I doubt many of us are really prepared for the serious medical emergency while we are traveling. No matter how well prepared or how seasoned a traveler, when the doctors say “surgery,” you quake inside.
One Saturday evening in my second week on Oaxaca, I became doubled up with intestinal cramps and pain that lasted all night. It let up a bit and so I waited till Monday to go to the doctor. He listened to my symptoms and said “amoeba.” I took the prescribed meds and nothing changed. The pain was acute.
I found another doctor who again treated me for amoeba, and still there was no change. Now it was getting worrisome, and I was getting scared. After a series of tested, including a colonoscopy which could not be finished because of severe and infected blockage, my doctor started mention “surgery.”
This is when the alone part of traveling alone became an issue. First, of course, alone is not the way to be for a medical emergency, especially one that takes you into the finer workings of a foreign medical system. You need someone to talk to and to go to the doctor’s with you, because in the circumstances, your judgement may not really be the best. Hand holding is called for, and someone to talk you off the ledge of extreme fear. Someone soothing who will both let you cry and talk you out of weeping.
Second, in many countries, including Mexico, you are expected to have someone at the hospital with you, and someone to care for you post-operation. Of course everyone back home is working, or if they aren’t, like say a young adult grandson, they don’t have a passport. I checked in with everyone. I got lots of sympathy and concern and apologies for not being available, but it isn’t the same and doesn’t help you with the practicalities of recovery.
So here I was alone and afraid. Between the pain fear, I was crying a lot. A neighbor helped me some with diagnostic appointments, which was helpful, but I didn’t really know her. I sure could not ask her to help me through the whole process.
But it ended up not being necessary to have help this time. My condition started improving, which seems to have had something to do with the total cleansing necessary for the aborted colonoscopy. Between the colonoscopy and a cat scan a few days later, I had started healing. It was then that the doctor told me he had been convinced it was cancer, but it wasn’t, and I was healing well.
This, of course, has been a learning experience. I guess the most important consideration is whether or not you are comfortable having surgery in a developing country. If my cat scan had shown the same condition that the colonoscopy did, then for sure they would have wanted to operate pretty immediately. To go to the US for the surgery, where I have no established relationship with a doctor or medical system, would have postponed things for too long. But everyone was encouraging me to do just that. My doctor assured me that the surgeon here was excellent, and I have been assured by many that the hospital is very good.
Insurance is another issue. For me, at least. I travel “bareback,” meaning I have no medical insurance except for Medicare in the US. Self insuring is good for doctor’s visits and such, but surgery is a different story. My doctor told me the whole thing would be under $2000 US. I have set aside savings with exactly this eventuality in mind. Fortunately all of the testing and the doctor’s visits came to under $300.
I was extremely lucky. First and foremost because I found a doctor who had trained in the US, and who had grown up there. He has practiced in Oaxaca for over 20 years, so he is totally integrated, and integral to, the local medical establishment. His English is spoken with no accent and he understands the needs of American patients. In case you find yourself needing a doctor in Oaxaca, his name is Alberto Zamacona, and most call him Doctor Z.
I was lucky beyond what I every could have expected by having recovered without having surgery. For that I am grateful both to the ministrations of my doctor, and to my excellent immune system. I have been stunned by my recovery.
So, that was my month in Oaxaca. Now I have a couple of weeks left to enjoy the beautiful city and get acquainted with more than the medical system.
Yes. I am astonished. I had no idea. For years my doctors have told me to take statins to lower my sky high cholesterol. I even tried once, about 12 or so years ago, and had a miserable side effect-Burning Mouth Syndrome. My mouth and lips were on fire. To add to my misery, I was living in South Korea at the time, and the good food there is spicy hot. I could only eat bland food, and I was still miserable. That was the end of my experience with statins. I figured with diet and exercise I could control the numbers, but I wasn´t disciplined enough about either. Well, I have spent long periods of time when I have swum a lot and hiking and biking, but the numbers only got worse.
Losing weight is really hard and my weight was in a range where I didn´t really feel a great compulsion to suffer. Besides, all my other heart and health factors have been good. I take thyroid medication and have for many years, but that is all. I´m fairly strong and fit, so I have just suffered the reminders every couple of years that my blood was fatty. And then I would forget and go get another of those lovely Thai sausages.
