Bathroom Remodeling Idea Makes Bathroom Repairs Easier

June 18, 2017

Bathroom repair is easier with access panels

Soon after I had remodeled my small bathroom it developed a water leak. The first thing I knew about it was a puddle on the floor of the room below. A water pipe was leaking and it was buried in one of the bathroom walls which not only made it difficult to find out where the leak was but a lot of ceramic tiles had to be destroyed to get at it.

When I asked my bathroom contractors why they didn’t make it easier to get at the new pipe work they said that it would have made my quotation too expensive so they just buried the pipes and hoped that they don’t give any trouble. It was just my luck then that my bathroom was the one where they made lousy joints. The bathroom repair turned out to be far more costly than it would have been to make all the pipes accessible in the first place and I wish now that I’d had the foresight to put that in the specifications.

Where to put access panels

The obvious solution to the bathroom repair problem is to provide access panels for all of the pipe work joints and as much of the pipe length as possible. When you specify what you want in your bathroom remodel make sure that you will be able to get at every joint easily.

Where the water pipes are installed in a separating wall it’s often convenient to provide access on the other side of the wall rather than inside the bathroom where the ceramic tiles are. You may even be able to turn the access into a small cupboard, which would give you an added benefit. Opening the cupboard doors would provide simple access to the water pipes.

Pipe work under bathtub and under floor can be made accessible by removable panels. Make sure that the floor covering allows for this and a suitable sealer is used to fill any gaps when the access is closed.

If the access panel has to go on the bathroom side of the wall then special attention to waterproofing will be required.

How to make access panels in ceramic tiles

To accommodate a radiator in my bathroom remodel the contractors built a false wall to hide the pipe work. This wall was then set with ceramic tiles and the radiator mounted in front of the tiles. This pipe work has not leaked but I do wonder what I would do if it ever did.

Tiling a small part of the false wall separately on a removable section could have provided an access panel. This would then be screwed firmly to the main part of the wall and the edges sealed with a silicon-sealing compound. The screws would pass through the tiles so silicon sealer would be used to seal the screw heads and holes in the tiles. When the need arose the sealer could be stripped away and the panel unscrewed. Resealing when the problem was fixed would be just as easy.

For more bathroom remodeling tips take a look at this article on setting bathroom tiles:
Setting Ceramic Tile Made Easy

Best 2012 Halloween Costumes for Boys

July 26, 2017

If you are looking for the best 2012 Halloween costumes for boys, we have some ideas for you to get started. Depending on the age of the child, you are going to most likely want to get some input from them on what they want to be – unless they’re a baby, of course. In all seriousness, involving the child in the process of picking a suitable Halloween costume can go a long way in making sure they have a lot of fun on the big night, which is what it’s all about – not to mention the candy.

  • Spiderman Costumes – The Amazing Spiderman was big this year, and as in years past, you can expect many boys to want to become the wisecracking Spidey. The good news is that there are quite a few great – and relatively cheap – Spiderman costumes available.
  • Batman Costumes – Another Superhero that’s huge again this year is Batman. As with Spiderman, the popularity of this costume means there are going to be a lot of different options for you as a parent. From simple plastic outfits to complex costumes with a separate Batman mask and accessories, there’s something for every budget.
  • Historical Costumes – Not every boy is going to want to use a historical figure for a Halloween costume, but this can be great in many different ways. For one, not a lot of other kids are going to have the same costume most likely if you go with a George Washington, Ben Franklin or some other historic figure – Caesar anyone?
  • Homemade Costumes – If you are on a budget or just like to be creative and spend quality creative time with your children, homemade costumes for Halloween can be a great idea. You just want to make sure you involve the boy in every step of the process so he is happy with the outcome and will want to wear it on Halloween night!
  • Soldier Costumes – This is one that is relatively easy to put together cheaply. A little camo and some other accessories – no guns! – and you can have a great looking solider whether it’s a sailor or someone in the airforce or marines. Camo face paint really puts the final touches on this great costume idea.
  • Fireman Costume – Being a civil servant or first responder like a fireman on Halloween is a lot of fun and may be an indication of a future career path for your little one. There are a lot of great accessories you can get to make your costume really stand out from all the others. Don’t forget the cute fireman’s hat and boots!

After you choose which costume you want, it’s all about saving money. Next, we have some tips to make sure you get the most for your money when buying a boy’s Halloween costume this year.

