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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

3 comments:

  1. Great article. My experience so far has been great too.

    I wonder if you would share the name of your bone specialist/foot doctor if you really liked him/her? I have to get bunion surgery (am waiting until after the holidays) and I'm told, by a doctor friend in town, there is maybe ONE podiatrist in town. But I've been pricing the surgery (by a traumatologist/orthopedist) and I've gotten a range of $1000 to $2000 so that's a pretty big difference (for what it's worth, the high price was from a doctor at Mt. Sinai).

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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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