The Healthcare Experience in Chapala Mexico–Bonita’s Story Part 3

In Part 1 of Bonita’s story here and Part 2 here, Bonita is diagnosed with ovarian cancer and begins treatment in the U.S. After a well-earned vacation in Mexico, we contemplated, debated and then planned a provisional move there. Here is the conclusion of her initial experience with healthcare in Mexico.

We decided that the stars were aligned for a six-month over the winter trial in Chapala. I hand-carried copies of my recent scan results and other pertinent medical records with me. We got to Chapala early in December (2017) and one week later with arrangements made via email, I met with Dr. Diego in his clinic in Guadalajara and received my first infusion in Mexico my first deep experience of healthcare in Mexico.

THe staff greet me by name at the reception desk and personally escorted me up to the consultation room. Dr. Diego spent a half-hour with me reviewing the records and discussing the treatment plan to ensure that ti was the same that I had been receiving stateside. He then escorted me to the modern treatment room and introduced me to the nurses and the pharmacist who would be administering the chemotherapy.

The pharmacist interviewed me for medication allergies and surgical history. The nurse checked my vita signs and noted that my blood pressure was slightly elevated. She notified the doctor and he came back into the treatment room to discuss this and rechecked my blood pressure. He gave the go-ahead to proceed with the treatment but advised me that he would be watching the blood pressure and that there might be a need for additional medications to control it. The drug was administered with flushes befor and after over an hour.

The nurses and the doctor checked with me every ten to fifteen minutes. I ad no conerns. My bloos pressure did not go higher so no additional medication was prescribed. There was a very clean and comfortable bathroom just around the corner from the infusion room. The recliner in the influsion room was powered by an electronic controller. There was no television (which I did not miss). They offered me a beverage.

After the infusion, I was escorted to the reception area to make payment. The bill was exactly as quoted ahead of time and they were fine with taking my U.S. Visa card. The doctor did explain to me that his portion of the bill–$100 (U.S.); $2,000 (Mexican Pesos)–he would prefer payment in cash in pesos on subsequent visits.

I requested him to prepare a bill in U.S. dollars and his notes translated for submission to my insurance company in the U.S. He took my insurance information and said that they would take care of it.

I left the clinic very pleased and comfortable. He said he would email me the appointment time for my next treatment in two weeks.

We’re off to a very good start with healthcare in Mexico.

The Healthcare Experience in Chapala Mexico–Bonita’s Story Part 2

In Part 1 of this post, Bonita shared her journey with cancer and embarking on a vacation to Mexico for rest and investigation and the possibility of cancer treatment in Mexico.

Family voiced some trepidation about traveling and particularly traveling to Mexico. (Is it safe????)  Even so, we visited for two weeks as tourists on an informational quest, partly about cancer treatment in Mexico. We were wonderfully assisted along the way. One of our Air BnB hosts directed us to an insurance service that many expats in the Chapala-Ajijic area use. We also met with several agents at the Lake Chapala Society (an active group providing lots of local information to help expats learn the ropes).

We were dismayed to find that I am not insurable for cancer treatment in Mexico with my pre-existing condition. I would have to pay out-of-pocket for all cancer treatment. However, along with that “bad news” I was assisted by the insurance agent with Blue Angels to get an appointment with a local oncologist, in two days time nonetheless.

Dr. Diego Herrera works mostly in Guadalajara, yet visits a satellite clinic in Ajijic weekly. We had a very pleasant and informative visit. He assured me that I could receive the same treatment (chemo) that I was receiving stateside and was willing to get me a cost quotation to pay directly for the care.

This forty-five minute consultation cost me $40 (U.S.). I was greatly encouraged and began to correspond with Dr. Herrera via email periodically after we returned to Wisconsin to make additional preparations and further our “feasibility study.”

I was again very fortunate to learn that my employee “retired” insurance would reimburse me for cancer treatment in Mexico as long as it was consistent with my ongoing medical care (no “alternative clinics”). I would have to pay upfront, get the bills and medical records translated into English and U.S. dollars and be reimbursed rather than the doctor and clinic being paid directly by the insurer.

My U.S. doctor was very supportive of my decision to pursue treatment in Mexico. Once I got the dosages of the drugs from my WI provider–which was not as easy to do as I assumed it would be–I emailed that information to Dr. Herrera and within a week had my quote.

The treatment being provided in the U.S. at a cost of about $57,000 per month would cost about $15,000 (U.S.) in Mexico. A lot to pay out-of-pocket, but $40,000 less per month is substantial. The cost of the periodic scans I need to document response to therapy is $14,000 (U.S) in Wisconsin and $4,000 (U.S.) in Mexico.

