Rewiring and Reclaiming


One man’s distraction is another man’s refuge. ~Khang Kijarro Nguyen

    

Oh Ometepe! Do I miss you? Not really. I have always said I have a love/hate relationship with Nicaragua. I am in the hate phase…not because of the people, instead because of the Ortega regime. I abhor what they have done to the people. But, this post isn’t about Nicaragua. It is about how distractions and a crisis in Nicaragua helped to save our lives.

Ron felt a lump in his neck last February. Friends and professionals said it was nothing to worry about. It was palpable and soft. But, they cautioned us to get it checked anyway. We waited under a mango tree on Ometepe Island, avoiding the hot sun, to see the technician who had an ultrasound machine. He discovered two lumps, one the size of a grape, and the other the size of a pea which was deeper in the tissue of his neck.

Again, he said it was nothing to worry about, but recommended a biopsy. So, we ferried to the mainland the next day for a fine needle aspiration of the largest lump in his neck.

When the results were ready, we were unable to go to Rivas because the paramilitary had blocked the roads and they were shooting up the town. So, we asked Robinson to call the doctor and if it was cancer, just don’t call us back.

Minutes later Robinson called us and said Ron was good to go. The results were benign, however the doctor recommended surgery to remove the lump because it could turn into cancer in 10 years or less. It was diagnosed as a pleomorphic adenoma of the salivary gland.

Relieved that Ron’s tumor was benign, yet still stressed from the gunfire we heard late at night on the street behind our house, we debated on whether to stay or leave Nicaragua. If we left, we could go to the states and have the tumors removed. It was impossible to travel to Managua because the paramilitaries were shooting, kidnapping, imprisoning, and killing protesters. It took two more months to pack, give away our belongings, and find trustworthy renters who would adopt our pets and love our home. On July 19th, we left Nicaragua on one-way tickets and returned to our home in the states.

We forgot how beautiful our area was. The Nolichucky River beckoned Ron for a few abundant fishing days, and because our home in Tennessee was rented to our friends, we decided to make an appointment with the Ear, Nose, and Throat doctor to have his tumors removed, buy a car, drive to Canada for a couple of months, return to TN and have the tumors removed, and plan a six month trip to warm places for the winter. 

Little did we realize that “Winter was Coming” in more ways than one…and beyond our control.

Again, Ron’s tumors were biopsied and the results were both benign. The ENT surgeon removed the tumors and sent them to pathology. Meanwhile, we were staying in a small bedroom in our house while Ron recovered from his surgery and I planned our six month trip to warm places in tropical zones.

The week before we were to leave, the doctor called. “You need to have a PET scan as soon as possible.” OMG! Frantic with worry, we knew the news could not be good. The pathology report returned with a diagnosis of HPV+ squamish cell carcinoma. The glands that were removed were the secondary source of the cancer. The PET scan would determine if the cancer had spread to other parts of his body, locate the primary source, and tell the doctors the next course of action.

We entered Cancerlandia…. it was a mystifying, stressful, anxious, and fearful world. We would rather be whale watching in the Dominican Republic.

 We were living in crisis mode. The stress was overwhelming with the anguish of 3 more surgeries, radiation, and chemotherapy which was the recommended standard treatment for HPV positive throat cancer according to the American health-care system. The turmoil of the many choices we had to make, and the false hopes such as three benign biopsy results, were almost too much to bear. We fluctuated between periods of happiness and despair, gratefulness and the curse of hope, spiritualism and faithlessness in a religious world, and anger accompanied by bouts of grief. We had to rewire to survive. Yet, how? 

The radiation oncologist wouldn’t start radiation until Ron had all of his teeth pulled. The chemotherapy oncologist would’t start chemo until Ron had a port and a stomach tube embedded into his body. The ENT surgeon had to find the primary source of cancer at the base of his tongue before treatment could start. Everyone wanted a piece of him and we were led like zombies from one office to the next, wondering how much this would cost.

Our salvation actually came in a gallon of Tropical Nut paint. Since we were going to be spending the winter in our house, it disheartened us to see the paint chipped off the walls and ceilings and blankets covering the skylights and doorways to save heating costs. It resembled a dark, cold cave. I couldn’t imagine Ron trying to recuperate in such a depressing environment.

