Chronic obstructive pulmonary disease (COPD) treatment in 144 Thoracic surgery clinics in Americas

We were at Vanderbilt before transferring to Mayo. This has been an amazing experience! It’s like it’s a requirement is to be super nice; Vanderbilt, not so much. I would recommend anyone to come here, and I’m so glad we chose to switch. The doctors, nurses, and even the staff (cafeteria, welcome center, etc) were by far nicer than Vanderbilt. They are so knowledgeable, thorough, and patient. Very impressed!!!

The Mayo Clinic is such a special place! It’s a medical facility that could also be a museum of art museum, history, and architecture. People travel from all over the world to be treated here, but what makes it truly special are the compassionate, skilled, and dedicated employees. I stood outside the Mayo Building and watched bus after bus pull up to the staff entrance - and watched countless everyday heroes get off those buses and go to work performing “miracles” at a place that provides hope to people who need it most.!!

I had 7 uterine fibroids removed by Dr Khan. Well done. No complications. After six weeks I was back in gym doing great. Dr khan is the best. Great doctor. Nurse Logan day shift and Susan night took good care of me.!!

I'm currently here and I can tell you this place is a sad example of a hospital nurses are not interested in taking care of people they see how fast they can get out your room you going to be room up with someone and you have to watch out for each other the doctors are dumb all they do is tests and hope they find something and they wait until something bad is about to happen before you get any treatment had better treatment in smaller hospitals pass on this place they just in it for the money also food is bad nothing good please save your money. Place is like a burning trashcan.

The Cleveland Clinic is a different breed of hospital from the others I’ve been in. Everyone who participated in my care was thoughtful, well trained, and skillful. They’re a hub for up-to-date practices & medical knowledge. And the practitioners have exceptional levels of experience earned through high volumes of cases. Importantly, the staff seem well supported. So many members of staff went above & beyond. The cleaning staff made an origami elephant out of a towel when I first got there. The dining staff tailored meals for my specific needs and made a surprise cake for my birthday. Transport held good conversations while easily navigating. Nurses, technicians, etc adapted to limiting check-ins/procedures to the certain hours when I asked (to protect sleep). There’s museum quality art on nearly all the walls (good incentive to go on walks in the halls) and nice facilities. There were some bureaucratic challenges when I was first admitted, but in spite of that, I still evangelize to friends & relatives all the time - if you need more serious care, go to the Cleveland Clinic.

This place is a gift from above. It’s absolutely amazing how they put together the teams and staff that they have. My surgeon Dr. Faisal Bakaeen gave me a bypass (CABG) surgery and I cannot thank him enough. His team, the nurses and staff in this hospital from the emergency room to step-down are honestly the nicest people I have ever met in a hospital. They truly care and will not let you leave if your problems are not solved. This place is the real deal, don’t hesitate to get there opinion, I’m so glad that I did. Thank you Dr Bakaeen, you save my life and I will never forget you…

If you have a true emergency, this may not be your best choice. Waited 3.5 hours and still not seen except to check in. Other patients with really serious issues (which we hear about because there is no privacy at check-in) have also been waiting and I’m worried about them. Good luck.

Worst emergency room I’ve been to. It’s been 3 hours since anyone said anything to my husband and that was only to draw more blood. Nurse was exceptionally rude and dismissive. It’s 11:45 pm and we got here at 6 pm. They aren’t telling anyone a thing! I will not recommend this emergency room ever.

If I could give this hospital a 0 I would. The nursing care here on the 4th floor so far has been awful for my daughter. Just basic care and concern for patients would be appreciated. Hoping the night crew is better. The nurses are all out at the desk laughing it up and sharing their phone pics. No that I care about that but shouldn’t the patients come first? I’m afraid to leave my adult daughter here and go home because I’m not sure they will even check on her. Seriously. There are 2 people in this room. The patient next to my daughter hasn’t moved in the 3 hours we’ve been in here and no one has checked on her either. I asked for a pillow multiple times and they keep saying they’ll bring it but no one does. It’s not like I’m asking for an extra pillow. She has NO pillow. She needs her arm(that she had surgery on) elevated and I used a blanket. Really? I had to put a blanket behind her head. Thank goodness there are plenty of those on this desk by her bed. A stack of probably 8 blankets for some reason. Very disappointed Cleveland Clinic.

