June 29, 2012


[Here, many Mexicans talk with pride about the easy access they have to their doctors, sending them frequent text messages with questions and expecting calls back within minutes. One oft-repeated anecdote illustrates a sign of more compassionate care: nurses will warm a patient’s hand before sticking him with a needle.] 

By Jennifer Medina

Monica Almeida/The New York Times
The nurses’ station at Hospital Almater in Mexicali, Mexico, 
where many patients come from outside Mexico. More Photos »
MEXICALI, MexicoTourists often come to border towns looking for some kind of illicit adventure, trotting among the bars, strip joints and seedy motels that dot the streets. Here, though, the visitors are searching for something more basic: a root canal they can afford or surgery they have been putting off for months.

Mexicali has adopted medical care as its primary tourist lure, and it has been attracting a growing number of health care commuters from California and other nearby states. Hospitals offer operations for gastric bypass, liposuction and chronic back pain. Dentists promise that extractions, fillings and whitening can all be done for less money. And ophthalmologists advertise laser surgery and routine exams.

Thousands of people are crossing the border in search of care they either cannot afford or wish to get more cheaply. The influx has grown steadily over the last several years, attracting uninsured Mexicans who have made their lives in the United States and desperately need affordable care. But it increasingly includes a smaller but growing group of middle-class patients from all over the country looking for deals on elective surgeries that most medical insurance will not cover.

“At first, I was like, Mexicali, where is that?” said Stephanie Rusky, a 26-year-old social worker from Perkins, Okla., who paid roughly $8,000 for some liposuction, a breast lift and a tummy tuck (a combination known as a “mommy makeover”) that would have cost about twice that in the United States. “But I asked every question I could think of and eventually felt really comfortable with it.”

Such sentiments are sweet music to the ears of Omar Dipp, who oversees tourism for the city.

“There’s a huge market for this,” Mr. Dipp said. “We just have to package it the right way. Everyone benefits: the hotels, the restaurants, the local economy. We give them a reason to come, and they will be here.”
Last year, more than 150,000 patients came to Mexicali, pumping more than $8 million into the city’s economy, officials said. There are some dozen hospitals that regularly see Americans, and many have a special administrator to coordinate medical and travel plans. With nearly 100 medical offices in a six-block radius, the city hopes to create a special medical zone by improving streets and sidewalks and adding more services for tourists.
Just across the border in Southern California, the small city of Calexico has struggled for decades. The area has one of the highest unemployment rates in the country.
Many of the residents in the Imperial Valley there rely on seasonal agricultural work and have no insurance. For them, coming to Mexicali for care can seem obvious. A few insurance providers have even expanded some coverage into Mexico, encouraging their customers to seek the less expensive care. A 2010 study showed that roughly 85 percent of those who crossed the border for medical care were Spanish speakers, but Mr. Dipp said he expected more and more “blue-eyed Americans” in the coming years.
In strip malls and office buildings here, there are far more medical offices than anything else. Hotels offer special rates for patients, and the local tourism office has begun subsidizing van rides from Las Vegas to bring in those who would rather avoid the drive themselves. And this year, the government opened a special lane to allow medical tourists to bypass most of the wait on the Mexican side of the border, which can often take as long as three hours.
The doctors, with strong support from the local government, are hoping to attract more Americans for elective procedures or more basic care that they may not be able to afford at home. And many here believe that the market will only grow as health care costs continue to rise and more people, particularly low-wage workers along the border, are desperate to find affordable care.
Juan Salas drove nearly three hours from his home in Desert Hot Springs, Calif., to have his 11-year-old daughter, Abigail, fitted for braces. While he has medical insurance through his job as a restaurant supplier, it does not cover dental work, so he has come here dozens of times. Saving thousands of dollars will make up for the round trip of at least five hours he will soon be making a couple of times a month, he said.
“Saving the money is as important as the time,” Mr. Salas said as his daughter sat in the chair of the small office, where the orthodontist explained that he was using the same equipment Americans would. Mr. Salas’s wife, Araceli, said that her family had come here for medical care since she was a child.
When their eldest daughter was struggling with seizures, their local doctor could not see her for weeks. Anxious to get a diagnosis more quickly, they came here to see a doctor who offered not only new medication but also his cellphone number so they could call him for follow-up questions.
“At that point, paying for the care didn’t really matter,” Ms. Salas said. “We were talking about our daughter’s life, so we wanted help right away and we had it.”
Here, many Mexicans talk with pride about the easy access they have to their doctors, sending them frequent text messages with questions and expecting calls back within minutes. One oft-repeated anecdote illustrates a sign of more compassionate care: nurses will warm a patient’s hand before sticking him with a needle.
But there are many other considerations potential patients must take into account. None of the hospitals in Mexicali have been certified by American medical accreditation teams. While the facilities appear clean and modern, there are no published studies monitoring infection rates or other risk factors.
Still, seemingly comfortable with the information they do have, people from the United States flock here for surgery.
Carlo Bonfante, an owner of Hospital de la Familia, where Ms. Rusky was a patient, said that the most popular operations were gastric bypass and gastric band surgery (“thanks to all the fries across the border,” he said with a laugh), but that he hoped more people would begin coming for primary care.
“The people who live a few miles away from here but in another country can’t afford the care,” he said, “so we will provide it for them for less, whatever they need.”
Since the special medical lane at the border opened at the end of April, doctors have issued roughly 1,600 passes, which are required to use the lane.
“We want to make it as easy as possible, so that there is no hesitation to come,” said Diana Cota, who oversees international care at Hospital Almater, where roughly 20 percent of patients come from outside Mexico. “Even before the point where someone says they can’t pay for what they want in the U.S., we want them here.”
 @ The New York Times


[The main American effort to open peace negotiations remains centered on the stalled talks in Qatar, where Taliban representatives are supposed to be opening an office. But those talks, which became public this year after months of secret negotiations between the Americans and the Taliban, were suspended by the insurgents in March.]

