03/10/2013, Santiago Bay, Jal, MX
Well these first few days on the boat have been a whirlwind of activity. It started with Jim, Colton, Curtis and myself diving on the boat to clean what was clearly a Japanese buffet on the hull. But I have to say that we all love the Micron 66 that the Boatyard at Grand Marina put on (thanks Neil!). It was nice getting back in the water after a month as well. We moved Sweet Dreams and Rubber Duckies from Las Hadas to Santiago Bay the same day we moved back aboard. Something about having enough of the Macarrana and Gungam Style ;-) The first couple of days here where pretty quiet. Jim and I took what ended up being an 8 mile walk into Santiago to look for some boat and fishing supplies, we have been doing movie nights on both boats.
But last night was a highlight for Marcus. His friend Isaac and our friend, his mother, Nancy came out to visit on the boat. We had the crew from Duckies and Sweet Dreams and it was a very nice evening. Nancy introduced us to a local liqueur, Cola Blanca, made from Peanuts and Almonds. It's quiet scrumptious. Marcus even got out for a dinghy ride. The boys got the surfboards out and did some dinghy surfing and Isaac even got up for some nice rides. Marcus sat on the deck of Duckies with score cards!
Today Jim and I are going to scuba Elephant Rock and see what that has to offer. Tomorrow is the big day for Marcus, it is hopefully his last checkup. If we get back to the boat soon enough we are going to sail down to Barra de Navidad on Monday, otherwise it's Tuesday morning. Well, no internet, no photos sorry. Hopefully when we get to Barra and I connect at the Sands Hotel and upload some new content.
All in all, Marcus' recover is moving along spectacularly.
Our Experiences with Mexican Healthcare
03/06/2013, Manzanillo, Colima, MX
It's hard to believe that this all started over a month ago. It's been a whirlwind of emotions and too much like a 9 o'clock movie. Through it all we have had the best support of friends, family and the cruising community that anyone could ask for. Through it all there has been a resounding undertone of doubt about the Mexican Healthcare System, albeit mostly from those that are not down here. Having just spent the last 30 days under the auspices of said system I feel that we have a much better understanding of that system. And here are a few of my thoughts for those that are curious.
From the moment of Marcus' first diagnosis from Dr. Jose Armando Nava to what will be his final checkup next week from Dr. ? He has had first rate care from the attending and surgical physicians. The hardest part of the ordeal has been a communication and cultural issues. I feel it was divine intervention that Dr. Nava replaced the doctor at Blue Bay Resort in Tenacatita. Having just rotated out of a 2 year stint at a trauma center in Guadalajara he nailed it on the head when he felt that Marcus had internal bleeding. Dr. Nava even went so far as to drive Nicki and Marcus for an hour looking for a center that could perform the blood test to rule out appendicitis. This little adventure lasted for over 4 hours and until midnight. He remained with them the whole time acting as translator when necessary. Then when his condition did not improve he found the center in Manzanillo and helped them arrange transportation. We still owe him dinner on the boat! This is where many will consider Mexico a third world country in truth. There are few medical centers that have much of the equipment that we take for granted. For example, finding an ultra-sound machine meant making a 3 hour car ride.
The Hospital Echauri was our real indoctrination into Mexico. Nicki and Marcus arrived early afternoon and they swept into the CAT Machine. Within 30 minutes they determined that Marcus needed surgery and Dr. Rivera stepped in. It was the day to day care that our Spanish, or lack of, really became the issue. The nursing staff tried to communicate, but there where details that could have helped us with the care of Marcus that did not get articulated. Echauri, being a private hospital, meant that we had a private room and it included a couch for a family member to sleep on. Nicki spent most of her time here during the 7 days that Marcus was a patient. When Marcus' condition deteriorated and our funds started running low Dr. Rivera suggested we move him to Hospital General (Civil) since he is also an attending surgeon there as well. The Civil hospital also had the benefit of easier access to blood (he would later need a second transfusion), and the ability to give Marcus IV nutrition while his pancreas had time to heal and his hematoma (which was still very large and causing problems in his GI tract) shrank.
Speaking of blood, there was a lot of concern (even internally) about getting blood from the Mexican Blood bank. It was not helped by the fact that Echauri we would need to make the 1 hour drive to Colima to retrieve the pint of blood ourselves. Mexico recently underwent a change in their blood supply for the better. It was privately managed for years, unsuccessfully, and recently the government took control. It is now required that a family needing blood has to arrange making a donation. If no donation can be made then a letter of inquisition explaining why is submitted along with a hefty 'monetary donation'. Echuari did not have facilities to take a donation and due to timing having us donate in Colima was not an option. Due to Marcus' age some strings where pulled and we had a 'minor monetary donation' along with the car ride. Of course since the center does not handle money that meant a drive across town their accountant and then returning with a receipt... At Hospital General they were pleasantly surprised that not only Nick and I were ready to donate, but our good friends Jim and Gina from Sweet Dreams where ready to donate as well. They only needed two donors so Gina and I were eliminated due to a small reaction to Sulfur based Antibiotics, and that was after a pretty serious questionnaire. Nicki and Jim where selected. At this point they perform a blood screening to check for certain things and have you come back. Upon their return Nicki discovered that she was slightly anemic, go figure, but Jim was a good donor so at least we had one! I illustrate this only to demonstrate how serious they are about the supply.
