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Translation: Doctor: Is This Normal? Part 1

Translated by: Patrick Moseley

Daniel Alarcón: Thanks for listening to Radio Ambulante. I want to tell you about a new NPR show, a new way to stay on top of the news. It’s called “Up First”. In 10 minutes, more or less, you can get an idea of the important news of the day. Those things you should really know about. Kick off your day with “Up First,” available from Monday to Friday at 6 AM on NPR ONE or on any podcast app.  

Commercial 1: Do you want more definition on your waistline? The body you’ve always dreamed of? Perfect. You could be happy today!

Commercial 2: Get a perfect backside with a technique that has Hollywood raving. Get bigger glutes without implants.

Charlotte de Beauvoir: When I arrived in Colombia, I was surprised by commercials like these.

Daniel Alarcón: This is Charlotte de Beauvoir. She’s a French journalist who’s lived in Colombia for 10 years.

Charlotte: In France, I don’t know, it’s different. Yes, there is a lot of plastic surgery, but there’s a different aesthetic.

In Colombia women get surgeries because they want to be very voluptuous.

Commercial 3: Welcome to Colombia, world leader in plastic surgery.

Charlotte: I guess it’s just part of the culture.

Daniel: Welcome to Radio Ambulante, from NPR. I’m Daniel Alarcón. And before we get into the story, a little context:

If we look at the number of registered surgeries, there are more than 1,000 procedures a day in Colombia and that number continues to increase.

And it’s not just Colombians who are getting procedures done, rather, many foreigners also come to the country to do what’s known as “aesthetic medical tourism.” That’s because it’s much cheaper in Colombia than in the United States. For example, in the United States a buttock augmentation can cost between 7 and 25 thousand dollars. While in Colombia —at a well-known clinic— it costs between 4 and 10 thousand dollars.

Charlotte: But these numbers only cover reported operations, done by surgeons who are members of local professional organizations. What we can call the “white” or legal route, for cosmetic surgery in Colombia.

In parallel there exists a whole “black route”  —in other words, doctors that don’t have all of their degrees, or that sometimes aren’t even doctors, and who operate in unauthorized locations. These are much cheaper cosmetic surgeries. They can cost a quarter of the price of a legal surgery.

There are no statistics on how many operations are performed through this illegal route because it’s a clandestine market. The thing is, the Colombian cosmetic surgery boom crosses all social classes. The richest people can pay a fortune for good surgeons. But the women with fewer resources also want to change their noses, have bigger breasts or backsides. And the parallel market surfaced for them, with dishonest people taking advantage of the naiveté of those who dream of having a “perfect” body.

Daniel: And well, as you can imagine, today we’re going to talk about one of these people. Ximena López wanted a plastic surgery, but she couldn’t pay the price of a legal procedure. Ximena grew up in a middle class neighborhood in Medellín. Her father was a custodian and her mother was a stay-at-home mom. She has two siblings.

Charlotte investigated this story with the help of Juan Camilo Chaves. Charlotte tells us the story…

Doris Cuervo: Ximena looked really good. Physically, she was very pretty. She had very defined features, large eyes…   

Charlotte: This is Doris Cuervo, Ximena’s mother. She lives in Caldas, a middle class suburb south of Medellín.

Doris: She was very lovely, and you know you always think your children are beautiful. But yes, she had a slender body, and was…she had good…well, she was voluptuous. Yes, she looked very good…physically.

Charlotte: But Doris knew that Ximena wasn’t completely happy with her appearance.

Doris: And so she would say that her breast and her butt were disproportionate. It was, well, all she talked about.

Charlotte: Doris remember that every time Ximena would buy a pair of pants…

Doris: She would look in the mirror and say to me: “Mom, look, look they’re not snug. I wish I had a little, a little…more butt, hips.”

Hanna: Honestly, her bust was bigger than her butt. She didn’t have much of a backside.

