While idling in neutral

Nobody wants a house guest for six months.  Nobody wants to be a house guest for six months. Oh, what to do?

It’s a curious position. As faithful readers know, I’m on the wait list for low-income senior housing in Louisville. I’m thankful that I have a good friend who’s willing to put me up but the apartment is small and let’s face it, it’s a burden both ways. I feel like I’m perpetually stuck in idle and I’m sure she feels like she has no privacy.

For a good part of each day, I find my mind leaving the present and looking forward to my own place with my own rhythms. So I’m revving constantly – day dreaming about interiors, decorating, sewing drapes in my mind … but there’s no place to go until I get that call.

Ha.

This then is obviously a test in wrestling with Monkey Mind [though I know the objective is to simply observe without judgement.]

Artist unknown, but appreciated

Artist unknown, but greatly appreciated

Along with my monkey, I swing between the poles of quiet observation or attempting to quiet the monkey, resenting the monkey, laughing at the monkey, or sighing with resignation. Sometimes I can visualize my ego-monkey swinging through the neural trees as it rushes about spying shiny objects and grabbing at birds on the wing.

It’s tiring.

Then comes a night when the air is so still that it feels like life is momentarily suspended. Still as living in the country and hearing the Holy Baptist church choir two miles away. Autumn leaves are briefly held in amber while the street light illumines the tracery of veins. It is, of course, ineffable and even the monkey pauses in wonder. In these moments I go back to my life-long work – Baba Ram Dass’s “Be Here Now” -and allow myself to be overwhelmed by the magnificence of the human position.

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What I am not waiting for:

Since I applied to Medicare and qualified for “Extra Help” on my prescriptions I’ve had three cat scans performed – chest, abdomen & pelvis – as a preventative screening for the cancer beast I’ve danced with twice so far. Instead of being asked for my $250 deductible up front as I was in 2011, nothing was said and I’ve yet to receive a bill. I’ve also learned that I will not be subject to the drug Do-nut Hole.  Yes, more than I could have asked for.

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I’ve reached out via the internet to a Meet-up group in da’Ville around permaculture. There’s nothing shakin’ yet, but my next call will be to the Jefferson County Agricultural Extension Co-op.  I’m convinced that vertical vegetable gardens are an answer for renters in the city –

Vertical vegetable garden (1)

 

 

and I want to be part of a DIY movement that extends this vision in Lu’vulle. [It hasn’t escaped my thought processes that the 99 low-income senior apartment dwellers at Highland Court could use this too, but I think it’s too much to go into that setting with an agenda.] <giggle>

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Today’s celebration:

In August of 2012 Mia was rescued from certain death at the hands of Ecologia in San Miguel de Allende. She had three foster moms, including myself for a bit more than nine months.  Today she is in the arms of her forever mom in Calgary, Canada. I’m sporting a big grin as I write.

CIMG2152

Mia is now home for good.

Happy Dance!

The way, way back

No, not the recently released film but thoughts about leaving San Miguel.

On June 29 I returned to Hospital General with lab results. The lovely GP spoke directly to my bi-lingual friend Julie. In rapid-fire Spanish.

Arrrrrgh.

frustration

gun to head

So … I sort and pack for my return to the U.S., medicare, and a doctor I can understand.

And, in many ways, America calls to me.

looney bin

Yeppers.

From non-stop cable news coverage of the Zimmerman trial to mercenaries in the North Woods of Wisconsin

mercs in Wisconsin

Protecting GTact Mining against fishing, hiking, hunters, and …. potential “eco-terrorists”

to the NSA, GMO, tanking economy, governors imposing ultrasound probes, Europeans taking “Ghetto Tours” in the Bronx, TBTF, the bankers’ attack on credit unions, kabuki style political parties, and the fires and floods of climate change, from here it looks like I’m going back to

clowns

In comparison, San Miguel de Allende’s relative tranquility and unrivaled climate now just make me wish

I was rich

I was rich

It’s a hellofa place to vacation!