The move to Hospital General was another level of indoctrination into the Mexican culture. The public hospital is exactly that, for everyone. And there is a resounding mantra from the staff, 'The same treatment for all'. This was a bit of a shock at first. Marcus had gone from a private room with a TV to a wing of 8 beds and curtains, and no facility for family to stay and a strict (militant) policy of only 1 visitor period, and no kids. Dr. Martinez arranged an expection twice for Curtis to visit. We also learned that a parent must be with the child at all times as they will not treat a minor without a guardian present.
The treatment also changed, and the first 24 hours where a bit of a roller-coaster as well. Marcus went from 1 doctor and 1 nurse to 6 doctors and a team of nurses giving constant care and supervision. There was a bit of turmoil at first with doctors suggesting treatments that ranged from a second surgery to transfer to Colima and the Pediatric Intensive Care Unit. Boy, good Spanish could have saved a lot of bent feelings here. Thus introduces our best hope for success, Dr. Thomas Martinez, the Gringo resident. Thomas was brought in to interpret Gringo to medical Spanish and back and ended up staying with the case throughout. I really think that without him things would not have gone as well with Nicki and I. The Medical notes from Echauri had not made it back to the surgical unit and there was some confusion regarding the 600ml size of the hematoma (which greatly concerned them until they realized that it had in fact shrank considerably at this point).
Marcus was moved to the surgical wing and the nursing staff took over. A primary difference between the private and public hospitals was the attention and methods in place by the staffs. Where Echauri's nurses may ask if Marcus had gone to the bathroom, at the Public hospital they gave him a container and measured. They also had a more reliable tracking mechanism for medication and other statistics. Overall we were much more pleased with the level of care and professionalism at the Public Hospital, even at the expense of much of our personal comfort and privacy. Many of the families that stayed slept in chairs and blankets provided by the hospital, which didn't have much. None of the patients had pillows and there was no hot water. We later learned that both of these are purposeful to decrease the chance of infection and not cost related.
Overall the hospital was kept very clean.
When Marcus was released under strict guidelines to allow his Pancreatitis to subside we went home and thought we were out of the woods. However, after 5 days he began to experience increased pain and nausea. On day 6 he threw up and we immediately went back to the Urgent Care wing. When they got the paperwork he was immediately seen and then as quickly re-admitted. I have never gotten this kind of care at either a public hospital or Kaiser in the states. After a series of x-rays(in house) and ultrasounds (which are done by taking you by ambulance to the private hospital Echauri, since the public hospital in Manzanillo does not have this equipment) they determined that he had an intestinal blockage.
Through it all we consulted with many medical professionals back in the states from Surgeons to Nurses, the overall consensus was he was getting the same level of care here and there was no reason to evacuate based on medical reasons. There was some internal debate about getting the right information for Nick and I, we managed to pull Mary Lou in at Echauri and at the Public Hospital it was Dr. Martinez so there we were blessed.
Marcus also made a new friend, Isaac. His mother is Nancy, she is the office manager at Echauri and has been actively involved with Marcus since his arrival in Manzanillo. They visited Marcus on several occasions at Hospital General (I think Nancy pulled some strings!) and it was a highlight for Marcus to see others not involved in his recovery. We have invited them out to the boats (Rubber Duckies and Sweet Dreams) for the day to celebrate.
As we pack up to move back onto the boat after 33 days it amazes me at the help we have received through this. Especially to Dwight and Mary Lou Davis for putting up with us in their house for 30 days!
Others I would like to mention that where involved (and not limited to, so sorry if I failed to mention anyone):
• Uncle Darrell
• Jane & Russ
• Harmony (Alameda)
• The gentleman who acted as ambulance dingy in Tenacatita (I can picture his face, but not his name)
• The woman who came along to translate P?
• Everyone who offered us meds when I put out a call to fill a prescription from Dr. Nava in isolated Tenacatita
• Margarita and her husband
• Kia Ora
• Moon Tide
• Ojo Rojo
• Sweet Dreams
• Dr. Ibara, head of Surgery at Manzanillo General(sp?)
• Dr. Nava
• Dr. Martinez
• Dr. Rivera
• The staffs at Echauri and Hospital General, Manzanillo
The next week will be waiting for the last check up on 3/11. Between that and how Marcus does staying on the boat will determine our next steps.
Marcus recovery - Day 1
02/28/2013, Manzanillo, MX
Today was Marcus' first full day home. He has been doing great, his appetite is back and he is walking more stable. The crew from Sweet Dreams came up with Sandwiches, Guac and chips for a really nice lunch and visit. The kids went swimming and took a tour of the place. After lunch everyone ended up on Marcus' bed watching 'Fail' vidoes on YouTube!
Tom, thanks again for all you translation and medical advice throughout... You will always be welcome on Rubber Duckies. And congradulations on your new arrival this Saturday. Es miho o miha?
