FOCUS ON ECUADOR - Our Adventure in Cuenca Ecuador Through My Lens!: medical care in Cuenca

When we first moved to Cuenca, Bo and I decided to be "self insured" for our medical needs. We figured if we kept the money we would have to pay for monthly health premiums in our own account, we would come out ahead - due to the low cost of medical care here. Most insurances we had inquired about wanted at least $100 a month per person (way less expensive than the high premiums in the USA) and the coverage wasn't that great - plus the paper work and hassle to get reimbursed was not a smooth process. We decided that $2,400 in the bank per year would cover more than enough of our yearly medical bills. But, what if we had an emergency? A BIG emergency???

Sometimes we sail through our life by faith. We have been back to the USA three times without any medical coverage. Yes, it's risky - but, we've been okay so far. As for medical coverage in Cuenca, that's different. To spend a day or several days in the hospital is low enough for us to pay out-of-pocket if we had to. Yes, it would be a big chunk of money, but we could do it. Then I heard about the IESS Government insurance. For a few months it was blocked from ex-pats being able to apply for it, and we missed that window of opportunity. Around March of this year it became available again for ex-pats, and I jumped on it and got Bo signed up with me as his dependent. However, the rules were changed. Now, there was a three month wait for coverage from the time we were entered into the computer. Bo's monthly payment would be $70.04 and mine would be $11.59, for a total monthly medical premium of $81.63.

For the first three months, the payments were for Bo's coverage only. My payments then began in August. We are now both covered 100% for all of our medical needs: Doctor appointments, lab work, x-rays, ultrasounds, prescriptions, eye, and dental (the DENTAL covers us when we turn 65). So how does it work?

1 - Once your 3-month waiting period is met - you call the IESS phone # (07-413-4555) and ask for your first GP doctor appointment. I told them I wanted a doctor in El Centro, so they scheduled Bo at the IESS Consultorio building near Parque Calderon (we love walking to everything - even our doctor appointments!!!). On Friday, we met with Dr. Marco at 7:15 am. He was kind, attentive, and thorough. Of course, going to a doctor appointment here is so painless. No waiting, no paperwork to fill out. The doc does all of that in front of you on his computer - and it's minimal and to the point, "How can I serve you, and why are you here today?" No privacy act rules, no secretary or nurses or other patients waiting in adjacent rooms! He does it ALL and you're it for the entire appointment. He asked Bo why he was there, we told him all Bo's concerns, he ordered labs, an ultrasound, and scheduled Bo for his specialist appointments and physical therapy. He checked Bo out for a couple of GP issues, gave us our future appointment instructions, shook our hand, and we were out the door. No papers to sign, no money to pay - just a friendly "Gracias."

2 - We were given a slip of paper with three different numbers. We went to the pharmacy line, gave them the paper, and they gave us Bo's prescription. Free! We then went to the lab area, gave them the paper with the other two numbers, and they entered two appointments into the computer for Bo's lab work and Ultrasound.

3 - Today we walked back over to the lab (same building as our doctor). We stood in line for about 5 minutes, Bo's turn came and they sat him down and drew his blood - free. His results will be back on Thursday, and he has a follow-up appointment on Monday with Dr. Marco to review his labs. He is also scheduled next week at the IESS Hospital for physical therapy and in September he will go see a specialist at the IESS hospital.

4 - The next appointments we will make will be for eye care and to have Bo's hearing checked. The procedure is the same. The General Practitioner doctor will schedule these appointments during Bo's Monday visit.

5 - The appointments are important to keep. If one has a medical emergency during the waiting period, you can go to any hospital and supposedly IESS will cover your medical care there. I have heard conflicting stories about this - so I need to verify this information. Sometimes the pharmacy does not have the prescription required, so one has to go to another pharmacy (plenty of those in Cuenca) and pay for the prescription. Because medication is so inexpensive here, no problem!!

