Update December 2019:
On a sad note, we left Nicaragua mid July 2018 due to the Civic Rebellion that continues to this day. On a good note, I had to have another eye surgery and my doctor in the states said my Nicaraguan retina specialist had done a wonderful job with my last surgery. I wish I could tell him, but he fled to Costa Rica during the Rebellion as did most of the good surgeons and doctors.
“If I save my insight, I don’t attend to the weakness of my eyesight.” ~Socrates
Since I had my first eye operation in the United States and my second eye operation in Nicaragua, I thought it would be interesting to compare the surgeries in two vastly different countries. Both surgeries were similar. I will try to withhold judgment, but I can guarantee that if you are concerned about having a delicate or major surgery in a developing country, I will put your worries at ease.
A Tale of Two Surgeries Through The insightful Observations of an Expat
A look at my island from the taxi window as I was on my way to the hospital in Managua.
Surgery in the United States
The facility where I received my vitrectomy in the U.S. was modern with all of the latest equipment. Johnson City Eye Clinic Website
My initial exam consisted of ushering me into several examination rooms, where specialized technicians would jab me with yellow dye, shoot streams of air into my eyeball to test for eye pressure, dilate my eyes, and test my visual acuity. After each exam, I rested in a waiting room packed full of old people with eye patches, those big dark cataract sunglasses, and sometimes canes and wheelchairs.They have a great website. Be sure to check out the section called Through My Eyes, where you can get an idea of what it is like to see with cataracts, glaucoma, detached retina, and various other eye conditions. My condition wasn’t listed, but I describe it like looking through the world with my eyeball covered in Saran wrap.
2.Doctors and staff
Every need was met by caring, efficient, and responsible doctors and staff. I met with the doctor initially, then I was sent into several examination rooms with technicians who performed the tests. They weren’t permitted to tell me the results of the tests, but they prepared me thoroughly for each test and told me what to expect.
At the end of the exams, I met with the doctor who explained the results of the tests and gave me two options. Since I wanted to fly back to Nicaragua as soon as possible, he said he would put silicon oil in my eye after the vitrectomy because with the gas bubble, I wouldn’t be allowed to fly for two months.
3. Insurance and payments
Since I am covered by Medicare, the payment process was very simple. I paid 20% of the doctor fee, the facility, and the anesthesiologist. Although I couldn’t pay online, it was easy to go into the office and make payments for the three fees.
4. Documents and paperwork
I had to fill out a complete medical history, including my family history. Then, there were the ‘odd’ questions like my hobbies. One question was, “Do you read the Wall Street Journal?” Hmmm…not sure why they asked me that question.
The U.S. Is very concerned about privacy. I must have signed a million forms stating who can have access to my medical records. Then, there were the liability forms. I hold no one responsible and I understand the risks….initial here, and here, and here, and here…over and over again.
5. Operating Room
I described my experience like a train of gurneys wheeled into the operating room, one right after another. My gurney was parked in a curtained partition. The attending nurse placed an automatic blood pressure cuff on my arm, an IV in my arm, and hooked me up to a machine that monitored my heartbeat. She told me to relax until it was time for my surgery.
Right before I was wheeled into surgery, the anesthesiologist placed the anesthesia in my IV and I happily drifted off to la la land. I woke up in the middle of the surgery and the my doctor was talking about hiking in Hawaii. I saw the needle in my eye, but strangely, it didn’t concern me. Instead, I asked the doctor, “Have you ever hiked in New Zealand? My favorite hike was in the Abel Tasman National Park.” The last thing I heard before I drifted off to sleep was, “Jim, put her under again.”
When I awoke, I was in the recovery area sitting in an easy chair. I don’t remember how I got into the chair, but they gave me orange juice and cookies and I was a happy camper! I hadn’t eaten all day and I was starved!
6. Post Op Treatment
The next day, Ron and I went to my doctor’s office for my follow-up. I went into one exam room where a technician removed my bandages. He must have been new because it took him forever to peel the sticky bandage from my eye, and he kept apologizing for the pain I felt when the bandages adhered to my skin.
He held up some fingers and asked me, “How many fingers do I have?” At that point I was thinking, “Holy sh*t, I am blind.” I answered, “Well there are five fingers on your hand, but I can’t even see your hand.” He tried to reassure me, but I wasn’t having any of it!
In the second exam room, the doctor checked my eye with a big machine, and reassured me that my surgery was a success. The oil would have to be removed in 3 months, so he scheduled me for surgery in August. When I asked him about having the oil removed in Nicaragua, he delicately explained to me that maybe I should fly back to the states. But, he did give me the names of the machines he used for surgery and what to ask the doctor in Nicaragua if I chose to have my second surgery in a developing country.
7. Cost of Surgery
My total cost was approximately $5,000. Medicare covered 80%, I paid 20% for the doctor, facility, and anesthesiologist. It was an easy process, I could use my credit card and pay for everything immediately. Four days later, we were on our way home…sightless in my left eye, but appreciative that the surgery was successful.
Surgery in Nicaragua
Metropolitano Vivian Pellas Hospital in Managua, Nicaragua is a modern, private hospital that caters to Nicaraguans who can afford to go to a private hospital and many expats. Here is a fascinating history of how Vivian Pellas created the hospital after a horrific airplane accident. Love Without Limits: Health Care in Nicaragua
2. Doctors and staff
I made an appointment with Dr. Juan Carlos Rivers, a retina specialist, when I returned to Nicaragua. He told me that he left Nicaragua when he was 14 years old because of the war, and received his medical training in Costa Rica and Madrid, Spain. Then, he returned to Nicaragua to start his practice.
