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Friday, December 16, 2016

### 300,000 ### .............and a HEART ATTACK!!!

WHAT????!!!!!   

I had a heart attack??  Noooooo....but I betcha it scared ya a bit, eh?

First off, I hit the 300,000 mark!  My blog has been viewed 300,000+ times!  Woohoo!!!

Now, about that heart attack.



The post before this one was about various people's medical experiences here in Ecuador...namely, Cuenca.

Two friends of mine, Franny & Robert, bought the house I purchased when I first moved to Cuenca.  I'm on Facebook but I rarely check it because I HATE FACEBOOK...its invasion of privacy, tracking, and the overwhelming task of keeping up with all the comments posted there.  I choose to have a life.

Well, Robert had a heart attack and Franny posted about it on FB to let all their friends know what transpired.  So, it wasn't until about a year later that I ran into Franny and heard about it.

I asked them if they would mind telling their story so I could add it to the medical stories published last week.   Ooopsie...I published it before getting their submission.

But, I think their story merits its own blog entry.    And, here it is (composed by Robert...the heart attackee):


One bright morning in June of 2015, I finished my exercise class and, as usual, walked the half mile or so back to my house.  I was a little winded and sweaty, but no more than usual.  

At this time, as far as I knew, I was in pretty good shape.  I was smoking about half a pack a day, though.  Indeed, I remember having a cigarette on my way home that day.  It would be the last I'd ever have.  

When I got to the house I discovered to my pleasure that our friend Rocío was visiting us.  She said she'd dropped by just because she'd had a feeling that she ought to.  

I chatted with Rocío and Franny for a while.  I began to notice that I was continuing to sweat way more than I would normally have expected to, and also that my pulse seemed to be awfully fast.  Then I began to feel a certain pressure, mounting to pain, in my chest.  I quickly realized that something was seriously wrong.  Pretty shortly after that I got a pretty good idea what it was, too.  I ran upstairs to use the bathroom, but collapsed before I could use it.  

I realized now that I was in real trouble and called Franny to help me.  She ran up to find me in a limp, wet mess on the bathroom floor.  She said, "I'm gonna call an ambulance."  

New Yorker that I am, I said, "No, fuck that.  Call me a cab."  So she ran to do that while I stripped off my sopping clothes and dressed myself in dry ones as quickly as I could.  Franny later expressed consternation that I would waste time so, but I didn't want to present myself as the sweating wreck I felt myself to be, even at an ER.  By the time I was dressed Rocío and Franny had found a taxi.  

By the grace of God Rocío knew not only where to go but how to get there.  We piled into the cab in a hurry and were at the Sala de Emergencias of the Clínica Santa Inés in ten minutes.  

If it hadn't been for Rocío, we wouldn't have had any idea what to do.  But she knew exactly what to do.  It is not an exaggeration to say that she saved my life.  They told me later that if I'd been even twenty minutes later I might not have made it.  

I ran up to the ER admission desk and stammered out my symptoms in the best Spanish I could: "Dolor severo del pecho . . . sudo mucho . . . pulso elevado."  Immediately they got me on a table.  They took my wallet, with Franny looking on, and I remember authorizing them to use my credit card.  I also told them at this time that I didn't have insurance.  

I felt terribly agitated.  I felt compelled through all this to be up, about, and active.  I felt this way even though I knew it was irrational.  Finally I heard someone say, "Give him something," and then they did, and it was easier.  

They catheterized me at once.  That is to say, they passed a special tool via an artery in my arm into the blocked artery in my heart, clearing it and simultaneously implanting a stent, a device intended to keep the artery permanently clear and open.  

It seemed to me only a short time later -- maybe ten minutes (but I heard later it was more like 45 minutes) -- that the procedure was over.  Sedated though I must have been, I distinctly remember turning to the med tech who had inserted the catheter, looking him in the eye, and telling him, "Gracias por salvarme."  

We'd asked not to have a private room, but I awoke in one anyway.  I spent the next three days there.  We knew the room would be expensive, and it was, but it was also very comfortable.  Indeed, in every respect, the care I got at Santa Inés was the equal of the best you could expect from any U.S. hospital.  

My cardiologist, Dr. Xavier Vásquez, visited me at least once every day to advise me about how I was doing and what I should do (which was, of course, mostly to relax).  The food was bland and awful in exactly the manner of the food in the better U.S. hospitals.  The maintenance of the facilities, cleanliness, etc., were absolutely the equal of the best U.S. hospitals.  

When I was released I wondered how they would bill me.  They had kept me with a saline drip running into my arm for some days.  When the time came, they simply insisted I go to the billing office and settle my bill before they would remove the needle.  This seemed a bit coercive, but one cannot deny its effectiveness.  (The only alternative would have been to rip out the needle and run.  I shouldn't wonder that people do this, but somehow, it didn't seem like the righteous thing to do.)  

Over some several minutes, the billing office totted up my bill, printed it out, and handed it to me for my signature.  It was seven pages long.  I asked something to the effect of, "But what if I dispute a charge?"  The answer was, "You'll have to take it up with management later.  For now, just sign."  And so I did.  

