The Fall...and My Experience with the IESS

First, a bit of background information for my friends and family back home.  There are three different ways to pay for healthcare in Cuenca.  You can pay out of pocket for any expenses you incur; you can purchase private health care insurance; or you can register for Ecuatoriano de Seguridad Social, (Ecuador's social security system,) which is commonly referred to as IESS.  The cost for IESS is $70.00 with an additional $12.00 for your spouse, per month...although, it was recommended to us that we pay $70.00 for each of us.  You need your cedula, (or national ID,) and a local bank account before you are able to register for IESS.  Once registered, you have access to a variety of services, including doctors, dentists, hospitals and pharmacies.  100% of your expenses are covered under this system.  Your first payment must be made at Banco del Pacifico, with the option of having subsequent payments withdrawn automatically from your local bank account.  (Please note, I referred to Mara's, blog for some of this information.  You can read more about her experience with the healthcare system at ganosinecuador.wordpress.com.  Simply search for the post entitled, "Doctor, Doctor Gimmee the News" and you will learn all about her recent experiences with healthcare.  However, for reasons she explains, she currently does not use the IESS system.)

After careful research, and attending the informational meeting for gringos at the Chamber of Commerce, Lance and I decided to opt for the IESS coverage.  We paid someone to help us register online, and even visited the IESS office when ran into some problems with our online registration.  Upon completing our registration, we were told that we needed to make our first payment between January 1st and January 15th.  However, Lance was nervous about waiting so long, so he went to the bank in December in hopes of making the payment early, only to be turned away and instructed to come back in January.

As stated in my previous post, Lance and I went on a trip with an Ecuadorian family on Sunday, December 21st to hand out toys.  At our first school stop, we hopped out of the car, and as we walked across the parking lot, I took a bad spill on the pavement.  I came down hard and knew immediately something was wrong with my left arm.  My wrist started to swell and I couldn't bend it.  Everyone started to fuss, but I was so embarrassed and didn't want people to worry about me...so I didn't say much.  Besides, we were hours away from Cuenca, and I didn't want anyone to feel like they had to take me back home.  Not to mention the fact that I had looked forward to the trip and I wasn't about to miss any of it.  (Later we discovered that I had tripped on a piece of twine that had been stretched across the parking lot.  We think it was there because they had recently laid new cement.)

As the day went on I had some discomfort, but I could handle it.  It wasn't long before some of the women started to notice the swelling of my wrist.  They stopped at a local pharmacy, and bought me some menthol smelling ointment and an ace bandage.  I put them both on and remarkably, by the end of the day, the pain was minimal.

The next morning when I awoke, I had still had very little pain, but my wrist was swollen, seemed to be at an odd angle, and I still couldn't bend it.  We decided it was time to have it checked out at the IESS clinic.  I was thinking it was probably a sprain or a possible fracture.  Lance and I walked two blocks to the clinic, eventually figured out how to register, and after waiting for quite awhile, we were taken to see a doctor.  Please note...this was the first of two mistakes we made...we should have taken an interpreter with us.  Most of the people we met at the clinic could not speak English, or if they could, it was very limited.  As we struggled through the interview with the doctor, he finally determined that I should have my arm x-rayed.  Luckily, the job could be done right there at the clinic.  When the results came back, it was determined that I had a fractured arm.  We were given a transfer paper and sent in a cab to the IESS hospital, along with our x-rays, to get a cast put on my arm.

This was our second mistake, again, we should have hired an interpreter to go with us.  The hospital was big, with lines everywhere, and no one could speak English.  Trust me when I say we tried to ask many people where to go, but nobody could help us.  Finally, we stopped a young woman in a lab coat, and she pointed us in the right direction.  We waited in a line and when we got to the window we were given an appointment to see a doctor at 4:00...the following day.  So, back home in a cab we went, with my fractured arm.  Thank goodness it didn't hurt!

Day 3 of the break and still no pain, but no one has attended to it yet.  However, we were lucky this time, because when the administrator of our building heard what had happened yesterday, he insisted that one of the front desk people go with me to help with the Spanish.  I also might mention that as an Ecuadorian man, he had nothing positive to say about the IESS system and encouraged us to go elsewhere.  Our feeling was that we already had the appointment, and I was just getting a cast, so how bad could it be?  Besides, this was the insurance we had signed up for, so we should use it.

At 3:30 P.M. Caroline and I set out for the hospital in a cab...this time Lance stayed home.  After searching, we finally found the doctor's office.  We had to wait about an hour, but eventually she showed up.  Again, she spoke no English...but this time I was prepared with Caroline as my interpreter.  After viewing the x-rays she stated that I would need surgery to fix my wrist.  Wow...I didn't see that coming...surgery is a whole new ball game.  She looked in the computer and the first available appointment was January 9th.  Her advice to us was to go back to the emergency room and tell them I was in a lot of pain, (even if I wasn't,) and needed to be taken care of immediately.  So, off we went.