I was very impressed with how much more transparent the pricing and billing is outside the U.S. In Mexico, all citizens have access to basic healthcare and treatment at state-owned facilities, for free. Those with better financial means can purchase affordable insurance with allows access to well-run private hospitals and clinics.

For expats, private insurance in Mexico is more affordable than the “affordable care act” coverage in the U.S. In the Chapala area, we can also purchase a clinic membership that allows full access to physician services in that clinic for about $300 (U.S.) a year. Lab tests, x-rays and pharmacy service are independently paid by the patient. For under $2,000 (U.S.) per year, an expat can buy more comprehensive coverage or catastrophic coverage.

To be continued.


Hollywood at Lake Chapala

Last night we sent to see The Last Jedi. It was our first outing to the movies since we moved to Mexico.

We are pretty big movie fans.

We really had no idea what the movie-going experience would be like here in Chapala (full disclosure–both the local movie theaters on this side of the lake are in Ajicic). All we knew was what we could find on the theater website.

The Last Jedi was listed with showtimes and then either ESP (presumably dubbed in Spanish) and SUB (obviously referring to subtitled–but how? With English subtitles with the audio track dubbed in Spanish or with the audio track in English with Spanish subtitles?).

We also had no idea what the theater experience itself would be.

We got our answers.

The best surprise was the ticket purchase. Bonita had just returned from visiting her folks and extended family in Florida. Several of them were planning to go see The Last Jedi in the Naples area. Ticket price? $12.50 per person.

At the local theatre, Moviespace, Friday evening, tickets are priced at $40 MX–yes–that’s about $2.50 U.S. (All in we paid $86 MX including tax for the two of us.) Have I mentioned yet how much I am loving Mexico???

The theater was truly stadium seating. A steep row of seats. Comfortable, not luxurious. As with our local theater in WI, you pick from available seats at the box office, so the seating is reserved.

Nice big screen. Digital projection.

Trailers ran. And then instantly, the feature presentation. No ads, no theater self-proclamation.

And, finally, the answer to our big question. Turns out SUB means English (or country of origin language) with Spanish subtitles.

As someone who has serious hearing loss and needed hearing assistance at the theater in WI I got an unexpected lesson in written Spanish.   I could make out little of the dialogue but was pleasantly surprised that I was able to read as much of the subtitles as I found I was able to. Grinding my way through daily Spanish lessons seems to be paying off.

Still, next time I’ll ask if the theater has hearing assistance. Now……how do I say that in Spanish?

Update on January 28, 2018: Last Friday night we took in The Shape of Water (La Forma de Agua). We were reminded of yet another difference between movie-going here compared to in the U.S. Here, the screen is blank until the lights go down. Then, previews roll. We saw three previews and boom, the feature started. No ads, no self-promotion by the theater, no urging to visit the snack bar. Lovely!

Christmas Eve and Christmas Day in Chapala

The big day is finally here. Christmas in Chapala.

The streets (calles) have been bustling. Folks Christmas shopping. Kids thrilled.  All sorts of street vendors hawking their wares: shoes, clothes, cakes, wrapping paper, pinatas, art. You can pretty much find anything you want.

It’s been total sensory overload.

That’s the streets. The malechon has been pretty quiet.

Today is beautiful, sunny, warm, sixty-eight degrees. In a word, perfect, perfect in paradise.

To my surprise, the malecon on Christmas is jammed. Almost shore to street with families, couples, solos, all enjoying the festive atmosphere and the sun. The park across the street from us, which borders the malecon to the East and has lots of picnic space and tennis courts and soccer fields as well as a delightful lakeside walking path is rocking and rolling.

So this is what it’s like on Christmas in Chapala.

Meanwhile, in town, the streets are quiet. Sure, some of the shops are open. Vendors are grilling and lots of munching going on.

The hit of the day, of course, is ice cream. While the ice cream shops I passed were pretty quiet, the individual vendors on the malecon had long lines waiting. Extended families getting a treat, from the youngsters to grandma and grandpa and from what I could gather, even, great-grandma and great grandpa too.

I didn’t know what to expect for the big day here. And what a delightful surprise. Although, thinking about it, really not a surprise. Mexico is a family culture, honoring the aged and indulging the young.

I’m loving it.

The Healthcare Experience in Chapala Mexico–Bonita’s Story Part 1

I am very fortunate.

