That seems like a very different argument from, “the population of seriously ill people is too low to have providers maintain their skills”. In fact, it suggests that there is a demand and it would be costly to meet the demand of seriously ill people.

The WHO, abandoned by MAGA America, comments the following…

Health systems in action 2024: Mexico

Mexico’s health system has comparatively few hospital beds, physicians and nurses and there are substantial geographical disparities between urban and rural areas.

Access barriers include long waiting times, financial barriers, geographical imbalances and shortages of health care professionals, particularly for marginalized populations.

There are ongoing efforts to address these challenges, such as programmes to incentivize health care professionals to work in underserved areas and expand primary care services in rural areas.

Mexico’s life expectancy at birth was 75.2 years in 2021, lower than the OECD average (80.4 years). The primary causes of death are noncommunicable diseases (NCDs), mainly ischaemic heart disease, diabetes, stroke and renal disease.

Premature mortality rates in Mexico are much higher than in other Latin American countries, the USA and Canada, with kidney disease rates up to 12 times higher.[/i]

It seems that with sufficient local efforts by La Union, Zihuatanejo, and Petatlan there would be opportunities for success.

Such hospital need not try to serve the widest range of medical issues, but could concentrate on those that are responsible for the greatest disabilities and premature deaths.

Those of us over 65 enrolled in Bienestar receive free bimonthly health checkups in our homes by an extremely qualified nurse who maintains a history of our health and makes recommendations based on our diagnosis. As Bienestar's health program continues developing and growing, we will have access to some free medications, many that are better quality than what are usually prescribed. We will have access to free medical services and procedures at any hospital we go to. No, we don't yet have the level of medical care as the people in Denmark, but that and more is the eventual goal. In a generation or so we should be one of the healthiest countries in the world. Proud to be a Mexican!

The WHO, abandoned by MAGA America, comments the following…

Health systems in action 2024: Mexico

Mexico’s health system has comparatively few hospital beds, physicians and nurses and there are substantial geographical disparities between urban and rural areas.

Access barriers include long waiting times, financial barriers, geographical imbalances and shortages of health care professionals, particularly for marginalized populations.

There are ongoing efforts to address these challenges, such as programmes to incentivize health care professionals to work in underserved areas and expand primary care services in rural areas.

Mexico’s life expectancy at birth was 75.2 years in 2021, lower than the OECD average (80.4 years). The primary causes of death are noncommunicable diseases (NCDs), mainly ischaemic heart disease, diabetes, stroke and renal disease.

Premature mortality rates in Mexico are much higher than in other Latin American countries, the USA and Canada, with kidney disease rates up to 12 times higher.[/i]

It seems that with sufficient local efforts by La Union, Zihuatanejo, and Petatlan there would be opportunities for success.

Such hospital need not try to serve the widest range of medical issues, but could concentrate on those that are responsible for the greatest disabilities and premature deaths.

Even if there are cardiologists there, without a functioning cardiac cath lab available 24/7/365, they can’t do much.

Do you happen to know the cost of such a facility? Must it function within a full-service hospital or could it be a standalone clinic or medical office?

Thank you very much for your expertise, Doctor.

I live on Vancouver island in Canada.

Example #1.

The Regional District of Nanaimo (RDN) has a population of approximately 170,367 (2021 Census).

Located in Nanaimo, Nanaimo Regional General Hospital is the central acute-care hub for the mid-island region. It operates as a regional referral center, meaning it supports smaller community health centers from Bowser and Parksville down to Ladysmith. It features a full emergency department, intensive care unit (ICU), inpatient surgical suites, psychiatric care, and comprehensive maternity/pediatric wards.

NRGH hosts a specialized, state-of-the-art Medical Device Reprocessing Department and has seen recent expansions, including a new permanent intensive care unit to support the rapidly growing regional population.

Example #2

The Comox Valley Regional District has a population of 72,445, but when combined with the adjacent Strathcona Regional District (roughly 48,000) and the northern Alberni-Clayoquot corridors, this entire upper-island healthcare catchment serves a combined baseline population approaching 140,000 to 160,000 residents.

The North Island Hospital (Comox) opened in 2017 as a modern, purpose-built acute care facility designed to consolidate regional care. It operates in tandem with its sister campus in Campbell River to cover the northern geography. The hospital provides 24/7 emergency services, acute inpatient care, general surgery, obstetrics, diagnostic imaging (including CT and MRI), and specialized outpatient clinics.

Designed to modern environmental and medical standards, it features a high percentage of single-patient rooms to enhance infection control and patient privacy, serving as the primary anchor for the northern half of the island.

Example #3

The Cowichan Valley Regional District (CVRD) has an official census population of 89,013.

The Cowichan District Hospital serves as the primary acute-care center for the diverse communities spanning from Malahat up to Ladysmith, and west to Lake Cowichan. It features a 24-hour emergency department, general surgery, intensive care, inpatient psychiatry, and a dedicated maternity care unit.

The existing facility is currently being replaced by an entirely new, state-of-the-art Cowichan District Hospital on Gibbins Road. The new facility is designed to be significantly larger, incorporating enhanced trauma spaces, expanded inpatient capacity, and modernized infrastructure to better support the valley’s population demands.