Blue-door-San-Miguel-de-Allende-Mexico-And what of this word back in the U.S.?

retirement out of focusThat’s right.  It’s out of focus.

 

 

 

 

 

 

 

Eva’s hair, The Contest, Mia

braids EvaI have two nieces in the States who are half-Guatemalan on their Dad’s side.  Eva, the eldest, inherited her father’s thick, glossy black hair. Wherever I go in San Miguel I’m surrounded by women and girls with Eva’s hair.  And, because so many Mexican women keep their hair long, I’m surrounded by some of the most fabulous braids on earth.

It can be fancy-dancy dress-up braiding for special occasions,

braiding3

but mostly it’s a unique braid that Mom wove in her daughter’s hair, or a creative twist a young woman has woven for her self.

braiding1

I’m endlessly fascinated by the iterations on the braid here, though I guess I shouldn’t be. Mexicans are justly famous for their weaving. What a delight.

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Which is useful when I’m riding buses back and forth to the health clinic in La Lejona, or up to Hospital General in Colonia Ignacio Ramirez. I  now study braiding and wonder how weird people would think I am if I start taking pictures?

Seguro Popular is “testing, testing, testing”  for my medical mystery, but it’s a bit of a process. For example last week the clinic referred to me an Internist at the hospital.  I saw her on Sunday, June 9 and she ordered a complete blood test.  I went back to the lab at the hospital today, stood in line behind 27 people (yes, I count them), to receive my appointment to come back to take the tests.  The tests will be done on June 26 and I’ll have to return to pick up the results.  Then I’ll see the Internist again on June 29.

I’m grateful for the tests of course, all of which are being done at no cost to me. It’s likely though that some American doctor is going to have to get her Espanol on to interpret them, because it looks like I’m heading back to U.S. towards the end of July.  One of my nieces is facing a serious operation.  I want to be in Seattle to hold her hand.

Which brings me to The Contest.

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I’m of many minds regarding returning to the U.S.

Bizarro

Like so many of my generation, I’m a prisoner to health care and Medicare lives the States.

If I’m not saying this clearly enough, I’m a boomer with no money.

Immediate hat tip to Gabrielle who calls this “Positive Poverty.” You see, we’re trying not to wage slave until the grave – god, that has a ring to it, doesn’t it? The deal is: return to the U.S. and get in line for the fraying safety net. (I’m laughing bitterly to myself as I type this – you just can’t hear it.)

Soooooo …. if you want to follow my meanderings, I’ll have to rename this blog.

enter_to_win

Just kidding.  You won’t win a gosh darn thing, but if you want to make suggestions – feel free!

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I’ve been tossing around:

Back to the Belly of the Beast

The Bag Lady Chronicles

[For interested peeps, Paula Deen just founded The Bag Lady Foundation.]

Thanks for All the Fish

 … I know. Copyright problems.

The Ice Flow Papers

    and

Jax in Looneyville

… though that won’t work because it’s a town in West Virginia.

Oh.  So you think I should be more upbeat, do you?

That’s why YOU’RE invited for submissions.

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Sadly I’ll have to give up fostering Mia, ‘the Manchurian Princess’ or ‘The Dog Who Smiles When You Return.’

If you’re reading in San Miguel, please give a thought to fostering this girl.  I can tell you ALL about her!

I be smilin' right now cuz I a happy girl!

I be smilin’ right now cuz I a happy girl!

Have your people call my people, k?

San Miguel de Allende: I am right where I didn’t want to be

This is going to be about medical treatment in San Miguel de Allende. We’ve had these discussions before, but this isn’t going to be hypothetical.  I hope reading about a health experience on-the-ground in a foreign country will be useful to expats contemplating the move. If you’re interested, read on, but be aware – we are all adults and I’m going to discuss an intimate subject.

IV dripBecause I can’t afford an ex-pat health plan, I’m a member of Mexico’s national health insurance system, Seguro Popular. This afternoon I went to the Clinica de Salud in La Lejona and after consultation with a different, younger doctor than I’d seen a few months ago received a 45-minute I.V. drip antibiotic for a worrisomely recurring Urinary Tract Infection.

