Wealth International, Limited (trustprofessionals.com) : Where There’s W.I.L., There’s A Way

W.I.L. Offshore News Digest :: December 2009, Part 4

This Week’s Entries :


“A country, just like a business, must decide what it is and what it wants to be. Then it has to have the discipline to make a plan and stick to it in order to be successful in the branding game.”

A gentleman who services the construction and real estate development industry in the Dominican Republic interviewed Marta Vallejo, the CEO of Spanish company which specializes in “Place and Country Branding.” Like beer, shampoo, cars and financial services, tourist destinations need to create a brand awareness to be successful. A particular challenge for a Caribbean island is to differentiate itself from the other islands. Not easy when the default image is sunny beaches, palm trees ... and not much more.

What about the Dominican Republic? According to Ms. Vallejo, “Dominicans have a unique and kind personality that is almost impossible to find anywhere else in the world, so that also has to be a part of their branding.” And, “Dominican Republic has a wonderful colonial city, with monuments that are the first in the American Continent, yet in Europe we believe that Cuba has the colonial heritage, not the DR.” Further, “Costa Rica has taken the eco-tourism brand, yet I just learned that the Dominican Republic has many micro-climates that are not told to the world – ranging from deserts with dunes, temperatures of zero degrees in the mountains, tropical rain forests and desert forests – it is a nice combination that nobody knows about.”

So the DR has lots of good raw material. But it has yet to be effectively sold.

“The need to differentiate the Dominican brand from the rest of the Caribbean is a key to the tuxury market”

This past month I had the wonderful opportunity to interview Marta Vallejo, CEO of Granta Place and Country Branding, a consulting firm that specializes in Place and Country Branding located in Spain. In this age where globalization tries to make everything the same, travel, tourism, and the perception of each country, is not immune to being perceived as “more of the same” and that the only differentiation between all the diverse nations is price.

In our quest to be able to differentiate our tourism offering with more options and value added alternatives, I have learned that branding is a major key to differentiate and to succeed in the business and tourism worlds of the Caribbean.

The Caribbean has to make sure that it is perceived differently and especially the big islands like the Dominican Republic.

Marta was very illustrative in letting us know “the Caribbean has to make sure that it is perceived differently, and especially the big islands like the Dominican Republic, it must show the world that as a traveler the experience will be different visiting the DR than Jamaica or Cuba. This is the challenge of place and country branding.”

In our interview she was kind enough to share her ideas and opinions with us. Our objective is to offer our readers, developers and investors an overview on the whole concept of place and country branding and the need for it in the Caribbean and in particular in the Dominican Republic to differentiate our offer to the world, simply and effectively.

Guitze Messina: Granta specializes in Place and Country branding, why do you believe that what you do is important and why so few places and countries do it?

Marta Vallejo: Place and country branding is a new specialty, it is related to marketing but it also has the influence of diplomacy and governments that want to attract a share of the travelers that vacation every year all over the world. It is not used extensively for various reasons:

(a) it has to be planned for the long term
(b) it must use mega events, for example the Olympic games, international fares, the world cup, etc.
(c) it must use trade events repeatedly using the same message for a long time (d) it is a relatively new specialty and more and more countries are becoming aware that they need it in order to compete, but it is just beginning and that is the main reason so few countries use it today, but it is soon becoming an important strategic weapon

What would be the typical process to follow in order to brand a particular country or place?

The process would vary depending on the needs of the sector that is determined to brand the specific location or country. It is usually a combination of the private sector and the public sector, but the process has to be adapted to the needs of the players and the specific differences that each country offers that are sustainable for the long term and are 100% real and verifiable by the traveler.

The variables that are always present, but not necessarily in this order, are the following:

1) You need to think long term: To make a brand you need time and for a country there are also previous perceptions that take time to change, that it is why the government is also involved with education, planning and development. The private sector must be involved as well and because it is a long term plan – and situations will come and go which can deviate you from it.

You must do your outmost to stick to your plan and make sure that the things that do change are for the benefit of society as a whole. In other words, you may adapt your plan, because it is long term, but you must stay in course.

2) Your communication has to be 100% real, always: After everyone agrees on what to change to, all communication must be real – 100% of the time. In this age of fast communications if you say something that is not true, it will be in the internet in two seconds and your message will fall apart.

3) We are all in the same boat: Everyone must communicate the same message with actions and words, and we must forget our particular self-interests for the benefit of the country. The private sector, the government, the tour operators and the hotel owners must forget that inside the country they are competing and they must think about “the message” that must be given; and that message must be “lived and acted upon in the same way” by everyone of those players.

These steps are always a part of the process, but the formula will always need more ingredients depending on the needs of the particular country or place.

More and more we find that tourism requires “an experience.” Could a country or a place always be able to differentiate their experience from another, and I truly mean, always?

Yes, what you need to do is to detect the essence of each location, their history, their people, and their natural wonders and mix them in a way that only that particular place can call its own. You have to be able to put emotion behind the message and that emotion has to be held together by that experience.

You need to have a “collective mentality” where all of the players have to pull together in the same direction and think about the whole, not just their specific business.

You also need to have a “collective mentality” where all of the players have to pull together in the same direction and think about the whole not just their specific business. If you combine the right message with the right “collective mentality” you will be able to succeed in the long run, without a doubt.

How frequently does Granta have to work united with the private sector and the government?

Almost always the government is the one that looks for our help with a determined idea or desire for branding their particular differences, but the private sector has to play its role and in the end our consultants work in close connection with both and using the input of all the players.

Could you give us an example of how one of your clients was able to change their branding?

Granta is a new company with partners that have worked together in many previous projects and we just decided to keep working together under one company. If you take into consideration that place and country branding takes a long time in order to succeed, then Granta as a company requires more time to show those results. With that said, many of the consultants that work at Granta today worked for the branding of Spain as a new tourism destination featuring sun, beach and more.

We must remember that Spain was perceived as a poor European country back as the 1970s. We worked with the government in order to change this perception and many steps were taken to insure the success of this effort. Here are some of them:

1.) The government got together with the different sectors and decided to work in conjunction towards the achievement of economic and social improvement.

2.) I was a part of a team that within the diplomacy of the country worked in order to use mega-events, such as the Olympics in Barcelona and the International Fare of Seville, to show the world how much we were changing.

3.) We all communicated the same message “Smile You Are In Spain” to show that we are a new and vibrant, happy society to the world.

4.) We kept adapting the message by using the new communication devices, like email, the web, social media, etc.

Today Spain remains the largest sun and beach destination in the world and has become the second most visited country in the world. We were able to tell the world that we are now a modern country, safe and fun to visit. That is what place and country branding can do.

How much does your company have to know about trends in tourism and how does that help you in your consulting work?

It is very important; we have a department that is in charge of getting and analyzing tourism data. The key is that the trends are just a raw material, you cannot start from the end, you must first see what each country or location has to offer and then try to fit those differences into what the world trends are requiring. So the first step is always to find the essence of the place and then to use the “demand trends” to take advantage of those differences.

I have visited some Caribbean islands as a tourist only, but I can say that they are all totally different, yet they are mostly sold just as sun and beach in Europe.

What are those trends telling you about the Caribbean?

I have visited some Caribbean islands as a tourist only, but I can say that they are all totally different, yet they are mostly sold just as sun and beach in Europe. For example the Dominican Republic has a wonderful colonial city, with monuments that are the first in the American Continent, yet in Europe we believe that Cuba has the colonial heritage, not the DR.

I also think that the people are totally different. Dominicans have a unique and kind personality that is almost impossible to find anywhere else in the world, so that also has to be a part of their branding.

Costa Rica has taken the eco-tourism brand, yet I just learned that the Dominican Republic has many micro-climates that are not told to the world – ranging from deserts with dunes, temperatures of zero degrees in the mountains, tropical rain forests and desert forests – it is a nice combination that nobody knows about.

Many Caribbean nations are looking forward to 2012 when the baby boomers start looking for their home in paradise, Panama is betting on that trend and recently decided to market their country with Costa Rica. Cuba is opening and soon will be a market to consider, so the scenario is there. The country that brands itself and sends the correct message will stand a better chance to participate in that future.

What would you like to add regarding this fascinating subject of place and country branding?

A country, just like a business, must decide what it is and what it wants to be. Then it has to have the discipline to make a plan and stick to it in order to be successful in the branding game. We hope that the Caribbean countries learn this lesson soon, and being in the DR today I certainly think that the opportunity and the raw materials are presently here to succeed.

Thanks Marta, for your ideas and we certainly hope that your interview serves as a call to action on many Caribbean countries and specially the Dominican Republic – after all there is just one place in the world where Columbus started to colonize the rest of America.


