Subject: FW: Pending Travel Plans (2)
From: "O'Connor, Kevin C. COL USA WHMO/WHMU" <[email-masked]>
To: "Hunter Biden" <[email-masked]>
Date: Tue, 10 May 2011 11:52:31 -0400

FYI.  Safe travels!

V/R  KO

From: O'Connor, Kevin C. COL USA WHMO/WHMU
Sent: Tuesday, May 10, 2011 11:52 AM
To: 'CHERYL DUNN (VPD)'
Cc: Hartung, Charles S. LCDR USN WHMO/WHMU
Subject: Pending Travel Plans (2)

Cheryl,
Big concern in Mexico is GI - the water is bad, just about wherever you go.  Cook it, boil it, peel it or forget it....  And food that's washed doesn't really help if it's washed with contaminated water.  We gave you plenty of GI packs in the kit - but go ugly early if things start to loosen up.  I'll list some general concerns, and then give you recommended hospital choices for each city.  Air quality in Mexico City is famously among the worst in the world.  Folks with asthma or other lung problems should stay away.  Malaria is not a concern in either Mexico City or Monterey, but let me know if your plans change....  Routine shots.
OTHER CONCERNS

 *   HIV: 6% of sex workers in the capital city are estimated to be HIV positive. Travelers should clearly understand STD concepts and risks for HIV transmission.
 *   Dengue fever presents significant risk in urban and rural areas. Risk is greatest in the states of Vera Cruz, Guerrero (including Acapulco), Morelos (including Cuernavaca), Michoacan, Oaxaca, Jalisco (including Guadalajara and Puerto Vallarta), and Quintana Roo (including Isla Mujeres, Cancun, and areas along the Mayan Riviera); Risk is also significant in the municipality of Los Cabos. Minimal risk in Mexico City. There is a marked seasonality, with more than 90% of cases occurring from July to December. Daytime insect precautions are recommended.
 *   Leishmaniasis (cutaneous), transmitted by sandflies, is widespread in rural areas in the south of the country, especially the Yucatan peninsula including all the Mayan ruin sites, and Coahuila in the north. Daytime and nighttime insect precautions are recommended.
 *   West Nile virus, transmitted by mosquitoes, is found throughout most of Mexico in animals; human cases have been recorded in the northern states of Chihuahua and Sonora along the U.S. border. The disease presents minimal risk to travelers. The elderly and those with compromised immune systems are more at risk of serious disease if infected with the virus. Evening and nighttime insect precautions are recommended.
 *   Chagas' disease (American trypanosomiasis) occurs in rural areas; risk to travelers is unknown but is thought to be negligible. Avoid overnight stays in houses constructed of mud, adobe brick, or palm thatch.
 *   Lyme disease reports have yet to be confirmed by the detection of the bacteria from ticks in this country. Risk to travelers is presumed to be absent.
 *   Brucellosis is common. Travelers should avoid unpasteurized goat cheese (always white in color) and other unpasteurized dairy products.
 *   Air pollution in Mexico City is among the worst in the world and is intensified by periodic thermal inversions from December to February. Likely to exacerbate preexisting cardiopulmonary disease. Some authorities recommend against long stays or residence by children under 12.
 *   Marine hazards may include jellyfish (often causing sea bather's eruption), coral, and sea urchins. Dangerous (potentially deadly) jellyfish are present year-round, but particularly during the rainy season. Children are especially at risk, and adults wading, launching boats, or fishing.
 *   Security-Warning against Travel: Due to escalating violence linked to drug trafficking, a U.S. Department of State bulletin currently advises against all non-essential travel to Michoacan and Tamaulipas and to parts of Sonora, Chihuahua, Coahuila, Sinaloa, Durango, Zacatecas, San Luis Potosi, and Jalisco. Other governments advise against all non-essential travel to the border areas between Mexico and the United States. Other Information: Drug-related violence and crime occur in the border region and along major drug trafficking routes. Travelers should exercise extraordinary vigilance and strict adherence to personal security strategies at all times. The FAA (U.S.) has determined that the civil aviation authority of this country oversees its air carriers in accordance with minimum international safety standards.
 *   Safety Bulletin - Posted April 27, 2011
Since 2006, the Mexican government has engaged in an extensive effort to combat drug-trafficking organizations in Mexico. Military troops and federal police have been deployed. Much of the country's narcotics-related violence has occurred in the northern border region. However, travelers have been injured or killed in violent attacks and firefights in cities across the country, including areas frequented by tourists. The situation in the state of Chihuahua (specifically Ciudad Juarez) is of special concern. Travelers should make every attempt to travel on main roads during daylight hours--particularly the toll ("cuota") roads--and take common-sense precautions (visiting only legitimate business and tourist areas during daylight hours and avoiding areas where criminal activity might occur).
MEDICAL CARE