Majority of our experience here has been great, however since we spend most of our time in the Nicu with our baby boy, you would think that the nurses who are watching them follow some type of guide to respectfully work quietly so that the babies who needs rest can rest peacefully, but no! That’s not the case, they gossip out loud with one another, they slam drawers, trash lids, and more. Our kid has a heart condition so resting is the best thing for him to get him where he needs to be for his surgery. He is always startled or woken up by all of the noises going on. All I ask is that you guys respect the needs of the kids who needs to rest and try not to make so much noise or talk so loud, especially if is just about gossip. Thanks

UCLA should be ashamed to call itself a hospital . I placed a negative review of UCLA, Ronald Reagan Hospital A few days ago and I see it it has been removed. First of all upon my arrival at the ER, after requesting That all of my doctors be within my network I was told by the person checking me in ( cold As a bottom of a rock ) it is against the law for him to tell me if the doctors are within network. Which I know is against the law in California. This place is basically not any better, and has lower standards than any Third World country hospital. If I was able to give it a zero or even minus I would. There was basically a dozen seats in the ER for waiting so as you are exposed to any illness. I was seen after five hours for a heart problem There is nowhere to charge your phone, so as to keep in touch with loved ones. People are spread out and strewn throughout the hallways ( including tents, just outside the ER ) with no privacy and total humiliation. The ER is full of homeless, looking for a place to sleep. I will continue to post continuously, until my experience is not deleted. If you have or care for your loved ones, do not bring them here like I said, this is below third world healthcare standards

I gave birth to my daughter here in early 2022 & will be giving birth here in early 2024. I wouldn’t want to go anywhere else for OB care. I live in Tarzana so the drive while in labor was not fun & I could have gone to a much closer hospital but I trust UCLA Westwood more than any other ER/OB department & can’t imagine having gone elsewhere. The labor & delivery nurses are compassionate, informative & kind. My Dr. Is Dr. Zapata but she wasn’t on call when I gave birth so I saw another Dr, so sorry I don’t remember her name, but she was amazing and I felt in very capable & caring hands. I recommend this hospital for anyone I know who’s pregnancy for maternal & postpartum care. I’m very surprised the rating isn’t higher as overall the doctors are wonderful, up to date, the nurses are very capable & always warm in my experience. Also, it’s such a well maintained campus with updated equipment & very clean overall.

I’ve been in the er waiting room for 3 1/2 hrs now and haven’t been seen yet and when I got here there wasn’t any one else here. now it’s full of patients. I worked in an er for years so I understand the situation and process of seeing patients but just because I wasn’t bleeding and wasn’t screaming in pain I was put on the back burner.

My wife has been coming here for long time because she has a pacemaker/ defibrillator for over ten years. Couldn't tell there was anything wrong with other than that. September 7, she had an amulet placed in her heart because she couldn't take blood thinners. Week later she had lost 4 pints of blood. They had to repair the leak. While she was in surgery they did CPR on her. Not blaming anyone for that. On November 16 she was transferred to heart hospital because she built up with fluid. We were in there for 11 days and everyday I asked them what the game plan was. It was always still trying to get the fluid off. Nothing else was ever brought up to me about them trying to do anything different but giving her diuretics. NOTHING!! I'm not a doctor or nurse and I sure don't know every question to ask. They sure as hell didn't offer any information. Dr Lane was even going to send her home 9 days later. We told him no. Not until we knew what was going on. A day later her defibrillator shocked her because her heart rhythm went crazy. Never told us how bad her heart was. Two days later they still just said they had to get the fluid off. Did find out that my wife had stage 3 kidney failure. Also had to ask them to check her liver enzymes since they were doing blood work every day. Found out she had cirrhosis of liver but that's all the ultrasound showed. They never told me there were other options they could do to try and help her heart. I finally got my daughter-in-law up there that's a nurse practitioner. She got in and started going over everything asking questions about the other options that was never mentioned to me. She had more information in 15 minutes that they had given me in 11 days. That's just tells me that they don't care about all of their patients. Over at Baptist now and has gotten more done in 4 days than they did in 2 weeks. Got 30 pounds of fluid off in 4 days. Her heart is still real weak but getting a little stronger each day. These people actually seem like they care about their patients. Especially her cardiologist. She takes time to talk to us and explains what they can and can't do. I think GOD that my daughter-in-law came or my wife would have been dead. Don't need any excuses from anyone at heart hospital. Don't want to hear that you're sorry for what happened either. I already know how sorry you are.

