At first glance, Puerto Palomas, Mexico, is the proverbial, forgotten border town. Big pickups kick up dust on dirt side roads. Crowing roosters perk up the afternoon. Frolicking, stray dogs wander about the pueblo.
But big historical developments have taken place in little Palomas, and continue doing so to this day.
Only yards from the international border crossing with New Mexico, a small plaza fronts a city hall, dominated by a statute of the Centurion of the North, Francisco “Pancho” Villa, the Mexican revolutionary who in 1916 headed the last major attack on U.S. territory until Pearl Harbor, when his soldiers attacked the village of Columbus, N.M., about three miles up the road.
More than a century later, the binational relations between Columbus and Palomas are far more cordial, solidified in good measure by the U.S. health care crisis and particularly its dental services component.
In “downtown” Palomas, dental clinics with English-speaking staff, serving a mainly elderly U.S. clientele, enliven storefronts. They’re joined by a sprinkling of pharmacies and optometry outlets.
“Make your teeth smile,” beams a greeting in English above the colorfully painted entrance to a dental implants business.
On a recent day, Violet and Ronald Cauthon were taking a break in Palomas’ Pink Store from a dental appointment. Seasoned regulars of this town of an estimated five or six thousand souls nudged on the northern tip of Chihuahua state, the retired couple from Las Cruces, N.M. said their Mexican dentist, Dr. Oscar Perez, had over the years performed teeth cleanings, tooth extractions, a bridge replacement and a root canal.
Confessing that she and her 85-year-old husband don’t have dental insurance, Violet said high U.S. costs motivate the hour-and-a-half drive from their home to the border town.
“We watch our pennies,” Violet said. In addition to lower-cost dental care, Violet claimed significant savings at Palomas’ pharmacies — comparing, for example, a $50 bottle of medicine sold at a Walgreen’s with the $11 price tag in Palomas.
“It’s so much cheaper it’s ridiculous,” she said.
Ronald praised his dentist. “He’s very professional,” the former bank loan officer said, recalling the aftermath of a complicated procedure. “I had no pain and came out and ate my lunch.” Added wife Violet, “We are part of (Dr. Perez’s) family and he takes care of us. … We also bring our family members from Oklahoma when they come.”
The Cauthons moved to Las Cruces from Oklahoma in 1992, immersing themselves in New Mexican history, politics and border culture.
In many ways, the life path of the couple is emblematic of the fate of the U.S. working and middle classes, thrown into personal economic turmoil by corporate mergers and buyouts, pension fund pilfering and skyrocketing health care costs. The Cauthons described how they suffered from pension raiders and, separately, lost half their savings in the popping of the 2001 stock market bubble. Subsequently, the transplanted couple downsized their lifestyle, even finding Medicare’s supplemental premiums too high for what is delivered, according to Violet.
So in a penny-pinching economy, why do the Cauthons make the trip all the way to Palomas, considering more Mexican dentists are available in Ciudad Juárez, Mexico, which is only a 40 minute drive or so from their home?
“This is safer. This is more stable, and it’s not as big, of course. Part of it is they need the economic help here. It’s a poor town,” Violet said.
The Las Cruces resident acknowledged that she and her husband stopped coming to Palomas several years ago after the so-called drug cartel wars devastated the small town, unleashing a spate of violence that included the murder of Palomas Mayor Estanislao Garcia in 2009. But like others interviewed in Palomas, she insisted that the public safety situation had stabilized.
“(People) are trickling back, and part of it is that Charlotte Lipson in Las Cruces has posted on Facebook how happy she is about Dr. Perez’s work,” she said. “And some people say, ‘I’ve heard of (Dr. Perez) for years.”
Historically, the Cauthons and their cohorts are part of a two-way convergence on Palomas from both sides of the border. From the U.S. come folks seeking relief from an economically strangling health care system. Though vastly reduced in numbers compared with previous years, migrants from Mexico and points farther south arrive fleeing climate, economic and public safety disasters, perhaps like the little indigenous girl who asked this reporter for “korima,” Raramuri for help or spare change.
