Hidden Gem: A Guide to Surgical Tourism
in Cartagena, Colombia
K. Eckland, ACNP, MSN, RN
With Dr. Albert Klein, PharmD
K. Eckland 2010
Copyright K. Eckland 2011
Published at Smashwords
Please respect our work.
Footnote conversion for e-reading devices: [footnotes contained within parentheses]
Authorization is specifically granted for printing of surgical checklists and Appendix Fill in sheet. All other portions require additional written authorization from copyright holders.
Additional Titles
Bogota! (hidden gem series)
The Thoracic Surgeons
Acknowledgments
Without the unwavering support of my research team this project would not have been possible. The team, consisting of my darling husband, and copy editor, Peter, my mother and on-site photographer, Susan Eckland, and my father, translator and research assistant, John Eckland helped me translate ideas into reality.
I have sincere appreciation to Dr. Albert Klein for his willingness to join me on this endeavor, without hesitating.
To Debbie, from Danville, Virginia, who initiated the idea for this project during our previous discussions on dental tourism.
Special thanks to all the wonderful people in Cartagena who gave me intimate access to their patients, practices and operating rooms. This experience has done more than provide the foundations of this book, it has changed my life, for the better, and for that I am eternally grateful
Lastly, thanks to Roberto, the best taxi driver in all of Cartagena.
Medical Tourism versus Surgical Tourism
Brief Introduction to Cartagena, Colombia
PostSurgery Information/ Emergencies
Selected Providers in Surgical Specialties
Special Focus: Bariatric Surgery
Special Focus:Cardiothoracic Surgery
References & Resources for Additional Info
While all of the information provided in this book has been thoroughly researched, this book is not a substitute for medical care, or the services of a physician nor is it a recommendation or guarantee of services provided by the individuals listed within. This book should be used to augment other sources of medical and travel information, and ultimately, should be used in conjunction with the judgment of both the consumer and their practicing medical providers.
Health care conditions and facilities can change without warning due to natural disasters, epidemic disease, war or political disturbances. Please be aware of the geopolitical situation of the areas you are planning to visit.
Modern surgery has advanced greatly in the last century, and it has changed the way we live our lives. Coming from a background in cardiothoracic surgery, where the last fifty years have heralded some of the greatest changes to the human condition, I have been able to see the amazing impact of surgery across the human lifespan. From babies, once destined to die at birth with congenital defects to octogenarians undergoing valve replacement, to cardiac transplantation; heart surgery has changed the collective human experience.
Conditions that were once thought of as an inevitable part of the aging process and eventual infirmity such as osteoarthritis, or degenerative joint disease are now routinely treated with joint replacement. Other diseases, once life-threatening such as appendicitis or solid tissue tumors are treated with routine, almost mundane frequency. Even chronic conditions such as morbid obesity, organ failure and diabetes can now be treated very successfully with surgery, with results untouched by even the most revolutionary medicines.
These surgical procedures and the science behind them have changed the very foundation of our concepts of health and illness, thus changing our expectations. However during this time, the American healthcare system has failed to recognize, adapt and accommodate these changes. The system has become an overburdened, wasteful and unnecessarily complex entity that has lost its original vision. At a time, when more and more Americans are living longer, more productive lives, a single illness can financially devastate and destroy an entire family.
Surgical tourism has become a viable option for sophisticated consumers, and for some, the only option available. With the globalization of health care, education and surgical technology, surgeons in Colombia, India, Argentina, and other areas around the globe are able to perform the same intricate procedures, and surgical techniques as even the finest institutions in America.
Dr. Peter K. Smith, MD
Division Chief
Cardiothoracic Surgery
Duke University
Durham, NC
May 2010
Welcome to a new age. The world is becoming a smaller place, and healthcare services are now offered as part of a global marketplace. Medical tourism has changed since the days of the Laetrile clinics. It’s now possible to receive state of the art treatment, and care comparable or superior to North American standards at a fraction of the cost, with minimal waiting.
