A personal experience: knee replacement surgery in Mexico
Carol Schmidt
August 27, 2007
Why are so many U.S. citizens going to Mexico for health care? Those 45 million uninsured Americans need the lowest costs they can find. Even those with insurance find their out-of-pocket expenses in Mexico may be cheaper than their copays. But is the quality the same?
Sometimes it can be better--just as in the U.S. health care system, individual doctors and hospitals can vary widely. But after undergoing my first knee replacement surgery in Mexico last week, let me share my experience.
I retired to San Miguel de Allende, an art-centered colonial town of 80,000 about 165 miles northwest of Mexico City, five years ago and had learned to trust several local doctors and the 60-bed general hospital for basic health care.
It was the increasing arthritic knee pain that made me think about having replacement surgery. And then the question was whether to have it locally or go back to the States. I deepened my committment to my adopted country of Mexico with my decision, and the cost was a sixth of what it would have been in the U.S.
I came through the Saturday morning sugery fine, was kept in the hospital until Tuesday because the doctor knew I had 21 steps to maneuver to get into our apartment, and am walking around already just as good as before the surgery. I'll need rehabilitation therapy to finish the straightening, since for years apparently I have been favoring my right leg. It's been nine days.
I'd been processing this decision for months, just as any expat who doesn't have the money for excellent full medical coverage does. Dr. Michael Schmidt does orthopedic surgeries out of Munich, the US, Hospital Angeles in Queretaro, and Clinica Queretaro, a small clinic above the offices of about ten medical specialists.
To have a knee replacement in the US would have cost about $40,000 USD plus all the travel, hotel, restaurant meals and living expenses of staying in the States at least three weeks for final clearance. At Hospital Angeles in Queretaro, which is affiliated with Houston Memorial, it would have been about $20,000, and at Clinica Queretaro it was 68,000 pesos, about $6,400 USD.
My research found that it is actually better to have something specialized done at a clinic specializing in the procedure, since all the staff and facilities will be geared to the procedure and they will have handled hundreds of cases.
Dr. Schmidt's reputation is excellent, I know many people in San Miguel who have been operated on by him, and we could stay at home and not board our pets and have all the travel hassles of a US trip. We calculated the total costs of going back and forth to the US and all the hotels, etc., and it could easily have reached $6,400 USD not paid for by any Medicare and Medigap insurance plan. No brainer decision.
Big factor: Mexican hospitals allow a family member or friend to sleep on a cot or sofa in your room, eliminating hassles and hotel costs. No one qestioned who Norma, my partner for 28 years, was. Your visitor is expected to do much of the routine care nurses' aides do in the U.S.
Clinica Queretaro has only six patient rooms that I saw, plus two operating suites and recovery area. A lumbering elevator to the second floor requires a staff member with a key. Usually you take the stairs. The first room we were to be in for an Aug. 4 scheduled operation was fairly small and the sofa on which Norma would sleep for the duration was typical hard-as-rocks Mexican furniture.
But that room did get BBC on the TV set. For some reason our next room a few doors away didn't get BBC, though we watched some pretty sappy movies in English with Spanish subtitles on the Hallmark channel Sunday and Monday.
I need to spend much more time watching Mexican TV so that I can work more on my pronunciation and understanding of spoken Spanish. But I just wasn't in the mood both before and after the surgery. I did have along The Hummingbird's Daughter (excellent historical novel about life in Mexico around the time of the 1910 revolution) and The People's Guide to Mexico, as well as the latest John Sandford mystery.
We checked in at 8 pm Friday night with a small suitcase mostly of clothes for Norma, our robes and slippers, and plush towels, our own pillows tucked under our arms. We also brought a cooler of Diet Pepsi and snacks on ice for Norma, and she walked to a nearby supermarket and restaurants to replenish her little fridge. She even found a Lebanese restaurant in a nearby mall and brought me back baba ganouche and hummus my last day. (Queretaro is a city of a million people.)
The hospital food wasn't spectacular--yes, I have had fantastic meals in hospitals, mainly private ones in LA. These were boring even by most US hospital standards, though. Norma could have had the staff bring her a tray at each meal same as I was getting, but she preferred her own.