I will return to the clinic to have the same drip of Ceftriaxona, an old school antibiotic similar to penicillin, for the next four days.

The clinic is also setting up an appointment for me to see a Urologist at Hospital General next week.  I’m to schedule an ultrasound at Hospital General and all of this, including the visit to the specialist, will be free. PLUS: the doctor, nurses, phlebotomist, pharmacy technician and social worker I saw today were all genuinely decent, likeable people who took their time [I’m sure we non-Spanish speaking people take a WHOLE lot more time than average] and treated me most kindly.

So far, so good, eh?

But there’s a catch.

confused-smiley-face-7816

My Spanish is poor to middlin’.  With Seguro Popular you’re likely to see a different doctor each visit. There’s a small chance that your doctor will speak poor to middlin’ English, if that. Mostly your consultation will take place in Spanish.  There will be no one capable of explaining the substance that is about to go into your body, and you will rely on the Internet at home to try to understand what you’re ingesting. If you have a medical mystery like I have and you’re referred to a specialist it will only get more interesting from there.

This predicament is way beyond my comfort zone.  First, I have no continuity of care as we call it in the States, and second, I’m not sure I understand what anyone is ‘really’ saying.

So, unless you’re relatively fluent in Spanish, or have big bucks to see an English-speaking general practitioner who will guide you through your specialists, you should think long and hard about moving to a Spanish speaking country and relying on the public health system.

Let me reiterate.

broken ankle 2A broken bone is a relatively straight forward fix for most of us.  In this sense alone Mexico deserves considerable props for providing a national health service at no to low cost with a floor, broken bones for example, that no one can drop through.

High Fives for Mexico!

But when things get a little more complicated – and you don’t understand the language – you’re in a whole different ball game.

Take my little medical mystery for example. I’m not a doctor and I don’t play one on t.v., but I suspect that I’m developing antibiotic resistance. A particular strain of E coli is resistant and increasingly showing up in female urinary tract infections. It’s all over the U.S. news.

If you or someone you know is being diagnosed with Cystitis, or recurring and virulent urinary tract infections, this link is for you:

http://www.shea-online.org/View/ArticleId/198/Antibiotic-Resistant-Strain-of-E-coli-Increasing-among-Older-Adults-and-Residents-of-Nursing-Homes.aspx

Well, here’s some good news.

In Mexico there’s a lab test called an “antibiograma.”  As far as I can make out, it’s a dish culture that’s targeted by a bunch of antibiotics. The antibiotics that don’t kill cells are the antibiotics that you’re resistant to.  Hopefully one [or two] antibiotics do kill cells, and they are the ones that will work for you.  My handsome young Mexican doctor, eager to track down the culprit causing me all this trouble ordered the test. Brilliant!

But there’s a catch.

Seguro Popular and Hospital General don’t do the test. That means a private lab, and that means

roulette-wheel

There are a lot of people in San Miguel who swear by one private lab or another.  Because I keep getting these damn infections I’ve been to the one with the highest consensus several times.  None of my visits have been confidence-builders.

Don’t be squeamish and take my advice.  Carry medicated wipes with you.

Moving on.

I’m actually lucky.  My friends Rog and Clint are heading to a lab in a Queretaro hospital tomorrow and I’m going with them.  They’ve been here ten plus years and they know which labs to trust – though they don’t think any of them are in San Miguel.  (If you’re in San Miguel and you want to argue about this, the comments section is open.)  I trust them.

So, it’s likely I’ll get an accurate test and finally learn what’s going to work for me – and perhaps more importantly, what’s not. I now have hope that I won’t be perpetually prescribed an antibiotic stew which we all know is not good for the human body.

And what happens after that?  Ah.  The Specialist.

specialistI don’t know about you but at 66 years old I’ve seen a few specialists. Even in my native language it’s always felt a little like

rabbit hole

going down the rabbit hole.

It is the rare doctor who can break out of “medicalese”. In the states I could see more than one to figure out if we can work together.  In Mexico, I don’t have a shot.