The charge was about $9,300.  I signed the slip and went home.  



Later I reviewed the charges in detail.  They were voluminous, of course.  The charge for the stent alone was something like $2,500.  But I could not find a single instance of anything being charged to me that I didn't know I'd used, or at least have pretty good reason to know I'd used.  

There is no doubt that the cost of this hospital stay, especially for an uninsured patient, was an immense bargain by U.S. standards.  We have at least one expert friend who has estimated that it would have run into six figures in the U.S.  

Dr. Vásquez prescribed four medications at first.  One was an injectible that I had to shoot straight into my gut.  Yuck!  Fortunately, I only had to do that for four days.  Another medication, though, was a blood thinner called Plavix.  I had to use that for a year, and as I guess you've heard, it did cause a problem at one point.  But then the year ended, and I didn't have to take it any more.  

The other two medications were atorvastatin (aka Lipitor) and 81-mg aspirin.  I must take these every day for the rest of my life.  But apart from these pills (and continuing to not smoke tobacco), my life is quite unrestricted, not only as to diet (I can eat anything I please) but as to activity (I can do pretty much any exercise I like, too).  

In general, my experience of Ecuador's health-care system has been extremely positive.  My doctor has been great, the hospital staff was great, and if the bill was a bit of a blow, by God it beats the bankruptcy we'd have faced in the States.

What Robert THOUGHT he saw when he woke up.

....then reality set in.
...til next  time!

Dano


............AHHHHHHH......but WAIT!!!!    You thought the story ended there, right?   Hang on.

Franny, Robert's wife, tells us about the next exciting event in their lives.


A Bloody Emergency!!


My husband Robert suffered a heart attack in June of 2015. He received excellent care at Santa Inez hospital and was temporarily put on a blood thinning medication. One morning about six months later, he told me that while taking his morning shower his nose had started to bleed. It had taken a full ten minutes for it to stop. We agreed this must have been caused by the blood-thinning medication he had been prescribed. The next morning I heard Robert calling me and walked into the bathroom to find him with his head over the sink, a blood-stained towel in his hand and blood splattered all over the floor. He turned to me and said, “It won’t stop. I‘m going to faint.”

I immediately called our doctor, Pedro Martinez, and asked him what to do. He told me to take Rbert  to the Santa Inez emergency room. I was very glad our houseguest, Sara Coppler, was there. She ran into the street to hail a taxi while I helped Robert dress. She helped me get Robert into the taxi and came with us to the hospital. (A good thing, too, because during the bustle and stress of getting Robert into the cab, I lost my wallet with my keys, money and ID. I wouldn’t have been able to pay the cab driver or get back into my house!) I sat in the back seat with Robert, with towels held to his face and on his lap, for the quick ride to the hospital.

Once there Robert was hustled into an examination room while I provided his information to the receptionist. They were in contact with Dr. Martinez. Medical staff tried to stop the bleeding using pressure techniques, but when that didn’t work, we were told a specialist was on his way. We were taken to an office on a higher floor, where the nose specialist attempted to cauterize the wound five times. When that didn’t work, he explained he had done everything else possible, apologized to Robert, then jammed what appeared to be a blue plastic tongue depressor about five inches long up Robert’s nostril, followed by an injection of water. The item was actually a tamponade made of a special material made to swell up and provide pressure from within. 

Robert turned white. Apparently, this treatment is fabulously painful, thus the doctor’s apologies. Back in the emergency room, Robert was given intravenous pain medication and put under observation. Our total time in the emergency room was about three hours. We left with prescriptions for more pain killers and Robert was instructed to temporarily cut back on his blood thinning medication.

We are very grateful to the staff at Santa Inez. Without their intervention, Robert would have bled to death. He had to keep the tamponade in his nose for five days. It was incredibly uncomfortable and he had a hard time sleeping, but it did the job.



We did not have any medical insurance. The cost for the emergency room visit, the cauterization and treatment was $270. The prescriptions cost $60 to fill.

My advice: Be prepared to be confused and stressed when under pressure. I am a fluent Spanish speaker but it all flew out of my head during the emergency. 



So it is a good idea to keep the hospital address, your medical information and doctors’ names and numbers on a card. We keep ours taped to the inside of a kitchen cabinet. Also, scout out the emergency room nearest your home. Figure out where the entrance is. 

(Dano)
Well, that's the end of their stories.  No more drama.  You can all go back home now.  Nothing more to see.

...til next  time!

...really.

Dano

Sunday, December 11, 2016

Medical Stories from Cuenca

Nooooo....this is NOT one of our ambulances!!!
I've heard many a medical story in the 6 years I've lived in Cuenca.  Many are worried when you tell them you're going to Cuenca....Ecuador....South America because they have an (ill-informed) impression it's a 3rd world country and what would happen if.....?  I've been asked countless times, from those considering relocation here, how the medical/dental services rank here.

As a result, I collected stories from people I personally know, as well as some publicly published, on top of my own personal experiences.

