It’s been a long time since I did a cost of living post. So, here’s an account for the month of October, 2014.
“[When asked why are numbers beautiful?]
“It’s like asking why is Ludwig van Beethoven’s Ninth Symphony beautiful. If you don’t see why, someone can’t tell you. I know numbers are beautiful. If they aren’t beautiful, nothing is.”
― Paul Erdős
This week’s Photo Challenge is Habit – stuff of the everyday, places we go, things we do, people we see.
This is our electric bill attached to our fencepost. Last month, when the electric man came to our house to cut off our electricity…AGAIN…I said, ” What happened to the bicycle deliverer this time?” You see, as hard as I try to be efficient and pay our bills in a timely manner…it’s almost an impossibility on Ometepe Island because good financial habits that I have developed throughout my lifetime don’t exist in Nicaragua.
The first time the electric guy came to our house to cut off our electricity he told me, “The fat guy on the bicycle quit delivering the bills.” In the ‘land of the not quite right’, even though we never received a bill, it was our duty to pay in a timely manner. So, Ron raced off to town on his motorcycle to pay our electric bill, while I entertained the electric shut off guy on my porch and taught him a few English phrases like efficiency, good financial habits, pay bills online, and I am never late paying my bills.
This time, the new electric bill delivery guy was afraid to deliver the bill to us because he didn’t speak English. “Oh my Lord…just tell him to hang it on the fence,” I said. And so, coming home from paying our other bills in town today, the electric bill was posted happily and fearlessly on our fencepost.
Let me explain the Latin logic in our bills. The big stack of receipts…over 3 years of receipts (in the picture on the right) is our Claro internet bill. We didn’t have residency when we wanted the internet at our house, so a friend of mine who had residency used her information to get us the Claro internet dongle. Every month, I have to go to the office to pay the internet bill and every month he asks me, “You are Betty?” At first, I tried to tell him that Betty passed away, and it was my internet bill. But, when he said, “Muchas gracias, Betty” after I paid the bill, I thought… what the heck. I’ll be Betty for the rest of my life as far as Claro is concerned.
The confusion at the Claro office started when I got the Claro phone plan with my residency card. I pay the bills on the same day. “Muchas gracias, Betty,” he said when I paid my internet bill. “Muchas gracias, Deborah,” he responded when I paid my Claro phone bill. I think they are humoring me and suspect that they are dealing with a loca gringa with dissociative identity disorder.
Good financial habits don’t exist in Nicaragua. Very few bills can be paid online…only my SKY satellite TV bill…and that’s from Mexico. The electric company is the only one that delivers the bills from house to house on a bicycle…no mail service here. For the other bills, we play the game of seek and pay. First, we have to find the stack of old receipts attached to the original contract, then pay them in the right office.
It really becomes tricky if we can’t find the stack of stapled receipts because the electric and water bill aren’t in our names. We tried to change the bills to our names…but don’t get me started on that fiasco…which involved Spanish words like abogado ( lawyer), escritura (our property title), and mucho dinero ( much money).
Maybe I really have developed dissociative identity disorder? Paying bills in a fiscally responsible way in Nicaragua is a habit I’ve had to break. It’s the only way to stay sane in the ‘land of the not quite right.’
I was asked to write a short piece about our lives on Ometepe Island for a website Retirement and Good Living. You can check out the article here. The Retirees and the Volcano.
I have to add that I love blogging. I have met so many wonderful people through my blog. Thanks to all my friends, old and new, who have enriched my life beyond my wildest dreams.
“Blessed are they who hold lively conversations with the helplessly mute, for they shall be called dentists.”
― Ann Landers
We’ve been searching for professional and trustworthy dentists in Nicaragua for three years. Finally, after excellent recommendations from several friends in Granada, Nicaragua, we found the perfect couple to attend to our dental needs.
Ron had major teeth problems and I needed a thorough cleaning. So, we contacted Dr. Erwin Esquivel Chavez through an email for an appointment. He responded the same day and set up appointments for our dental exams.
