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For cheaper medical care, try Tijuana

By Remy Scalza
Special to The Washington Post
Sunday, March 6, 2011; F01

Adrian doesn't look like a pharmacist. He's not wearing a white lab coat and hasn't shaved in a few days. He pats the breast pocket of his shirt to show me the best spot to stash pills when crossing back over the border.

"They won't check here, and if they do, just tell them you have a medical condition," he explains.

Out in front of his little shop, under his neon pharmacy sign, a busty mannequin done up in a skimpy nurse's uniform and holding a heart-shaped sign for Viagra beckons more customers off the street. No prescription? No problem.

Tijuana, Mexico, just across the border from San Diego, has long been a favored destination for Americans in the market for cheap and illicit meds, among other things. The city was a seedy refuge for Hollywood pleasure-seekers during Prohibition, and then came decades as a playground for hard-partying co-eds and service personnel too young to imbibe north of the border.

But times are changing. Discount pharmacies such as Adrian's are slowly disappearing as Tijuana turns its attention to American medical tourists looking for more than painkillers and sex pills. Savvy comparison shoppers, they stream in from California and beyond for deep discounts on everything from cosmetic and weight-loss surgeries to hip replacements and stem-cell transplants. Some are uninsured in the United States. Others are hoping to save on the high cost of elective procedures back home.

And then there's me, just here to do a little browsing. I'm not in the market for an operation, but I'm curious about the people who are. In a city where you can't drink the water, can it be safe to go under the knife?

I duck out of Adrian's onto Tijuana's main drag, Avenida Revolucion, a riot of garish neon signs extending south from the border. Until a few years ago, this strip would be reliably packed on weekends with American girls and guys gone wild. But a triple whammy of swine flu, recession and drug violence has hurt business, and thatch-roofed dance clubs and strip bars sit shuttered with "Se Renta" signs out front. Though the security situation here has improved dramatically - and daylight shootouts are thankfully a thing of the past - the continued State Department warning against travel to Mexico has kept many visitors away.

Deprived of these tourists and their easy dollars, Tijuana has turned inward. The city's cultural life, as well as its emerging medical tourism sector, has migrated from the seamy border zone farther south to Zona Rio, a newer district along the banks of the river that gives the city its name.

A little nip and tuck

Traffic is heavy in late afternoon along Paseo de los Heroes, the stately boulevard that bisects Zona Rio. I leave the main road and turn down leafy side streets filled with the newer stores and restaurants where upwardly mobile Tijuanenses spend their money. There's an imposing mall with a modern multiplex, a cluster of expensive hotels and, next to a Domino's Pizza, the building I'm looking for: the gleaming glass-and-concrete tower that houses Medica Norte.

A modest-sized clinic specializing in plastic and cosmetic surgery - tummy tucks, nose jobs, you name it - Medica Norte gets 80 percent of its patients from the United States. It even offers a pickup and drop-off service in San Diego and can help you get a deal at the swanky Camino Real hotel a few blocks over ($85 a night for patients).

Marco Rodas, a soft-spoken plastic surgeon, is one of several doctors who work out of the clinic. "I want to show you this because my patients are my best publicity," he says, apologizing for his English, which is actually quite good. He brings out a small photo album filled with dozens of before and after shots collected over his 25-year career: noses slimmed, bellies flattened, breasts enlarged or reduced. He leafs through, pointing and commenting like a proud father.

I ask what draws so many American patients to Tijuana. "The most important thing is the price," he says. "You're going to pay 50 or 60 percent of what you pay in the U.S." A full facelift - neck, face and eyelids - goes for $4,800 at the clinic, a bargain that even the shadiest of strip-mall surgeons in the U.S. would be hard-pressed to match.

But what about safety?

"The quality of plastic surgery is very high here," Rodas says. He pulls out a certificate embossed with the seal of the Mexican government - his federal license to practice plastic and reconstructive surgery. "Here in Mexico, we need to study medicine first. That's six to seven years. Then we need to do general surgery as a specialty. Then we need to do plastic surgery. That's 12 to 14 years in all."