My 1st appointment with Dr. Lo was on 06/28. I was given an EKG and after reading the results and consulting with me regarding my medical history, Dr. Lo listened to my heart and was able to get me approved for an Echocardiogram and lab work immediately 2 hours later. Getting 3 tests performed in 3 different departments in the same building on my 1st appointment was not only convenient but crucial. I received a call 24 hours later and was advised that I have a complete heart block and that Dr. Lo wanted me back immediately and scheduled me for surgery Monday 07/03. It's been 6 weeks since I received ER heart surgery and a pacemaker to save my life. Thank you Dr. Monica Lo and your team at the Arkansas heart hospital for going above and beyond for a new patient that was literally on borrowed time. I am truly blessed to have you as my cardiologist. I highly recommend Dr. Lo and her team at the AHH. Leicha Wilkerson

Very positive experience. Dr Davies was extremely professional, listened to my concerns, reviewed and explained the MRI and dedicated the necessary time without being rushed. Very pleased with him and all his staff from scheduling, checking-in, radiologists, nurses and doctor assistant. 👍🏻

Went in for a full left hip replacement with Dr Jacob Drew. My interactions with him and his staff were always positive. He took the time to explain the procedure and answer any questions that I had. He even called to check in the night before my surgery. I would highly recommend him for anyone needing a hip or knee replacement.

Great Doctor and Staff to work with. Removed my cancer and still cancer free 3 years later. Extremely helpful and has answered all my questions and then some. She is a doctor who actually cares about her patients unlike my PCP . I would Highly Recommend Dr Megan E. Anderson and her staff.

I want to give them a 5 star because as soon as my son was checked by the emergency, nurses and doctors came and admitted him into CCU. They saved my son! Now I know where my donations can go. We can't thank doctors and nurses and all the volunteers and staff enough. Beside their professional knowledge and equipment, everyone wats to make sure parents and siblings are well taken care of. However, the emergency is as busy and not very favorable a unit as all other ones in Canada. At 2:00 am, there was only one nurse doing the reception job and checking patients. She could attend to our son sooner but she was busy with the reception.

I appreciate the hospital's efforts in managing a high volume of patients, and I understand the initial wait time for a bed. However, after securing a bed, there was an additional four-hour wait to see the doctor. While I recognize the challenges, it was disheartening to wait for a medical consultation only to be informed that we were cleared to go home after the doctor's brief checkup. In order to enhance the overall patient experience, I would like to suggest that the hospital consider increasing the number of doctors available, and if possible, encourage doctors to start their checkups a bit earlier. This adjustment could potentially help free up beds more promptly for patients in need of urgent care.

One of the Best Hospital in the world, best patient care, The doctors are very friendly , professional and using advanced methos to detect the problems, I visit this hospital frequently with my nephew for his sickness. The hospital is very clean and well maintained. Parking is available in underground $20.

We unfortunately had a five night stay at the NICU over the Thanksgiving holiday. The staff provided excellent care to our kid and were extremely compassionate to us as parents. We were grateful for the private sleep rooms and shower, and they even had a free Thanksgiving dinner for everyone. The parent / family lounges have places to grab coffee and store food, and everything is very clean and organized. The doctors and nurses were very communicative and kept us in the loop the entire time.