After waiting a bit, we were placed in an urgent care room where two medics were attending to patients.  We showed them the x-ray, they took a picture of it with their phone and left the room to show it to the doctor.  About 5 minutes later they returned and stated that I would indeed need surgery and they would be admitting me that night.  At this point, Caroline said she would go get Lance and  some items I would need for my overnight stay.  Off she went, and I was on my own.

While she was gone, they found an English speaking doctor to come in and tell me there were no empty beds in the hospital and that I would be allowed to go home, but needed to be back the next morning.  (Fine with me, I thought.)  In the meantime, they put a half cast on my arm, then told me they would need to draw blood and take an EKG.  Drawing bloods a tricky business for me because they can never find the vein, which results in a lot of discomfort and bruises on my arm.

After awhile, a young, English speaking girl, arrived with a rather old, rickety looking machine, to do the EKG.  Next, she was ready to draw the blood.  After a failed first attempt, I explained the difficulties that people usually have getting blood from me.  She left, and brought back a young man to give it a try.  No luck. I explained that they usually use something called a "butterfly" in the clinics at home, so she left again and came back with one.

At this point I should stop and tell you what was beginning to concern me.  First, although there was a sink in the room, no one bothered to wash their hands before treating me.  Second, no one, including the girl drawing blood, wore gloves to protect her hands.  By the time they got the blood flowing, it was poring out of my arm, and she was attempting to collect it in a tube.  The blood was dripping onto her bare hands, and the floor.  All I could think of was all the  Bloodborne Pathogen classes we were required to take each year as classroom teachers.  Touching blood for any reason was a big No No!  When she was done, both the young man and woman rinsed my blood off their hands, but did not use soap.  I was stunned, and started to question the wisdom of being there.

Then, they left, and I was on my own again.  No directions on what to do, where to go tomorrow, and what time to be there.  After waiting, I finally saw the English speaking phlebotomist and asked her what time I should be back tomorrow and what part of the hospital I should go to.  She left, and eventually she came back with the information.  I wandered out into the lobby, then the parking lot with my x-ray and EKG in hand, where I finally saw Lance and Caroline walking from her parked car.  Caroline took it upon herself to go back in and make sure we had all the correct information.  That was a good thing, because after talking to the nurse, we learned that I was not to eat anything, and that I should be there an hour earlier than  indicated.

Day 4...Christmas Eve, 5:45 A.M.  Lance and I were up early and ready to go.  Freddy, another one of our desk clerks was going to take us to the hospital in his car and Caroline was going to meet us there later.  We arrived, answered some questions for one of the nurses while she typed on her computer, then waited...and waited...and waited.  Twice we were told the surgery was pushed back for more urgent needs.  That was understandable, so we...kept...w-a-i-t-i-n-g.  Finally, at about 10:30, I was given a room and told to change into my nightgown.  Just before the surgery, Caroline (who arrived to take Freddy's place,) went down to take care of some paperwork for me, when she was told for the first time that we could not have the surgery because we had not made the initial payment.  This had never been an issue until now.  We explained how we had tried to make the payment...and offered to pay now...but it was no use.  I was told to get my things and leave.  So much for IESS.

Caroline was relieved.  She said there were better places to go, and she immediately called her father to tell him what happened.  He contacted a doctor friend of his who is an orthopedic surgeon and asked him to see me immediately.  We picked up her dad and went directly to a private clinic called Clinica de Fracturas.  After waiting 50 minutes, the doctor arrived, and explained...in English...that I had 3 options to fix my wrist.  All 3 involved being put under because the bone needed to be reset.  I chose to have pins put in because I would only need to wear a cast for one week.  The surgery was done right at the clinic in an operating room.  Caroline and her dad left because they needed to go to work, so the doctor brought us home.   We would have taken a taxi, but none were interested in driving to El Centro due to the big parade.  The entire cost for the surgery...(including, I believe, follow-up visits,) was $700.00.  The doctor told us we could wait to pay, but we decided put it on our charge card.

This is picture of my doctor that was hanging on the wall in the clinic.  His name is Christian Ochoa.  Both his father and brother are also orthopedic surgeons.  

Having the surgery on Christmas Eve, didn't make for a very nice holiday, but that couldn't be helped.  I was in a great deal of pain/discomfort for the first three days, but I am finally starting to feel better.  Mostly, I am looking forward to getting my cast off and getting on with my life.

There are so many people I need to thank throughout this whole ordeal.  First and foremost, my husband Lance, who has been an endless source of help and support and never once complained.  Since my injury all the work has fallen on his shoulders, not to mention my care.  I love him very much.