All roads lead to Palomas
Logistically, getting in and out of Palomas is simpler than a similar trek to Ciudad Juárez. For travelers arriving in their own car, a free parking lot is situated on the U.S. side of the border and the subsequent walk to any of the dental and health care related businesses in Palomas takes minutes. Crossing back into the U.S. on a late weekday afternoon, the reporter found he was the only person “in line” and was whisked through after the obligatory passport check.
In contrast, border parking in El Paso, across from Juárez, generally costs four bucks. The walk over the Rio Grande bridges takes longer and trips to dental and medical providers in the inner reaches of the city necessitate a vehicle, though several companies and clinics advertise free transportation from the U.S. side. Pedestrian and vehicular lines in Juárez-El Paso aren’t normally as bad as a few years ago, but long back-ups from the still understaffed U.S. border inspection stations crop up at times.
New Mexico’s highway network makes getting to Palomas easy. From the west or east, travelers can take Interstate 10 to Deming and continue south for about half an hour on Highway 11 to Columbus-Palomas. Another route from El Paso and Sunland Park/Santa Teresa is the relatively rustic but scenic Pete V. Domenici Memorial Highway that skirts the Mexican border.
From the north, Santa Fe and Albuquerque travelers generally exit Interstate 25 at Hatch and then, after a short drive through the chile ristra decked town, drop down to Highway 26, cross Las Uvas Valley into Deming and continue on to the border.
A Mexican dentist on the border
Decked out in his work duds, Dr. Oscar Perez gave the reporter a short tour of his clinic. No advance appointment had been made, and Perez was notified less than an hour before the visit of the request for an interview. The tour revealed a clean, recently expanded facility where 15 people find plenty of work.
An easy conversationalist with a semi-bushy black beard, Perez recounted coming to Palomas in 2001 from Guadalajara, where he graduated from a local university but found opportunities limited in a city legendary for spawning many of Mexico’s doctors and dentists.
“In Guadalajara, there’s a clinic on each corner,” Perez quipped. The border dentist defined his specialty as root canal therapy but added he “will do everything.” Perez estimated he sees up to 240 U.S. patients a month, with 95 percent of them seniors. And he knows his clients well: Eighty percent of them are from New Mexico, principally Las Cruces, with the remainder split between Arizona and Texas.
“We look at our patients like they are our grandparents,” Perez said. “We treat them with the greatest warmth.” The Mexican dentist extolled the financial advantages of using his service, which he said hover around 30-35 percent of U.S. prices.
Keeping a lid on prices, he said, are lower costs for labor and materials such as titanium implants, which international companies now produce from expired European patents. The quality is the same as in the U.S., Perez insisted, but varied international pricing schemes lower the price tag in Mexico. “It’s like a car,” he mused. “It’s the same car in the U.S. or Mexico but costs differently.”
Perez confirmed times were tough in Palomas when violence flared, with 2007 and 2008 constituting the worst years, but like the battle-hardened Juarenses about 97 miles to the southeast, he held on to his business. Although the patient volume still has not recovered to pre-2007 levels, it is rising again, he said.
“It’s secure and peaceful. Palomas is a very warm place,” Perez said. “(My workers) are from here. They live here… there are opportunities for good, honest work.”
For nearly two years, one Santa Fe-based business, Beyond Borders Dental, has shuttled patients from north-central New Mexico to Palomas and Dr. Perez. An estimated 80-90 percent of Beyond Borders Dental’s clients are more than 60 years of age, said Terri Heeter, company president.
“We’ve had a few younger people come in but most of them are older,” she said.
In a phone interview after the reporter’s Palomas visit, Heeter retraced how Beyond Borders Dental was born after her 20-year stint in the tourism business in Egypt evaporated with the 2011 revolution. Facing significant dental work while back in the U.S. in 2014, Heeter said she and her husband found out about Palomas, decided to give it a try and wound up saving $6,000 in the process. From that round of crowns arose a new business.
Currently, Beyond Borders Dental averages two vans a month to Palomas and makes occasional trips to Ciudad Juárez as well. Heeter and company will also arrange for individual visits for New Mexicans and others who contact it from out of state. The company maintains a website with background information, estimated costs and business terms. Before an excursion to Palomas is made, Heeter assured she has two drivers in the van for safety reasons; clients are lodged overnight at special rates at a Hampton Inn in Deming, she added.
