Molar City

How a small Mexican border town transformed itself into the dental tourism capital of the world, where dental care costs up to 80% less than what it might cost in the United States.

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Roman Mars?

  Instagram teen accounts have automatic protections on by default. Built-in content settings for the content teens can see, contact limits for who can contact them, and time management tools like daily time limits and sleep mode. Teens are automatically placed into teen accounts, and teens under 16 will need a parent's permission to change any of these settings to be less strict. Instagram will continue adding built-in safety features to help create age-appropriate experiences. Learn more about teen accounts and Instagram's ongoing work to protect teens online at instagram.com/teenaccounts. This episode is brought to you by PNC Bank. Some design was made to be seen by all, like, for example, the seven wonders of the world. I mean, everyone should see those. While some were made to be less seen, like sewer systems.

• 0:44Roman Mars?

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• 1:55Roman Mars?

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• 2:00Roman Mars?

  The walk begins at the parking lot at the end of the road. The site isn't much to speak of, just a sprawling expanse of asphalt peppered with cars. Over a million people come here every year to embark on a kind of pilgrimage. They're here to cross the border.

• 2:18Speaker 01

  We are getting ready to go to Mexico this morning. Yes, one more time, so we shall see what the rest of the day holds.

• 2:30Speaker 02

  There are hundreds of videos online documenting this experience. Watch as many as I did, and they all start to meld together.

• 2:38Roman Mars?

  That's 99PI producer, Lashma Dawn.

• 2:41Speaker 02

  Some people seem nervous in the videos. Others are more excited. Many will turn to their imagined audience behind the camera and speak in a reassuring tone.

• 2:52Speaker 03

  You see that American flag up there, y'all? This is one of the safest crossings there is. And it's not scary, I promise you. It is not scary.

• 3:07Speaker 02

  Everyone here is headed to the same town in Mexico. It's called Los Algodones, and it's a place where, for decades, Americans have roamed the streets. They come here in desperate search of something they need, something that's almost impossible to find where they live. They're looking for a dentist, one that they can afford.

• 3:31Roman Mars?

  Every day, thousands of people, mostly American, mostly white, and mostly retired, come to this town looking for relief from the turmoil in their mouths. Here, dental care costs up to 80% less than what it might cost in the US. Dental tourism to Los Algodones is so common that many call this place "Molar City." Today, there are nearly 1,000 dentists in this 7,000-person town. And 98% of those in the patient's chair traveled here from outside Mexico. Lashma is going to take it from here.

• 4:08Speaker 02

  Watch any one of these YouTube videos and you'll see how a trip to Molar City is made easy for an American. For decades, this crossing didn't even require a passport. In one video, a retired couple arrives at Arizona's edge. They do a 360, displaying the massive lot where they've just parked. "We love Mexico," they say emphatically, talking to the camera. The camera then pans to show the rust-colored border wall in front of them, that corrugated monstrosity. They marvel. Then, a US Border Patrol vehicle starts driving past the screen, on guard, it seems, for anyone trying to cross in the opposite direction.

• 4:52Speaker 02

  To this, the camera woman speaks again, as if she's talking directly to Border Patrol. "Get 'em, boys," she says. Then, they begin their walk into Mexico. In Los Algodones, there are dense clusters of medical offices and a canopy of billboards above them. Vendors are set up on sidewalks where they sell handmade goods and kitschy souvenirs, like this one graphic tee that says, "Keep calm: You're on the fun side of Trump's wall." And then there are the street promoters, people who are stationed at almost every street

• 5:33Speaker 02

  corner, each of them competing for superlatives: the best deal, the quickest appointment, the most popular clinic in town. In Molar City, a street promoter is the first person a tourist will encounter.

• 5:47Speaker 04

  Good morning, buddy. What is it? Dental, pharmacy, glasses? I got dental promotion.

• 5:54Speaker 02

  Some promoters try to lure people in with discounts. Others vie for attention in more creative ways, like dressing up in a full-body-tooth costume and waving a sign. Then there's Alberto, a street promoter who takes a different approach altogether. He tries to attract customers with humor.

• 6:11Speaker 05

  I'm always trying to make stuff fun, you know? Make them laugh like a comedian, almost. Make them relax, just for that second.

• 6:20Speaker 02

  Alberto is employed by a couple clinics in town. He's assigned to a specific street corner, where he stands all day and tries to make his commissions.

• 6:29Speaker 05

  Because I'm like at a corner... I have a lot of people that pass by. So I talk to everybody. Eight hours out there, I'm over. From early in the morning, I'm talking and talking and talking all day.

