Deep vein thrombosis (DVT) treatment in 185 Vascular surgery clinics in Americas

Bad Experience I had an unfortunate experience when I accompanied my boyfriend to the emergency room. Upon our arrival, I couldn't help but notice that the staff at the cashier's desk were engrossed in conversations about their personal lives, as if they were attending a social gathering rather than attending to the needs of the waiting patients, many of whom were feeling unwell. This lack of professionalism was disheartening. Subsequently, we proceeded to the consultation, hoping for a resolution to my boyfriend's health issue. Unfortunately, not only did they fail to address the problem effectively, but they also took an extensive amount of time dealing with the paperwork related to our health insurance. This bureaucratic delay was frustrating, especially considering that my boyfriend was still feeling terrible after over an hour of waiting. To make matters worse, we were unexpectedly presented with a bill amounting to nearly 400 dollars. Given the exorbitant cost, we were disheartened to realize that we still had no concrete diagnosis. The doctor merely provided us with the name of a specialist, leaving us feeling dissatisfied with the level of care provided. It is disheartening to conclude that this hospital seems to prioritize profit over patient well-being.

Private hospital, hete you can find all medical specialties prices range between $85 to $120 for dovtor visit. ER visit costs under $100. The hospital has all types of diagnostics equipment.

I visited the emergency room. It was my first time at CIMA. I was seen quickly and received thorough testing and care. All of the staff were kind and patient. They were even kind with my limited Spanish and never made me feel bad for not speaking Spanish well. The ER doctor was especially kind, listened well, and explained his thoughts and reasoning thoroughly. He was also patient when i struggled to remember medical history in the moment. He was easily one of the best doctors I have ever seen. All of the staff was wonderful.

Huge hospital with many specialties, including non-invasive cardiology, urology, oncology, orthopedics, among others. It is well located in the city of São Paulo, close to Vergueiro station. There are two other hospitals close by, including the BP hospital.

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I have been here several times, but today seems to be the time that this hospital's ER is the least prepared. Having passed through covid season peak now the hospital seems not being able to cope with the current influenza surge. The expected waiting time for a clinic evaluation, not considering possible needed exams or medications is of 4 hours! Seems that there is no medical staff at all right now. However the nursing and administrative staff are whatever possible. Hope somehow they can cope better with this seasonal flu...

I was at the Oswaldo Cruz Vergueiro unit on 11/24/23 at 8 pm. The service was for my mother and it was reasonable, however I witnessed the arrival of a girl with an injury to her head. The family in panic with the girl on their lap. The security guard and triage nurse were so quick that I didn't even see where they came from. The medical team was also quick and I saw the stabilized girl being taken to the upper floors. Of all this, what caused surprise was the apathy of the receptionists. They didn't help at all. Not even the family seeing the issue of documents to open the file. Even the nurse on duty was irritated with the receptionists. There was a lack of empathy, there was a lack of humanity in the service. Reception grade zero. Security and medical team, grade 1000

This hospital it’s unclean and the service are very bad we was waiting over 8 hours just to see the doctor

Hospital increasingly abandoned. Bad mood from reception to service floor. Doctor, thank God, he treats me well. Dr Alexander. So abandoned that there's no one to even pick up the token... 🤦🏻 (3rd floor) Sadly.

Terrible service, I needed to perform a procedure with anesthesia, I had to ask God and everyone for permission, and on the day of the procedure they said that it wasn't in their documents that there would have to be anesthesia. I had to do the procedure without it and it was horrible.

I had a Coronary Angiotomography on 11/28/23, excellent service since my arrival, the doorman who opened the car door for me to get out, the reception had excellent service, a 10 for the girls at the service and the interview and at the location of the exam I was very well looked after by the Nursing Team and the Doctor who carried out the exam. Mother of God Hospital Congratulations on the service, excellent.

