Random Rants about My Country of Birth

Random ranting is always good for the soul. It is like a pressure cooker value releasing steam. A good rant is cathartic. Sometimes ranting keeps me sane. And living in Nicaragua as an expat, I have some frustrations about my country of birth. It has been a while since I’ve ranted, and Anita of the blog No Particular Place to Go inspired me with her rant-a thon, so here are a few of my random rants.

U.S. Health Care Rant

Don’t get me wrong. I appreciate having Medicare, but we can’t use it abroad! With my first eye surgery in the states, single payer was quick and easy. I paid 20% of the total cost of the doctor, facility, and anesthesiology. When I told my doctor that I needed to fly back to Nicaragua, he said he would have to replace the vitreous in my eye with silicon oil, which necessitates a second eye surgery to remove the oil.

“I am going to see if a doctor in Nicaragua can remove the oil in my eye,” I said to my surgeon. “Good luck with that,” he responded. “I doubt that you will find anyone as competent in Nicaragua as eye surgeons in the states.”

What is it with doctors’ arrogance? Waiting for surgery in the gurney, I watched as a train of gurneys were moved in and out of the operating room. “How many retina surgeries do you do here in a day?” I asked the attending nurse. “Usually 15 per doctor per day,” she said. I quickly calculated that the doctors each made $1750 per surgery X 15 surgeries a day = $26,250 a day!!! That is just the doctor! It doesn’t include the facility or anesthesiology fees.

I made an appointment in Managua at Vivian Pellas Hospital to see a retina specialist. Dr. Juan Rivers gave me a through exam and patiently answered all of my questions. When he said my eye was still extremely swollen, he asked, “Why didn’t the surgeon give you steroid shots to reduce the inflammation before injecting the oil?” I said that the doctor told me oil and water don’t mix, so he couldn’t put steroid shots in my eye. “Well, that is what we do before we inject the oil or gas,” he said kind of irritated. He shook his head and said that I would have to keep the oil in my eye for three months, which could have been avoided if they reduced the swelling first.

Through my tears… in only one eye… I thanked him for his patience and his TLC and scheduled another eye appointment for the end of August. His initial consultation cost $160.89. The surgery to remove the oil and replace my corroded lens will cost $3,000 for everything. Since we have international health insurance, we weighed the cost of airline tickets, a rental car, and at least two weeks of expenses to repair my eye in the states in a train of gurneys vs the cost of surgery with Dr. Juan Carlos Rivers at Vivian Pellas. I opted for a competent, caring doctor in Nicaragua. I can file claims with my international insurance and get some of my money back.

U.S. Online Forms Rant

What’s with the U.S. online forms and telephone numbers?

If you live in Nicaragua, you know that our cell phone numbers have an area code with three digits, then the number looks something like this… 505-8824-4689. I don’t have a number in the U.S. So, when I fill out banking forms, or purchase airplane tickets online, or a number of other forms from the U.S., I am always frustrated because the online forms don’t accept four digits.

For example, we got a new mini iPad and were setting it up. It asked the location and we entered United States. To verify our information, they were gong to send us a code from a U.S. cell phone number we made up because our 4 digits wouldn’t fit in the box. So, we had to change our location to Nicaragua so the number would be accepted and we could get the code.

Most of the time we just make up a U.S. cell phone number. Still, it is frustrating and if they need to send a verification code and don’t provide spaces for international numbers, we are out of luck unless we get a Skype or Google Voice number.

Online Entertainment Rant

Living abroad presents challenges with Netflix, Hulu, Amazon Prime Video, and other online entertainment sites. In order to receive my U.S. subscriptions to these sites and receive the U.S. selections, I have to use a VPN. And…Netflix even blocks some of the most popular VPN companies and certain locations from these companies, so I had to change my location from Miami to San Francisco to watch the U.S. selection.

What about travelers who are passing through countries? If they have a U.S. subscription, shouldn’t they be entitled to receive their U.S. selections?

U.S. Address

Anita mentioned this in her rant and it is something we as expats have to deal with on a regular basis. Fortunately for us, we still have a house in the states, so we can use our U.S. address to keep our credit cards, our U.S. bank, pay our taxes, renew our drivers’ licenses, vote, and receive mounds of junk mail at our house in the U.S.

Without a street address, we would not be able to keep our credit cards or our bank because they do not accept a P.O. box as an address. Anita resorts to using a family member’s address, and I suppose many other U.S. expats do the same.

Because of U.S. regulations imposed on foreign banks, many foreign banks are throwing their hands up in the air and refusing to accept U.S. citizens who want to open an account in a foreign bank. Every year foreign banks have to notify their U.S. customers that the U.S. wants to know how much money they have in their banks. I guess they are concerned about money laundering, but seriously?

Here is another reason to have a U.S. address and U.S. bank. If you collect social security and deposit it in a foreign bank, every two years you must fill out a “Proof of Life” form to continue to have your social security deposited in your foreign account. Yep! That is really the name of the form. You must prove that you are still alive and kicking by submitting the form in a timely manner or they will cut off your social security. I guess they are concerned about social security fraud, but seriously?


Believe me when I say, I do try to be transparent in my dealings with U.S. bureaucracy. However, sometimes for the sake of my sanity, I have to be a little deceptive. I pay my taxes, I follow the laws. I am a good citizen in my adopted country as well as my birth country. But, dang it! I wish the U.S. would show a little more flexibility and a more modern approach to a global world with all of its complexities. One can only continue to hope…right?