However, the medical tourism marketplace can be overwhelming, and finding objective information can be difficult, particularly for individuals seeking surgical treatment. In a recent poll; over 70% of medical tourists chose their destination from the internet [Medical Tourism Association (MTA) Survey, 2009]. If you’ve ever bought clothes, or any other personal items through on-line shopping, then you know that items are not always as described, and what you see is not always what you end up with. Third party, objective informational sources are difficult, if not impossible to find. Information provided in this book was obtained through interviews and first hand observation. The authors have no personal or financial interests in any of the clinics or services discussed within this book.
Before you go:
1. Research the procedure including risks, complications and post-operative recovery time. Cartagena advertises as a destination for bariatric surgery, which is a more complex medical procedure, carrying a higher risk of complications including serious infection, blood clots, bleeding and death. [In comparison with most elective cosmetic procedures, orthopedic and dental procedures]. Cardiac surgery, organ transplantation and some complex cancer operations carry a higher risk profile than traditional gastric bypass procedures. Lap-band and other new bariatric procedures have a lesser risk but may not be appropriate for all individuals ]. Make sure you are well informed about the desired procedure, no matter where you plan to have it done.
There are several reputable medical websites including WebMD.com, mayoclinic.com.
2. Bring a list of questions to ask your doctor. Be frank and truthful about your medical history and habits. Everything about your medical history is relevant and important. For example, people with a history of radiation have poor wound healing in the irradiated area, even years later. It’s not worth risking your health due to embarrassment, or shyness. Remember, in most cases, you can also email your surgeon ahead of time. You should receive prompt replies within 48 hours of your inquiry for non-emergent issues.
3. Plan to spend at least two weeks at your medical tourism destination.
4. Choose your travel companion carefully. Do not travel alone, or bring small children. Your travel companion needs to be someone who is capable of assisting you after surgery. This person should also be someone that you trust to make decisions for you while you are incapacitated (during and after surgery). While several medical companies offer nursing services as part of the package, in general these nursing services are limited to daily visits or phone calls to your hotel room after you are discharged from the medical facility, so your companion needs to be prepared to help you dress, shower, and perform activities of daily living after surgery.
5. Arrange for hometown follow up with your primary care provider. Schedule a follow up appointment with your primary provider before you leave, for approximately one to two weeks after your return home. Ask your surgeon for a copy of his surgical report, and other medical records to give to your primary doctor. Be aware that your primary care doctor may attempt to discourage you from seeking treatment outside of the local area.
6. While many people prefer to undergo cosmetic procedures with a veil of secrecy, safety is paramount when travelling away from home.
Notify at least one family member or friend of your departure and return dates, along with hotel information. Alternatively, you can register your travel with the state department at
https://travelregistration.state.gov/ibrs/ui/
7. Use caution and good judgment when buying or consuming food, particularly when purchasing from street vendors. Restaurants and grocery stores are safe but the hygienic condition of products sold by numerous street vendors can be questionable. Before dismissing these concerns please consider that the vast majority of transmittable illnesses encountered during travel, including serious or life-threatening illnesses such as Hepatitis A occur from fecal contamination of uncooked foods such as unwashed fruit, vegetables, lettuce. This is very similar to numerous serious and potentially fatal food contaminations with E. coli that have occurred in the United States.
This is especially important for all potential surgical patients and in particular, bariatric surgery patients. Surgery itself weakens the body’s ability to fight infection as immune system reserves are engaged in healing from the surgery itself. Taking a few extra precautions to prevent contracting a serious food borne illness when planning to undergo surgery, or after a recent surgery is essential for maintaining comfort, health and well-being.
In bariatric patients or patients who have undergone abdominal surgery, forceful vomiting may disrupt surgical sutures. Dehydration and electrolyte imbalances may also occur more readily in bariatric patients who can only consume very small portions following surgery.
8. Pack light.
- Travel only with one small, preferably wheeled bag if possible, for your own comfort, convenience and safety. Travel can be tiresome enough even in the best of circumstances. Struggling with excessive baggage can be frustrating when tired, and sore. Post surgery restrictions may limit your ability to lift or carry for several weeks to months after surgery. Don’t rely on others to keep track of or carry your luggage.
- Limit yourself to the absolute essentials.
- Bring easily washable clothing in synthetic fabrics such as nylon, or polyester. This will allow you to bring less clothing and wash clothes during your stay. Light fabrics such as polyester dry quickly with a minimum of fuss, and no need for ironing. Sweats and other heavy knits are not suitable for the local climate.
