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As I announced my plans to move to Mexico to friends and family, their most frequently voiced cautions centered around health care issues.  How competent were medical practitioners south of the border?  Were there high quality medical facilities?  What was the risk that a major illness could wipe me out, financially?  I thought I’d addressed all those fears by arranging to remain active enough for the Tucson ad agency that employed me to maintain my U.S. health insurance.  But, as reported here earlier, the hours necessary to doing that began to interfere with the reasons I’d pulled up stakes in the first place. (see links to previous articles by Sandy Caputo Loving in Additional Resources to the right) Simultaneously, I was able to witness first-hand the excellent and personal level of care available here and the relatively minimal costs.  I investigated IMSS - the Mexican national health care program that is officially called Instituto Mexicano del Seguro Social and referred to commonly as Seguro Social.  Learning that very extensive health-coverage could be had for around $300 (U.S.) per year, per family, I shifted to consulting for my company and let the U.S. insurance lapse.  What I didn’t do was sign up for IMSS.  Hey, I was healthy! Besides, about that time, my fiancé decided to take early retirement and join me in my adventure.  That was in March, 2001.   My IMSS investigation was based on Internet information that turns out not to have been updated since 1996.  That information told me that annual sign-up periods were  available only during the months of January, part of February, and through July and August.  While we waited for July, we visited private doctors here, had thorough check-ups, each blithely paid our 200 pesos (around $20 U.S.), and decided that since we were to be married in late October, we might as well wait and get the two-for-one insurance that’s extended to married couples. In September, I discovered a lump in my breast.

At the turn of the millennium, Sandy Caputo moved from her home in Tucson, Arizona, to the historic Michoacan city of Morelia, Mexico, nestled within the Sierra Madre Mountains 217 miles west of Mexico City. She fell more in love with old Mexico, was joined by her stateside fiancé, married, built her dream house, and discovered she had breast cancer. This is the story of Sandy’s discovery of the excellent health care provided by the Mexican national health care program, the IMSS. It saved her life. Sandy writes, “Both my husband’s family and mine have deep medical experience and/or access to the latest in medical practices in the States, and you can be sure we compared all information with what was gleaned from home.  Every single diagnosis and prescribed treatment was right on the mark with what would have been done in the States. I was able to witness first-hand the excellent and personal level of care available here and the relatively minimal costs.” This article has valuable information on health care in Mexico. Note: Sandy's first article for Escape from America Magazine chronicles her move to Mexico. Her second article describes how she is able to live better for less. Harper Collins has her recently completed manuscript, "Shortcut To Morelia," and aside from freelance writing, she does video scripting to also help make her life a reality. .. Additional Resources Living Overseas  Unique Lifestyles  Articles on Mexico  Overseas Retirement  Sandy's First Article  Sandy's Second Article  Contact Sandy Caputo Loving  .

There was no use kicking ourselves over our cavalier attitude, because the six to eight-month waiting period for coverage would have left this emergency uncovered, anyway.  When we finally did get around to registering in January 2002, we discovered that numerous things had changed, but that we still would not have been covered for a surgical procedure within the first six months of coverage.  Regardless, there we were in September with no insurance.  You can imagine the nightmares we had over potential costs before we made it through all the tests that confirmed a malignancy. 
 

When we sat down with the recommended oncologist (a Pavarotti double and aficionado) and asked the big cost question, we were greatly relieved.  Poor Dr. Valencia had first been put through a grilling the likes of which made me worry that one more question about credentials, accreditation, and/or experience and I’d be sorry he’d be in a position shortly to be standing over me, wielding a scalpel.  But he met and surpassed all my one-time pharmaceutical salesman fiance’s tests:  Board certified,  practicing for some 15 years, experienced in performing more than 700 mastectomies, and more and more. The cost?    Well, let me preface this with the fact that it would cover the several pre-consultations with my OBGYN (a lovely young woman who actually teared-up when she had to tell me the

Sandy with Dr. Arturo Valencia Ortiz

tests predicted malignancy), many lab tests, meetings with the oncologist, the anesthesiologist, and the internist who were to be a part of the surgical team, three days’ hospitalization in a private women’s hospital in a spacious private room, all medications, supplies, surgery, meals, the unexpectedly supplied and much appreciated services of Dr. Valencia’s cousin as an interpreter (so that there would be no confusion about any of what was diagnosed and recommended), and some dozen post-op visits with the surgeon.  All that, for under $4,000 (U.S.) 

Both my husband’s family and mine have deep medical experience and/or access to the latest in medical practices in the States, and you can be sure we compared all information with what was gleaned from home.  Every single diagnosis and prescribed treatment was right on the mark with what would have been done in the States. 
 

Our costs for the subsequent six months of chemotherapy and radiation and the services of oncological specialists ran another $3,500 but all of this would have been covered had we understood how to be properly covered under IMSS.  There still is no updated information available on the Internet, but here’s what we’ve learned:  Coverage is now available only on a per person basis and runs in U.S. dollars from $899 per year for those up to age 19 to $233 for those 60 and over.  Coverage begins the first day of the month during which you register.  Pre-existing conditions and surgical procedures have some initial restrictions, but there are no restrictions within six months to a year of coverage.  Costs are normally picked up by employers, but anyone legally in the country is eligible. There are three levels of care.  The first involves primarily health maintenance and preventative care; the second, specialized services; and the third, whatever is required for more serious needs.  Facilities and medical care is excellent at all levels – with many private doctors also working for IMSS to supplement their incomes - but the waits for IMSS appointments can be lengthy compared to private care.

