the (often) meandering travels of a student anthropologist
Dental work is never fun, nevertheless, I find I enjoy our trips over the border.
One of our party, who wants to get glasses, drives us over from Pilot Knob. Scott and his girlfriend travel with a truck and trailer setup and we are grateful he is willing to play chauffeur, while she remains in camp to keep an eye on our rigs and pets. Well before the border we see people park on the sides of the road to avoid the parking lot fee, and for the last blocks an abandoned RV park, a few trailers still decaying on their lots, like scattered toys abandoned in a weedy playground, plays with the imagination.
We opt for the $6 per day parking lot. It also includes what looks like an option for overnight parking. At the eastern edge of the lot we walk down a short ramp, cross through a seven foot white metal turnstile, wind around a path behind the information office, and we are across the border. It's odd to see military police standing around with rifles and guns, but during the three days I was there, I never saw any aggressive policing–only they remind people to use the designated crosswalks.
Los Algodones is an explosion of sight and sound. The kaleidoscope of color in the markets, as Dave points out, is almost intoxicating after months of being in the desert.
It's important to clarify that we never ventured past the first two blocks so I can't report on what I understand would be a more authentic experience farther into the town. Instead what I experience is nothing short of a dental Disneyworld for snowbirds. These first blocks are crammed back to back with dental offices, eyeglass doctors, pharmacies, souvenir markets, and the constant cadence of street hawkers. By hawkers I mean dark-faced and smiling men and women who are paid by the different businesses to stand outside, hand out brochures, and urge you to come into their office to have a free exam. It's a clash of cultures, considered intrusive by the uninitiated, but I notice, also welcomed by many of those in the steady stream of white-haired, limited Spanish-speaking, sandal and tennis-shoe clad tourists. This is a yearly rite and they seem comfortable, laughing, sometimes pushing about like rowdy children, and making bad jokes with the patient vendors.
I follow Dave into Dental de Franco–he researched this dental office in advance and decided if it was good enough for the people he trusted, then it was good enough for him. Scott goes into the eyeglass store next door, although he could have come in with us. The front room of the glass-fronted Dental de Franco has the other three walls dedicated to eyeglass frames. There is also a tiny desk where the pretty young jeans-wearing receptionist/cashier sits. A narrow hall going back is lined with high-back black leather chairs and constitutes a waiting area. The chairs face the two dental exam rooms. The space that is left, between chairs and legs, is just enough room for the technicians to move back and forth, and people to squeeze back into to the optometrist's exam room. In between that and the dental examination rooms is a narrow, but well appointed, bathroom.
In minutes we were whisked into dental chairs and examined. A few more minutes and Dave is undergoing extractions.
The exam is free, no obligation, and even the x-rays are free. However, all the work they say I need – an impressive list, I don't fully trust as it requires a filling in every molar – is reviewed with me while I am still pinned in the chair. It is what I consider a strong arm tactic, but I have a budget and say as much. What are the most urgent problems?
On one side I need a root canal and crown. This is not a surprise. My dentist recommended this seven years ago. On the other side one of my teeth has a crack down the center. I know this too, as it bothers me often. This is a concern to the dentist. She is afraid, because of how the crack is positioned, it can't be prepped properly for a crown, and instead, the tooth will require extraction and an implant. I am told they will call in a specialist.
As Scott is finished with his eye exam, and waiting for his eyeglasses to be made, we try a nearby restaurant. The food is good, the singer/keyboardist eclectic, the margaritas weak, the beer cold, and the prices are what one would expect at an American restaurant. Raphael, my 'guide' who hawks, and translates for the dentist, comes and finds us when the specialist arrives.
The specialist is a quiet young man with a pleasant face and invisible braces. He tells me his name is Julio, and he rotates from dentist to dentist with a rolling bag to do his work. He takes a look at the cracked tooth. He determines, to my relief, that a simple filling is my best option for now.
In the end, the work I agree to, is what I went in thinking I would have done. One filling, one root canal and one crown. In hindsight, and in terms of the sales pitch, potentially it's less strong arm tactic than simply encountering a different cultural way of decision-making. In America we are often afforded the time to go away and think over large purchases, especially as it relates to health care, but here, it's a rapid-fire conversation with expectations of immediate decisions. Later, someone will tell me that they experience the same pressure from their own dentist back in the states.
