Monday, October 30, 2017

Health care in Latin America, beyond the myths and legends

We have been bombarded with comments asking us why we stayed in Nicaragua for my daughter's knee surgery. We have also been inundated with questions about or our impressions of healthcare abroad, costs, access, etc. We will try to be as objective as possible but some of what we are asked to present is our opinion of healthcare abroad. So whenever possible we will try back up our opinion with facts. Remember, I am just a regular guy that needed immediate medical assistance for my injured daughter and we did what we thought best. What made it a little easier for us is, we happen to know a pediatric physician and she recommended the top pediatric surgeon, in the country, for us. The surgeon we used has practiced medicine in 3 countries and appeared to know what he was doing. In the end, seeking medical care is as much a matter of trust as it is science. For us, it was an emergency surgery and we did not have the luxury to shop around.
   Regarding all those questions about what healthcare is like down here, my wife and I broke it down to some basics.  As best we can describe, we feel there are three major components of healthcare: access, quality, and affordability. Below we will try to share some of our experiences but keep in mind there are other opinions on this as well. We will rate each category on a scale of 1 through 10, with 10 being the highest, 7 being average and 1 being the lowest.

Access: We have had 4 experiences with urgent/emergency healthcare in Nicaragua, and one in Peru. In addition, we have spoken with American, European, and Canadian citizens who have received medical care in Panama, Nicaragua, Colombia, Mexico, Peru and Argentina. Some of the Americans that we spoke with were doing stem cell therapy abroad as the procedures are banned in the states. We have spoken with people who had acute appendicitis, altitude sickness, broken bones, or heart issues. In every case, without exception, the patients spoke highly of their quick access to care. None of them, or us for that matter, had to schedule an appointment a month in advance. In fact, each of our stories were similar, we called and got same day help, or worst case we had to wait a day for care.
   If you feel like you want blood work done, all you need to do is go to the neighborhood laboratory and tell them what you want tested. No doctor approval needed here. This is such a huge time saver and allows the patient to narrow down the concerns without a doctor's visit. If after all, you decide to visit your doctor, you'll already have the results of the blood work which enables the physician to correctly diagnose you and eliminate the guess work. We have a family member in the United States and he needed to see a cardiologist  and there was a 4 to 6 week waiting list for an appointment to see a cardiologist. Here a friend made a next day appointment and I was there when it happened. On a scale of 1 to 10 we would rate accessibility of healthcare for expats, in Latin America, an 8. Our score reflects a negative hit for lack of ambulance services throughout large parts of Latin America. We realize ambulance service is available in most major cities but response time outside the populated centers is either non existent or unacceptable.

Quality: The single biggest criticism that we hear on developing world healthcare is quality. This is, in our opinion, more an aspect of believing in myths and legends than in reality. 
Myth: healthcare is better in my home country. 
Legend: we have the best physicians in the world, in my home country. 
   So let's look into quality of healthcare, which we believe can be roughly divided into three categories: facilities, equipment and care.

Facilities that we have seen in Panama, Nicaragua and Peru actually make many U.S. hospitals look like third world facilities and that is no joke. As a person walking into a hospital or using the emergency room you notice a lot of superficial things fairly quickly. Are there a lot of desperate patients in the waiting room? Is it clean, does the staff look rushed, irritated? The list can go on and on. The facilities that you see are your impressions for the entire hospital. When we checked my daughter into the emergency room in Miraflores, Peru it felt more like we were checking into a Four Seasons hotel than a hospital. In fact, to this day I have never had a cleaner, more elegant hospital experience than in Peru.

Equipment has a funny way of being the same or very similar all around the world. Just like you can buy an iPhone or a pair of Nikes anywhere in the world, so too can hospitals buy the same ultra high tech hospital equipment regardless of location. Access to modern medical equipment is the great equalizer in healthcare around the world. As for my daughter, her digital x-ray was done with the same GE equipment that would have been used back in the states. In fact, the gurney that she was shuffled on, at Vivian Pellas. was brand new and from Indiana. In fact, it feels like everything is brand new at Vivian Pellas hospital in Managua.