Meet the dentists: Dr. Erwin Esquivel Chavez and his wife Dra. Ximena Urbina Ordoez
Website: Clinica Dental Esquivel-Urbina
Office Phone: 2552-0664
The oral surgeon,Dr. Gilberto Martinez, aka TITO,
comes every Friday.
Dental Tourism is growing in Nicaragua. Dr. Erwin specializes in oral rehabilitation and implants. His wife, Dra. Ximena specializes in root canals.
State of the art dentistry at its best. Modern, sterilized equipment is provided for every procedure.
Gentle care: Dr. Erwin cleaned my teeth for over 1 and 1/2 hours. He took 5 x-rays and showed them to me immediately on his computer screen. He stopped often to ask if I felt any sensitivity. When my fingers started playing Fredric Chopin’s Polonaise (over the stereo system), he stopped suddenly, concerned that I was in pain. “Not at all,” I said, “I used to play this on the piano.” He was impressed…lol…because it is an extremely difficult piece to learn.
Ron had five teeth extracted by the oral surgeon. Next, he has to decide whether to get implants or partials. Where else can one sit in the office, watch the step-by-step extraction with a detailed explanation of everything in fluent English, and receive HUGS after it is over?
I asked the dentists if they are required to have liability insurance or malpractice insurance and they said that Nicaragua doesn’t have anything like that. So, the savings are passed down to the patients.
1. Teeth cleaning: $45
2. 9-10 x-rays: $100
3. tooth extraction: $60
4. Ron had 5 teeth extracted, injections to numb his mouth, and stitches: $300 for all of his dental work.
5. Antibiotics and pain pills $15
total: $460 for both of us
If he wants implants, they will cost $1,200 each for everything. For a partial denture: $300
Nicaragua is generally a cash only society, and the dentists were no exception.
If these same procedures were done in Tennessee, I calculated the cost using this website:
Dental Cost Calculator in the United States
1. Teeth cleaning $84.71
2. single x-ray $17.34 for 10 x-rays $170.34
3. Tooth extraction $ 126.82 each additional tooth $131.87
for 5 teeth $ 654.30
4. Initial surgical consultation $84.71
5. antibiotics and pain pills $80
One Implant Placement: $2,407.31
Partial Denture: $1,544.97
We could have shopped around for a good dentist that would have been considerably less money. For example, Ron went to a dentist in Rivas and had a tooth removed. It cost $25. But, for the comfort, sterile environment, modern equipment, and dentists who speak fluent English, it was worth the extra money. They were wonderful and I would recommend these dentists to anyone seeking dental procedures. In fact, after our first appointment, we stopped at a main street cafe…a very touristy area. Two groups of people overheard us talking about the dentists and came over to our table to ask us more questions. Did I ever tell you how much we love Nicaragua…even when we are helplessly mute!
Also, see my new friend’s blog article Holes in the Head about her experience with these dentists.
At the current $7.25 an hour, the federal minimum wage has become a poverty wage. A full-time worker with one child lives below the official poverty line.
Yesterday, we hit the jackpot when shopping in Rivas, on the mainland. For the first time in Nicaragua, I found a jar of whole dill pickles, French honey mustard, and Snyder pretzels. Today, I received my first Social Security deposit. I’m officially old and lovin’ every minute of it. Yet, both of these events got me thinking about the poverty level in Nicaragua.
Do Nicaraguans think they are poor or do we, who were born into a capitalistic society, only perceive Nicaraguans as poverty-stricken? Do Nicaraguans prioritize their lives around how much things cost? To help answer my philosophical ramblings, I asked myself, how long would a Nicaraguan have to work for a jar of dill pickles?
On the average, a full-time Nicaraguan employee earns 100 cordobas a day. That’s the equivalent of $4 a day at the current exchange rate. My jar of dill pickles cost 135 cordobas, which means the average Nicaraguan would have to work more than a day to buy a jar of pickles.
