did not agree with my wife so we went to live in Guadalajara – close enough to visit her parents 150 miles away in Tepíc but not too close. During our year there, two major events affected our lives. Most importantly, we had a son, born by Caesarean section in a private hospital, my first real experience with Mexican medicine. In a way it was a double experience as an American couple were there, having a son also, having flown down expressly for that purpose. The experience of both couples was that things couldn’t have gone better.
The other event was a major devaluation of the peso that cut the value of our savings in half and caused us to go back to San Diego where I worked for three years. During that time we had another son, also by Caesarean. I had the privilege of being present for this, holding my wife’s hand, trying to share her pain. It was an odd experience, listening to doctors talking about their vacations and other trivia while cutting away on my darling. But they too knew their business and excellent care was taken of both mother and child. Of course, I could not stay the night in her room, the exact opposite of what I had been told to do in Guadalajara. Two months later we were back in Mexico having missed it to the point of longing, and we’ve been here twenty-five years.
A Lucky Diagnosis
Having hepatitis may not seem very lucky – people do die from it – but here is my strange tale. In the summer of 2002 I was helping a San Francisco lady find both her bearings and an apartment in Tepíc. (I should mention that we lived 12 years in Guadalajara and have now been in Tepíc, capital of the state of Nayarit on the Pacific coast, for thirteen years.) At lunchtime, neither of us was hungry so we split a club sandwich. I couldn’t even finish my half – my first symptom of something wrong. What followed was a period of zero appetite and zero energy. For two weeks I lived on sips of chicken broth and spent most of my time in bed. My wife called in a doctor and he said it looks like hepatitis, and there’s not much you can do about it but take it easy. However, hearing that I had Medicare and was due to go on my annual trip to San Diego to see four other sons and have my annual checkup, he suggested I go on up. I called a dear friend in San Diego who not only put me up for eight days, but also arranged a quick appointment with one of the town’s leading internists.
Aside: The conventional wisdom is that if a gringo marries a Mexicana he marries the whole family and they set about bleeding him white. This has never been true in our marriage and in this case the family insisted I not take the bus to San Diego and gave me the money for an airline ticket. Not a loan, a gift, a gift of life.
Once in San Diego, blood was drawn, there was a great deal of poking and pressing of my abdomen and a CAT scan was ordered. This because the illness can damage the liver and the scan would show this. The result was that liver and kidneys were fine but there was a very obvious tumor in my stomach, a bit over three inches across. Prognosis: it could be benign; it could be true stomach cancer and I could go home to tidy up my affairs; or it could be a type of cancer that is curable. An endoscopy with biopsy showed a Type-B lymphoma, curable through chemotherapy, radiation and/or surgery. Wasn’t it lucky I had hepatitis, and good friends and nice family and Medicare and IMSS?
Eight Months with IMSS – and Counting
I never checked to find out how much treatment would have cost in the U.S. – with me paying my share of Medicare – because my family was in Mexico and because I had IMSS. That stands for Instituto Mexican de Seguro Social (Mexican Social Security Institute). Their main role is as a nationwide system of clinics and hospitals providing medical service to a large percentage of the Mexican population. We joined in 1990 by paying an annual fee but never used it until this emergency. This is close to what people in the U.S. call “socialized medicine,” but is what Canadians and Europeans largely depend upon for their medical care.
We first went to our assigned local clinic, presented the San Diego findings to our assigned doctor and received a paper the doctor had typed. (Every Mexican doctor has a typewriter and does his/her own typing. Some even type their prescriptions – a great improvement over most doctors’ handwriting.) At the big hospital this paper got me an appointment with an oncologist. The first order was to report for lab tests to see if the numbers associated with the hepatitis were now good enough for me to start the chemo. They weren’t. Too much of this and not enough of that, but the tests were later repeated and I was judged ready for quimioterapia.