My only limiting issue has been my knees, which have endured every sort of insult from skiing accidents, 10 K races and daily runs till I was told to stop, falls, and even torn menisci from swimming (breast stroke with frog kick, bad news for knees). My orthopedic surgeon in Bangkok, treating my knees after some serious damage done in Nepal, which resulted in a fall and a broken foot, told me, many times in fact, that the best thing I could do for the knees was lose weight and strengthen my quads. But, I whinged, I am trying to lose weight, and I am always hungry, and I don´t seem to lose anything but my temper. Kindly Thai doctor that he is, he told me that suffering from hunger is a very good thing because it helps you sympathize with the hungry of the world. I exercised more once I was back on my feet, but my knees hurt and my weight stubbornly increased.
I think most of us of a certain age have heard it: lose weight and all of your health factors will improve. It is good for the blood pressure, cholesterol, aging joints, yada yada. But there is no magic bullet to improve these things, right? It is just a matter of age, and I have felt lucky that my only real problem was my knees. Well, and those nasty cholesterol numbers.
So, what happened that my most recent cholesterol test came back with results in the excellent range, without the use of medications?
As my few darling regular readers know, I headed out at the end of January, with a back pack and a small pension, to explore South America. I have been traveling by bus and in the 4 wheel drive truck of some friends I met along the way. I have hiked my way around major cities and little villages. I have walked for hours every day. And meals have been what can be grabbed along the way, and what fit on my budget. In South America the big meal of the day is between about 1 and 3 in the afternoon. I fell into the habit of eating then and either skipping dinner or just having a snack. My evening meal shrank and disappeared. I accidentally fell into the habit of intermittent fasting before I knew it was a thing. The new diet science (fad of the day?) suggests that if you limit your eating to a 8-12 hour period each day (there is disagreement on exactly how long) you will lose weight even if you eat the same as you would in a normal day. New research indicates that it can be as long as 12 hours. I was doing my eating most days within a 6-8 hour time period.
Last month in Cuzco I started having tingling in my lips when I walked for very far, and soon it spread to my whole right side. It got gradually worse, and finally in Antigua, Guatemala, I went to see a doctor. I was convinced that my high cholesterol had finally caught up with me, and I was going to have a stroke or a blood clot. I was scared to get on my next flight. The doc ordered up lots of tests, and I went back to the hotel and skipped eggs at breakfast. I figured I was going to have to give them up anyway.
The doc and I went over the results. Blood pressure, slightly high but okay, as I was stressed and my BP is normally a bit low. Clotting factors, okay. All other blood work, just fine. Sugars, fine. Cholesterol levels? In the mother fíng excellent range! Damn. I haven´t ever, since having it checked for the first time, had such good numbers. Oh, and I had lost almost 30 pounds! I knew I had lost weight, as my clothes were really not fitting and I had had to buy a new belt to hold my pants up, but, wow! I had not been on a diet. I had just changed my habits to accommodate constant travel.
The immediate problem, the tingling and right side numbness, seems to be my thyroid, and that medicine has now been adjusted. So I am still only on thyroid medication, and I am not taking statins. I am so thrilled I never started them.
So, my friends, it is possible to get cholesterol under control with diet and exercise. I personally think the weight loss and exercise are the most important aspects, because I have been eating eggs and pork all summer, but only in that 6-10 hour window of time. I would highly recommend taking a year off and trekking the world. But of course, that is not practical for everyone, and it is not practically as a lifelong life style. Going forward I will have to manage the exercise and diet while not traveling. But at least I now know that it works, and that I really must make that commitment.
There is really no deciding where it is best to spend the rest of one´s life. It is all done with some bittersweet hope and trepidation. I´ve been too many places and have seen and experienced too much disappointment after having earnest confidence. I´ve read the stories of others whose hearts were broken by a place they fell in love with. Perhaps that is part of the reason I have been looking for so long, and have been mostly crest fallen at what I´ve seen.
