Language

The first solution to the language barrier is to use medical practitioners who speak your language. Global medical tourism has exploded in India, Colombia, Mexico, Thailand and several other nations. Traveling to a nation in which medical providers speak your language prevents the language gap.

Another choice is to hire a translator. However, it is critical to use a translator who is familiar with medical terminology as well as local jargon. You cannot afford to misunderstand medical instructions or reports of symptoms.

As good as a translator can be, he or she can never replace a doctor who speaks your language and is actully able to ignite your trust into the doctor-patient relationship.

Quality

Healthcare has been going global in a push for cheaper care. Yet patients need to be careful about the quality of care they receive. This can be done through a vetting of the medical credentials of those performing the medical care. Preference should be given to medical practitioners whose training and credentials were received in the West or are recognized as equal to those in the West.

Cost

Consult with your health insurance company before assuming care abroad will be covered. If traveling overseas, consider getting health insurance for travelers that will cover emergencies in that nation. If seeking care abroad because you cannot get timely care in your own nation, find out if the national health insurance program will cover the medical costs of service abroad.

Travel

Travel to cheaper locations for medical care ranges from three hours from the USA to Colombia to a full day from the USA to India (consider the drastic time zone change). The cheaper cost of global healthcare is partially offset by the cost to travel to other nations. To have a fair comparison you should always ask for TCOT (Total Cost of Treatment), which includes travel and accomodation, whether it’s abroad or in the next big city.

Travel also adds additional risks for patients. Patients should not travel long distance when facing serious health challenges. Global healthcare works best for elective procedures and those that improve quality of life but do not risk the patientís life to delay. Medium risk procedures like knee replacements, gastric bypass and cosmetic surgery or low risk fertility treatments are examples of this type of beneficial and expensive procedure that can be scheduled and handled overseas.

Procedures such as coronary bypass surgery should only be done when there is no risk of someone having a heart attack while traveling to the overseas location. First rate aftercare and close monitoring after the surgery at the same location where the medical procedure was performed also reduce the risk to patients. By ensuring the patient is stable and safe to travel, the risk of traveling home is eliminated.

Aftercare

Select health care providers who allow aftercare in addition to any procedures they perform. For example, do not use a healthcare provider that only performs a surgery and sends you back to a hotel room. Select a healthcare provider who either covers several days of supervised recovery or releases you to a resort that monitors your recovery while you enjoy recreational activities or a spa-like setting. Ensure that seeking private care abroad will not disqualify you for medical care and monitoring upon returning home.

The explanation is simple. Breakfast seeks to break the fast of the night, which on average is eight hours. If someone does not have break-fast, the body interprets this as a sign of starvation and reduces its metabolism to spend as little as possible. At lunchtime, after being without food for more than 12 hours, the body begins to feel hungry and order food. Under these circumstances your body will bot accept just an apple or lettuce, but rather ask for food rich in carbohydrates. All this excess food is then stored as fat. It’s like saving for future fasting.

If you eat a healthy and nutritious breakfast, your body is stimulated. Breakfast is the spark to ignite metabolism.

Having a healthy breakfast supports a balanced nutrition throughout the day!

You have questions or want to discuss health-related topics – ask our specialists on FlyClinic’s Healthcare Forum (www.FlyClinic.com).

But the city is also showing off in other fields. Several international companies in 3D movie animation take advantage of a great pool of creative talent in the city and set up shop here. Medical services have also always been a strength of Medellin. Some of South America’s best doctors and clinics can be found here, providing first class healthcare to an increasing number of patients from the US who either can’t afford their medical procedure in the US or who prefer the privacy of a cosmetic treatment or plastic surgery abroad. Couples in desperate search of a baby spend some time in the relaxed ambient of some of the best and most successful fertility clinics in the country – many of them going home with a dream fulfilled. Serving this increasing demand of medical procedures and cosmetic treatments abroad, South America’s first online platform for medical services and cosmetic treatments has been founded in Medellin in 2011 by two foreigners who have experienced the exceptional medical services in Colombia themselves. FlyClinic is is carefully selecting doctors and clinics, offering patients a variety of professionals and institutions to choose from. It’s 5-star healthcare for budget prices.