For me, every meal after the surgery included a cup of fresh fruit such as a thinly sliced apple or pear, a cup of Jell-o or yogurt, a glass of juice, and either hot chocolate or a cup of hot water, usually minus the tea bag. Breakfast or late meal would include a cup of corn flakes and milk, and the other meals included plain quesadillas, a fried mystery meat with a tomato sauce, or an egg and veggie frittata.
I joked once that at least I'd confused the words hombre, hombro and hambre only in Spanish classes--from what I'd said you couldn't tell if I was saying I needed a man, a shoulder, or I was hungry.
And then I goofed in real life. I figured out a nurse was telling me that a workman was coming into the room to fix the hot water. (We were told later by the workman that the hot water came out of the cold tap, why didn't we see that, what was the problem? That's Mexico. If you can't go with the flow, whichever tap it comes out of, you'll hate it here.)
So I indicated to the nurse that I understood, a man was coming into my room, and I should put on my robe. But I realized as soon as the sounds came out of my mouth that I'd said hambre, not hombre, and another tray of corn flakes appeared instantly on my table.
Some days I feel pretty good about my Spanish, other days I'm still estupida. I had moments of both during my stay. A nurse would ask me something too quickly and I'd do the standard, Repete, por favor, mas despachio, and she'd give up on me, ask if I were from nearby San Miguel (home to some 12,000 expats), use some sort of sign language to convey her message, and leave the room fast.
But other nurses hung in there with me and we did communicate. One saw me hobbling with my walker the first time after my surgery and called me Speedy Gonzales. I said no, more like un caracol (a snail). So I was nicknamed the snail. Mexicans love nicknames.
We had the spacious room looking like a college dorm within minutes after arrival. Usually very well organized Norma had brought various computer games and programs to use while I was in surgery or asleep, knowing we wouldn't have wireless internet--and then she forgot the cable for the electrical outlet plug-in. She had only two hours battery usage of the laptop. Next time that cable is packed down her blouse or something so she absolutely will not forget it.
We'd brought a complete set of toiletries, not expecting to get a welcome packet of soap, shampoo, toothbrush, toothpaste and slippers in a Mexican hospital, but here one was. But it did not come in your very own take-home bedpan and washing tub.
Thanks to hospital stays we've always had plenty of big plastic tubs around our house through the years, and I'd always thrown away the bedpans once I left the hospital in the past. Here, I felt squeamish using the same bedpan many others had used before me, but, hey, I never think about unisex toilets on planes.
We didn't want friends stopping in while I was in the hospital, but we've had wonderful offers of help from many people, including a male friend who was ready to get me up those stairs one way or another. (I was thinking about having to call the fire department or the Red Cross if I had trouble. I was told they'd help.)
I never felt the nurses were unattentive, they did check on me frequently and certainly were prompt with the shots and pills. I had to dial 111 on the phone to get a nurse between visits, and one always came much more quickly than when I pushed the help button in US hospitals.
I wasn't automatically given a sleeping pill at 9 pm the way US hospitals usually did, even if I had to be awakened to get that routine sleeping pill. So we were up until our usual 2 am watching TV or reading, the nurses not quite understanding that. Dr. Schmidt, by the way, is definitely an early bird, alert and confident at 7 am for his first surgery of the day. And he checked in on me all day long.
Another English-speaking doctor was in the operating room who helped with the tools and such. The rest of the six or eight people in the operating room didn't speak any English and I tried my best to understand word one. Probably just as well I couldn't. I had only a spinal and so could have been awake for the whole procedure. I chose to keep my eyes closed and dozed. Yes, I could sense the sawing and hammering. That's why I forced myself to sleep.
Though the doctors and nurses followed standard hand-washing and sterilization procedures same as a good US hospital, I did notice little things. One of the china cups in which my hot water arrived each meal had a chip out of the rim, right where you would drink from. One nurse trying to find a spot for my second IV just gave up on the rubber gloves.
And I doubt if the thick blankets were washed after every patient. I was so surprised the first time I spent a night in a Mexican hospital, at De La Fe in San Miguel, where I was given the warmest, thickest, fur-like blanket I could imagine and I luxuriated in it--until I thought about all the dust that could linger in the pile.
The thin smooth blankets you get at a US hospital have definitely been washed and sterilized between patients, and often are even heated for you.