This may sound a little crazy when I am just one year past an ovarian cancer diagnosis and major surgery and still undergoing aggressive treatment. Still, it is true.

First and foremost, it has opened my heart to give and receive love and support more than I though possible. Second, it has helped me appreciate each day as the gift that it is.

Having had a long-term career as a nurse, primarily in Home Health and Hospice, I though I pretty well understood the ins and outs of cancer treatment. I did not. It involves being caught up in a whirlwind of decisions, options, questions and quandaries that I had only glimpsed as a caregiver RN. These tough questions and decisions and financial worries are overwhelming and I have thought many times are worse than the actual disease.

I chose current western medicine treatment because this was the environment I had developed comfort with though my twenty-five years of practice as a nurse. My family has been very supportive and they also gently made me aware of nutritional, herbal and alternative options that the medical establishment and big pharma in the U.S. for the most part ignore. So many options and so much information–it adds to the overwhelm.

Then the cost of treatment sinks in and takes its toll. In the U.S. system, medicine tries very hard to isolate the patient from the  cost.The healthcare insurance system is upfront about insured premium costs, deductibles and co pays which we know are getting higher every year. But when the explanation of benefits arrives from the insurer showing what has been billed and paid, it is quite staggering. Sticker shock takes on a whole new meaning.

In order to maintain my healthcare insurance (because I am not Medicare eligible for another year), I must pay just under half of my total social security benefit each month. Not much left to pay rant, buy food, operate a vehicle, much less enjoy leisure pursuits.

Yet here is another reason I’m very fortunate. I have parents who are much better prepared for “the golden years” than myself and have been very generous in their support. I’ve also had to spend down about half of what I had saved for retirement in the year since the diagnosis.

Not knowing how long one has to live puts another spin on retirement planning. My cancer “came back” quite aggressively less than six months after initial surgery and chemo. I was not ready to throw in the towel. More decisions–more support.

How to maintain quality of life? How to embark on new adventures? Let’s go visit Mexico!!

[To Be Continued]

Drinking Water in Chapala Mexico

Pretty much everyone’s heard the admonition of “Don’t drink the water!” if they’re headed for Mexico.

Totally. Don’t drink the tap water that is. Fine to bathe or shower in (keep your mouth closed……), but not to drink. We’ve followed this advice and so we cannot report what happens if you do drink the water. But I suspect that you, like us, have heard the stories.

Instead, do what the Mexicans themselves do. Buy bottled water. It’s everywhere. Convenience stores, big box stores, mercados (Mexico street markets),  homes with little shops, roadside stands and enterprising locals selling it at intersections.

And all sizes too. From carboys that require either superhuman strength to lift and pour (for a geezer that is) to sizes of several liters to the familiar liter and half-liter bottles that dominate in the U.S.

Yes, Mexico is like the rest of the world–on the metric system.

Even though we have not taken the plunge of trying the tap water, we have tried to boil it to use for washing dishes and vegetables and fruit. A failed experiment. Upon heating, our tap water turned murky white and left a rather unpleasant coating on our pot that has been heck to try and clean off.

For those of you, like me, who avoid sugar and sugar substitutes, be aware that the variety of bottled waters here in Mexico are not nearly as extensive as in the U.S. Equivalents of La Croix or Perrier are difficult to find and with nowhere near the selection. We have been consuming Penafiel sparkling water with lime and salt (Penafiel Twist con Limon y Sal) and I particularly like the straight sparkling water called Topo Chico Agua Mineral.  (I call it Topo Gigio [for those who remember Ed Sullivan], but don’t tell the natives…..) Penafiel also markets an orange (naranja) flavored variant .

Finally, we’ve had no problem with the water in restaurants, nor the ice. We’ve heard that restaurants are required to use bottled water for ice-making.

So bottom’s up!

Starbucks in Mexico

I love Starbucks Cold Brew.

Unfortunately, I discovered it only shortly before we moved to Mexico.

Cold Brew is a real treat to me. I did not buy it often, more as a treat than as a regular beverage. And I knew I would miss it in Mexico if I couldn’t find it here.

Well, I didn’t find it. At least not in the single serving bottles I am familiar with back in the States. Heck, Walmart carried them. So did pretty much every grocery store I visited in the last couple of months in the U.S. I got my last one at a truck stop in New Mexico. Paid $1 more than normal. Boy, it was worth it.

The day after we crossed the border, we happened upon a Walmart (yes, Walmart de Mexico is alive and well) and I eagerly searched the isles for Cold Brew. No luck. Same thing in the next few stops we made. Some at Walmart; some at other grocery retailers in Mexico. No Cold Brew. Starbucks energy drinks, yes. But none of their brewed coffees.

