Doctor, Doctor, Gimmee the News

Or “Our Experience with Healthcare in Cuenca

First disclaimer:  The following post reflects only our experience with Ecuadorian healthcare.  Your mileage may vary.  Many other Expats, some that we know, have had very different experiences. Generally speaking, we are fairly healthy, 50 something adults with very few health risks.  Our visits to healthcare professionals in the past two months of our residency in Cuenca were not in any way emergencies or major medical events.

Second disclaimer:  No pictures!  In our defense, how many pictures do you take during a medical exam or procedure?  But never fear, Los Ganos de Cuenca have a bonus section for you in this post.  If you persevere and read all the way down to the bottom of the blog, you will be treated to some photos from our most recent excursion out of Cuenca.  You are on the honor system to read this valuable information before you look at the pictures.  Promise?  Okay, read on.

General Information about Ecuador’s Healthcare System:  Ecuador has both a private and public healthcare system.  Like in the United States, those with good (private) health insurance or a bucket load of cash can afford private healthcare and, within limits, can go to doctors, dentists, therapists, hospitals of their choosing.  However, every resident of Ecuador is offered the opportunity to access the public healthcare system.  For a very nominal premium (to us, but perhaps not to the average Ecuadorian) of $70 per month, one can have access to doctors, hospitals, pharmacies and other services within the Instituto Ecuatoriano de Seguridad Social (Social Security) system, also known as IESS.  Citizens without insurance or resources are not denied healthcare.

If you wish to read more about the IESS system and one expat couple’s experience with it, please read Linda and Bo Longood’s blog “Oregon to Ecuador – Longoods’ Journey at www.boandlindainecuador.blogspot.com.  Go to the Blog Archive and click on August.  The third post in the list is the one we are referring to.  The Longoods did a subsequent post of their experience with a dentist through the IESS.

Since we have free health insurance and reasonable premiums for vision, dental and auditory through Mara’s pension plan, we have opted not to apply for IESS insurance at this time.  So far we have paid for all of our medical care out of pocket and with the exception of the prescriptions we have had filled, the costs have been less than what our co-pay would have been if we were seeking the same care in the States.  But, I get ahead of myself.  Let’s continue on more systematically . . .

The first thing we had to do is find healthcare professionals that spoke English.  That’s actually not that hard to do because the Cuenca Expat community shares information quite generously.  There are Facebook groups, bloggers, and websites that have lots of resources, reviews, rebuttals, points and counterpoints about any topic or need you can imagine.  Word of mouth is probably the most valuable.  Two websites that have been quite helpful to us in finding our healthcare providers are gringotree.com and gringopost.com.  Both have a recommendations feature.

Chiropractic and Massage:  The first practitioners that we visited were chiropractor Dr. Mike Pettella and his massage therapist wife Jing [contact info for our Ecuadorian readers who may want to reach them: ph #099 686 2157; email2jingjing@yahoo.com; Rafael Maria Arizaga (18-62) y Octavio Cordero].  The Pettellas are Gringos formerly from Florida.  We contacted them first by phone to make an appointment and then by email to fill out some forms.  They operate their practice out of their home at this time but are working towards renting space nearby for a clinic.  Mara received chiropractic care for back spasms and Glenn had a Thai massage from Jing.  We were very pleased with their thoughtful and professional care.  We have seen them for subsequent visits and have referred their services to others.  They are not set up to provide receipts for insurance purposes so we just paid them from our “self-insured” medical fund.  The initial chiropractic evaluation and adjustment was $25 and the follow up treatments were $15.  Jing’s massages, whether Thai or traditional deep tissue are $25 per hour.

Medical Doctor:  We felt that we needed to establish a relationship with a general practitioner physician prior to the event of a serious illness or injury.  Observant readers of previous posts will recall that one kisses everyone when one greets them (germs) and the lowly pedestrian is at the bottom of the food chain (accidents).  Dr. Pablo Parra was recommended by many as an outstanding Ecuadorian doctor who speaks English.  We contacted him by email (parra5432@yahoo.com) and he instructed us to come to his office between 10 am and 1 pm (Mt. Sinai Hospital Tower N1, Miguel Cordero 6-11 y Av. Solano, Office #511).  If you come too late, like we did the first time, you will not get to see him.  The second time we came, we arrived before 10 and got an appointment ticket from the receptionist at the end of the hall.  She was the one we paid $30 to as we got our ticket.  We were number 3 in line and our expected appointment time would be 10:30.

It was actually about 10:40 when we were greeted by Dr. Parra and asked to come into his office/examination room.  From the moment we met him, we both felt comfortable, listened to, and that we were dealing with a very professional and kind person.  Dr. Parra asked questions, listened to the answers and took notes about our medical histories and what our medical needs were at this time.  (We both needed prescriptions written to be filled at a local pharmacy.)  Dr. Parra not only has his office at Mt. Sinai but sees patients and does rounds at the public hospitals as well as any private hospitals that his patients might be at.  Here’s the real kicker!  We not only have Dr. Parra’s office phone number but as his patients, we have his private cell as well.  For our US readers, you know this is unheard of in the States, right? But here in Cuenca, it is the norm.  (ph # 072 885 595, ext. 2511)

Pharmacy:  To refill our prescriptions, Dr. Parra first called the pharmacy at Mt. Sinai to see if they had the generic version.  They did not, so he suggested we go to Cruz Azul (Blue Cross) which is one of the gazillion pharmacies in the city of Cuenca.  We went to the nearest Cruz Azul and muddled our way through in our improving Spanish (honest, it is improving!) to find out that that particular Cruz Azul did not have it right now but they could get it for us.  And they did.  But it was expensive because when we were in the States, we only ever paid the copay.  At Cruz Azul, we paid it all and now we will see how well Aetna pays claims from providers in other countries.