Most importantly, FlyClinic provides vast information to patients prior to their procedure, raising awareness about opportunities and risks of medical procedures as well as cosmetic treatments and plastic surgery. Our blog frequently discusses critical issues ranging from causes of infertility, stress management, risks in medical procedures to recommendations on whether or not one should go for plastic surgery or a cosmetic treatment. Finally, patients can directly communicate with their specialists through our Patient Health Forum and book their flight or hotel on FlyClinic Travel.

Where do patients and their families stay after the successful surgery? Medellin features some of the best hotels in the country – however, most families decide to go for an apartment and find one of the best providers in The Apartment Medellin, an extremely successful project by another Expat – catering to the specific needs of the foreigner coming to Medellin on business or medical trips.

The Apartment Medellin started 5 years ago when tourism began to increase in Medellin.  From a single room, the company has expanded to more than 40 upmarket units to service the growing need for comfortable and affordable accommodation for discerning western tastes.  An apartment is the perfect option to relax and enjoy privacy in your own home away from home while undergoing any medical procedure.  The ability to have full time medical staff or assistance with you 24 hours a day if required is a huge benefit considering the cost, size and impersonal nature of hotels.

The Apartment Medellin not only provides excellent service to tourists visiting Medellin but also provides the tools and expert advice for investors to purchase rental property in Medellin and make double digit returns while enjoying their vacation home whenever they wish. If you are coming to Medellin often for regular treatments, this could be a golden opportunity to not only buy into a blossoming market, but also generate rental income that could pay for your medical procedures.

The Apartment Medellin and FlyClinic are presenting this week at the “Live and Invest Overseas Conference” in Medellin, the first event of its kind to be held in Colombia, showing future retirees and savvy investors opportunities in this market … South America’s hidden secret.

There are a number of factors that have been seen to contribute towards this peculiar and highly interesting development. The first factor is the ever increasing number of Colombian doctors and healthcare professionals who have trained in the US and Europe. Having pursued their medical training in distinguished medical schools, these Colombian doctors deliver healthcare services that are at par with their counterparts in North America and Europe. They are highly qualified and skilled with most having had some experience practicing in the country where they trained. To date, there has been a very high success rate reported by doctors and fertility experts who are offering fertility treatment in Colombia.

In addition to highly skilled professionals, Colombia has seen significant improvement of its medical facilities over the recent past. Hospitals and health centers around the country now have state of the art equipment and operate in line with internationally accepted medical procedures. The country is now an international healthcare destination thanks to the excellent facilities and highly qualified staff who are working to provide treatment.

Another big advantage that has led to an increase in the number of couples seeking fertility treatment in Colombia is the favorable cost of medical services in the country. When compared to services of a similar nature and standard in other parts of the world, Colombia is significantly cheaper. A procedure that costs 35,000 USD in the States will cost about 6,000 USD in Colombia. With the average difference in costs being about 70%, it makes a lot more sense to seek treatment in Colombia.

While all the above benefits are great for anyone seeking medical care, there are a number of advantages that are specific to the treatment of fertility related issues. A relaxed environment is the biggest benefitthat the country has to offer. Fertility problems are significantly aggravated by stress and tension. While abroad, most people tend to find it easier to relax and thus they respond better to treatment. Combining fertility treatment with some holiday time is a great idea that has been embraced by a lot of couples.

With its great weather, breath taking natural spectacles, rich culture and fun activities, Colombia offers an opportunity to not only heal the body but also the mind and soul. It is the perfect setting and has the needed facilities as well as capable experts to help couples overcome fertility issues. If you and your partner or someone you know is looking for help, seeking quality fertility treatment in Colombia should be among the top options you consider.

To be successful achieving pregnancy in a couple with a fertility disorder it is essential to consult the right specialist at the right time.

Questions your fertility specialist will ask you:

- Have you tried unsuccessfully for more than a year, with an active sexual life and without using any method to prevent pregnancy?
- Is the female partner older than 35 years and have you tried more than six months without success?
- Does the female partner have severe menstrual cramps or a history of endometriosis?