 *   The best private health facilities in Mexico City are comparable to those in other industrialized countries, though highly specialized cases or complex emergencies may require evacuation to the United States. Adequate care for simple medical problems is available in a few private clinics in major tourist areas. Medical care is substandard outside major cities.
 *   For emergency services, dial 060 or 066.
 *   Training and availability of emergency responders may be inadequate.
 *   Recompression chambers are located in or near major cities and resort towns where scuba diving is popular. Before diving, check that facilities are operational.
 *   Doctors and hospitals expect cash payment prior to providing medical services, including for emergency care. Although credit cards are widely accepted in the general economy, there is no clear information as to whether credit cards are accepted for medical care.

Monterrey

Note:  We haven't been here since 2004, but the TRAVAX assessment is from November 2010.  I believe that this is the best capability in the area.

Hospital San José Tec de Monterrey

Demographic Data Confirmed. Care Preferences Indicated. Last data update: November 2010. Demographic information was confirmed in November 2010. Hospital San José Tec de Monterrey is preferred for the following: basic emergency/basic trauma care and medical cardiology. This facility received JCI accreditation on December 25, 2007 (see www.jointcommissioninternational.org/).

Score and Assessment:
2 - Outstanding; comprehensive specialties. Very high standard of care at the level of major tertiary-care referral hospitals in industrialized countries with respect to short- and long-term outcomes. Almost all medical and surgical sub-specialties are available. Some sophisticated services may be offered. Often affiliated with a medical school.

DEMOGRAPHICS
Hospital San José Tec de Monterrey
Avenida I. Morones Prieto 3000, Colonia Los Doctores
Monterrey, Nuevo León 64710Mexico

GPS Coordinates:
Latitude 25.66750 Longitude -100.35170

Main Phone: [+52] (81) 8347-1010
24 Hr. ER Phone: [+52] (81) 8347-1011
Web Address: http://www.hsj.com.mx
Type of Facility: Hospital
Temporary Facility: No
CARE OVERVIEW
Trauma Level: Level I<Javascript:window.open('https://www.travax.com/scripts/reports/help_trauma_levels.asp#Subjective_1','oHelp','toolbar=no,location=no,directories=no,status=yes,menubar=yes,resizable=yes,copyhistory=no,scrollbars=yes,width=550,height=450').focus();> (subjective equivalency assessment)

POINTS OF CONTACT:

Organization-Specific Contacts

Private Contact 1
Catherine Kazmin
US Embassy Medical Officer
[email-masked]<mailto:[email-masked]>
Phone: 011-52-55-5080-2800
Cell: 011-52-55-5436-6877
Fax: 011-52-55-5080-2380

Private Contact 2
Dr. Francisco X. Trevino Garza
Director of Medical Operations
[email-masked]<mailto:[email-masked]>
Phone: 011-52-81-833-6913

Mexico City

American British Cowdray

Most Recent On-Site Survey: Miller, Stewart - 4/11/2010
Care Preferences Indicated. Last data update: April 2010. American British Cowdray is preferred for the following: surgical trauma team, full invasive cardiology, stroke center, routine pediatric care, pediatric-specific emergency/trauma care, routine obstetric care, advanced life support in obstetrics, and routine primary care. The facility is considered to have excellent technology and doctors.

Score and Assessment:
1 - World class. Internationally recognized for the highest standards of excellence in patient care, medical training, and research. All medical and surgical sub-specialties are available. Provides sophisticated specialized services (e.g., cancer, high-level trauma, transplantation). Almost always affiliated with a leading medical school.