Hospital Mãe de Deus was once a reference hospital in Porto Alegre, but it is currently in terrible condition. Nursing technicians unprepared to care for people, too long waiting times, information that exam machines - resonance, x-ray, are "damaged" (which would be a reason for delays and rescheduling of exams), structure is very bad (broken tables, beds that don't work), poor hygiene (hospital waste on the floor in the medication room, such as bloody gauze and used cotton), hospitalization schedules are not followed (meals are delivered many hours late to patients ), between others. Hospital Mãe de Deus currently leaves something to be desired and any possible inspection of minimum requirements should even be able to penalize them. Relatives of patients talk to each other there and the vast majority are perplexed by what they are doing with Hospital Mãe de Deus, which was once a reference entity. Currently, Hospital Moinhos de Vento and Complexo da Santa Casa de Porto Alegre are far ahead in every way.

Trusted hospital in Curitiba. I had surgery and their infrastructure is incredible. Everything very clean and organized, waiting rooms and apartment well equipped. The surgery was a success! Meals were served in generous portions with good flavor and temperature. My gratitude to the hospital's surgical team. I've needed their emergency care too, but the staff who go to an elective consultation instead of the emergency itself end up delaying the service (a problem more of the culture of the population than of the hospital), making the waiting time long, but later service, the professionals provide a great service. I will come back whenever I need to.

Nice one

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I went on 11/22/23 at 11pm something (I don't remember the exact time) with a fever of 40 and discomfort throughout the body, with vomiting. To which they answer that they only attend to emergencies. Only guard is from 8am to 9pm. How can it be that a public hospital has guard duty all day and night and this hospital, which is classified as the best, only has guard duty during certain hours. The person who assists me tells me after I complained that I required medical attention that they would attend to me but I would have to wait at least 4 hours, but that it was safer in 5 hours. With terrible abdominal and body pain, I waited 1 hour and a half and left, to which they wanted to charge me for parking and with a card only. I had cash. But at night it is only with the posnet and you charge yourself. I had to go to the Lomas de San Isidro, and upon seeing my condition, they treated me in 30 minutes, where they referred me to a room and made me Urgent studies and analysis. They treated me excellently. Let's see if the hospital commission understands that the patient does not have a stipulated time to feel bad. That is why it is a guard to attend at any time. I know that the word (Guard) has a certain schedule for whoever manages the hospital. I must clarify that the hour of parking is too expensive, the hour costs more than two liters of gasoline. And the car is left out in the open. Also Sometimes to pay for parking there is a long line and there is a delay when you are in the sun or rain without shelter. It should be subsidized. But the greed is greater. I must clarify that the professionals always treated me more than well in the Austral. The issue is They give you shifts with a delay of 2 months. There are never shifts.

The hospital has excellent doctors. The serious problem that this hospital has is access to medical appointments. A patient has follow-up checks for chronic medication and the SHIFT staff, after several attempts, respond that they do not have appointments for this month and do not know when they will open the agenda for the next one. I go through the application and it doesn't schedule an appointment for that doctor and it tells me to contact me by phone. And as best as you can during your work hours, you keep trying and spend the month with the Same answer 🤷‍♀️ It's an epic to get a turn. And an almost impossible challenge to achieve medical follow-up for treatment. How to solve it 🙏🏻? How many more patients are there in this same situation? A first level hospital has to be able to solve this urgent issue.

Excellent attention from everyone, from the security person at the entrance, to the receptionists as well as the doctors, who are super professional. They treated me quickly and gave me an accurate diagnosis. There were a lot of people in the waiting room, I thought I wasn't going anymore. But the service is fast, since there are many receptionists and many doctors serving at the same time. The building is beautiful, large, clean, with coffee machines (you can pay with MercadoPago) and some things for breakfast. Highly recommended.

Disgusting unprofessionalism! A child of 11 months arrived at night with a temperature of 39.6.! Doctor looked at baby throat and said it was streptococcus. I was told to do a streptococcus test, to which the doctor said absolute stupidity that it don't do for children!! And she didn't prescribe any treatment! Streptococcus needs to be treated! We have insurance in this hospital, I don't recommend it to anyone! We will leave this hospital!