The facilities, albeit small and a little worn, appear clean and the tools are opened from sterile packaging in front of me. The dentists and hygienists wear masks, surgical gloves, and utilize all the dental tools and procedures I've come to expect from an American dentist. Mine, Dr. Victoria Quintero is gentle and patient.
What surprises me is the casualness of it all. It feels more like popping in to see a manicurist than going to the dentist. I don't have to wait weeks for an appointment, wait 40 minutes in a waiting room before being let into the inner sanctum, only to be prepped and spend another hour waiting for the dentist. X-rays are casual - no lead blanket, and the doctor and assistant don't run to another room to take the image. Julio even leaves his finger in my mouth to hold in the film while he shoots the x-ray after doing the root canal. I personally like this approach. It feels efficient, practical, and somehow, normal.
The filling is accomplished the first day after Julio approved it, and I set an appointment to come back the next morning at 9:00 for the root canal and crown fitting. I take an audio book for the procedure, and while the two hours passes quickly enough, I will say my jaw continued to ache over a week from holding it open for that long with only a break in the middle. The final morning, my crown is completed. The dentist takes time to ensure it is properly fitted. For everything, I walk out paying just under $500. My estimation is back in the states I would have paid over $3000.
If you are considering this work, I would keep in mind you want to stay near the area for a few weeks so that if you do have issues you can easily go back. The receipt is the warranty, and crowns at this dentist are warrantied for a year.
I also had another issue to deal with–trying to get a prescription filled for a controlled substance.
This was unplanned. I only take two medications and my insurance covers them, so they are not costly. However, what I did not realize, is that one of them is considered a controlled substance–and what that means for a nomad.
At home, a controlled substance means that I can not get refills, and my prescription has to be written–it can not be faxed or called in. My doctor knew I would be traveling and wrote up what I would need, prescriptions for several consecutive months, doubling so I could split and make one prescription last 60 days, and dating accordingly.
My first refill was to happen in December, and it was then I discovered not only in California, but also in Arizona, pharmacists are unable to fill controlled substance prescriptions from out of state. Hmm. My next option was to get an in-state doctor to write one. I called fourteen doctors, but it is mandated to have an examination, and not a single doctor of those could get a new patient in for almost four months. Finally, it is illegal for urgent care to fill a controlled substance prescription. After being rudely dismissed in a phone call to the hospital in Yuma, I didn't try the emergency room.
What it comes down to, from what I gather, is that if an American citizen who needs these medicines also wants to travel, they can't do so for more than 30 days before returning to their home state.
This may be an unintended consequence of the regulations, but the ultimate effect is to restrict travel and movement within certain populations.
I was left with the option to go without my medication, try to fill it in Mexico, or return back to my home across the country at a considerable expense. The latter wasn't an option. While my medication isn't life-saving, it does help me function 'normally'. Without it I am forgetting to put my steps up before driving off, trying to back into delivery trucks, and ill-managing other assorted tasks that require focus. Doing without makes functioning, in what already is a fairly complicated lifestyle, more difficult.
After researching I discovered I could could fill my prescription in Mexico and legally bring a controlled substance back across the border–as long as I declared them, AND I had a valid American written prescription.
The process I discovered to keep legal, and myself safe: First, I had to identify a reputable Class I pharmacy that can dispense controlled substances. For this I relied on Raphael, my Dental de Franco guide. He escorted me and introduced me to the pharmacist. Another Julio, coincidentally.
Class I pharmacies should have a Mexican doctor on hand that will review your American prescription and can write you Mexican prescription. You need this to legally have your controlled substance medication on your person on their side of the border. Your American prescription doesn't cover you, and Mexican penalties for having controlled substances without a prescription are harsh.
Then, when you cross back over, declare (you can bring, as of this writing, up to 90 days worth over for your personal use) and show your American prescription. Don't leave it in your pocket! If there is any problem, if you declare, my understanding is the worse that will happen is they will confiscate it and you will be out your purchase. Milligrams have to match milligrams, not number of pills (in the event the pharmacy doesn't carry your prescribed dose).
Other precautions I took were to check the medication name (you'll need to translate) and the expiration date. My medication came in blister packs.
Not filling my prescription would not have been the end of the world. But, I admit, I feel indignation for those I've met that are on disability and with dealing chronic pain or mental health issues. Many of them are trying to find a lifestyle that allows them to remain self-sufficient and manage on their limited incomes, but these regulations create severe obstacles. It is part of a trend I have both studied, and now am witnessing, where poverty is consistently criminalized by our legal system.
Short 180-degree pan of street outside of the Dental de Franco.