But Mexico. In the last 14 years I have been in Mexico more time than in the US. I have worked there, a bit, and slept there a lot. I´ve invested in land there, only to be ripped off by my partner/good friend; a real soul crushing experience. I have few romantic delusions about Mexico. I am currently reading Under the Volcano, which should banish what remains of my fantasies. I think if I stay in Mexico, it will be a measured decision.
I landed back in Mexico City a couple of weeks ago, from Lima, Peru, and it didn´t take long to remember why it has always been my first and last choice. Why hadn´t I just decided that long ago? First, I am very concerned that I won´t qualify for residency with my very limited resources, besides, I still had exploring to do. The issue of financial requirements scares me. If I can´t get residency here, then I am back to the start in terms of finding a place. For a variety of reasons that I will try to cover in another post, I was not satisfied with the options in South America.
I am set on Mexico for now. I have contacted an attorney, and I hope they can help me sort out the residency visa. Now is a good time to do this, as the dollar is at an all time high vs. the Peso, so at least it seems like I have more money than I do.
What is it about Mexico? That is the ephemeral aspect to choosing a place. I can give lots of practical reasons; I am learning the language, it is close to the US, I love the food and the culture, yada yada. But it comes down to walking the streets of Mexico City and feeling a part of it, and yet totally foreign. It gives me the psychic space I personally need while allowing and inviting me to be part of it.
If I stay, I will try to spend a lot of time in Mexico City. I imagine I will need to settle some place less costly, but I love the city. Here are some photos from the recent visit:
First, there is the architecture, the very bones of the City. The Cathedral is actually built upon the Aztec bones of old Tenochtitlan, upon and with the stones of the old empire. The architecture spans centuries and tells the history of the city. I think now the powers that be understand the importance of this and will protect it.
And the food! My favorite two countries for street food are Thailand and Mexico. I really cannot decide between the two, but ranking Mexico with Thailand in terms of food says a lot. The food is cheap and plentiful, and of course, muy rico.
And cool, stylish, joyful street life. Mexicans live hard and party harder.
So, hopefully, it will be Mexico.
What a difficult choice! I have so many pictures of transport. Here are a few. I think my photos tell stories more than demonstrate technical skill. I like to go back through the archives and look for stories.
So I haven´t written anything here all month. Peru and the death of my computer are my excuses. But now I want to go back and catch up. I’m currently in another small town that is quite tempting to a lot of retirees, dropouts, new age practitioners, ayahuasca and San Pedro enthusiasts, fake and real shaman, and snake oil sales people. In other words, the southern Peruvian version of Vilcabamba. So it put me to mind to get to work on my blog.
Vilcabamba has a reputation. It is also a bit of a mystery to me. The reputation is as a valley of longevity where you can retire on thin air and live forever. It also has a reputation as a place to take “plant medicines” aka ayahuasca and San Pedro. Hence its attraction to the above list of motley characters. The mystery is how this place has developed in a little rather hard to get to valley in the south of Ecuador on a barely used/usable stretch of road that leads to the least used jungle border crossing to Peru. To the north by an hour or so is the town of Loja, but that is far from an outpost of urbanity. If you are looking for a city, it is a 4.5 hour flight to Quito. It is in the middle of pretty much nowhere.
So, I had a rather jaundiced view before my arrival. I had read the stories of drugs, hippies and violence. I had also read all the glowing reports from International Living Magazine, a publication dedicated to convincing retirees or future retirees that they can live an idyllic life on next to nothing in one of their selected locations, for all of which they just happen to offer seminars and webinars for a small fee, so you can learn how this prestidigitation is performed. Yes, I know snake oil when I smell it.
This wariness was reinforced when I got on the bus from Loja to Vilcabamba and sat down next the an escapee from Alaska. Now I have spent years in Alaska and I know that when they emptied out the mental health hospitals in the lower 48 in the 70´s and 80´s, a good percentage of the former residents headed for Alaska. This kind lady made her second escape to Ecuador. She checked all of the boxes for what I had come to expect from some of the residents of Vilcabamba; spaced out, check, paranoid, check, conspiracy theorist, check, spiritually committed, check and double check (Seventh Day Adventist), broke, check, delusional. . .well, you get the idea. So upon my arrival I already might as well have continued on the Peru.