Balcony in El Centro, historic district
What to bring on your medical trip: Checklist
[ ] All necessary travel documents (with photocopies of all photo identification) including driver’s license and passport.
[ ] Copy of written documentation related to medical procedure, medical facility with local addresses of hotels, medical clinic, and other local contact numbers.
[ ] Bring copies of all pre-operative testing performed prior to your trip. X-rays and other imaging studies can be copied to CD-ROMs or DVDs for travel. Other medical information can be emailed directly to your surgeon with your pre-authorization. Make sure one copy of your medical records travels with you.
[ ] Photocopy and fill out Appendix A from this book. Keep this form with you. This will help medical providers of your medical information in an emergency.
Depending on your medical history and scheduled procedure, your surgical team may need you to have some testing before traveling to your destination. You may need to undergo additional blood tests after your arrival.
[ ] All current medications; along with a typewritten list of medications. Pack medications in carry-on luggage only. Be sure to know the generic names of your medications as these names are the same internationally.
Diabetics:
- If you are diabetic, and require insulin or frequent blood glucose testing, be sure to have adequate supplies on hand. Insulin can be packaged in insulated containers to maintain medications at appropriate temperatures. Notify all security screeners at airports that you are carrying insulin and syringes to prevent delays or damage to supplies. While TSA regulations allow diabetics to bring juice, during recent travel, we witnessed juice being taken from a type 1 diabetic wearing an insulin pump during security screening. He also endured several rude, muttered comments from security screeners. The individual reported he had experienced inconsistent rule enforcement at airports, and frequent harassment.
[ ] Support garments as recommended by your surgical team (i.e. sports bras, or girdles). Abdominal binders are helpful to reduce pain with movement following abdominal surgery. Sports bras and other wraps help reduce pain, and speed healing after surgery.
[ ] Anti-embolic stockings / socks for air travel after surgery [These are available at pharmacies, medical supply stores, and large chains like Wal-mart. Measure your calves at the widest point for proper fit. Socks should be snug but not painful. Individuals with a history of peripheral arterial disease (PAD), gangrene or other lower extremity conditions should check with their physicians prior to wearing compression socks].
- Be sure to inform your surgeon if you have a past medical history of a previous deep vein thrombosis (DVT), “blood clot” or pulmonary embolism (PE), “clot in the lungs.” He/ She may want to prescribe additional medications to prevent a blood clot on your trip home, particularly if your flight is of long duration.
[ ] Small supply of ibuprofen and acetaminophen for pain and fever post-operatively. Be sure to inform your surgical team of all the medications you are taking.
Patients with kidney disease, hypertension or diabetes should limit their ibuprofen consumption. Be cautious using acetaminophen in combination with other medications (acetaminophen is an added ingredient to multiple medications including over the counter cold remedies to prescription narcotics.) Current medical recommendations limit acetaminophen to less than 4 grams (4,000 milligrams) in a 24 hour period [This is equal to eight extra strength acetaminophen tablets. Currently these recommendations are under consideration for revision, to a lesser threshold of approximately 2.5 grams per 24 hours.].
Medical tourism has existed for decades, but has only recently received greater scrutiny. In the past, the United States was the leading destination for medical tourists. [Medical tourism to the United States is generally called “in-bound” tourism. The reasons / rationale behind in-bound and outbound tourism are quite different.]. However, changing perceptions of both the American health care system, increasing health care costs, and globalization with increasing economic opportunities abroad have changed the nationalities of both the recipients and providers of medical care. Most patients travelling to the United States for care are seeking advanced technologies (from third world countries) or seek to avoid waiting periods that are endemic in socialist countries. By eliminating geography as the primary determining factor for medical care, our treatment options are increased. Medical care should be about choice, not limitations.
How common is it?