So imagine my eagerness when Bonita had an appointment in Guadalajara. I dropped her off and drove around a little. We were in a commercial zone and I had a couple of hours waiting so I parked in the lot of a Soriana (a national Mexican grocer). Around me too was a cinema, a Home Depot, a Carl’s Jr, and a KFC. So I thought, well maybe, just maybe there could be a Starbucks.

Sure enough there was. Unfortunately, the orientation of the map was confusing. I wasn’t sure which way to walk.

At that moment a police car was driving through the lot and I asked the officers in my stumbling Spanish, where is Starbucks? (Donde esta el Starbucks.) Of course I prefaced this with my current favorite phrase in Spanish, Hablo espanol solo un poco (I speak Spanish only a little). They gestured and said, a la derecha (to the right).

A few minutes walk and there I was. It looked like any Starbucks in the U.S. And it was rockin’ and rollin’ and to my delight full of Mexicanos. Not a gringo in sight (except yours truly).

I walked up to the counter, explained my ability in Spanish and haltingly asked for a “Cold Brew”. And they had it! Not in bottles, but fresh brewed. Yes!

So I settled in to enjoy the brew and hang. As I went back to the counter for a straw, I encountered a young barista who asked me something in Spanish. She was standing next to a little table with three small mounds of ground coffee, a french press and some coffee beans.

She explained in her limited English (so she said) that she was doing a demonstration of coffee-making and asked me to join in. Another patron happened by, the other baristas and the manager gathered around and she launched into the demonstration. For the most part, I had no clue what she said, but between the actual demonstration and my slight Spanish, I caught the drift.

A pot of coffee brewed in the French press and little sampling cups poured, we all saluted and drank. The inevitable photos taken (sadly not by yours truly) and a few moments of fellowship, smiles and laughter all around.

Mexico is feeling more and more like home.

And Starbucks in Guadalajara, I will be back!

Why We Expatriated

When you finally disclose to close friends and family and then to an ever wider circle of acquaintances that you are going to move out of the good ole USA, the first question almost invariably is Why? You grew up here. You know here. You are rooted here. Why jump ship?

We’ve had to think long and hard on this matter. It has been a decision years in the making. It has involved a ton of angst and hand-wringing and perplexity. But we needed an answer. Not to satisfy our friends and family, but for us. To know, deep within ourselves, that this decision was the right one at the right time. So, readers, here’s our current answer. Undoubtedly it will morph and re-form and this blog will record those changes. But for now, here is the answer:

We’re boomers, baby boomers that is. Children of the 50s, coming of age in the 60s, the era of hippies and free love and John Lennon crooning Imagine. Maturing in the Me Decade of the 70s, going corporate in the 80s and 90s and entrepreneurs in the 2000s and 2010s.

We grew up in an America that had ideals rather than platitudes. Did we meet those ideals? Heck no, but there they were, sometimes inspiring, sometimes taunting, always in the background and sometimes in the foreground.

We believed, and still believe, in the American Dream. Not the dream of shop til you drop or nuke’em til they glow, but the Dream of a good life for us and a better life for the next generation.

Instead, we’ve watched our elected officials sell us down the river. We recall with not a bit of irony the words of then presidential candidate George Wallace (1968), there’s not a dime’s worth of difference between the Democrats and the Republicans. How sad that his words were so true, even though then we didn’t see it as so. We still believed that our government had our interests at heart. We don’t anymore.

And approaching retirement age, social security and medicare, we have run smack into the awkward truth that healthcare in the U.S. is incontestably broken. This became painfully clear when one of us received the 2018 pricing for coverage under Obamacare. The premium would go from about $75 a month (the premium paid by us–the actual premium was around $650) to $450 a month. Forgive us for not even looking at the total cost of the coverage. All this and a measly $6500 deductible. The ugly truth was that the cost of healthcare coverage for one of us would be more than our housing cost, all in, per month.

But but but I can hear, healthcare in the U.S. is the best in the world. Sadly, on an empirical basis, it is not. What it is, is by far the most expensive in the world, by magnitudes. We were forced to face this unfortunate truth in making the expatriate decision.

Finally, at least for now, we are expatriating for climate. Political climate first and foremost, yet physical climate as well. One of us is adverse to the cold; one to the heat. So we needed a geography that would satisfy both. We found one such geography in Lake Chapala, Mexico.

So here we are, just starting our adventure.

Thanks for reading and check back with us here for our progress.

All the best to you!