Tuesday, November 28, 2006

Doctores, Clinicas y la Farmacia

Gringos can only dream of having the level of quality and access to health care that Costa Rican's enjoy. Life expectancy here is 3rd in the world behind Japan and France, and in front of the UK and US. Healthcare is available to all, whether you are a citizen, resident or visitor. Costa Ricans can join the national social security system for a minimal monthly cost. Foreigners can purchase health insurance through the national insurance company for about 1/5 the cost of equal coverage in the US. Or you can just pay as you go for private healthcare.

Even if you pay as you go here, the cost of drugs at the pharmacy, a visit to the doctor, injections in his office, independent laboratory tests or a trip to the emergency room is a fraction of the cost in the US or Canada (though still expensive for the average tico). And the service is as good or better. In fact, in my experience the level of health care service has always been better. ALWAYS!

Now, I haven't been deathly ill, gracias a dios, but I did pick up some sort of flesh eating bacteria a couple of times, and have been doubled over in so much pain with an intestinal infection that I couldn't walk. For the skin thing, I went to the farmacia (pharmacy). Pharmacies here work much differently than where I'm from. Most have a doctor on call in the pharmacy with whom you can consult and get a diagnosis (or, in my case, lift up your shirt to show him your flesh eating disease and watch him leap backward in horror while squealing, "Eewwww!" like a little school girl). Now, he's not going to diagnose a heart condition, diabetes or a brain parasite, but he can help you out with a lot of the more common ailments that affect people. He can then recommend medicine that you can purchase at the pharmacy on your way out of his office for an eighth of what it would cost in the US.

It's preventive health care at its finest and I find myself relying on it much more than I did in the US. I was in an HMO to which I and my employer paid a significant chunk of change each month. But every time something bothered me, I had to make an appointment with a 'primary care physician' to either get a diagnosis or a referral to see a specialist. It might be a week or two before he could see me. If he wrote me a prescription, I had to make a second trip to the drug store to fill it. If it was lab tests, it was a trip somewhere else and then I had to wait days or a week for the results to be delivered to my primary care physician for another trip back to his office. I found myself waiting until I was almost unconscious before going to the doctor in the US. I don't anymore. My pharmacist and I are good friends and I'm enjoying the best health of my life. So is my wife.

For the intestinal thing I went to a private clinic. I arrived with no appointment, gave the nurse my driver's license, sat down, waited a total of 10 minutes and was called into the doctor's office. He questioned me for a few minutes, examined me, gave me an i.v. to stop the contractions in my bowels that had me doubled over and gave me an injection of an antibiotic for the infection. He then prescribed three drugs for me: a mild pain killer, an antibiotic and a pill for parasites (just in case). So let's tally that: 1 office visit, 1 i.v., 1 injection, 3 prescription drugs. It was $45 for the first three and $30 for the prescription drugs that I purchased at the pharmacy in the same building! I went for lab tests at one clinic that included a urinalysis, stool analysis, and blood workup. For this I had made an appointment. I showed up at 10:00AM, was stuck with a needle at 10:10AM for the bloodwork and had the results in my hands at 2PM the same day!

An orthopedic surgeon friend of mine - a big skier from upstate NY who deals with a lot of sports injuries - was visiting me with his family and became ill. We'll call him Dr. Heal Thyself. After 3 days of misery with cramps, diarrhea, headaches, sleeplessness and dehydration, Dr. Heal Thyself decided it might be a good idea to see another doctor. He and his wife were a little leery of the level of healthcare that he would receive in this 2.5 World country. I told them not to worry. In the end, Dr. Heal Thyself's experience was the same as mine. He was impressed with the quality of health care delivery as well as the price tag.

But what Dr. Heal Thyself was most impressed with was the flavored tongue depressors the doctor used in his office for little kids. "These are great!! Where can I get these!!??"

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