I also need to thank Caroline and Freddy at the Colombia Suites who helped with all their interpreting skills, plus spent endless hours waiting with me at the hospital and clinic.  I want to thank the administrator of our building for covering for his workers so they could assist me.  And, last but not least, I want to thank Caroline's father, for arranging the doctor visit, and making sure I was taken care of, after my surgery was cancelled.  In addition, I need to thank all of our new ex-pat friends who sent flowers, and offered to come and visit or help in any way possible.

In closing I want you to know that we have read many favorable comments from people who have experienced the IESS system  We also have many ex-pat friends who have signed up for it.  Each person will need to make their own decision about what kind of health care they want.  We have decided, based on my limited experience, to consider other options.  The bottom line is, there is good health care available here, but like everywhere else, you may have to pay more for it.

Christmas Eve

Since we were unable to attend the parade, I want to share some links to other blogs that have pictures of the Pase Del Nino.  One of my biggest disappointments was not being able to attend this event on Christmas Eve, which happens to be the highlight of the Christmas season.  I hope you take the time to look at some of these photos on the links below.  

Souvenir Photo Studio by Al Bourassa  - look for the post in the blog archive that is dated, Wednesday, December 24th, 2014 Pase Del Nino.

Los Ganos de Cuenca  - this is my friend Mara's blog.  Write in the search box, "I'm Dreaming of an Unwhite Christmas,"  and you will see some great pictures from above the parade route, plus two short videos.

Nancy and Chuck - Retirement in Ecuador  - the parade post on this site is called, "Cuenca Parade of the Children 2014."

There are many other websites with pictures, but I thought these were some of the best.  I hope you enjoy them.

Thanks for all the recent emails from friends and family back home.  It is aways a joy to hear from all of you.  

        

       

    







  
          



  



  



    

A Family Tradition

I had hoped to write this post several days ago, but an unexpected fall and trip to the hospital got in my way.  I'll tell you more about that in my next post, but first I would like to tell you about the most amazing experience that Lance and I had since arriving in Cuenca.

If you are regular readers of my blog, you might recall that Carolina, the young woman who works at the front desk where we live, was collecting toys, candy and animal crackers to distribute to children that live in some of the poorer towns located north of Cuenca.  When Lance and I made a donation, we were kindly invited to go along with her family to hand out the items.

On Sunday, December 21st at 7:00 A.M., Carolina came to pick up the two of us and another gringo couple, (Lynn and James,) who had also donated to this worthy cause.  We were all taken back to her home where we met up with many members of her extended family, including her 94 year old grandmother.  For the past 25 years this kind family has made it a tradition to travel together to 5 small towns in the Provincia of Canar to hand out all the toys and candy they collect for the boys and girls.  They load all the donations in a truck, and then a caravan of cars takes off for the mountains.

It was a beautiful sunny day and we were really looking forward to the trip.  Without a car, we rarely have the opportunity to see other towns, so we were excited to see what lay ahead.  After so many years of doing this, the family had the event well organized.  All the distributions are made at the local schools.  As we pulled in we would hear a cheer ring out from the children who were gathered on the playground.   They were lined up and ready for our arrival.

The young men in the family would immediately unload the truck...

while the woman would gather all the girls in one line and all the boys in another line.  They would place the children from youngest to oldest.  Before the items were given out, a speech was usually given by someone from the school...most likely a teacher or principal.  Then, the grandmother would  give a short speech and everyone would applaud. After the speeches, the children would often perform a song or dance.

When all the formalities were finished it was time for the gifts to be distributed.  Boys were given some type of vehicle, and the girls were given fashion dolls.  Each toy was valued somewhere around $2.50.  In addition, they were each given a bag filled with animal crackers and candy, and another bag that had a small Christmas bun inside.  It would no doubt be the only gift they would get for Christmas.  Everyone was grateful for what they got.  No one pouted or complained if they got something different.  No one pushed or shoved, instead they all waited quietly for their turn.

After the children received their gifts, we were treated to a meal.  At some schools, it was something small, but at others it was an entire meal with chicken, guinea pig (cuy,) potatoes, salad, tea, deep fried dough, etc.  5 schools...5 meals...and it would be considered impolite not to eat something at each destination.  Often, leftovers were sent with us.  

This is the inside of one on the nicer schools we visited.   Most classrooms we saw were much smaller and had very few supplies compared to our schools back home.

Here are a few pictures of scenery we saw along the way.  Unfortunately we couldn't get some of the more spectacular views that we saw from our moving car.  

Our second to last stop was one of the most interesting.  It was a small school high up in the mountains.  When we arrived an ice cream truck was on the scene.  

Later a priest gave mass to the crowd before we gave out the gifts.  We were offered shelter in a building, but all the others had to sit out in the hot sun for the service.  After the adults were fed the children preformed a dance, and then invited us to dance with them.  