  • Shop Early – One of the best things you can do is shop early. If you were thinking smart last year, you bought your costumes a day after Halloween when they went on sale. Even if you didn’t do this, the earlier you start shopping – even during the final summer months – the more you are going to be able to look around and find the absolute best price.
  • Shop Online – Speaking of finding the best price, another great idea is to make sure you do most of your shopping online. While there’s nothing more fun than taking a kid (or five) to a Halloween costume shop (sarcasm!), there’s something to be said about shopping for a costume online. It’s easy, safe and convenient – and you can save money too.
  • Read Reviews – Finally, you are going to want to make sure you read reviews of the various costumes before you get out your credit card and make any purchases. There are quite a few places you can read reviews these days, but you should find a website you trust and stick with them and their recommendations for the best Halloween costumes for boys in 2012.

Halloween is all about having fun and being able to dress up and score a lot of candy. Picking out the costume should not be stressful or a headache! The sooner you start shopping for a Halloween costume, the sooner you’re going to be able to relax and just enjoy the holidays.

Property Guide To Alicante

July 25, 2017

In the south-east corner of Spain between Valencia and Murcia, is Alicante province. Dubbed the ‘California of Europe’ by some, this part of the Spanish coastline became known as the Costa Blanca or ‘White Coast’ because of its 200kms of pristine sandy beaches and crystal clear waters.

Prior to the tourist boom, Alicante was comprised mainly of fishing villages, wine and citrus farms. However all that changed when the first air routes to the Valencia region opened up in 1957. Today, Alicante is a tourist mecca with first-rate infrastructure and leisure facilities, receiving around five million tourist visitors annually, making it an excellent place to invest in holiday letting properties.

Already fairly populous with nearly two million permanent inhabitants, Alicante has over the years become home to a thriving community of foreign retirees and lifestyle immigrants, many of them British or German, attracted by the healthy Mediterranean climate, unspoilt beauty of the lush, rocky coastline and Uncategorized salt marshes, as well as the fresh local seafood. Today, English is probably the second-most commonly-spoken language in Alicante after the native Valenciano.

Traditionally divided into a more affluent north and less well-heeled south, since the Spanish property boom, such demographics have become meaningless. All along the Costa Blanca, you’ll find luxury beach resorts, spacious villas and modern housing developments, as well as marinas filled with yachts.

The province has not lost all of its original charm though – there are still quaint Mediterranean villages with charming cobbled streets, ancient churches and historical architecture to be found; and the old quarters of many towns such as Altea and Javea continue to act as major drawcards for their historical value and café culture by day, and their restaurants and bars by night.

The capital, Alicante, is a genteel city with an international airport – the main point of access for the province – as well as many historical buildings, tree-lined boulevards, parks, palm-fringed beach and eye-catching harbour with marina.

Other places worth mentioning are Benidorm – the tourist capital of the Costa Blanca with first class entertainment facilities and pleasant micro-climate; Torrevieja -with its great golf courses and bird sanctuary in the Uncategorized salt marshes nearby; and Javea – a lush enclave of exclusive cliffside villas.

Property prices in Alicante are generally 3% higher than the Spanish national average, but buyers can still get good value for money if they do their research. Currently real estate sales in Alicante tend to centre around major tourist centres where holiday rental yields are still healthy, although bargains can still be found in the less-crowded outskirts.

Second home buyers and retirees tend to prefer quieter, less crowded or developed areas such as Benitachell, Denia and Javea. However, this less commercial aspect has begun to take on a certain cache, so that property here is not as cheap as one might expect.

Still, though, for health, lifestyle and quality of life, the Costa Blanca is hard to beat and property in Alicante is well worth considering.

Nursing Entrepreneurship Creates New Opportunities For Nurses

June 19, 2017

While too many people in most industries are still struggling to find jobs, nursing continues to be one the most in-demand positions. This demand for nurses brings more than job security, it brings opportunities for nursing entrepreneurship to those nurses who are looking for more than just a job.

Taking the Leap to Self Employment

The first question potential nurse entrepreneurs need to answer is whether freelancing or business ownership really suits them. Most everyone can agree on the advantages: being one’s own boss, more flexibility with one’s schedule, able to focus on the work one enjoys most, and best of all, unlimited economic potential.

There are, however, serious challenges as well. People mistakenly believe that the greatest obstacle in starting a business is having the money to get started. This is false. There are a number of business opportunities that require very little start up capital. If some money is needed, entrepreneurs have a number of ways of accessing it.