Rest, recreation and reconstruction for the body on the Yucatan.

Are you in the market for medical care? Looking for prompt service, courteous and caring staff, qualified professionals, attentive and concerned doctors who make time for you, state of the art technology and excellent value? As the writer here puts it, happy hunting trying to find all six of these aspects in Canada, the U.S. or Europe these days. So where does one go to find all six ingredients?

“Medical tourism” is becoming a big business. You can fly half way around the world, get similar or better care than at home, recuperate in a resort-like atmosphere, and fly home when you are good and ready, all while – the kicker – paying less and waiting shorter than if you stayed home. Even if you have insurance. Some health insurance companies are paying to have clients make such a trip due to the savings.

India was the first medical tourism destination which came to our attention. But Western Hemisphere residents can fill their needs without making such a strenuous flight. This article features a very convenient destination indeed, as candidates go: the city of Merida on Mexico’s Yucatan peninsula. It will come as a revelation to those previously unaware of just how good the quality/value ratio is for medical care south of the border. This article supplies details such as where to stay in Merida, should one choose to take advantage of its medical amenities.

Citizens of many advanced countries continue to encounter astronomical health insurance premiums, snail pace scheduling of treatment, out-of-control doctor and hospital costs, and excessive exclusions for procedures they need – not to mention the misery of millions who have neither health insurance nor access to affordable services whatsoever. Is there hope?

As we say Adios to this first decade of the millennium, smart consumers are crossing international borders in greater numbers for health solutions. Where can you find: “Bienvenidos” to Merida, Yucatan, Mexico.

My first successful medical procedure in Merida was a colonoscopy. Next, I had an operation – a complex sphincterectomy and closing of a fissure requiring a spinal injection from an anesthesiologist, plus removal of a small tumor. And, this too was a success.

And why would it not be a success? After all, if it is good enough for the President of the United States, then it is good enough for me. One of three major private hospitals in Merida, Star Medica Hospital & Clinic is the same one that in 2007 underwent extensive scrutiny for the visit of the President of the United States. Based upon high quality doctors and staff, advanced technology, and sophisticated infrastructure, this hospital met the rigorous requirements for White House certification should something have happened to the President on his visit to Merida.

Where in the World is Merida, Yucatan?

Located on the huge Yucatan Peninsula of Mexico, Merida is the capital of the state of Yucatan. She is both a modern city (Wi-Fi in all parks, box stores, universities, mega-screen malls, art premieres, international concerts) and historical city (ancient Mayan ruins, 400-year old colonial architecture, centuries-old opera house, and generations of traditions) to well over 1 million residents. The 200-mile wide Yucatan Peninsula sticks out like the thumb on your left hand, jutting out into the Caribbean on one side; Gulf of Mexico on the other; and Cuba just across the Yucatan Channel.

For centuries this distinctive geography kept the Peninsula culturally closer to Europe, the Caribbean and Central America, and even New Orleans. After all, Merida’s main boulevard, the Paseo de Montejo, was fashioned after the French Champs Elysees. And then there is the taste of the Caribbean where many Yucatecan dishes are wrapped in banana leaves. Lastly, many are unaware of the historic ties between Merida and New Orleans (approximately the same line of longitude) that led to a cultural-economic Sister City agreement in 1990 and was renewed in the fall of 2009.

And the area is so different that at one time the Yucatan even declared its independence for several years. Yes, it is definitely a long way from Mexico City and the rest of the country – in many ways. Today, Merida, statistically one of the safest cities in all of North America, seems light years away from the perils that plague other metropolitan centers in the Western Hemisphere.

Merida is certainly not without its own urban problems – particularly an ongoing population mini-explosion fueled by migration from within Mexico’s borders, and to a lesser extent more foreigners discovering its many benefits. But Merida does remain one of the few North American cities where you can still walk the streets at night safely. Merida’s closest familiar neighbor is Cancun – a 200-mile ride from the Mexican Caribbean. Merida is 20 degrees North, 89 degrees West; or roughly 700 miles southeast of Houston; the same distance southwest of Miami, and ditto the number of miles west of Kingston, Jamaica – and almost the same distance from Mexico City.

The all-inclusive costs for my Merida colonoscopy were $285 (vs. $900-$2000 in the States). Performed delicately by Dr. Icaza, the operating room was pristine. After the procedure Dr. Icaza took the elevator and sought out my friends in the cafeteria.

Then she led them upstairs for her detailed narration of the video procedure.

No charge for added humanity.

2nd Operation

Fast forward one year. At check-out the pain medication was doing its duty, but now a new, mental pain emerged as I approached the “Dreaded Discharge Desk.” Yes, I have complete private insurance coverage (only $1500 annual premium) obtained here in Mexico (See the information about Insurance, in Part 2 of this article, January, 2010 issue). And yes, I realized that the costs were low. But then thought – I do have a deductible and then maybe I will be hit with a large co-pay and all of those “other” charges. Frankly, that is what I expected as I knew that similar costs in the States could exceed $10,000. So I grimaced when the official pulled my hospital folder, now a full 1-inch thick. I did not want to look.

When she took the first medical invoice off the top of the pile it was for several extra bottles of water – to the tune of $3. I awaited more invoices. But it did not happen. That was it. I was 100% covered with no deductible owned and no co-pay. She smiled, said “Gracias,” bid me “Buenas Tardes,” and professionally, took her leave. Stunned more by surprise than medication, I felt paralyzed. Perhaps this was a mistake? As an old jock, I thought of sprinting for the door, but realized I was still in the discharge wheelchair. Later, my Yucatecan insurance agent called me at home to see how the discharge went and how I was feeling. I thanked him for his help but did not mention that I had paid only for water. This was too good to be true – but it was true.

“No habla Espanol?”

If speaking Spanish fluently was a pre-requisite to access quality health care in Merida I would be out of luck. My semi-functional Spanish would grade out to a “D.” I find that nearly all physicians here speak English since most have had training in the States or the UK or mastered English from an earlier time; some nurses speak English, but many do not; most receptionists do not speak English. But they will find someone who does!

Dr. Araujo, a gastro-enterology surgeon in Merida has a reputation for devotion to his patients and a witty presence. And then those credentials: international post-medical school training as a Harvard Surgical Fellow and a 2-year stint at Southampton University Hospital in England could not keep Dr. Araujo abroad – he came home to Yucatan to serve and is proud of it.

The team is enriched with the young and intelligent Dr. Icaza, gastroenterologist and the tour guide of my colonoscopy. Together, she and Dr. Araujo have assembled a proactive health group by adding a licensed nutritionist plus a coordinator for English-speaking patients. “We have seen the number of our U.S. and Canadian patients double in the last two years at our clinic. Through recommendations and referrals the word is getting out about the high quality of medical care in Merida,” states Dr. Araujo, who is also licensed in the United States and Europe

And the benefit of Karla Presuel, formerly a medical assistant in Riverside, California, and now in her second year as the English Coordinator for the group, “We are here for our foreign patients whenever they need us. In fact, they can call on us to make appointments for them with doctors in other specialty areas.

And if there is a language barrier on a trip to the Emergency Room they can simply request that we be contacted to assist – day or night. We give patients our cell numbers so they can contact us anytime.” The group established an Obesity Clinic and works closely together in providing laparoscopic gastric bypass surgery and the intra-gastric balloon procedure for qualified patients. (Please check out the Elective Surgery information in Part 2 of this article, January 2010 issue).

Christy’s Hormone Replacement Therapy

A regular at the Emergency Room, Christy, “a woman of a certain age,“ goes to obtain her monthly estrogen-testosterone cocktail for her selective lifestyle.

“Although not really classified as an emergency, it is the hospital’s policy to have the injection administered in the ER with a doctor’s prescription,” states Christy who jokes, “If I gave my real name in this interview I might have too many gentleman callers at my door!” And yes, to some adherents of HRT it really is an emergency!

And readily available: in Merida, it is the woman’s decision along with her physician. Christy purchases the hormone mixture – with syringe – from the pharmacy for about $10. Then at the hospital she pays – including nurse, emergency room, administration of the injection, and tax – a grand total of $4. “But I do have to supply my own band-aid,” laughs Christy.

Mike’s Emergency H1N1 Scare

When the flu scare began last spring, long-time Merida resident Mike Riniolo developed H1N1 symptoms and was rushed to the Star Medica ER. Mike recalls:
“They called in an epidemiologist who was also the Public Health Service specialist. Because I have a rather lengthy medical history, he then called in a specialist in internal medicine. Together, these two doctors brought me back to health and ascertained that I did not have the Swine flu or any other flu, but did have bronchial pneumonia and treated me accordingly. Incredible care by incredible professionals!