6 - Are the doctors as good as the ones practicing outside of the IESS Government Insurance? Absolutely. Our family doctor in Cuenca, Dra. Rosita, told us that she would be an IESS doctor but because she doesn't have handicap ramp access to her office (you have to climb stairs - yes!) - she was not approved. I think some doctors like that monthly fixed income paid to them by the Government. We will still see Dra. Rosita if we need her medical expertise. She is brilliant, kind, and charges $10 per visit with free follow-ups. We love her! For now, we are establishing our medical care with IESS so we are in their computer system. Then if and when an emergency occurs, we will have that 100 percent coverage.

Yes, for less than $1,000 a year medical insurance premiums and 100% medical coverage, it's worth it for us to go through the system. Nothing fancy here when it comes to hospital care. You don't get a private room, you provide your own personal care items for your hospital stay, and you're not pampered and charged for every little thing like back in the USA. The important thing is the quality of care - and we have heard only wonderful things about the care and treatment others we know have received from the IESS doctors. Is it like the USA? Of course not! Don't come expecting a USA doctor-hospital experience. But, do expect to receive quality medical care from excellent physicians.

If you are a legal resident of Ecuador and have a Cedula, you are qualified to apply for IESS Insurance. Application for voluntary enrollment can be made at the Social Security office in Cuenca on Gran Columbia (Instituto Ecuatoriano de Seguridad, or IESS). You can also sign up on line at www.iess.gob.ec.

We embrace the medical benefits and care we continue to receive here and we are thankful for a country that offers us, as ex-pats, the opportunity to be a part of their Government health care benefits. Another reason we love living in Cuenca!!

MEDICAL CARE IN CUENCA

Being ill in Cuenca is NO FUN! Why? Because you end up missing so much. Every day in Cuenca there is something to see and something not to miss! I've had an unfortunate situation with my health lately, and in less than 5 months here, I've been ill three different times (almost as many times as we've moved!!!). This last bout took me down, down, down. I though I was over illness #2, and after a week of feeling great, it hit me again - only now I had a high fever, a hacking debilitating cough, breathing issues, and absolutely no energy to leave my bed. So, it was time to visit the doctor for the first time since living here.

There is a wonderful pharmacy around the corner from our apartment. The doctor there (yes, pharmacists here are doctors) speaks English and she is absolutely wonderful and knowledgeable. We have been going to her for our medications and medical advice since we arrived here in December. So she knows us, and she cares about us. Bo went there to see if he could get me a stronger cough medicine, and when he described my continuing symptoms to her, she immediately, without hesitation, told Bo he must take me to see a doctor. Bo said that right there, she phoned a doctor at the Santa Ana Clinic and made me an appointment for exactly one hour later. I could barely dress and go down our three flights of stairs. I was so ill, I was ready to do anything and take anything to feel better.

When we arrived at the doctor's office, I simply paid $30 for the consultation. No paper work. No questions asked. You just pay the money to the secretary and have a seat. The doctor called me in immediately. No waiting, no going into a room to be seen by a nurse and wait some more. He had us sit at his desk, and he began to ask me a few questions and type them into his computer - name, address, phone, date of birth. Then he got right to it - what were my symptoms? I explained (Oh, this is all in Spanish, of course!) how I had been ill several times since moving to Cuenca, and now I was at my worst. He saw my feeble condition and reached for my hand, smiled and said, "I'm going to help you. I promise you, in less than 48 hours you are going to feel well again." His kindness, promise, and gentle touch assured me I was at the right doctor.

Now, Dr. Manolo had me sit at his exam table and began to check my sinuses and listen to my breathing. He immediately diagnosed me with Chronic Rhinitis and Asthma. He ordered a chest x-ray, and Bo walked me around the corner to the facility where I paid $25 and was taken in immediately. Being so ill, the "no waiting" was something I appreciated. I had been instructed to go back home, and then return at 5 pm so Dr. Manolo could do some pulmonary function tests, which he could not do at this time since I had taken a hit from my nebulizer, and he needed several hours for it to wear off. Bummer! I couldn't even imagine going home and then having to do this all over again the same day - but I knew it was necessary to get the medications I needed to fight this illness. This kind doctor said he was so sorry I had to wait and return again, but he promised me once again that he would help me. He told me to call him if I needed anything, and I now had his personal cell number. Doctors here give you their cell #'s, and they invite you to call them anytime! A friend here who recently became ill had his new doctor come to his apartment for a house call. Who does this? Only here in Cuenca.

