#545 – The Expat Files: Medical Treatments, Language Confusions, and Credit Card Culture in Latin America

Automatically transcribed from the original recording; names and wording may contain errors.

[00:00] South of the border, down Mexico way That's where I fell in love when the stars above came up to play and now I wonder Hello there all you expat wannabes I'm Johnny Mueller and you're listening to the expat files living in Latin America the show that tells you just what it's like to live Work play and or retire down here in Latin America It's a mix of the good the bad the ugly and the great and it's all right here. So let's get started Here's a story. I've been wanting to tell you for a long time You do like stories about living in Latin America pertaining to gringos. Don't you I thought so Let's talk about first world medical treatment here in Latin America. I know a lot about that I know I must have mentioned this fact on a past show about

[00:48] 26 or 7 years ago now when I first came down here to Latin America I was suffering from a few common first world ailments one being I had arthritis in my left knee Diagnosed carpal tunnel in my right hand and they wanted to operate up in the States You know even back then I was a victim of the computer keyboard age Not to mention way back when when I first came down I had high blood pressure I hear three out of four adult Americans suffer from that right now. Anyway, about maybe a month ago I was helping out my maintenance man with some plumbing chores. Sometimes, you know, that's a two-man job I like to get involved a little bit and keep my eye on these guys too because you know details details That's what us gringos are all about and your average Latin maintenance guy called by the way an Abenil down here

[01:34] That's Abenil begins with an a there what you might call a jack-of-all-trades up in the States Oh, they'll get the job done. All right, the electrical and plumbing will function But some of these guys can't draw a straight line and they don't have a level or a plumb Bob So a simple job can sometimes look like the Three Stooges have done it. Anyway Pipe wrench slipped and I bashed and cut my right thumb I was wearing gloves, of course, but it didn't matter next day. It swelled up pretty good and man was it tender I never was so conscious in my life that your thumb Well, you use it for everything next day still tender and it swelled up even more I phoned up a personal friend of mine a medical professional and I said, what do I do? Who do I go to and that you know really is the value of coming down to Latin America and knowing people and having a network Which some people say is the best part of my Latin insider seminars not to put a plug in for the seminar

[02:24] But just to say you need to have some real trusted professionals and how else you're gonna meet him, right? Anyway, he sent me off to a female dermatologist in the big city back She's an internal medicine specialist and expert in skin conditions received her undergraduate degree in a private Latin University Specialty degree in the US and Spain. So anyway, she's located in a nice upscale strip mall This is way off the gringo tourist trail, by the way And when I walked in there there was nothing but women sitting in the waiting room and I know they had to be upscale women Why because there was a little sign at the reception desk that said Monday is Botox day Now not that Tuesday Wednesday Thursday and Friday aren't Botox days too, but it just so happens on Monday Botox is six dollars a unit for whatever that means and the rest of the week. It's seven dollars a unit

[03:15] Now I understand in the States it runs anywhere from 15 to 20 dollars a unit when it's administered by a specialist like a Dermatologist or a plastic surgeon. However, I understand if you go to one of those Botox parties Where a beautician or a veterinary assistance handing out the Botox, I guess it can be around 10 to 15 bucks a unit That's the rumor on the grapevine down here Anyway, by the way, do they still have Botox parties up in the States or is that as old as disco? It's all the rage down here right now lag time again, huh? So again, I'm the only gringo in the waiting room. In fact, I'm the only male in the waiting room It's about seven or eight other women waiting to get pummeled by those needles. By the way, I asked the doctor later on What's the average amount of Botox people get in her office? She said some people need the minimum around 30 units and some people 50

[04:04] Which means at minimum 30 separate hits with a needle all within a tiny space of time Don't think I could handle that But as expat Eddie's runway model fiance once told me when she was trying to fit into some so let Ohio He'll she said beauty and pain are two sides of the same coin So anyway, I filled out the patient history form and all that and guess what? Immediately my gringo advantage kicked in she took me ahead of everybody oh and by the way when I asked her about that Botox discount day, she said the reason why she does that on Mondays is because Apparently a bottle of Botox contains a hundred units and a lot of the patients come in They only need 30 or 50 and after you open the bottle if there's any unused portion It only lasts about one day before it's ineffective So often in the past when she had just one Botox patient

[04:52] She'd have to throw the rest of the units in the bottle away because she didn't use the whole thing So thus cut rate Botox Mondays makes sense, huh? So anyway, she ushered me in and I sat down in her very nice first world office Examination room and of course seeing that I was a gringo She informed me of the last two or three times she'd been up to the states my jammy Orlando Nueva Jersey Nueva Jork, etc. Oh and by the way for Latin's whose English is not nearly a hundred percent They always say Nueva Jork instead of New York or Nueva Jersey for New Jersey because Nueva is new So let me joke. That's why you'll hear Latin's down here saying over and over again Chicago Nueva Jork in my jammy and oddly enough I met a lot of Latins who are totally confused with New Mexico versus Mexico