Instead, the most common roadblock to entrepreneurship is in the mind. A freelancer or entrepreneur has to have the internal fortitude to put themselves into the marketplace and have the confidence to pursue their vision. Everyone’s confidence waivers from time to time, the larger issue is whether such mental blocks can be overcome.

Freelance or Open a Small Business

Deciding whether to freelance, that is work as an independent contractor, or open a small business that will grow to have additional employees, isn’t a decision that has to be made immediately. In fact, since the value nurses have to sell is expertise, it’s very easy to begin as a freelancer. As demand grows and the nurse entrepreneur becomes more comfortable with the business side of the work, then a freelancer can transition into a small business if one wants.

In either case, there are legal issues surrounding working as a freelancer and starting a business. A number of organizations that specialize in helping new entrepreneurs or nurse entrepreneurs specifically can offer some guidance on the potential legal issues that can arise. They will also likely be able to connect new entrepreneurs with lawyers who can help.

What Types of Nursing Businesses Exist

The best businesses are those that find a need in the marketplace that isn’t being met. Any nurse who’s worked through the system can list the situations where nurses, medical staff, patients, or anyone part of the health system has gotten frustrated by an issue. Exploring potential solutions for those types of situations can lead one to a good business idea.

However, it isn’t necessary to reinvent the wheel. There are a number of well-established nursing entrepreneurship ideas that others have already made successful. Just as the need for nurses grows as health becomes a larger national issue, so will the need for the types of nurse entrepreneur businesses that already exist. One should never think because the business already exists, the marketplace is full.

Experienced nurses can use their backgrounds to pursue any of these entrepreneur ideas:

- temporary staffing services

- home care service

- care case managers

- medical bill review

- personal coach in wellness, nutrition, or patient advocacy

- operational consultant for facilities

- trainer either for other medical professionals or to general public as part of a wellness clinic or program

- medical equipment or clothing supplier

Copyright (c) 2012 Nurse Entrepreneur Network

What to Expect From a Bespoke Internet Marketing Service

July 12, 2017

What would you expect from a company that promises a bespoke, tailor made, Internet Marketing Service for your business? You’d expect something that had a slightly individual feel to it I think! Bespoke or package; the elements are very broadly similar. As a business you will know your market reasonably well following your market research. This should be followed up by very focussed keyword research. Once levels of competition and user intent are understood, it is possible to look at your existing website and identify it’s strengths and weaknesses in terms of ranking for identified and desirable keywords. With a new website you have the opportunity to map its design around the keywords that really give you a chance to compete, right from day one. In the modern era of internet marketing it is also necessary for almost all serious online companies to get engaged with social media to raise their profile. In detail the recommended process is set out below.

Initial Data Gathering and Keyword Research

A solid starting point needs to be established so that the success of each part of a tailored SEO project can be judged and strategies adjusted, to ensure that a client website attains and then remains on the first page of any Search Engine’s Results Page. The recommended steps would be.

Part 1 Establishing Your website’s Current Optimisation Status

a)Google Analytics (or your own solution) review:

It is essential to understand how much web traffic has already been arriving at your business website, the sources of that traffic and the actions that visitors have taken on landing. Google Analytics or your own analytics solution will give a clear picture of where you currently stand and areas that need to be developed.

b)Keyword Research:

Frequently neglected… and even more often misunderstood. This aspect, of all Internet marketing strategies, is critical when companies move their resources online. Keywords represent the questions asked by your customers and prospects; so your online presence must play to what people are searching for: i.e. your landing page must provide the best answer to their questions. Establishing the keywords that are used to search for your services and products, plus the ability to gauge the competitiveness of each; allows the next step of the process to be much more targeted than with our standard packages.

c) Website SEO Review:

Your SEO company will carry out a thorough review of your existing on-page and off-page optimisation. In plain English, the on page factors include such things as: ensuring all your header tags use the appropriate keywords; ensuring page titles reflect content and keywords: ascertaining the degree to which the content of each page is relevant to your business activities and that it is relevant to those keywords. Part of the that review will assess your webpages for accessibility via mobile devices and tablets.

Off page factors to be reviewed include: the number and quality of the backlinks that point to your domain and the individual pages of your website. They will also assess the quality and optimisation of Google places listings and map listings in other search engines, as well as determining your company’s visibility in business and other relevant directory listings around the web.

This will be presented as either a text report or frequently these days, a screen video report, if you prefer.

Part 2 Improving Your Rankings and Getting Top Google Placements.