Once again, every need was met by a caring doctor. The difference was that Dr. Rivers completed all the tests and the exam without any technicians. I never had to leave his office. He explained each exam and told me the condition of my eye immediately after each exam.
He took photos of my eye and printed them for me, and explained every detail. He noted that my eye was very swollen and he asked why the doctor in the states didn’t put steroids in my eye before the surgery to reduce the swelling. He explained that it is standard procedure to use steroids to reduce the swelling before surgery.
I told him that the doctor in the states said, “Oil and water don’t mix.” He replied, “Of course they don’t, but he should have reduced the swelling before the surgery so it would heal faster.”
I liked him immediately. He was a no-nonsense doctor with many years of experience. He had all the equipment and expertise to perform my second surgery. We scheduled another appointment for three months later to see if the oil was ready to be removed, and I left as a comforted patient knowing I made the right decision to have delicate eye surgery in Nicaragua.
Once again the payment process was simple. For my first two consultations, I paid with my credit card and after the surgery, I paid for everything with my credit card as well. This is where it is very important to know what your credit card limit is because if it is low, one must pay cash.
I saved all my receipts so that I could file my first claim with my WEA International Health Insurance. That process was surprisingly easy, too, but I will discuss that later.
4. Documents and paperwork
I wasn’t sure what to expect in the way of paperwork. Surprisingly, my surgery only required two signatures, results of a blood test, and three questions asked by the anesthesiologist before I went into the operating room. He asked me if I was diabetic, if I had high blood pressure, and if I was allergic to antibiotics. That was it! No privacy statements, no liability statements, nothing requiring me to sign my life away. Very simple and practical!
5. Operating Room
When I went for my last consultation, Dr. Rivers said I could have my surgery as soon as I wanted. I scheduled it for two days later. I had enough of an oily view of my world! He said that he would do the oil extraction and another doctor would do the cataract removal and the lens replacement because the oil had corroded my lens.
While sitting in his office, he called the other doctor on his cell phone and arranged the surgery for me. He handed me his business card with his private cell phone number and told me to call him at any time if I had any questions before surgery. Amazing to me! I had his cell phone number! Also, he gave me three bottles of eye drops that I needed to use before surgery. In the states, they said they couldn’t give me free samples anymore and I had to buy the drops.
The day of my last consultation was the same day as the solar eclipse. While he was explaining the procedure for surgery, a frantic pregnant woman called him on his cell phone. I overheard the conversation and laughed. She was worried about going outside because she believed the eclipse would cause a birth mark on her unborn child. He reassured her that she needn’t worry about going outside. After the call, we laughed and he said, “Sometimes Nicaraguans have crazy superstitions.”
Nicaragua has no street addresses, so he drew me a map of where the surgery would take place. The hospital didn’t have the necessary equipment, so I was going to a laser surgery center. His map cracked me up! But, that is how Nicaragua functions without street addresses.
The day of the surgery, Dr. Rivers met me in the office. He introduced me to the other surgeon, and I went into the dressing room to change into a gown. I had to wear booties and a surgical cap. Then, they took me into the waiting area for surgery, where the anesthesiologist inserted an IV in my hand, asked me three questions, and then took my hand and we walked down the hall into the operating room.
I sat on the operating table and they told me how to lay down. I had to laugh because the nurse knew a few English words and didn’t know I understood Spanish. She barked, “Sit down” “Now, lay down.” “Put head here” Put feet here.”
I started to feel light-headed, and realized they had inserted the anesthesia into my IV. Next thing I knew, I was told to “Sit up!” and walked into the waiting room with the nurse. After a cup of tea, I was helped into the dressing room and Ron helped me get into my clothes.
Dr. Rivers met me in the patient waiting room and explained that the surgery was successful. I would meet him for my follow-up the next morning at 9 am at the hospital. I hugged him and left pain-free, but starving again!
7. Cost of Surgery
My total costs, including the consultations, surgery, and follow-up exams was approximately $5,000. I handed the receptionist my credit card, and Dr. River’s daughter, who was on a break from her senior year in high school, translated the receipts into English for my insurance claim.
My WEA International Health Insurance will cover 80% and I will pay 20%. It is exactly the same as my surgery in the states with Medicare. Filing a claim was super easy, too. I called them the day before surgery to tell them I was having surgery. Two days after surgery, I took pictures of all my receipts, my diagnosis, and reports from the doctor, and my WEA Insurance claim forms, and sent them electronically. They have everything they need and responded immediately that once my claim is processed in 21 days, they will send me a check.
So, I will let you be the judge as to where I received the best care. Both surgeries were successful with competent doctors and staff. Yet, I can tell you that I wouldn’t hesitate to have a delicate or major surgery in Nicaragua after this experience.
I had my second check-up this week. Everything is progressing fine! I can see the long distance with my new lens, and hopefully I will only need reading glasses in about a month. Currently, there is an epidemic of the pink eye virus in Nicaragua. Dr. Rivers told me to avoid places where there are a lot of people, so I have quarantined myself in my house this week. Better safe, than sorry. I don’t want pink eye in my fragile eye.
But, who can resist this view from my front porch! Everything is brilliant and clear! Gotta love Nicaragua!