I hate to say it but all bets are off
when you live outside the protected borders of the good old
US of A. Speaking as an ex-paramedic, I was able to
offer my friend advice as to what should be done until the
ambulance arrives, but calling 911 was the first thing that
needed to be done.
North Americans take for granted many
of the basic necessities we rely on each and every day.
For example, we know that if we dial 911...
The phone will be answered by a
trained professional who (more than likely) speaks your
Once you give the operator your
address and describe the nature of your problem, the
proper emergency response will then be dispatched
Generally within 4-5 minutes, the
proper police, fire or EMS services will arrive at the
scene and highly trained professionals will then render
the appropriate aide.
The emergency equipment that
arrives will be properly maintained and stocked with all
the tools necessary to initiate a satisfactory
In the event of a medical
emergency, one will be transported to the nearest, fully
accredited medical facility that can address the related
Such is NOT the case in Costa Rica and I
speculate that this may be true for many other, non first-world
As a potential newcomer to a Costa Rica, you
need to understand that if you call 911...
Your call (if answered at all) will be
answered by a Spanish speaking individual.
Assuming that the call is answered, that
individual will NOT be trained to the extent of which you are
accustomed back in North America.
You will NOT be able to give the 911
operator you address because you wont have an address. You
will need to give directions as to where you are physically
located. For example, you may have to instruct the
operator that you live "300 meters west of the church and 200
meters east of white fence." Be advised, the fence may no
longer be white or even there. Plus you will have to do
this all in Spanish!
Depending on where you live in Costa Rica,
response times for emergency services can vary from 10-15
minutes (in highly populated cities like San Josť) to an hour or
more if you reside in less populated areas. And it is even
highly conceivable that there may be no response at all.
In many cases, private doctors will make
house calls but don't plan on them providing much help in the
event of a life threatening situation.
Sometimes an ambulance may show up with
only a driver. The trip to the hospital then turns into a
"load and go" scenario with nobody providing medical assistance
while en route to the hospital.
Once you get to the hospital, unless you
are going to (one of the four) North American style hospitals,
you will find yourself stepping back in time to medical
facilities resembling those of the late 50's and early 60's in
Why Am I Telling You This...
On New Year Eve, a friend of mine collapsed.
His wife immediately called her friend who then called me.
After asking a couple of key questions, I was able to determine that
my friend was incoherent, verbally non-communicative, sweating and
lethargic. His pupils were reactive to light but were unequal
in size. He was not able to follow simple verbal commands.
Based on this, he needed to be kept still, put on oxygen and
transported to the nearest hospital for a CAT scan.
The following chain of events took place.
Is this sort of thing routine or just a rare situation? I am
likely to think it is more routine than not. However, I'm
certain that there are parts of Costa Rica where emergency services
are top notch... perhaps the neighborhood where our President lives!
My friend called her private doctor but he
was out of town for New Years. He advised my friend to
call his back-up doctor.
The back-up doctor was summoned.
He immediately called for an ambulance and then proceeded to go
my friend's house.
The doctor determined that my friend's
blood pressure was high and that he may be having a
The doctor asked if they had any blood pressure
medicine in the home. Unfortunately, the answer was NO.
When the private ambulance arrived, oxygen
was immediately administered, however within minutes, the tank
was empty. The doctor sent the
ambulance driver to the local pharmacy to purchase the needed
blood pressure medication.
The nearest hospital was 40 minutes away
in the town of Liberia but unfortunately the hospital's CAT scanner was out of service.
The only other option required a trip to CIMA Hospital in San
Josť, a four hour ambulance ride away.
Realizing the criticality of the situation,
an air-ambulance, located in San Josť was ordered.
While awaiting the ambulance driver to
return with the blood pressure medication, the doctor started an
IV line but did not have any IV fluids to administer.
After awhile, the ambulance drove
to the Liberia Airport to meet the air ambulance. For some
strange (and unknown reason), the doctor sat in the front seat
of the ambulance next to the EMT driver. The wife sat in
the back with her husband, the patient. In all my years as
a trained paramedic, I have never seen this done. Leaving
a potential stroke patient, unattended, in the back of a moving
ambulance is stupid, irresponsible and potentially criminal.
The ambulance (eventually) arrived
at the Liberia Airport, where they met the air ambulance,
started a real IV and flew to San Josť where a ground ambulance
took them to CIMA Hospital.
Once at CIMA, my friend was
attended to immediately
and received top notch medical care.
It was determined that my friend may have suffered a
mild stroke, but is expected to make a full recovery. But one
needs to ask the important questions...
What if my friend were alone and his wife
was not there?
What if he didn't have the $7500 fee for
the air ambulance?
What if the back up doctor was busy?
What if the ambulance never made it to the
As North Americans, we take for
granted the high quality emergency medical care we have back home.
Automatically, we expect the same quality of care anywhere we
travel. For those of you wanting to relocate to a Costa Rica
or similar type of country, make your decision with your eyes wide
open. Ask lots of questions, not just of the residents who
live there but of local doctors and pharmacists. Before you
make the decision to move to a particular location, know what it
will take to summon assistance. But in the end, if you have medical issues, you need to understand the
risks. If you are not willing to accept those risks...
PLEASE STAY HOME!