Using the information gleaned in the previous research, your consultants will help you develop a strategy tailored to your website, your business and your best customers. The business of optimising your online presence and then making you more visible to your ideal prospects rarely brings instant results. Search engine optimisation needs to be an ongoing process: it’s a bit like keeping the garden watered. Like most gardens this needs a significant chunk of work up front and then regular maintenance for best results. SEOs and the search engines have a strange symbiosis. This results in the search engine algorithms constantly being tweaked so that SEO companies are, quite rightly, prevented from completely gaming Google. The constant tweaks by the search engines, the ever-changing competition and frequent changes in legal frameworks result in a situation where, once front page rank has been obtained, it needs constant maintenance.

Part 3. Social Media Management Strategy

Business ignores the world of social media at its peril. There are so many success stories rooted in the successful application of social media sharing that it is no longer a NEW thing. Facebook with its 500 million regularly and active members, online for over an hour a day, is the most obvious and well documented marketplace. Google spokesman Matt Cutts has let it be known to the SEO community that the Google algorithm is now taking more notice of the signals provided by Twitter, Facebook and the other social networks that identify the trustworthiness and engagement of companies, characters and organisations with their customers. Social media now provide huge leverage for your reputation management, word-of-mouth recommendation and as a source of traffic to your website. The plethora of social platforms and microblogging sites; added to the interconnectedness of many of them leads to the possibility of a huge viral effect of the most favourable kind for your business. Businesses know well that the best form of advertising is word-of-mouth from satisfied customers: Facebook, Twitter and LinkedIn are the 21st-century word-of-mouth channels. They are now, a crucial aspect of any Internet marketing strategy whether your company is purely online or a traditional bricks and mortar enterprise.

Internet marketing service companies are able to assist your company in developing a coherent strategy to raise your profile and promote your brand to your target market. The bespoke aspect is down to the way in which the consulting company will adjust their approach to the subtly different dynamics of each customer group, developing a truly individual presence on the web.

Travel Nursing Jobs

August 10, 2017

Do you have what it takes to get hired for travel nursing jobs? More importantly, are travel nursing jobs really the door of opportunity you’re waiting for or does it simply lead to a more undesirable path? Make sure that you’ve researched completely and made a lot of soul-searching first before making a final decision.

What Makes an Individual Eligible for Travel Nursing Jobs?

Just because you want to have a travel nursing job doesn’t automatically mean your wish will be immediately granted. Just like any other job, travel nursing opportunities are only offered to those who meet the criteria the employer or agency is looking for.

In terms of experience certain travel nursing jobs will require applicants to have the necessary experience before they can be hired. If you’re only beginning as a nurse, it’s possible that you’ll have to wait one more year or so before you can have a fighting chance to get hired.

Expertise can either be shown through your experience or your grades during nursing school. Hospitals may lack experts in a certain field of medicine, and this deficiency is what will make them hire you even if you’re just a recent nursing graduate.

Never mind the absence of experience or expertise. If you meet the hospital’s educational requirements, you may be immediately flown off to your future workplace…abroad!

Travel nursing is a job for the young nurse, rarely are travel nursing jobs offered to people beyond forty. As working in hospitals and clinics requires you to have extraordinary strength and longevity, employers would wish to employ younger people because they’re unlikely to pass out from exhaustion and become patients themselves.

Certain nations don’t exactly enjoy pleasurable relations with each other. As such, even if you’re more than qualified for a certain travel nursing job, your nationality might prevent you from taking advantage of that particular job opening.

Factors Affecting Travel Nursing Jobs

In the event that you’ve all the necessary requirements to qualify for any travel nursing job, don’t say yes just yet…there are still a couple more questions you have to ask yourself before signing on the dotted line.

First of all, in which part of the world are you going to be assigned? Is the country affected by politically influenced wars? Will it be dangerous for you to leave home alone at night? Is your home and workplace in the city or country?

Choosing travel nursing as a career is a very significant point in a career of a nurse, and it can lead to many opportunities that will follow, in any case a nurse considering taking travel nursing should learn everything it can before committing to this professional channel.

The Benefits Of Internet Marketing

July 11, 2017

Whilst it is fair to say that Internet marketing has certainly had an effect on offline trading figures, the comparisons are not directly proportionate for the simple reason that the Internet has opened up huge new markets which were not feasible before this ‘information superhighway’ was born. The interactive nature of Internet marketing, and the low costs involved in distributing information and media to a global audience, makes a very attractive platform for any business model, regardless of size. Latest figures from credit card companies report a 15 billion dollar turnover from Internet sales in the last year, and rising rapidly. So it is not surprising that budgets for Internet marketing are taking a bigger slice of the advertising cake and the numbers of individuals earning their living directly from Internet marketing are ballooning off the scale.