The day after he had all of his teeth pulled, we started scraping the walls of the hallway closest to our little bedroom and repainting. Little by little we were reclaiming our house and our space….and it felt so good!

Our friends moved into his mother’s basement until home sales increased, which would probably be spring. Throughout the daily radiation treatments and three chemo treatments scheduled two weeks apart, we dreamed of complimentary paint colors, watched YouTube videos on how to repair peeling ceilings, and woke up excited to take our daily walks in Lowes and buy more painting supplies.

The snow fell and we were blissfully unaware of the cold. Ron started toasty fires in the wood stove in the basement. Our distractions of painting, remodeling, decorating, and unpacking our belongings that we stored in our house for eight years were life-saving. Our lives didn’t revolve around cancer.

We tore down the blankets covering the sky lights and heavy dark curtains on the windows. Let there be light… symbolic of the tunnel we were traveling through…we could see light pouring in at the end of the treatments.

Cory took family leave from Yosemite National Park. He brought another fantastic distraction, a sour dough starter from 1890. He taught me how to make a delicious sour dough bread that we could share with the nurses and doctors who tended to Ron’s every cancer need.

By mid February, Ron’s treatments were over. The doctors and nurses declared him their star patient. He was in a clinical trial to reduce the painful side effects of the radiation. He received weekly infusions to prevent the throat sores and mucus build-up from the radiation. It was a roaring success. He was the only person in the trial in our area who had no side effects from the radiation…no mouth sores…no trouble swallowing…no throat pain!

Our remodeling was almost done, too! The downstairs was painted and redecorated. the boxes were lovingly unpacked and our treasures were placed around our home. Transformed from a house to our home, we were both proud of how well we handled the stress and demands of the cancer treatments. As the doctors have repeatedly stated, “This is not only the standard treatment for your cancer, but it is the cure.”


What is next? We are not sure where our paths will lead us. Ron has several months of recovery. Meanwhile, we have many miles to go before we rest. We would both like to explore Croatia, Slovenia, Slovakia, Greece, Prague, Montevideo, and Albania this fall.

However, I learned to buy travel insurance for those unexpected emergencies, like Ron’s cancer. Travelex was better than my expectations. I spent two months planning our winter trip, and a month canceling our reservations and verifying our refunds, but we received all of our money back down to the penny.

I want to thank everyone for your concern and comments since I have not been posting. Please know that I appreciate you! My focus has been on helping Ron through the maze in Cancerlandia.

Our lives have changed drastically since last April. But, throughout all the stress and changes, we have both remained optimistic and are looking forward to new paths in our rewired lives…with a little help from our distractions, passions, and friends. 🙂

Next up:

Comparing cost of living in Nicaragua and USA
Will we return to Nicaragua?
The cost of Cancer in the USA

 

 

Review of WEA International Health Insurance


I want to give you a quick update on our WEA International Health Insurance. In 2015, we explored options for Health Insurance coverage in Nicaragua. See my post below:

Part One: Let’s Get Real about Health Insurance in Nicaragua

After much research, we opted for WEA Signature Plan excluding coverage in the United States. See my post below:

Part Two: Let’s Get Real About Expat Health Insurance

We have now completed two years with WEA Signature Plan and are currently renewing for our third year and this is what I have learned.

1. Deductibles
Each year, as we move into a different age bracket, the cost rises, like all health insurance. We counteract the rising cost by increasing our deductible. Our first year, our deductible was $250. Our second year, our deductible was $1,000. This renewal year since we both have moved into a different age bracket, our deductible is $2,500.

Living in Nicaragua, the cost of procedures and hospital care is much less, thus we pay out of pocket for small procedures and apply them to our deductible.

2. Claims
Our second year with WEA ( Nov. 2016-Nov. 2017) was the first time I had to file claims. I had two eye operations at Vivian Pellas Hospital in Managua with a wonderfully competent retina specialist, Dr. Juan Rivers.

After each operation I filed the necessary documents they requested. My first surgery was considered an emergency, so I did not have to be pre-approved. My second surgery, I requested approval and received it before the operation.

Filing the documents was very simple. I took pictures of all the documents provided by Dr. Rivers, including receipts of the costs of the operations. Then, I attached them to an email to the claims department.

