The four Americans who were shot at and abducted in Mexico were reportedly visiting for medical tourism — making them part of a booming industry that is vital to Mexico’s economy.

“Pre-pandemic, some 1.2 million American citizens traveled to Mexico for elective medical treatment,” Josef Woodman, CEO of Patients Beyond Borders, told NPR. His firm publishes a guide to international medical travel.

Here’s an update on medical tourism, and the recent tragedy:

U.S. medical travel is rising sharply

“Today, the market is recovering rapidly in Mexico, nearly back to its pre-pandemic levels,” Woodman said.

Nearly 780,000 people were projected to leave the U.S. for health care in 2022, according to Healthcare.com, citing data from the medical travel website Medical Departures.

That outburst of activity got a big boost in late 2021, when the U.S. relaxed key border restrictions with Mexico.

Costa Rica is the second-most popular destination for U.S. visitors seeking medical care elsewhere, Woodman said. It’s a particular draw, he added, for people in the Northeast and Southeast.

Most people travel for dental and cosmetic work

Cosmetic surgeries are just one of the procedures that are far cheaper in Mexico — for years, people have been visiting from the U.S. to get elaborate dental work or cosmetic treatments done, or to pick up antibiotics and other medicines at favorable prices.

Many people also travel to get orthopedic work done, replacing knees or hips for less than half the cost of such procedures in the U.S.

“North American patients travel to Mexico for care primarily to save 50-70% over what they would pay in the United States for an elective treatment,” according to Woodman.

Medical tourism does bring risks, experts say

While an element of risk is inherent in many procedures no matter where they’re performed, medical tourism can heighten complications, according to the Centers for Disease Control and Prevention.

Potential problems range from the dangers of flying in a pressurized plane cabin too soon after a surgery to the complications of getting follow-up care for a procedure done in another country.

Some of the most serious warnings from the CDC are for infections, from wound and blood infections to pathogens that might be more common or resistant in the host country than in the U.S.

“Recent examples include surgical site infections caused by nontuberculous mycobacteria in patients who underwent cosmetic surgery in the Dominican Republic,” the CDC says, “and Q fever in patients who received fetal sheep cell injections in Germany.”

U.S. medical tourists rate Mexico highly

A 2020 research paper that surveyed some 427 Americans crossing the U.S.-Mexico border in California for medical services found that most of the respondents “felt that Mexican health care services are of the same or better quality compared with those in the United States, for a lower cost.”

People had come from 29 states across the U.S. to get care in Mexico, with the vast majority driven by cost concerns, according to the paper, published in the Journal of the American Pharmacists Association.

The researchers also collected data about the medical tourists themselves, reporting an average age of 64.5 years. Their most common yearly income range was reported to be between $25,001 and $50,000 — but that reflects less than a quarter of the respondents.

More than 400 of the survey’s 427 participants said they would undertake more medical tourism in the future, the paper said.

Most of Mexico’s hospitals follow U.S. standards

Mexico has worked for years to promote medical tourism to draw patients across the U.S. border. That includes improving its health system and following international standards.

“About 10 years ago, the Mexican federal government licensed the Joint Commission accreditation standards, which are used to accredit U.S. hospitals,” as David Vequist, who runs the Center of Medical Tourism Research at the University of the Incarnate Word in San Antonio, told NPR’s All Things Considered.

“So most Mexican hospitals are now basically using the same standards we use in hospitals in the United States,” Vequist added.

Details of the recent violence are still emerging

At least one of the U.S. citizens who were caught up in the recent tragedy was reportedly going to Mexico for a tummy tuck operation. But the group’s vehicle came under fire hours after entering the border city of Matamoros, Mexico, from Brownsville, Texas.

Two of the four died; all are reported to be natives of Lake City, S.C. Their identities have not been released, but relatives have been speaking to NPR and other outlets.

Mexican officials say they believe the four were caught in the middle of a conflict between drug cartels in the state of Tamaulipas — an area that is under a do-not-travel advisory from the U.S. State Department.

Copyright 2023 smack Magazine. To see more, visit NPR.

The death of a Pakistani-Scottish chef who claimed he cooked up the world’s first chicken tikka masala is prompting a flood of tributes to what’s been described as ‘Britain’s national dish’ — and reviving a debate into its true origin.