• 6:41Speaker 02

  He told me that street promoters can also get a little territorial with each other because they're all vying for the attention of the same Americans who walk into town.

• 6:51Speaker 06

  You don't need appointment, my doctor's open right now. You give the service right away. We're not working with appointment.

• 6:59Speaker 04

  Good morning, buddy. What is it? Mento pharmacy glasses?

• 7:02Speaker 05

  You know what I did all day? I talked dumb stuff all day. And I still have that energy left.

• 7:10Speaker 02

  Alberto loves to talk. When I told him I wanted to talk about Molar City, he was like, how much time do you have? He told me how one time, he was on the phone with a girlfriend for a whole 24 hours, standing at a payphone for an entire day, just talking. From this anecdote alone, I got the impression that Alberto was probably good at his job, or at least that he had the stamina to endure it.

• 7:38Speaker 07

  Well, maybe let's not aim for 24 hours, but I'd love to chat a little bit.

• 7:44Speaker 02

  Alberto grew up nearby, and over the course of his life, he's seen how Los Algodones transformed into Molar City.

• 7:52Speaker 05

  Being in the border, we have this, we have America. America is very influential. America really affects everything that happens to the people right here.

• 8:06Speaker 02

  Los Algodones has built itself up to serve the dental needs of Americans and Canadians. And the town has become wildly successful in this goal. But Algodones went through many reinventions before it became Molar City. And I wanted to understand how it all happened and why.

• 8:26Speaker 02

  Los Algodones means cotton in plural. And that's because commercial cotton farming is what this land was once known for, back when it was still vibrant and green. Then a series of policy changes depleted the soil and dammed the flow of the Colorado River into Mexico. By the 60s, riverbeds were drying up and crops were struggling. But many Mexican border towns have long had another thriving business: booze. And after the farming industry crumbled, that's what Los Algodones relied on. At one point, the town had 48 bars. American soldiers living on military bases in Yuma, Arizona, were regulars. Alberto spent his childhood in Yuma, too.

• 9:11Speaker 05

  Yeah, we go to Algodones to get drunk. But yeah, I just, that's what Algodones has been to me from the beginning, it was just a little town.

• 9:19Speaker 08

  Algodones was a very small town with lots of cantinas. And used to come people from Yuma to dance in the cantinas or drink.

• 9:29Speaker 02

  This is Dr. Jesús Medina. He moved to town fresh out of med school in 1973, and he's been working here as a doctor ever since, although he seems to be perpetually on the brink of retirement.

• 9:41Speaker 08

  I think one day I have to retire. And my sons tell me, "When you gonna retire?"

• 9:47Speaker 08

  "Why? It's too young to retire."

• 9:51Speaker 02

  Dr. Medina first learned about Los Algodones from his brother-in-law, Dr. Bernardo Magaña, who's often described as the godfather of Molar City.

• 10:00Speaker 08

  He was the first dentist from this town, you know?

• 10:03Speaker 02

  Magaña is now in his 80s. He is retired and didn't want to be interviewed. But Medina told me about how his brother-in-law, Magaña, first had this vision to transform the town into a dental mecca.

• 10:19Speaker 02

  Back in the 60s, Magaña and Medina were living together in a city about 25 miles from Algodones. Magaña was a young dentist looking for a place to set up his private practice. At the time, he was working for someone who already had a few American patients, patients who likely lived in the South and would cross into Mexico to take advantage of lower prices.

• 10:41Speaker 08

  Lots of them start to tell about Algodones. Says, "Why you move to Algodones? Because Algodones is four minutes from Yuma." Says, "If you go there, you're gonna have a lot more patients."

• 10:54Speaker 02

  At first, Magaña was skeptical. He paid Los Algodones a visit, and it was a lot like he expected, a sleepy little place with a lot of mostly drunk people. But many of those drunk people were Americans. Its proximity to the border meant there was already a culture of coming and going. He saw the Americans spending their money at the bars and thought, maybe they'd spend money on dentistry too. Magaña knew he could offer them a price lower than what they could get in America.

• 11:23Speaker 08

  And my brother-in-law, he got the idea. He says, "I'm gonna put an office in Algodones." And he put the office, and it grew so fast. And he had so many patients, so many patients.

• 11:36Speaker 02

  Magaña set up his clinic right across the street from the border crossing. On his first day, he saw nine patients. And for the first three years, he was the town's only dentist, sometimes working from 6:00 in the morning until 11:00 at night. The demand for health services ended up being so much more than he could handle on his own. So he started asking others to come set up shop, including Dr. Medina.