In general, there's a large population of doctors and dentists in Ecuador who did their studies and training in America or Europe.  New hospitals have been constructed and equipment modernized in older establishments.  The government has drafted doctors from other countries (ie; Cuba) to come to Ecuador and provide their services.  

In the past few years, Ecuador has been seeing a continual increase in 'medical tourism'.  Why?  Some of the reasons include:
·         The quality of the services
·         Lower cost of the procedures and medications 
·         Low cost of accommodations while staying here

Interesting things to know:
·         In general, there are 3 levels of Hospitals/Clinics
o   State/Public/Welfare hospital
§  Primarily used by the poor/un-insured and services are free.
o   Government Social Security hospital (IESS)
§  Government healthcare provided free of cost for those who’ve paid into the system via payroll deductions.
§  Also, 100% coverage provided to those who directly pay a monthly premium on their own.  For example, myself, an expat who has residency.  I pay roughly $70 a month for full coverage.
o   Private institutions
§  Those that receive services here either pay the full cost themselves, or may have a private insurer that covers all or some costs.
·         We have 911 here.
·         Some doctors make house-calls!
·         Many doctors will give you their personal phone number so you can check in with them (when they ask you to) on a weekend and/or holiday.
·         When you get X-rays done, they’re yours.  They’re handed to you to take home, give to the doctor, make Christmas cards from…whatever.
·         You can walk into any pharmacy and pretty much ask for whatever you want.  You rarely need a prescription.  I was taking certain meds back in the USA when I moved here.  All I had to know was the equivalent name here, the dosage, and how many I wanted.  That said, it’s rare that you can purchase, in one stop, a 6-month supply.  Most pharmacies don’t stock that much in any particular store.  However, you can purchase whatever they have and (usually) the next day they will have the remainder for you to pick up.
·       When you visit a private doctor, you won’t find a front-office full of admin staff to pre-process you.  Maybe ONE person provides assistance to several doctors, but many times there’s no one.  You simply walk to his/her office, take a seat outside the door and wait your turn.  The doctor pops his/her nose out the door and asks for the next person.  Most doctors do their own computer data entry.  Likewise, you hand him/her the dough when you’re done.
o   If you’re seeing a doctor in, let’s say the IESS hospital, you will need an appointment.  The only difference over the above process is that he/she pops his/her head out their door and shouts out your name at the appropriate time (vs ‘NEXT!’) and your insurance takes care of the payment.

Instead of me regurgitating all the nitty-gritty details of the medical system here, let me give you this link below to click on.  It’s a good overview of the system, published in CuencaHighLife several months ago.


Now that you have all this backdrop information, let’s see what reality is.  The following are real stories from real people, including MOI.

FAINTED IN CUENCA

I was ill in Cuenca, due to the altitude and dehydration, and passed-out on the sidewalk in front of the Kookabura Cafe during our March visit.

The Ecuadorians, who were on their way to work and school at 8am, all stopped their cars to help me, offered candies out their car windows, called the ambulance, which was busy elsewhere, offered me a ride to the hospital and/or my hotel, and were generally very concerned and helpful.  Had I passed out on a sidewalk in Houston, I would have been stepped on!

Once my husband and a friend got me back to the Hotel Crespo, down the street, the hotel called a local doctor who was there within 20 minutes.  The hotel staff kindly took care of me, because my husband had an appointment that could not be missed.

The doctora gave me a complete once-over; one of the most comprehensive hands-on physicals I have received in years.  Between my very poor Spanish and my English/Spanish dictionary, I was able to communicate with her - she left me a list of the appropriate foods to eat, what to drink, a drug to pick up at the nearby pharmacy.

Total cost for a 45-minute consultation at my hotel: $30.

I was feeling much better by late that afternoon, and managed to attend a dinner party that evening.

One of our Cuenca friends had a huge cancer problem which was successfully treated through surgery - total cost, including surgery, hospitalization, home visits by the doctor, was $4,300.


ER FOR 53

Spent much of the day yesterday in the emergency room...hurting, weak, 102 fever since Nov, taking meds, seeing doctor, but not getting better.  My GI doctor met me there, gave me 4 prescriptions.  Parasites are extremely dangerous to me, lethal.

The entire visit to emergency room, including blood work, 2 doctors, consultations was $53.  The 4 prescriptions were $23.   No American complains about national healthcare here.  Can you spend an afternoon in an ER in the US with services for $53?

SAME GUY – ANOTHER TIME

I have extreme bone loss, lack of bone density, which is caused by the disease...which causes inflamation, which causes swelling and pain.

They wanted me to go see bone specialist/foot doctor.  The doctor sent me home with 2 prescriptions...they said one was stronger than the oxycotin I have been taking.    So, the x rays , the doctors, the actual drugs were all given to me when I left, and my friend spotted me to $87 for the bill.....I have money to pay him Wed of next week. so no big deal.  