[05:42] Nueva Mexico versus Mexico, especially young adult Latinos and adolescents They think they're the same thing or that one is part of the other some think that New Mexico is in Mexico I guess maybe they are see Senor, but the confusion doesn't end there There's Panama City, Florida, and then there's Panama City Panama. Don't get me started. That's right even Latin's with nearly a hundred percent English fluency just can't seem to smooth out that accent and it works in reverse too we Can't seem to kill our gringo accents either In fact, the only Latins I ever meet down here that a perfect English without an accent our kids who have a gringo parent and or kids who have continuously attended one of those private expensive helicopter schools where 20 to 30 percent of the faculty are

[06:28] Native English speakers like you and me that said instantly as I walked into the doctor's examining room She immediately broke into English and it was pretty good But not perfect though her accent was fairly muted because she picked up one of her university degrees in the States now You got to know after I've been down here a quarter century or more I almost always speak Spanish that's become sort of my default language Because I'm way off the gringo tourist trail nearly all the time and unless I'm speaking directly to an identifiable gringo I speak Spanish with of course my terrible Chicago accent I guess and even then sometimes when I'm speaking English, I'll shove in a few Spanish words because well getting old I guess so anyway for the first three or four minutes We're speaking in English and then she pops out of the room comes back and I start speaking in Spanish to her and she

[07:16] Stops me and says no. No, please English. Okay, so we speak in English then she pops out of the room again comes back in I start in Spanish again because I you know speaking Spanish all the time here Who knows maybe just a touch of Alzheimer's kicking in then she said again. No, please English By the way, it's nice to compliment Latins on their English when they try to speak it to you Even if it sucks because I'll tell you what when you're speaking Spanish no matter how bad it sucks Latins will compliment you on it and they'll genuinely mean it even if they don't understand a stinking word of it Oh, and by the way, when you do compliment a Latin on their English speaking abilities They'll almost always downplay it even if it is really excellent. They'll say oh, I know you're just being kind and polite

[08:03] But thanks anyway, but as for us gringos and expats when Latins compliment us on our bad Spanish We're a lot more proud and happy that we can actually get our point across. We don't say oh, thanks anyway I know you're just saying that to be kind Even though that's exactly what they're doing. Nope We suck it up like they really mean it even if they didn't understand a frickin thing we said So anyway, I kept on falling back into Spanish and she kept on saying no, no English, please So she finally explained to me sort of exasperated that she never gets a chance to practice her English And in fact, she fears she's losing her touch When by the way all professional schools in Latin America now require their students to take English professional schools meeting engineering the sciences

[08:49] Medicine jurisprudence all masters and doctorate programs, too Now you might ask why is that since 95% of Latin America is off the gringle tourist trail and people just don't speak English Well, that's because all the literature the latest breaking developments in science and all the best internet info and search engines and stuff Are in English and things are changing so fast, especially in science and medicine That everything cutting-edge comes out in English first not to mention a lot of universities and graduate schools now have webinars And they're almost always in English and although the printed literature eventually gets translated into Spanish It often takes years and if there's no demand never Plus like one biology grad student told me the cost of books in English is one-third the price of the same ones

[09:35] Translated into Spanish. That's a great incentive to learn English. So anyway, I'm in the doctor's office showing her my swollen painful thumb She looked at it probed a while and said oh we're gonna have to lance this and I said doc Is it gonna hurt and she said think pleasant thoughts just think pleasant thoughts and I said go ahead do it So she proceeded to inject it with an anesthetic and that was a real treat. She lanced it Out came some pus. She gave me another injection and a biotic She said wrote a prescription and proceeded to spend the next half hour. Just shooting the breeze with me in English Meanwhile, there's a gaggle of cut-rate Botox ladies sitting in the waiting room massaging their wrinkles now that my friends is the gringo advantage But there's more. So what do you think that sent me back? How about a grand total of 45 bucks?