“I am not saying that the care I received in the U.S. was not good, it was just much better here in Mexico.”

“Having been hospitalized several times in the U.S., the overall quality of care and compassion I received here in Merida actually surpasses that which I have received in the U.S. I am not saying that the care I received in the U.S. was not good, it was just much better here in Mexico. The hospital staff was far more cordial than I would have expected or that I ever experienced before anywhere.

“My 3-day hospital stay in Merida, including admission through the emergency room, admission to a private room, two professional medical specialists, a host of nurses and hospital staff members, multiple x-rays, throat and nasal cultures, extensive blood work, a series of other lab tests, and all my medications, cost me the equivalent of just an emergency room visit to a hospital in the U.S. My total bill (Mike did not have the insurance applicable to Mexico) was just over the equivalent of $3,000 US. I was totally amazed to say the least.”
Consumers First!

Solid, quality medical care should mean: Savvy consumers look to alternatives in health care that combine all of these aspects. Certainly there are many choices these days with the spread of Medical Tourism from India to Thailand to Juarez, Mexico.

But do you really want to be laid up in Calcutta so far away? I know Bangkok is fun to visit, but I would not want a hip replacement there. And sedated in a border city has no appeal to me either. ... This is why for the last 5 years; I have had ALL of my medical treatment in Merida, Yucatan. And, my dental care too!

Try to find all six of these aspects in Canada, the U.S. or Europe these days and, well, happy hunting to you. So where does one go for quality medical treatment that encompasses all six ingredients? More and more foreigners are discovering the hospitals and clinics of Merida, Yucatan.

Routine Office Visits

Be prepared to spend up to an hour actual face time with the doctor. Nearly all doctors in Merida take their own notes, enter your data in their PC as they interview you, and conduct the routine blood pressure, pulse, and height and weight checks themselves.

Office hours are generally early morning until 1:00 p.m. and then again in the evening, making appointments consumer-friendly. You can make them a day or more in advance, but it is always okay to simply “show up” and they will fit you in, regardless.

And if this is not enough good news already then consider this: patients actually are responsible for retrieving and keeping their own records (blood test results, x-rays). So you can have multiple appointments the same day and easily show your records to each specialist you see. Routine visits cost between $30 and $45.

Altabrisa Zone: Your Recommended Destination in Merida

A new Medical-Shopping zone that has blossomed in the last couple of years is called the Altabrisa Zone located in the northern, newer part of Merida. It is here that you will find a six-lane boulevard and new, modern hospitals – including Star Medica Hospital & Clinic and Hospital Alta Especialades – plus a 20-screen mega-shopping mall (Sears and others) sandwiched between the two major medical centers.

There are convenient and comfortable accommodations in Altabrisa plus restaurants (Boston’s, Chili’s and other chains as well as restaurants serving local and regional fare). A brand new UNO/ADOGL bus station offers 1st class express, non-stop service to Cancun International Airport for visitors coming into Merida from Cancun (Read more on How To Get Here in Part 2 of this article, January, 2010 issue).

Where to Stay: Closest to the Altabrisa Hospitals

A tourist, convention, and medical services destination, Merida offers an array of accommodations to fit every budget. From the more expensive anchored by the Fiesta Americana and Hyatt in colonial downtown to over two-hundred lesser priced hotels and B & B properties scattered throughout the city, Merida has it all (including both urban and rural hacienda stays – most in the upper range of rates).

However, there are few quality accommodations in the proximity of the Altabrisa Zone – the new Medical Zone of Merida – offering both value and convenience.

In Ka’an

Now in its 15th year, In Ka’an caters to a nearly all foreign clientele from November through April (and currently 50%-50% American & Canadian). Smack-dab in the middle of the Altabrisa Zone In Ka’an is a one-of-a-kind spacious retreat with a relaxed, intimate feel. What you find behind the tall white walls is surprising: sprawling well-manicured grounds and gardens.

Less than a two-minute drive, Canadian-owned In Ka’an is just several blocks from the nearby clinics and hospitals. The Torontonian owner offers accommodation types to meet all needs. In fact, In Ka’an offers more variety in accommodations choices than any other place in the greater Merida area.

Depending on the desired length of stay, you and yours have a choice of a very comfortable bed and breakfast room in the Main House for several nights to a rental house, apartment, or townhouse for longer stays (all accommodations come well-furnished). Owner Bonnie Wrenshall and her sidekick Pat Tapia Hopkins offer the right personal touch in catering to their guests.

3 Bed & Breakfast Rooms (80/single; 90/double)
2 Guest Houses (625-650/week)
4 Townhouses (575/week)
3 Apartments (425-600/week)

A/C, Pool, Free Wi-Fi, Communal Cable TV/Media Room, Medical Massage Therapist Available, Laundry, Pet-friendly. Website here. (I stayed at In Ka’an prior to and after my most recent Altabrisa hospital stay where I recovered in peace for several days).

Lumi Bed & Cocktails

A laid-back hideaway, Lumi is thankfully NOT your granny’s sweet little bed and breakfast. And contrary to its libations name, this adults-only accommodation is the quietest anywhere in the Merida area. Inviting pathways traverse lush, tropical gardens guiding you to a refreshing pool, palapa with hammocks, a soothing waterfall and fountains, multiple patios and a sun-drenched roof top terrace (which becomes moonlit after dusk).

With so many private areas, you can be quite the recluse if you choose. Lumi offers 3 modern king bedroom lodgings for short-term stays (2 nights to 2 weeks) and will indeed provide breakfast as well as welcome cocktail or wine from the patio bar. The ex-pat owner also doubles as cook and bartender extraordinaire. Besides breakfast, arrangements can be made for other meals upon request.

An innovative and welcome alternative, Lumi is located just north of the Altabrisa hospitals. And a brand new, no-traffic highway puts you there in 10 easy minutes or less. A peaceful and secure setting in the country with no next door neighbors. King Rooms at $85/night/double. King Beds, A/C, Pools, Free Wi-Fi, In-room Satellite TV, Private Bar, No children. Opening Spring, 2010. Website here.

Meson de la Luna Hotel & Spa

Directly across the street (literally less than 50 steps door-to-door) from Star Medica Hospital is Meson de la Luna offering rooms, suites, and even a penthouse. The most convenient location of any accommodation – no driving required – for some it may be too close to the hospital. And at times it is perhaps too noisy as the emergency room drop-off is in clear hearing range and the parking lot is in front of the hotel rooms.

But the attractive ease of access may just overshadow the potential of an occasional noise interruption for many patients or their loved ones or friends. The UNO/ADOGL mini-terminal with non-stops to and from Cancun is in the same block adding to the hotel’s prime location. And the mega-shopping mall is only 100 meters away. Rooms starting at $80/night.

A/C, Wi-Fi, In-Room Cable TV, Mini-Bar, Laundry. Site here.

NOTE: Costs in this series are converted from pesos into $U.S. dollars. The United States is used for comparing costs (listed in parenthesis as noted).

Be sure to look for part 2 of this article coming in the January, 2010 issue. That article will feature information on:

Merida Medical Tourism, Part 2

Geography and good value make Merida the most attractive medical tourism destination in North America. Private medical and dental procedures cost 30% to 90% less in Merida, Yucatan compared to similar procedures in the United States. And you just cannot beat the location.

A 2009 Medical Tourism Association study cited here found that “63% [of respondents] said the foreign medical care was better than it would have been in the U.S. [with] 37% stating that it was equal to what they would have received at home.” So 100% said they received equal or better care than they would have received at home! Do we really need to go any further?

Here is the second of two parts on the virtues of Merida, Yucatan as a destination to fufill your medical needs. The writer, Alan Graham, is a guide and widely published freelance writer who focuses on the Yucatan Peninsula. He also spent several years as a relocation and investment consultant guiding foreigners in establishing a home in Yucatan.

Are there problems with the idea that are being overlooked? Most objections to the idea of obtaining medical care in a foreign country are based on ignorance. Followup care back home will have less continuity than a complete home-job, so you do have to intentionally make sure that relevant information is retrieved and lands in the right place. Often this means hand-carrying your information back home. What a concept.

The traveler must, of course, always be cautious of the overly broad generalization. But I am an American, and a paucity of data does not stop me from making sweeping vague conceptual statements and, if necessary, following these statements up with troops.” ~~ George Saunders, from “A Brief Study of the British” in The Braindead Megaphone Essays

Eventually we expect the AMA and their medical/industrial complex fellow conspirators to create some roadblocks, and follow up with troops if too many captive customers fly the coop. So far they have muttered darkly that medical tourism is fine as long as long as certain principles, including proper accreditation – their accreditation, of course – are adhered to. The bottom line is how good are the caregivers. Who cares who says they are good besides their patients and clients? We would expect initial pressure to come via restrictions on what gets reimbursed by health insurance companies. We shall see. If costs are less in a foreign country than the deductible in the home country this would not be much of a disincentive.

