Yesterday we had a new opportunity to experience another segment of Costa Rica’s national healthcare system, when my husband underwent ambulatory surgery at the hospital in San Ramon. All went well and he’s doing just fine – which is important for more than the obvious reasons.
As I have mentioned before, medical care is one of the big reasons we made the decision to move to Costa Rica. I’m in that *gotcha* age group for healthcare insurance in the U.S. – too old and laden with a litany of small pre-existing conditions to obtain full coverage and not quite old enough to qualify for Medicare. Moving here provided us the opportunity to buy into the country’s national healthcare system, which is referred to as Caja, for a nominal monthly fee of $47 (for both of us!) which entitles us to see family practice doctors, obtain tests and formulary prescriptions, and use the emergency room at our local clinic. More complicated treatments, like consultations with some specialists, ambulatory surgery, and in-patient medical treatment takes place at a regional hospital. In our case, it will typically be the hospital in San Ramon, which is about twenty minutes from our house. Non-formulary prescriptions have to be purchased at non-Caja pharmacies and we have the option of using private clinics and paying for services out of pocket.
So over coffee this morning we did a little Monday morning quarterbacking to determine just what we thought about the process. (A) Who did what right (B). Or wrong. And (C) mostly, whether we were beginning to question our decision.
The short answer is (A) Lots (B) Not much and (C) No. If you’re interested in the details, read on.
The system seems a bit more cumbersome than what we’re used to in the U.S. Appointments have to be made in person as opposed to over the phone. Few, if any, instructions are posted or otherwise available, so it’s a matter of blindly feeling your way along, asking questions (mostly in Spanish), and basically figuring it out as you go along. In three separate instances, we stood or sat with a group of patients (‘the herd,’ as I called it) until someone appeared and instructed us to follow.
There is virtually no hand-holding in the process. You get the paperwork. You take it to the proper window for stamps, dates, etc. You show up. You get treated.
The one exception to that rule is that one of the papers we received when the surgery was scheduled (6 months ago, by the way) instructed us to show up two days before the surgery for what we could only surmise was a pre-surgery consultation. It turned out to be a classroom lecture on how to prepare for the surgery (e.g. , no food or water after 10 p.m. the night before, how to put on the hospital gown, etc.) The instructor asked each patient to bring along a box of juice and some cookies or crackers for after the surgery so they could judge when you are ready to be discharged – as measured by whether or not your stomach will tolerate food and drink. (You’re probably thinking that in the U.S. THEY provide that. And you’re right, of course, but then how much does it cost you?!?)
The day of the surgery, we reported at 6 a.m., as instructed, took our place amongst the herd and waited to be escorted to the ambulatory surgery center. There, we took a seat and waited. One by one, people were called, disappeared behind an unmarked door, and re-emerged several hours later. My husband was called at about 9 a.m. At 12:45 p.m., I was called to the door, handed a prescription for an antibiotic and an anti-inflammatory, which I took to a special window of the pharmacy where it was filled while I waited. When I returned with the prescription ten minutes later, my husband was sent on his way with post-op instructions and referrals to see the appropriate doctors for follow-up.
To be perfectly honest, it was a little unnerving at times simply because of the uncertainty of each and every step. But what really counts is the care he received, which he tells me was top-notch.
He was given the choice of a local or general anesthetic. For an abdominal procedure, I would have chosen the general, but Mr. Macho chose the local. Consequently, he was awake and able to observe the medical staff in action. Some of them spoke English, so they had good communication throughout. They were attentive and seemed competent at what they were doing. But as the old saying goes, the proof is in the pudding. Based on the outcome, I have to give the process a solid A-, with the minus earned only for not providing one more handout that would have told us when and where to go for appointments and how the process works.
But then again, the next time we will be pros and know exactly what to expect!
I can’t end my little report without mentioning the help we received along the way. I have concluded that the population of Costa Rica is peppered with little angels. They are the folks who show up at just the right moment and go way beyond what one would expect to help us out. There was the security guard at the hospital who we asked for instructions on where to go to make our appointments. Instead of pointing, he took our referral slips and walked us from office to office, spoke to the clerks on duty, and sent us on our way with all of the appropriate paperwork in hand. Then there was the Intel employee, who accompanied her father for his surgery, and who jumped in to serve as translator when my meager Spanish failed me. And then there was the father, whose son was undergoing surgery, who walked me to the pharmacy and waited with me while I had my husband’s prescriptions filled. These kinds of things happen all the time here, but I never stop being amazed by and deeply grateful for them.
Pura Vida
