By Deborah Bickel, PA, MPH
I moved to San Miguel de Allende in 2014. I came here from Mozambique in southern Africa, where I worked for many years serving communities affected by HIV as an advocate, clinician, epidemiologist, program manager, policy wonk, and writer. I trained as a physician assistant at Stanford University and completed a graduate degree in public health at the University of California, Berkeley. Before leaving the states in 1993, I practiced medicine in a variety of busy inner-city clinics for nine years, while teaching medicine at Stanford. I am fluent in Spanish and have been involved with health in the United States, Mexico, Guatemala, and Africa for the past 30 years. I founded Be Well San Miguel Patient Advocacy Services (Bewellsanmiguel.com) in 2016. I do not diagnose or treat patients, but I can help you get the best locally available health care.
These are just some of the ways an advocate can help you:
- Review your medical history before your doctor visit to ensure your concerns are communicated clearly.
- Identify an appropriate care provider and assist you in making appointments.
- Accompany you to appointments with care providers and take notes for your files.
- Provide education and support for the management of chronic disease and wellness.
- In the event you need hospitalization or critical care, assist you in the admission process.
- Be with you at key times during hospitalization and recovery.
- Coordinate and assist with post hospitalization and home health care.
- Facilitate advance health directives and other end-of-life decisions.
- Translate, create, and organize your medical records.
Over the years, one of the single most important ways Be Well has assisted people is to help them make and implement plans for health emergencies. In my experience, some of the most common problems and mistakes people experience when they get sick in San Miguel are related to a failure to adequately imagine, let alone anticipate and plan for, a health crisis. The most common barriers to good care include:
1. Not knowing where to go in an emergency or being unable to locate their doctor when needed.
2. Being unable to speak enough Spanish with medical support staff even if the physician is English speaking.
3. Have no advanced health directives legal in Mexico in place before acute care is needed.
4. Have no plans in place with family in other countries in the event of a health emergency.
5. Know too little about local resources to evaluate who can provide the best medical care in areas such as cardiology, dermatology, obstetrics/midwifery, orthopedics, dental care, and cosmetic procedures.
6. Have no insurance for covering the costs of emergency care here and/or no plan for evacuation to a place they do have medical insurance.
7. Extreme isolation at times of hospitalization because of ineffective language skills.
Jacki Brummund wrote about my advocacy work on the Civil List saying, “I had the opportunity to see how Deborah Bickel works… and believe me, she is in a league of her own. I was so amazed and impressed with the way she handles herself. Her professionalism and her compassion are rare and, as said by others, ‘San Miguel is so lucky to have her.’ There is nobody in town who I would recommend more highly!”
I invite you to ask me any general question about getting health care here in Mexico. I will answer your questions in this column or privately by email or Skype. For more information, contact me at 415 115 7815 and/or at Deborah@bewellsanmiguel.com.
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