I'm a traveler from the US who had a ear pain and needed to see a doctor right away. Most hospitals in the area have bad reviews so it was hard to find some healthcare for myself. Eventually I choose this hospital because people referred me here the most. Went to the emergency room but they directed me to the specalist inside the main building. After registering I needed to pay but they wouldn't accept cash over 10k pesos and i didn't have my credit card with me. So i had to go across the street for a bank deposit. After that i paid and saw the doctor immediately. So in my situation since i saw a specialist that doesnt have many patients i was in and out in about an hour. Im very satisfied with the care i recieved and how prompt everything was despite the language barrier and i dont speak much spanish so Google translate is my buddy. Id recommend this hopsital if you want to be seen faster than a public hospital and are willing to pay. This was a faster and wayyy cheaper experience than in the US. I give this 4 stars because of the bank deposit thing, but otherwise im very pleased 👌

Updating my review cause now I'm a holder of their health insurance and I'm very happy with it. The phone line sucks though, it takes ages to get an answer and then they tend to transfer you to a different department that cuts the call or never answers. It's way faster to go there and ask everything in person.

Good hospital but total inflated prices, they charge so high that they reach above the TOPE of your insurance. For a small one - hour surgery, they charge 7 million CLP

“Urgencia” doesn’t move with much urgency. I’m currently in the waiting room in the respiratory area of the emergency department. My mother in law arrived in bad condition and I saw no sign of triage or prioritization based on symptoms , first come first served. NONE of the alcohol hand dispensers have alcohol, staff aren’t using alcohol gel. Not just in the emergency area but also in the other buildings I passed through. Very surprised by the experience considering the cost and reputation of the hospital. Go to Clinica San Carlos de Apoquindo UC or Clínica Alemán.

I had a severe reaction to a Lyme disease infection contracted in the USA, that manifested itself when I arrived. I was hospitalized at Clinica Los Condes for 3 days. The care was superb. Since Lyme disease does not exist in Chile, the staff coordinated their care for me in coordination with the USA CDC.

My brother was in this hospital because he had appendicitis and had to get surgery and He said the nurse was nice! I think this place is really nice because it's clean and Its nice looking, I know that because I was there to visit him in the hospital. I also want to thank you for saving my Brother before more consequences happened to him and that he could've died.. but thank God this hospital was there! Once again, thank you for saving him🙏🤍 Also I definitely Recommend this place if you want nice doctors and want to feel less anxious and comfortable here.👍

This hospital isn't what it used to be! It seems to be loosing patient focus and fast. We've been a CHLA family for 11 years and I think it's time to switch. My autistic son was SCHEDULED for Dental Surgery. Originally it was supposed to be at 1pm and us be here at 11am. When we got the call from the nurse last night that we needed to be here at 530 AM we were like no one told us! But we got here right on time. We'll let me tell you that they took him upstairs to Surgery PreOp it took over 4 hours to get him into the the surgery room, because he needed to be admitted after surgery and no beds were available. This hospital needs to have better planning for these types of things OBVIOUSLY there will be emergencies that come in over night THAT SHOULD'VE ALREADY BEEN ACCOUNTED FOR!!! Maybe you need more staff and more beds!!! Because to have a child basically starving because you couldn't plan Accordingly is just plainly ridiculous! Then when I spoke to the Charge Nurse in the Surgery Dept she tells me that if my autistic son has an outburst that the anesthesiologist and nurse are there to help give him something to calm down. So basically if my son has an autistic outburst they will just drug him up. I'm like realistically drugging my son just to calm him down because your hospital didn't plan accordingly is uncalled for and unnecessary! Again I am seriously contemplating switching hospitals even though my son is on the Heart Transplant List!!! -A Frustrated Autistic Heart Mom

Ok so I had open heart surgery 20 years ago. I was well cared for and was in icu for three days and then went to a step down room where I was later discharged home after only three days at the hospital. My team was so amazing and so supportive and loving. And a picture of me twenty years later.

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!

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.

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.

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.

Malpractice. My grandmother was left to die. After an isquémic stroke. Proper measures were not taken within first 6 hours. Instead of ICU, she was put in a regular room. Nurses shifts had no records of prior shifts. Avoid at all costs.