Dano, could you go to the ER, be taken in right away...no paperwork, be seen by a doctor, have x-rays, diagnosis, and  prescription filled in about an hour for $87 in US?  They gave me my diagnosis in writing, my x-rays...you keep all your own medical records here in Ecuador.


GRATIS

I wanted to share this info because all residents of Ecuador are qualified to use the public hospital, Hospital Vincente Moscoso.  This is not the social security (IESS) hospital.  Let me start with the information that my husband had a heart attack on December 12th.  At that time a stent was placed and the cardiac team of doctors at Santa Inez told us that he needed open heart surgery within 90 days.  At that point our friend suggested that my husband register with the public hospital to qualify to have the surgery done gratis.  At that point we hired someone to facilitate this process.  It took about 4-6 weeks but a team of cardiologists were consulted and the surgery was done at Santa Inez on February 21.  The only charge to us was nominal for meals and consumables.  The surgery was done gratis via the public hospital system.



Applied for IESS at 11 AM; had Bus "Accident" at 1:30 PM

The process (applying for Gov’t insurance) couldn't be easier.  We asked the receptionist for an English-speaking clerk and were given a number.  Two minutes later we were called up.  Forms completed, payment process explained and we were out the door in under 10 minutes.  I bought our friend lunch as a thank you, we bought flowers nearby and went our separate ways.

I hoofed it over to Pio Bravo to catch a #16 bus home.  Mr Driver was having a bad day, I guess.  The lady in front of me, with her 5-ish son asked the driver to slow or stop so that she and her boy could get seated safely.  He angrily claimed the bus was full.  I saw plenty of seats.  I swiped my bus card and the driver gunned the engine, launching me through the still-open door.  I hit the street hard on my side.  The young boy saw me hit the pavement and for a few moments I didn't move.  Poor kid was hysterical, “Mommy, Mommy that man is dead!”  Mom demanded that the driver stop.  

Within a minute or two, she was telling an officer what happened.  Passers-by helped me out of the street onto the curb, checked me for orientation, returned the items that had fallen from my pockets and even brought me water to drink.  

The ambulance arrived very shortly, I was examined, cleaned up a bit (I was bleeding) and transported to a small hospital.  EMTs were friendly and efficient.  The same can be said for the hospital staff.  Lots of scrapes, bruises, broken teeth, and cracked ribs.  My mouth was stitched together (my teeth got pushed completely though my lower lip.  I could whistle in harmony through the new hole!

I was discharged with some meds and a return date for the stitches to come out.  In the hospital parking lot, I was waiting with a patrolman for a cruiser to transport me downtown for my statement. To my surprise and relief, the young mom pulled in, driven by her hubby.  She was checking my condition and volunteered to ride with me and the po-po to town.  When we arrived, the "driver" was there along with his supervisor and the bus company's general manager.

On the drive in, the officers explained that I could ask for a cash settlement.  I wasn't really interested in that until I asked if the "driver" will get a ticket.  “Oh yes!”  So how much is the fine?  "$35." $35?!?!?" That's barely dinner and drink money for two.  We negotiated an amount that was lower than I wanted, but enough so it will “put a hurtin'” on him.  The supervisor kept trying to get me to lower the amount, saying “I can see you are a good man...”  Not today, sonny.  The driver showed no signs and made no expressions of remorse.  Maybe next time he'll be a bit more thoughtful, assuming he'll still be driving a city bus.

I apologize for this somewhat lengthy post, but I want to express my deepest thanks to a lot of caring people I met during my ordeal: concerned strangers on the street, the EMTs, hospital workers, and the very professional, courteous, helpful police and most especially to the dear young mother who would not let the matter drop until the "driver" was called to account for his callous disregard for passenger safety.  She even rode with me afterward when the police drove me home.

I am going to be on the mend for a while, but I am cheered by all the wonderful Cuencanos/Cuencanas I met.

Oh, and IESS pays for medical costs due to accidents from day one.  Suh-weet.



A BAD SKIN CONDITION ON A SUNDAY

A female friend of mine developed a rash on her face on a Thursday.  Over the course of the next few days, the rash worsened and became accompanied by severe swelling around one of her eyes and partial swelling around the other.  At first she thought it was an allergic reaction or a fungal infection, so she decided to treat the rash with some simple over-the-counter medications and wait a few days to see if the symptoms diminished.

When that didn’t happen, on Sunday morning she and her partner went to the emergency room at Santa Ines Hospital, which is a private hospital in Cuenca and recognized as one of the best for caregiving but more expensive.  They were met at the door by a security guard who immediately escorted them inside to the main nurse’s station.  None of the nurses spoke English, but my friend’s partner speaks some Spanish and was able to convey the gist of the problem.

A nurse took my friend to an examination room and recorded her blood pressure, temperature, and other vital signs as well as personal contact information.  Then a male resident in his late 20s came in and looked over her info and asked to examine her a little more closely.  This included listening to her breathing, checking her torso for other marks or rashes, and asking some questions like “how long have you had this rash” and “did you eat any seafood or anything you might be allergic to.”  Then he left to go get a primary doctor.