DEMOGRAPHICS
Last confirmed by on-site (full survey) on 4/11/2010
American British Cowdray
Calle Sur 136, Esq Observatorio, Mexico, D.F. 01120
Mexico City
Mexico

GPS Coordinates:
Latitude 19.40034 Longitude -99.20419

Main Phone: [+52] (55) 5230-8000
Type of Facility: Hospital
Number of in-patient beds: 165
CARE OVERVIEW
Last confirmed by on-site (full survey) on 4/11/2010
Trauma Level: Level I<Javascript:window.open('https://www.travax.com/scripts/reports/help_trauma_levels.asp#Subjective_1','oHelp','toolbar=no,location=no,directories=no,status=yes,menubar=yes,resizable=yes,copyhistory=no,scrollbars=yes,width=550,height=450').focus();> (subjective equivalency assessment)
Cardiac Capability: Invasive cardiology with cardiovascular surgical support

POINTS OF CONTACT
Last confirmed by on-site (full survey) on 4/11/2010
General Public Contact:
Nancy Stich
Public Relations Officer
[email-masked]<mailto:[email-masked]>
Phone: 5230 8085

Organization-Specific Contacts:

Private Contact 1
Dr. Jorge Cervantes
Professor of Surgery
[email-masked]<mailto:[email-masked]>
Phone: 5252-3410
Cell: 04455-5500-0909
Home: 5596-0730
Excellent resource: Trained in DC (Georgetown, GW). Department head of Surgery

Private Contact 2
Gail Sims, (Nurse Practitioner)
Medical Attache
[email-masked]<mailto:[email-masked]>
Phone: (52)55-5080 x2800
Cell: 0445591971084
Head of Embassy Health Unit until June 2009

For Dental care, would recommend to use the presidential hospital. It has a modern dental set-up in a secluded hospital setting where dentists are on call or can be called in. Coordinate this thru Gail Sims.

Hospital Central Militar

** A Military Hospital - not entirely sure that you could use it - use American British Cowdray as primary, but this would be worth knowing about, depending on threat....

Most Recent On-Site Survey: Shoreland Processor - 4/11/2010
Care Preferences Indicated. Last data update: April 2010. Hospital Central Militar is preferred for the following: surgical trauma team, full invasive cardiology, and stroke center. Excellent trauma and surgical capabilities. Excellent cardiovascular capabilities. The facility is considered to have excellent technology and doctors.

Score and Assessment:
2 - Outstanding; comprehensive specialties. Very high standard of care at the level of major tertiary-care referral hospitals in industrialized countries with respect to short- and long-term outcomes. Almost all medical and surgical sub-specialties are available. Some sophisticated services may be offered. Often affiliated with a medical school.

DEMOGRAPHICS
Last confirmed by on-site (full survey) on 4/11/2010
Hospital Central Militar
Colonia Lomas de Sotelo, Mexico D.F. 11649
Mexico City
Mexico

Main Phone: [+52] (5557) 3100
24 Hr. ER Phone: [+52] x1232
Facility Ownership: Military
Type of Facility: Hospital
Demographics Comment: Military hospital with secured/guarded access. This is the facility used to treat the President of Mexico.

GPS Coordinates:
Lat. N 19 deg 26.31' Long. W 99 deg 12.88'

CARE OVERVIEW
Trauma Level: Level II<Javascript:window.open('https://www.travax.com/scripts/reports/help_trauma_levels.asp#Subjective_2','oHelp','toolbar=no,location=no,directories=no,status=yes,menubar=yes,resizable=yes,copyhistory=no,scrollbars=yes,width=550,height=450').focus();> (subjective equivalency assessment)
Cardiac Capability: Invasive cardiology with cardiovascular surgical support

POINTS OF CONTACT
Last confirmed by on-site (full survey) on 4/11/2010
General Public Contact:
L.M. Garcia Nunez
trauma surgeon
Phone: 3539-1581
Lead trauma surgeon on one of the trauma teams. Very good English.

Hope this helps!  Safe travels!

V/R  Kevin

Physician Public Contact:
Rosario Valenzuela
ER head nurse
Phone: 555-54-8883
Good English.

Kevin C. O'Connor, D.O., FAAFP
COL, MC, USA
Physician to the Vice President
Office:  202-757-2499
Mobile:  202-757-7633
Home:  410-721-8927
[email-masked]