• 12:02Speaker 08

  And then I have the idea to come and, and, and, and practice right here.

• 12:06Speaker 02

  Magaña helped Medina acquire a small office for his practice.

• 12:11Speaker 08

  He gave me a key. He says, "Take this. What? Go to my office and see." And then I come and I see he made me a very small office, you know, two rooms, waiting room and the, and the office to give attention, a table or desk, and that was my first, my first practice office I have, you know.

• 12:33Speaker 02

  Medina remembers those early days with amazement. Once, he stepped out of his office to see a line of people, Americans, all waiting for an appointment with him. He wasn't even taking appointments. He says the demand was immediate.

• 12:48Speaker 08

  And I start to work and I start to see American people, you know, hard time because I don't speak too much English, but I don't kill nobody, you know.

• 13:00Speaker 02

  Maganya and Medina were treating patients who would talk about their struggles with healthcare in America. For most Americans, dental care has always been out of reach. Early dentistry was considered more of a craftsman's trade. Dental work was performed by barbers and blacksmiths, people who were considered quacks by the larger medical field. And ever since then, dentistry and general medicine have fought hard to keep themselves separate. Cut to today, and dental and healthcare are still separated. They have separate insurances, separate teaching schools, separate medical records even. It's as if matters of the mouth are separate from the body. But of course, they're not.

• 13:43Speaker 02

  Every year, hundreds of thousands of Americans end up in emergency rooms for something like a toothache, something that could have been treated in a dental office. But most ERs don't have on-call dentists. So often, these patients are sent home with painkillers and are told to go visit their dentist. But a lot of these people don't have dentists, or if they do, the cost for a visit is impossibly high. And yet, people are held personally accountable for the state of their teeth in ways that they're not held accountable for many other health conditions. Poor dental care can be both life-threatening and humiliating, as if unhealthy teeth are a failure of individual responsibility

• 14:26Speaker 02

  rather than the symptom of a broken system.

• 14:31Speaker 02

  In Algodones, Dr. Magaña saw the state of dental care in America as an opportunity to turn this small Mexican border town into a place full of dental services catered to desperate Americans and Canadians looking for deep discounts. But the town was still mostly strip clubs and bars, and he felt like that was holding them back.

• 14:54Speaker 02

  So in 1980, Magaña became mayor, although the technically accurate term is municipal delegate. As municipal delegate, Magaña shuttered most of the cantinas. It was his first major step in transforming Algodones into Molar City. Year after year, the same buildings that housed those cantinas gave way to more clinics and pharmacies.

• 15:17Speaker 08

  In cantinas, I don't hear there no more. Only one or two in Algodones, you know? And but they disappear almost, you know? If we drink, we drink at home.

• 15:31Speaker 08

  All cantinas are dental offices now.

• 15:34Speaker 02

  Magaña helped transform the town in other ways, too. He opened a middle school, a high school, and a dental school. And Dr. Medina, like his brother-in-law, also got involved in town leadership. He coached the local sports teams. And he became the town's first official delegate of tourism.

• 15:53Speaker 08

  And when I come, we make the revolution right here, you know?

• 15:57Speaker 02

  More and more healthcare professionals were migrating to Algodones. And among Americans, knowledge of the town's services was spreading, although mostly by word of mouth. Still, Dr. Medina was looking for a way to take Algodones to the next level. And so he decided to attract people to their reformed party town by throwing a giant party. A party specifically for snowbirds, a term for retired Americans and Canadians who migrate south every year following the sun. "Come on over," Medina advertised. "We'll have free margaritas, free Viagra, discounted root canals."

• 16:35Speaker 09

  When kind of did you start this?

• 16:37Speaker 08

  Wait a minute, because I forgot.

• 16:42Speaker 08

  Right here is when they give me the position, you know, in the newspaper of Mexicali.

• 16:49Speaker 02

  Dr. Medina is sitting in his office, flipping through an old photo album that he's holding up to our Zoom screen. It's full of newspaper clippings and pictures of all the parties he threw over the years. His first one was in 1987. 7,000 tourists showed up. In the photos, they're all crammed into the town's four-square blocks. Many are holding red solo cups.

• 17:14Speaker 08

  This was my first party. Look at the American people, how I doing just in the street. You know, I don't have places to do it.

• 17:23Speaker 02

  Medina flips through the book fondly, as if he's cooing at baby photos.