In one of the buildings they had an altar constructed that was made out of fruits and vegetables.

Carolina took a selfie with the kids and they loved it!  By the time we arrived home, it was 6:00 P.M.  We were exhausted, but so honored to be a part of this great family tradition.  

   

     

A Jolly Santa, A Snarling Bobcat, and other Assorted Tales

I doubt that Lance and I will ever get use to the idea of Christmas without it being cold and snowy.  We've both lived in Wisconsin for most of our lives and for us the holiday and the cold winter season  go hand in hand.  Here in Cuenca, you will often see winter decorations...such as snowmen, and it just doesn't make sense, especially when you are wearing short sleeved shirts outside and the hot Ecuadorian sun is beating down upon you.  Nevertheless, the Christmas holiday is only a week away and things here are ramping up.

We were walking through Parque Calderon on Saturday and we happened to see Papa Noel sitting in the park.  There was a small crowd of people standing in line hoping to get a picture with this jolly old man.  Most were children, but there were a fair number of adults also looking for a photo opportunity with him.

As we headed toward the flower market, we noticed many children entering one of the churches dressed in costumes.  We assumed it was a dress rehearsal for a Christmas pageant.  

The two kids above were posing for pictures, so I took advantage of the opportunity.  I especially love the little boy with the long brown wig and mustache.  

  

Later in the day, Lance was out exploring the city when he stumbled upon a Papa Noel 5K run...  

and this huge Nativity Scene, which is located in one of the plaza's in El Centro.

In addition many tents have been set up around El Centro selling items for Christmas.  One of the more popular items for sale are fancy outfits for the Baby Jesus.  I imagine they are used for floats in the parade or perhaps for their own nativity scene at home.  

The grocery stores are loaded with baskets of holiday fare and candy...lots and lots of candy!

It must also be popular to give food as gifts, because you can find huge displays of containers with non perishable food items in plastic containers or boxes.

This week, a variety of free concerts are being held around the city.  Today we are going to see some of the local school choirs perform in El Centro.  The symphony is also performing for free this week and next week in several locations.  In addition, our favorite venue, The Jazz Society, will be giving a holiday performance.  We plan to attend with our friends, Roz and Ken. 

In other news, we visited the art exhibit at the Mansion Alcazar with new friends Totsie and Winn.  While we were there we had a chance to see our dear friend, Enzo, working hard.  It was a great turnout.  Below are just a few photos of this great hotel.  The first picture is an outdoor conservatory located in the hotel gardens that we ate in last Christmas when we came for our exploratory trip to Cuenca. This hotel is beautiful and well worth a visit.

We went to La Parola last week Wednesday to see a blues act by Bob Cat Jack.  He had a good voice and was a very talented guitar player.  In fact, he mentioned that he would be touring with Van Morrison in the new year.  However, near the end of his performance he got nasty with the poor sound man, and publicly berated him.  That was not cool...and I think it made many of us uncomfortable.  I think if he had a beef with the guy, he should have addressed it privately instead of making a scene in front of everyone.  It ruined what could have been a good performance.   

On the way home, we saw the usual hard workers power washing the sidewalks of our fair city.  It's too bad they can't control the graffiti that is often found on the buildings.  

I also saw these performers in Parque Calderon.  I was walking home from Spanish class last week when I heard a Beatle song coming from the Parque.  This man was singing "Let It Be" and several dancers were taking turns performing to his music.  They were surprisingly good.  

It's Cherry Season in Cuenca...and let me assure you, they are as good as they look.  Everywhere you go in El Centro you will see wheel-barrels full of cherries.  They started at $3.00 for a bag, but the price has now dropped to $2.00.  YUM!  I can't get enough of this tasty treat. 

Lance and I also enjoyed Mexican night at Joe's Secret Garden on Saturday with friends David and  Claudia, and some of their neighbors.  It was an enjoyable evening, with nice conversation and delicious food.  

On Sunday we finally got to the Inca Lounge to see our hometown team, the Packers, lose to the Buffalo Bills.  Ouch!   That was a bad game.  Hopefully they will turn it around next week.

Finally, I thought I would add this photo that David sent me from the Hearts of Gold charity dinner that Lance and I attended.  The couple we are talking to are neighbors of David and Claudia.  They were also with us the night we went to Joe's Secret Garden.  They are lovely people and have led a very interesting life.  Before coming to Ecuador, they spent time in India working with the poor.    

 I hope all of our family and friends back home are enjoying the holiday season.  We miss all of you...especially during this time of year.  I hope to post one more time before Christmas...but if I don't we wish all of you a very Happy Christmas and a Joyous New Year.  Please write when you find the time.  Oh, by the way, I changed my email address to mentink.kathleen@gmail.com.  I was having too many problems with my yahoo e-mail.  Please note, my iCloud account is still active.