So, yep, I’m right where I hoped I wouldn’t get to in Mexico. I don’t want to follow Mexican specialists down the rabbit hole in Spanish.  In fact it makes me want to build up a stash of Valium.

This is all on me, of course. You will know better.  You’re either coming down with fluent Spanish or cold hard cash to hire a translator or pay for the best and the brightest who speak English but work at private hospitals. Or, you’re younger, healthier, braver, or more optimistic than I am.

But just in case, hopefully, a word to the wise.

 

 

 

 

 

 

 

 

 

 

As the jacaranda bloom, we reach new heights of hyperbole

God knows the Jacaranda is a beautiful color, somewhere between lavender and periwinkle blue. Shaken by the breeze, literally hundreds of blossoms fall to the ground each hour laying a carpet of dazzle over my patio stones, the plastic chairs, the table and the rest of the plants. And with the individual blossoms, which look a little like short, stubby-stemmed champagne flutes, comes a carpet of BEES.

bees in jacaranda

[It’s interesting that the bees never approach the flower from its wide fluted mouth.  It is always from the stem.  I suppose they’ve been living together for a very long time.]  So, if I want to sit on the patio I must sweep out a wide space around my chair, sending the flute flowers and a passel of angry bees away from my feet.  I like the look of Jacarandas, but so far they have dropped something on the patio – seeds, pods, blossoms – all day every day for the last six months. Were I a landscaper, I would plant them at the far end of a garden.

During my recovery from oral surgery we’ve been treated to another breathless article on the charms of San Miguel.  I kid you not, this is the title from Treats Magazine: San Miguel de Allende, The Most Interesting Town in the World. (Link comes later.)

Our author, Kelly Lee, is a “Beverly Hills-based lifestyle, travel, and fashion writer” and, without a hint of irony regarding the hyperbole of her title, gives us the San Miguel of “hidden courtyards”, “storybook lanes”, sensuous sunsets, and “languid ambling.” Ha!  I’d like to see her amble languidly on the uneven cobblestone sidewalks in Centro.

But, this is the San Miguel of the rich.  In this world it is all roof top gardens, tinkling wine glasses, and watching, during the “early-morning silence the light morph from an ombré gradation of inky indigo, turquoise, and periwinkle to amethyst, amber, and blush.”

San Miguel at dawnOh, Kelly!

O.k., fair enough, we all get to see the light in San Miguel.  But, let’s get real.

San Luis Rey 1Outside of Centro – the coveted, cossetted historic district where one bedroom apartments go for $750 USD and up and honestly, are not all that -and excepting a few manicured and gated developments, most people in San Miguel live on a street that looks like this. And most people in San Miguel are struggling to make housing costs and food prices that look a lot more like New Jersey than anywhere else in Mexico.  Repeat after me: San Miguel de Allende is the most expensive town in Mexico.

For example.  A gallon of milk in San Miguel costs 45 pesos.  At today’s exchange rate, that’s USD $3.78.  A loaf of (the most average) bread is $2.14.

Inside the city limits, one would be hard pressed to find a one bedroom apartment under $500 US.  If you did, you will freeze in the winter and bake in the summer because Mexican builders don’t go for insulation.  And if you did, you will probably be in a dicey neighborhood – which is basically all the rest of San Miguel except said cossetted historic Centro and the “developments.”

This blog has always been for the frugal expat – or, the poor Boomer – if you want to call us that. We live in an ordinary town where we can’t afford art lessons that are priced at Marin County levels from gringo artists who more often than not are visiting for the winter cull I guess, or get our chi straightened out while someone does our nails for $2.00 an hour. Combined with our out-of-pocket costs for prescriptions and health-care, outrageous rents for an emerging nation, and fairly average U.S. prices for food, we do NOT live in a bargain paradise.  Though of course the rich never have to think in those terms.

We are obviously not the people who make San Miguel “the most interesting town in the world.” So who the hell are they?

