One of the real oddities about being an expat is dealing with healthcare in a different culture, different legal system, and a different language. I think most people think, “medicine is medicine, right?” but the differences are profound. Living here in what some derisively label Gringolandia can bring the differences home.
Take how hospitals approach inpatient services. In Mexico, nurses are something less than a licensed practical type in the states. Most here are more administrative helpers than anything else. Hospitals expect a family member to stay with you (the patient) in the hospital to help with basic care! Going in for surgery? You will probably be reminded to arrange a group of friends to come and donate blood for you. And the blood donor restrictions go all the way to how many hours since your last meal, so while you’re sitting around waiting to give blood, you’ll also be worrying about those (there are too soon AND too late limits). Of course, every visiting tourist who ends up hospitalized in Mexico also reacts in horror when the hospital refuses to release you before you pay your bill! But from the hospital’s standpoint, it has no way to collect once you’re gone, so you’re not leaving until they stamp la cuenta with pagado.
Mexico has free national health care, and it provides health services directly equivalent to the cost (nada). It is not uncommon to hear of local hospitals short on basic medicines (e.g., antibiotics) or bandages. Very good private hospitals are available, and the prices here are much less costly than in the States. Partly that’s because of the Mexican health market. Mexicans rarely go to the doctor. They don’t trust the government ones, and they don’t see the point in paying for the private ones. Without much demand, there is little inflationary price pressure. Also–and very importantly–there is little or none of the malpractice legal regime so familiar in the states. Just doesn’t happen much here.
All these factors play out in an unusual way at lakeside. In an area with slightly more than 50,000 people, we have at least three hospitals, three specialty clinics, and a Cruz Roja (Red Cross) facility. And twenty dentists and no one knows how many farmacias! This surfeit of health care is driven by the expats, those (like us) who have insurance coverage or others who simply pay as you go. Costs have been rising as local doctors/hospitals realize there is a captive population here which doesn’t want to travel up to Guadalajara (which is the medical centro for Mexico) and is willing to pay a premium for English-fluent (relatively speaking) staff and doctors. Dentistry is still pretty cheap for the same reasons I mentioned, and often the care and equipment are state of the art. I know I have mentioned before the immediate 3D printing for crowns which is common here.
What goes on behind the scenes of all these health services is even more interesting. Expats highlight the relative costs (still a deal), the quality care (doctors still make house calls), and the great availability. But it’s a totally different health system. Mexico in general has a “you get what you want” approach to medicines, services, and regulations, and many expats forget that. The view among medical professionals here is, “if you as the patient want to try something, you should be able to do so.” In the States or Canada, the medical industry is tightly regulated from top to bottom, and constantly checked through the government inspection and legal regimes. Here you can find a doctor who will work for you with any treatment you can imagine, for any reason. You take the risk, so it’s up to you. And doctors will gladly refer you for more tests and treatments, if that’s what you want.
Take stem cells, for example. In the United States, the Food and Drug Administration (FDA) has approved stem cell treatments for blood disorders like leukemia and lymphoma, conditions like osteoarthritis and Crohn’s disease, and cord blood stem cell therapy for certain cancers and blood disorders. There are numerous clinical trials underway with promising possibilities. Meanwhile, unlicensed clinics and doctors in the States have pushed unapproved stem cell treatments, resulting in hundreds of deaths and severe complications. In the States. With all that regulation and all those lawsuits.
In our little pueblo, there are two stem cell clinics and many private doctors offering stem cell treatments. Now it’s just possible that tiny Ajijic is a hotbed of cutting-edge stem cell medicine. And it’s also possible local doctors are just providing for the treatment expats are requesting. And it’s also possible some quackery is involved. If you peruse social media, there are many testimonials from local expats to this doctor or that treatment. What you have to understand is there is no medical evidence behind these testimonials. There is ample anecdote, and people swear they got better. But the plural of anecdote is not data.
People misunderstand the placebo effect, and think it means the result (“I got better”) is fake. It’s not. The improvement post-treatment due to the placebo effect is oftentimes real. That’s why the placebo effect is so important in medicine: just doing something (for example, giving someone a sugar pill which has no utility), results in a positive outcome. Why? Medicine does not know why, they just know it happens. What are some theories? One is that the appearance of treatment “tricks” the patient’s psyche into greater effort (The medicine will work, my body needs to help, too).
Another is even more simple: what happens most times you get sick? Well, you get well, treatment or no. Barring an accident, you’ll get sick hundreds or thousands of times (for many diseases, like West Nile or Dengue, the vast majority of people are asymptomatic: they had it and never even know they had it), and you eventually get better. Ok, eventually you get one that you just up-and-die from, but the most likely outcome of most sickness is: health. And this could show up in the placebo results, too.
So when you read about all the people saying, “I got stem cells, and my sciatica cleared up” or whatever, remember (1) they may not know whether they got stem cells or not, (2) sciatica can resolve on its own, (3) the placebo effect is real and could be the cause, or (4) they may be the leading edge of a medical breakthrough. But what you should never do is to confuse how medicine is practiced here with how it is practiced back home, wherever that is. It’s not that one way is better than another; just that they’re different, and the differences are important.
Well dang, I though from the title this would be a football post…but equally interesting. Totally true. Sometime I will tell you about a friend and his eel juice treatment!
Ron White, the comedian, had an accident years ago while driving in Mexico … he tells the story of the treatment and surgery required as he had a head injury and had a plate surgically implanted. He said it was OK, but he remembers hearing the nurse say “Be careful, the plate is hot” as she was setting it down in front of the doctor … just different, you say.