So I surprised myself and actually fell deeply in like with the place. The local church certainly was painted by some cosmically inspired group. The people I met on the sunny town square were not the cashed up one I´d heard about, and maybe they had their ¨plant medicine¨ moments, but mostly they were friendly down to earth exiles from gringolandia.
I have written a lot about Cuenca, but the bottom line for me was a lack of feeling connected. Cuenca seems to roll up the sidewalks at night and everyone escapes to their own little, mostly family, enclave. Certainly the glorious town square in Cuenca lacks the social vibe that to me defines town squares. It was quite the opposite in Vilcabamba. Choose a bar or restaurant, order a beer and you will be chatted up in a matter of minutes, and deep in conversation before you know it.
I really liked that one of the first conversations I overheard was a deeply cynical and very humourous take on the local new age pretenders. Complete with pantomimes of yoga positions. There are at least some here who have a sense of irony and humour about themselves and the place they live. I had conversations with people living on less Social Security than I get, and feeling at peace and at home here.
During the day young hippie types, probably on the ayahuasca trail, sell the same trinkets you find at every beach or vacation town – beaded bracelets, hand made thises and thatses, and some fake stuff from China. A dreadlocked poser juggles, 2 more have a clown act, and a young gringa in a long skirt nurses a baby, beneath a sky inspired by plant medicine.
There seem to be (invisible) hitching posts actually in use, and lots of antique 4 wheelers. Ducks are steered through the dusty streets lined with small stores and living spaces.
Okay, a confession, I was actually quite taken with the quality of the food here at very good value. I think I was hungry a lot of the time in Cuenca for good food. I know, many would argue with that assessment, but I was there for 2 months, and on my budget I never had a great meal. I had three really good meals (and one really mediocre one) all on the small town square. Fried potatoes and an omelet with salsa and good coffee. Now that is a breakfast.
So, could I live in Vilcabamba? I´m not sure. It is a bit far from urban escape, and it really is a small dusty town. But it is reasonably cheap, in Ecuador, which has great benefits for retirees, and it is close to Peru, which I am growing to love, and close to the Amazon, which I quite love. Spanglish seems to be the common language, and there are people that I can relate to. It might make it to my short list.
There are many reasons to love Cuenca, but in the end, they are rather prosaic. Where to live and what feels like home to a person is highly personal. I’m moving on, but I can understand why many people stay.
It is a cheap enough place to live, now. But the developers are coming, and have been here for a while, and the cost of living is rising. The cheap little apartments that probably once housed Ecuadorian families, then new-comer immigrants, now are being redeveloped into more expensive “loft’ spaces. As rents go up, so will the cost of things as locals have to adjust their incomes. Cuenca is not cheap today, by Ecuadorian standards, and will become relatively more expensive as time goes on. Even if I were totally convinced to stay in Cuenca, this would convince me otherwise.
That Cuenca appeals to middle-class economic refugees from the developed world is no surprise. It is a very easy and undemanding place to be. There is an excellent symphony, with free performances, as well as dance and other arts, museums, clubs and cafes. The hope for many is, I believe, that you can pick up your “life-style” where it left off where you left from, only at a fraction of the cost. The relative loss of standard of living as one transitions from working income to pension will be absorbed by the difference in cost of living between the home country and Cuenca. This is the hope, of course. And given this ehop, it is easy to see that learning a new language and adjusting to a very different culture are not part of the expectations of the newcomers.
For me, Cuenca lacks a certain edginess that comes with international cities-the clash of cultures and classes that keeps things lively and fresh, and a touch threatening. I think that sort of sums up my personal response to it. It is a pretty place to visit. I’m happy for the displaced foreigners who find a second home here, and a comfortable one. I’m sorry for the fate of the locals, but in truth Cuenca has belonged to foreigners for 500 years. Really since the beginning. It was born a middle class European colonial city, and that is remains.
There is my final hurrah for Cuenca. It will continue to be promoted by the developers and the International Living magazines. As the US becomes increasingly unaffordable for retirees, they will seek out the Cuencas of the world. Meanwhile, I am off to Vilcabamba, a retiree spot of a decidedly different, funkier sort in the far south of Ecuador.