I was supposed to have surgery in this clinic on 10/17/22. I arrived around 10:30 at the O.R floor, 4th floor in the building, and no one was there. The reception desk was dark with zero employees. While I sat waiting for someone to show up I looked at my paperwork handed to me at check-in, when I realized they had me as a Colombian citizen born in Barranquilla. I'm a U.S citizen. The address, phone number, and emergency contact provided by me earlier had been overlooked and ignored. I went downstairs and corrected it. Finally, the nurse showed up; she was a nice lady. There isn't anything negative to say about her. Around 3:30 a nurse assistant brings a wheelchair and wheels me into the OR. My surgeon, Dr. Carlos Cala was running late, she said. The O.R had a two way-in, bidirectional, restaurant style, swing door with small windows. At his point I had not been sedated, medicated, nor given a relaxant to prepared me for the cultural shock I was about to experience. There was, right in the middle of the room, an overwhelming sight of a surgical bed dressed in brown sheets ready for a bloodbath; and a dented, shallow bucket, right at my feet. The pan was wide enough for my feet to fit in. The N.A explained to me that she was going to bathe me with antiseptics and soap before surgery. I followed her with my gaze, noticing a disturbing sight of two soiled, worn out, filthy, and grotty, styrofoam coolers. There they kept the antiseptic and soap warm that she was about to use on me. She asked me to stand in the pan facing the door and those swinging doors started to open and close while medical staff came in and out. I was naked and a swing away to be seen by everyone sitting at the desk just outside the OR (recovery area). Then, as I’m looking around in dismay, I spotted a recording video camera IN the OR. All the feelings of humiliation, indignity, disrespect, and violation of privacy took over me at this point. I complained about this to the NA and she called the floor manager. The manager explained to me that the video was for liability reasons and to cover their backs, privacy wasn't a concern to them and video recording was a common practice. I requested an appointment with the clinic’s director and It seemed as if I threw a stone in a hornets nest. The floor manager called the anesthesiologist, Dr. Bernal, and he asked me what was the problem. All of this time I was still naked. I tried to explain to him that I felt my privacy was not being respected as I had never gone through anything like I was experiencing at that moment before and his replied was: “you should go back to the United States and get surgery there.” I don’t know what was more upsetting; the fact that this doctor represented COLOMBIA so poorly, not aspiring to anything beyond mediocrity as a professional, stepping over his Hippocratic Oath, and having a condescending tone towards a CUSTOMER (I’m a paying client in a private clinic, I reminded him), or the fact that his lack of character, dignity, and vulgar behavior, were an irrevocable proof of his unprofessionalism. When did lack of HYGIENE and violation of privacy became a common practice in healthcare?! Both, Dr. Bernal and the floor manager, proceeded to tell me to calm down and that if I wasn’t ready for surgery I could reschedule. I kept saying that I still was interested in an appt with the clinic’s manager. The floor manager kept hinting that there was not going to be a surgery if I insisted to see the director because that meant I was upset, while Dr. Bernal kept using my request as leverage pertaining to the final success and outcome of the surgery. Again, all of this time I was naked. Because I didn’t shut up and submissively obeyed, the surgery was canceled and I was scorted out of the OR while the nurse assistant was making signs behind me at everyone we were passing by (medical staff, patients, and their families around) that I was crazy. I did speak to the director days later. Even though he was nice, I opted to have my surgery elsewhere. Avoid at all cost unless you're dying.

Good service but they would have bigger watings rooms...

The emergency service was not able/ willing to apply an intramuscular injection. Clowning.

My recent experience at this medical facility was incredibly disappointing. Despite paying for the premium plan, the service was incredibly slow and disorganized, and the communication was almost non-existent. The nurses and security staff were consistently rude and unhelpful, making the already stressful situation even worse. We had to ask multiple times for updates on the patient's health status, and even then, we were met with angry faces and a lack of information. It took hours before we were given a decent status update, which was an awful experience. I hope that this facility can improve their customer service and communication skills to better serve their patients in the future.