The room had one of those stand-up cylindrical fans that we'd always ignored when we saw them advertised on TV or at Sharper Image shops. But this one was wonderful for moving the summer air and getting some circulation into the room. Of course there was no air conditioning, but the fan was sufficient.
The IV stand was the old manual kind, no hefty electronic marvel to beep and warn of almost-finished drips. So I was able to walk with it easily.
I think this account gives you the feeling of what it is like to be a surgery patient in a Mexican hospital, or at least one person's experience at one hospital.
Since I've been home I've seen two TV segments on US citizens coming to Mexico for health care, for example combining a beach vacation with intensive dental reconstruction so that the entire "vacation" plus dental work cost half what the dental work alone would have cost in the US.
Now if only the US government would realize how much they could save on Medicare costs alone if they allowed even a few select hospitals in Mexico to accept Medicare payments. Would we see an influx of expats into Mexico then! But that's not likely to happen in our lifetimes.
By the way, I mentioned that the surgery was first scheduled for August 4. I was actually on the operating table Aug. 4 when Dr. Schmidt got the results of my final bloodwork and said the surgery had to be postponed, my blood coagulants were too low, and he got me off of Advil. I've heard since from others who were not told, who were not checked, and who nearly bled to death when their blood would not clot during surgery. Those cases were all in wonderful USA hospitals.
All the NSAIDs such as aspirin, Advil and Aleve thin the blood, as does Vitamin C and gingko biloba, and some allergy pills, etc. One woman was given a list of 50 medications, both prescription and over the counter, to come off of before her surgery. Another woman wrote to me and said I may have saved her life because she had no idea some of her meds were duplicating the blood thinning effects and she was anticipating surgery. Her US doctor had never said a word.
So I'm walking around our three-bedroom level-floor apartment with ease, not even using the walker except when I feel tired or am going a long ways (or what passes as a long ways in an apartment). I'm feeling great, and am very positive about the whole experience.
I hope my sharing it in detail helps someone out there whos has health care issues about moving to Mexico. Could I have had a medical disaster here? Certainly, just as we have relatives who died from medical mistakes at US hospitals. Health care is still a crap shoot.
(For 200 free jigsaw puzzles featuring photos of San Miguel, go to www.fallinginlovewithsanmiguel.com and click on "SMA Jigsaws" on the left.)
Sometimes it can be better--just as in the U.S. health care system, individual doctors and hospitals can vary widely. But after undergoing my first knee replacement surgery in Mexico last week, let me share my experience.
I retired to San Miguel de Allende, an art-centered colonial town of 80,000 about 165 miles northwest of Mexico City, five years ago and had learned to trust several local doctors and the 60-bed general hospital for basic health care.
It was the increasing arthritic knee pain that made me think about having replacement surgery. And then the question was whether to have it locally or go back to the States. I deepened my committment to my adopted country of Mexico with my decision, and the cost was a sixth of what it would have been in the U.S.
I came through the Saturday morning sugery fine, was kept in the hospital until Tuesday because the doctor knew I had 21 steps to maneuver to get into our apartment, and am walking around already just as good as before the surgery. I'll need rehabilitation therapy to finish the straightening, since for years apparently I have been favoring my right leg. It's been nine days.
I'd been processing this decision for months, just as any expat who doesn't have the money for excellent full medical coverage does. Dr. Michael Schmidt does orthopedic surgeries out of Munich, the US, Hospital Angeles in Queretaro, and Clinica Queretaro, a small clinic above the offices of about ten medical specialists.
To have a knee replacement in the US would have cost about $40,000 USD plus all the travel, hotel, restaurant meals and living expenses of staying in the States at least three weeks for final clearance. At Hospital Angeles in Queretaro, which is affiliated with Houston Memorial, it would have been about $20,000, and at Clinica Queretaro it was 68,000 pesos, about $6,400 USD.
My research found that it is actually better to have something specialized done at a clinic specializing in the procedure, since all the staff and facilities will be geared to the procedure and they will have handled hundreds of cases.
Dr. Schmidt's reputation is excellent, I know many people in San Miguel who have been operated on by him, and we could stay at home and not board our pets and have all the travel hassles of a US trip. We calculated the total costs of going back and forth to the US and all the hotels, etc., and it could easily have reached $6,400 USD not paid for by any Medicare and Medigap insurance plan. No brainer decision.