Unfortunately, hard data about the medical tourism industry is scarce, and often from dubious sources. Various estimates of the number of annual patients participating in medical tourism vary widely. Several widely quoted sources cite the figure of “12 million by 2012” but information about how this number was generated is not well explained. In contrast, the McKinsey Quarterly estimates 60,000 – 85,000 in-patients per year in their May 2008 issue. [As mentioned in the report, the figure ignores the large numbers of patients undergoing out-patient or same-day procedures, which represents a large portion of cosmetic, dental and other procedures. This report discusses in-bound and outbound medical tourism. Ehrbeck, T., Guevara, C. & Mango, P. D. (2008, May). Mapping the market for medical travel. The McKinsey Quarterly].
A more reasonable estimate was provided by the Deloitte Center for Health Care Solutions which estimates health related travel to expand to 1.2 million by 2012, with current estimates of 750,000 per year [Harvard Business Review, The Daily Stat for April 9, 2010].
As health care providers, the authors know first-hand the problems and failings of the current American system. While talks and reforms are being proposed and designed, millions of Americans are going uninsured in the interim. Millions more are underinsured. Even well insured individuals may receive substandard care at American hospitals due to chronic understaffing and defensive medicine practices. Cost does not equal quality in today’s healthcare market. The medical tourism industry has now become a viable mechanism to bridge the gap created by inefficient, burdensome and expensive healthcare systems [In a Gallup poll conducted April 16 – 20th 2009, showed a significant number of Americans were willing to travel overseas for medical care. (Percentages stratified by treatment.) Additional information on this poll available at http://www.gallup.com/poll/118423/americans-consider-crossing-borders-medical-care.aspx ].
While popular media and much of the advertising literature primarily promotes medical tourism for cosmetic surgery procedures, millions of Americans are going overseas for procedures such as joint replacement, bariatric surgery, and cardiac surgery. In many cases, medical tourism isn’t a luxury; it’s a necessity due to out of control health care costs. For example, joint replacement costs anywhere from 30,000 to 60,000 US dollars in the United States [Americans consist of 99% of consumers seeking care abroad due to cost considerations according to the McKinsey Quarterly ]. For uninsured patients, the entire cost is passed along. For many others, high co-pays or limited access to health care translates into poorer quality of life due to limited mobility and chronic pain. In comparison, the same surgery can be performed for around $3,000 – 8,000 USD in several countries in Europe, Latin America and Asia [While procedure and travel costs are important considerations for the consumer, cost should not be the primary determinant for destination and services. Please take the other factors such as reputation, facility, services, and training into consideration when choosing a medical provider.]
There is no fast, easy or simple solution to the myriad of problems plaguing the current health care system, but medical tourism may help fill a much needed gap. In countries outside the United States, such as Canada and parts of Western Europe, socialized medicine presents its own set of problems and failings. There is no size fit all approach to addressing these healthcare discrepancies. Medical tourism is not for everyone, and not all medical tourism destinations, clinics or surgical programs are the same. Quality, service, cost, and qualifications of the personnel vary by destination, facility and procedure.
Medical Tourism versus Surgical Tourism
Medical tourism is used to describe any and all healthcare travel while surgical tourism is used to more specifically describe travelling for surgical care. Surgical tourism accounts for the vast majority of medical tourism but patients can and do travel for other types of medical care such as chemotherapy and alternative cancer treatments. Surgery, which is episodic, not chronic in nature, more easily lends itself to travel or destination treatment. Most surgical patients undergo the procedure, recuperate in a fairly short period of time, and require little follow up, where as medical treatments such as medications may require frequent titration and adjuvant monitoring which may make travel more cumbersome. In the literature, medical tourism is the most frequently used terminology to indicate any care undertaken at an outside location, where as this publication deals more specifically with surgical tourism.
Medical Tourism in South America?
Wait! Do those people even have running water? You wouldn’t know it from reading some of the outdated tourism literature, but the medical tourism industry has been well established in South America, where specialty surgery such cosmetic surgery is more commonplace. Standards of living in many parts of south and central America rival the United States, with more and more Americans choosing to retire in the southern hemisphere.
In Colombia, Bogota is a more popular destination for surgery, and boasts a variety of all-inclusive medical tourism companies, clinics and medical facilities. Cartagena, with its beautiful and historic Caribbean backdrop is just beginning to emerge as a medical tourist destination. Currently, the World Health Organization (WHO) ranks Colombia #22 for world health rankings. (In comparison, the United States is ranked #37 [World Health Report, 2000 June 21. Unfortunately, WHO no longer produces rankings, citing the complexity of the task ].