Geography and good value make Merida the most attractive medical tourism destination in North America. Merida offers the highest quality treatment at low costs combined with a well-situated and safe city. And, private medical and dental procedures are 30% to 90% lower in Merida, Yucatan compared to similar procedures in the United States. And you just cannot beat the location. Why spend more money flying elsewhere?

Ex-pats living on the Yucatan Peninsula have already learned the fine features that Merida offers the Medical Tourist: Travel for the Health of It

A 2009 Medical Tourism Association (MTA) study shows over half of patients who sought care in a foreign country used a company as an intermediary to facilitate their trip and treatment. 93% felt “very safe” or “safe.” And 63% said the foreign medical care was better than it would have been in the U.S. and 37% stating that it was equal to what they would have received at home. Reasons for going:

32% Weight Loss / Bariatric
22% Orthopedic
12% Cosmetic
2% Spine
32% Other

In Merida, a complete facelift and neck lift cost about $10,000 ... compared to $30,000 and up in the U.S. ...

The Deloitte Center for Health Solutions forecast that by 2015, between 10 and 20 million Americans will travel abroad for treatment each year. The economic slowdown did cause some medical tourism patients to postpone elective procedures that involve big out of pocket costs.

The exception is cosmetic surgery where medical tourism continues to boom. The cosmetic surgery profile is 86% female and middle class, with 60% having an annual income of less than $90,000. In Merida, a complete facelift – and additional necklift, eyebrows, and forehead procedures – cost about $10,000 including surgeon’s fees, hospital stay and anesthesia, compared to $30,000 and up in the U.S. for the same package.

Dental Care in Merida

Among the busiest dentists in Merida is Dr. Javier Camara. Another Meridano who returned to serve at home, he traces his family tree to the 1540s Spanish colonists.

Foreigners account for 50% of his patients at his dental offices in Altabrisa and Garcia Gineres. While most are Americans and Canadians, 1 of 4 is from Europe and other countries.

Recently as I was packing to leave Merida, I cracked a huge chunk from my molar on a Friday and Dr. Camara saw me immediately, drilled, and made crown impressions. Just two working days later he set the new crown in perfectly. While the charge was a tad more than normal for the emergency crown creation, the total cost was still 70% less than what I pay in the States.

Dr. Camara spent six years of training in Oral Rehabilitation in Houston. Further study at UCLA and Mexico City earned him degrees in Implantology and Orthodontics. Currently he is an Affiliate Member of the American Dental Association and the World Federation of Orthodontists. “For updates in my fields of expertise, I attend the Greater Houston Dental Meeting and other professional conferences. Twenty people work with me in the offices including an oral surgeon, a periodontist, an endodontist, a pedodontist and several general practitioners.”

Flight, hotel, and dental work less than the dental work alone back home.

Some of Dr. Camara’s foreign patients even plan their vacation around scheduled major dental work. At the conclusion of their appointments they visit the Mexican Caribbean beaches or enjoy colonial Merida. Their flight, hotel, and dental work are less than the dental work alone back home.

Here is a breakdown of some typical dental procedures and their costs: (Please note that prices quoted by Dr. Camara & Associates are converted from pesos to U.S. Dollars. Comparable U.S. price ranges in parenthesis. Quotes throughout the article are approximate costs.)

Patsy Parker’s Cancer Scare

When Patsy made an appointment with an Oncologist at Star Medica Hospital & Clinic it was for a bothersome calcified growth on her jaw line. She had no idea Dr. Victoria would discover a potential thyroid cancer danger unrelated to her visit.

First, Dr. Victoria escorted her to Radiology for X-rays that revealed a heretofore unknown growth in her thyroid. Dr. Victoria scheduled her for the next morning with another specialist, an Oncology Pathologist, who would perform an in-office fine-needle aspiration biopsy.

However, they could not palpate it correctly and changed strategies immediately. Following a quick phone call, Patsy and the doctors met with a 3rd physician just 30 minutes later who performed the identical procedure – but this time a transendoscopic ultrasound-guided, fine needle aspiration biopsy.

“All 3 doctors were in the room for my entire procedure. It was incredible. I was scared, but felt so cared for and the doctors were all so comforting and sensitive. The very next day I went back to Dr. Victoria’s office to learn that the tumor was benign – but still a thyroid problem,” cautioned Patsy.

Dr. Victoria referred Patsy to an Endocrinologist the following day. With advanced training from the University of Texas-San Antonio, Dr. Cervera would take the reins. “The new doctor is medically managing my thyroid problem satisfactorily. It was quite a week and I was so happy by how quickly everyone responded to my crisis – I surely didn’t wait long for the good no-cancer news!” exclaims a very relieved Patsy Parker.

Treatment for 3 days, including all medical procedures, hospital costs, lab work and the attention of four doctors was less than $300 – without insurance!

Patsy’s treatment for those 3 days, including all medical procedures, hospital costs, lab work and the attention of four doctors was less than $300 – without insurance. In the U.S., the procedure, hospital and lab costs alone run upwards of $2,000.

Medical Trip Companies – Your Liaison to Travel Health

Travel agents have been booking health vacations for years. But due to the increased popularity of medical trips abroad, many Medical Tourism companies have emerged. In Canada, over 20 companies exist for the sole purpose of arranging all-inclusive trips for patients. And in the States many times that number.

Another sign of the growth of this industry can be seen in the number of newer annual conferences, including this year’s 4th Annual World Health Tourism Conference and only the 2nd year for the World Medical Tourism Conference.

A need exists for knowledgeable, ethical, and caring medical travel managers. A welcome consumer-friendly innovation is when U.S. and Canadian ex-pats (who actually live in the patient’s selected destination city) serve as on-site facilitators in the “foreign host city” – where the patient receives the medical treatment – rather than to administrate long-distance from the faraway “departure country.” Having afellow countrymen there in-person coordinating your stay, and even providing hand-holding along the way, is reassuring in making your foreign health experience a success.

One out of three medical tourists travels for weight-loss surgeries known as bariatric surgery

Weight Loss Surgery in Merida

One out of three medical tourists travels for weight-loss surgeries known as bariatric surgery. As an elective surgery this popular choice changes your digestive system, usually limiting the amount of food you can eat. According to the Mayo Clinic, these surgeries help you lose weight and can lower your risk of medical problems associated with obesity.

Laparoscopic Gastric Bypass is the most frequently performed bariatric surgery. Many surgeons recommend gastric bypass surgery because it usually equates with fewer patient complications than other weight-loss surgeries. It is a surgical procedure that causes weight loss by simply reducing the quantity of food intake by lowering absorption.

Another weight loss strategy is the placement of a balloon, known as the Intragastric Balloon, in the stomach basically decreasing your stomach’s storage capacity.

Take a look at Clinica De Obesidad at Star Medica Hospital in Merida. The team consists of a Gastroenterologist, a Laparoscopic Surgeon, a Nutritionist, a Psychologist and the Coordinator for English speaking patients. Several consumer-friendly health packages are personalized to each patient’s particular need with an overriding mission: combine the correct treatment with lifestyle changes in nutrition, physical activity, behavior, and diet.

For about $14,000 US all-inclusive costs (expect to pay at least double to triple that amount in the U.S.) Gastric Bypass at Clinica de Obesidad includes:

1) Doctor and Surgeon’s Fees
2) Anesthesiologist
3) Operating Room Costs
4) All Hospital Costs Including Your Stay (3-4 Nights), Medications
5) Up to 5 Pre- and Post-Op Consultations with each Doctor
6) Up to Double that number with Psychologist and Nutritionist

Intragastric Balloon

This procedure is performed on an outpatient basis and runs about $3000 US all-inclusive costs. ...

American Medical Association Gives Green Light

Surprising to many, the American Medical Association in 2008 adopted an officially “neutral” position on Medical Tourism. But the AMA shows “de facto” endorsement for Americans seeking health care in other countries. They state “our AMA advocates that employers, insurance companies, and other entities that facilitate or incentivize medical care outside the U.S. adhere to the (nine) principles.”

The AMA principles acknowledge that there are advantages to seeking medical care outside of your own country. Some principles are sound while others – including accreditation issues – are controversial. Experienced medical travelers know that obtaining a mandated type of accreditation does NOT always guarantee quality health care.

Many superior foreign hospitals may not even consider the AMA’s recommendation on certification or accreditation because they see it as an unnecessary duplication of accreditation – their current accreditation may already be sufficient, and perhaps it is simply too expensive to seek another accreditation.

