Nothing New

I see it has been two years and more since my last post.
Anything more recent has been posted to my website barrygriefer.com in the form of photos, videos and some narrative.

Taking the Kids to School in Zacatecas

The building in the background it a large primary school.  Grades 1-6, I beleve.  There are enough classrooms for 4 classes per grade.  Even though a lot of the kids live within 4 blocks of the school, many parents drop the kids off in the morning around 7 and pick them up at 2.  Class starts and ends early because 2PM is the traditional "comida" hour.  That's the big meal of the day.  Supper may be anytime after 8PM.  It's one of the nice things about local culture that many families can take the one or two hours to enjoy the meal and family.  More and more stores run a 9 to 9 schedule or at best an 11 to 9 schedule that don't allow employees the 2 hours for lunch.  Manufacturing companies often run an 8-8 1/2 hour schedule providing a hot meal during a half-hour lunch break.

I'm happy I found a place where the traditions that make the Mexican culture attractive still abound.  It's no longer true in cities of 500,000 or more.

No, Not by Burro

Far from the beliefs of some misanthropic people outside Mexico, mail is not delivered by burro.  These motorcycles are very handy in the steep narrow streets of the historic center of Zacatecas.  Mail is not as heavily used in Mexico as in the US.  Families tend to live close to each other, visit each other daily or weekly and spend hours on the phone with out of town relatives.

I now have had several months experience with Seguro Popular and a much broader perspective.

The idea that it's Mexico's answer to Universal healthcare is very definitely false.
1)  It's totally voluntary.
2)  It's not financed by a special tax, funding comes from the federal government's plus premiums paid by the top 20% of wage earners.
3)  Since that top 20% is covered by Social Security, Company health plans or Private Insurance, it's pretty much an exclusive club for the bottom 80% and only that part of the bottom 80% that aren't covered by Social Security or a company plan.

There are severe limits on the level of care Seguro Popular can offer even though a treatment, procedure or test is authorized.  Only certain generic medications are available and only if the local health center's allotment hasn't run out.  The reagents for some very common blood tests may not have been ordered because federal appropriations haven't been approved yet.  You may have to schedule routine tests 3 to 6 months ahead of time because there aren't enough specialists to go around.  You may have to travel hundreds of miles for certain treatments because there aren't any suitable facilities in you local area.

Is the a harbinger of things to come under Obamacare?  I already see healthcare providers making provisions to conserve income and protect themselves as much as possible from the direct demands of Obamacare, 

A recent AARP Bulletin had an article warning working age people to put aside lots of money for future medical care.  Having been insiders to the original Obamacare deal, should you be on the lookout for failures in the "promise" of Obamacare?

Navigating one part of Mexico's "universal" healthcare system.

I had written that I'd signed up with Seguro Popular in September. This week I took a stab at seeing a doctor.

I live in the historic center of Zacatecas, 4 blocks up the hill behind the cathedral. The Health Center (Centro de Salud) is about 2 miles from the nearest bus stop which is about a half mile walk from my house. The bus

costs 3 pesos for Seniors with an INAPAM card. It's probably walk able by a slightly different route which I haven't investigated yet. I mention this because walking is imperative for managing my diabetes and high blood pressure.

I took my first shot Tuesday morning, arriving at 8:30AM. It looked like a mad house, with people milling about or lining up in what looked like endless files. A young lady in a lab coat was passing by so I got her attention and asked what I needed to do to see a doctor. She said she was a student and didn’t know but led me to one and then another window where I found out that you had to go to the window with the "Fichas" sign and they'd give you a chit with an office number and a turn number. But, it was Doctor's Day and they wouldn't be giving them out till 11AM because all the docs were at a breakfast. I thanked the young lady and said I probably come back the next day. I hadn't had breakfast because I expected they'd want me fasting and decided I'd rather eat than wait.

Yesterday, Wednesday, I arrived around 8:00AM and it looked like bedlam again but I already knew where to go. I got my chit for "consultorio 6," turn #3. I presented my chit to the nurse at the desk out front. She said that were 3 people ahead of me, I should have a seat and she’d holler when it was my turn. My turn came and she took a history, blood pressure, blood sugar, height, weight, and waistline and filled the personal data page of a booklet that lists the basic services Seguro Popular provides and contains pages to record visits, tests and treatments. Now it was time to wait for the doctor whose shift was about to start. When my turn came, the doctor spent plenty of time getting to know me and going over my needs and concerns. As we were finishing up, he hollered over to the person in charge of the lab and asked if there was still time for me to get blood drawn. No, they’d already started processing the morning’s collections. The doctor gave me a lab order and a cup to pee in, telling me to see his nurse at 8:30AM next morning for laboratory chit and to bring the full cup with me. I left, got the bus to downtown and decided to have breakfast at McDonalds. The time on the cash register receipt was 11:29AM. The waits did seem long, longer than the actual time. I’m not really sure how much time was just waiting and how much was time I was actually being attended to. Three hours doesn’t seem that long compared to driving times and wait times I faced in the US over the years.

