Health Issues, a Female Perspective...

by Fran Browne


Where to get quality healthcare is always a concern whenever one moves to a new location.  Living in the States, we had the luxury of having and excellent and consistent healthcare delivery system.  However, it becomes a serious concern when living in a foreign country.

You CAN Have Your Cake and Eat It Too...

In Costa Rica when you are not feeling well, you have two choices.  You can avail yourself of the CAJA (Costa Rica’s National Healthcare System) and pay nothing out of pocket or you can seek a private doctor and pay for everything. Both have their advantages and disadvantages so you need to weigh the options and decide for yourself. 

Although the CAJA is free, you need to go to their local clinic, play musical chairs and wait until it is your turn to see the doctor of the day.  It is not inconceivable to wait for hours to see the doctor only then to be redirected to a different facility the next day for a blood test and x-ray.  There is no way that this gringa is going to wait in line for hours just to come back and do it all over again the next day.

Actually, I use a blended version of both plans.  I see my private doctor for routine visits and tests however he also has the ability to write prescriptions that can be dispensed (for free) by any CAJA pharmacy (Farmácia).  Let me share with you one recent experience.

Since every woman (at one time or another) has had a bladder infection, we are keenly aware of the symptoms.  After two days of discomfort and drowning myself in cranberry juice, I decided to visit my doctor.  I described to him my symptoms and he gave me a prescription for a broad spectrum antibiotic.  Since the antibiotic was not available thru CAJA, I went to my local Farmácia and paid for it out of pocket. 

The doctor visit cost $40 and the antibiotic $30.  My total cost was only $70, not a whole lot different than my co-pays would have been back in the States.  But there was one huge difference, back home we would have paid $1800 each month in healthcare insurance premiums, regardless of whether I was sick or not. 

After taking the pills for 5 days I still was not feeling significantly better. I could have gone back to the doctor (at no cost) but decided (instead) to talk to my local pharmacist. He gave me a different antibiotic that he felt might work better. 

The new meds (he suggested) significantly helped with my original problem, but now I developed another small problem which required additional medicine.  But in the end (no pun intended) my bladder infection was cleared up and I was once again a happy gringa.  Total out of pocket… $100.

In the States, my doctor would have performed tests to determine if I had a bladder infection and if yes, prescribe an appropriate medicine.  But here, my doctor listened to what I had to say and prescribed (what he thought) was the best medicine.  I am wondering if I should have insisted that my Costa Rican doctor test my urine.  Maybe I would have received a different medicine and been cured faster?  I guess we’ll never know. 

I’m not in a position to know which is the better process.  But what I do know is I had a problem, it was fixed and it cost me only $100.

In Costa Rica, most pharmacists are the equivalent of a nurse practitioner (back in the States) and have the ability to prescribe medications and provide inoculations.

Prevention Is The Best Cure

In the first situation I was sick, I knew it and I sought relief.  However, we all need to look at prevention as the best way to maintain good health.  Women (as do men) need to be proactive when it comes to their health.  That means periodic self exams, routine OB/GYN visits and annual mammograms.

A few months ago I was watching the evening news featuring a story about Breast Awareness month. It dawned on me that it had been 2 years since my last mammogram exam in the States.  Wow, how time flies.  I decided it was time to get one here in Costa Rica although I did have a few concerns.

  • Do I go though CAJA or use a private doctor?  

  • If I use a private doctor, do I use my regular physician or a specialist?

  • How would I communicate or understand the results, my Spanish skills are horrible?

  • What type of equipment would they have here in Costa Rica?

  • How would I get my results since they do not have real mail delivery here.

After reading several recent articles about CAJA's inefficient methods of dealing with potential breast cancer cases, I decided seeing a private doctor made the most sense.  I began my research by asking a girlfriend where she had her mammogram.  That turned out to be of little benefit because in all the years she has lived here in Costa Rica she has never got a mammogram!  So I decided to see my personal doctor and get his recommendation.  Doctor Pablo gave me detailed instructions on a clinic in Liberia (35 minutes away) that performs the test.

I decided to stop by that clinic a few days later and make an appointment (un cita) in person.  That worked out well, perhaps due to my pathetic look and smile coupled with my uncanny ability to use sign language.  I later learned (through a Facebook friend) that the woman doctor at the clinic was trained in the U.S. and spoke perfect English.  How awesome was that!

A few days later Andy dropped me off at the clinic for my 4:00 appointment.  I checked in at the reception area and was told to take a seat.  This was fantastic.  Hopefully I’d have the test and soon be on my way home.

WRONG!  This is Costa Rica

Nothing happens on time

I assumed that I was in a clinic dedicated to mammograms.  Nope.  There were sick people coming and going but finally, after about 90 minutes a lady called my name and waved me into a small exam room with an accordion door.  

She directed me to a smaller room that contained the high tech mammograms equipment.  Was this my doctor?

As it turned out, she was the technician.  Although she could not speak English, she instructed me to take off my top and “assume the position.”  It felt a bit weird, for back in the States I would have gone into a separate changing room and put on a dressing gown before proceeding to the "machine."  Oh well, we are in Costa Rica, but at least it was a private room. 

By the way, the equipment and the test process were identical to what I have always received in the States.

Once we were finished she motioned me to go back to the waiting room.  Again, I was back waiting amongst the sick men and coughing kids.  By that time “the gringa attitude” was beginning to surface.  My patience was growing thin.  Where the hell was the doctor?  Finally after about 30 minutes, the technician came out with my films and laid them on the receptionist’s desk.

A few minutes later, the receptionist walked them into another unmarked room closed off by smoked glass walls.  I think this may have been the doctor’s office.  

A few minutes later the receptionist motioned me into that office.  To my relief, the doctor did exist and she did speak perfect English. 

After chatting a little, I learned she was born in the US and moved to Costa Rica when she was a child.  A few minutes later she looked at my films and then decided to do an ultrasound.  The ultra sound was a surprise to me and made me feel (at first) quite concerned.  Did something show up on my films that necessitated more testing?  To my surprise, I received a Costa Rican “two-fer”.  Not only did they do mammograms but they also routinely perform an ultrasound as part of the testing process!

Back in the States I would have simply gone home after the test and would have waited a few weeks to receive my results via a postcard.  But not here.  To my surprise the doctor explained to me their findings and allowed me to leave with my films in hand.  It would be my responsibility to bring these x-rays back the next time I have to take this test.  Even though the total experience took 2 hours, I walked out knowing my results. 

I could have gone to the CAJA but the wait times would have been enormous and I would still have to wait even longer for my results.  However, by going private, I received immediate gratification and it cost me a whopping $80 out of pocket!  Not bad for a 3rd world country.


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