Care, being our third component of quality, is more subjective. We are talking about physical care, not access. We have always had wonderful care here. What can I say, we went in for something and left better, for going. The physicians seem well trained, attentive and helpful. Heck, the physicians will even make house calls in Latin America, without blinking as eye. I am sure there are medical situations that can spiral out of control here just as back in the states. But if someone would assume care is automatically better in the states than in Latin America, that person would be wrong. Care is a case by case comparison. For example, when we were in Panama and spoke with Americans obtaining life saving stem cell therapy abroad, we were shocked. We weren't shocked in the medical tourism aspect of it. We were shocked that some of their physicians at John Hopkins University in Panama City we actually physicians from Chicago, New York and other American cities. You see, reality is odd sometimes. Imagine the irony, American physicians expanding their medical knowledge, in a foreign country, because of the prohibitions back in the states. It isn't too difficult to see why we shake our heads when we hear blanket statements about substandard foreign healthcare. For quality of healthcare we would rank Latin America a 8 out of 10. We deducted two points because the best quality healthcare is, again, limited mostly to the largest cities.

Affordability is matter of perspective. For example, for a Canadian most healthcare abroad is expensive but for an American, the healthcare is ridiculously cheap. Here, we can share more facts  than opinions. Our emergency room visit, in the most beautiful hospital we've ever seen, was in Peru and the cost $40. At Vivian Pellas, in Nicaragua, three days of out patient observation with a cardiologist, blood work, stress test, angiograms and so on, just $500. For the record, the cardiologist personally spent 4 hours with the patient during the testing, which would be an unheard of in most other countries. Furthermore, if open heart surgery was required the total cost would be around $20,000. We know of another retiree who was admitted to Vivian Pellas with acute pancreatitis and was hospitalized for 8 days and her bill came out to about $8,000. Finally, my daughter had a knee operation along with a full leg cast and our total out-of-pocket expenses were $5,200.
   These are just some of the examples that we have seen abroad. True $5,000 or $8,000 is a lot of money, but for first class healthcare, it seems affordable to us. Coincidentally Vivian Pellas takes most reputable insurance plans from around the world. So theoretically one could even get a direct payment set up from another country, though we have not done that as we are self insured. For affordability we rank Latin America a 10 out of 10 by American standards and maybe a 5 out of 10 by European standards, as most healthcare in Europe is extremely inexpensive.

   The scoring average for an American expat is 26 out of 30 or 87% . The scoring for a European or Canadian expat is 21 out of 30 or 70%. An American would benefit from the affordability more than a person from a country that practices socialized medicine. For the average expat seeking medical attention in Latin America one would see very few differences other than language spoken. Even language should not be a factor as most hospitals can arrange a translators for you, if needed.

   What I have not mentioned, thus far, are the many local hospitals and clinics throughout Latin America. Most are free and offer residents access to much needed medicines and care. However, many of the free clinics suffer terrible supply shortages, often use lesser experienced doctors, and are plagued by mismanagement. True, there are many well run community clinics but those are more the exception than the rule. Most expats would volunteer or fund raise for rural clinics than actually go there for medical treatment. We have seen some of the poorer clinics using dirty plywood for exam tables, we saw dogs walking through hospital lobbies, and we have even been to a clinic that didn't have running water. Think about that for a moment, the filth of not having running water in a medical clinic. Free or not, some minimum standards, like running water, should not be optional. For most expats who fear third world medical care, these are the visions that first pop into mind. I am here to say, most people with money, even Latinos with money, prefer paying extra for better care. It is human nature to want better, so too would it be for any expat seeking medical help down here. Most expats, including us, are lucky for having options to obtain better care in the premium hospitals throughout Latin America.
   I am not trying to take sides, not trying to say what is better. I am just trying to give balance to what healthcare looks like in other countries. Cali Colombia specializes in breast augmentation, so much so, that most wealthy Latinos call Cali, silicon valley. Panama specializes in stem cell therapies while Nicaragua has a world class burn center and trauma unit. As for most things in life, seeing it with your own eyes is more beneficial than hearing about it from someone else. Sorting through the negativity and stereotypes can be difficult at times, but with persistence you might find exactly what you were always looking for. On-line research is important but actually visiting these places for yourself is priceless.

The bustling gem of a hospital in Miraflores, Peru.

Post operative recovery in our spacious hospital room. 

Clean and uncrowded hospital.

Vivian Pellas is a well run hospital 

Ordering blood work is a simple process in Latin America.

How about this clean and not chaotic emergency room 

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