Charlotte: This is Hanna, a friend of Ximena’s.  She’s 24. They met at a party in 2015, they got along really well and then after a few months they decided to move in together. Ximena was 21 years old. She was happy to be independent and have a friend to live with. They became confidants.

Ximena told Hanna that she had a complex about her butt. And then, Hanna also told her secret.

Hanna: Yeah, that’s when I told her: “Listen, I had work done on my butt. I had it done at this please. I think it’s really good. Nothing ever happened to me”.

Charlotte: Hanna told her that when she wanted to have the procedure, she searched on Google and came across a substance called “hyaluronic acid.”

It’s a synthetic substance used to fill parts of the body. It’s 100% compatible with the human body. So she specifically searched for: “Hyaluronic acid” and “buttocks.”

Hanna: And right away this Nubia D’Lavalle came up.

Charlotte: Nubia D’lavalle is described as a spa, a kind of beauty center. The address that Hanna found on the internet was for an area in a shopping center called Río Sur. It wasn’t anywhere special: it could have been a shoe store in the mall. Río Sur is in El Poblado, a very high-end neighborhood in Medellín. It’s the city’s center of economic development.

Hanna: I said, well it’s hyaluronic acid, alright, it’s in Río Sur, on the fourth floor, I imagine that in Río Sur they would have… they would ask, I don’t know, the Secretary of Health or something like that. In other words, I didn’t see any problem. I said, no, it should be fine because it’s there.

Charlotte: Hanna went to the spa and there she met with Nubia D’Lavalle herself. We tried to contact her several times but we were unable to. Nubia D’Lavalle is a Colombian woman. Along with her family, they have opened several spas not just in Medellín, but in other cities in the country. Hanna was impressed by the woman’s attitude.

Hanna: She has a very imposing attitude. She thinks she knows a lot. She thinks that things are, as she puts it, easy. She doesn’t allow for suggestions, things like that. No. She is very sure of what she says: “It’s normal, nothing is going to happen to you. All good? OK.”

Charlotte: There they tell her that the hyaluronic acid procedure costs 2,500 Colombian pesos. About 850 dollars. Hanna makes up her mind and schedules an appointment for a few days later.

Hanna: And when I go inside this place, well, I could see a hospital bed with a few bottles. But that was it. It didn’t look like, well, like a great clinic, like a clinic in Medellín or something like that. They had adapted it to make it look as hygienic as possible, and I imagine that it was hygienic.

Charlotte: Rafael Nieto was waiting for her. He is Nubia D’Lavalle’s son. I also tried to speak with him, but when I called his cell and introduced myself, he told me he didn’t want to speak to me and hung up. He was going to perform the procedure.

Hanna: I liked him because he was very nice. Like: “Yes, have a seat, get comfortable.”

Charlotte: Hanna changed, laid on the bed, and…

Hanna: He says a prayer… That gave me confidence in him.

Charlotte: And then he started the procedure which Hanna describes as very painful. They give her a local anesthetic and then mark a spot on each buttock. That is the spot where they will inject her. Hanna told me the needles they used were very thick. She compared them to the kind that are used on cattle. She was conscious the whole time.

Hanna: And then they started to apply a gel, and they start putting in more and more and more…

Charlotte: After a while, Rafael Nieto’s wife came in and they continued the procedure together.

Hanna: I could see that he was combining and combining things…

Charlotte: They were mixing liquids which seemed odd to her…

Hanna: But anyway, what was I going to do? I was there, that was that. That’s what I was thinking, like: “I want to do it. I’m going to do it anyway.”

Charlotte: And the whole procedure took about five hours.  

They injected Hanna with 600 cubic centimeters of liquid, but none of it was hyaluronic acid. That substance is never used for buttocks augmentation because it’s extremely expensive. A single cubic centimeter on average costs $250 dolars. So that substance is used in very small quantities to fill areas in the face, for example.

It’s impossible to know exactly what they injected her with. But it has been found that in these cases they may inject cooking oil and even wax. In Hanna’s case, according to what she describes, it’s more likely that it was industrial silicon. But not the same kind that is used in breast implants.