I received instant notification that they received my documents and was assured that they would contact me if they needed additional information. So far, so good.

Then, I waited and waited. They say that all claims will be processed within 22 days of receipt. However, that was not the case. I began to worry when we got closer to our renewal date of Nov. 7th because how could we renew and why would we renew if my claims were not approved.

The closer we got to the renewal date, the more I panicked. I sent emails every day to the claims department. Finally, with the help of Robert Tillotson, the Offshore Health Benefits, LTD and my awesome agent, my claims were processed a day before our renewal.

3. Reimbursement

All of my claims were approved and I received almost total reimbursement for everything, except for my initial exam. My exam cost $220, and I was reimbursed for $70 because I had exceeded the maximum benefit for my policy.

My first reimbursement check was sent to my house in the states. All other reimbursement checks are deposited into my bank account.

4. Customer Service

Except for the lateness of my claims, they were efficient, polite, and responsive to my inquiries. If they were not in the office, they responded with an auto message email that said they had received my email. I think the claims department needs  some encouragement to respond to their customer’s requests, but then I had Robert that pushed them into action. Thank you so much Robert!

I know many people interested in getting WEA Signature International Health Insurance asked me about the claims process. Now, I can respond with my assurances that viable and documented claims will be reimbursed, but not with speed! You must keep on top of them.

Overall, I am pleased with their service and grateful to have insurance that can be used in 182 countries, excluding the U.S.

 

My First Experience with Medicare


“One quarter of Medicare beneficiaries have five or more chronic conditions, sees an average of 13 physicians each year, and fills 50 prescriptions per year.”
― Clayton M. Christensen, The Innovator’s Prescription: A Disruptive Solution for Health Care

I went to see my eye doctor in Tennessee the other day. When the nurse entered my information into the electronic files, she asked me, “Are you sure you don’t take any medications?” I replied, “Yes. Nothing.”

She couldn’t get over the fact that I had no pre-existing conditions, took no prescription medications, and had no medical history other than my appendectomy and tonsillectomy, which were removed when I was a teenager.

“I have to put something in the spaces,” she commented. “Do you take any vitamins?”
“Once in a while I take glucosamine,” I replied. With almost a sigh of relief, she asked me how many milligrams and how often I took glucosamine. “You are the best and easiest patient I have ever had,” she said. “But, you aren’t normal.”

Continue reading

The Power of Focus


Stay alert and aware. The signs you are seeking are very clear at this moment. ~Hawk

IMG_1817

The month of August has been extremely challenging for me. Two weeks ago, I partially dislocated my kneecap chasing my dog in flip-flops. Then, our new internet tower was possibly struck by lightning. I say possibly because every technician who has been to our house has a different troubleshooting approach for our internet loss.

Continue reading

Marina and Socialized Medicine in Nicaragua


IMG_5793Marina and her family have been our closest neighbors for ten years. We’ve watched her five children grow into loving, responsible adults. Throughout the years, all of her children and their families have lived with Marina at one time or another.  When Jose and his wife and three babies moved into Marina’s one bedroom shack, she just slapped some old tin on the side of the house and made herself a dirt floor bedroom. Every morning, her smoky cooking pot boiled with beans for her grand babies. Every afternoon, she hung the hand-washed bleached white cloth diapers on the barbed wire fence. She’s a hard worker and very proud of her family.
IMG_1441Two years ago, Marina began to complain of a lump in her neck. “Toce aqui,” (touch here) she’d say, while grabbing my fingers to make sure I touched in the right spot. “It hurts,” she complained. That was the beginning of my limited understanding of socialized health care in Nicaragua, and the things I’ve learned through Marina’s fight for equal health care.

1. I’ve learned that Nicaraguans depend on a three-tier health system that reflects the fundamental inequalities of their society. The wealthiest Nicaraguans use private health care, often going to Miami for specialized treatment. A small minority of privileged government workers are served by the Nicaraguan Social Security Institute. The rest of the population, about 90%, is poorly served at public hospitals, usually understaffed, mismanaged, and under equipped. Marina fits in the last tier and her journey has been an eye-opener, for me, into the world of socialized medicine in Nicaragua.
IMG_49772. I’ve learned that the patient can’t choose the doctor in Nicaragua. Marina was shuffled from one doctor to another. There’s little room for shopping around or for switching from one doctor to another when the bureaucrats have to “go by the book”.   She couldn’t afford to go to a private clinic. Her options were limited and so was her economic status.