Dr. Rogelio Gaona Nava

Our experience with the registration and initial appointment process has given us a clearer insight into why so few of the ex-pats we know here carry medical insurance.  It’s quite possibly that in this instance you really need to at least be minimally able to communicate in the language of the country.  And then there’s the waiting thing.  The standing in line.  The need to visit six places to accomplish what so obviously could be done under one roof. Streamlined customer service is simply not a concept that’s been embraced in this part of the world.  And, let’s face it, we came of age in a culture where things are expected to be accomplished yesterday.

But we tell ourselves this lack of concern for the value of an individual’s time is part of why life is appealingly slower here.  So we tuck a book in with all the required paperwork and expect to make the best of the waiting.  It’s really not such a bad trade-off for the tremendous savings and assurance that we now have a medical safety net. 

Before my surgery, we visited a friend who was hospitalized under IMSS as the  result of an embolism.  The hospital was modern, clean, and well-staffed but, indeed, crowded with patients and all manner of visiting friends and family.  Our friend was in a semi-private room.  He was there for more than a month, and all expenses were covered under his employer-paid national policy. 
 

I find it interesting that the first two articles in this series on my adventures in Mexico drew so many questions about the costs and quality of health care.  I really didn’t intend to give the matter this close an analysis, but as long as I have, thought you may as well benefit from it.  What I had promised you in this final of three installment pieces was a bit of a glimpse into the things that make living in Mexico

Mufflers-A-Go-Go

at once charming and exasperating.  As I recall, I teased you with questions like why are those dogs on all those roofs; how come there’s rebar sticking into the air everywhere; and what’s that car doing coming at me in my lane?  I could have also said what’s the deal with all these muffler shops when NO one seems to have a properly functioning one?  I finally decided that folks take the working ones in and have holes drilled in them!  How else would those shops stay in business?
 

As for the dogs:  this is a city of a million people, but the housing is rather New York City like – no yards to speak of and many spare houses of two or three stories all with roof-top areas that feature not only the household’s clotheslines, but also offer the greatest space for their cats and dogs to hang out.  The result is that everything from Great Danes to Toy Poodles spend their days patrolling the sidewalks below from their perches on high – erupting into wild barking at the stub of a toe on an uneven sidewalk.  Trust me, it’s startling when you first look up and see a gnarling dog looking as if he’s about to leap down on you. And the rebar?  I’ve been told that it’s a tax-dodge of sorts.  Seems that the taxation on your property will be higher once the building is finished.  So the rebar is evidence that a project is still under construction.  It’s everywhere!

Speedy Gonzalez: Guardia de las Casas

But the driving, takes the cake.  Police don’t patrol the streets to assure that rules are followed.  They only show up if there’s an accident.  This leads to a variety of get away with what you can driving that has to be seen to be believed.  Eye contact is essential as are nerves of steel.  An example:  When oncoming traffic stops for a red light and you’re in the left turn lane waiting for your signal, suddenly there are three or four cars zipping out into the lane to your left, bent on making that left turn right along side you.  Sometimes they’re barreling down that lane when a car turns right – right into their path.  And everyone leans on their horns at the slightest provocation.

Eventually, the noisy cars just become a part of a general dissonance that begins before sun-up when the first little boys walk through the neighborhood ringing  bells that say the garbage truck is approaching, so please get your bags and your pesos ready. 
 

Then there’s the distinctive music blaring from the gas trucks that bring canisters of natural gas to the door to keep your water heater and gas stove functioning.  There’s a whistle – high pitched and prolonged – that says the hot sweet-potato cart’s on the corner and a different, lower one, that means the knife sharpener’s in the neighborhood.  It goes on and on like this straight into the night when, should a paramour want to prove his love to some sweet young thing, he hires a band of mariachis which suddenly breaks into song under her window (and unfortunately next to yours) from, say, two to three in the morning.  Worst is the local policia who comes by weekly to collect 10 pesos for the pleasure of hearing him bike through the neighborhood every hour blowing a shrill whistle meant, I presume, to ward off burglers.  All it truly does is set all those

Sweeeeet Potato!!!

dogs on all those roofs to barking.  Fortunately, he only seems to make his rounds the night following collecting.  I’ve tried telling him that I would gladly pay him NOT to patrol the neighborhood, but to no avail.  He smiles at me, pockets his ten pesos, and bikes away probably thinking I’m just a gringa loca.
 

Another job that entails a keen use of a whistle - with particular toots signifying particular moves the driver should execute - is that of parking lot attendant.  They’re good at finding you a parking spot, directing you in and out of such, loading things into your car and taking the cart away.  It’s all a bit confusing at first, but I see very few parking lot fender benders and have never had to get out of the car to move a grocery cart before I can pull into a space.  Not bad for a peso or two propina (tip).  Compensating for the dearth of policemen actually patrolling streets for traffic violations is a series of topes (those horrible ridges sometimes called speed bumps that you usually find in apartment complex parking lots).  These appear across Mexico, not just in small villages where you would normally slow down, anyway, but they also crop up with seemingly no reason smack in the middle of a busy highway.  They usually come in groups of two and you learn (after a couple of screeching attempts to avoid them) to remain alert for signs warning of their impending presence.

Con Mucho Gusto!!!

Topes warnings are generally yellow signs with two spherical black bumps on them.  These have always looked to me like little black bras.  Which since my surgery have now given me a whole new perspective on the sights, the sounds, the lumps and bumps that come with living anywhere – but especially in Mexico.