[10:26] 25 for the office call and 20 for the Lansing and antibiotics and all that now after that I checked cost for similar medical procedures on the web and I came Up with a number between four and seven hundred bucks. That would be if you were in a first-world specialist office and had that done Meanwhile, she pretty much told me her life story So then somewhere along the way the subject of her family and her husband came up You see I just shut my mouth and let her rip in English I know what it's like to have a pent-up desire like that first couple years I was off the gringo tourist trail and my Spanish really sucked when I'd meet a gringo I'd blast on him in English, too Of course, that was way before Skype and Magic Jack even caller ID now gringos and expats Tell me they talk more to their family and friends up north than they ever did when they were living up there

[11:16] Like one gringo told me when he lived back up in Biloxi when certain family and friends would call he'd have to stop everything and actually go over there and handle some kind of situation Some people are perpetual complainers and time vampires, you know. Yep. There's one in every family I think in my family There's four which is why being a couple of thousand miles away can actually make some of those previously miserable connections even tolerable Anyway, turns out the doctor's husband's a real estate developer. So that's why her waiting room was filled with all those glossy real estate magazines Anyway, she began to mention a high-rise residential project that her husband was working on upscale Of course, and she took the opportunity to give me his card telling me what a great ground floor opportunity It was then I opened my big mouth and said but I recommend no one buy any real estate down here

[12:07] Unless it's from a distressed seller because it's a huge real estate bubble Well, that's when the conversation stopped for a few moments Her eyes glazed over and we slipped into a less volatile subject though out of politeness I did ask her how much the unit started at and she said Oh around $200,000 then she smiled and said but you only need a thousand dollars in ganche That would be a thousand dollars down on a two hundred thousand dollar unit Rest will be bank financed or through the developer then I snuck in a curveball I said by the way doc how many of your patients pay with credit cards and how many pay with cash? And then she said oh almost all of them with a credit card. I said, oh, well, I always pay in cash You will take cash won't you and she laughed and said of course then I said just out of curiosity

[12:56] How often does it happen when someone's trying to pay with a credit card and the car doesn't go through from whatever reason? Because it's maxed out. Whatever. She said, oh, I don't know but it happens a lot That's why people have multiple credit cards And then I said that thousand dollar down payment for a unit in that complex Can you finance that on your credit card? And she said sure some people do why would you like to do that? I don't have a credit card And she said really and gave me a kind of nebulous look that said oh boy another crazy gringo I mean, come on who in the world doesn't have a credit card yours truly not one in my name. Anyway How do I get around how do I rent cars hotel rooms and even get airplane tickets? Well, I'm not at liberty to discuss that stuff on the air

[13:43] So you'll have to come down to one of my expat insiders seminars and find out for yourself So really the object is to get the hell out of the US that is actuate that plan B Which is vote with your feet That's when you get your one and only second chance to have a very small footprint and a very low profile That said you can learn all about that stuff at my July expat insider seminar Oh and speaking of credit cards just last Sunday I had a dinner with a good friend who came to one of my expat insider seminars a couple of years back He's a very smart gringo with Brazilian connections and a Brazilian wife and as we were having dinner He said you know what Johnny I noticed here in Central America as opposed to South America specifically Brazil down there He says banks and credit card companies and retail stores hotel chains

[14:32] You name it are doing a hard press on the locals to sign up for various credit cards In fact, he said right now the population of Brazil is credit card crazy. The more the merrier boy Don't we know that drill? It's a country where everyone's in debt. However, he said he doesn't see the same thing in Central America He doesn't see the big push for people that get credit cards and my answer to him was this lag time my friend But not all lag times are equal. There's lag time between what happens in the states and Mexico That's a short lag time because there's an open border Then there's a lag time between what happens in Mexico and Central America that could be a pretty long delay Then there's lag time that happens between Central America and South America a still longer delay So again, not all lag times are created equal that said I can confirm that around two to three years ago in

[15:22] Central America now every bank credit card company and big retail store and In every mall credit card reps were bugging the hell out of everyone who walked by I remember Latin guys and gals with clipboards practically chasing me down the aisles to get me to sign up In fact, it got to the point where I'd say to the more persistent ones. You want to know why I sleep really well at night I don't have credit cards. Of course, they gave me that crazy gringo look again But you know, that's what life is like down here So you could say in the last three years or so pretty much everyone who's credit worthy in Central America has been tapped out with Just an avalanche of credit card offers companies just aren't aggressively pushing it like before in fact the credit manager at one of the big Banks here in Central America told me that right now there's too much competition and they're at the point of diminishing returns

[16:12] In fact customers are so tapped out some credit card companies are taking losses because people just can't pay and now Surprise surprise Latin Congresses are passing interest rate limit caps for credit cards talk about lag time They must have passed those laws back in the states some 40 years ago now By the way that Latin credit manager also told me this He said if you follow the way credit and credit cards kind of developed in the United States It started with a few big retail stores like Sears and Montgomery wards and then Visa and MasterCard and American Express And it was a slow evolving process getting people on board Slowly developing credit bureaus and credit scores over something like 30 years the same thing happened with cell phones in the state Say started with those big brick ones that almost no one could afford