3. The doctor can’t choose the patient. Under socialized medicine, there are few referrals made to another doctor. Marina needed a specialist, but it screwed up the system. Because medical services are free, demand for them goes up, patients are put on long waiting lists, and doctors quickly become overbooked and overworked. It took two long years before Marina received a specialist who was able to diagnose her problem.

4. The patient doesn’t get consoled or consulted. “Marina, what did the doctor say?” I would ask after every trip to Managua. “I don’t know,” she would always say. “He just gave me a slip of paper for another appointment. He doesn’t talk to me.” My understanding of the role of a healer is to always give comfort, support, and encouragement to a worried patient. This is not the case in a public hospital in Nicaragua. I’ve accompanied several local friends to public hospitals in Nicaragua, and it’s more like going to the Waffle House, where the doctors are short-order cooks, dispensing cheap aspirin in a cookie-cutter, uncompetitive state-run way.

5. The patient doesn’t get well. Marina suffered for two years waiting for an operation when the tumors growing on her thyroid could be removed. She was scheduled for her operation in December, but after a long, expensive trip to Managua, she was sent home with orders to return in January because the hospital was full of patients with Dengue. Don’t you think they could have saved her a costly trip with a simple phone call? The truth is, Nicaraguans go on long waiting lists all the time because the right equipment, or medicines, or doctors are not available when they need it the most. Thus, these patients become chronically sick as a direct result of the above four points.

The only consolation in Marina’s case, is that she received her operation this week…two years after her first symptoms. There won’t be a bill, and her loving family members are gathered around her, tending to her every need. She returned home yesterday, a day after her five hour delicate operation. Julio harvested our basil leaves and Gloria mixed  a refreshing tea bath of basil, alcohol, and warm water. When I walked into her house to give her a warm bowl of tapioca pudding and strong pain pills, her daughters surrounded her, pouring basil leaf tea all over her body. The warm water pooled over the dirt floor, while the girls tenderly bathed their mother and grandmother. Marina’s mother gently walked her to the outhouse, and the rest of the family members followed behind, hands holding hips, as the little train of compassion chugged to the outhouse. Touched by the compassion and loving care of their cherished mother, I tried to hold back my tears.

IMG_5506“There’s a story behind everything..but behind all your stories is always your mother’s story..because hers is where yours begins.”
― Mitch Albom, For One More Day

Observing the tender care Marina’s children bestowed upon her, I learned that our mothers’ stories are where ours begin. It takes courage and compassion to raise loving children. Marina is one of the most courageous people I know, therefore her children carry on her legacy.  It’s a shame that economic status determines the type of health care one receives in Nicaragua. Yet, knowing Marina and her children, I have no doubts that she will recover quickly.

Dr. Google and Cyberchondriacs


“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.

IMG_3368We 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

IMG_3369A 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?

Expats and Obamacare for los Idiotas


“Everyone should have health insurance? I say everyone should have health care. I’m not selling insurance.” ― Dennis Kucinich

A blogging friend from Ecuador recently wrote a post asking many questions about expats and Obamacare.  The second phase of the Affordable Health Care Act will start on January 1, 2014 requiring all USA citizens to buy health insurance. But, how will this effect expats living abroad?

Did you ever try to decipher the IRS tax code? The statute states that there’s an exemption for USA citizens living overseas tied to Section 911. The Secretary of Health and Human Services cannot override it, though the Treasury Department can issue regulations interpreting it.

“Any applicable individual shall be treated as having minimum essential coverage for any month . . . if such month occurs during any period described in subparagraph (A) or ( B ) of section 911(d)(1) which is applicable to the individual.” IRC Sec. 5000A(f)(4)(A).

HUH???  Or this….

“The term “tax home” means, with respect to any individual, such individual’s home for purposes of section 162 (a)(2) (relating to traveling expenses while away from home). An individual shall not be treated as having a tax home in a foreign country for any period for which his abode is within the United States.”