I’m not convinced that the population of 179,000 in the three municipios is so remarkably superior to the health of Canadians that the need for services is so dramatically lower that for these Mexicans “the population of seriously ill people is too low to have providers maintain their skills”.

It might be that the population of seriously ill people is sitting at home, disabled and waiting to die.

And then there is the adverse effect on the region due to gringos who say they are considering no longer spending their time (and money) in the area because of insufficient health care being available. (Cough, cough.)

But there has to be sufficient patient volume to pay staff and to maintain skills. Even if the government pays everyone’s salaries and buys the latest equipment would you want to be operated on be a physician who did his last operation of your type 6 months ago? There simply would not e enough patients for specialists to maintain their skills.

Locals just want a hospital to go to where there are decent waiting room facilities, medicine, supplies, sufficient and competent nurses and doctors, a courteous staff, where the paperwork for the past 3 decades isn't sitting in boxes in the hallways, where the roof paneling isn't falling, where the bathrooms have toilet seats, where the ill are attended to when they arrive. The barebones basics that any public hospital for a regional population of over 150,000 should have.

Explain how you would staff it with competent professionals when the population of seriously ill people is too,low to have providers maintain their skills, let alone generate enough revenue.

So, how big a city is necessary to support a full-service hospital and staff? Are there opportunities in Zihuatanejo for specialists to open offices or clinics that could take Mexican insurance as well as serve out-of-pocket tourists and ex-pats? For example, how much would it cost to open an office to serve severe heart issues?

Clearly not every hospital in Mexico will perform heart transplants any more than every hospital in the US or Canada will perform heart transplants. But it seems that the opportunity to access necessary medical services in the Zihuatanejo area is much more limited than in comparably sized communities in the US or Canada.

I recently had lunch with a gringo ex-Pat who had surgery in Zihuatanejo for a hernia. He asked the surgeon whether he had done many of these surgeries. The physician responded, “Have you seen how hard the labourers here work? I have done hundreds of these in recent years.” But the person had to go to a private hospital to get the surgery.

Maybe as a Canadian I am “spoiled” by a public health care system based on the five principles of the Canadian Health Act”

Public Administration: Plans must be administered on a non-profit basis by a public authority.

Comprehensiveness: All medically necessary services from hospitals and physicians must be insured.

Universality: All insured residents are entitled to coverage on uniform terms.

Portability: Coverage must remain in place for residents moving or traveling within Canada.

Accessibility: Reasonable, barrier-free access to insured services must be provided, ensuring no financial penalties like user fees.

But I don’t think that is being spoiled.

While I totally agree with the sentiments expressed. Just BUILDING a new hospital does nothing. It needs to be staffed and staffing it with personnel with advanced capabilities is not likely to happen any time soon. Zihuatanejo is simply too small to have enough patients to support most specialty care.

Hospital staffing, operations and equipping are responsibilities of the state and federal governments. The most the city can actually do would be to donate the land and the building. Although our mayor made a big production of going to Mexico City once to request a new hospital for us, it was apparently way too little effort and seriousness. So Lázaro Cárdenas got a new modern hospital instead. If we need modern medical care, we have to drive 2 hours to get it.

The cement everywhere is horrible. I don't know anyone thrilled about Zihuatanejo becoming a paved Disneyland. Why isn't the focus on a new hospital. Sure miss the good ol' days.

I couldn't agree with you more. Apparently for very selfish reasons and with much arrogance our municipal government ignores the sector of our tourism that encompasses foreigners with high purchasing power. All this so-called modernization is apparently only geared for appearance's sake and to fool local voters, not to attract actual visitors. So we keep seeing land get sold and condo projects get built, but our general prosperity continues in decline as more people with less money to spend replace our more affluent visitors who for so many years have been so generous in helping to support so many local businesses and causes but who, like you, feel Zihuatanejo is not changing for the better. Many of us locally suspect at least some of the real estate boom is allegedly associated with money laundering, and of course politicians who own cement companies would stand to benefit from selling more of their product, so why slow it down even if we're running out of water and destroying the area's natural beauty? Not for decades have we had any local politicians who understood Zihuatanejo's niche in the tourist market and marketed it correctly, a place NOT like Acapulco, Vallarta, Cancún or Los Cabos. But now it looks like we're imitating those other places. Decades ago I predicted that imitating other tourist destinations would be to our detriment, since we'll never be them, only what we are. And now we're no longer playing our strong hand by being what we are, a place NOT like those others. So most local merchants no longer enjoy sales of thousands of pesos a day as we used to. We're lucky to make enough to make ends meet. Hopefully we'll see the change we need in local leadership with next year's elections. Locals half-joke that we need to elect a mayor who owns a tree nursery instead of a cement company.

Rob graciously offers his online living room here for us to chat about things that interest us.

Some of that discussion is spirited, but polite people never insult their host, even by innuendo.

I wonder whether Rob will be more tolerant than I would be in my living room.

There is a very wise saying from Steven Covey in the book The Seven Habits of Highly Effective People:

"Seek first to understand, then to be understood."

I don't believe I will ever understand people like Max.

Sí, hay muchas historias relacionadas con la historia del puerto; una de ellas trata sobre una angustiada sirena dorada, proveniente de una familia establecida y de profundas raíces, que intentó vivir de su nombre.

Vamos Pumas!

That was a totally unacceptable and rude comment. Adiós, "Max".