Now I am smilling!
Marcus has returned, again....
02/28/2013, Manzanillo, MX
The Saturday after his surgery was pretty much a 'surgery recovery day' so there was no change really. Sunday started the walking regim to get his bowels moving and keep him from recurring. Things went well and he was pretty worn out by the time my 'shift' started. We had quiet a fright when he had bloody discharge at 2 am. By 4 am there was enough concern that an Endoscopy was in order, but Dr. Martinez was convincing us to keep very calm. He still was not eating as much as he should and seemed in a little too much pain. But even Dr. Rivera (the actual surgeon) was convinced that the problem should be treatable without surgery.
Echauri didn't have any openings to get him in, but the head of Echauri was at the hospital for a meeting and the head of surgery cornered him to plead the case. He was already aware, and very interested in Marcus' progress so he arranged to have a 'slot' open and we where off. It's a good thing too. We quickly discovered the Marcus had ulcers in his stomach and thining of the soft tissues of the intestinal walls. All very treatable with medicine. And due primarily to a combination of the stress of surgery and his Pancreatitis. And fortunatly the head of surgery already presumed this and upped the stomach medication he was already on.
By Tuesday he was remarkably improved and they started him on a liquid diet. By lunch he was eating solids and moving around quiet easily. He was, and is, very week due to losing almost 30 lbs of mostly muscle. By the afternoon rounds they where ready to release him. I consulted with Dr. Martinez and we both agreed that he should be kept overnight to be sure that his recovery was actually starting. Marcus also had a visitor. The office manager of Echauri's 13 year old son came and sat with Marcus for a while. They had visited before, but this time came bearing a gift. He enjoyed the company of 'other than nurses'. By Wednesday's 9 am rounds everyone, including Marcus, was ready to call it. He was out by noon!
During all of this week our good friends from Sweet Dreams have been eagerly waiting with us, anchored down in Las Hadas. Part of the medical system here is a strict policy around blood. If you use a pint, the family donates a pint +1. Little did Gina and Jim realize they where about to become entwined in this latest Ducky adventure. They volunteered to donate on Tuesday, so they asked us to be in by 6:30 am on Wednesday. Well, Mexican 1/2 hours are measured using the same curve as a Mexican minute. Four hours later we where wittled down to the 2 donators. Then 1 finalist was elimated due to temporary anemia... but allas we arranged other options and by 12:30 all was done. This had to be done to get Marcus out....
And then we where gone!
02/23/2013, Manzanillo, MX
Last week ended on a very low note for us. Marcus took a turn for the worse on Tuesday with severe abdominal pain and lack of appetite. It then turned to vomiting again on Wednesday which put us back in the hospital. It was determined that he had intestinal blockage, which is unforatunately a fairly common side effect of abdominal surgery. I really need to go on the record and say that an American doctor, Thomas Martinez, has been our salvation at the Hospital General. He has been translator and guide for us to get over the language hurdle. The doctors, nurses and staff have been great and very knowledgable. It's our feeble grasp of the Spanish language that is the real problem... so future expats, learn espanol before you get here!
Yesterday morning we started the day be running to Echauri to get a CAT Scan and determine what was causing the blockage. The good news is that all his studies (panels) came back looking good so there was no infections present at this point. The scan showed adhesions (scar tissue) forming around the end of the small intestine and possibly the appendix. Due to the amount of time the blockage had been sitting we all agreed that surgery was required before the tissues started dying due to blood deprivation. At 2:35 AM we wheeled Marcus to surgery. At 5:15 AM they brought him back.
At this point all I can say is they he looked better, his color was back and he was more alert. He is also sleeping. Nicki took over at 9am and she has been waking him every hour to walk, but he is sleeping the rest of the time. I am heading in now to take the night shift. I don't expect any major changes before tomorrow, but I will keep you all posted.
Marcus Update Part VI - Return of the Marcus!
02/14/2013, Manzanillo, MZ
This is the best Valentines Day gift ever!!!!!!!
The last 36 hours have seen huge, remarkable, God gift, improvements for Marcus. It started with the last vomit session on Sunday morning (9:36 precisely), with a bump from the Ultra Sound showing a decrease the Hematoma from 640 cc's to 429 cc's in just a week, then it was the change to a liquid diet last night. It finally culminated in a solid food (potatoes and carrots) at lunch today. The addition of the nutrional bags pushed his body over the edge and his hemoglobin shot right up to normal. At 3pm they decided to discharge him back to the house.
He is waiting for the anesthesiologist to remove the tube from his chest. I am sitting here writing this waiting for Nicki to let me know it's OK to come down and get them. I was looking forward to another 4 hour stint of Civ 4 with Marcus, but this is so much better! He still has Pancreatitis, and his stitches are healing, but he can recover here with his bland diet. We are staying in Manzanillo for the next few weeks for followups so Duckies is still not on the move.
I will have a writeup very soon of our experiences with the Mexican health care system. I think my impressions will suprise many, and probably cause some heated debates with a few recent commenters... We really cannot express our fealings for every single family member and friend who has supported us for the last few weeks, God bless!