= = = = =

The next day, Thursday, I was there at 8:00AM and went directly to the nurse’s desk where she gave me a laboratory pass and told me to go to the Seguro Popular office and get a receipt for the lab work.  She also told me to come back after I finished at the lab, the doctor wanted to see me.  It turns out the Health Center is a State of Zacatecas operation and they do have paying customers, something I’ll look into in the future to salve my curiosity.  I headed down the hall to the Seguro Popular office where there was a line about 20 people long.  I passed the time just chatting with people about nothing in particular.  My turn came and it was a simple matter to show the doctor’s lab request and my “policy” proving I had Seguro Popular. 

The next step was to check in with the laboratory, another line, this one with 30 people.  While standing in line, a phlebotomist verified demographic information and took a couple of additional pieces of information and handed me the form saying results would be ready at 4PM the next day Friday.  When I got up to the window, the clerk took my lab order, the form the phlebotomist gave me and the laboratory pass and stamped them with a code number.  She then hand wrote 4 labels each with the code number and a procedure code.  One was for the urine sample which I put on a tray next to the window, the other 3 for the vacutainers which the phlebotomist on the next line handed to me after applying the labels.  This one was only 15 people long.  That phlebotomist also reminded me results would be ready at 4PM the next day Friday.  This line ended at a little room where two phlebotomists we drawing blood.  With that taken care of I went back to the waiting area by the nurse’s desk.  The doctor hadn’t come in yet, he should be in “ya merito,” almost immediately and that there were two patients ahead of me.  The wait didn’t seem too interminable, the doctor arrived and took care of the two patients plus 3 or 4 interruptions.  My turn and about the time I was walking into his office/examination room, two other doctors came by looking to go to lunch.  My doc said he wouldn’t be long and they should sit in if they wanted.  Well, it took a good bit longer than I would have suspected.  I was asked about my background and why I came to Zacatecas and we detoured into philosophy and politics a bit and then my doctor explained his diagnosis of my problems and the next few steps in his plan including meds from those available through Seguro Popular plus certain ultrasounds at the General Hospital.  He gave me an order for the Hospital and told me go the next day and look for Dr. Navarro in the X-ray Dept., referring to him, Dr. Molina.  The four of us chatted a bit more and then it occurred Dr. Molina to call Dr. Navarro and set up an appointment for Friday at 5:30PM.  I didn’t have to wait long for a bus back to downtown.  I stopped in at my favorite gordita place and got some for breakfast and lunch before treating myself to a cab up the hill to the house.  I had to call the lady who cleans up for me on Fridays to see if she could come early so I’d be sure to be able to pick up the lab results around 4PM.  No problem.

= = = =  =

I was out there at 4PM today, Friday, and sure enough the results were ready.  Instead of going back home, the General Hospital is only about a half-mile from the Health Center.  I took a little walk to kill time before 5:30 and stopped at restaurant for a soft drink right across the street from the Health Center.  It’s a fairly upscale place with nice décor and attentive staff.  I guess I’ll go back and see what the food is like.

I got to the General Hospital around 5:20 and asked for Dr. Navarro.  They didn’t seem to recognize the name and the best they could offer was wait a half-hour or so and see if he shows up.  I wandered around built.  The place looks modern, opened in 2010, and kept well maintained.  I don’t know how many beds, but it has all the departments you expect in a major facility.

About the time the half-hour was up, a “doctor-looking” gentleman walked out of a door marked Ultrasound.  I asked him if he knew Dr. Navarro.  Of course, he’s a colleague and a friend.  Do you know if he’ll be in today?  No, they should know at the reception window.  I already asked.  He took me over to the window and talked to one particular person who hadn’t been there when I arrived.  Dr. Navarro left a message that he wouldn’t be able to make it today.  After a little bit of back and forth I settled for an appointment next Wednesday at 5PM.  Nobody thought to give him my phone number so he could contact me and maybe the people I talked to first didn’t recognize the name because of my accent.  If we connect on Weds. All will be forgiven.

BUYING BUS TICKETS

This morning's walk was broken into three legs due to a trip to the bus station to pickup/buy tickets for an upcoming trip to McAllen.  Total distance 1.65mi.

I'm in Mexico and it's still Mexico.

The way you buy bus tickets on the Internet changed about 3 months ago making it almost silly trying to do so.

You still can't buy tickets, even on the same company, where you change busses.  Each leg has to be a separate purchase.  And of course, you have to buy from each company's website separately.  You can't even print you boarding passes online, you have to go down to the bus station with the originalo and copy of you voter's credential if you are Mexican or you passport if you are a foreigner to pick up your ticket.  You can wait till 30 minute before departure to do so, but I like to have my tickets in hand well before the date even though there has never been a problem.  The only reason to buy online is to save time at the ticket counter which can be considerable.