So, for expats, like us, I have written an idiot’s guide ( mainly for me..a dummy when it comes to legal terms) for expats and Obamacare. Of course, it’s all based on my interpretation of the law, which really means..it’s a jungle of legal jargon in section 911 open to anyone’s interpretation.

Who has to buy the mandated insurance?

In the new Internal Revenue Service (IRS) tax code, expats are treated as if they have health insurance regardless of whether they do or not. So, it looks like expats don’t have to buy insurance or pay a penalty for not purchasing insurance.  But there’s a catch…there’s always a catch.

What is the IRS foreign earned income exclusion?

How does the IRS decide if USA expats (I refuse to use the word “American’ because everyone living in North or South America is an American) are exempt from the insurance mandate? Enter the IRS’ definition for foreign earned income exclusion.

In order for USA expats to be exempt from the insurance mandate, they must already be eligible for the IRS’ foreign earned income exclusion. Now, I know why we were asked 4 questions on our income tax return about how long we have lived abroad ( I’ll come back to this later, because it is a touchy subject for some expats).

In order to meet the criteria for the exclusion that allows U.S. expats to avoid paying U.S. taxes on their first U.S. $91,500 worth of income, the expatriate must have a tax home (the general area of your main place of business or employment where you happen to be permanently or indefinitely engaged) in a foreign country, as well as be either a legitimate resident in that country, or spend at least 330 days a year outside the United States.

Since we are legal residents of Nicaragua and spend at least 330 days a year outside of the USA, we are eligible for the IRS’ foreign earned income exclusion. If we are asked to prove it, we can simply scan a copy of our residency ID cards and send the IRS a fax.

What is a tax home?

When it comes to the tax penalty for not having health insurance, the legislation borrowed the test from the Section 911 Earned Income Exclusion: tax home overseas, plus either 330 out of 365 days overseas presence or legal foreign residency. Thus, if one qualifies for the earned income exclusion one doesn’t have to worry about having U.S. health insurance.  “Tax home” is a concept that applies awkwardly to retirees, since it’s a requirement intended for those who are working and earning income.

Because we are retired, we may have to use our Nicaraguan address on our income tax forms. That should be a good for a couple of laughs: 300 meters south of Puesta del Sol, on the beach in La Paloma, across from where the giant Ceiba tree fell down 3 years ago, but is no longer visible, 2 kilometers from the port town of Moyogalpa, on the island of Ometepe, in Nicaragua.

What about Medicare? Does that count for insurance?

For USA expats 65 and over, Medicare qualifies as required insurance coverage. Although, medicare coverage can ONLY be used within the U.S. boundaries. It cannot be used abroad.   Retired U.S. Military have TRICARE which qualifies as the required insurance coverage. Other retired expats may have insurance plans included in their retirement plans that qualify. They are insured. The law goes after the uninsured residing in the USA.

Problems expats may encounter

1. What if I don’t want the U.S. government to know I’m living abroad?
From my understanding of the law and in filing an income tax return, you will be faced with a difficult decision. Either you tell the IRS you are living abroad for at least 330 days,  pay the $95 penalty (which will increase every year), or don’t file an income tax return.
I’m not aware of any other choices.

2. What if I live abroad less than 330 days?
This is a problem, and I’m not sure what the IRS will do about this. If you split your time abroad and in the states, you will either have to buy health insurance or pay the penalty. The problem is that health insurers will continue to offer insurance only to residents of a particular state, since rates will vary geographically. If you’re not a resident of a U.S. state within the meaning of an insurance policy, you’re not going to be able to get insurance. And if you do claim residency on a questionable basis, the insurer can deny your claims. There is no meshing between the tax penalty and the insurance policy requirements. It’s impossible to get health insurance for a 2 or 3 month visit back to the states.

If there’s any message in the health care act — and in the legislative process that produced the act — it’s that the insurance companies are in control.

Now more than ever.