The full-fledged doctor arrived – “Dr. Pablo” from Portugal, who just happened to be a specialist in infections.  Very nice and distinguished and knowledgeable but spoke no English.  My friend’s partner described the events over the past 3 days and showed him her medications.  He examined her closely, looking at head, torso, neck, legs, etc. and then said “no” very decisively when asked if the rash and swelling were fungal.  He was certain it was viral and prescribed very strong dosages of an antiviral.  He also requested that she return to the emergency room in 3 days (on Wednesday) at 5 pm so he could check her progress.

After confirming the date and time, they left the ER and went to the cashier to pay the ER bill and then to the hospital pharmacy to fill the prescription.  The prescription could have been filled at any pharmacy but they decided to do everything at the hospital for convenience.

Total time in ER with doctor, pharmacy & bill:  45 minutes
Total cost:  $120 ($60 for ER and $60 for prescription)

Her swelling and irritation started to subside within 24 hours, and by Wednesday she was starting to look normal again.  After doing some Internet research on the prescription and talking with friends who shared stories of similar outbreaks, they figured out that she might have had shingles and decided to ask the doctor at the appointment.

They returned to the ER about 4:30 pm on Wednesday and were greeted by the same security guard from Sunday.  He asked them to wait in a small area outside the main nurse’s station.  About 10 minutes later, Dr. Pablo walked in from the street and recognized my friend right away.  He gave a big smile and said in Spanish “You are better!” Then he asked them to come back into the ER where he examined her again.  Her partner asked him if the virus was shingles and he frowned, saying he was uncertain what she meant.  Then she asked him again, using the Latin (medical) name of the virus and he said “Yes, that is exactly what it is” and then proceeded to say how very glad he was that she had come in because it could have been very bad if the virus had gotten in her eyes.

Then Dr. Pablo wrote another prescription for more of the same medication – he had only written 3 days’ worth of prescription to ensure she would come back – and told her that if she had any more trouble, she could just go to a dermatologist and not have to return to the ER.  

And then he hugged her and her partner goodbye.

Total time in the ER for 2nd visit: 15 minutes
Total cost for 2nd half of prescription: $60
                 
Her rating of her experience on a scale of 1-10:     10 

Next stop.....DANCING WITH THE STARS!!


NOT EVERYTHING IS HUNKY DORY

With the government Social Security system (IESS) you can't make an appointment with a specialist directly.  For example, I was having knee problems.  You must see a generalist first, and that doctor will determine who to refer you to.  

I called the central number for making appointments.  I asked the service rep for an appointment with a doctor who spoke English.  She had no problem with my request.  I was booked for Dr Orellana at 5:15pm.  I arrived at 5pm and got in at 5:45.   

Again, when you arrive for your appointment, you take a seat outside their office in the hall and wait for your name to be called.  When it was my turn Dr Orellana initially turned me away, saying 'no hay sistema' (system down).  I returned to my seat and waited a few more minutes and then she called me back in.

I asked if she spoke English?   "NO!"  I said, in 'my' Spanish that I had specficially asked for a doctor who spoke English.  After all, if you're talking serious things, you don't want to have communication problems, right?   She didn't acknowledge me.  She never said 'Hello', she never smiled ONCE.   She seemed pissed.  I finally asked her why she was angry with me.  Her only response was 'don't worry' in Spanish.

She was condescending and downright rude....no question about it.   She cranked out a few appointments for me to see a knee specialist and I was out the door.

I went to the reception area of the hospital and asked if there was someone I could talk to, in English, about the experience I just had....I was pissed!!  They summoned a very helpful young man.  The moment I mentioned Dr Orellana's name, his eyes semi-rolled.   He knew.  There was a generalist doctor sitting nearby that he knew and he approached her and asked her if she would mind talking to me.  I told my story and she, too, 'knew' about Dr Orellana's reputation.



MY KNEES ARE NOT THE BEES KNEES

I had an11:15am appt with a specialist for my knees.   I arrived just on time because the parking lot was full…one out, one in.  I kinda freaked because the overhead clocks in the halls said 11:30.  Just as I arrived at office #25, the doctor stepped out and called my name.  I verified my cell phone clock was indeed correct.  

The doctor said I needed knee replacement after viewing xray images I had brought with me (and analysis) from 2010.  Arthritis.  UGH!  Arthroscopy was not an option.  He used his computer to show me pictures of knee replacement surgery on the internet.  NOT PRETTY!!!  He didn’t speak much English but we seemed to communicate well.  I told him about 'rude' Dr Orellana.    He, too, 'knew'.  


I asked about alternatives to placate the problem for awhile.  Cortisone and Glucosamine.  He entered comments into his computer and used Google Translate to convey things to me I wasn't understanding.  He entered a prescription into the computer.  


I had to go get cortisone from the hospital pharmacy located in the lobby of the hospital.  I walked over there and gave them my ID#.  It was all in their system.   The pharmacist handed me the vial of cortisone and a (LONG) hypodermic needle to take back to the doctor.   