17 thoughts on “Random Rants about My Country of Birth

  1. One time I wrote a post about going to the dentist in Ukraine. (In short: I had a problem, they fixed it, it was fine.) Ukraine was just starting to show up in the news back then, so the post was shared by an American dentistry network as a “hmmm… this is interesting” link. Oh boy! A very angry US dentist showed up in the comments. He was basically the tooth doctor version of your eye doctor and he. was. furious. How dare anyone ever get dental care outside the US, especially in a (guess the adjective) country like Ukraine? Haha. And, of course, a lot of his rant came down to money.

    I think it’s hard to get good care abroad if you haven’t already invested time in the country. Like, if you just show up and demand treatment based on some internet reviews of a clinic. There’s going to be cultural misunderstandings (or different ways of doing things) and probably a language barrier to boot. It’s a lot to deal with on top of whatever medical stuff you’re going through. In your case, though, Nicaragua is a second home. You’ll be recovering in a country you know well, and you clearly made sure you were getting a professionally competent and considerate doctor. Good for you for considering all your options, both in the US and elsewhere. Hope your eye is doing better, and the next appointment is a quick and easy one!


    • Oh Katherine, I can’t stop laughing at the tooth doctor. I wondered about my post being seen by my doc in the states. How would he respond? Also, when I asked the stateside eye doc about a correlation I researched between Chikungunya and eye disease, he told me to stop chasing zebras and that this was a horse! He humiliated me because I was a layperson trying to research the possible causes. Dr. Rivers was not like that. When I asked him about the correlation he and I had a long discussion about it. I didn’t feel humiliated or afraid to ask him anything.

  2. I haven’t had any trouble with my Nicaraguan APDO box address with either my US bank or my US credit card company, but I understand that these have to be set up while one is in the US (one CC company sold its customers to another, and I found the new CC company to be aggressively proactive in protecting my account. US Social Security wants a street address now but was okay with a PO Box earlier. I registered my APDO address with them at a Social Security office in the US.

    Second Apple FaceTime if you know people who have either iPhones, iPads, or Macs. I also do the $10 a shot on Skype which also lasts me quite a while for US calls to people who don’t have Skype on their computers.

    I think my iPad Mini thinks I live in Mexico, which is where I bought it. I use my Nicaraguan bank account to pay Apple as they have insisted that the card must be issued in the country of residence, but apparently I can also access the Mexican Apple Store.

    I can get Netflix and Amazon Prime Videos without a VPN. Sony seems to be less wildly cranky about those of us with Sony gear outside the US, Canada, Europe, or other Approved Countries than it was when I first got a Sony camera and had to use a VPN to download programs for the camera.

    Doctors and dentists here are less likely to be Dr. Gods. My Cuban-trained cardiologist wanted me to understand that what he was doing for me here was as competent as US treatment would have been.

    • Thanks Rebecca. It is always good to hear suggestions from people living in Nicaragua who don’t have a U.S. Address and how they work around it.
      Skype is great, and we use FaceTime video to chat with family. I keep $10 on Skype, too. Seems to work fine until someone wants to call me back if I leave a message. And I don’t keep Skype open on my tablet, phone, or laptop, so, if I did get a number, they wouldn’t be able to reach me until I opened the Skype app.
      Thanks for the information. I have my next eye appointment in Managua next week. I hope to write a post about how everything goes, once my eye is fixed.

  3. Doctor’s arrogant? HaHa! After years working as a pharmacist, my conclusion was they’d all attended a mandatory, “I am God” class where no questions were allowed. My comment echoes Thomas Maye’s as US heath care is far from the best. In fact NPR recently published a report that concluded that the “U.S. Has The Worst Rate Of Maternal Deaths In The Developed World.” Costs are driven by a for-profit system and the people of the US pay exorbitant rates while being fed the *Cadillac* lie. (Maybe the comparison is more like an Edsel?) We’ve been quite impressed by the competent medicare we’ve received outside the US (including 3rd world countries like Nicaragua, Guatemala and Ecuador) and it sounds like your experience is the same. Staying with your Managua retina specialist sounds like a good decision! And, darn it Debbie! You got me all worked up on a different rant! HaHa! Anita

    • I didn’t know you were a pharmacist! Oh, the rants you could write about the prices of prescription medicines! I asked the doc if he had samples of the eye drops I needed after surgery, and he said he can’t give samples out anymore. I don’t have Part D for prescription meds, so the nurse gave me a discount card for Walgreen’s Pharmacy. I asked the pharmacist how much the eye drops would cost if I had insurance and the cost was double! Go figure! Who is making out here?

  4. I’d stick with the Nicaraguan eye surgeon. He seems to concentrate on the patient rather then the bank account…Good ranting Debbie.

  5. I’m also always amused at the arrogance of medical folks in America that constantly harp on “we have the best care in the world – none better” Is it pretty good – yup; but not as wonderful as claimed. It’s a bit of a scam to charge outrageous prices to consumers. I actually had a Dr. tell me once (about US hospitals and surgeries) “Of course you’re paying the cadillac price; you’re getting the cadillac!”

    • Haha! So true, Thomas. Actually, I was very pleased with my first eye surgery in the states because I only had an appendectomy and tonsillectomy when I was young. But, when I spent time with the Nicaraguan doctor, I began to realize how health care centers around the patients much more so than in the states. Plus, Dr. Rivers did all of his exams and talked to me explaining each procedure. In the states, I was ushered from room to room to see a variety of technicians and they never explained what the tests meant until I saw the doctor at the end of the exhaustive tests.

  6. The USA is on its way …

    .wayyyyy out ..

    beyond…and more beyond ,,its done…

    with 53 % of the population on more than 4 prescription drugs the good ole boys are making their dream come true…
    future generations will be injected and stamped ,, like the sheeple they have all become

    Get out .. its done.. depopulation is working there …

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