• 17:28Speaker 08

  And that's the way I go on to start, you know, with that. And like this, you can see all my book is full of parties, you know, till I go and everything, you know. Well, it's all my life in this book, you know.

• 17:45Speaker 02

  It's clear that Medina put his heart into these parties, into making the town grow the way it did. He convinced his neighbors to cook enough food to feed thousands for free. He hired a mariachi band and converted an old boxing ring into a stage. And the Americans had a great time. Medina made sure the margaritas were strong.

• 18:04Speaker 08

  And they was drunk like crazy, you know. The American customs told me, "Dr. Medina, why you keep the little guys? Why? They grow right here. They don't want to show the papers. They tell us, son of a bitch."

• 18:19Speaker 08

  They was very drunk.

• 18:20Speaker 02

  Year after year, Los Algodones would continue to throw parties like that first one. Americans would return home, talk of the tacos, the town, their teeth. What was once a town of about 750 when Magaña first arrived is now crammed with clinics, hotels, restaurants, and pharmacies. Today, young dentists and souvenir vendors from all over Mexico continue to migrate to town in hopes of finding stable work. And the tourists keep coming in droves.

• 18:51Speaker 08

  In winter, it's too much people, and they make lines. And that's uncomfortable for them, but they don't care. They make the lines, you know. And they're still coming because they find dental services good, a good price and everything, and very handsome doctors.

• 19:12Speaker 08

  We live from the tourists, you know?

• 19:15Speaker 02

  We live from the tourists. It's a sentiment I heard from everyone in town. Teenagers will run to the border after school to sell trinkets to people waiting in line to go home. Women will walk up and down the line selling handmade sweaters and hot meals. And on the American side, the Quetzal tribe manages a casino resort. It's a popular spot for dental tourists who try their hand at the slot machines in between appointments.

• 19:42Speaker 05

  I think Agudonis is a good town. It's become a better town than it was before. You know, we really don't have a lot of like scenic views or like anything touristic. But the people are really like, they're really like hardworking people and, and they're also, they like to party, you know? They like to have good times also.

• 20:04Speaker 02

  Street promoter Alberto moved back to the area eight years ago. In part, to be closer to his family after a road accident in Cancun made it difficult for him to walk. He told me he gets discounted dental care from the clinics that employ him. But he's been putting off amputating his leg for years because of the cost of surgery.

• 20:23Speaker 05

  Promoters, we vary anywhere from a hundred and twenty dollars to some of us, some of us are making like a five or eight hundred dollars a week.

• 20:33Speaker 02

  I asked Alberto what he thought about the town's transformation into Molar City.

• 20:38Speaker 05

  I think dental has helped Agudonis a lot, but I think people just make their money and they, they, they go somewhere else, you know? They go live it up somewhere else.

• 20:51Speaker 05

  Because a lot of doctors have been, become millionaires.

• 20:54Speaker 02

  Many of those original dentists live in mansions, complete with indoor courtyards and pools. In addition to their dental practice, certain families in town own many of the hotels, restaurants, and pharmacies here. But zoom out of the town center and you'll see mostly unpaved roads and humble homes.

• 21:20Speaker 02

  There's this 18th century paleontologist Georges Cuvier. He has this famous quote about teeth. "Show me your teeth," he said, "and I will tell you who you are." It's true that from teeth alone, a dental anthropologist can gather all sorts of information. They can decipher migration patterns and cultural norms. They can tell if you ate with your fingers or if you endured famine. Our teeth are biographies. They hold facts about ourselves, facts we may not even recognize while we're alive. I'm curious how you would describe your relationship to your teeth.

• 22:04Speaker 10

  You know, my relationship with my teeth was, you know, I didn't really take the time on a daily basis to have good dental care. I haven't truly smiled in probably 10 years.

• 22:17Speaker 02

  This is Jeff Jackson. He's a retired veteran in his 60s. Jeff and his wife live in their RV, which is parked in Nevada for most of the year. Over the last couple of years, Jeff started losing more and more teeth. By the time he made the decision for implants, he had 13 teeth left.

• 22:35Speaker 10

  Both my wife and I are both waiting to get those permanent teeth in. Yeah, it's just, it's gonna be a fun time. Go down there and get them in and be able to enjoy it.

• 22:46Speaker 02

  I spoke to Jeff after his second trip to Moeller City. He was planning to go back a third time to complete what's called a full mouth restoration, which is one of the more popular treatments in town.

• 22:58Speaker 10

  You know, you understand why people go through it. I was like, you know, I'm just gonna be an ugly old dude anyway. But the confidence booster.

• 23:09Speaker 10

  And not having to sell my house to do it.