To put this into perspective, a minimum wage worker in the states would have to work about 42 minutes to buy a jar of pickles. Of course, pickles are a luxury item here, so the cost is much higher than in the states. My neighbor kids love mayonnaise. They beg for mayonnaise when they come to visit because it is pricy and out of reach for most wage earners in Nicaragua.
Honestly, I seldom look at the prices of most food items in Nicaragua. We buy very little processed food, but there are certain treats like peanut butter, mayonnaise, pretzels, chocolate and pickles that we enjoy when we can find them.
Out of curiosity, I’ve compiled a list of how long a Nicaraguan would have to work for various items that we normally think nothing of purchasing.
One day of work would buy: 100 cordobas or $4.00
1. 1 jar of mayonnaise
2. one giant Hershey bar
3. A week of telephone minutes ( depending on how long one talks and if calling a Moviestar phone from a Claro phone)
4. 4 pirated DVD movies
5. 4 bottles of Tona beer
6. almost a jar of pickles
One week of work would buy: A work week is 6 days. 600 cordobas or $24
1. A month’s Claro internet plan for a dongle modem
2. 3 jars of peanut butter…very expensive in Nicaragua
3. A tank of gasoline for a motorcycle
4. A cloth hammock
5. 2 bags of cement
One month of work would buy: About 3,000 cordobas or $120
1. Rent under $120 a month for a small house.
2. One double mattress thick and padded
3. A used bicycle
4. 4 baby piglets
5. Two taxi rides to Managua from Rivas
One year of work would buy: 36,000 cordobas or $1,440
1. A cheap Chinese motorcycle
2. A refrigerator, a washing machine, a bottle of propane, and a small two burner cook top.
3. 2 rt airline tickets to Miami , plus the cost of the visas
4. A manzana of land for grazing cattle on the volcano
5. 2 fiberglass canoes
Compiling this list put a lot of things into perspective for me. Now I understand why the prices for most furniture, appliances, electronics, and vehicles are listed first in monthly installments with the full price at the bottom. Most Nicaraguans buy on credit with little understanding of interest rates. Usually, they will buy an item on credit, and if they can’t make the monthly payments, the repo man visits. The repo men are very busy in Nicaragua.
Now, I understand why most young families live with extended family members. Who could afford to rent a house? Even on Ometepe Island, where the rental prices are still reasonable, a small house with a tiled floor, one bedroom, and a flush toilet will run about $150 a month unfurnished.
Now it makes sense to me why mayonnaise is “rico” and gallo pinto for breakfast, lunch and dinner is the life force of Nicaragua. I can see why they cook with wood instead of propane because a bottle of propane costs about $15.
Now, I understand why the Nicaraguans barter, beg, or steal. They are their best when bargaining for a good deal. It’s accepted practice to never take the first price offered. In fact, it’s a performing art to watch the thrifty Nicaraguans bargain.
Now it makes sense why most Nicaraguans live a stress-free life and why making money or getting rich is not a main goal in their lives. I understand why they don’t have a clue about budgeting because they live day-to-day with little extra money to budget.
Finally, I understand what it is like to live like a Nica. Money is not high on their list because they have so little of it. They creatively make do with what little they have. They work hard, play hard, and laugh often. They don’t think they are poor. Their birthplace determines their future, and in my opinion, it has little to do with money. They prioritize their purchases depending on immediate needs, not wants. If their basic needs are met, then they buy luxury items on credit, or barter and bargain for them. Do I think the Nicaraguans would work a whole day to buy a jar of dill pickles? Not a chance!
“Be careful about reading health books. You may die of a misprint.”~ Mark Twain
Without a doubt, the internet fundamentally alters all aspects of health care. Dr. Google has been my reliable internet physician since we moved to a small, isolated tropical island in Nicaragua. Online information empowers passive patients of the past, like ourselves, where symptoms can be diagnosed with the click of a key, a bonanza of data appears instantly, and treatment options are dispensed freely.