Is it Safe?
“Is it safe?” This is the number one question posed by consumers, and deserves ample discussion. The answer depends on who you ask, and what their interests are. The American Medical Association (AMA) and the American medical community have taken the position that surgery performed outside the USA should be considered an inferior service, and places patients in inherent jeopardy. Travel warnings on government websites reinforce this belief. Anecdotal evidence and scare stories abound, of liposuction “gone wrong” with tragic consequences for patients involved.
However, medical care by its very nature involves risk, in every setting, and it is important to categorize that risk; (i.e. is a tummy tuck performed in Rio de Janeiro riskier than the same procedure performed in Atlanta, Georgia or Tyler, Texas?)
Conversely, the medical tourism industry claims that products and procedures offered are not only safe, but often superior in service to American counterparts. A recent poll conducted by the Medical Tourism Association polled patients after undergoing medical procedures overseas. According to their published data 70% of survey respondents rated their hospital/ medical care as excellent [Survey conducted by the Medical Tourism Association which is an organization created to support the medical tourism agency, which may introduce bias into these results]. MTA also reported that an overwhelming 93 % of respondents would recommend international travel for medical care, and 88 % of these patients would use medical tourism for medical care in the future.
In truth, quality and safety is operator dependent, not patient perspective. Patient perspective is often based on subjective and variable qualities such as quality of food and customer service. While these measures are important in the overall quality of service, this is a very limited and unreliable indicator of patient safety and patient care. Most of the most important factors in determining patient safety are not easily discernable by the layperson. These include criterion set by national and international agencies based on years of research data on infection control and operating room safety. Some of this information requires on-site inspection for confirmation; such as visual and physical tours of the operating rooms in several hospitals in Cartagena. For example, in both New Bocagrande Hospital and Medi-help surgery clinic, surgeries were performed in clean, safe facilities that met all standard criterions for sterile processing of equipment, operating room procedures and post-operative care.
The surgeries themselves were conducted effortlessly, efficiently and in accordance to current recommendations for surgical treatment. These recommendations for the reduction in complications include concrete criterion such as; pre-operative antibiotics were administered within one hour of first incision, proper surgical site cleansing, and draping, and maintenance of sterile technique through out the entire procedure [This is an abridged list ].
Other issues related to safety
Geographic concerns related to safety deal with the safety or relative danger of the destination. Most established surgical tourism centers are in larger geographic areas. These cities overall crime rates vary by location. However, oft cited concerns for kidnapping, murder and general mayhem in regards to travel to Colombia are exaggerated, particularly when discussing the city of Cartagena [Johnson, R. (2005). Cultural soul of Colombia. LA Times, September 11, 2005.].
While Cartagena does have a large suburban slum area, the city itself is fairly safe and crime is comparable to most north American cities. For the most part, the surgical services are located in the more upscale areas of the city, which are generally safe, and tourist friendly, even at night. However, as with all travel, we advocate the use of common sense in regards to personal safety in any locale; be aware of your surroundings, don’t carry large sums of cash on your person, and avoid solo travel in unfamiliar areas late at night.
What about health insurance?
Several American health insurance carriers have begun offering payment for procedures done outside the USA. In fact, some companies offer incentives for their enrollees for having procedures done at lower cost facilities outside the United States [Blue Cross /Blue Shield, WellPoint are some of the health insurance companies interested in medical tourism. Belcher (2008). WellPoint introduces international medical tourism pilot program: Global Health Care Partnership with Serigraph, Inc. Reduces Costs for Members Undergoing Elective Procedures in India. More information available at company websites. Blue Cross currently covers medical tourism under out-of-network plans/ rates.]
If you have insurance, call or contact your insurance carrier and ask out out-of-network providers, and medical tourism recommendations.
Investigative Methods/ Author’s Note
In an earnest attempt to offer unbiased and factual information on the surgical tourism industry in Cartagena, Colombia, the authors have conducted an investigative review of facilities and providers. While we are unable to verify the veracity of all the claims set forth by individuals, clinics and companies here in, we have attempted to personally interview and tour facilities and staff on location. Participation by these facilities is voluntary, and refusals to participate or cooperate have been duly noted for your information.
