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  Your first payment must be made at Banco del Pacifico, with the option of having subsequent payments withdrawn automatically from your local bank account.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.