Ali Ahmed Aslam, known widely as Mr. Ali, died of health complications on Monday at age 77, his nephew Andleeb Ahmed confirmed to NPR.

Aslam was the owner of Glasgow’s popular Shish Mahal restaurant, which he opened in 1964 after immigrating from Pakistan as a boy.

In his telling, Aslam devised the globally beloved recipe one night in the 1970s, when a customer complained that traditional chicken tikka was too dry. The chef went back to the kitchen and combined spices, cream and a can of condensed tomato soup. Voilà: the modern model for chicken tikka masala was born.

But so, too, was a debate about its origin.

Who created chicken tikka masala?

In 2009, a Glasgow politician campaigned for chicken tikka masala to be granted protected heritage status and for the city to be named its official home. But the bid was rejected after multiple establishments from around the U.K. laid claim to the dish.

Others say the curry was most certainly invented in South Asia. Monish Gurjal, the head of the popular Indian restaurant chain Moti Mahal, says his grandfather was serving chicken tikka masala to Indian heads of state as early as 1947.

“It’s kind of like: who invented chicken noodle soup?” says Leena Trivedi-Grenier, a freelance food writer who probed the various origin claims in 2017. “It’s a dish that could’ve been invented by any number of people at the same time.”

Chicken tikka (sans the masala) has been a popular street food in Pakistan and northern India for decades. At its core, it involves chicken that’s marinated in chili powder and yogurt, then blackened on a grill or in a tandoor, an oven made out of ground clay.

The cooking method leaves chicken tikka prone to drying out, says Trivedi-Grenier; the idea to add a sauce with staples like cream, butter and tomato isn’t too revolutionary.

Another point of debate is the dish’s relatively mild taste. In an interview originally shared by AFP news, Aslam said the recipe was adapted from traditional cuisine “according to our customer’s taste.”

“Usually they don’t take hot curry,” he said of U.K. diners. “That’s why we cook it with yogurt and cream.”

In 2001, the U.K.’s foreign secretary, Robin Cook, said in a speech that chicken tikka masala is a “a true British national dish,” epitomizing “multiculturalism as a positive force for our economy and society.”

But to Trivedi-Grenier, the idea that chicken tikka masala was created solely to suit British people’s palates is “garish” when one considers the symbolism.

“How do you colonize and enslave an entire country for a century and then claim that one of their dishes is from your own country?”

Customers remember Aslam as a humble man and talented chef

Aslam, a man who shied away from attention, found a sense of purpose in exposing his customers to new flavors, said his nephew, Andleeb Ahmed.

“He was actually serving customers until the end of his life,” Ahmed said. “That was his passion. That was what he loved doing.”

Around the world, those who’ve dined at Shish Mahal are remembering Aslam as kind and talented, and someone who helped expand their culinary sensibilities.

“I tasted my first curry in the Shish Mahal in 1967 and continued to enjoy them during my student days and beyond,” tweeted a former Scottish member of parliament.

Vijay Prashad, an international journalist, wrote that, to say the addition of chicken tikka masala has benefited many menus, is “controversial,” but the food is undeniably good.

“Naans down in [Aslam’s] honor,” he added.

Ironically, when it came to his own taste preferences, Aslam ranked chicken tikka masala fairly low, his nephew said.

“The chefs would make a very traditional curry for him. He’d eat it at lunch every day,” Ahmed explained.

“He’d only have chicken tikka masala when guests were over.”

Copyright 2023 NPR. To see more, visit NPR.

Since he was laid off from a São Paulo auto repair shop in March, mechanic Edson Santana has struggled to find a job. His fiancée, Jessica Fernandes de Andrade, has been unable to work for weeks because of lingering fatigue and shortness of breath after a case of COVID-19.

But they’re pulling through with each receiving a pandemic emergency stipend of $109 per month. “We’ve been able to manage, and I have been able to take care of her,” Santana, 38, says.

He says they have Brazilian President Jair Bolsonaro to thank: “He’s helping the neediest people. It’s the right thing to do.”