However, as part of our commitment to honest, and transparency during research for this project, the primary investigator has clearly identified myself, and my purpose during all conversations, on-site visits and other interactions. In the interest of safety and consumer trust the authors have maintained personal and professional integrity at all times. Using my professional status has a secondary benefit in that it allowed me to have access to facility and staff members that would not otherwise be possible via professional courtesy [ Strict privacy and safety regulations in facilities in the USA and many other countries restrict access to many areas of health care facilities. Few, if any allow at “stranger off the street” to inspect facilities or interview staff. Use of my credentials established legitimacy in these circumstances.].
Facilities and providers were chosen using both the yellow pages, internet sources, recommendations from locals and referrals from other providers. We started with the providers that were the easiest to find, either by internet advertising or word of mouth. This way we able to evaluate the services that overseas consumers would be most likely to find. This list included is not meant to be all inclusive of all specialties. It is a list primarily of surgical providers, and is heavily weighed on providers in the most commonly requested specialties, as well as cardiac surgery, which is my own background.
Prior to surgical procedures, patient consent for observation was obtained.
Why Cartagena?
This is a time of great change in Cartagena, particularly in some of the local health facilities in Cartagena. One of the local hospitals, Hospital Bocagrande has just entered a new multi-million dollar affiliation with the University of Miami [El Universal, 21 February 2010]. This affiliation will bring new equipment and training to Hospital Bocagrande, to update and improve services available. Medi-help, a well-known and recognized private facility for excellent surgical care continues to expand and attract a wide range of experts in surgical specialties. More and more innovation in medical and surgical technology along with exploding growth in medical tourism worldwide is driving these changes, and bringing Cartagena into the forefront of destination surgery.
Location. Cartagena is a relatively short flight from many US locations (2.5 hours from Miami, 5 hours from New York.) This is an important consideration for comfort, convenience and safety. Longer flights increase the risk of late post-operative complications such as deep vein thrombosis (DVT) and pulmonary embolism (PE). These complications can occur even several weeks after surgery, particularly orthopedic procedures, bariatric surgery or liposuction [Recent research focusing on women, suggests that the incidence of post operative thromboembolism (clot) peaks about three weeks after surgery, but persists up to 12 months after surgery. Biggs, W. S. (2010). Risk for venous thromboembolism lingers long after surgery. Journal Watch. 10 February 2010.].
Pulmonary embolism or a blood clot travelling to the lungs can rapidly be fatal. The risk of thromboembolism is increased in patients with certain additional risk factors such as oral contraceptive use, obesity, smoking, cancer or previous clot history.
In – flight ambulation (walking in the aisles periodically), ankle and calf stretches while sitting, anti-embolism stockings, and short flight duration can reduce this risk. Patients with prior history of DVT, PE or with a history of cancer or other coagulopathies may be prescribed medications such as warfarin, enoxaparin or other blood thinners to reduce this risk.
Modern; thriving, downtown Cartagena
Climate. Cartagena has a humid, Caribbean climate, with year-round temperatures in the upper 80’s Fahrenheit, with minimal seasonal variations. There is a rainy and a dry climate, but there is little risk of inclement weather disrupting your travels at this destination. Due to Cartagena's position on the northeastern coast of Colombia, sea breezes provide evening relief to much of the daytime heat. This makes for a pleasant visit for medical travelers and their companions.
Cost. In comparison to many more popular tourist destinations in other parts of the Caribbean or South and Central America, as an emerging market Cartagena remains affordable. With a little advanced planning, or the assistance of travel guides and the internet, even a two week trip to Cartagena won’t break the budget. However, as currency values change, Cartagena may become more expensive for Americans in the future [Currently much of Cartagena’s economy remains in a growth phase in comparison with most of North American; which has suffered from severe financial setbacks, economic losses and double digit unemployment.].
Brief Introduction to Cartagena, Colombia
City Basics:
Cartagena is one of the oldest European cities in South America. It was founded in 1533 by Spanish explorers. In comparison to the glamorous reputation of Buenos Aires, Argentina, “the Paris of South America,” Cartagena remains a low key, casual paradise “the jewel of the Caribbean,” filled with treasures from its glorious maritime history.