• 23:12Speaker 02

  Jeff isn't eligible for Medicare. He makes too much money for Medicaid, and he couldn't find a private insurance plan with a premium he could afford. A dentist in Nevada put together a price tag of about $50,000. In Los Algodones, he found the same treatment for less than $20,000. On top of the implants themselves, that price included getting his remaining teeth pulled, the cost of his pain medication, and his hotel stay.

• 23:42Speaker 02

  Mexican dental work is less expensive for a couple of reasons. Labor and real estate in Mexico costs a lot less than in the US. And dental school is heavily subsidized, meaning fewer dentists graduate school with the kind of colossal debt that's rampant in the US. And in Mexico, dentists don't need to get malpractice insurance. Still, it's not as though Mexican dentistry is affordable to all Mexicans. Only 48% of Mexicans nationwide who are in need of oral health care are able to receive it. But to the average American, it's a discount worth traveling for. And this trend might increase. By 2060, the number of Americans over 65 will practically double.

• 24:27Speaker 02

  And the US will see an exploding need for all kinds of health care services in a system that won't be able to support all of its people. People like Jeff. I'm just curious if you have any thoughts or opinions on healthcare, access to healthcare in the US, you know, from your perspective. I mean, there's clearly a problem, right?

• 24:55Speaker 10

  I am a dyed-in-the-wool capitalist kind of guy. And so I don't really buy off on socialized medicine. But we have to bring down costs. You have millions of people who can't afford health insurance.

• 25:17Speaker 02

  To Jeff, Mueller City might be a solution. But dental tourism is also a measurement of the problem. It shows us the lengths people must go to seek an end to their pain.

• 25:38Roman Mars?

  More with Lashia after the break.

• 25:47Roman Mars?

  Instagram teen accounts have automatic protections on by default. Built-in content settings for the content teens can see, contact limits for who can contact them, and time management tools like daily time limits and sleep mode. Teens are automatically placed into teen accounts, and teens under 16 will need a parent's permission to change any of these settings to be less strict. Instagram will continue adding built-in safety features to help create age-appropriate experiences. Learn more about teen accounts and Instagram's ongoing work to protect teens online at instagram.com/teenaccounts. This episode is presented by Air France. Air France Business Cabin offers comfort from start to finish. Enjoy priority check-in and boarding, followed by access to peaceful lounges.

• 26:32Roman Mars?

  Onboard, savor menus created by renowned French chefs paired with wines and champagne selected by Smollet. Stay connected with free high-speed Wi-Fi. Then unwind in a fully adjustable lie-flat bed with a mattress topper developed with Sofitel MyBed, a signature touch of French hospitality. The art of travel elevated, because Air France Business Cabin goes further in every detail to make your journey exceptional.

• 27:01Speaker 11

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• 27:30Roman Mars?

  This episode is brought to you by PNC Bank. Some design was made to be seen by all, like, for example, the seven wonders of the world. I mean, everyone should see those. While some were made to be less seen, like sewer systems. Like, when was the last time you thought about an aqueduct? Yet, that doesn't mean they're any less impressive. You could say the same thing about PNC Bank's smart, calculated approach to banking. It won't make for flashy hair. Headlines or trends on social media, but it'll make the right money moves that'll help set you up for the successful financial future you're looking for. A design everyone can get behind. PNC Bank, brilliantly boring since 1865. Brilliantly boring since 1865 is a registered mark of the PNC Financial Services Group, Bank. PNC Bank, National Association, Member FDIC.

• 28:16Roman Mars?

  We're back with Lasham Adon.

• 28:24Speaker 02

  On a typical day, dentist Myra Jimenez is buzzing around her clinic. Myra moved to Algodones from Guadalajara two decades ago. She says her early memories there are a blur, mostly because she was so busy working.

• 28:39Speaker 12

  Saltándonos comidas, saltándonos todo. O sea, era muchísimo.

• 28:44Speaker 07

  I mean, skipping meals, skipping everything. I mean, there were so many people. I did up to 100 crowds in a single day. I was the machine.

• 28:56Speaker 02

  Myra told me that in those days, the streets were so packed with Americans that you couldn't get through.

• 29:01Speaker 13

  She was always working, all day. I'm telling you, from 8:00 in the morning to 10:00 p.m.

• 29:06Speaker 02

  This is Myra's daughter, Rennie, who works in her mom's clinic. Rennie grew up in this clinic. She uses the words waiting room and living room interchangeably.