Yet, sometimes, I feel like a cyberchondriac. I can find a wealth of worse-case scenarios for my symptoms, all leading to …You’re gonna die. If I have a sore throat…I’m going to die of throat cancer. Dr. Google diagnoses a minor stomach ache as an infestation of cyclosporiasis, the same rare parasite called Cyclospora cayetanensis, that sickened 466 people in 15 states. I’m sure this must create a major new headache for doctors throughout the world. A bit of information can be a dangerous thing.
I’ve decided that the only way to cure cyberchondria is to have regular health check-ups with real doctors. Ron and I bought the Silver Plan health discount for Vivian Pellas hospital last year. Health Care for Expats in Nicaragua Since we’ve had the health discount for over 6 months, we received a 30% discount for extensive health exams. So, we made an appointment with Arlen Perez at Vivian Pellas for our super-duper exams last week.
We arrived in Managua at 7:30 am. Within a few minutes, Arlen met us in the lobby with a printed schedule of our procedures for the day. She took us to the lab where we gave blood and other bodily fluid samples. Then, Arlen’s new medical tourism partner, Maite Soto, filled out a questionnaire for us in Spanish.
Maite spent the rest of the day with us, translating, attending meticulously to all of our needs, and taking us from lab to lab. After our blood samples, we had EKGs and stress tests on a treadmill, then ultrasounds, chest x-rays, and I had a mammogram. What astounded me was that we could ask the technicians, “How does it look?” and “Do you see any abnormalities?” Try that in the states and you will get a response such as, ” You will have to wait until the doctor reads the tests and you’ll find out in a couple of weeks.” Instead, the technicians reviewed the exams with us and reassured us that everything looked fine.
At noon, we finished the major procedures. Maite took us to the cafeteria for our free lunch and COFFEE! Since we had to fast the night before, I missed my morning coffee. Then, we had an hour to wait for our consultations with the doctors, and my gynecological exam.
We walked around the well-manicured grounds, where I discovered the children’s burn unit. You must read the experience of Vivian Pellas and why she started the children’s burn unit. Love Without Limits: Health Care in Nicaragua
A friend, who lives on the island, took her small son to Vivian Pellas Children’s Burn Hospital for a badly burnt foot. Poor little toddler accidentally stepped on a ground fire. She was very impressed with the care and attention he received and all expenses were free.
Our private consultations with English-speaking doctors were held in the afternoon. They carefully reviewed all of our test results and gave us plenty of time to ask numerous questions. The only test result that wasn’t available was my Pap test because I had just completed my gynecological exam 30 minutes earlier. But, not to worry. They would scan the results and email me within two days. ( AND…they did! )
Now, I know you are curious about the cost of these exams. What would be your guess?
The public price for the Male over 40 Physical is of U$ 350
With the 6 months discount (30%) is of U$ 245
With the 3 months discount (25%) U$ 262.50
The public price for the Female over 40 Physical is of U$ 420
With the 6 months discount (30%) is of U$ 294
With the 3 months discount (25%) U$ 315
We were at the hospital until 5:00 pm. All exams were professional and we received same day results! They sent us home with hugs and packets complete with our x-rays, ultrasound pictures, EKGs, thoroughly reviewed blood analysis’, and most importantly recommendations for improving our health as we age. Although, I am proud to announce that we are in excellent health for two aging baby boomers. :-)
Was it worth it? Absolutely! Would I recommend Vivian Pellas to other expats? Without any doubts! Their medical tourism program is growing rapidly. Many foreigners come to Vivian Pellas for hip replacements, cosmetic surgery, and other procedures at 1/4 of the cost of procedures in the states.
Does this mean that I’m abandoning Dr. Google? No, of course not. But, now I can make more informed decisions about my health care because of the thorough services I received at Vivian Pellas. Is my cyberchondria cured? Yes! Thanks to the attentive, caring doctors and staff at Vivian Pellas. It is very reassuring to know that we have an excellent expat hospital, same day results, and hospitable staff available in Nicaragua. Have I told you how much I LOVE this country?