With 1.2 million inhabitants, Cartagena is a bustling, sophisticated and fashionable city. The city has a wide variety of activities and attractions for almost every kind of interest. Recently Cartagena’s industry has expanded to include surgical tourism.
As part of a new initiative to welcome English speaking tourists to Cartagena, the ministry of tourism has provided the taxi cab drivers of Cartagena with English- Spanish phrase cards to assist taxi cab drivers in communicating with their English speaking passengers [Norkin, Brett. (2010). Improve your Spanish: Take a Cartagena taxi. Colombia Reports. April 6, 2010.]
Clock tower in historic walled city
There are several distinct neighborhoods within central Cartagena. The most famous and popular of these is the El Centro neighborhood.
El Centro/ Historic section
El Centro, and the neighboring San Diego are small neighborhoods within the historic walled section of the city. This area of Cartagena is characterized by narrow cobblestone streets lined with colorful, stone buildings from previous centuries. This is a fun, tourist laden area with an interesting mix of charmingly quaint, and colorful nightlife. With notable exceptions such as the Soffit Hotel, the majority of hotels and lodgings within this section are smaller, more charming, and often family owned hotels.
Bocagrande
Bocagrande and Castillogrande are the more modern and upscale sections of downtown Cartagena. Castillogrande is primarily residential, with limited lodgings but the Bocagrande neighborhood is a thriving tourist district with larger hotels with more amenities. Bocagrande is also home to several medical offices, clinics and Hospital Bocagrande.
Getsemani & La Matuna
Gestsemani is a working class neighborhood that borders the historic district. There are a few hotels and hostels that primarily cater to budget travelers in this area.
Manga & Pie del Cerro
Manga is one of several other neighborhoods on the ever-expanding area outside of central Cartagena. Much of Manga is a busy, commercial area with several residential streets tucked behind the larger throughout fares. Beyond Manga, the larger, less affluent sections of Cartagena stretch out for several miles. Clinica AMI, Clinica Cartagena del Mar are located here on Pie de la Popa, a major road through Pie de Cerro. The cruise ship terminals, and Club Nautico, are located in Manga.
Health care and the health care system
The country of Colombia has undergone a widespread metamorphous since the late 1980’s. While much of this transformation has been related to crime and public safety, the Colombian health care system has undergone widespread changes as well. Access to care remains a problem in many outlying areas related to substantial population displacement from previous armed conflicts, drug violence and terror regimes [Tomasouw, T. Violence in Colombia isolates millions from health care. Published July 2, 2007, Doctors without Borders newsletter ].
Colombian health care is essentially two – tiered; with public health care of varying quality, as well as a more elite private clinic option, utilized by the upper and middle classes. The quality and availability of public services varies by regions of the country. Cartagena, in comparison to smaller, more rural areas has public facilities including the academic hospitals, and the naval hospital. Most medical tourism procedures are performed in private clinic facilities or the more exclusive hospitals. Corruption within the public sector remains a huge problem with the recent Salud Coop scandal illustrating many of the problems plaguing the Colombian healthcare system [The Salud Coop scandal involved a health cooperative that was convicted of taking millions of dollars from subscribers, and misusing these funds for executive purposes such as vacation homes, travel, etc. Salud Coop was fined over 627 million pesos by the Colombian courts in February 2010].
Public Health
Recently the Colombian Finance Minister, Oscar Ivan Zuluago declared a ‘social emergency’ regarding the Colombian health care system. Mr. Zuluago reported that Colombia needs 500 million dollars to rescue the failing system from imminent collapse, and has appealed to the United States for immediate financial aid. However, there is no evidence of any significant impact on services likely to be utilized by medical tourism. By definition, medical tourism is based on the principles of first tier, privatized and exclusive medical care. This area has been unaffected by recent problems.