Internet marketing draws together all the creative and technical aspects of the Internet, which include design, development, advertising and sales, and the techniques used in Internet marketing include search engine marketing, email marketing, affiliate marketing, online advertising and more recently, social media marketing methods as employed in blog marketing, and viral marketing.

Internet marketing is the process of building, growing and promoting a business individual or organization through any online activity including websites, blog sites, article marketing, press releases, online market research, email marketing, and online advertising. In order to fully comprehend the huge benefits offered by the Internet marketing process, it is difficult not to draw comparisons with offline marketing methods, but it has to be remembered that one is not a replacement for the other. Internet marketing and offline marketing will both have an important part to play in the future of any business, assuming it is not purely Internet based. Let us now look at the benefits that Internet marketing has to offer..

Low Cost

Since the Internet can be regarded as a ‘free for all’ activity center where information is shared freely with all interested parties, the cost involved in the overall Internet marketing strategy is relatively low. Apart from the obvious expenditure incurred in operating a web site, a large proportion of the budgets set aside for Internet marketing will typically be swallowed up by services and resources offering expertise in the various marketing techniques that fall under the Internet marketing umbrella. For example, Search Engine Optimization plays an important role in the positioning of a web site in search engine rankings and the larger organizations will often employ the services of a search engine optimization company to carry out this duty. Equally there are Internet Advertising Agencies available to handle all aspects of online advertising. Smaller companies or sole traders may carry out their own search engine optimization and advertising campaigns and would need only a few hundred dollars budget for marketing software tools. Either way, the overall cost of Internet marketing is much lower than the cost of a similar offline campaign.

Work From Any Location

All activities that fall under the Internet marketing banner can easily be organized from a laptop computer. Most communications are made using online contact forms, email or instant messenger, and payments for items such as web site hosting, internet marketing software tools and resource fees can all be paid online using a credit card. Web site design and management is also another area of Internet marketing easily managed from a laptop computer. The versatility of the ‘laptop’ means that these duties can be carried out from any location and therefore those involved in the Internet marketing fraternity can easily work from a simple home office, or even when away from home. Commuting is totally unnecessary.

The Level Playing Field

Unlike offline commerce, the use of Internet marketing techniques now make it possible for an individual or sole trader to compete with the larger organizations in his online business. It’s true that a larger company whose name was on everyone’s lips would have a head start in the marketing of their web site, and a larger presence in the search engine pages, beyond that the doors are opened and it’s quite common to see a smaller commercial outfit riding higher than their much larger competition in search engine results. Yes the online advertising budgets would be much bigger for the national companies, but there are many Internet marketing techniques and resources available to the solo marketers that would help them to stay in touch. There are literally hundreds of new Internet millionaires developed on a daily basis.

There are also many niche areas with good benefits derived from Internet marketing, but generally the process is attractive all round as a method of promoting any business, recreational or personal projects across the Internet. Internet Marketing is where the future lies for businesses large and small. The Internet has arrived and no-one can deny it!

Trevor Taylor

Grow a Wealth Building System by Learning Internet Marketing Skills With a Free New Wealth Report

July 28, 2017

Well you may not know it but to build wealth you must use internet marketing strategies and techniques because Internet marketing is the lifeblood of any affiliate, network marketer or home based business. Therefore you need to understand that internet marketing may sound complex but it is a skill you can develop and learn. So if success is mandatory now in your business then getting web traffic is a must so here are some of the skills you need to master to build international wealth in your business.

When it comes to building wealth, especially international wealth, which is very possible on the internet, then you need to understand:

  1. The basics of internet marketing and the importance of it to your business.
  2. How to choose an internet marketing system to market your business.
  3. How to understand the marketing lingo and the many ways people use the same term to mean many things.
  4. The importance of an autoresponder selection so you can start to build a profitable list.
  5. That you need to discover how to get yourself into profitability sooner rather than later.
  6. The funded proposal system to support your initial business advertising costs.
  7. The selection process that helps you develops your affiliate programs as part of your funded proposal system.
  8. That you have to build the foundation of your business by working your way from the simple and easy to the complex.
  9. The necessity of daily business activity means you will have many monotonous,repetitive activities and you will need to become much more efficient.
  10. That these monotonous, repetitive activities require you to learn how the process of developing and using automated business solutions.
  11. That you will need to learn the nuances of your competition and what they are doing so you can stay one step ahead of them.
  12. How to perform the most important activity which is the advertising of your business because there are many, many different types of advertising and you need to master a number of them.
  13. That once you advertise you need to learn how to track and monitor all your activities to ensure you are performing profitable activities.