After all, patients seek health care in foreign nations because their own country’s medical and insurance establishment makes medical care prohibitive one way or the other. It is wiser to combine the recommendations that make sense to you, with the positive experiences and success stories of other “veteran” medical tourists when selecting the right physician and hospital.

The AMA provides welcome support for a consumer’s right to choose medical care across borders. However, there are political agendas as the AMA and others intend to craft and support legislation “regulating” Medical Tourism.

Timely Travel to Merida

On any given day you can cruise Merida’s medical centers and spot license plates from Belize, Guatemala, and Honduras as well as U.S. and Canadian plates. Most recurring U.S. plates are from Florida, Texas, and Virginia while Ontario overwhelmingly represents Canada.

Many plates – after the home-state Yucatan license plates and neighboring Campeche – are from the Mexican Caribbean’s Quintana Roo, the country’s newest state and Yucatan’s eastern neighbor. Quintana Roo includes Cancun, Playa del Carmen, Tulum, Chetumal, and Mahahual on the Costa Maya. Rather than drive to clinics and hospitals closer to home many ex-pats choose to make the trip to Merida instead.

I was in a spotlessly clean private room with nice artwork on the walls. The surgeon was trained in the U.S. and his care was excellent and personal.

Emergency appendectomy for less than what the deductible would have been in the U.S.

One of those ex-pats is Kevin Graham, U.S. Counsel Warden who lives in Mahahual, a 5-hour drive away, and doubles as owner of Costa Maya Living Real Estate. His thoughts and experiences are compelling.
”Where would we go if something serious were to happen? When I asked other ex-pats about their healthcare experiences here in the Yucatan Peninsula, Merida was consistently mentioned and with positive comments too. I have always been partial to using hospitals that are near to teaching institutions. Again, Merida fits the bill.

“The need did arise one evening when I had an appendicitis attack. I threw a few items in a bag and made the long trek to Merida. I arrived at the emergency room of Star Medica Hospital, and was seen by the emergency room physician in less than five minutes. A prompt examination and a few tests and my suspicions were confirmed. They called in a surgeon and I was in surgery shortly after my arrival. (The surgeon was actually sitting in a chair outside of the operating suites, waiting for me.)

“I only spent one additional night in the hospital. I was in a spotlessly clean private room with nice artwork on the walls. The surgeon was trained in the U.S. and his care was excellent and personal. He gave me his personal cell phone number and made arrangements for me to have my sutures removed back in Mahahual. The hospital staff was attentive without interrupting my rest and recovery.

“The cost for emergency room, emergency room physician, all tests, surgeon, operating suite and two nights in the hospital – $3,000 USD. That was my deductible when I lived in the U.S.!

A reason I picked Star Medica was due to positive things I heard from other expats. It always makes you feel a little better when you run a doctor’s name by someone. I have come to appreciate how really good health care can be here in Merida.”
3 Private Hospitals in Merida – With Comments

Star Medica Hospital & Clinic Calle 26 No. 199 between 15 & 7
Col. Altabrisa, Mérida, Yucatán
(New hospital, and quickly became the #1 choice of foreign visitors and ex-pats)

Clinica de Merida Ave. Itzáes No. 242
Col. García Ginerés, Mérida, Yucatán
(The previous #1 choice among foreigners before Star came to town)

Centro Medico de las Americas
Calle 54 No. 365 by Perez Ponce Ave.
Centro, Merida, Yucatan
(Competent, caring doctors but the hospital is old-fashioned and worn)

International Insurance Benefits

Bi-cultural and independent insurance agent, Hector Lopez, grew up in the States but returned to his Merida roots. His clients are nearly all foreigners including 70% American, 20% Canadian, and 10% European.

Hector represents ALLIANZ and has been my agent for years. At 59, I pay $1,500 annually for private and complete medical insurance. My deductible is 5,000 pesos or about $385. Better news is that the maximum age to enroll in an ALLIANZ health insurance plan is 70. You can even apply a few months before your 70th birthday to qualify. No medical exam is required, but you have to complete a medical questionnaire and cite any serious preconditions. International insurance adds value to already affordable private medical treatment.

ALLIANZ, an international insurance company headquartered in Germany, is the second largest global carrier. Their presence in over 70 countries is almost twice that of their nearest competitor. And my health insurance policy covers me for up to three months while in the U.S. or Canada.

There are other health insurance companies available for your consideration. GNP (Grupo Nacional Provincial) is headquartered in Mexico City, AXA (acquired the Mexican insurance arm of ING in 2008) and Metropolitan Life. But not as much bang for your buck in Yucatan, and lacking the extensive worldwide presence of ALLIANZ.

Are there major drawbacks to medical tourism?

Medical Tourism is not for everyone. Some patients find that they are just not capable of traveling to another country for treatment – even when advantageous. Reluctant patients may exhibit mixed emotions of leaving loved ones behind, or are unaccustomed to traveling anyway, or irrationally buy in to the media’s fear-mongering about foreign countries.

But for many others, medical travel provides great peace of mind via financial savings alone – especially if you are not covered for a particular procedure, have too large of a co-pay, or have to wait eons in your home country for a much needed surgery.

Despite the AMA and others embracing medical travel – some critics continue to cry, “But what about shoddy care in foreign countries?” That myth has been shattered already in this 2-Part series (see December, 2009 issue for Part 1) [above] and by independent research studies.

A better question – depending on the procedure – might concern continuity of care when you return to your home country. A good response is to inform your home physician of the planned treatment beforehand, then follow up after you return. And Merida’s proximity provides easy, affordable access if a return trip is needed.

Of course, your home country’s laws do not apply abroad. In the worst case scenario there may be little recourse for poorly delivered treatment. However, high medical standards and pertinent accreditation should eliminate most apprehension. But legal liability may concern some doubters who find medical travel too disquieting for them. (Ironically, one major reason for out of reach, overpriced medical care in the Merida is the astronomical liability premium that physicians and hospitals face due to the fear of unbridled lawsuits.)

Wiser medical tourists will weigh the advantages of treatment abroad accordingly. For those who take this route – access, timeliness, choice, affordability, or not having to be on a waiting list, eclipse any perceived risks every time.

Merida Websites for Foreigners

Yucatan Today is a useful resource for foreigners. Combination tourist magazine, event calendar, and ex-pat bulletin board plus a helpful website.

Yucatan Living: Chockfull of information featuring articles about the nitty-gritty of living here and finding your way around Merida.

Yolisto: An entertaining site whose focus is on the beach ex-pats (beach is 30 miles north of Merida) who utilize Merida’s services.

The U.S. Consul in Merida provides an incomplete list of English-speaking physicians in Merida. Rarely updated, all information is supplied by the contributor.

Getting to Merida, Yucatan, Mexico

Flying into Merida
Continental Airlines offers non-stop flights Houston to Merida most days of the week; departing at 7pm makes connections easy. Some travelers find it convenient to make a connection in Mexico City rather than Houston.

Flying into Cancun
Regular flights or charters into Cancun are plentiful but you must rent a car or take the 1st class bus to reach Merida.

Driving from Cancun
About 200 miles, Cancun to Merida – a straight, safe shot across the peninsula. If you rent a car, the autopista (excellent, well-maintained toll road costs about $30), although not very scenic, is fast with no traffic.

Bus from Cancun
Luxurious 1st class buses run from the downtown Cancun bus terminal non-stop to Merida’s Altabrisa medical area. Be sure to take an ADOGL or UNO bus.


From an investor’s perspective.

Here are some pretty blunt assessments from a real estate investor about rental yields and appreciation potential for various markets around the world. These are not “Can I afford it and do I want to live there?” assessments. For help there see the postings below. Rather they are relative total investment returns available assessments. The guy does not think too highly of Costa Rican values, e.g.

Resident global real estate investing expert Lief Simon has taken out his crystal ball. Looking ahead to 2010, what does he see? Here is a quick look at what Lief predicts for key markets worldwide in the New Year.

Lief says ...

Here are the five markets where I ouldd think about putting my own money over the coming 12 months:
  1. Panama. Yes, I am well invested, but I am also actively shopping and keen to buy more at the right price. In Panama City, buy any apartment (new or resale) for which you can negotiate a price that will translate to a good yield. Sellers are very open to your offers, and it is going to continue to be very possible in this market to see net rental yields of 8% and higher. I am currently seeing 12% net from my avenida Balboa rental.