I took a seat and waited until his patient left. He beckoned me in and injected my knee.  Unfortunately, I had to buy the glucosamine myself at the pharmacy of my choice, because it’s not a medication and the IESS system only covers medications.   An hour and I was out of there.
 

Cost = $0.


OBSERVATIONS
  • It seems whenever a doctor opens his/her door, people rush to get his/her attention.  It's like a horde of reporters trying to get a story.  It's irritating to me, but the doctors don't seem to mind and I've never seen any of them get terse in response.
  • If you need to get a blood test, go with a lot of patience!!!   Usually, you're not supposed to eat or drink anything before a blood test, so naturally people go first thing in the morning.   When I went, there had to be 100 people in line by 8am.  There were two lines and I couldn't tell which one was for what.  After I stood in one for 20 minutes or so and no movement, I switched to the other line.  An hour later, I was processed and out of there.
  • So far, I have not had to fill out any forms or sign disclosures and waivers of liability, etc.

...til next  time!

Dano

Sunday, November 27, 2016

Trip to Spain - The Return Home to Cuenca...Ecuador...South America

Check-out from my Mallorca apartment was 10am...a bit earlier than the average bear.  My flight didn't leave until 1:30pm, so I knew I was going to kill time at the airport.   Per the instructions, I took the garbage and recycling out to the public bins about 1/2 block away.  I didn't know what the taxi procedure was (some cities you can hail, others you must call).  So, I schlepped my bags across the plaza and waited at the first street.  There wasn't much traffic, so I decided to walk a couple blocks and there I was able to easily hail a taxi.

About taxi's here.  They're almost always very nice modern cars.  They're all on meters which are coded with various formulas based on where you were picked up and where you're going, how many bags you have, etc.  The 3 or 4 I rode in all had GPS systems the drivers used to find their way through winding streets to your destination.  None of them had security cameras or emergency (call 911) buttons like they have in Cuenca.  And, each driver drove very calmly, honoring all stop lights/signs, pedestrians, etc...UNLIKE Cuenca.

$20 later and I was at the airport.  As I mentioned before, the Mallorca airport is HUGE given it's location on an island and the largest city (Palma) is only 400,000.  But, apparently Mallorca is extremely popular, therefore there's lots of direct flights.  Scanning the reader boards, amongst Madrid and Barcelona there were flights to Paris, Manchester, Liverpool, Stuttgart, etc.   However, what I DIDN'T get was there's no Migration or Customs services here.   Does not compute.

Before I left the apartment, I took one last look at my emails.  I had a new one from the travel agency I booked through.  It acknowledged my first departure was on time.  It recapped my two segments following that.  I noticed it said I was to depart Madrid at 9pm.   Noooooo, it's supposed to be 4:25pm.   HERE WE GO!!!  I re-checked my papers and indeed they said 4:25pm.   So, I decided to check-in online so I could select my seats and verify flight times.  Yep, Avianca changed my flight from 4:25pm to 9pm (ESTIMATED).  I was never notified.  No reason given.   As a result of that change I noticed Avianca changed my follow-on flight from Bogota to Quito.   Ok, at least that was taken care of, but dammit, now I had a huge layover in both cities whereas, originally, they were perfect.  Add to that, the arrival time at Quito (10am) now put me AFTER my departure time to Cuenca (9am).   So, I had to cross my fingers that I could get a later flight to Cuenca on the same day.

SIGHHHHH!!!!

A flight slightly over 1 hour long and I landed in Madrid, a MASSIVE airport.  I saw an aircraft taking off on another runway which had to be nearly 1 mile away!  At least this airport's signage made it easier to find my way around than Barcelona or Mallorca's.   I noticed when my taxi pulled into the Mallorca airport there were no signs overhead indicating what airlines were served by which door/stop.  NADA.

It was another sunny day when we took off from Mallorca, so I seized the opportunity to take a few videos.  The first flying over Palma where I spent the last 5 days, the second of the coastline.

Click on the arrow in the video screen.  Once it starts playing, click in the lower right corner to make the video larger to view.



Since Madrid was my last stop before Bogota, I needed to dispense with my Euro's of which I had about $100 left.  Ain't gonna do me no good in Columbia or Ecuador.  Duty free?  Starbucks?

Luckily, it was daytime and the airport was alive, busy, and shops were open.  So the 5 hours I had to kill before my next flight wasn't tooooo bad.  The Madrid airport has internet but you have to PAY for it, unlike many which are free.

Madrid airport terminal....cool ceiling designs.



9:30pm rolled around and I boarded a brand-spanking new Boeing 787 Dreamliner.  The first thing I noticed was the size of the windows...they're almost TWICE the size of typical passenger windows.  NICE!!  We sat at the gate for about a half hour after everyone had boarded and nothing was being said, nothing was happening.  Finally, the captain announced a passenger was getting off the plane (no explanation why) and per security rules, their bags had to be removed, too.  So, we were delayed because the ground crew had to open up the cargohold and search through a pile of probably 100 bags to find that persons and remove it/them.   Oi Vey.