To gain international wealth, you should explore the internet marketing strategies and techniques that you can use to promote your business. You can create your prosperity marketing system that helps you develop your international wealth. These strategies will improve and shore up your business’s general marketing objectives.

Why to Buy Electronic Cigarettes?

June 9, 2017

The easiest way to by electronic cigarettes is online. Just visit an ecigs online store and check out different ecig brands, ecigs styles and accessories and make a quick purchase. Ecigs are available in varying styles such as mini, pen style, cigar, pipe and much more. Anyone new to using ecigs, start out with a disposable type or a starter pack. The disposable type is only for one time usage and is usually a single device that’s large and a bit on the heavy side. E-cigarette starter packs on the other hand include all necessary items such as atomizer, rechargeable batteries, carry case, wall charger and cartridges.

Those looking to quit smoking will find e-cigarettes the best alternative because it is a far more effective product than other quit smoking products. Taking a drag on an ecig is an experience on its own because you can pull as long as you want and inhale a big puff of vapor that’s really addicting.

Ecigs give the same sensation as that of smoking a traditional cigarette. They look just like normal cigarettes, feel just like them and are definitely a healthier alternative because they do not have any tar or tobacco. They do not pollute the air around you and can be used in places where smoking is banned because ecigs vapor is just white smoke that does not have any pollutants.

Another reason to buy e-cigarettes is that the nicotine or flavor cartridges last for a long time. One cartridge is equivalent to a carton of cigarettes and you can use them for essentially such a long time, without having to go to a store. E-cigarettes cost a fraction of what a normal cigarette costs.

There are many e-cigarettes brands and the difference lies in the device structure and available flavors. Some brands offer a three-piece device and others a two-piece one, which is easier to use. Top e-cigarettes brands include Green Smoke’, Smoke Stik’, Blu Electronic’, Volcano E-Cigarettes’, USA Cig’, eSmoke Freedom’, and CigartiTM’, and The Safe Cig’.

E-cigarettes users have reported a definite change in their habit after using them because of the way they work and the smoking satisfaction that they provide. Many report that they do not take up a traditional cigarette afterwards. The device is easy-to-use and cheaper than traditional cigarettes that can cost an average smoke more than $2000 annually.

Medical And Dental Treatment And Coverage In Oaxaca, Mexico

July 26, 2017

When I first gave up the practice of law in Toronto in favor of early retirement in Oaxaca, I assumed that the years I would add to my life by leading a much more stress-free existence in Mexico, would be lost by the inferior health care system to which I would be exposed, subjected and restricted. This, then, is my assessment of the extent to which my presuppositions have been accurate, together with information and advice for both vacationers to and would-be ex-patriot residents of Oaxaca.

Aside from the small, private hospitals, often referred to as clínicas, there are four publicly funded and insurance – based hospitals in the city, as well as a hospital just outside of the city offering specialized treatment for a number of serious ailments. There is the Red Cross facility available to all, often used for emergency treatment only. The civic hospital provides free services or treatment at a modest cost based on a sliding scale respecting means. ISSSTE is a federally funded facility restricted to government employees who are members of a union. Finally, there is IMSS, a federal insurance program available to ex-pat residents and Mexican citizens alike, with an extensive network of clinic doctors and a large hospital. It’s funding is provided in large part by business owners. Aside from these hospitals, there are several, small, easily accessed clinics scattered throughout suburban and rural neighborhoods.

For the vacationer, and the ex-pat with a VISA permitting residency in the country, the most common means by which to obtain emergency treatment is through Red Cross, IMSS (which accepts patients without coverage on a pay-per-service basis) or a private hospital. However, the last of these three is the only one in which you can be reasonably reassured of being attended in a timely fashion by extremely competent and efficient personnel.

WHAT TO DO AS A VACATIONER

If you do not have out-of-country healthcare coverage, by all means go out and buy it before leaving for your trip. However, it’s advisable to first inquire of your credit card company, to ascertain if in fact you already have at least some coverage simply by virtue of, for example, having a gold or platinum card. You can then make a more informed decision concerned whether or not to purchase coverage, and if so at what level. On the other hand, a broken leg, gastrointestinal problem or other non-life threatening ailment can be attended by a private doctor or clinic without breaking the bank. Of course for an outlay of more than $100, it’s nice to be reimbursed.