    Outside the capital city, buy land in the path of progress. The region that best qualifies is the Veraguas Province, not only the west coast of the Azuero Peninsula, but throughout the province in general, including in the mountain and river towns of Santa Fe and San Francisco, etc. New President Ricardo Martinelli hails from Veraguas. He is already making it clear that his home province is going to benefit generously from the aggressive investment in infrastructure this country continues to make.
  2. Philippines. Along with Panama, this is the other market I am most focused on. Great opportunity for yields through resort rentals and condo hotels. You are going to be hearing a lot more from me on why you should be looking closely at the Philippines right now over the coming months.
  3. Dominican Republic. Shop for land – early-in lots in planned developments or raw ocean-view land.
  4. Australia. Look for renovate-to-flip opportunities. This commodity-based economy is already recovering from its downturn, and I believe it is going to continue down this track, seeing steady appreciation. In fact, the demand for housing in key markets in this country continued to outpace supply even through the global financial meltdown. Again, I see this continuing.
  5. Colombia. The market I am most interested in understanding better in the New Year. I am planning a scouting trip early 2010.
What about other markets I have recommended and invested in in recent years? Here is what you need to know about past picks:
  1. Nicaragua. Yes, current President Daniel Ortega has adjusted this country’s constitution so he can run for re-election in 2011 (the country’s constitution disallowed any president to sit consecutive terms; Ortega did not feel ready to move on, I guess, so he recently changed this). Running again does not guarantee winning again, though, and, as long as the opposition parties unite, as they are already indicating they will do, Ortega should be out. The Nicaraguan on the street has had enough of his do-nothing, blow-hard politics. Still, the guy is a loose canon. I am well invested in Nicaragua and holding tight, happy to wait out the Ortega Factor. Eventually, Danny will go away. Meantime, I do not intend to invest further. If you do not currently hold a stake in this country with a beautiful Pacific coastline and a history of political strife, consider it. Understand the risks and shop for a deal. You should be able to find one. Right now, this market is dead, meaning sellers can be eager.
  2. Ecuador. There is no compelling reason to believe prices in this country will increase. I would not buy here now, with the possible exception of productive land. Though, if you are in the market for farmland, for example, you have better choices.
  3. Costa Rica. On sale! However, real estate in this country was so over-priced pre-crash that even a 40% to 50% drop in asking price might not get you where you want to be. Remember Costa Rica’s track record for infrastructure (they had not built a new road in nearly 40 years until recently) and remember, too, that the current administration is broke. The Costa Ricans are making some effort to improve their battered roads and collapsing bridges and even to build, finally, long-promised new ones. But you have to wonder where all the money will come from. And, to buy now, you have to see some reason for prices to turn around and move up again. I do not anytime soon.
  4. Brazil. Good opportunities, especially in vacation rentals at the beach. Also a growing middle class, which is an important indicator when shopping real estate investment markets. However, this is not an easy place to do business. Moving money in and out of the country can be complicated. Plus, you have got a currency risk. The real is strong right now. Factor this in to your buy decision. Also understand the currency exchange implications for whatever terms of purchase you choose. If you sign on for a long-term monthly payment program, consider buying reals ahead.
  5. France. A short-term rental in Paris remains a solid long-term, bolt-hole [“A hole through which an animal may bolt when pursued into its burrow or den.”] play. You will not get rich this way, but a short-term rental in the City of Light means steady yields over the long haul.
  6. Argentina. Yield plays in Buenos Aires can make sense if you buy for the right price, and productive land in the interior can be a good play (again, if you buy right and if you are buying for the very long term).
  7. Uruguay. Not the time for investment. Great place to live or retire, but I see no compelling reason for appreciation. The exception can be an investment in a beach apartment for rental yields; however, prices have risen, so you have to shop harder to make the numbers work.


An the winner is ... Ecuador, at least measured by the criteria used.

International Living has come out with its annual “Best Places to Retire” rankings. They conveniently provide the weightings used for their scoring criteria, so one can measure those weightings against one’s own preferences and priorities. For example, climate is given a 5% ranking and entertainment 10%. We would at least reverse those two. A look at all the weightings, however, reveals how much careful thinking one should do during the search process.

North American retirees looking for lives of comfort at bargain-basement prices might do well to look at countries located near to the equator. Most of the best places in the world to retire, according to expatriate lifestyle magazine International Living, seem to hover near that famous line of demarcation.

As a matter of fact, 5 of the Top 15 Best Places to Retire are in the Caribbean Basin and 10 out of the top 15 positions are countries located in the Caribbean, Central America, Mexico and South America. Caribpro could not agree more! Aside from sun, sea and sand there are several critical criteria that determined the country rankings:

Scoring Criteria: And the Top 15 Best Places Are:
  1. Ecuador
  2. Mexico
  3. Panama
  4. Uruguay
  5. Italy
  6. France
  7. Brazil
  8. Argentina
  9. Costa Rica
  10. Australia
  11. Malta
  12. Spain
  13. Belize
  14. Chile
  15. Nicaragua


Panama manages to become more appealing all the time.

Live and Invest Overseas editor Kathleen Peddicord comes up with a rather different ranking of top retirement havens than her former employer does above. She has previously admitted she is not partial to third world countries “like Ecuador,” and it appears this is a subjective list, so we are not surprised to find IL’s #1 pick missing entirely. Then again, there is definitely a concensus that Panama is among the most attractive retirement destinations out there. (An LIO spinoff publication, The Panama Letter, may be useful for those focusing on that country.)

Very interesting list, with helpful explanations.

Getting the jump on January 1, here are the world’s top 10 overseas havens as we move toward New Year 2010:

World’s Top Haven #1: Panama

Long-suffering readers are not surprised to hear this, but what surprises even me is how this country manages to become more appealing all the time. This land of potential is realizing more of it every day thanks to new President Ricardo Martinelli. After only four months in office, Martinelli has engineered more change than most leaders manage to accomplish over their entire terms. Martinelli’s approval rating is better than 90% as he pushes ahead with his flat tax proposal, his labor reforms, his zero-tolerance anti-corruption-in-politics campaign, his Panama City metro system, his new international airports, and on and on.

The Panamanian government recently issued US$1 billion in 10-year notes yielding 5.224%. The issuance coincided with S&P’s upgrade of Panama’s credit rating, which is now one level below investment grade. US$1 billion is a lot of money for a country this size, and Martinelli is keen to make sure it is well-spent.

For the foreign expat, retiree, investor, and businessperson, all this translates to a great big Welcome! sign. Panama City is no longer super-cheap, but the rest of the country sure can be. If you have not looked closely yet at what Panama has to offer, I ask you now, what in the world could you be waiting for?

World’s Top Haven #2: France

World’s best quality of life, world’s best health care, world’s best infrastructure, world’s most romantic city ... France is a country that begs superlatives. Downsides are a draconian approach to taxation (so do not become a legal resident); a cultural distaste for entrepreneurial activity (so do not consider any business in this country that would require local hires or a local shopfront); and, as we move toward 2010, a super-strong euro (maybe a concern if your nest egg is denominated in U.S. dollars).

On the other hand, retirement in France can be more affordable than you might imagine, certainly when you consider the country beyond Paris. As Intrepid Correspondent Paul Terhorst wrote from Buenos Aires recently, “Argentina has gotten expensive again. The South of France would be more affordable right now ...”

World’s Top Haven #3: Uruguay

The banking, residency, and tax advantages of Panama without the chaos or the construction dust. While Panama is running on over-drive right now, making sure the world realizes she is open for business, Uruguay is, as always, content to sip her maté from the sidelines. Uruguay is an ideal choice if you are considering a move with children. On the other hand, retired way down south to not-so-accessible Uruguay, you might not get back home to North America to visit your grandchildren as often as you would like. And, frankly, you might get bored.

World’s Top Haven #4: Dominican Republic

Easy foreign residency, favorable approach to foreign taxation, and, right now, a down real estate market that has created great crisis buy opportunities. For this reason primarily, the DR is my top 2010 pick in the Caribbean. Also, there is an interesting and welcoming expat community on this island, including an established French population.

World’s Top Haven #5: Argentina

Buenos Aires is the most cosmopolitan city in Latin America and the only city in Central or South America where you could enjoy a lifestyle that could be described as “luxury” according to a real-world definition of that word. With few exceptions, anything available in Paris (the world’s number-one luxe destination) is available as well in Buenos Aires, at lesser cost and with a Latin edge, including five-star restaurants, nightclubs, comedy clubs, open-air cafes, world-class live theater and ballet, art galleries, museums, indoor shopping malls and outdoor antiques markets, European-style parks, plazas, and gardens, plus classic architecture of the kind found in but a handful of cities around the world. If you want to live a life filled with art and history, culture and interesting company, but you cannot afford Paris and its euro, look to Buenos Aires.

A basic budget for retirement in one of this eclectic city’s best neighborhoods could be as little as US$3,000 a month, with about half that given over to rent (and not including a maid). You could build out your luxury lifestyle budget from there.