Jefferson is a weekend philanthropist…a young giver with a heart that invests in people. He came to Ometepe Island seeking a way to help people change their own lives. Not only did he find Mariselda, a ten-year old with polio, he also became engaged to the love of his life while visiting Ometepe.
This is his story…a story of helping unconditionally, loving freely, and simply giving for the joy he receives in knowing that he can make the world a little better one person at a time…one weekend at a time.
Thanks to Jefferson for allowing me to share his story: Buying a Girl a Bike
The U.S. Trickle-Down economic theory sounds hopelessly pessimistic to me. The word “down” used as an adjective reflects negativity and is downright depressing. It defines a lower position ( Nicaragua has a down economy.), something unable to function (Our electricity is always down!), and someone who is sick. ( My neighbor is down with the flu.)
Therefore, with optimism and enthusiasm, I am going to attempt to explain my expat economic theory of Trickling Up. Just the word “up” sounds so much more encouraging, don’t you agree? If there is one thing I have learned while living in Nicaragua, it is to always be optimistic and encouraging, and lend a hand up when possible.
When we moved to Nicaragua, we received advice from everybody… from how to purify our water to how to bargain like a Nica. Some of the advice was well-received. Other advice, I couldn’t help but wonder about. For example, I was reprimanded by other expats for providing a free lunch for our workers, tipping too much at local restaurants, and paying too much for a taxi. They said, “You are driving up the cost of everything by paying gringo prices willingly.” Or, “The workers will expect the same treatment and pay from us, too.”
I look at it this way. Trickle-Down has never worked in impoverished countries because huge sums of money allocated to government officials never reach those who need it the most. What is wrong with reversing the system of aid by trickling up? The average Nicaraguan earns five dollars a day! Even in Nicaragua, that is well below a level of poverty that defies my understanding of how hard-working families exist.
Here’s an example of my trickling up theory. We are building an addition to our guest house. We hired Marvin to build a bathroom, dig a new septic tank, and add a new kitchen/living room area…nothing fancy…just small and comfortable for our guests. First, we had Marvin make a list of all the materials he would need and give us a list of the costs of materials. Then, we told Marvin that in the U.S., we usually figure labor costs based on the cost of materials. Labor is usually the same amount as the cost of the materials. The carefully prepared list of materials came to $2,000, so we told Marvin that we would pay him $2,000 for his labor. “That is not how we do it in Nicaragua,” Marvin honestly replied. “We charge $10 a day for the contractor and $5 a day for the helpers.” If we did it Marvin’s way, he and his helpers would make much less and take more time to complete the job.
We wrote up a contract, specifying the payments in six weekly installments. Marvin orders the materials with our approval and we pay the bill at the local hardware store. It is a win-win situation for all of the families. Marvin will have enough money to buy more tools and supplies for his business, and meet the needs of his growing family. His son and another friend are his helpers. Marvin can decide how much of a percentage to pay them and knowing Marvin, he will be generous with his percentage.
Trickling up is a fair and sound economic system for expats. We can live comfortably on our retirement savings because the cost of living in Nicaragua is about 1/4 of the cost of living in the states. Our money goes a lot farther here, so why not invest in the future of Nicaragua? Trickling up makes sense to me! With a simple system of accountability and fairness in good labor practices, everybody is happy.
One of the biggest challenges of living abroad is health care. When we opted for early retirement, we could have continued our group health insurance, but the cost of the insurance would have reduced our pension checks by half. Plus, when we retired, our health insurance was not accepted in Nicaragua. We are too young for Social Security and Medicare. Medicare is not accepted in Nicaragua either. At the time, our only option was to take a risk, self-diagnose, and live cautiously on our tropical island.