If you intend to make a claim to your private carrier, credit card company or government funded health care plan, ensure that you not only keep all receipts, but request a written diagnosis and treatment plan, and that the prescriptions you are given indicate for what purpose each medicine is being prescribed (i.e. antibiotic, analgesic, etc.). Many doctors provide all required information simply as a matter of course. Accepted practice, at least except for when narcotic medications are being prescribed, is for the pharmacy to return prescription forms to you. Often medical plans require translations of each document that is presented to them as a prerequisite for processing and reimbursement. When in doubt, submit all documentation with your claim, making sure to determine if originals are required, and keep copies. Frequently, as is the case with Ontario, it’s a two step process. Treatment receipts and diagnosis is submitted to the provincial plan. Once you’re notified of the portion not covered, prescription receipts together with a request for reimbursement for the amount not covered by the province, is submitted to one’s private plan. In theory, between the two plans, 100% reimbursement is achieved.

You can ask the manager of your hotel or bed and breakfast to do you a favor by translating each of your supporting documents, to save you the trouble upon your return home. Make a note of the then prevailing rate of exchange, and submit a calculation to your plan with your documentation, to more easily facilitate payment. When a member of a clerical staff is processing your claim, he’ll be less inclined to put yours aside for another day or week if it already contains all the necessary and relevant data, organized in a readable format.

Concerning where to go in the event of illness or emergency, your accommodations host should be able to make recommendations for English speaking physicians with private practices, and for private clinics. Regarding competency of the former, while there is a medical school in Oaxaca, many doctors travel out-of-state for their post-graduate training such as to universities in Mexico City or the US, and regularly attend conferences and upgrading courses. Some travel abroad within the context of their specialization training. Indeed the Oaxacan populace appears to take notice of and prefer those physicians who are able to display foreign diplomas.

Our personal experience with emergency treatment over the past 10 years has been nothing but positive for ourselves, our family and our guests, at hospitals Carmen and Molina, both downtown … in terms of competence, speed with which one is attended, and the presence of English speaking ER doctors. On the other hand, we cannot recommend the emergency departments at the civic hospital or IMSS because of delays in receiving treatment, and at minimum in the case of IMSS unavailability of competent medical personnel 24 hours a day to attend to even a commonplace emergency (i.e. suturing). Having said this, many excellent surgeons with private practices perform surgery at the non-private hospitals where there tends to be the more state-of-the-art and sophisticated equipment.

The normal range in price for a consultation with a family doctor, specialist or dentist, is $20 – $50 (all figures are stated in US dollars and are approximate for 2008 unless stated otherwise).

PURELY ELECTIVE AND COSMETIC PROCEDURES

Over the past several years Oaxaca has become a popular destination for Americans and Canadians seeking both plastic surgery and extensive dental work. Word has spread of the competence and quality of work of both nip-and-tuck and dental surgeons, and of course of their extremely reasonable charges relative to those paid to hometown practitioners. Many foreigners, as well as Mexicans from Mexico City and other regions of the country come to Oaxaca for face lifts, breast reductions and augmentations, liposuction and other appearance enhancing procedures. A friend who attended for plastic surgery in Oaxaca by a well-known plastic surgeon a couple of years ago, recently commented that she had read an article in a Canadian magazine indicating the cost for the same procedure which she had performed for $500, was $3500 – $5000 at home. In effect she had a free trip to Oaxaca, and returned home with extra money in her pocket.

Our personal experience with dental treatment has been extremely positive. Cost tends to be about a third to a half of American and Canadian prices, for example for crowns and bridges, implants, root canals, gum and bone work, etc. While the use of nitrous oxide (laughing gas) has not yet arrived in most Mexican cities, a dentist with a gentle touch can more than make up for that lack of temporary high while in the chair.

RESOLVING THE EX-PAT CONUNDRUM

Get whatever coverage is made available to you both in your homeland and in Mexico, subject of course to affordability.

To my thinking, with IMSS coverage costing under $400 annually for a couple, why not go for it regardless of what other coverage you already have. Then supplement IMSS with international coverage for catastrophic injuries unless you have other similar insurance from another source. Our Oaxacan friends tend to disagree, but theirs is a different mindset where insurance in general has historically not been stressed or valued, be it home, car or health.