Argentina also boasts Mendoza, one of the world’s top wine regions. Argentines enjoy great food, good vino, and interesting conversation, and, here, in the interior of this country, these things are the priorities of life.

World’s Top Haven #6: Malaysia

Malaysia’s capital Kuala Lumpur is my top pick in Asia for living the very good life on a budget. K.L. is an affordable choice, but Malaysia outside its capital city is one of the cheapest retirement havens on earth right now.

World’s Top Haven #7: Chile

Beachfront, wine country, and First World services. Chile also boasts the lowest violent crime rate and the highest GDP per capita in Latin America. Such a high standard of living usually comes at a high cost, but not so in most of Chile. This country has not gotten the attention it deserves. We intend to right that in 2010.

World’s Top Haven #8: Belize

Safe, stable, and English-speaking. Caribbean Belize is not as affordable as the Dominican Republic, but, inland, the Cayo (my favorite part of this country) can still be described as cheap. Belize in general is my top get-away-from-it-all, back-to-nature, retire-off-the-grid pick.

World’s Top Haven #9: Croatia

The cobalt blue of the Adriatic Sea off Istria’s coast is almost other-worldly. Onshore, the Istrian peninsula is a fairy-tale land of fortresses and bell towers that so attracted and impressed the Romans they invested in some of their best building here, including, for example, a large and largely intact coliseum at Pula where lions and Christians once entertained. Later, this region was ruled by the Venetians, who also left an architectural legacy. In Istria, both Nature and man have worked together over many centuries to create something very special, almost magical. In fact, the ancient Romans named it “Terra Magica.”

I defy you not to fall in love with this region, whose landscapes and way of life rival the best of Tuscany or the French and Italian rivieras, but this place is still undiscovered and therefore affordable. Renovation projects (centuries-old stone farmhouses on hillsides overlooking valleys of olive groves and vineyards) start at US$50,000.

World’s Top Haven #10: Vietnam

As Asia Correspondent Wendy Justice, explains, “Vietnam is an emerging market that has only recently moved beyond the dark transition following the war. Now this country is changing almost daily. The population is youthful, and an energy permeates everything. This is a land of beautiful beaches, cool mountain retreats, and cities seething with vitality. Many Westerners head to Vietnam and love it. Others complain about the hustle, the noise, and the lack of Western influence, particularly in the northern part of the country (Hanoi). On the other hand, the cost of living is temptingly low.”

These countries, for all these reasons, will drive our editorial agenda for New Year 2010, including the editorial calendar for our Overseas Retirement Letter, in the virtual pages of which we will publish complete Country Retirement Reports on each of these top havens over the coming 12 months. Scouts have been dispatched.


Asia and Latin America still provide the most value for the money.

A slightly different list for the two above, although Panama once again shows up well. “Sovereign Man” Simon Black gives his top picks among his top value-for-money regions: Asia and Latin America. China, he says, “is becoming nicer and more livable by the day. In terms of its modernity, it will be the first developing nation in Asia to match the west, and it will happen in the next 5 to 10 years.”

I am sitting in a comfortable, overstuffed leather chair this morning typing away at this letter while a team of local women give me a traditional Thai foot massage. 30 minutes in the chair will set me back about $4, and I cannot think of a better way to part with my money.

It is with great hesitation that I am even sitting in this chair – not because I do not like massage, but because this particular chair happens to be at the airport. You see, I am waiting for my departure to Europe, and if it were not for an important meeting in Spain that I am looking forward to, I would be staying right here in Asia.

It is not that I don’t like Europe – I love it, actually ... the scenery, the people, the history, the architecture. It is hard to not feel alive on a summer day in Krakow, racing down a ski slope in the Italian Alps, or driving a Porsche down the Croatian coastline.

In terms of value for the money, however, Asia has Europe beat hands down.

Europeans feel that “serving” another human being is elitist, which is part of their egalitarian socialist dogma.

Take this simple, $4 massage; it would be difficult, and entirely cost prohibitive, to find a team of European professionals who would be willing to provide this level of attention; Europeans feel that “serving” another human being is elitist, which is part of their egalitarian socialist dogma. The session would be courteous, at best.

Many cultures in Southeast Asia, on the other hand, are happy to go the extra mile, especially when there is a gratuity attached. The ladies who staff this airport location, for example, would not even let me remove my own shoes and socks – they did it for me.

Having another person do that honestly makes me feel a bit uncomfortable ... but providing this level of service is what they are accustomed to, if nothing else than for the gratuity at the end.

The motivation to earn more by providing excellent service is clearly more prevalent in the Orient than in Europe. Neither mentality is right or wrong, just different. Naturally, though, as a consumer, I prefer a greater level of service.

The cost of living very well in Europe is easily five times the cost of living very well in Asia. Is Europe five times as nice?

Price is also a major factor. In Asia, with few exceptions like Singapore, Japan, and South Korea, you have to put up with some level of squalor – trash in the streets, gratuitous displays of poverty, etc. While these indications are not completely lost on Europe, it is safe to say that cityscapes in the west, in general, are cleaner.

That being said, however, the price difference is enormous. The cost of living very well in Europe is easily five times the cost of living very well in Asia. Is Europe five times as nice? Depending on what you are looking for, most likely not.

As I look around the world and price compare, I wholeheartedly believe that Asia and Latin America still provide the most value for the money. My top picks for those regions are:

Latin America

(1) Chile: Strong economy, beautiful landscape, modern and developed infrastructure. Living costs are low, and the cleanliness makes it feel like you are in Europe. The biggest concern with Chile is that it is growing too quickly; the Chilean peso is one of the best performing currencies in the world, so costs for foreigners are going up.

(2) Panama: Also a strong economy with developing infrastructure and increasing local standard of living; costs in Panama City are going up, but if you get out of the city, you will find that you can still live incredibly well for very little.

(3) Colombia: Clean, modern, and home to some of the best weather on the planet (especially in Medellin). You have to be willing to look past the “Colombia stigma,” but I guarantee it is well worth the exercise in intellectual independence.


(1) Malaysia: Home to a growing influx of Islamic funding, the country is on solid economic footing while maintaining very low living costs. Medical care is strong, and the “My Second Home” program provides an easy route to permanent residency.

(2) Philippines: Stable economy, cheap real estate, and excellent English proficiency. Manila and Quezon can be tough, but just outside of the cities you can find inexpensive, pristine coastal property. I know many expats who are happily living out their years being fed grapes on a hammock with just a meager retirement pension.

(3) China: Lack of English proficiency can be very frustrating ... but China is becoming nicer and more livable by the day. In terms of its modernity, it will be the first developing nation in Asia to match the west, and it will happen in the next 5 to 10 years.

Naturally, I will provide more about these locations in future letters, but I wanted to give you a quick overview today; if you have any specific questions or your own additions, please let me know.

Why not Thailand and Uruguay?

In reaction to the above piece some readers wondered why these two countries were omitted from Mr. Black’s top picks in Asia and Latin America list. His reply, with a nod to Ecuador as well ...

The biggest question – why weren’t Uruguay and Thailand included on the list?

Thailand is a fantastic country, and I will be spending more time there next year. The problem is that it is difficult to reside in Thailand for the short-term and long-term.

Neighboring Malaysia gives 90-day, extendable tourist visas upon entry; Thailand is good for 15 to 30. Malaysia makes it easy to establish residency; Thailand only issues 100 permanent residency permits each year.

The property market in Thailand is also quite cumbersome, with significant restrictions on foreign ownership and a lot of sharks who will take advantage of foreigners.

Overall Thailand is a wonderful place, and there are ways around these challenges. But comparing price and hassle, I think Malaysia is a better value.

Uruguay is also great country and would probably be #4 on my list. I would not dissuade anyone from buying property or living there. In terms of value, available services, and lifestyle, though, I would pick Chile, Panama, or Colombia, mostly because Uruguay can be exceptionally sleepy.

And although I did not mention it in the original letter, I really like Ecuador as well. The country is poor ... very poor, but its local agriculture is spectacular – “all natural” is the only way they know how to produce.

This is of vital importance to me. I am very careful about what I put in my body and think that the poison and hormone-filled foods in North America significantly contribute to poor health ... and health, after all, is our most important asset.

We are fortunate that world class physicians are available in places like Panama and Thailand for the price of a steak dinner, but as someone who has a natural aversion to doctors and hospitals, I tend to focus more on staying healthy. To me, this has a lot to do with food.

Aside from Ecuador, I have also noticed that Laos, Chile, New Zealand, and surprisingly China have a vast stock of organic and all-natural food products. Meanwhile I am highly suspect of foods in Buenos Aires and Eastern Europe, especially at restaurants.