And so we left the office. By the time I returned home and a couple hours went by, I thought I would die. My fever was now up to 103, and I was almost delirious. So, Bo dialed my doctor's cell number and he immediately answered. I could barely talk, and through tears I explained I had a very high fever and needed help NOW, before our 5 pm return. He instructed me to tell Bo to go to the pharmacy and get a certain prescription and take it immediately, which Bo did. I took the prescription, not even knowing what it was, and for the next few hours I slept. Now, If you know me, you'll know that I never take anything, especially Pharma Poison, without first looking it up and finding out what it is. I was now in "trust mode" and would take anything. This is how absolutely crappy and sick I felt. Ahhhh, to sleep away a few hours and not feel the misery. During this time, my doctor called back to check on me. He was so available to me.

Bo woke me at 4:15 pm (shoot me now!!), I slowly dressed, and we were once again in a cab headed for the clinic. At 5:00 pm I checked back in. No charge. Dr. Manolo took me in right away, and quickly did the pulmonary tests. He then wrote me three different prescriptions for antibiotics and my asthma and then sent me on my miserable way. Again, he reassured me that I would feel better by "tomorrow." And so it was! Bo got me home and back in bed, and he went and bought my Big Pharma Poison drugs. I loaded up and then closed my eyes for the next 24 hours. Ahhhh, more sleep. I woke up only long enough to take drugs and drink water. By the next evening, my eyes popped open. I still had a fever, but it was now only 101. Amazing what that 2 degrees can do. I still felt extremely ill and weak, but hopeful. On the third day, my fever finally broke!

I continue to take my drugs and today, over one week later, I feel better. I'm still tired and unable to do much in my day, but I know I'm healing. Bo asked my doctor what could be causing my breakdown in my health (I'm always so healthy - really!). Well, it could be the dust that was created in our apartment when they repaired and sanded the damaged floor in one of the bedrooms - and didn't cover up things so there was "polvo" everywhere. Or, it could be the bus fumes, daily climate changes, or altitude (we're at 8,500 feet). Maybe it's just seasonal asthma here. For now, we're not going to try to figure this one out. Our hope is that we can continue to live in Cuenca, that I will completely heal this round with all the drugs I'm ingesting, and that this too shall pass - permanently!

The cost of my medical care for this round was $155.
Doctor Consult - $30
X-rays - $25
Pulmonary Testing - $40
Medications - $60.

Every time I went to my allergist back in the USA, the visit alone was written up as an intermediate consult for $225, even though the doctor spent less than 10 minutes with me. His nurse did all the work - writing my history, performing the pulmonary testing, taking my vitals, etc. Then came the drugs. If anyone reading this has asthma, you'll agree that the big pharma drugs for asthma are absolutely unaffordable without medical insurance, unless you're rich! I remember spending hundreds of dollars just for the basic breathing medications. This doctor visit was very affordable in comparison to previous allergy visits in the states. I'm so thankful for this.

So, this is my personal experience with my first doctor visit here. I'd heard many positive testimonies from other ex-pats that we've met since being here who have had unfortunate medical issues and were either hospitalized or had to visit a physician. Not one of these testimonies was negative - only positive. The medical care here in Cuenca is 5-star. The final bill is always well below what one would expect, being used to the outrageous cost of medical care in the states. Those of us here who have had to seek health care are truly thankful for this affordable benefit living here. It gives me another reason to say, "What's not to love about Cuenca?"

Cuenca's 15K Race 2013

The Sunday morning before I became too ill to wander around my city and capture "life in Cuenca," there was a 15K (9.3 mile) race that attracted over 10,000 participants. I could hear them running early that morning, and I looked from our terrace to see the herd of runners racing down Calle Larga. Quickly, I grabbed my camera and headed out the door for Simon Bolivar and Parque Calderon, knowing that was the main "calle" where these athletes would be circling towards. I was right! I had the opportunity to capture this yearly race to share with you. It's always my joy to bring our readers photos of Cuenca's weekly events. I love the fact that Cuenca is a city with extraordinary talent and incredible athletes. So, enjoy!