But Rodas is quick to rattle off a few caveats: Watch out for cosmetic surgeons, who, unlike certified plastic surgeons, are often just ordinary doctors who dabble in breast implants and facelifts. "Maybe they do a six-month course in Cuba," he says, waving his hand dismissively. Shady clinics - think glorified dentists' offices - have a nasty reputation for attempting ambitious operations, everything from joint transplants to gastric bypasses. "The problem is that many patients from the U.S. just want to save money," says Rodas. "They don't do their homework."

This afternoon, several procedures are scheduled at Medica Norte. Rodas invites me to watch one. I slip a pair of hospital-issue booties over my shoes and shuffle down the hall into the diminutive two-room OR. A surgeon and nurses in scrubs and masks sit huddled over a woman from San Diego who's midway through a facelift. Light rock is playing softly on a radio. The team works steadily, slicing, stitching and chatting while the patient slumbers away.

Major surgery for less

Back outside, the late-day sun has cut through the blanket of smog and haze that often hangs over Tijuana. Neat rows of housing developments climb the dry mountains that rim the town, a mosaic of concrete walls and adobe roofs receding into the distance. I pass groups of school kids in crisp blue and white uniforms lined up outside the huge cultural center, a modern building that looks like a space-age pyramid and hosts concerts, lectures and conferences.

Inside, a kind of citywide pep rally is in progress, a month of exhibits and speakers extolling Tijuana's virtues - a growing manufacturing sector, world-class wines, booming medical tourism - and emphasizing how far the city has come. In 2007 and 2008, rival drug factions armed with automatic weapons and rocket-propelled grenades turned Tijuana into an urban battle zone. The situation grew so dire that wealthier residents, worried about kidnappings and getting caught in the crossfire, packed up and headed for California.

But since then Tijuana has done an abrupt about-face. A hard-nosed new chief of police quelled violence and pulled corrupt cops off the street. New restaurants and nightclubs have blossomed as the city has awakened from years of shell shock. Back out on the streets, a sense of optimism is evident in the new galleries showcasing local artists, the cultural cafes where musicians and dancers perform and the crush of shoppers in Zona Rio. While other parts of Mexico struggle to reign in drug violence, Tijuana is in the midst of a mini-renaissance. Setbacks and lingering challenges mean that the State Department still counsels caution for visitors, but the city appears to have turned a corner.

The outside world, however, has been slow to take notice. "You say you're going to Tijuana and people act like you're going to Beirut or Kabul," says Ray Goodrich, a 60-year-old real estate developer from Texas who has accompanied his wife, Melissa, to Tijuana for her weight-loss surgery. "So we didn't tell anyone we were coming here for the operation. Our kids think we're in San Diego on the beach."

Ray and Melissa are in a private room at Hospital Angeles, a new 122-bed, $60 million private facility that caters to medical tourists from the United States, nearly 1,500 of whom were treated here last year. Melissa has just had her surgery, a new procedure known as gastric plication, which is not covered by their insurance and would have cost nearly $20,000 back home. Hospital Angeles does it for $7,500, an all-inclusive deal that covers hospital and surgeon fees, the hospital stay, even round-trip transportation to and from the airport. Plus, their surgeon happens to be the guy who pioneered the technique. "If you want the best doctor for this kind of thing, you have to come to Mexico," says Melissa.

I take a look around her hospital room. Warm sunlight is slanting through the Venetian blinds. There's a flat-screen TV, hardwood floors, a private bathroom, even a little pullout bed for Ray to snooze on. Downstairs, the hospital lobby is done up in Italian marble. Friendly nurses smile in the halls and signs point to CT scans, MRIs and a laser eye surgery center. I try to remember a hospital quite this nice that I've been in and can't.

As I leave Tijuana, traffic is backed up along the border. Eight lanes of cars inch northward for two straight hours and then stop. Street vendors converge on idling motorists, selling homemade furniture, statues of the Virgin Mary and lots of food - deep-fried and cheese-slathered gorditas, tacos, empanadas and burritos cooked curbside and brought right to your car. Drivers bound for San Diego roll down their windows, order and commence chowing down.

Beside the highway stands a big billboard. "There's an option for you," it reads over a picture of a stomach surgically girdled with a lap band. The price: just $4,600.

Scalza is a freelance journalist and photographer who blogs at RemyScalza.com.

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