Aside: The 7am scene at the lab looks at first like a Chinese fire drill. But everyone gets a number and thus knows what group of twenty he or she belongs to. Your little slip of paper has a number from 1 to 8 which tells you which door to go to when your group steps forward and, lo and behold, by about 7:30 you are out of there and off to breakfast. Over 100 people in that short time is pretty quick pricking, and the results are available that afternoon.
The Joys of Chemotherapy
We – I keep saying we as my wife was with me every step of the way – arrive at 8 am. Four of the five chairs are already occupied and nurse Sandra (Sahn-dra) is getting bags of drip ready to hang on the stands, as well as arranging the different chemicals which will go in different person’s veins. All goes very orderly: Bags are changed, chemicals (basically poisons) are injected into the lines as ordered by the doctor, and the drip lasts till well after noon. The other patients are all ladies, all better upholstered than I after my big weight loss, and my butt on the hard chair suffers. My wife folds our sweaters and jackets to make a sort of pillow and I survive. At my next session I find an upholstered easy chair awaiting me and it is mine for the other four sessions. These average 26 days apart. It’s a while to sit but I read and doze; others watch morning TV. (which is at least as sappy as morning TV anywhere).
After three sessions, a CAT scan (TAC in Spanish) and an endoscopy with biopsy are ordered. The endoscopy apparatus at IMSS is out of order, so this is done in a private office. Both tests and the pathology report of the biopsies show the lymphoma lesion gone. There are two more chemo sessions after that. Then I am told that surgery is ruled out in my case but that I should have radiation. As Tepíc does not yet have radiation, this means going to Guadalajara, and living in Guadalajara for over a month; we mean to make the best of it.
Radiation Honeymoon in Guadalajara
All trips to Guadalajara were on the buses chartered by IMSS (transportation for patients and their accompanying family member/friend is part of the health benefits provided). Once there, we could bus across town to the post office and to Lloyd’s (the investment firm) for money, have lunch in that area or downtown and still bus back to the huge Centro Medico in time to see doctors. First an examination by the radiation oncologist, with an introduction to the radiation technician who would be administering 20 jolts from the front and 20 through the back (I say “jolts” but they don’t hurt). Then (another trip) to have a cardiogram and have the cardiologist write a paper that tells the onco guy that radiation would not bother my pacemaker (I could have told him that). Then a team had me on the TAC (CAT scan) table to pinpoint where the radiation should be aimed and to make tiny blue tattoos front and back. Radiation appointments were set for 7PM, 20 days.
First we stayed in a hotel for two or three days but found it difficult to stay on the strict diet I’d had since beginning chemo: no red meat, no citrus, one egg a week, no coffee, black tea, or chocolate, no pepper or chile, no irritants of any kind. For radiation there were more restrictions: no milk or milk products nor the least bit of fat. (This worked; I never had the vomiting prevalent with chemo, only some upset stomachs and a bit of constipation early on.) Short-term apartment rentals run from about $300 a month to $900. We splurged on Suites Futura at $26.55 per day – nice kitchen, dining area, living room with cable TV and two double beds. Good location at Mariano Otero 1901, next to Lloyd’s, and close to the bus line that took us an hour across town to Centro Medico for 31 cents. Except for our honeymoon, my wife had never had a long vacation and, though she still had to cook (which is common on Mexican vacations), she did not have to clean house or get kids off to school. We had a sort of sexless second honeymoon – two people still very much in love enjoying each other’s company 24 hours a day. The dark cloud over our heads was held at bay – and remains that way.
Continuing Treatment with IMSS
Mexico being Mexico, there was no radiation Holy Thursday, Good Friday, or May Day which is Labor Day in Mexico (and all over the world except the U.S.). Also the radiologist was sick a day, so we were there an extra week. At the end I was told to stay on the diet for two more months, though I was allowed three coffees a month and could eat the mild citrus lima, so mild it is almost tasteless. Had another CAT scan in Tepíc and an endoscopy in Guadalajara. No less than two doctors and two medical students looked down the eyepiece and we could all view my stomach on a TV screen. A full-page report was made out and a copy sent to my doctor in Tepíc.