Big factor: Mexican hospitals allow a family member or friend to sleep on a cot or sofa in your room, eliminating hassles and hotel costs. No one qestioned who Norma, my partner for 28 years, was. Your visitor is expected to do much of the routine care nurses' aides do in the U.S.
Clinica Queretaro has only six patient rooms that I saw, plus two operating suites and recovery area. A lumbering elevator to the second floor requires a staff member with a key. Usually you take the stairs. The first room we were to be in for an Aug. 4 scheduled operation was fairly small and the sofa on which Norma would sleep for the duration was typical hard-as-rocks Mexican furniture.
But that room did get BBC on the TV set. For some reason our next room a few doors away didn't get BBC, though we watched some pretty sappy movies in English with Spanish subtitles on the Hallmark channel Sunday and Monday.
I need to spend much more time watching Mexican TV so that I can work more on my pronunciation and understanding of spoken Spanish. But I just wasn't in the mood both before and after the surgery. I did have along The Hummingbird's Daughter (excellent historical novel about life in Mexico around the time of the 1910 revolution) and The People's Guide to Mexico, as well as the latest John Sandford mystery.
We checked in at 8 pm Friday night with a small suitcase mostly of clothes for Norma, our robes and slippers, and plush towels, our own pillows tucked under our arms. We also brought a cooler of Diet Pepsi and snacks on ice for Norma, and she walked to a nearby supermarket and restaurants to replenish her little fridge. She even found a Lebanese restaurant in a nearby mall and brought me back baba ganouche and hummus my last day. (Queretaro is a city of a million people.)
The hospital food wasn't spectacular--yes, I have had fantastic meals in hospitals, mainly private ones in LA. These were boring even by most US hospital standards, though. Norma could have had the staff bring her a tray at each meal same as I was getting, but she preferred her own.
For me, every meal after the surgery included a cup of fresh fruit such as a thinly sliced apple or pear, a cup of Jell-o or yogurt, a glass of juice, and either hot chocolate or a cup of hot water, usually minus the tea bag. Breakfast or late meal would include a cup of corn flakes and milk, and the other meals included plain quesadillas, a fried mystery meat with a tomato sauce, or an egg and veggie frittata.
I joked once that at least I'd confused the words hombre, hombro and hambre only in Spanish classes--from what I'd said you couldn't tell if I was saying I needed a man, a shoulder, or I was hungry.
And then I goofed in real life. I figured out a nurse was telling me that a workman was coming into the room to fix the hot water. (We were told later by the workman that the hot water came out of the cold tap, why didn't we see that, what was the problem? That's Mexico. If you can't go with the flow, whichever tap it comes out of, you'll hate it here.)
So I indicated to the nurse that I understood, a man was coming into my room, and I should put on my robe. But I realized as soon as the sounds came out of my mouth that I'd said hambre, not hombre, and another tray of corn flakes appeared instantly on my table.
Some days I feel pretty good about my Spanish, other days I'm still estupida. I had moments of both during my stay. A nurse would ask me something too quickly and I'd do the standard, Repete, por favor, mas despachio, and she'd give up on me, ask if I were from nearby San Miguel (home to some 12,000 expats), use some sort of sign language to convey her message, and leave the room fast.
But other nurses hung in there with me and we did communicate. One saw me hobbling with my walker the first time after my surgery and called me Speedy Gonzales. I said no, more like un caracol (a snail). So I was nicknamed the snail. Mexicans love nicknames.
We had the spacious room looking like a college dorm within minutes after arrival. Usually very well organized Norma had brought various computer games and programs to use while I was in surgery or asleep, knowing we wouldn't have wireless internet--and then she forgot the cable for the electrical outlet plug-in. She had only two hours battery usage of the laptop. Next time that cable is packed down her blouse or something so she absolutely will not forget it.
We'd brought a complete set of toiletries, not expecting to get a welcome packet of soap, shampoo, toothbrush, toothpaste and slippers in a Mexican hospital, but here one was. But it did not come in your very own take-home bedpan and washing tub.
Thanks to hospital stays we've always had plenty of big plastic tubs around our house through the years, and I'd always thrown away the bedpans once I left the hospital in the past. Here, I felt squeamish using the same bedpan many others had used before me, but, hey, I never think about unisex toilets on planes.