Absolute terrible service , my child who has a seizure disorder and potential c- diff was made to wait in the ER for 3 and half hours plus without even being properly triaged . She didn’t receive a wrist band , at any point & we can run the cameras back , no one was alerted to her allergies , there was no band received for that as it typically is .. and she begin to have diarrhea thru the long wait due to the virus she’s had the past week and in turn she begin to get worked up and her fever returned . I asked how much longer the wait would be abd for an approximate timeline .. as I’ve observed plenty of patents come in after one in which I knew personally with less servere circumstances… literally come and go and my child was still suffering in the ER … the Nurse on duty was unaccomidating and almost seemingly unwilling to engage .. as I waited for some kind of answer on when my severely sick child would be seen . I asked if it would be more then another 30 mins and he said he couldn’t promise but shouldn’t be . Well it was . After 45 mins of them calling more then 3 patients who arrived after us .. I reluctantly decided it best to take my fevering , baby who now was covered in feces home.. as she was in her 3rd bowel movement and we had difficulty changing her in the nasty public restroom . I ultimately watched them call two more patients who had come after us exhibiting no signs of eminite health scares then I ordered our ride so I could take my child home to change her and give her medicine to help reduce fever and prevent seizure . I am pissed and very upset that my child and I spent. 3 plus hours we can’t get back in the ER after already being across the street at the Berger building for 3 hours prior this was wayy less then pleasant This is the second poor experience in this particular Emergency Dept but this is the first time it was so horribly handled that I had to leave with not only an even sicker baby then I arrived with . She still now will have to go to another ER to be seen .. because she did infact have a seizure once we got home from her fever that arose& I informed them but that did nothing to medicate the situation or get her seen. Now my kid is home fevering still sick potentially has c-diff and I am skeptical to return her to this terrible hospital because they haven’t even returned my call. I called to speak with charge nurse after filing formal complaint and was told by Jennifer in WR I could not speak to any charge nurse and then she took my information and said a nurse on duty would call back and it’s been an hour with out a returned call. This is negligence and unprofessionalism tht promoted us to leave in the first place and CHOP is looking at a pretty decent lawsuit if we do go to another practice and something is severely wrong with my child with so much documented instances of me trying to get her helper seen and have a team leader consult about next steps. This place wasted my time , cash as it’s costed money I didn’t have to travel to and from and I felt like the poor treatment was racially motivated , as as kid who came in after us was pulled to the back cuz her mother told them she was seizing but I was looking at the child. Who literally just had woke out her sleep. This place is incompetent , and of all the amazing experiences we’ve had here . Today ultimately casted a shadow on them all and I will be contacting the PA board of insurance aswell to file a formal complaint because they need to do better on managing and transparency in the ER wait times. We got there at 12:15 and didn’t receive a text saying my child’s room was ready until 4:15 pm that’s 4 freaking hours for a child who had 2 seizures in past week, has a virus, and cold and caught fever while there … when she has a history of febrile seizures … 0/10 would not recommend. Shame on u all

Very friendly staff and amazing doctors. The information desk is very helpful. The front lobby is well designed and honestly fun to be in due to it's design: there is a meandering ramp that goes up several stories with interesting interactive stops on the way. The lobbies on each floor are also all well laid out: they have great views outside and inside were designed with children and comfort in mind. The plaza out front and the cafeteria/Cafe are both relaxing places to recharge.

My husband and I rushed our son to the hospital last week cos he had a seizure. It was at midnight and they had just one doctor attending to so many people before us so we had to wait for about 7hrs. We were attended to in-between by nurses but the last nurse who came to us started asking some questions that we had already answered over and over again but before she started, she looked at both my husband and I and asked “which one of u can communicate with me better?” We didn’t understand what that meant so my husband asked “what do you mean?” And she said “I need to ask a few questions to whichever one of you can communicate with me better in English” I couldn’t speak out of shock, my husband just walked out of the room cos he didn’t want to get upset, she asked the questions again before I could bring myself to answer her. This was after 6hours of waiting for a doctor. Shortly after, a doctor came in, we were attended to and we left there. The other nurses were sweet but I was disgusted by that nurse thinking we used to live in trees and caves and only spoke gugugaga before coming to Canada.

ACH is so nice that makes me being a kid again, minus sickness. This was my first visit at ACH for my son and we enjoyed the environment.

My son had a very long procedure done in endocrinology, and the nurses there were awesome! They gave my son $15 Apple card for good behavior😄

I found some english speaking doctors here and they have an international office to help you translate if you dont speak spanish. Thank you very much Carolina 🙏

Horrible! Dont go to this clinic. The most unfriendly employees I have experienced in this Hospital. Yes I do speak spanish but once I didnt understand smth the lady just ignored me! Errors start already in front of the Clinic. Apparently they don't know the difference between a Swiss flag and a medical (red!!!) cross. So my question: is this a Swiss Clinic??? Of course not...

My mom got a well planned surgery in this Clinic. Excellent outstanding service what a relief. Fast service, very diligent and well trained all staff. Great place to get well and get some recovery. If you get sick go there you will be fine quickly. Do not visit Los Nogales clinic or La Colina. Marly is the best! Thank you all for your service! Mom is doing great. The doctor was very profesional!