Fortunately, Hospital Metropolitano Vivian Pellas in Managua is committed to providing healthcare with international excellence. So, we made an appointment with Arlen Peres, the Medical Tourism Manager, called our faithful taxi driver, and visited the hospital to explore our insurance options.
Arlen met us in the lobby of the hospital and attended to us like newborn babies. She took us on a tour of the immaculately clean and modern hospital, answered all of our questions with the honesty and professionalism of a Supreme Court Judge, and spoke fluent English. Impressive!
She explained the two insurance plans for the hospital: the Silver Plan and the Gold Plan. When we were trying to decide which plan would be the best for us, she recommended the Silver Plan because it cost less and it would meet our needs until we are 65 years old.
We filled out the health insurance application for the Silver Plan. It was three pages of general health questions..all in Spanish, which Arlen patiently translated for us. Ron’s Silver Plan is $21 a month. Mine is $18 a month. We could pay monthly or annually. We chose to pay annually and we charged $468 on our credit card for a year of health insurance for both of us!
The Silver Plan offers discounts for emergency room services, medical and physical rehabilitation, laboratory diagnosis and tests, annual preventive health check-ups, intensive care, and operations. The discounts increase after 24 hours, 90 days, and 180 days of insurance coverage. The discounts range from 15% to 70% depending on how long one has had insurance coverage.
Next, we had to have blood tests and urine samples tested for health insurance coverage. Arlen sent us to the lobby where we waited for about 10 minutes while she set up the appointments.
Arlen returned and took us directly to the admittance booth, where we paid $25 each for all the laboratory tests. Then, she took us to the laboratory for our tests…no waiting! Top notch service! We went to the emergency room for general physicals: weight, height, blood pressure. While we were in the emergency room, Arlen toured us through the offices and operating rooms. They have a kidney dialysis room, where we heard soft music and the TV behind the closed-door. She said the kidney dialysis room is open 24 hours a day and is always busy. I don’t know why so many people in Nicaragua have kidney problems, but it is prevalent.
We met with the doctor for a few more questions and prodding and poking. Then, on to the cafeteria where we had lunch while we were waiting for the results of our lab tests. Thirty minutes later, after we had delicious cappuccinos and chicken burritos, we met Arlen in the lobby with our test results. The best news was that the test results indicated that we had no parasites. Ron had just completed a round of parasite pills because he had a bad bout with parasites the week before. I know the parasites were the result of him eating mangoes that dropped to the ground!
We were finished for the day! Our lab tests and physicals would be reviewed by the insurance director and we would be notified of our acceptance within a week. I have never encountered such personalized attention. Where in the states could one have a personal attendant, who tends to every health need? Not to mention immediate test results hand delivered the same day. Before we left, we asked Arlen how much each operation or procedure cost. She said, “Email me with the specific procedures and operations you may need and I’ll send you a list of the all-inclusive costs.” Can you believe that? No hidden costs? A list of all the costs of the procedures and operations? I’m amazed! Why can’t they do that in the states?
My expat friends from Granada went to Vivian Pellas hospital two weeks ago for their annual check-ups. While they were doing the stress test, they discovered that J had a serious heart blockage. They operated on him that evening and placed 2 stents in his heart. He did not have the hospital insurance, and he had to pay upfront for the operation. He charged $16,500 on his credit card for the total bill. His wife had the same operation seven years ago in the states. She only had 1 stent placed in her heart. Total cost for her? $50,000. What is wrong with the health care system in the states? I won’t rant here, but something is terribly wrong when the same operation costs 3 times as much in the states.
Vivian Pellas Hospital has a website, but when we checked for information, the website was outdated. I talked with Arlen about the website and she told me that someone had hacked into the website. They had to put up the old website until October when the new website will be completed. Here’s a link to the old website: Vivian Pellas
If you are an expat living in Nicaragua, or a potential expat, please feel free to contact me for more information about Vivian Pellas Hospital. Nicaragua is advancing daily in health care for expats. It is reassuring to know that excellent, affordable health care is available in Nicaragua.