The other thing I noticed different about the Dreamliner (whose fuselage is made of carbon-fiber) is the swept-back wings.  Instead of extending predominantly straight out like most planes, these were swept back as if you were to extend your arms outward and backward of your body.  They also were bowed especially during flight...like a big backward swoop.   Because of the innovative design, you can easily see the wings flex during flight, disturbing as that may seem.

Plane next to us.  Air Bank of America?  LOL

I didn't like anything on the in-flight entertainment system, so I got bored fairly quickly.  I whipped out my handy-dandy mid-sized bottle of scotch and knocked back a few to knock me out.  Yes, it was no problem buying booze in the Madrid airport and taking it on the airplane with you.   Snoooooooze.

We landed in Bogota at 1:30am...that's in the manana.  Since I was continuing on, I didn't need to collect my bags and go through customs/migration.  I landed in a very small area of the terminal cordoned off so I couldn't go anywhere else.  Everything was closed.  Half the lights were off.  Folks who were there before me had already nabbed any seat without armrests so they could lie down and sleep.  My only option:  the concrete floor.  Mind you...I had 6 hours to kill before my next flight from Bogota to Quito.  To top it off, there was NO INTERNET.  NADA!!!  ZILCH!!!!

Can we say 'excruciating'?  I found a series of seats with no armrests in an adjacent gate and plunked down and snoozed....for awhile.  I was awakened by a security guard who was closing that part of the terminal.  I had to get out.  DAMMIT.   No place but the floor.

Somehow I got through 1 hour, 2 hours, 3 hours.....till there was only 2 hours to go.  Finally, my flight showed up on the monitors.  WHAT?   8:20am?  My tickets says 7:20am!!!  Dawned on me that 7:20am was the 'report to your gate' time and 8:20am was departure time.  DAMN....when I thought I only had 2 more hours of pain to endure, it was 3 more hours.

I was now at the point of becoming a hatchet murderer.  Don't CROSS ME!!!

We departed Bogota and headed for Quito.  Everything was swell if you ignored the fact my deodorant had worn off and I had'nt slept a good sleep in, I dunno when.

Landed in Quito.  My bag was there (miracle).  Since I missed my flight from Quito to Cuenca due to Avianca changing my flight to 5 hours later, I dragged myself and my bags up to the ticket counter for LATAM to ask if there was space to still get to Cuenca the same day and simply change my ticket versus having to buy another.

Ticket counter wasn't open.  Will open in 2 hours.  (enter expletive).   So, I dragged my bags outside and across the street to a food court building.

Now...I'd like to add a side comment here.  Cuenca has a lot of what I call 'stupid noise'...noise that's totally unnecessary.  Horns honking, car alarms yelping, etc.  I was in Barcelona..... Rome....Naples....Marseilles, France....Mallorca, Spain.....cities of millions of people and millions of cars.  In my ENTIRE time in all these places, I hear a horn honk MAYBE three times and a car alarm scream ONCE.   I walked out of the Quito airport terminal to the food court and 1 second later a car alarm was wailing and horns were honking.  10 minutes in Ecuador, I heard more alarms and horns than I did in 2 weeks!!  RIDICULOUS!!!

Back to the counter when they opened and I was able to get on a 7pm flight to Cuenca, with a $15 change fee.  It's was now 1pm, the flight wasn't scheduled to leave until 7pm.  NO WAY was I going to spend another 6 hours in an airport trying to kill time!!!   So, I called Quito Airport Suites where I normally stay when I'm in their neck of the woods.  They have a 'day use rate' where you can get a room and rest and shower for $25 even though you're not overnighting.  I called them and asked them to send a cab ($5 vs $10 the airport charges).

I waited....and waited....and waited in scalding sun.  After 30 minutes, I called and they told me the driver was circling looking for me and couldn't find me.  I had told them to look for a Gringo, wearing black shorts and blue tee shirt.  After all this flying and no sleep, my brain was mush.  It finally dawned on me, the driver was circling below, one level down, via the arrivals circuit, but I was standing (in the hot sun) one level up in the departures level.  SHEET!!!

Once we got that corrected I was on my way to Quito Airport Suites and flung myself into bed.  Couldn't sleep.  WHAT????!!!!!   I think I was too wound up.  After about an hour, I finally got to snooze.

5:45pm QAS called a taxi and I was back at Quito airport for my 7pm flight.   All went smooth and a 50 minute flight later, I was back 'home'.   Jerk taxi driver tried to overcharge me by quoting a flat rate to my apartment...thinking I was an ignorant Gringo who didn't know better and fresh off the turnip truck.  I squashed that real quick by telling him (in Spanish) that I lived here and to use the #!@^(% meter.  GRRRRR

Within 30 minutes of arriving home, I was unpacked, clothes hung in the closet, and the laundry running and I was back into my old routine.