In other words, what’s most likely is that they injected her with cheap silicon that can be bought at any hardware store. And maybe mixed with a substance that has minimal parts of hyaluronic acid.

Hanna says that it hurt a lot, but she left the procedure alone. After walking for about 20 minutes, she caught a cab and went home. For a few days she didn’t feel very well. But then she got better and mainly she felt…

Hanna: Really satisfied. I mean, it changed everything: my self-esteem improved. I mean, it’s really sad to say it, but yeah, it’s the truth.

Charlotte: Ximena was really excited about the idea and Hanna recommended the same spa to her.

So Ximena decided to have the same procedure on Friday, March 17, 2016, at the Nubia D’Lavalle spa.

It was one week before Easter and her parents were going on vacation. She said goodbye to them on Wednesday, but she didn’t tell them anything about what she was going to do later that week. Hanna remembers that before she left, Ximena…

Hanna: Was really nervous, like “oh I’m a little scared” and I said: “Oh it hurts, but…it’s OK.” So we said goodbye: “Bye, girl.” And she gave me a kiss on the cheek and I said: “Don’t worry, you’ll be fine.”

Charlotte: That afternoon, Hanna gets a call from the spa’s receptionist asking if she can come pick up Ximena. Hanna was surprised because she had left on her own. She asked if everything was alright and the receptionist said yes, but that Ximena wasn’t feeling very well. So Hanna heads out toward Río Sur.

Hanna: I enter the room and I see her lying there. Well, she didn’t look well. So I said: “How’d it go?”. She said: “It hurts a lot. You’re really strong,” and I don’t know what. “Well you are too, because you were able to get through it…”

Charlotte: Hanna remembers that Ximena wasn’t alone. Someone from the spa was with her, but she doesn’t remember exactly who it was, if it was Rafael Nieto or his wife. Either way, that person helped put them at ease.

Hanna: That she was fine, that everything was normal. And I told them: “But it’s odd, because I left on my own. I walked out. It was painful and all, but not like this.” But I saw her…she was breathing like…like she was tired. Very, very tired.

Charlotte: They leave the spa, buy and antibiotic and something for the pain, and they take a cab home. And when they arrive…

Hanna: We get in the elevator and she passes out.

Charlotte: As soon as they make it to the apartment, Hanna calls Rafael Nieto and he tells her that everything that’s happening to Ximena is normal. That all bodies react differently.

Hanna: Yes, it felt strange at the time, but I trusted what the doctor told me: That is was normal. So I said “oh, OK.”

Charlotte: But hours went by and she wasn’t getting better. On the contrary…

Hanna: She obviously got worse. She kept getting worse and worse.

Daniel: We’ll be back after a short break.

Daniel: NPR and the Knight Foundation are working together to better understand listeners like you, who listen to Radio Ambulante and other podcasts. Please help them by filling out a short and anonymous survey at npr.podcastingsurvey.com. It would be a great help. Thanks.

Daniel: Before the break, Ximena and Hanna were noticing that something was wrong. Ximena was feeling worse, and the two friends were very concerned. Charlotte de Beauvoir tells us more.

Charlotte: The next few days are a little blurry in Hanna’s memory. But I’m going to tell you what we’ve been able to verify about what happened in the days after the procedure.

In order to reconstruct this timeline, we have Hanna’s account of what happened and the majority of the Whatsapp conversations between Ximena and Rafael Nieto. We had access to the texts and voice messages they exchanged on the app in those days.

And before moving forward, we should warn you that what’s coming up is quite shocking. We haven’t edited any of these messages, neither Ximena’s nor Rafael Nieto’s.

OK, here is one of the first voice messages Ximena sent to Nieto in the early morning on Friday, at about 4 am; so, the day after the surgery.

Ximena’s Whatsapp: Doctor, I wanted to ask if it’s normal for me to feel so out of breath when I get up. I feel like I’m being choked whenever I do anything. What…what should I do? I’m really worried, I can’t breathe well. What do I do?