We didn't want friends stopping in while I was in the hospital, but we've had wonderful offers of help from many people, including a male friend who was ready to get me up those stairs one way or another. (I was thinking about having to call the fire department or the Red Cross if I had trouble. I was told they'd help.)
I never felt the nurses were unattentive, they did check on me frequently and certainly were prompt with the shots and pills. I had to dial 111 on the phone to get a nurse between visits, and one always came much more quickly than when I pushed the help button in US hospitals.
I wasn't automatically given a sleeping pill at 9 pm the way US hospitals usually did, even if I had to be awakened to get that routine sleeping pill. So we were up until our usual 2 am watching TV or reading, the nurses not quite understanding that. Dr. Schmidt, by the way, is definitely an early bird, alert and confident at 7 am for his first surgery of the day. And he checked in on me all day long.
Another English-speaking doctor was in the operating room who helped with the tools and such. The rest of the six or eight people in the operating room didn't speak any English and I tried my best to understand word one. Probably just as well I couldn't. I had only a spinal and so could have been awake for the whole procedure. I chose to keep my eyes closed and dozed. Yes, I could sense the sawing and hammering. That's why I forced myself to sleep.
Though the doctors and nurses followed standard hand-washing and sterilization procedures same as a good US hospital, I did notice little things. One of the china cups in which my hot water arrived each meal had a chip out of the rim, right where you would drink from. One nurse trying to find a spot for my second IV just gave up on the rubber gloves.
And I doubt if the thick blankets were washed after every patient. I was so surprised the first time I spent a night in a Mexican hospital, at De La Fe in San Miguel, where I was given the warmest, thickest, fur-like blanket I could imagine and I luxuriated in it--until I thought about all the dust that could linger in the pile.
The thin smooth blankets you get at a US hospital have definitely been washed and sterilized between patients, and often are even heated for you.
The room had one of those stand-up cylindrical fans that we'd always ignored when we saw them advertised on TV or at Sharper Image shops. But this one was wonderful for moving the summer air and getting some circulation into the room. Of course there was no air conditioning, but the fan was sufficient.
The IV stand was the old manual kind, no hefty electronic marvel to beep and warn of almost-finished drips. So I was able to walk with it easily.
I think this account gives you the feeling of what it is like to be a surgery patient in a Mexican hospital, or at least one person's experience at one hospital.
Since I've been home I've seen two TV segments on US citizens coming to Mexico for health care, for example combining a beach vacation with intensive dental reconstruction so that the entire "vacation" plus dental work cost half what the dental work alone would have cost in the US.
Now if only the US government would realize how much they could save on Medicare costs alone if they allowed even a few select hospitals in Mexico to accept Medicare payments. Would we see an influx of expats into Mexico then! But that's not likely to happen in our lifetimes.
By the way, I mentioned that the surgery was first scheduled for August 4. I was actually on the operating table Aug. 4 when Dr. Schmidt got the results of my final bloodwork and said the surgery had to be postponed, my blood coagulants were too low, and he got me off of Advil. I've heard since from others who were not told, who were not checked, and who nearly bled to death when their blood would not clot during surgery. Those cases were all in wonderful USA hospitals.
All the NSAIDs such as aspirin, Advil and Aleve thin the blood, as does Vitamin C and gingko biloba, and some allergy pills, etc. One woman was given a list of 50 medications, both prescription and over the counter, to come off of before her surgery. Another woman wrote to me and said I may have saved her life because she had no idea some of her meds were duplicating the blood thinning effects and she was anticipating surgery. Her US doctor had never said a word.
So I'm walking around our three-bedroom level-floor apartment with ease, not even using the walker except when I feel tired or am going a long ways (or what passes as a long ways in an apartment). I'm feeling great, and am very positive about the whole experience.
I hope my sharing it in detail helps someone out there whos has health care issues about moving to Mexico. Could I have had a medical disaster here? Certainly, just as we have relatives who died from medical mistakes at US hospitals. Health care is still a crap shoot.
(For 200 free jigsaw puzzles featuring photos of San Miguel, go to www.fallinginlovewithsanmiguel.com and click on "SMA Jigsaws" on the left.)
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