Now I see my Tepíc doctor every three months. Each six months I have a CAT scan and an endoscopy. Probably these intervals will be stretched out in the future. I saw a doctor at the clinic for a very bad cold last winter. If my prostate cancer acts up I will be under the care of a urologist, not my regular oncologist. All medicines are free with a pharmacy at each clinic and hospital, though there are sometimes shortages. There are no more dietary restrictions but I have never regained my full appetite. I tolerate orange juice but not my dearly loved grapefruit. But I’m cured, life goes on and I’m glad we signed up with IMSS.
How To Sign Up With IMSS
To affiliate with IMSS go to their administrative offices with your passport, proof of address, and two photos infantiles (that means passport -sized, not your baby pictures). IMSS is open to all foreigners regardless of immigration or visa status. The cost for a year are: age 0-19, $86.46; 20-39, $101.06; 40-59, $151.06; 60 and older, $227.26. Two pages of an application form are filled, signed, checked and copies made. Pay your fee at a nearby bank and return with the receipt.
Is there a catch? If one should call it that, the catch is pre-existing conditions. One paper you sign has you check if you have any of 19 illnesses, conditions, or addictions. If you are later found to have one of these and you lied on the form you can be dropped with no money back. However, if you have had certain operations, you may join but not receive treatment for those conditions for one or two years. There is limited dental care, no eye surgery, or providing of glasses or hearing aids. You are assigned to a clinic and the clinic assigns a doctor.
IMSS website: www.imss.gob.mx
The Private Option
If you prefer private care, there are many providers. It is beyond the scope of this paper to investigate other cities but we have data on Tepíc. The most recommended hospital is Sanitorio de La Loma, a Catholic hospital using both RN’s and nursing sisters. Its 37 private rooms are $35.62 per day, operating rooms $66.15 to $76.33, recovery room $156.27. The hospital can supply you with names of specialists and nearby are diagnostic services. MRI Office visits in Tepíc run about $18 to $27.
Major hospitals in Guadalajara, such as Carmen, Mexican-American and San Javier cost much more, the current room cost at Carmen being $155 and up. However, with two major medical schools and huge medical centers, Guadalajara is closer to state-of-the-art than are the smaller cities.
Why I Got My Pacemaker in San Diego – Or Why You Should Keep Your Medicare
I was in Zacatecas, huffing and puffing as I walked the steep streets at over 8000 feet altitude. But I had never huffed and puffed before and became a bit alarmed. I took my pulse and it was 42 instead of proper 72. On my return to Tepíc I asked around for the best cardiologist in town. Dr. Quiroga did a resting cardiogram and said I needed a pacemaker. He also attached a Holter, which one wears for 24 hours resulting in a tape with a full day’s heart rhythm data. He said he could put in a pacemaker at the General Hospital, which would not be expensive for either surgery or hospitalization but that I would have to pay about $5000 for an imported pacemaker. I said I had IMSS, to which he replied that IMSS would take over three months to do it and by then I might be dead. I called my cardiologist in San Diego, told him I needed a pacemaker and he replied, “Come right up.”
About 24 hours later I had a pacemaker and a day after that I was out of the hospital. The cost was much less than the pacemaker alone would have cost in Mexico, thanks to Medicare.
Medical Tourism in Mexico
Soon after I arrived in San Diego in 1954 I learned that many Americans went to Tijuana for dental work, which was much cheaper, and for abortions – which, by the way, are still illegal in Mexico. Drugs did not seem to enter the picture; probably fifty years ago Mexico did not have the great variety of medicines it has now. Many flocked to the border cities for bogus “cancer cures,” wasting time, money, and hope. This undoubtedly gave Mexican medicine a bad name. However, the good news greatly outweighs the bad. We mentioned above the couple that came down to have their baby. A friend from Hawaii came for abdominal liposuction and breast reduction – Guadalajara is a well-known center for plastic surgery. From 1975 to 1983 my wife had an appendectomy, Caesarian birth, and a hysterectomy, all very professionally done in Mexico. My mother came to Mexico in the 1980s, was hit by a car, and spent 32 days in hospital, all expenses paid by the driver’s insurance. I stayed with her 30 of those days and a private nurse was hired to relieve me twice. She was 86; her recovery was prolonged but complete. She later went to Florida and the climate killed her.