Colombia has its share of public health problems including HIV, Tuberculosis and Hepatitis. Sources cite HIV as the fifth leading cause of death in the ‘working age population’ which is a somewhat misleading statistic due to both the changing nature of HIV infection, and the relative youth of the infected population (UNAIDS, 2006 [Alsema, A. (2009, December 24). Colombia declares social emergency over failing healthcare system. Colombia Reports ]. Like many other nations, the use of anti-virals in Colombia has led to HIV infection being largely transformed from a rapidly terminal disease to a chronic illness. “The fifth-leading cause of death” is a misnomer in an age category where death from disease is uncommon. More common causes of death in this age group include trauma, motor vehicle accidents, and drug overdoses. Health problems related to poverty persist in primarily rural areas outside larger cities of Cartagena, Medellin and Bogota. Wide disparities in health care exist, with upscale clinics offering state-of-the-art treatments and procedures in cities such as Cartagena, while basic primary care services are often non-existent in war scarred areas of the Colombian countryside.
Due to its tropical location, Cartagena residents also include malaria, dengue fever and several other parasitic infections as public health concerns but there was little evidence of this problem within the city proper. However, the majority of Cartagena residents subsist on minimal economic resources and a large slum exists of the outskirts of the city, which is clearly visible by air. Large discrepancies between classes exist. For the majority of inhabitants health care is minimal at best.
In comparison to large North American cities, the number of specialty practitioners for this area seems woefully inadequate. The cardiovascular surgery programs here are a perfect example of that, with one full time surgeon for the entire city, and one other part time surgery service operating out of the Clinica University de San Juan de Dios.
International perceptions of Cartagena’s population as third-world inhabitants with widespread poverty, filth and pestilence are generally overstated and inaccurate. Available literature including guidebooks and governmental websites tend to reinforce this belief [Lonely Planet Colombia, 3rd edition, (2003), pgs 48 – 53]. In reality, a large portion of city residents do live in poverty but after reviewing and touring the majority of hospital facilities in the greater Cartagena area, including the economically deprived Hospital de Cartagena there is little evidence of gross pestilence, plagues or other such literary dramas. There is a true reflection of poverty in that many patients present late to the public facilities with advanced cancers, complications of diabetes and other otherwise potentially treatable conditions.
Availability of certain diagnostic and treatment modalities are limited. There is no PET/CT scanner in the state of Bolivar. However, since this modality is primarily used for the staging of cancers, this should not impact your visit to Cartagena. Oncology patients travelling to Cartagena should both email and bring CD-ROM copies of their studies.
While much of Latin American has the reputation of having limited and primitive medical care; recent research and tours of the local facilities demonstrated that by and large, this simply wasn’t the case. However, visitors to Cartagena should exercise caution when seeking medical treatment in the public facilities (Universitario de Cartagena & to a lesser degree, Clinica Universitario de San Juan de Dios), unless no other alternatives available due to the limited availability of people with English language skills, and the sometimes scarcity of resources available.
General Sanitation
Hand washing is almost a religion in the health facilities here and is enforced rigorously. Even in the more crowded public facilities, everyone entering the intensive care units, pre-operative areas, step-down units and other select areas must wash their hands with hospital grade liquid antibacterial soap, and wash again before and after patient encounters. All hospital staff, physicians and visitors wash their hands again before leaving one area to travel to the next.
The same rigid adherence to practice guidelines was observed in all surgical areas, with surgical attire, frequent hand washing/ surgical scrubs, and sterile handling procedures strongly enforced.
Hospital Bocagrande
Calle 5ta C/Carrera 6ta
Barrio Castillogrande
Cartagena
Colombia
http://www.hospitalbocagrande.com.co/
Basic Hospital Information:
First opened in 1954.
An urban, beachfront hospital offering services in general, orthopedic, cardiac, plastic/ cosmetic and other specialty surgery. Hemodialysis services are offered through Fresenius, similar to many American facilities. New Hospital Bocagrande has a fully functioning cardiac catheterization lab, with interventional cardiologists, who have the ability to place stents, and an established STEMI protocol for acute myocardial infarctions. This hospital has the only 24-7 cardiology and cardiac surgery capabilities in Cartagena.
English language services: Many individuals with varying degrees of fluency in English available to assist.
Overall appearance: A moderate sized facility with a dated exterior, in architectural style characteristic of Latin America, inside is very clean, bright, modern appearing with marble floors, air conditioning. Evidence of on-going construction apparent.