[16:58] They were a luxury item then little by little prices came down phones got smaller and they weren't just toys for the upper classes anymore And that took some time to something like 20 years enough time for people to easily adapt Whereas down here in Latin America all that time was compressed into a space of around three years Same with credit cards so down here with a very compressed learning curve the markets instantly got saturated And now people are feeling the pain by the way as an aside this credit card bank manager told me that he's had Problems in his own family with credit cards, and he's cut both his daughter and his wife's credit cards up into little pieces Hmm sound familiar oh and one more thing about that lag time effect. They still haven't got so-called credit Consolidators here in Latin America. It's not at all like up in the states where you see them advertised on midnight TV

[17:48] You know one-stop shop to organize and rebuild your crappy credit Well those kind of services have not arrived yet, but they will it's all I'm not our lag time Which is why by the way so many of us expats and gringos appear to be Clairvoyant because we can predict that kind of stuff sometimes months even years before it ever lands down here That's all part of your gringo advantage. You know, but where were we oh yeah at the dermatologist office anyway before she lanced my thumb Oh Naturally she checked my patient history the form I filled out in Spanish of course because here way off the gringo tourist trail Nearly everything's in Spanish, and if it wasn't English you know you're on the gringo tourist trail and probably facing gringo prices or nearly So you'll see that kind of bilingual stuff all over Mexico and Costa Rica by the way, okay?

[18:36] Now I'm gonna tell you something that you may or may not want to believe, but it's a hundred percent true She was looking at my patient history form she looked at me and said this can't be right and I said what she said Your age she said it's a mistake right or you're fibbing and I said nope, but she said come on Let me see your driver's license. Yes. She actually said that now since I'm a low-profile guy I'll almost never pull my ID out for anyone so then I said would this help look at my hands And she examined my hands mostly the back of my hands and said yes I guess you're right the hands never lie even a neck we can nip and tuck But the hands no then she winked and said did you have any plastic surgery? And I gave my canned expat Eddie answer and said well no more than the next guy

[19:24] Then she asked me to go into some detail on my diet physical activities and such Then I told her nearly all the fruits and vegetables I've been eating for the past 20 years or so come from the big open produce and vegetable markets And the clincher was when I told her I don't eat bread pasta or dairy products And I don't put sugar on anything in fact I told her you know how long a pound of sugar lasts in my house Probably around a year and you know what the statistics are for eating sugar up in the states the average US citizen eats over 100 pounds a year in fact It's only my cleaning lady and maintenance guy who used the sugar around my place Or I should say they have a cup of sugar and put a little coffee in it now I told her I wasn't militant about that lifestyle And I don't bring it up unless quizzed about it and when at a restaurant or a birthday party or something

[20:10] I will have the occasional piece of cake or a little pasta When at an Italian restaurant and that would be maybe once or twice a month I told her I don't have any junk food on hand either Which works fine for me because as Oscar Wilde said the only thing I can't resist is temptation What about exercise she said well I told her I generally do about one hour a day on a treadmill in about Five to ten minutes of weightlifting then about 50 to 75 push-ups not the girly ones either So that's my routine about six days a week and even when I'm traveling I try to do parts of that Then the doc said what about your genetics? What about the rest of your family? I said well I have a brother about a hundred pounds overweight another about 50 pounds overweight a sister

[20:55] That's about 40 pounds overweight and my mother and my 30 year old nephew are injectable diabetics Then I mentioned that I don't have arthritis in my left knee anymore. I don't have carpal tunnel I don't have high blood pressure. I take no prescription medicine Though I've always gotten the occasional migraine since I've been 12 years old. I can't seem to be able to lick that So then why do I look 20 years younger a lot of reason? But I think it's about that amazingly fresh non-gmo diet and the fact that you have much lower stress living down here in Latin America together with the fact that I eat no pasta bread rice or dairy products though I might have one or two coca-colas at the beach. What else you're gonna have it's mighty hot, right? But remember down here in Latin America There is no high fructose corn syrup to actually use real cane sugar

[21:43] And I really blew her mind when I told her that I hadn't had a fast food hamburger hot dog or anything like that In over 25 years ever since I'd been to the Oscar Mayer Wiener factory in Chicago Then she said hey, I belong to a natural nutrition and anti-aging group We meet every couple of weeks at a restaurant then I said which one McDonald's or Burger King. She didn't laugh She didn't get it Then she said would you mind maybe coming to one of our meetings to tell everyone your story your diet your history and such She said you do look 20 years younger than your real age and you're at the perfect weight for your height, too Then she shook her head and said we have a tremendous diabetes and obesity problem here in Latin America now She said the poor the middle class and the rich are equally affected

