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.
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.
[For readers of my other blog, Velissima, this is a copy of the post earlier today.]
Cuenca, I have such mixed feelings about you. I will say, to start, that if you are traveling in Ecuador, you must see Cuenca. Visually it is a mix of colonial Spain and the Vatican. 52 churches scattered around the city punctuate this impression. As I wrote in my last post, Cuenca is beautiful and the people and markets are splendid.
But this trip is about checking out places to park my caravan and pitch my tent, and Cuenca, which comes highly recommended, and seemingly affirmed by a seemingly endless stream of immigrants from northern climes, was high on the list to check out.
And that is probably the biggest problem. How does a 500 year old Ecuadoran City, built on Spanish conquest and colonialism, settled into decidedly conservative, conventional ways and institutions, accommodate this new invasion by new colonialists? In some ways, too well. In some ways, everything changes.
Too well? As a recent article in Cuenca Highlife, a local English language newspaper reported about “urban renewal” in the Historic District; “. . .the cost will be born by working Cuencanos, many with incomes well below [that of] the ‘economic refugees’ who have relocated from North America. Plaza San Francisco [the site of one such development] is a microcosm of global inequalities, and draws attention to the inherited advantages of those of us born into social positions that have historically benefited from exploitation of non-European workers in former European colonies.”
The money is arriving, according to another recent article, from big investors who see the future of Cuenca as a comfortable enclave community for gringo retirees and escapees. The tramway now being built to relieve the central district of traffic and fumes from old buses, has so far put 200 local enterprises out of business. One doesn’t have to have been to Bangkok or Mexico City to see where Starbucks will be setting up shop. Some of us may only have $1300 in Social Security, but that is still an order of magnitude more than local working Cuencans, who are being driven out of the historic center by rising rents and gentrification.
The city was born of colonialism, as the author of the Highlife article points out:
[The] cultural wealth, however, has come at the expense of other cultures, which have been marginalized. The built architecture of Cuenca is the product of one of two activities: either manufacturing exports (quinine and panama hats) that exploited people in rural areas of Azuay; or from large haciendas, especially sugar cane producers in the temperate valleys of Paute and Yunguilla, which also exploited rural workers. Rural workers, or campesinos, in Ecuador worked in relations of dependence and without pay until the late 60s or early 70s, right around the time current American retirees may have bought their first house.
The local indigenous population does have an ongoing, albeit, uneasy presence in Cuenca. The markets, including Plaza San Francisco, cite of the currently debated gentrification. “Plaza San Francisco has long been the interface between the rural and urban worlds of southern Ecuador — a place where poor rural workers have come to supplement their incomes by selling to urban middle classes.” The indigenous vendors, and urban poor, as well as the working class, stand to lose with the ongoing development:
The potential to increase the value of San Francisco and surrounding areas is what has led the Bank of International Development — a division of the World Bank — and the Ecuadorian central government to provide funds for municipal intervention in the square.These interventions are intended to increase economic activity and boost growth, but as in all such projects, the benefits fall very unevenly. Plaza San Francisco provides a local example of how tourism and development projects affect actual people who are being ‘developed.’
I highly recommend reading the article in its entirety, because it is a succinct explanation of the new colonialism of development and gentrification that too many western immigrants to developing regions wittingly or unknowingly precipitate and participate in.
The fact is that though we want to think well of ourselves and the financial benefits we bring to places, it is important to be aware of our impact. I can’t resist one more insight from the article:
The displacement of the popular mercado also reinforces the racial hierarchy of the current global division of labour. North Americans in Cuenca do not support racial hierarchies, however, displacing the popular market will also lead to a phenotypical whitening of Plaza San Francisco as it becomes a transnational social space oriented towards the tastes and imaginaries of North American and European tourists and lifestyle migrants.
This, then, is my first and strongest objection to Cuenca as a place to live. Cuenca is a beautiful place built at the expense of indigenous peoples. The lovely religious and colonial architecture is a direct repudiation of the spirituality and aesthetics of these people. What is loved by the immigrants with fat wallets is the ongoing, never ending legacy of Pizarro. We may offer aid and assistance, and want to do the right thing. Volunteering to teach English is welcomed, and deeply ironic. In the end we are 21st century colonialists continuing a 500 year project pretty much unbroken, bringing what we think of as progress and enlightenment, some of us even bringing protestant proselytizing. All the time wanting to improve our own lives at the expense of the natives.
I meant this as a summing up, but it has turned out into a long attempt at explaining the role of migrants from the historic colonizing countries to former colonies, in an ongoing project of colonialism. This could actually could be a sufficient reason on its own to resist the charms of Cuenca. But, of course, I have more to say on the topic. In my next post.
After a couple of weeks with a bad cold, which coincided, not coincidentally, with two weeks of really lousy, cold, wet weather, I went out with my friends walking in Cuenca, under a random and resistant sun.I was reminded what a beautiful city it is, and what a sweet temptation.
I’ve now been in Ecuador almost 3 months, and in Cuenca for about 7 weeks. As Cuenca was a destination for me in terms of considering retirement, and I was fortunate enough to gain a couple of friends along the way who also wished to spend time here, I have had the time to check things out and get a feel for the city.