Other resources:

1. Nancy’s blog post that started me on my quest. Obamacare and the Expat

2. U.S. Tax Code, section 911 document

3. Obamacare and Americans Living Abroad

 

 

 

 

Health Care for Expats in Nicaragua


Update December 2019:
We left Nicaragua mid July 2018 because of a Civic Rebellion that continues to this day. My eye doctor from Vivian Pellas fled the country because the doctors who treated the protestors were ordered to stop treating them or be fired. Most of the ethical doctors left the country…and I don”t blame them. They treated horrendous injuries of protestors who were shot in the eye, or burned,  or tortured, raped, and mutilated for simply speaking out or marching for their human rights or fighting back with stones against armed paramilitary. Nicaragua is no longer a county I choose for retirement. It continues to be full of suffering and sadness.

 

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 Peres, Medical Tourism Manager

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.

The Silver Plan

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.

Ron and one of our friends

The reception desk in the lobby

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.

 

 

 

 

Sharing the Light


Francisco, Esther, and baby Sayid

When Nicaraguan women give birth, they say, “Da la luz.” It means give the light.” I adore that phrase. Three simple words that signify hope, love, and anticipation of a bright future…a shining star is born.

Esther went into labor right on schedule. I was hoping that she would bring forth the light on Cory’s birthday. On our walk to the local hospital I asked Francisco, “Can you attend the birth of your baby?” “I do not think I can help Esther because men are not permitted in the delivery room,” he responded. What a shame, I thought, because a birth is a family affair. “Maybe you can ask the doctora if you can be with Esther when she gives the light,” I said.

We parted a blue sheet that separated the waiting room full of coughing people from the patients, and entered the labor-in-process room. Six beds lined the light green room, each with an assortment of bed linens the women were required to bring for their beds. Frayed posters hung on the walls displaying various birth-control methods and the importance of breast feeding. Francisco wasn’t allowed to enter the room, so he stood at the doorway.

Esther was sitting on the bed close to the open window. “It’s so hot in here,” she panted. I looked for a fan. Nada. The beds were full of women in an array of labor or post delivery. Two mothers-to-be were chatting with their families, another mother was nursing her newborn, and one woman, in heavy labor, was moaning, while her mother stood behind her cradling her limp body.

“I brought you water, food, and a few gifts for the baby,” I told Esther. There are no cafeterias in the hospitals in Nicaragua. In fact, the patients bring everything…sheets..pillows…food…everything. Esther called to Francisco standing in the hallway. “Did you remember to bring rags?” Rags? My imagination was running wild. Rags? “Did you remember to bring me a loose dress when I give the light?” she yelled. ” I forgot to bring rags and a dress,” Francisco lamented. “No problemo,” I said. “I’ll call Ron and he can pick you up on his motorcycle and take you to your house.”

Meanwhile, the sweat was rolling off my eyebrows and into my eyes. “Esther, let’s go outside and sit under the mango trees,” I pleaded. I called Ron, he was on his way, and we settled into 3 metal chairs under the mango trees eating ice cream. “Francisco, ask Esther if she knows how to breathe and how the labor process works,” I asked because Francisco speaks English, too. “She says, the doctora told her to breathe deep and she will tell her when to push..nothing more,” he translated. So, with Francisco’s help, I explained everything in vivid detail, and we practiced breathing through her contractions.

A friend of Francisco’s delivered a plastic bag with more food and a special cactus drink for Esther. Apparently, this Pitaya cactus juice lubricates the birth canal and it is also good for a man’s prostate. “Francisco, when Esther gives the light, will they give her any pain medication or anything?” I wondered. “No,” Francisco stated emphatically, “It is illegal. The baby is delivered naturally with no pain medications.”

When Francisco returned from his house with all of the necessities, Esther was in heavy labor and it was getting dark. Francisco asked the doctora if he could attend the birth, and she replied with surprise and delight, “No man has ever attended a birth before. It will be a first!”

Ron and I returned home, and Francisco lovingly attended to Esther. Sayid was born early in the morning on Cory’s birthday. Esther and I now share a special bond. We both gave forth the light on the same day, 28 years apart.

Francisco spent the night at our house. Esther’s family spent the night with Esther and baby Sayid at the hospital.  I made a big chocolate cake to celebrate our bonds and births of our children on the same day. We invited our neighbors and sang happy birthday in Spanish, then in English. Once again, I am humbled and awed to be sharing our lives and our lights with my gracious Nicaraguan community.