What a slow clinic! They make him come on time but he is late in his shifts, no one comes out to give a reason. The only redeemable thing is the girl at the reception, the rest is a terrible service, the air conditioning in the surgery waiting room does not work. If you can avoid using their services, almost 8 hours for a simple surgery. The worst thing is that EPS SURA has an agreement with them but it is horrible!! Better care has a neighborhood pharmacy than a private clinic

The waiting room is horrible. There are patients lying everywhere on the floor. The runners. There is no decent place for the elderly while they undergo examinations and remain under observation. There is one bathroom for many people. And they don't clean it. This is in the emergency room. It is a site where all rights are violated

I hae been there a few times, because my insurance has them as a provider. Once I managed to secure an appointment, all works; however setting up an appointment can be a formidable task, as they dont answer the phone and if they do they pass the buck to sumeone else, or worse they ask you to call a bunch of wrong numbers. The whatsup useless. Today I spent 4 hours trying to get an apointment without any luck. I will soon go in person with a spy camera and will publish my experience on all available social media. What a shame, good doctors and deplorable IT and customer service. Management is unreachable for some strange reason (NOT !!!)

Terrible admin care. There is no real patient ownership and each unit blames the other. There is deep lack of coordination among stakeholders. Patient has been to the hospital 3 times now to get surgery and something always fails because there is lack of coordination and communication between staff. There is need for a real overhaul. Very sad to see this historically best-in-class hospital treat patients this way.

First off this is the best hospital in Bogota according to the locals and my Colombian friends. I came here on a work trip and had an emergency operation to remove my appendix. I came in at 2am, got the diagnosis at 3:30am and they didn’t operate on me until 12pm. The delay was due to the incompetent hospital admin people dealing with my work insurance. I offered to pay out of pocket to get things rolling but they refused. They told me they don’t want double payment incase the insurance goes through. I definitely suggest bringing a Spanish speaker here if you don’t speed to local language because most of the staff don’t speak english. Before the surgery, I had to sign a bunch of disclaimers and waivers which were all in Spanish. My surgery was great. The surgeon spoke good english and was very professional. He reassured that I’m not going to die. As far as hygiene goes, the facility looks clean except there were a few times I caught my nurses taking my blood and iv out without wearing any gloves. Make sure you have money before coming to the hospital. They wont operate on you until payment is confirmed. Last but not least bring a blanket and pillow so you can sleep on the bench while you wait to be seen. Overall I’m grateful for the nurses and Drs that saved my life. My appendix was on the verge of bursting. I would like to give this place a 5 stars had it not been for the front desk admin people.

I had to get a covid antigen test prior to flying back to the US, and was reading reviews at labs all over Bogota, stating the antigen test took 5-7 days to come back. I was worried that would be the case here, so when we went in, I asked, and they said only 4 hrs at the most (it took about 2 hrs, yay!). The staff was so kind and helpful, even though we understood hardly any Spanish. They were very patient with us and we were able to get all the paperwork filled out without any problems. Also, the antigen test was only 120,000 COP, which was better than anywhere else I had found at the time.

They do not do their job well, 7 hours in the emergency room and do not attend and then say that they cannot attend to a patient

Undoubtedly one of my best experiences, location in the center of the city, excellent medical and administrative staff, old but well-kept infrastructure, spacious with gardens.

This opinion is directed to block 6 of the hospital, which is in an area where you can see people who consume drugs, although there is surveillance and once inside the hospital it is safer, if it is scary, at least walk to the hospital at dawn, and block 6 is opened at 6 in the morning and meanwhile everything is dark or with little light, a perfect place for homeless people, you have to travel with great caution and at least if you are patient and come from somewhere other than Medellín, it is not advisable to be in line before 6 in the morning to check in at block 6, arrive with 5 minutes left or at 6:00 am, there a guard opens the door and when you are already inside the place is much more pleasant and neat, there is a waiting room with chairs where you can wait for them to call you for the billing card, there are elevators, there is natural ventilation in that waiting room, almost all the staff there are friendly to the extent they should be. I give it a 3 star rating, for a not very pleasant event that I had to go through in there, I think that of all the possible days in which that bad event had to happen, it happened just on the day of my appointment, I don't know who it was from the fault of that negligence but thanks to a call to my eps I was able to quickly solve that difficulty so as not to continue in that unpleasant situation in that hospital block.