Charlotte: A few hours later, at about 7:30, Nieto sends her this message.

Rafael Nieto’s Whatsapp: Hello, miss, how are you doing? How have you been feeling? How did you feel this morning? Tell me how your breathing feels. Remember the most important thing is that you try to keep a slow, calm rhythm when you breathe. I know you may be feeling short of breath. This is important: take your medication, start with the Desloratadine and the antibiotic, don’t forget to take that too. Tell me how you’re doing, OK?

Charlotte: A few hours later, Ximena responds with a voice message, saying that she feels very weak and that her breathing is still choppy. But she doesn’t get an answer from Nieto. Around 9 in the morning, via text, Ximena asks him: “What kind of degree do you have? Are you a doctor?”.

Nieto doesn’t answer the questions, he just writes: “Remember: a lot of rest, in bed.”

An hour later, Ximena sends him a few messages with her complaints, but she doesn’t appear to get an answer from Nieto. The next exchange between the two of them recorded on the chat isn’t until 7pm that evening.

But Hanna tells us that that Friday, seeing that Ximena was still doing poorly, they decided to go to the hospital in Envigado. When they arrive, Hanna goes up to the front desk and…

Hanna: I told the truth: that it was a cosmetic procedure and that she couldn’t breathe, so, well they needed to take care of her or something. They told us: “Yes, in order to admit her in that case, you need 500,000 pesos.”

Charlotte: That’s about 160 dollars. Ximena had health insurance. What’s known as EPS in Colombia. She was covered under her parent’s insurance. But at the hospital they told her that since it was a problem caused by a cosmetic procedure, insurance wouldn’t cover it.

So Hanna tells Ximena the amount. She’s sitting off to the side in a wheelchair.

Hanna: And right away she started shouting from the chair. “Let’s go! Let’s go! No, no, no! Let’s go! Let’s go!”.  And I said: “Really?”. She said: “Yes. Let’s go! Let’s go!”. And she got up on her own, even though she was tired and everything, she got up from the chair by herself and left. And I followed her and said: “Ok, alright.”

Charlotte: They left, but decided to go to the spa in Río Sur, where she’d had the procedure done. Neither Nieto nor his wife were there, but she was seen by a doctor who —according to Hanna— was Venezuelan. He gave her an abdominal injection and an inhaler. Hanna says that this made her feel a little better. Ximena kept sending Nieto voice messages to keep him up to date on what was happening.

A few hours after having gone to the spa, at around 7 at night, he sent her a voice message:

Rafael Nieto’s Whatsapp: Well, everything you did sounds very good to me. You already sound much better. Remember, it’s the same thing I told you: all of the symptoms you are experiencing are effects of the procedure you had yesterday. That’s the truth: all of the symptoms you have are effects of the procedure you had done. They tell me they told you to get an inhaler and put you on some medication, I now know which one it is. Anyway, you have to rest, no matter what, you have to get a lot of rest and a lot of peace and quiet. And stay hydrated so you can really detoxify, and eat well. And…well, anyway, I’ll call you tomorrow to see how you feel in the morning.

Charlotte: That night, Ximena sent him a few messages about how to use the inhaler. It seems both her and Hanna were a little confused. They send him several messages but it wasn’t until a few hours later that Nieto answered.

This is the last message he sends her on Friday night…

Rafael Nieto’s Whatsapp: Hello, miss. Yes, you can use the inhaler if you want, you can use it now. Remember: the effects are still going to last for a little longer, it’s all a matter patience and you need to wait, OK? So that your body can get better on its own.  All your symptoms are fine, you are going through the normal process with anesthesia. And… At this point it’s just a matter of time. It just a matter of time before you get better. And what I said about getting rest is serious: you need to stay calm, you have to stay calm.

Charlotte: The next day, Saturday, Ximena got up, but she wasn’t getting any better. She spent the day laying in her pajamas, either in her bed or on her couch. She never stopped trying to get ahold of Nieto, with messages like this one, which she sent at noon on Saturday.