• 29:15Speaker 13

  Like, living rooms, like, the waiting areas would be packed with people, just packed. And I remember, I had a ride that would drop me off at the border, and one of my mom's workers would pick me up, walking. So I'd come back, walking to the office. And I remember, my mom didn't know how to speak English. And so I remember sitting in the living room, in the waiting area, with patients from Canada, from Utah, from Texas, from California, and all the patients helping me do my homework, every single day.

• 29:48Speaker 02

  Myra never expected to move up to Los Algodones, to raise her kids on the border. Her first impression was that the town was arid and boring. But Myra likes having Americans as patients. She says that they're especially grateful. Before moving to town, Myra had never met people so excited to be seeing a dentist.

• 30:10Speaker 07

  And what I love most is that the Americans always treated us very well. They were very grateful patients, and you became friends with them. I love that.

• 30:26Speaker 13

  I remember being a little kid, and my mom would come home with patients to my house. "Oh, this is so-and-so, and they're gonna be eating dinner with us." And I'm like, "Who are these people?"

• 30:37Speaker 02

  Myra and Rennie talked a lot about this sense of community fostered between dentist and patient. But Myra also has concerns about the industry. In fact, there's one thing that it seems like almost everyone is constantly worried about: that the town stays safe. And more importantly, that the town is perceived as safe.

• 31:00Speaker 02

  Violence and organized crime is a real problem in the Mexican borderlands, but medical tourists are rarely targeted. Still, one dental coordinator told me that trying to quell concerns about safety is a major part of her job. She told me that her American clients bring it up all the time.

• 31:18Speaker 14

  I think because Mexico has, you know, a bad reputation in the US, and everybody thinking coming into Mexico is dangerous. I've had people thinking that, "Oh, we're gonna come to Mexico, and we're gonna be waiting here with guns and stuff like that."

• 31:34Speaker 13

  People have told you that?

• 31:35Speaker 14

  Yeah, they're like, "Oh, I thought it was gonna be the cartel outside." And I'm like, "No, it's very safe." And they're very scared. But I think it's more because of the news.

• 31:47Speaker 02

  More than real incidents of violence and crime, people working in Algodones are concerned about how Mexico is portrayed in American media.

• 32:00Speaker 07

  The news comes out that there's going to be a shootout, that they're going to kidnap you, that if you cross to Mexico, you're in danger, that your life is in danger. Yes, I think that affects us.

• 32:16Speaker 08

  I think most people, they're a little scared to come to Mexico because the histories they hear in the United States, you know, they can steal them right here, or they can do something, shotguns, and things like that, mafia guys, whatever, you know.

• 32:31Speaker 02

  Los Algodones itself is actually a pretty safe place to visit, but still, the town works so hard to correct the narrative that many Americans have about Mexico. Their livelihoods depend on it.

• 32:45Speaker 15

  The industry is having to put a lot of effort and spend a lot of money and make lower profits than they might otherwise if they didn't have to put so much effort into dealing with that narrative or those prejudiced assumptions about Mexico.

• 32:58Speaker 02

  This is Christina Adams. Christina is a public health researcher who studied the ethics of dental tourism in Los Algodones. She wanted to know how the industry might be affecting locals.

• 33:09Speaker 15

  I think it's completely normal for someone leaving their home country and accessing healthcare to be questioning, you know, is this, is this safe? What are the standards of care in this different country? And then I think there's another layer on top of that, where I think they're also trying to combat really prejudiced assumptions about Mexico as much as possible, that it's, you know, a country from the global south, that it's underdeveloped or even undeveloped, that there's no way the standards could be as high of quality in a place like Mexico.

• 33:37Speaker 02

  Christina says that clinics in Algodones employ certain strategies to maintain a positive reputation with tourists. Some clinics will pay medical tourism companies in other countries to act as a middleman between patient and clinic. Many of these companies are based in Europe, and they'll put Mexican clinics through a vetting process to prove their legitimacy to a non-Mexican clientele. When making interior design choices, clinics might consider an American aesthetic, whatever that means. The goal is to make sure the image of Mexican dental care is squeaky clean. Sometimes, quite literally. Christina remembers being hit by the intense smell of sanitizer when she walked into the many clinics in town.

• 34:20Speaker 15

  It was overwhelming sometimes walking into a dental clinic, just the smell of sanitization. Like, it feels like above and beyond anything I'd ever experienced myself walking into healthcare spaces. Like, they're really trying to make sure you smell and notice right away. Like, this is clean.