By the way, pharmacists in Ecuador can prescribe some medicines, too.  You don’t always have to go to a doctor.  When we had our little friends, the Parasites, we described our symptoms to a pharmacist and she gave us what we needed. But if one needs something which Americans consider over-the-counter, like Tylenol or Motrin, don’t expect to pick up the 500 cap bottle off the shelf and buy it from the clerk.  The pharmacist sells it to you by the tablet and it ain’t cheap!  Good thing we brought the Costco size bottle with us.

Dentist:  Mara has been having a bit of irritation in one of her molars so we decided it would be a good time to meet a dentist.  Again, Gringopost and Gringotree had plenty of referrals by previous patients.  We emailed Dra. Christina Tosi and made an appointment.  We arrive a few minutes before our scheduled time and so did she.  We had heard she was prompt which is very rare and high praise given to an Ecuadorian by a Gringo!  Like Dr. Parra, Dra. Tosi was a one person show.  No nurses, hygienists, receptionists, billing specialists, and appointment reminder callers.  She asked the questions, filled out the paperwork, conducted the examination, and received payment which was $15.

Dra. Tosi wanted me to get an xray so she wrote an order for one.  Xrays and lab work are very rarely done in the same office.  So another day, we went in search of the xray lab.  We found it and $12 and ten minutes later, we had the xray.  By the way, that xray belongs to ME and it is in MY possession.  I took it to Dra. Tosi on my follow up appointment.   In case you’re interested, I have some inflammation around the root of the tooth in question.  It will probably end up needing a root canal but it is not that bad yet so I’m holding off for as long as possible.  I’m sure you can’t blame me!  Dra. Christina Tosi’s contact info is:  cdentalspa@yahoo.com; cell # 099719 8709; 10 de Agosto y Moscoso, Torres de Yanuncay, ground floor).

Ophthalmologist:  Glenn needs new glasses so our most recent excursion into Cuenca healthcare was to visit Dr. Rene Cabrera at SOI Opticas for an eye exam.  SOIoptical is in a pretty swanky building with opticians and frames on the ground floor, the lab on the first floor (that would be second floor for us Americans) and the doctors’ offices on the top floor.  Dr. Cabrera had both a receptionist and a technician who did a few of the preliminary tests before Glenn’s main examination.  The tech did not speak English but we guess our Spanish was good enough because we got the job done and had a little friendly conversation as well.

After a short wait, we saw Dr. Cabrera.  Another very professional and kind practitioner.  He prescribed new glasses for Glenn as well as some eye drops (oh goody, another trip to the farmacia!)  We paid $40 for the exam and went downstairs to order the new glasses.  But since we forgot our credit card, Glenn will have to go back another day to order them.  About $300 for his glasses but hopefully our insurance will cover a bit of it.  SOI Opticas and Dr. Rene Cabrera are at Florencia Astudillo 3-45 y Solano; ph #2 830 963; email – renepatyca@hotmail.com.

Hospitals, Ambulances, Specialists:  Fortunately, we have not had any need for these services.  Let’s just keep it that way.

Well, you’ve made it to the end of the Healthcare Issue.  Congratulations!  Now you have earned your bonus.  As our gift to you, please enjoy these pictures taken from our trip to Ingapirca, the largest Incan ruins in Ecuador.

The Ford Explorer from Cuenca Car Share that carried the Ganos, Angstroms and Storcs safely to Ingapirca and back. Greg Angstrom, the only one of us with an Ecuadorian driver’s license, was our more than competent chauffer.

The Incadinkadoo’s from top left to bottom right: Cindy Storc, Mara Gano, Glenn Gano, Jim Storc, Brenda Angstrom, Greg Angstrom

Ingapirca is the largest Incan archeological site in Ecuador. It is located about 70 km north of Cuenca and at about 10,000 ft. above sea level.

The Temple of the Sun – the focal point and highest point of the ruins. The Incans used the structure not only for a worship center for the sun but also as a calendar. The elliptical structure was built in such a way that on the solstices, the sunlight would enter through the door and illuminate the small chamber.

Our English speaking guide.  Notice how bundled up she is.  It was around 65 degrees.  That’s cold for Ecuadorians.  It’s a perfect temperature for former Alaskans!

 

This picture shows the construction of the rock walls of the Temple of the Sun at Ingapirca. Notice the tightly fitting stones on the right wall.

View of the Incadinkadoo Valley below the ruins. Honestly, I tried to find out the name of this valley but obviously my research skills are not up to par. We like the name Incadinkadoo!

A thunderstorm was building as the afternoon wore on.  Time to move on.

The same day as we visited Ingapirca, we also visited the “Church in the Rock” in the small town called Biblian.  So here is an extra BONUS of some pictures taken in a thunderstorm, after a climb up many, many steep steps, when we were hungry, AND needing to use a restroom.  That’s how much we love you.  Enjoy!

The Church in the Rock in Biblian is actually built into the side of this rock hill. You can drive up to the base of it but then we walked.

Yes, it is as steep as it looks. It was also raining fairly hard but thankfully the stone steps were not slippery.

You can see how the altar is built right up against the stone face of the mountain.

We think that’s enough for now.  In the very near future, we will post pictures from our trips to the Yungilla Valley (finally – a valley with a name!) and Chordeleg.  Also, as it is the Christmas season, some pictures of Cuenca’s Christmas decorations and festivities are in order.  Soon, very soon.

What we have learned:  Summer weather in the Andes of Ecuador can be AWESOME!  But we’re always prepared for a storm.

What we need to learn:  Not to drink too much water when you have to be on the autopista (highway).  Rest areas and truck stops with clean restrooms do not exit in Ecuador.