Beats me.  I’ve done the gallery route.  There are some wonderful artists, but most of it is derivative, like any other “arts” town.  You will not find anything that is politically provocative or  even ‘cutting-edge’ in terms of a new way of seeing.  There is a lot of music that comes to San Miguel, most of it very good, but the big acts go to Mexico City. In fact, there’s a huge amount of entertainment that the average Mexican can’t afford to attend.

And there’s a goddamn Christmas drive for the kids who live at the dump.

It is very true that Mexicans and Gringos work together in San Miguel to tackle its myriad of problems constituted by abuse at every level – from the “Disneyfication” of downtown at the expense of the neighborhoods,  to sub par housing for the majority of its citizens, to inadequate nutrition, roaming street dogs, and the ever-present La Grippa which seems to drift on an air composed of dust, feces, and poor waste treatment.  Perhaps the city does its best, though it is rife with rumor regarding disappearing public funds. Nonetheless, unless one is wearing incredibly rose-colored glasses, San Miguel de Allende has enormous public health problems that simply do not make it “the most interesting town in the world” UNLESS YOU’RE LIVING IN A BUBBLE.

Then again, there are those skies …

San Miguel sky

Oh.  Here’s your link from that parallel Universe.

http://treatsmagazine.com/articles/san-miguel-de-allende/

Did I say these articles make me grumpy?

 

 

Healthcare for American expats in San Miguel de Allende

Can you live in San Miguel de Allende on $1200 USD a month?  Yes, if you’re 40 and frugal.  Probably not if your in your mid-60’s with chronic conditions that require specialists, or those ever-so-expensive “watch and wait” tests.

$1200 USD per month was the income requirement when I moved to San Miguel last June.  Let’s say you have that, but like me, precious little savings behind you.  [Mexico just changed its income requirement to $1900 a month.  After you read this, you’ll understand why that is a more realistic figure.]

Seguro PopularTo its credit, Mexico has a form of universal healthcare and expat residents can join. English speakers don’t really know what it covers since the booklet is published in Spanish and we’re not learning Spanish that fast, but the best that I can make out is that it’s geared towards infant & maternal health along with chronic conditions like diabetes and asthma.  As well it should be.

So what do most older American expats living here do when Seguro Popular isn’t enough?

premier bus MexicoFor anything complicated they either self-pay specialists, most of whom are in Celaya or Queretaro (not in San Miguel de Allende), or they bus or fly to the U.S. so they can use their Medicare.

But, those costs aren’t really in your $1200 a month budget, are they?

budget busterIt’s not to say that inexpensive healthcare isn’t readily available in San Miguel de Allende.  It is, for simple things like a bout of bronchitis, a round of [gasp!] amoebas, or a urinary tract infection. If what you need is antibiotics, you can see a doctor for less than $2.50 US.  You self-pay your prescription – probably around $25.00 US – and you’re on your way.  A specialist in any of the routine scenarios might cost you $30.00.  Waaay less expensive than seeing a doctor for routine care in the U.S.

And you’re good for an accident in Mexico too.  That’s where Seguro Popular comes in. Break your ankle and you’ll be treated. There will be some cost, but your budget will heal.

accident budget busterSo, what’s not to like?  You can self-pay for routine care, and you’re fairly well set for an accident.

healthcare spending by age

I don’t care whose chart you look at, unless you won genetic roulette, your healthcare costs are only going up and your ‘conditions’ are only going to get more complicated. While the trend in the U.S. is definitely to extort more and more money from everybody, your Medicare still pays 80%. But if you don’t have the means to return to the U.S. and use it, what good is it?

In Mexico, your self-pay portion is going to go up.  This nation doesn’t yet have the resources to provide quality care for its own citizens, much less a Grey Wave from NOB.  You want quality? It’s here, but you’re going to have to pay for it.

And that is why Mexico’s new immigration requirements of $1900 USD a month is a realistic figure.  With that amount of money you can afford to buy an expat insurance policy that will have you seeing world-class specialists in Mexico City.