[22:30] So why do you think I'm bringing this up to brag to claim? I have good genes or something Well, I don't my dad died at 54 of a heart attack. That was my wake-up call That's what caused me to straighten up and fly right when it came to my own lifestyle So if you got any kind of chronic health problems at all coming down to Latin America Well, that will be a big part of the solution. There's no high fructose corn syrup local farmers bringing their stuff right to market quickly There's three even four growing seasons So you've got a selection of vegetables and produce to die for and the stuff that's expensive up in the states because it's imported From down here is dirt cheap. In fact, once the last time you paid 15 cents for an avocado or 25 cents for a pineapple Or a honeydew melon and if you're red meat eaters, you'll find it's all grass-fed and as for chickens Well, they have factory chicken farms of a sort

[23:18] But you can buy driveway chickens everywhere and as for seafood, of course They have stagnant piss pool fish like tilapia and shrimp, but you know better to keep away from that stuff Oh, I almost forgot before we get up the subject of the dermatologist. I gotta tell you this She had one of those expensive multi-purpose laser machines on wheels You know the ones with the wand that are advertised supposedly to do non-invasive liposuction and such And I asked the doc about that machine I said seems to me amongst all the wealthy ladies down here in Latin America Laser this and that is all the rage down here including your machine Now I know in theory what it's supposed to do heat the fat layers below the skin disrupt the fat cells They're supposed to die and liquefy and over time your body's lymphatic system absorbs and gets rid of them

[24:06] And she said that's right. Then I said but doc come on. Does it really work? She said for that purpose in a word no So then I said it's all a kind of a scam then all this non-invasive lipo And she said pretty much but the studies in the sales literature and other docs will tell you it does And then some will tell you it doesn't like me. She said with her patients She doesn't see a significant change. So there you have it an honest doctor and I found her in Latin America Telling me she paid 20 grand for a machine and it really doesn't work So then I said is it just an expensive door stopper now she said no It's great for superficial facial wrinkles By the way wrinkles in Spanish are called arugas and crows feet in Spanish are called patas de gallina Chicken feet guess that one got lost in translation, huh?

[24:55] So anyway, she said as for that machine's main selling point non-surgical lipo forget about it But certainly she said in the next three or four years they'll have it down The newer machines will work as advertised and she'll dish out another 20 grand But when that happens, she'll be a much more discriminating buyer So there you have it a report on my third world trip to a first world dermatologist So then what were the negatives to visiting that office? Well for one thing the waiting room had all white naga hide furniture Guess she was trying to be first world trendy at least it wasn't fabric but come on white There's no worse color. It shows everything So it was scuffed cracked and worn and was well past its prime There were two electric wall plate switches with the plates missing

[25:40] So the wires were kind of hanging out not good And as far as the usual drop ceiling in the waiting room There was a panel missing just an open dark space with cobwebs in it So again, it's details details Now that's not to say a lot of doctors offices up in the first world aren't pretty much the same But the last time I visited one of those was maybe 30 years ago And believe me some of those old docs back in Chicago had equipment That looked like it came from Dr. Frankenstein's medical supply house Hopefully things are much better up there now but I wouldn't know So anyway, I'll give this doc an A plus for effort and knowledge An A for cleanliness and sterile technique An A for having modern equipment A C for lighting that kind of sucked A C minus for the waiting room and patient comfort there

[26:26] A D for waiting room layout and design And a C plus for the restroom It had the requisite paper towels that was clean enough And even had an electronic soap dispenser And a spray bottle of glade And they call it glade en español Glade man that stuff can't be good for you So far so good except for the huge crack in the mirror Oh well details details Okay we're near the end now Be sure to go to www the new expat.com For master expat blogger John Galt and I'm on that site too Also subscribe to my youtube channel Check out the photos that go along with the show And if you're interested in getting in on the early bird discount For my upcoming July 2016 expat insider seminar

[27:12] Do send me an email and you'll be the first to get the info This time it'll be July 9th through the 15th So mark that on your calendar Now if your plan B is to hunker down in your basement With your dried beans and ammo Good luck with that But if your plan B is to vote with your feet And live the good life Then you really need this seminar You've been listening to the expat files Living in Latin America Coming to you twice a week from somewhere south of the border Email me The expat files at gmail.com And if you want me to help you sort out your own Latin American plans Schedule a one-on-one consult with me Just send an email and let me know at the expat files at gmail.com Nos vemos