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Lair Davis (Our Man in Costa Rica) |
| February 11, 2005 |
A Visit to the Caja Although I have been enrolled in the nationalized healthcare system since shortly after I moved to Costa Rica last June, I had not used it until last week. I pay my $37 a month to be enrolled in the system in case of an emergency. The system functions very well for such things as automobile accidents and catastrophic care. It provides ambulance service in cooperation with the Cruz Roja (Red Cross). Should I have a heart attack or other medical emergency, I will be well cared for. The nationalized system is less useful for regular healthcare. Those who can afford to pay for private doctor visits, do so. Only the poor use the nationalized healthcare system for routine treatment, just as poor people in the United States use hospital emergency rooms. Costa Rican doctors are required to work part of their day for the Caja, which is what the nationalized healthcare system is called. In exchange, they are permitted to maintain private office hours if they choose. Most do. My doctor, who speaks excellent English, spends his mornings at the Caja and teaching at the University of Costa Rica but is available for private consultations in the afternoon. He is a graduate of Harvard Medical School who charges $18 per visit, and if need be will come to your home for the same price. I only take two medications — Lipitor for cholesterol reduction and Accupril to help keep my arteries unclogged. In the United States these medications were very expensive, but I was employed and had health insurance. It cost a lot — a whole lot, in fact — and despite the money I paid to the insurance companies, I still had a $50 deductible that I paid each month for each drug. Buying my medications at a pharmacy in Costa Rica — the exact same ones — cost less than $40 total. For every two boxes of medications I buy, I receive a third box for free. The Caja will provide free medications that a doctor has prescribed. Since those that I need are so inexpensive, I have been in no rush to take on the complicated task of establishing an account at the Caja hospital in order to receive my medications for free. To become part of the drug-dispensing program is a bureaucrat’s dream requiring one to travel from one window to another and back and forth and back again until the pile of paperwork is huge. It is all completed in Spanish, of course, and although I study every day, my Spanish is not at the point where I could conquer this mountain without extreme difficulty. It has not seemed worth the trouble. I told my landlady last week that I have been buying my medications at the pharmacy on the town square, and she was horrified. “You are eligible to receive your medicines for free!” she exclaimed. “You should be getting them!” I explained that it seemed just too difficult a process to attempt at this point, and she announced that she would accompany me on Wednesday to complete all the paperwork and get me enrolled. Can you imagine? Should a relative of mine ask me to help with such a complicated process, I am afraid that I would say, “Well, this is what I know about how you do it, but the process will take the entire day. I’m sorry, but you will just have to go through it by yourself. I cannot spend the entire day to help you. And good luck!” Well, that is not the Costa Rican way! This warm, beautiful lady hired a babysitter for her two young children and dragged me off to the hospital, where we stood in one line after another through the morning, through the lunch hour and on into the afternoon. By the end of the day, all the mounds of paperwork were completed — and the process had been tolerable because of her gracious and generous assistance. On Thursday, I went to pick up my free medications for the first time. There was a glitch, and my prescription could not be found. The young professionals working in the hospital pharmacy began explaining the problem to me. I smiled and shook my head. “My Spanish is not good. I do not understand.” What do they do? THEY began to apologize to ME because they could not explain in ENGLISH! One young man called his mother in another province because she spoke a little English, and then he handed the phone to me so that she could explain what the problem was. They invited me into an office to sit down while they dealt with the problem. A beaming young man proudly brought me a ragged English-language magazine that he had found so I would have something to read while I waited. A young woman came in to offer me a glass of water. Finally, a group of the workers came into the office together and joyously announced that the doctor was on his way to deliver a new copy of the prescription. (Why hadn’t they just told me that I needed to go back to the doctor’s office to pick up the new prescription rather than have the doctor travel across town to deliver it? Because that would have been rude, and Costa Ricans are never rude intentionally. Never. The doctor would just have to come to me.) Finally, the group of enthusiastic workers came bursting into the office once again and presented me with my medications. They were quite happy to be able to do so, and again began to apologize for the inconvenience and for their not being able to speak to me in English. They then insisted I wait a few minutes longer, and shortly I learned why. Another young man, who works in an entirely different section of the hospital, was brought in to meet me, and it was announced that he would like to provide me with transportation home. He happens to live in the same barrio as I, and he has a car, and it had been arranged for him to leave work a little early in order to provide me with transportation services. When I got home and checked my medications, I discovered that not only had I received three months’ supply of Lipitor and Accupril, but also quantities of multivitamins, folic acid and calcium tablets to last three months. I had mentioned to the doctor that I took these supplements, and he had added them onto my medications list. So they will be provide to me free of charge as well for as long as I live in Costa Rica. Which will be for a long time I hope. I’m not going anywhere else! |
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