According to Heeter, Beyond Borders Dental is far more than a dental referral agency, and its small staff spend considerable time checking dentists’ credentials and sterilization practices, doing on-site inspections, personally meeting with dentists for updates on the latest technology and such, interviewing patients and compiling their records for the practicioners in Mexico, and analyzing customer feedback. All the Mexican dentists partnering with the New Mexico company guarantee their work for one year, she said.
“We have our own vetting system,” Heeter underlined. Admitting she had not had time to add up the total number of her clients who’d made the trip to Mexico since early 2016, the Santa Fe business woman nevertheless calculated between 500 and 1,000 persons. No clients have complained about the dental work, and in the event a problem occurs, a return trip for corrective measures is free, she said.
Heeter is a fan of word of mouth as the best promotional method, exemplified by one client who got a $50,000 estimate for a job in New Mexico but ended up getting the work done in Palomas for less than $4,000.
“She was ecstatic, and she’s referred a lot of people to us,” Heeter said.
Heeter credited previous tourism business experience for sensitizing her to the needs of both locals and travelers, and imparting a philosophy that not everything in the world is just about money.
“Especially working in a Third World country, you have to have cohesion with people, and we have to build trust with patients,” she reflected.
Trends favor dental, medical tourism in Palomas
Geography, economics and demographics all favor Palomas’ potential dental and medical tourism market. For instance, the Pew Charitable Trusts reported earlier this year that more than 850,000 New Mexicans live in areas designated by the federal government as afflicted by a dental health professional shortage, which was defined as one dentist for 5,000 or more people.
Of the state’s 33 counties, 32 were designated shortage areas, with rural areas especially impacted. The dentist deficit includes the entirety of the following counties: Catron, Chaves, Cibola, Colfax, Curry, De Baca, Eddy, Grant, Guadalupe, Harding, Hidalgo, Lea, Lincoln, Luna, McKinley, Mora, Otero, Quay, Roosevelt, San Juan, San Miguel, Sierra, Socorro, Taos, Torrance, Union, and Valencia.
According to the 2017 report of the New Mexico Health Care Workforce Committee, New Mexico counted 1,171 dentists in 2017 — 90 more than in 2014. Despite the increase, five counties lost dentists and 11 others remained stable during a three-year period.
What’s more, the demographic of Palomas’ dental and health care consumers is exploding. Based on U.S. Census Bureau statistics, a November 2017 report from the New Mexico Legislative Finance Committee projected that the number of persons aged 60 or older in the Land of Enchantment will mushroom to 682,000 by 2030, up from 487,000 in 2015. In 2030, nearly one-third of all New Mexicans are expected to be above 60 year mark, the report stated.
Further favoring dental and medical tourism in Palomas and other Mexican border cities are possible, upcoming insurance price hikes. N.M. Gov. Susana Martinez’s administration has proposed charging enrollees in the state’s Medicaid program, Centennial Care, premiums and co-pays. Meanwhile, a major private insurance provider in the state, Molina Health Care, sent out recent letters to members warning of sharp premium price hikes beginning in January.
Last but far from least, current dental insurance premiums with deductibles and caps combined with long waits for appointments make a trip to dentists in Palomas and other border towns an enticing option for many.
The future is now
Palomas’ undisputed hub of tourism, medical or otherwise, is the Pink Store. Located on the left side of the town’s main drag down, Avenida 5 de Mayo, two blocks after the border crossing, the commercial outlet offers jewelry, pottery, Day of the Dead figurines, dresses and more. The 30-year business is adjoined by a restaurant with live music. Welcoming to spice-loving New Mexicans, an English language sign inside the store reads “A day without chile (peppers) is like a day without sunshine.” At the store’s entrance, a Raramuri woman opens and closes the door for visitors, mainly U.S. seniors.
“It was all about teeth today,” chortled store manager Ivonne Romero, whose family has run the Pink Store and a predecessor business for generations.