- Does the female partner have polycystic ovaries, symptoms such as irregular menstrual cycles, increased body hair and face, acne, oily skin and / or abnormal vaginal bleeding?
- Have you ever had a diagnosis of adhesions syndrome or a history of pelvic infections, abdominal surgery, or perforated appendicitis?
- Is there a history of diseases or malformations of the uterus, and uterine fibroids and partitions?
- Is there a history of pathologies of the testicles, such as mumps with involvement of the testes, varicocele, testicular trauma, and / or testicular atrophy?
- Do you suffer from a sexual dysfunction, preventing you from an active sexual life, such as impotence (inability to achieve an erection) in men and vaginismus (severe pain at the time of penetration ) in women?
- Do you have difficulty ejaculating, due to previous surgery of the prostate, psychological disorders, malformations of the genitals or neurological diseases or diabetes?

Elements common to a crisis are:
1. Feeling the threat of living an insolvable situation in the immediate moment.
2. The feeling of not having your own solutions to the conflict.
3. Feeling threatened the couple’s goals and each partner’s personal goals.
4. Remembering critical past experiences of one or both partners.

The infertility crisis differs from a general traumatic crisis, because infertile couples can remain in this state of crisis in the long run if the problem is not solved.
Freeman [4] found that before IVF, 48% of women and 15% of men described infertility as the most traumatic experiences of their lifes.
Barbara Menning [11] in the 70′s made one of the greatest contributions by observing and describing systematically and scientifically a psychosocial approach, as on how the condition of infertility is threatening the life-project, social functioning, self-esteem and sexuality of the infertile couple. She describes the negative emotional feelings and the impact on the couple, after failure of treatment with assisted reproductive techniques. From these publications studies are emphasizing more on describing and interpreting the psychological consequences of infertility, i.e. the psychological sequelae of this condition.

The following describes the life crisis caused by difficulties in conceiving, the failure of treatment, repetitive reproductive losses and the grief accompanying the chain reaction of negative emotional feelings.

NEGATIVE EMOTIONAL FEELINGS

1. SURPRISE

A shock, an emotional jolt. As its name suggests the couple is surprised to face the difficulty of conceiving. Apparently it is very simple, everyone seems to be able to achieve it, other married couples who married about the same time, brothers and sisters. It seems they are the only ones or are among the few who are having this problem. It’s like waking up from a deep dream that started in your childhood. An illusion collapses and they, now adults, do not know what to do. Childhood fears are present again, stay awhile, for some only weeks, for others months. This sentiment mobilizes some couples to seek professional help.

2. DENIAL

To some extent, we all use is as a tool for adaptation whenever life presents us with a painful situation, tending to ignore reality, minimizing what happened, or creating a more acceptable fantasy of the situation we are living.
For couples seeking fertility it appears through thoughts like: that doctor does not know, this should not be our result, the lab made a mistake, repeat the test, we are very young wait longer, we are very healthy, we have not suffered from any rare disease. For this reason it is often observed that the couple had been treated by different institutions and been subject to various surgeries and treatments. However, they have not conceived.
Perhaps it is the denial mechanism that makes the couple sabotage the doctor’s efforts. When the couple actually abandons their denial and starts believing that they need help, they better accept treatment and will become more cooperative and be able to receive effective support.

3. FEAR

… of losing control, especially of their life. Fear can be irrational, seeking explanations in past situations, such as abortions, contraception, infidelity, homosexuality, infertility, masturbation, sexually transmitted infections, child abuse, etc.

4. GUILT

… presents itself as valve to release the pressure exerted by the situation of infertility and the pain experienced. Knowing what the source or type of fear is the couple lives is very important. This should be discussed in a safe environment like a therapy, which provides a non-judgmental acceptance and sincere empathy.
The situations referred to unleash feelings of frustration in the couple, which leads to anger and rage. They feel at a crossroads end. It does not depend on them whether or not the situation changes. The situation and the achievement of this goal in their own development depends on the doctor and professional group that attends. This triggers helplessness and frustration, being upset with the way the world is organized.
They feel that life is unfair, while teenagers and people who are not willing or prepared to conceive do, while they who have all the love, do not. They become moody towards many situations and expressions of people around them, even their partner and family, being irritable and easily angered.

5. ISOLATION

The function of insulation is to avoid moments that prove to be painful for them and remember them or get in touch with their infertility situation. They are trying to get away from people, declining attendance to family and social gatherings, avoiding occasional encounters with neighbors, friends, etc.. Their aim is to prevent certain people who’s verbalized phrases unintentionally become painful for them as: “How long have you been married?”, “Six years and no children?” and “When do you want to have children? – When you are old?”, “Marriage is no marriage without children!”,”Is it by choice or forced upon you?”, “Which of the two does’nt function? “. As we were raised much importance has been given to fertility, the role of gender, motherhood and fatherhood in the validation of being a man and woman.