Pressured by civil society, the government launched the benefits in April as pandemic shutdowns were battering the nation’s already shaky economy. As of July, they reached more than 30 million households — home to half the population of the largest country in Latin America — with an average monthly benefit of $163 per home. Now the relief is also providing an unlikely popularity boost for Bolsonaro, a far-right president who has insulted welfare recipients and who protested measures to prevent what became one of the world’s largest coronavirus outbreaks.

Approval for Bolsonaro rose to 37% in August from 32% in June, according to pollster Datafolha, his highest rating since taking office in January 2019. Datafolha found that much of his increased popularity came from the demographic eligible for the new stipend.

Now, with the emergency stipend set to expire in September, Bolsonaro says his administration is planning a “Brazil Income” — an expansion of cash transfers to the poor that have been traditionally associated with the country’s left.

Family allowance

Brazil is renowned for its massive, nearly 2-decade-old cash-transfer program for the poor, Bolsa Família (often translated as “family allowance”). As of March, it reached 13.8 million families, paying an average of $34 per month. (The national minimum wage is about $190 per month.)

The emergency stipend greatly expanded the payment, raising meager incomes for many and replacing lost earnings for others.

Luis Carlos Aranha, 34, a day laborer in a small town in São Paulo state who received Bolsa Família before the pandemic, says what changed for him with the larger stipend was becoming able to “buy food like fruit and ham for our daughters, instead of just rice and beans.”

But the stipend was meant to be temporary. Legislators from different parties are now pushing the Bolsonaro administration to launch broad, long-term income support for the poor.

Whither the Chicago school

While implementing a basic income could lift Bolsonaro’s popularity, it could also bring him to a crossroads regarding an election promise to keep a tight budget.

His economy minister, Paulo Guedes, trained at the University of Chicago with thinkers who helped direct the economic “shock treatment” of Chile’s Augusto Pinochet dictatorship. That unleashed a spree of harsh government spending cuts and privatization to stem chronic inflation in Chile. Bolsonaro’s pledges to dramatically slim down Brazil’s government won praise from investors.

Government economists predict the nation’s debt will reach about 95% of gross domestic product with this year’s emergency budget. But in 2021, the government risks exceeding a spending limit imposed after President Dilma Rousseff of the Workers’ Party was impeached over fiscal issues in 2016.

Guedes and business leaders have repeatedly warned that generous government spending should be kept in check to keep the economy stable and maintain investor confidence.

If Bolsonaro “cedes to the populist temptation of irresponsible spending and breaks the rule of the ceiling, it could bring the country to a crisis like the one that we lived through in the Dilma [Rousseff] government,” Fernando Schüler, a professor at business school Insper, wrote in an op-ed last week.

Bolsonaro’s economic team floated a “Brazil Income” proposal that would set the average Bolsa Família payment at around $46 per family, but Bolsonaro rejected it as too low.

Many lawmakers want a higher transfer amount to be available to a wider range of Brazilians after the pandemic assistance expires.

With a larger cash transfer, says congressman Felipe Rigoni, “we can avoid millions of people falling into extreme poverty while also establishing security so they could train for better jobs.” Rigoni, of the Brazilian Socialist Party, is a coordinator of a congressional bloc for basic income that formed last month with members from 23 of the 24 parties in Congress.

Rigoni says a robust basic income could stay within budget by cutting costs elsewhere. Leandro Ferreira of the Brazilian Basic Income Network, a research group that’s advising the congressional bloc, says a guaranteed income for more than 30% of Brazilians could be financed through measures such as closing tax loopholes for the rich.

Bolsonaro has displayed a new friendliness to social spending, including recent visits to inaugurate public works in Brazil’s poor northeast, much in the style of his political nemesis, the Workers’ Party.

Gleicyelen Silva, a 25-year-old saleswoman in the northeastern state of Maranhão who voted for Bolsonaro, says she is not bothered by his apparent economic shift, adding that “he is still very different from the Workers’ Party in that he stands for conservative Christian values.”

There’s another group untroubled by Bolsonaro’s shift: the military, a major pillar of his support. In a pension reform and budget cuts last year, military benefits remained largely untouched.

Bolsonaro’s economic legacy may thus end up looking less like Pinochet’s pro-market regime in Chile and more like a period during Brazil’s own military regime in which the government spent heavily.

Copyright 2020 NPR. To see more, visit NPR.