• 34:35Speaker 02

  All this effort is to make Los Algodones feel safe and comfortable, relatable even. And so, there are ways in which the town has worked to play up its Americanness by minimizing its Mexicanness.

• 34:49Speaker 15

  I definitely remember this sense of, like, staff being told to minimize their Mexican accents, because that would help people, tourists, feel more comfortable.

• 34:58Speaker 02

  Christina's research also found that some clinics would hire someone who speaks American English to just sit in the waiting room. The idea being that their presence might help nervous Americans feel more at ease. It seems like everyone who lives and works in town has their own strategy to calm anxious American nerves. One local dental tourism company uses a camera to occasionally livestream the border crossing from a bird's eye view. These videos exist almost as if to say, "See? It's so uneventful here. Boring, in fact. Safe."

• 35:39Speaker 02

  Back when Dr. Jesus Medina was head of the Tourism Department in the 80s, he developed his own strategy to make skeptical US tourists feel comfortable in a Mexican dental clinic. He created a complaint office, a place tourists could go if they felt like they were being scammed. He called it "The Office of Defense of the Tourists."

• 36:00Speaker 08

  That way, if one Mexican doctor do a bad job to one of the patients, they can go to that office, you know? And then, we call the doctor, and we make them give the money back to the patients, you know?

• 36:15Speaker 02

  The office functioned like an amateur courtroom, and Medina enlisted Dr. Magaña as the judge. Magaña would inspect the dental work of other Mexican dentists, occasionally calling the police in for backup.

• 36:28Speaker 08

  It was very hard, you know? We send the police, it comes there. He says, and Maraña says, your work is not good. You have to give the money back to the lady.

• 36:38Speaker 02

  Police in Los Algodones exist to protect the industry and to make tourists feel safe. There's an old promotional video for Molar City still up on YouTube. It's from 12 years ago, and it's less than a minute long. In the clip, a police officer does a salsa twirl with an elderly white woman. The video is titled, "All Tourists Are Safe and Fun in Los Algodones."

• 37:02Speaker 15

  There's parties, there's fun, there's bars, there's cheap food and drinks, there's dental care, there's a ton of pharmaceuticals, and the police are watching. If there's any sense of like any trouble brewing, police will be very much on it.

• 37:15Speaker 02

  Police might help tourists feel safe, but for locals, especially low-wage workers like street vendors and promoters, the police ensure that their movements are more tightly controlled. Remember those famous welcome parties, the ones that Dr. Medina started in the 80s? A lot of locals aren't invited. In fact, they're explicitly told to stay away.

• 37:38Speaker 15

  There's a lot of expectations around where people are allowed to be on those days. Like, you know, definitely do not show up at the party unless you're helping to work there. And so on a day like the welcome party, that involves sort of restricting the movement of other folks who live there and making sure that, you know, they're only seeing and experiencing what the sort of town elites want them to see and experience to ensure that the reputation of the tourist industry is upheld.

• 38:10Speaker 02

  Despite all this effort towards safety, whenever violence does occur anywhere in the border region, it can have major ripple effects on medical tourism. I spoke to someone named David V. Quest, a medical tourism researcher who conducted a bunch of surveys on Americans after an incident in 2023, when four American medical tourists were ambushed by a drug cartel, and only two of them survived. David was curious about Americans' perceived ideas about safety in Mexico and how those ideas might impact their decision to engage in medical tourism there. On one of his surveys, he asked Americans, "Would you feel safe going to Mexico?" And then another question, "Would you feel safe going to Cancun?"

• 38:57Speaker 02

  David's research suggested that Americans perceive Mexico and Cancun as two separate places. Cancun is safe. Mexico is not.

• 39:10Speaker 02

  In a way, I think Los Algodones has achieved that Cancun status. Molar City can exist as a performance for American consumers, disembodied from the forces that created it.

• 39:25Speaker 02

  And about how many people do you think in town have the same kind of job that you do?

• 39:33Speaker 05

  Oh, my competition.

• 39:35Speaker 02

  Does it feel like competition?

• 39:36Speaker 05

  Well, I got them all, you know, I got them all pulling it out. I got a report on every single one of them. Which one would you want me to start with?

• 39:47Speaker 05

  I got my competition's everywhere. Everybody's my competition.

• 39:52Speaker 02

  There are dozens of street promoters like Alberto. And because there are so many of them, all working on commission, Alberto's success depends on his charisma. He has to give the best performance. And so Alberto has his own strategies to try to stand out and make a good impression. Besides workshopping comedic material on the job, he told me this one other thing. He tends to play up how American he is. It's not a hard thing for him to do. Because like many people who grew up along the border, Alberto traveled back and forth a lot. He lived in Arizona, but crossed the border weekly. His English is good. He describes himself as being from the border.