Delving into the store’s history, Romero flashed a photo of her 94-year-old grandmother, Tillie Alvillar, who was at the helm of the enterprise for decades.
“Most of the people who come are regulars, but there are people who just come down for the dental,” Romero said. “And we’re lucky enough that they stop by for lunch.” According to the business operator, Palomas’ tourism flow has recovered during the last two years, economically uplifting the town by providing employment opportunities for receptionists, dental assistants, cleaning crews and like.
“It definitely creates a lot of jobs, so it has to be a good influx-positive,” Romero added.
If the Pink Store is Palomas’ Grand Central on the Mexican side of the international line, then Philip Skinner is wagering his Los Milagros Hotel will play a similar role in little Columbus on the U.S. side. Outside of his “day job,” Skinner also serves as the village’s mayor and a school bus driver.
Increasingly, Los Milagros Hotel lodges travelers headed to the dentists in Palomas. “We’re pushing (dental tourism) from the hotel standpoint, because we think it’s a real growing market,” Skinner said.
An older couple that drove down to Columbus-Palomas from the Albuquerque area sat playing cards one day inside the Columbus hotel. Like the Cauthons, the couple has a favorite dentist, though a different one than Dr. Perez.
Declining to be named, the pair answered a few questions about their experiences. Asked why they would drive hours to see a dentist in Palomas, the man simply rubbed his fingers together in the old gesture for money.
“We were stunned when we got the bill from our New Mexico dentist,” the woman said. “It’s not that we want to deny the dentists in the U.S. their due, but perhaps their education was more expensive.”
Overall, “We can say our experience in general with the dentists in Palomas has been excellent,” the man said.
“It’s funny. You go in the office and there’s all Americans there. And we’re friends, we exchange phone numbers,” his wife said. She had one cautionary note, however, advising visitors to shop around for pharmacy prices. “There are pharmacists and there are pharmacists,” she said. “You have to know which pharmacists to go to.”
Skinner figured the number of his guests specifically seeking dental treatment in Palomas doubled from about 20 in 2015 to 40 in 2017. “And I expect it to double,” he added. “They can call me and I’ll make an appointment for them. We try to make it easy on them.”
All signs point to bigger things in store for both Columbus and Palomas. Ground was broken last April on a massive, $85.6 million expansion of the U.S. port of entry, known for facilitating the northbound flow of Chihuahua-grown chile as well as the southbound parade of dental tourists. Completion of the construction project is planned for early 2019, according to the General Services Administration.
One young Palomas optometrist, Daniel Sanchez, is ready for the future. Situated a few blocks away from Dr. Perez’s dental beehive, Sanchez works at Medical Optical Vision, a business of more than 20 years that advertises free eye exams, a one-year warranty on frames and a wide assortment of regular eyeglasses, contact lenses and shades.
Like Dr. Perez, Sanchez said 80 percent of Medical Optical Vision’s customers hail from places in New Mexico – Deming, Silver City, Albuquerque and Portales among them. Most of the clients are 40 years of age and up, he said.
Depending on the frames, Medical Optical Vision’s glasses cost between $70-$185, according to Sanchez. A two-hour maximum wait is the rule, and glasses can be sent via the United States Postal Service if necessary, he added.
With three years under his belt in Palomas, Sanchez is upbeat about the prospects for local medical tourism, especially given political and insurance trends in the U.S.
“More people are coming, because the insurance is expensive or the insurance doesn’t cover eye,” he said. “If that continues, the medical tourism will be very big. Now (U.S. residents) don’t have Obamacare or Medicare doesn’t have options and they look for treatment options.
“You find everything on Main Street (Avenida Cinco de Mayo),” Sanchez said. “There’s me, dentists are over there, a pharmacy, a hotel across the street, restaurants.”
Kent Paterson is an independent journalist who covers issues in the U.S./Mexico border region and a fellow in the 2017 Journalist in Aging Fellowship Program. Enlisting a diverse cross-section of journalists from across the United States, the program is sponsored by the Gerontological Society of America and San Francisco-based New America Media. This article was written with the support of New America Media, the Gerontological Society of America and the Silver Century Foundation.