Two bus companies are involved because I take a bus to Reynosa on ODM, take a taxi to Mexican Immigration and walk across the bridge because the jitney from Reynosa to McAllen won't stop and wait for me while I got through Mexican Immigration.  The ODM bus, if it runs at all, gets to Reynosa and the taxi to Mexican Immigration early enough that there's not much of a line at US Customs and Immigration.  Coming home, I get a Grupo Senda bus in McAllen that does wait for me at the border where I have to go through Mexican Immigration again but connects with another ODM bus in Reynosa that gets me to Zacatecas.  Checking out and checking in with Mexican Immigration is a condition of my permit.

This morning I was able to buy my ODM ticket from Zacatecas to Reynosa, but I had to call an 800 number to get the code numbers I needed to be able to pick up the ticket.  I was then able to buy my Grupo Senda ticket from McAllen to Reynosa and print out a confirmation to take to the bus station.  When it came to buying the ticket Reynosa to Zacatecas, the transaction rejected for no logical reason.

OK, confirmation and code numbers in hand I headed out for the bus station.  The bus pulled into a gas station about 300 yards short of the bus station and a bunch of us got out there to walk.  

Between the 2 bus companies, it took less than a half hour in line and at the counter picking up and/or buying my tickets.

On the way back, I got off at the nearest stop to my bank, went to the ATM and walked home.

Yesterday, Apr. 3, 2012, was kind of a weird day.

I have 4 doctors’ appointments coming up May 1 & 2 in McAllen. I like to make my arrangements early because bus seats and hotel rooms can be in short supply at times.

First order of business was to make hotel and rental car reservations. Along the way I found out that the AARP discount at the hotel I like to stay at saves enough that two night’s savings pays for membership. I guess I knew that for some time, but was too fed up with their political maneuverings to stop cutting off my nose to spite my face. I signed up for AARP.

I like to get into Reynosa, Mexico (there hasn’t been through service to McAllen for about a year now) early because the peak period of people crossing on foot is between around 7AM and 9AM. The bus I take arrives at 6AM and I can make it to the car rental place in McAllen by 9-9:30. A half milligram of alprazolam gets me 7 to 8 hours sleep on the bus. Even though the Internet showed a few seats available on the bus to Reynosa and the buses for the return trip, it was obvious the best seats were blocked for bus company and travel agent use. The next order of business was to go to the bus station and buy the tickets. You can do it online but you have to trust that the system will be up and running at departure time. Experience convinced me that it’s best to just go to the bus station as soon as possible and buy the tickets there.

Going to the bus station can be a 10 minute cab ride for about $2.50 or a 15 min walk plus a 25 cent, 15 minute bus ride. In no hurry and wanting the exercise, I chose the latter. It also gave me the opportunity to check my P.O. box and got to the ATM, a good thing it turned out to be.

At the bus station, there were seven people behind the counter but only one person was actually dealing with customers. One or two of the others were counting cash (shift change?) and the rest were chatting, shuffling papers or on their cell phones. The one guy dealing with customers was slow and struggling to take care of the one customer ahead of. I had experience with this guy in the past and knew he was just slow. I tried to get another agents attention, no luck. They would answer questions but not sell tickets. After about 10 minutes, another agent must have finished what she had been doing and called me over. The customer ahead of me still hadn’t been able to buy his ticket. I gave the agent the details of the trip I wanted, stated that I’m eligible for the Senior discount and she pulled up the seat selection screen. As I would have predicted, 35 of the 38 seats were available. The Internet had shown that only about 6 seats were available. I selected my favorite #7, aisle seat close to the front where it’s quieter on the side opposite from the driver where you get just enough more legroom to make it worthwhile. I paid with my credit card and was off to buy my return tickets from another company.

What happened here was pretty unusual. Normally, if the system is up, buying tickets is quick and easy.

It took only about two minutes at the other company to get to the point of paying for my tickets but after a minute’s delay, the credit card terminal timed out because it couldn’t connect to the system. After trying and failing a second time, my choice was to come back later or pay cash. I elected to pay cash and have all my tickets in my pocket.

So far, 3 anomalous incidents, one of which is “routine” for Mexico, bus company websites not telling the truth about seat availability. The other two incidents, system reliability and “personnel” quirks, are infrequent enough to be truly anomalous.

I got a bus back to downtown immediately on leaving the terminal but had to get off before reaching my stop because the police were blocking off the center of downtown for the evenings Cultural Festival events. That meant only an additional 50 meters on my walk home. Anomalous event #4.

I arrived home to find Cristy just getting out of the shower. Water had filled the cistern while we were out and the landlord had turned on the pump to fill the tanks (tinacos) on the roof. My turn! I shed my clothes and jumped in the shower. Got myself good an wet, lathered up, and at the precise moment I started to rinse, the water started to turn cold. I managed to get reasonably rinsed before freezing or running out of water. The pilot light had gone out on the water heater.

Later in the evening Carol , one of our neighbors, accompanied us to hear Pablo Milanés, one of Cuba’s top Trova singers in Plaza de Armas..

http://en.wikipedia.org/wiki/Trova
http://www.youtube.com/watch?v=PEn6WZN-8Vw
http://www.youtube.com/watch?v=u436OUA6phU

It was a nice evening.
Here are a few photos showing what the Plaza de Armas looked like.

Carol and Cristy