What a trip!!!
  • Approximately 400 photos taken.  
  • 8 flights.  
  • 2 missed flights.  
  • Almost 24 hours spent waiting in the airports!!   
  • Approximately 26 hours of actual flying (in a plane, that is).
  • 6 hours time difference, coming and going.
  • 1 ship
  • 3 tours
  • 4 busses
  • 1 train
  • 3 countries (Italy, France, Spain)
  • 5 cities (Naples, Rome, Marseilles, Barcelona, Palma)
  • ...and a partridge.....oops.

...NOT to be continued.

El Fin
(The End)

Dano

Friday, November 25, 2016

Trip to Spain - 5 days in Mallorca (Day 5)

Weather:  Yet another perfect sunny day.

What to do for my last day in Mallorca?  Rent a scooter?  I was going to, but the address of one of their locations turned out to be under refurbishment.

Go visit the caves?  Next time.

Take the train to Inca, known for its Thursday markets (this was Thurs)?  Apparently it's known for its leather market, but it turned out to be soooo much more.  I walked to the train station, purchased a RT ticket for $7, and easily found which track to go to.  Like pretty much all train systems in Europe, this one left at EXACTLY the scheduled time.  30 mins later, passing orchard after almond orchard, I arrived in Inca, a town of approximately 26,000 (but felt much more than that).  Just 50 feet from the train station, the market started and wound down narrow streets for at least 12 blocks.  THOUSANDS were there.

Aside from leather goods, the area around Inca produces high volumes of olives, almonds, and cheese.


Just a little farm house seen along the train route!

Notice the hats strung up over the market.  Dunno why.

Seen along the way on the train.

Arenques = Herring

Lots of handcrafted cheese.  It all looked so enticing but I had no clue what was what and from what.  The vendor sliced off tidbits for me to taste and I bought some for my cheesy friends back home.

Several vendors featured kids selling goods they probably baked at home.  Some of the adults were dressed the same way.  I discerned they were playing a historical role versus this is the way they dress now.




Olives, Olives, and more OLIVES!!!  I didn't know there were so many types.  Personally, I don't like them.  They take up valuable space in my Martini!!!
Olives are grown in the higher hills of Mallorca.

SCADS of Olives!!!!

The area around Inca was well-known for growing grapes for wine.  This restaurant is located in an old wine cellar.  Notice the huge casks on either side.


Do you get the feeling these people LIVE LIFE versus the other way around?





At first I thought these were fake, but they're real.  RED cactus?

Mushrooms




...to be continued

Dano

Wednesday, November 23, 2016

Trip to Spain - 5 days in Mallorca (Day 4)

Weather report:  Sunny again.

A day to walk to the Cathedral and catch the hop on/hop off double-dccker bus.  So, that's what I did.  I walked down to the Cathedral (about 10 minutes) and there was a double-decker tour bus waiting for me.  $17, a map, headphones to listen to English translation, and we were off.

In Rome, Marseilles, Barcelona, and Mallorca the traffic was always light, polite, and you almost never heard a horn or a car alarm.  In fact, in my ENTIRE trip, I don't think I heard ONE car alarm and maybe (MAYBE) I heard 5 car horns.  That would take less than 30 seconds in Cuenca.

Speaking of near-non-existence, I think I saw Police 3 times in all of the 5 days in Mallorca.

Cars in Mallorca, Barcelona, and the Italian cities I visited, are 90% sub-compacts and 10% sub-sub-compacts (meaning they seat only 1 or two people).  No gas-guzzlers or giant double-cab 4 x4 Ford F250's here!!  Scooters were immensely popular because of limited parking space (you can park them almost anywhere) and you don't have to pay for parking.

Graffiti.  Very little of it in the most popular sections of each of the cities.  Somehow, aside from the lower economic neighborhoods, a lot of cities have clobbered the problem of graffiti.   Now, if they can only show Cuenca officials how they did it.

TONS of boats and yachts in the harbor.  I can only imagine the scene during summertime!

We're headed up there, to the castle on the hill.
Bellver Castle was built nearly 700 years ago BM (Before Mom).

While traversing various neighborhoods, interesting sites popped up.




View from the hill where Bellver Castle is located.  Semi reminds me of viewing San Diego harbor from Point Loma (eh, Ron?)

I like the part about $400+ dollar fine if you spray graffiti on the site.

The original moat canal (sans water)
Note the size in relation to the people on the bridge.




The entire hillside is reserved greens space with tons of hiking trails to take the pooch.





Some of the white blobs you see are yachts shrink-wrapped in plastic for the winter.









The seaside wall adjacent to the Cathedral and Royal Palace.

Massive gothic-style cathedral.  $7 Euros entrance fee.

This guy is almost 5 feet tall.

I don't think this would fit on my dining room table or yours.
It's almost 7 feet tall by 4 feet wide!!!

The dome in an adjacent room inside the Cathedral.





This is a one and 1/2 person car.  Just pull up and plug in!

...to be continued

Dano

About Me

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Cuenca, Azuay, Ecuador
This is all about my transition from an American lifestyle and culture to my newest adventure, life in Cuenca and greater Ecuador. I'll be recapping some of my day-to-day experiences (and mishaps) to highlight what it's like to live here.

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