Cuenca is architecturally and geographically gorgeous. The historic district is a living museum. Each blocks yields to the next in order of magnitude. As it is hilly, and the surrounds are mountainous, there are views from every angle. Oh, and the sky! West Texas would blush in jealousy. Being at 2600 meters, with the coast on one side and the Amazon valley on the other, the sky is a constant collision of wet clouds and sunshine. Yes, the beauty of Cuenca cannot be denied.
Of course, beauty may be a necessary, but not sufficient condition for a place to stay. It is necessary for me. I don’t know if “beauty is truth,” but the truth is, I need beauty where I live, as well as perspective-enough elevation to have a sense of where I am. Having a bit of a perspective and an ever changing horizon matters to me. Even threatening black clouds dropping over the mountain vista has an ominous charm. So I will give Cuenca full marks for inspiration.
I did rouse myself for a turn at the public market on Wednesday, one of the two big market days of the week. My post-cold lethargy made it a slog to get there, but I found my pace when I arrived in the midst of traders and buyers, and stacks of fresh produce and glistening fish. Cuenca has great markets. I realized how good when I was in Riobamba a couple of weeks ago catching my cold and touring the markets (not coincidentally, I suspect) There on Saturday, market day, the markets begged for buyers, and many sellers’ stalls stood empty. The women selling hornado de chancho, a whole roast pig served with mote (c0rn) and llapingacho (potato patties), were a uniform wearing dispirited lot, having squabbles with each other while badgering passers by to eat at their pig.
By comparison, the marketers in Cuenca smile in their randoms marketing clothes and tease each other and the customers. If you don’t buy, there is nothing more than a smile and a nod, no pushing. The markets here are a joy, even if you aren’t buying. And a photographer’s dream.
And the markets provide all sorts of possibilities for good cooking. As Cuenca does not really have a culture of eating out in the evenings, and the main meal of the day is mid-day, it helps to cook for yourself or yourselves. The main meal of the day, almuerza, can be a real money saver for people on a budget, but it is generally fairly prosaic and not terrifically inspired.
There are many kind words for Cuencans; pleasant, gentle, kind, self-effacing and helpful. But full stop at “quiet.” This morning as I write, at 8 AM, the local park is trying out the loud speakers. We are a kilometer away and it is a concert in the front room. Car alarms are a constant. We have come to consider it Cuenca’s theme music. I’ll never hear a car alarm again and not think of the days in Cuenca when 10 a day would be a quiet day. At night the local bar empties and the loud voices carry on as if it were noon, not as if the rest of the neighborhood had been asleep for hours.
Cuenca’s people are probably a very good reason for moving here. I haven’t met a mean one yet, though I am sure they exist, and they seem to me to be tolerant beyond reasonableness with our outsider ways and our big footprint.
They are also family people before anything else. In most Latin cities the evenings are spent in paseo, strolling with family or friends in the town square, and hanging out at taverns and cafes that ring the square. It is a social time and my favorite time of the day for this reason. In Cuenca people go home in the evening and stay there. There is a rush home, a marienda, or small dinner, and then, of course, I don’t know. It is private. Cuencans are a private bunch, it seems. My Spanish teacher told me that the local big park (home to this morning’s 8 AM concert) used to be a place utilized mainly by drunks and drug users. These days the place bristles with activity and weekends are full of families. She told me this was due to outsider influence, and Cuencans were getting outside more.
But back to my cold and the weather. I know that colds, and swine flu, of which there are 3 confirmed cases in Cuenca at the moment, come from rhino-viruses and not a change in weather. Mine probably has more to do with being in closed spaces such as markets and buses than with the weather. But I have barely been able to keep warm for the last two weeks, which has certainly made me feel more miserable. The spring-like weather of Cuenca seems to be one of its main selling points. But I think we tend to envision spring as a season of sunshine and blossoms, and warm weather broken by a few cool breezes. Here what I have experienced is Seattle spring on a bad day. The mornings are cold and cloudy dismal gray. Any tiny crease in the cloud cover causing reflections of the the sun that is surely out there somewhere is a reason for optimism. The optimism is sometimes rewarded with a full blast of sunshine which is, alas, quickly erased by a cold wind bringing in darker clouds and a freshet of rain. This cycle can continue all day till late afternoon yields to a downpour. And, as the PR agents say, there is no heat in the homes, as it is always springtime. I have had a cold and been cold for two weeks.
When the weather good it is glorious. Sunny days broken by clouds that wander by as close as your neighbor, ending with sunsets beyond words.
Cuenca is full of museums and galleries, and musical events. You cannot want for entertainment of that sort. We spent yesterday afternoon in two different museums, one dedicated to hat making and the other to Latino handicrafts from different countries. Both were homed in marvelous buildings. There are more museums to be seen. Art and history, archeology and anthropology are all properly celebrated. Pumapungo Museum itself is worthy of a trip to Cuenca. The Alliance Francaise hosts many events, musical and otherwise. The immigrant community of westerners also sponsor activities and fundraisers.
Cuenca is a pretty extraordinary place. A walk this afternoon took us first to some beautiful stairs up to the historic center, to a bookstore where I could exchange a handful of books for a new one, almuerzo, the post office, a street corner eyeglass repairman/photocopier, coffee and desert in a decidedly gringo little cafe and back via another grand staircase.
I leave Cuenca tomorrow, and I really don’t envisage returning. Ecuador was a surprise for me, and a gift. But I won’t be settling here. I’ll write about this decision and why later in the week. If you have gotten this far, thanks for your patience with such a long and rambling post.