It was a horrible visit. The nurses and stuff are not professional at all. Went in to get some exams done and just because they did want to they didn’t do it correctly. I don’t recommend this clinic.

There is no appointment assignment because "there is no agenda." But the EPS does make the punctual collection. Edit: The clinic is still terrible. Nurse Jeimy Oviedo, from the emergency room, is extremely rude and does not even see people to take signs. Edit 2: EPS Sanitas should consider ending the contract with this IPS, THEY NEVER HAVE AN AGENDA FOR ANYTHING. If I could I would give them 0 stars.

This clinic is now Christus Sinergia, according to the 3 hours I spent on the phone line waiting for one of those who answered me and went from one line to another to tell me how many hours they offer vaccinations, they have the best specialists and the best technology but they have the worst customer service or telephone service that I have ever had to endure for 3 hours without any response, just frustrated... they should have communication with palmira-cali and not throw the ball around

It is an institution with good facilities but poor reception of both patients and communication. For them to treat you urgently is deplorable, you have to be almost dead. When scheduling appointments, they do not give complete information. Apart from the girls at the reception who are kind on the phone, but in person they believe that, being despots, they do a lot; If someone arrives unwell it is due to the actions of the entries.

Terrible service as health officials from the doorman to the nurses, most lacking in humanity. Do not bring your families here because the sick must have a complementary plan or be prepared to be cared for on their own because one pays to be cared for like others because there must be discrimination, they need a lot of humility and empathy so that it is not noticeable that They work only for the salary. This career is about love and patience and serving.

That clinic is a complete hell, they leave the emergency patients in chairs, on the floor, they are not attended to, they lose their papers, there is overcrowding of patients in hydration, men and women, in the emergency room observation, please if you love your family member, don't take him there, the eps famisanar is rubbish, we need to transfer a patient from that hell, my son @supersalud, @famisanar. I attach photos that I was able to take in the terrible places that prohibited me from taking photos.

Foreign and locals please abstain from attending these very old and outdated hospital facilities. I've been a patient in the US, Spain, Germany and Colombia. This is by far one of the most frightening hospitals sub standard even for a tiny 3rd world town. Readers beware. Avoid at all cost, unless of course you happen to be a malpractice attorney. 1. Patient surgery intake. Expect a minimum of 2 hours 2. Nursing and Patient Information Systems. Pre and post surgical nursing staff use notebooks and handwritten notes as a the regular protocol for patient care. Despite revealing allergies with 5 different people and 5 different notebooks, the staff failed to write patient allergies in the surgical board and also failed to place the standard red bracelet. It had to be bluntly requested by the patient in the OR. The nursing staff laughed it off as normal noting it was goog "they" caught it on time. OMG. The nerve. 3. Institutional tardiness. Expect 3-4hour delay past scheduled surgical start time. Do not expect an apology nor a justification for tardiness. 4. During surgery expect nurses to answer questions to family at 8am, 11am 3pm. Should your family happen to run into a nurse and ask a question expect nurses to raise their voice rudely, only to be reminded to wait until the scheduled time. If your family receives a call from the OR team with a request (for information or supplies) and wish for you to ring the door, expect no responses to either of the two doors and one window. A family member witnessed a lady who could not find her father for 2 hours. Whiled the nursing staff dissed her, she had to appeal to a surgeon that was leaving the area. The information systems could not locate the patient. Frightening. Very Frightening. 5. After surgery expect 2 nurses to handle patient care for all 16 ORs. OMG. Frightening very frightening. Little help, fend for yourself. 6. Patient out-take. Expect the process to last a few minutes. But by all means do not expect it dignified changing room and or patient lockers. It's pretty gross 6. One week surgery follow up. Expect two hours wait on the 3rd floor of a brand new building just for check-in. Expect rude and insufficient check-in staff. Then expect another hour for the doctor to see you. I hope my comments help you make an informed decision. I hope my comments save lives and hardship. Steer clear if you can. Colombia has great hospitals. This is by fas substandard even for small towns in a 3rd world country.