Without realizing it, every member of society is watching and taking care to ensure compliance with the social mandate of conservation of the species. Friends and relatives are inviting to baptisms, first communions, social situations such as the birth of a boy or a girl in the family or meet someone pregnant, putting infertile couples face to face with these ambivalent feelings.

Avoiding people because they do not comply with the plans of the family and society is a difficult situation. When the couple is avoiding their lifelong support networks is paradoxically the time they are most in need of them.

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Whereas Martha Ramirez gave a brief introduction to the emotional and psychological aspects of couples undergoing fertility treatment in the first part of this 3 part series, she explained in this second part the elements common to a crisis and the negative feelings couples are facing if results do not show up as initially expected and dictated by social norms.

In the third part, Martha Ramirez will explain the reasons that might be causing such a crisis.

Please do share your experiences and thoughts on FlyClinic’s Healthcare Forum – helping other couples to overcome their own crisis or searching for help on resolving your own. To follow future publications and discussions on FlyClinic, subscribe to FlyClinic on Twitter (http://twitter.com/FlyClinic) and stay up to date on medical and cosmetic topics.

Your Global Healthcare Team at FlyClinic
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The proof of fertility has played a key role in our society. However, it has been changing as the number of children and the age of conception have too. Fertility is very important for gender roles as a validation of masculinity and femininity. Beginning in their childhood, boy and girls learn, through their games, what their role in society in terms of gender, sexuality and fertility is. Infertility is not considered, neither expected. All men and women are simply potential parents. When a couple decides to consolidate its union and share their life, different development goals are marked: personal, occupational, academic, among others. After achieving some of these goals, the couple seeks to fulfill one more, that is fertility, but sometimes this goal is not achieved as easily as expected.
The WHO defines reproductive health as a condition in which the reproduction is achieved in a state of complete physical, mental and social development. Not only the absence of disease or disorders of the reproductive process.
Infertility by itself may not threaten physical health but it certainly has a serious impact on social and mental well-being of couples. In many countries the stigma of infertility often leads to marital disharmony, divorce or isolation.
The suffering experienced by an infertile couple is very real, WHO estimates that there are 60 to 70 million infertile couples. A study done in Cali found that infertility is 14% in Colombia. An 8% to 10% of couples may face difficulty conceiving a child they want. This means that between 50 – 80 million people worldwide may require review and possible fertility treatments.
The ability for a couple to conceive without any adverse factors is 30% (3 of 10) in the first month. This percentage goes down gradually to 25% in the second month, 20% in the third and so on. The possibility accumulated at the end of one year is 80% or 8 out of 10 couples have been pregnant after the first year. From then on the possibility of getting pregnant spontaneously drops to only 5% per month. At this point it is advisable to enlist the help of assisted reproduction techniques.For a couple with fertility problems, the decision of treatment depends on: – the possibility of pregnancy without treatment, – the chances of pregnancy with a simple but moderately effective treatment, – the possibility of getting pregnant with complex / expensive but more effective treatment. Medical procedures in which the eggs are handled in women or sperm in the man, trying to promote fertilization, are classified as assisted reproduction. They can range from the use of ovarian stimulating drugs, ultrasound and hormonal measurements to monitor the process to the processing of semen, insemination, in vitro fertilization [IVF] and intra-cytoplasmic sperm injection [ICSI].
Medical science continues to advance in the area. Fertility studies have advanced since the late seventies with the birth of the first test tube baby in England, defying barriers and reaching the limits of the handling of gametes and embryos to develop techniques to clone humans. The great advances in technology and media have raised expectations in couples regarding to what science has to offer. Unfortunately the avalanche of information on new methods and their successes makes it difficult to have a clear vision about the real possibilities of treatment. Infertility is a problem for some couples because they trigger a number of feelings, emotions and transient adaptive mechanisms that do not involve mental disorder, but that couples are not able to handle.
There are different opinions about what fertility problems really mean. Infertility is classified as a disease, but does not involve the same emotional charge, or reflect as much anguish of those involved, although there are mood changes aligned with what happens during the time of treatment. Infertility is a problem in which both partners share responsibility, but in most societies, social and psychological burden is taken a lot more by women. In fact not only related to coping with infertility, but also in relation to diagnosis and therapy.
Couples today, in accordance with changing cultural values, manage new demands and pressures on the prevailing values – therefore it is normal for women over 40 years to go to a fertility center in search of their first child and review options and alternatives. Often, only after the age of 30, men and women are establishing the (marital) union, primarily due to working conditions and academic requirements. Couple’s life has won over other areas, seeking to consolidate their union and enjoy sharing their life. Gender roles in relation to motherhood and fatherhood have changed, having couples think more about the education and upbringing of their children – tending to postpone the search for them.
The life cycle of the couple and the family goes through different stages of development:

1. The RELEASE of each of the partners from their family.
2. The MEETING between these two people who are attracted to each other, forming a couple.
3. The CHILDREN are presented as a result of that union.
4. The ADOLESCENCE, marking the presence of teenage children in the family.
5. The REUNION, when the children leave to form a new couple and
6. The AGED family.

When a couple does not reach fertility or the full elaboration of a childless life, the development process of the couple consciously or unconsciously stops and does not continue, leaving the couple stuck in an unresolved experience. The reproduction is central to the lives of men and women and having children is often considered the meaning of life. This desire to have children appears to be extremely strong, transcending gender, race, religion, ethnicity and social class. For this reason, the situation becomes problematic, due to a lot of feelings, emotions and adaptive defense mechanisms. Those are normal and do not imply a transient mental disorder or psychopathology, but instead are rather normal adaptive responses to the new situation – painful and unexpected.

This triggers a crisis in the couple’s life. The resolution of a crisis may last about six months. You feel that your mind and your body will not hold and it will explode. After the crisis the couple can:
- emerge unchanged (crisis completely solved),
- emerge with increased emotional stress or
- emerge in a less stable state.

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In the second part of this 3 part series, Martha Ramirez analyzes the different stages couples are going through during a Fertility Crisis, explaining finally in the third part the reasons that might be causing this crisis. Please do share your experiences and thoughts on FlyClinic’s Healthcare Forum – helping other couples to overcome their crisis or searching for help on resolving your own. To follow future publications and discussions on FlyClinic, subscribe to FlyClinic on Twitter (http://twitter.com/#!/FlyClinic) and stay up to date on medical and cosmetic topics.

Your Global Healthcare Team at FlyClinic
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BIBLIOGRAPHY[1] Moller A, Fallstrom M,. Psychological consequences of infertility: a longitudinal study. J Psychosom Obstet Gynaecol. 12,13-26, 1991
[2] Whiteford LM, Gonzalez L. Stigma: the hidden burden of infertility. Soc Sci Med 40,27-36, 1995
[3] Lalos A. Breaking bad news concerninf infertility. Hum Reprod 14,581-583, 1999
[4] Freeman EW, Boxer AS, Rickels K, et al. Psychological evaluation and support in aprogram of in vitro fertilization and embryo transfer. Fertil Steril 43, 48-53, 1985
[5] Greil AL. Infertility and psychological distress: a critical review of the literature. Soc Sci Med 45, 1679-1704, 1997
[6] Dommar AD, Clapp D, Slawsby EA et al. Impact of group psychological interventions on pregnancy rates in infertile women. Fertil Steril 73, 803-811, 2000
[7] Fassino S, Garzaro L, Peris C, et al. Temperament and character in couples with fertility disorders: a double blind controlled study Fertil Steril 77,1233-1240, 2002
[8] Raigosa G. Evaluación del Factor Femenino. En Urología De los Ríos S, De los Ríos J. eds Editorial Universidad de Antioquia, Medellin 2004
[9] Hjelmsted A, Andersson L, Skoog-Svanberg A, et al. Gender differences in psychological reactions to infertility among couples seeking IVF and ICSI treatment. Acta Obstet Gynecol Scand 78, 42-48, 1999.
[10] Bendeck T. Infertility as a psychosomatic defense. Fertil Steril 527-541, 1952
[11] Menning BE, Teh emotional needs of infertile couples. Fertil Steril 34, 313-319, 1980