Of course, the hardest place to have a restaurant meal that is not served with a side of poison is in the U.S. – probably the impact of corporate chains.


Lessons learned from the school of hard knocks after three moves across three continents with family and businesses.

Kathleen Peddicord offers her Live and Invest Overseas readers yet more useful advice, honed by her personal experience in the matter. Perhaps the “11 things to know” all fall under the categories of (1) look before you leap, (2) communicate profusely with others involved in the move, and (3) seek good outside help.

Here are 11 things I have learned from the school of hard knocks after three international moves across three continents with two kids, a dog, a turtle, a husband, and two businesses:

1. The first step to any move abroad is to set your priorities and to be honest in the process. What matters to you most? Evenings at the theater? Friends whose company you can enjoy in English? Cost of living? A reliable Internet connection? Don’t kid yourself. If you cannot imagine life without a Maytag washer and dryer, for example, you may need to rethink the entire proposition.

2. Make all decisions jointly with whomever you will make the move. Your spouse’s ideas about what he or she wants may shock you ... and vice versa. Better to get them on the table sooner rather than later.

3. Recognize that no place is perfect. No climate is ideal. No city is 100% crime-free. Manage your expectations.

4. Understand that no other country on earth is as comfortable or as convenient as the United States of America. In many places, shops, banks, dry cleaners, and government offices close for lunch and call it quits for the day by 5 p.m. You cannot run errands on your lunch break ... or on Sundays. In some countries, you must pay utility bills in person. In the developing world (not only in Latin America and the Caribbean, but in emerging Europe, too), appointments and schedules are more suggestions than commitments. And only a handful of real estate markets outside the States operate with Multiple Listing Services, meaning the search for your new home in Paradise likely will be inefficient at best.

5. Don’t leave your good sense at the border – specifically, do not mix alcohol and property buying. We call it “Margarita Madness.” It is a syndrome that can set in shortly after your arrival in any sunny, sandy, tropical locale. The water is turquoise, the sand is soft, the palms are swaying. ... That guy you just met in the bar downtown (the one who shared a couple of rum punches with you), he is now driving you along the beach road bordering his development, pointing out where his clubhouse will be, where the marina will go, where your new home could be positioned. Look at that view. Feel that breeze. Boy, it does not get better than this. And, you know, we have got only two lots at this price remaining. A couple of buyers are expected in town tomorrow. I would hate for you to miss out ...

Would you buy a piece of real estate under those circumstances back home? A piece of property you are seeing for the first time in a place where you have never been before? From a guy you met in a bar?

You need to do more due diligence when investing in a piece of property in another country, not less.

6. There is no such thing as the world’s top retirement haven, no one-size-fits-all Shangri-la. The only one who can determine the best place for you to retire is you. There are dozens of beautiful, affordable, friendly, safe, charming places where you could choose to spend time in “retirement.” It is a question of what you are looking for and of what is most important to you (see #1 above).

7. Your U.S. health insurance will not cover you once you leave U.S. soil. Don’t worry, you have options (detailed here).

8. Rent first. Do not buy a new home in paradise until you have tried that paradise on for size for several months. Even if the country turns out to be your ideal retirement haven, maybe the city or the region or the neighborhood where you land at first is not where you ultimately want to be. Give yourself time to get the lay of the land before committing to a property purchase.

9. Be prepared for panic. In 25 years speaking with people who have made the move to another country, I have yet to know one who did not experience a moment of, “Geez Louise, what in the world have I done?” Expect to question your sanity for having ever considered the idea of moving so far from home and hearth, if only briefly. Expect it, prepare for it, and understand that it will pass. Everything you made the move for is waiting for you. You just need to give your perspective a little time to adjust.

10. You need local tax advice in the country where you are planning to reside before you take up residence. When we moved to Ireland 10 years ago, we met with Ernst & Young in Dublin during one of our pre-move visits. This turned out to be super-smart (though we did not realize it at the time). In Ireland then (this is no longer true today, as the relevant tax legislation has been amended since), if you organized your financial affairs according to a certain strategy that the advisor at Ernst & Young detailed for us, you could reduce your annual Irish tax burden substantially. I won’t bore you with the details (especially as they are no longer relevant). The point, though, is that the strategy had to be employed before we had an Ireland address. If we had waited until we had taken up residence in the Emerald Isle, our annual tax obligations would have been considerably greater.

11. Pay attention to your gut. A place either feels right ... or it does not. All your research and figuring in advance is important, but nothing substitutes for the feeling you get when you hit the ground.

P.S. These 11 tips for retiring overseas are excerpted from our “Join the Retirement Revolution: 101 Tips for Retiring Happy and Living Well Overseas” special report ... one of four special reports we send free to every new subscriber to my Overseas Retirement Letter.


Lake Atitlan, Guatemala Needs Major Environmental Cleanup

The current model of economic, technological and cultural development no longer makes sense.

A thick, chocolate-colored scum floats on the normally clear blue waters of Lake Atitlán, in the southwestern Guatemalan province of Sololá, caused by agricultural fertilizers and untreated sewage from surrounding villages and farms.

Scientists identified the microorganism responsible as Lyngbya, a species of cyanobacteria (similar to blue-green algae) that has grown at a prodigious rate over the last few years, forming filamentous mats in the depths of the lake that end up floating to the surface. It may also produce toxins with harmful effects on fish, crustaceans, aquatic plants and humans who come into contact with the polluted water.

Cyanobacteria thrive on phosphorus and nitrogen, at the surface or in the depths of the lake, and in order to eradicate them both these elements must be prevented from entering the lake. Cyanobacteria were first detected in the lake in 1976, although at very low levels. Now, however, they have grown into enormous surface mats, darkening its waters, because of the high levels of phosphorus and fertilizers in the lake.

A study carried out last year by the Institute of Agriculture, Natural Resources and the Environment (IARNA) at the Rafael Landívar University found that between 2002 and 2003, approximately 972 tones of nitrogen and 381 tones of phosphorus were added to the lake, which has no outlet. ...

While the present situation is regrettable because of the damage to the environment, it is not what most concerns the experts. “We also found contamination by Escherichia coli and other faecal bacteria, which trigger widespread diarrhoeal disease,” Pineda said. This has dire consequences. In the lake basin area, the health system reported cases of diarrhoea in five percent of the population, totaling 9,322 cases in the period studied, according to the report. ...

Germán Rodríguez, coordinator of the National Network of Environmental Training and Research (REDFIA), took the analysis to a deeper level and noted that one cannot talk about just one environmental crisis, or just one lake.

“It’s not just about an ecological crisis in terms of environmental loss and degradation, but about an economic, technological and cultural model that has plundered nature and that favors a mechanism of production and a lifestyle that are not sustainable,” he said.

In Rodríguez’s view, measures taken to save Lake Atitlán, as well as any other decision about the environment, will not be sufficient unless it is recognized that the current model of economic, technological and cultural development no longer makes sense. The REDFIA expert said there is a need for a general law on water, as well as a law on land use that protects the environment, although hurdles like lack of awareness and favoritism towards vested interests have prevented their being enacted. Meanwhile, pollution of this wonderful lake continues as it has for decades, in silence, only now giving a tangible reason for alarm.

Now Fly Ecuador Direct from New York

Good news for the estimated 100,000 Ecuadorians living in Queens. ... Ecuadorian airline AeroGal is starting nonstop daily service to Ecuador direct form New York.

The flights will go from JFK to José Joaquin de Olmedo airport in Guayaquil, Ecuador’s largest city.

Previously, AeroGal serviced only Miami in the U.S.

Introductory roundtrip fare is $547.76, including taxes.

Banana War Finally Over – EU Lets Latin America Back Into Market

Latin American banana producers have been paying hefty tariffs for 16 years while producers in the Caribbean and Africa have been paying nothing.

Prices for bananas in the European Union could fall by 12% as the banana war… the world’s longest-running trade dispute ... comes to an end.

In an agreement being hammered out in Geneva, the EU will cut import duties on Latin American bananas from $255.69 USD per ton to $165.61 USD per ton over the next seven years.

The EU is the largest banana market in the world with yearly imports of 5.5 million tons.

Latin American banana producers have been paying hefty tariffs for 16 years while producers in the Caribbean and Africa pay no tariff on their product in the EU. The intent was to give former European colonies in Africa, the Caribbean, and the Pacific (known as the ACP countries) a chance to grow their economies without the need for foreign aid.

Latin American banana producers complained immediately that the system was unfair, and the World Trade Organization declared the tariff on Latin American bananas illegal.

The end of the banana war is good news for the economies of Latin American producers, but it means tougher competition for ACP producers, so a compensation package worth more than $290 million USD for the ACP producers is included in the agreement.