By  And 

KABUL, Afghanistan A flurry of informal contacts between the Afghan government and insurgent representatives over the past week suggests that long-stalled peace negotiation efforts may be inching forward, Afghan officials say, though American officials played down the significance of the meetings.

Afghan government negotiators sat with representatives of the insurgents first at an informal meeting in Paris this week and then at an academic conference in Kyoto, Japan, through the past two days, officials said. President Hamid Karzai’s top peace negotiator, Salahuddin Rabbani, hailed the public contacts this month as an indication that the Taliban were backing off their demand that Americans be the main interlocutors in any talks.
But the Taliban, in a statement on Thursday, insisted that their policies had not shifted, implying that the group still has no intention of talking to the Afghan government. The representative in Japan was sent “only to clarify our position,” the insurgents said in a statement. “As long as we have not solved the issue with the Americans — an effort that is currently at a complete halt — talks with the Karzai administration would not be fruitful.”
American officials said that while any and all contacts between the Afghan government and Taliban and other insurgent groups were helpful — Washington’s official policy is that any peace deal must be made by Afghans, not Americans — they did not put much stake in the two recent meetings.
One official, who asked not to be named to avoid damaging relations with his Afghan counterparts, cautioned against “overhyping” the contacts. The Afghan government has repeatedly tried and failed to open parallel negotiating tracks with the Taliban. “Mostly, they are finding people whose influence with the leadership is limited, maybe less,” the official said of the Taliban representatives whom the Afghan government has engaged.
The main American effort to open peace negotiations remains centered on the stalled talks in Qatar, where Taliban representatives are supposed to be opening an office. But those talks, which became public this year after months of secret negotiations between the Americans and the Taliban, were suspended by the insurgents in March.
The Taliban halted the talks largely over a delayed prisoner swap that would see the Americans release five insurgent leaders imprisoned at Guantánamo Bay, Cuba, for the lone American soldier known to be held by the Taliban, Sgt. Bowe Bergdahl.
But the Taliban nonetheless sent a delegate this week to the conference under way at a private university in Kyoto, where he spoke alongside a senior member of the Afghan government’s High Peace Council.
The Taliban official, Din Mohammad, a member of the Taliban’s political council, traveled to Japan from Qatar, according to Masanori Naito, dean of the graduate school of global studies at Doshisha University, which hosted the conference. He was one of the keynote speakers alongside Mohammad Masoom Stanekzai, the member of the High Peace Council and a top security adviser to President Karzai.
In March, a second Afghan insurgent group — one that has opposed both the American-led coalition and the Taliban — also suspended formal peace negotiations. But this week, the group, Hezb-i-Islami, or Islamic Party, sent a representative to the informal meeting in Paris for talks with members of the three main opposition political parties in Afghanistan and several members of the High Peace Council.
According to Mr. Rabbani, the Paris meeting was “more a brainstorming session than a meeting to take action.” Those present discussed changes to election laws and the Constitution, and changes to encourage greater decentralization, as well as peace talks, according to another official who attended the meeting but spoke on condition of anonymity because attendees were asked not to discuss the talks.
The former Taliban ambassador to Pakistan, Mullah Abdul Salam Zaeef, was present at the Paris meeting. Mr. Zaeef lives openly in Kabul, though he is believed to maintain loose contacts with the Taliban’s senior leadership. He has in the past informally represented the insurgents, though usually insisting he is speaking only for himself, as was the case in Paris.
Hezb-i-Islami also sent a representative to the Kyoto talks, where each of the speakers spoke about what he considered necessary for peace in Afghanistan, Mr. Naito said.
In his talk, Mr. Mohammad, the Taliban official, “insisted on the withdrawal of foreign troops as a necessary condition for the start of talks,” according to Mr. Naito.
Reopening talks is at the center of the American strategy for Afghanistan, which envisioned the military surge of the past two years, along with increased targeting of the insurgency’s field commanders by Special Operations forces, as forcing the Taliban to the negotiating table.
Mr. Rabbani, who was appointed as the new head of the High Peace Council in April, hailed the Taliban’s presence at the conference as an important step forward. “Until recently, the Taliban rejected any contact with the government,” he said Thursday in an interview. “You see a clear change in their position. It is a positive shift.” Mr. Rabbani was elevated to the head of the peace council after the assassination of his father, a former leader of the council, who was killed by a Taliban emissary with a bomb hidden in his turban last September.
An employee of The New York Times contributed reporting.