Ximena’s Whatsapp: Hello, doctor. Look, I took a bath and I’m coughing blood. Is that normal?

Charlotte: In case you didn’t understand, she told him that she was coughing blood. Nieto doesn’t respond.

Hanna thinks they went back to the spa that Saturday as well. But she’s not exactly sure what happened during that visit. They kept putting pressure on Nieto. At 7 pm the conversation picks up again. The next voice message comes from Nieto’s cell phone, but we’re not sure if it’s his voice. It could be the alleged Venezuelan doctor, but we couldn’t verify that.

In any case, Ximena complains to him about severe pain all over her body, especially in her chest. The man asks her what she’s taking and she answers that she’s only been taking what she had been told to take. And he gives her another prescription…

Whatsapp from Rafael Nieto’s cell phone: Well, princess: go get some Winadeine F tablets, ok? Winadeine, it’s spelled WI NA DE IN E F. 500mg. And take one every six hours. For about five days. OK?

Charlotte: This is a powerful analgesic. But at this point, Ximena can’t stand the pain any longer, and just four minutes later, she literally begs him to come to her house.

Ximena’s Whatsapp: I need you to come! I really don’t feel well. I need to have a solution for this. I need you to come.

Charlotte: Next, Ximena texts him her address.

Hanna says that this is Saturday night, after the last message, Neito went to their apartment with his wife. His position, according to Hanna, was the same as before: all of Ximena’s symptoms were normal. So Hanna, of course, believed him. In the end, she assumes he’s the doctor and he knows what he’s doing. But Hanna does remember that that night she started to doubt that everything was so normal. Nieto’s wife…

Hanna: Made a comment… something that sounded like she was kind of worried. Like: “No, if she’s sick, then let’s take her to a doctor or something.” And all at once, like he’s scolding her, he stops her and says: “No she’s not sick!”.

Charlotte: And, in fact, according to Hanna, Nieto suggested that…

Hanna: That Ximena was putting on a show. And we… We were to blame for it because we were coddling her, that no, everything was normal and that nothing was going to happen to her, and that it would even last five more days.

He told me that himself. And in front of him, I can attest to that.

Charlotte: Hanna —at this point feeling very overwhelmed with the situation, seeing Ximena like that, not getting better— asked them to send a nurse.

Hanna: So they agreed, saying they would send a nurse. They never sent one.

Daniel: The last message Ximena sent Nieto was the one in which she sent him her address. That’s the end of the Whatsapp chat with him.

Next week on Radio Ambulante, we’ll continue Ximena’s story.

Hanna: “Xime, this has gotten serious. You need to tell someone in your family.”

Teresa Villa Giraldo: When he said Rafael Nieto, I said to myself: “that’s the doctor who operated on Ximena.” I said: “Well, what do you want?”. “No, I want know what the situation is, how she’s doing…”

Hanna: I told Xime, “I can’t handle this on my own…”

Daniel: Charlotte de Beuavoir is a journalist and radio producer. Juan Camilo Cháves is a journalist and editor at Cerosetenta. Both are professors at Universidad de Los Andes in Bogotá.

This story was edited by Camila Segura, Silvia Viñas and me. Mixing and sound design by Ryan Sweikert. Thanks for Estudio Sónica in Bogotá an CEPER, the Center for Journalism Studies at Universidad de Los Andes, in Bogotá

The rest of the Radio Ambulante team includes Luis Trelles, Else Liliana Ulloa, Barbara Sawhill, Caro Rolando, Melissa Montalvo, Désirée Baynet, Luis Fernando Vargas, Andrés Azpiri and David Trujillo. Maytik Avirama is our editorial intern and Andrea Betanzos is out program coordinator. Carolina Guerrero is our CEO

Radio Ambulante is produced and mixed on Hindenburg PRO.

Learn more about Radio Ambulante and this story on our website: radioambulante.org. Radio Ambulante tells the stories of Latin American I’m Daniel Alarcón. Thanks for listening.

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