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.

At least 13 people were killed in a stampede at a nightclub in Peru when they tried to escape police who showed up to enforce COVID-19 restrictions on such gatherings.

According to Peru’s interior ministry, 120 people attended a party at Thomas Restobar Club in Lima’s Los Olivos district on Saturday night, despite prohibitions on social gatherings under the country’s state of emergency.

Nightclubs and bars were ordered closed in March, and extended family gatherings were banned earlier this month in an effort to slow the spread of the virus.

After being alerted by neighbors around 9 p.m., according to the ministry, police arrived to evacuate the building. Party-goers tried to flee through a single exit, getting trampled and trapped in the staircase as a result.

Six other people, including three police officers, were injured. Twenty three people were detained.

“The Minister of the Interior deeply regrets the death of thirteen people as a result of the criminal irresponsibility of an unscrupulous businessman; and extends his deepest condolences to his family members,” reads the statement from the office of Jorge Montoya.

The ministry said that police did not use any weapons or tear gas on the scene, though the BBC reports one resident told RPP radio that the police threw tear gas canisters during the raid.

In a second statement, the interior ministry said again that police had not used firearms or tear gas at any point during the intervention, and had followed lawful, established protocols.

It also said the nightclub’s two owners, a married couple, were detained on Sunday.

Later that day, health officials said that 15 detainees had tested positive for the coronavirus, with 13 of those still actively contagious.

According to data from Johns Hopkins University, more than 585,000 people in Peru have tested positive for COVID-19 and more than 27,450 have died. The country ranks sixth in the world for its total number of cases.

Copyright 2020 NPR. To see more, visit NPR.