Health Care in Nicaragua: A Hypochondriac’s Story


Nasty ant bites, swollen foot

Last September, I was hauling brush away from the beach, when I felt a strange tingling sensation. It started at my toes, and like a super charged lightning bolt, the sensation passed through my body to the top of my head. I began to itch like crazy, then my upper lip swelled and became numb, as if I had just received a shot of Novocaine.

Living on a tropical island, we have learned to take charge of our own health care. There is a hospital in Moyogalpa, the port town; however, I have been there with Marina, and I don’t want to return. EVER! Our workers, propped my foot on two cement blocks, and gave me a little cap full of…I think it was Benadryl…because I fell asleep upright on the only piece of furniture we had in our house at the time. (a purple plastic chair)

My foot swelled to the size of a small papaya and I was unable to put any weight on it for a week. I’m not one that likes to be incapacitated, so I began to research ant bites and allergic reactions. The locals know the insects, plants, and animals intimately. They all agreed that I had a horrible allergic reaction to ant bites.

Thank God for the internet! Once I determined the cause of my swelling and the treatment, I hobbled to the closest pharmacy armed with an array of new Spanish words..swollen foot, allergic reaction, numb upper lip, cortisone cream. Prescriptions are unheard of in Nicaragua. One only needs to discuss the symptoms with the pharmacist and the pharmacist will dispense one pill, or as many as one needs or can afford to buy.

Six years ago, Ron thought he had parasites. We went to a little shack…literally…where they had the only centrifuge in town. A man handed Ron a little plastic cup and said, “I need poo poo.” Then he directed him to the outhouse. As the centrifuge whirled the poo poo around and around, we waited patiently on the front porch, watching a long string of leaf cutter ants hauling their loot to their nests to make a fungus for the queen.

“Poo poo white,” he announced. “No parasites.” So, because of the white poo poo, he sent us to the pharmacy with a little scrap of paper that told the pharmacist what we needed to buy. All for the cost of one dollar.

Health care is cheap in Nicaragua. Even at the best hospital, Vivian Pellas Metropolitano, in Managua, expect to pay much, much less for all procedures. For example, a hip replacement in the USA is approximately $53,000. At Vivian Pellas, a hip replacement will cost $8,700…total..no hidden costs. And, that price is without purchasing their insurance plan. With the Silver Insurance plan, take an extra 40% off the total cost of the hip replacement. I know you are wondering how much the insurance costs for Vivian Pellas….$26 a month!!!!

When we retired and moved to Nicaragua, we could have continued on our group health insurance, Cigna. However, the monthly cost of $500 would have been taken out of my tiny teaching pension check. Too young for Medicare ( which isn’t accepted in Nicaragua), and too poor to have $500 deducted from my pension, we really didn’t have any options. Before Vivian Pellas started to cater to expats, we had to take charge of our own health and care for our own aging bodies. Plus, we were at a disadvantage because of living on an island…with a one hour ferry ride to the mainland.

After my allergic reaction to the ant bites, I became a hypochondriac. Every sneeze, every ache, every insect bite, everything kind of out of the ordinary…I researched. Most of the little health issues were just due to an aging body. Yet, due to the fact that we are growing our own food, walking and swimming everyday, and always active, we are healthier than we have ever been before.

A retired RN lives close to us, now. I have become friends with a homeopathic doctor, who has a clinic in Moyogalpa. We found a great chiropractor in San Juan Del Sur, and an acupuncturist in Moyogalpa. Soon, we will have an airport a quarter of a mile away from our house. Should a medical emergency arise, we can hop on a flight to Managua for less than $50. Vivian Pellas hospital is getting better all the time, with international awards, U.S. trained doctors, and medical tourism programs.

Now, the only thing we have to worry about is health coverage in the states. Fortunately, we don’t return to the states often. But, when we do, the only health coverage we can get is on our car (stored in our garage back in the states). We upped the medical coverage for accidents in our car. So, if I break my leg, or anything else that requires immediate medical care, I have to do it in the car to be covered. What a shame! Health care in the USA is a mess. But, that’s another story for another day. A story I have no control over.

Here in Nicaragua, I have control over my own health, and a wonderful group of professional friends, and locals who can help us identify and treat the minor problems. If we need immediate medical attention, Vivian Pellas is only an hour’s flight away. What more could we want?