An American in Tepíc eight years uses only IMSS and is very satisfied. Another has just joined and was given a chest X-ray, complete blood count and urinalysis, apparently to serve as a baseline for when she goes in with an illness. This we take as an indication that IMSS is getting more into preventive medicine, as these tests were not given us when we joined in 1990.
As anywhere, service varies widely. Go to a remote beach or small town and you won’t get much help. Slightly larger towns will have both private doctors and government clinics, either IMSS or those under the Secretary of Health, or both. At the latter, patients pay a nominal fee. In Tepíc, a medium-size city, there are many specialists, small to medium capacity private hospitals, several IMSS clinics and three big government hospitals. There are also many health campaigns. Mexico has a higher percentage of children with all their shots than the U.S. At intervals nurses appear at our door with an ice chest asking if we have children under five years old. If there were, their shot chart would be checked and if any shot was lacking it would be supplied from the ice chest, free of charge. We ourselves got hepatitis B shots free.
But nothing is perfect. None of the hospitals here can do a CAT scan. At IMSS I was given vouchers to have these done at a private facility. Some very special blood tests had to be done at private labs, paid for by voucher (in some cases the blood had to go to Guadalajara). Once, the chemo lab lacked one of my medicines and we were sent to a certain pharmacy with a voucher to obtain it. And when the IMSS endoscopy apparatus was out of order we were sent to a private gastroenterologist. It may be a bit tedious but it’s all covered – a cancer cure for $227 is plenty cheap.
I will continue to use all the services available to me. On my annual trip to San Diego, I also see my urologist for my prostate cancer, the cardiologist to monitor my pacemaker, and the allergist/internist I have used since 1964. Incidentally, I went to him on my 2002 hepatitis trip. Upon hearing my symptoms he concurred and added: “I’d bet a million it’s hepatitis A.” Why was he so sure? Because he himself had caught it, and he named the restaurant. I probably caught mine in a restaurant also but don’t know which one. I have never bought a Medigap policy because I don’t think the return on investment would be worth it.
The Making of a Mexican Doctor
One of the main differences between medical schools in Mexico and the United States is that the Mexican student starts younger and may enter medical school better prepared. The Mexican student does not spend three or four years in college pre-med. In high school the wannabe doctors take the Biological Sciences track in which they get heavy doses of chemistry, physics, biology, math (including calculus) and English. In their senior year they take microbiology, pathology, pharmacology, medical ethics and other subjects directly related to their future careers.
Mexico has very few private medical schools; almost all are at state universities. Though tuition is almost free, there is a heavy personal expense for medical books and uniforms – from the beginning the students attend class in laboratory whites and call each other doctor or doctora. Then comes a year of internship; according to scholastic standing they get to pick their hospital of choice. They spend two months in each of several disciplines such as trauma, internal medicine, gynecology, pediatrics, etc. After passing internship they give a year of social service working in outlying clinics.
Those aspiring to specialize take a two-day competitive exam in a major city. Over 20,000 take the exam, some repeating from other years, and about 3,000 pass. Each lists three choices of where he or she wishes to study for the three years or more of residency, depending upon the type of specialty. In turn, they must be accepted by the chosen hospital. Pay is about $675 a month, less certain deductions. At the end of their years as residents, they must take an exam; passing that, they receive their sheepskin. A minimum of nine years has been invested, even more in the case of some specializations. Most graduates will work in the public sector, while some also develop a private practice. I have never known a really rich doctor in Mexico.