[I’ve been advised that an excellent policy can be had in San Miguel de Allende for $325.00 a month, with a one-time deductible of $2,500.00 – not a yearly deductible like in the States.  No cancellation if you become horribly ill. This policy is beyond my reach, but might suit some readers.]

Factor in your travel costs and you’ve have $1500.00 to live on.  In San Miguel de Allende, it will be a frugal lifestyle, but that’s simply because San Miguel is the most expensive place to live in Mexico.]

I have no doubt that Americans with financial means have Zero interest in this blog.  What I’m trying to do is give readers who don’t have those resources a heads up while they ponder ‘the simple life’ south of the border.  While it is true that the 20% that Medicare doesn’t pay can (and for many of us probably will) drive us to bankruptcy, it’s also true that for many serious conditions you won’t be treated in Mexico unless you can first pay out of your own pocket.

“First” is the key word here. There’s no billing in Mexico.

“Old age is no place for sissies.”, attributed to Bette Davis.

“I don’t write ’em, I just report ’em.” jaxinmexico

Reality … as tough as ever

For those of you who followed me down to San Miguel de Allende it probably won’t come as a big surprise to learn that the honeymoon is over.  True to Jon Kabat-Zinn, the one book I always have with me,

and despite a lot of wishful thinking, I did not leave my troubles behind.  Ha ha ha.  Big surprise, eh?  But, here it comes:

Setting aside the loneliness of the aging ex-pat in a foreign country, the biggest trouble that keeps me up at night in San Miguel is health care and money.

Granted that while in the U.S. these are thoughts that focus the mind, ultimately we know that the worst probable outcome ‘back home’ is that we’ll be driven into bankruptcy. [This is happening so frequently in the U.S. that the moral tarnish is gone. Now, a reasonable financial plan for the sick and elderly is to set aside money for the bankruptcy attorney every 10 years and get on with it.]

To Mexico’s credit, there is a floor here through which no one will sink. Ex-pats with residency qualify for “Seguro Popular”, the national health care plan, at a ridiculously low fee – if not free.  Seguro Popular is, and should be treated as, catastrophic coverage: if you break your leg in the middle of the street you will have your femur set. (Obtaining adequate pain relief is another matter.)

But, you’ve heard the expression “Medicine is more of an art than a science.”  If you are in Mexico with any kind of a ‘medical mystery’ requiring diagnostics, tests and specialists, you are going to face the self-pay equation.  In most cases, a good doctor is going to cost much less than the U.S., but some of us are going to hit the self-pay wall sooner than later.  While I’m not sure whether you’d be put in jail for failure to pay, I do know there is no reset button for your debt.

There’s another *huge* part to this.  If you think it’s difficult to understand your medical results in the U.S., imagine getting them in a foreign language.  Imagine being in a crisis situation and trying to communicate with the attending surgeon. Imagine trying to tell your nurse that you need more pain medication.  Imagine ….

Oh, don’t bother.  I’m imagining all of this for you …

And so, after the huge effort of making the transition, finding a place to live, exploring my new surroundings, and learning where I can buy salted butter, it’s s~l~o~w~l~y dawning on me that at my age I may not have enough time, or brain-power, left to sock ‘fluent in Spanish’ under my accomplishment belt.  Without the resources to hire a translator, I so do NOT want to find myself in a health crisis here.

Ouch.

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When I started this journey I wanted to know if it would be possible to retire [in a stimulating environment] south of the border on an average social security. After five and a half months, I still don’t know whether that’s a realistic figure in San Miguel de Allende.  I’m told that some people manage on much less.  For me, there’s been just enough of a financial surprise each month to push me past my budget, but not by much and, perhaps, not irrevocably.  In fact, it may indeed be possible to live la vida bonita here on that sum – as long as you are healthy.

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You should know that all of this will become a moot point at some time in the future because of the new Mexican income requirements. But more of that later.

For now, if it’s any help to older Americans thinking about the move, think long and hard about giving up the crap health-care that Medicare currently provides.  And, fight like hell against the “Grand Bargain” about to brokered in Washington, or you too may find yourself having … restless nights.