• 40:34Speaker 05

  So I grew up, you know, going to school and then coming down the weekends down to Mexico. That stuff, and a lot of kids grew up like that.

• 40:44Speaker 05

  Because there's a lot of people in Algodones. They were, oh, I forgot to mention this. I was deported.

• 40:52Speaker 02

  Alberto was deported to Mexico in 2010. In fact, I learned that almost all of Molar City's street promoters are deportees. It is, in fact, their Americanness, their American English, that makes them ideal candidates for this role.

• 41:09Speaker 05

  It helps me break the ice. It helps me bond with people. Right away, they can tell that I lived in America.

• 41:20Speaker 02

  Oh, they bring it up?

• 41:22Speaker 05

  Yeah, they'll say it like that. They'll be like, "Oh, I can hear you. Oh, you live in the States." I'm like, "Yes, got me a little education over there."

• 41:33Speaker 05

  So it makes me relate to them more and feel more relaxed.

• 41:39Speaker 02

  Alberto tells me he'll recognize familiar faces crossing into Mexico from time to time. So-and-so from high school, his friend's uncle. But he doesn't get to see his family so often. They all live in Arizona and don't like to come visit.

• 41:53Speaker 05

  They really only come when they have to.

• 41:55Speaker 02

  Yeah.

• 41:56Speaker 05

  The reason they don't like it is because of the immigration, the way they treat them. When they're crossing, they always get harassed. Yeah, when they're going back to America, they get harassed. So they get tired of that.

• 42:12Speaker 02

  Los Algodones has long been set up for the benefit of Americans. And the journey Americans take to cross into Molar City has always been a simple one. But of course, the journey in the opposite direction is much more complicated. Can I ask you a question that might sound, I don't know, I don't know how you'll take it, but I'll ask it anyway. You can tell me how you react to it. I've heard from Americans and Canadians, like people describing what it's like to go down to Los Algodones. And people describe just walking freely through the border, like just five minutes, no need to even show a passport.

• 42:52Speaker 02

  And I'm just curious what that's like for you on your end, knowing that you were kicked out. And yet, part of your job is to interact daily with, I don't know, hundreds of people who just walk so freely across this border, you know?

• 43:14Speaker 05

  The way I see it is like this. Since I am from the border and we lived in America, we went to school in America. What happens is that when I see people come from America and I see myself that I can't go back, which is like literally right there, I can see my mom's house from right here.

• 43:34Speaker 02

  Oh, wow.

• 43:36Speaker 05

  That's the hardest thing to see. I see my house, I got the Colorado River, and I can literally see the water tank at the reservation. And then I can see all the way to the Yuma Medical Hospital on 24th Street. And then I kind of know more that's where my mom's house is over here. If I had a drone, I could fly it over there and look at my mom's house.

• 44:00Speaker 02

  Yeah.

• 44:03Speaker 05

  That's how close I am. That's not easy. Very hard for me.

• 44:15Speaker 02

  It's 5:00 AM in Algodones. The sky is still dark, not quite sunrise. And Alberto is shuffling around the house, getting ready for work. The streets are mostly quiet at this hour, just the sound of other promoters and vendors setting up, setting the stage for Molar City. By 6:00 AM, he's at his post. The border opens and the Americans descend. They walk in the shadow of the 30-foot wall that divides them, crossing the very threshold Alberto cannot.

• 45:15Roman Mars?

  99% Invisible was reported and produced by LaShma Dawn and edited by Emmett Fitzgerald and Delaney Hall. Mixed by Martine Gonzalez. Music by Swan Real. Voiceover and translation support by Laura Ubate. Fact checking by Graham Heisha. Special thanks this week to Gabby Martinez and Griselle Castaneda. Kathy Too is our executive producer. Kirk Colstead is the digital director. The rest of the team includes Chris Berube, Jason DeLeon, Christopher Johnson, Vivian Le, Joe Rosenberg, Kelly Prime, Jacob Medina Gleason, Talon and Rain Stradly, and me, Roman Mars. The 99% of visible logo was created by Stefan Lawrence. We are part of the SiriusXM Podcast family, now headquartered six blocks north in the Pandora building

• 45:59Roman Mars?

  in beautiful Uptown Oakland, California. You can find us on all the usual social media sites, as well as our new Discord server, there's a link to that, as well as every past episode of 99PI at 99pi.org.

• 46:19Speaker 16

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