Excellent...!

3 days waiting in que for gallbladder surgery to be scheduled! Why does the patient get to wait? And why doesn't the clinic approach and explain what's going on to the patient's children.?

Customer service people on their cell phones while helping zero people in the que. The pictures say it all. Look at the customer service people chatting on the phone and the video board showing zero people in the que.

Terrible!! The triage staff are rude and the doctor who treated us doesn't even answer the greeting. They lack empathy. If one day they want to get certified, they should start with the staff. You can see the hatred they have for their work, which they project into customer service. The only good people are those in the goal and the laboratory!

Terrible 😣

I have blood cancer, so I get test at other testing place and than go here for treatment. Lots of waiting, I have to go down street to pay for service. Than more waiting. Not bad place, but everyone seems to be confused. Other than that, it's fine

Great hospital center with good care and doctors with experience in health.

My husband arrived urgently at this clinic and has been waiting to be seen for 5 hours, what kind of game is this? They are waiting for someone to arrive so badly that they die in the waiting chair, the attention is truly terrible!

Very Beautiful and Organized, the first time I visited it. They treated us very well. The nurses are kind and attentive. The clinic is in good condition, very clean. They gave me good attention.

The medical staff at that hospital seem more like a gang of robbers and drug addicts than professionals. Never in my life have I seen such "doctors" and "nurses" so stupid and stupid. They speak ugly, they answer people in a bad way, they morbidize the patients, or rather the little gaminitos are in the wrong place.

The truth is that it seems like a hospital with a very bad service, how is it possible that the patients who are in the ICU do not have the attention they deserve or at least what is necessary. On weekends there are no doctors to give information and the nurses who are there never know anything. In addition to this, during the week they only give one report all day and it is almost at 6 pm. The truth is that they seem very inhuman to me, they should improve this service since it is one of the main clinics in the capital.

Outpatient consultation, terrible service, at 7 AM and only one person serving more than 50 people. By saving a salary they harm us users. Terrible.

The telephone service is very poor, they never answer and do not give information. They need to improve in that regard.

A very regular clinic does not have specialized staff, such as a radiologist, not even for the endoscopy service. My experience with my father was very sad.

I want to share my experience in this clinic, I had surgery with Dr. Yobanka Prado and at first I didn't like the idea of ​​going to Palmira from Cali for surgery, but it was the best decision I made, the nurses are very attentive, they were attentive of me at all times and I listened from the observation room after the surgery how they treated people, very humane and close treatment, with empathy towards people. I really thank you very much for your attention, especially to a nurse named Olga, it's a shame that I didn't know her last name, her work is vocational for sure because her way of treating people is incredibly humane, I was feeling very bad and she was very Loving and attentive to me at all times. A thousand thanks in general to all the staff at this clinic. Great professionals with patients.

All staff member needs an urgent training to learn the meaning of empathy and serve to patients.

The best in town.

Omg I had to walk to the nurses station for everything from a blanket to medication. They have no tv in the rooms. They take for ever. You have to wait 6-8 hours to get something done. Just go to a regular clinic in Barranquilla they are not as nice but they get things done.

An amazing facility with an amazing level of care. Better than any US or German hospital I have ever been in. The office of international patients is very professional and thorough. Dr. Taboada is very thorough and professional. I can't recommend this hospital enough. Super experience.

I came to see if giving birth at Serena del Mar was an option. When I was given a tour of where the mothers and babies stay it was great. I was told to male an appointment to be seen by an obgyn so that they would have a history of me. The nurse took my info days before my appointment but apparently never followed through with setting up my profile. I showed up for my appointment and was never told who I would be seen by. Dr Maria Fernanda Toro Wils was upset that she had to wait on me because the staff had not created my profile. I finally went into my appointment with the doctor and she scolded me and told me she had no time we had to rush. I told her I did not understand whybinwas being treated this way when her staff was a mess. She told me she always does 40 minutes and she dedicated about 20 minutes if that. I left there feeling so upset and totally changed my mind about having my baby there. The treatment from Dr. MARIA Fernanda Toro Wils was terrible. I would not recommend her or her staff in a million years.

They neither answer their phones nor respond to emails seeking an appointment! Terrible customer service. I communicated in Spanish as well so not a language issue.