Some American acquaintances
swear by IMSS since it provides regular care including preventive procedures, all dispensed by government employed physicians including specialists, together with lab tests, medication and hospitalization. There are restrictions the first year of enrolment, and there are caveats. The level of cleanliness in the clinic environment tends to be below the standard to which most of us have become accustomed growing up in the US and Canada. Many physicians have not received the quality of medical education of their private counterparts. The medications provided through the clinic pharmacy are often not the best available in the marketplace for treatment of a particular ailment, because of cost. Often the wait to see your designated doctor or for your lab tests can be long, requiring a half day commitment for each step in the process: visiting a general physician, going for one set of tests, then for another, and finally seeing a specialist.

So why bother with IMSS at all, with all these downsides? It’s a failsafe, another form of assurance that you’ll be cared for in the event of a lengthy and serious illness. As suggested earlier, often it’s the largest hospitals such as IMSS which have the best equipment, and surgeons with private practices who perform some of the surgeries. And there is no additional cost for hospitalization once you have full IMSS coverage. While attending a private clinic is more akin to your experiences before moving to Mexico, if you must remain in hospital for a lengthy period of time, the cost of doing so in a clinic could be prohibitive…just like back home.

Visiting private physicians, and even biting the bullet and getting your tests done at privately owned laboratories, reasonably assures you of a familiar quality of care. Coupled with IMSS coverage, you can now be confident that you’re covered in almost all respects. In the event of a protracted hospital stay you can afford to be there for as long as necessary. The best locally available equipment will be used in your diagnosis and treatment, and you have a reasonable likelihood that attending surgeons are those who split their time between private practice and clinic work, and performing procedures in one or more large hospitals.

We maintain IMSS coverage, but rarely use it, preferring to tap our Oaxacan social networks for referrals to specialists to the extent they are required. And in any event, after having been resident in Oaxaca for a few years, those of us who are in our fifties or older have already been introduced to a broad range of specialists. As strange as it still is to be a Canadian and subscribe to the pay-as-you-play philosophy of medical care, it serves our purposes, with the IMSS safety net just in case.

Under certain circumstances you may not want to rely on even the best Oaxaca has to offer. Indeed the stream of Oaxacans traveling to Mexico City flows briskly and wide. The middle and upper classes with contacts in the nation’s capital, there quickly seek out the best in terms of physicians and state-of-the-art equipment, for diagnosis and for treatment of life-threatening diseases.

Even doctors working in Oaxaca at the IMSS and ISSSTE hospitals can make arrangements for patients to receive treatment not available here, to be attended in Mexico City or other larger centers. However, the process can be slow. We know of one case, that of a two-month-old baby with heart problems, who was finally sent to Puebla for surgery at ISSSTE, only to die before the procedure could be performed.

The solution, unless you have quality foreign coverage perhaps as part of your retirement pension plan, is to buy insurance which will pay for treatment in Mexico City, or better yet throughout the world as long as you can make your way to one of the participating top-of-the-line hospitals. In my case, I have a low annual premium, with high deductible which is waived in the event of accident. Again, it’s a failsafe mechanism in the event of, for example, a serious car accident, or cancer, stroke, heart attack, or other catastrophic ailment which would otherwise not be affordable. Oaxaca has less than the best of diagnostic equipment and treatment facilities. My plan provides for a $10,000 deductible, $2,000 annual premium, with member private hospitals in Oaxaca, Mexico City and elsewhere in the republic, and of course abroad including the US, with the Mayo Clinic in Rochester being a participant.

In summary, my medical coverage and plan for treatment is the following. We have our regular family physician, who, along with our Oaxacan friends, refers us to specialists in which we have the utmost confidence, and to whom we pay per visit. The same holds true for dental treatment. We have IMSS coverage which we reluctantly (because we don’t use it) renew on an annual basis, but believe it’s worth the price in the event we need extended hospitalization, or to have surgical procedures performed not available in private clinics. And I have my catastrophic coverage which hopefully I’ll never need to access.

Medical care and coverage can be inexpensive, and just as easily it can be costly. It’s a matter of the individual or family having a philosophy, or set of priorities, before electing to move to Oaxaca. You have to determine how you want to lead your life in terms of balancing having less disposable income as a result of medical and insurance costs, with having greater peace of mind in knowing that whatever is thrown your way will be looked after as best possible given your new life in a foreign land. If you cannot achieve a level of comfort in the resolution of these issues and decisions, then perhaps the move is not for you.

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