Healthcare In Cuenca Curious Cuenca Ep 3

Healthcare in Cuenca: An Insider’s Perspective with Dra. Maité Depreeuw

Welcome to episode 3 of the Curious Cuenca Podcast by YapaTree. Today’s guest is the wonderful Doctora Maité Depreeuw, a general practitioner originally from Belgium who now calls Cuenca home. Known for her holistic approach to medicine, Dra. Maité has become a trusted healthcare provider for many expats in Cuenca. In this episode, we delve into her journey, her medical practice, and the intricacies of healthcare in Cuenca.

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Maité’s Journey to Cuenca

Dra. Maité’s journey to Cuenca began with an internship in 2012, which she describes as a pivotal experience that not only enriched her professional skills but also led her to fall in love with the city.

“I went here in 2012 for the first time on an internship, we call it overseas internships, where we can go for three months in another country. And fate brought me to Ecuador, Cuenca, and I worked here at the public hospital for three months. But then, of course, I fell in love and that’s the main reason why I’m here.”

Her passion for Cuenca and her commitment to her profession drove her to navigate the challenges of practicing medicine in a new country. After completing a mandatory year of rural service in Guachapala, a town near Paute, she established her office in Cuenca in 2018.

Navigating the Healthcare System in Ecuador

The healthcare system in Ecuador presents unique challenges and opportunities, especially for expats who are used to different systems. Ecuador has a dual healthcare system with both public and private sectors, each with its own set of intricacies.

“Ecuador, as we know, has two different systems. We have the public and the private, and they are two completely different systems. The public healthcare has a lot of difficulties, but they can offer health services to people who normally would not be able to afford private.”

Understanding the availability of medications and navigating the different brands and names has been a significant learning curve for Dra. Maité. This knowledge has proven invaluable in providing effective care to her patients.

Holistic Approach to Medicine

One of the standout features of Dra. Maité’s practice is her holistic approach to medicine. This approach involves looking beyond symptoms to understand the whole person, including their environment, stress factors, and cultural background.

“For me, holistic is I see the person, I don’t see the symptom or the disease. A patient comes in and it’s the patient I’m talking to now, not just the headache. How does that headache affect their life? It’s about the patient.”

This patient-centered approach allows her to build deeper connections and provide more personalized care. It’s an approach that often requires more time and effort but leads to more comprehensive and compassionate care.

A Day in the Life of Dra. Maité

A typical day for Dra. Maité is unpredictable, filled with diverse patient needs and unexpected challenges. She schedules appointments every half hour, but the holistic nature of her practice often means spending more time with each patient.

“The fun or the stressful part of my job is I never know what I’m going to get in the day. I made appointments before it was 45 minutes, but then sometimes I had too much time in between, so I started to do it half an hour, but that’s also not working out.”

This flexibility allows her to address complex issues thoroughly, even if it means running behind schedule. Her commitment to taking the time needed for each patient is a hallmark of her practice.

Building a Trustworthy Network

Dra. Maité emphasizes the importance of building a reliable network of specialists and healthcare providers in Cuenca. Trust and communication are key components in ensuring comprehensive care for her patients.

“I’ve learned now who I can work with and trust, and they have learned to work with me too. They do get back to me and let me know, yeah, you were right, we have to do this or that.”

This network is crucial for navigating the healthcare system effectively and ensuring that patients receive the best possible care.

The Expat Experience

A significant portion of Dra. Maité’s patients are expats, who often have different expectations and healthcare needs compared to locals. This dynamic adds another layer of complexity to her practice.

“I would actually say 90 to 95% would be expats. The problem here in Ecuador, because even in Quito, I’ve talked with colleagues, family medicine or having a GP is not something common.”

She highlights the cultural differences in how healthcare is approached and the importance of having a trusted general practitioner who can coordinate care and provide a comprehensive overview of a patient’s health.

Challenges and Rewards

Practicing holistic medicine in Cuenca comes with its challenges, but it also brings immense rewards. The ability to make a meaningful difference in her patient’s lives and the deep connections she forms with them are what drive Dra. Maité.

“There is a bit of a culture here too, for being a good or a bad doctor. I sometimes don’t even prescribe anything and just give alarm signs or say like take that vitamin or drink some ginger tea. You don’t need medicine for everything.”

Her approach is a refreshing change for many patients, especially those who value a more integrated and person-centered model of care.

The GP’s Role: Centralized Care vs. Fragmented Systems

One of the striking differences Maité pointed out was the role of the General Practitioner (GP) in Belgium versus Ecuador. In Belgium, the GP is the cornerstone of healthcare, working in teams with specialists and having access to centralized patient records. This means that your GP can see all your medical history, even if you visit a hospital or another specialist.

“In Belgium, everything is on a portal where you get registered with your GP, and the GP can see everything that happened to you. Here, there is no system. Even within a hospital, there is no system.”

In Ecuador, the lack of a centralized system means patients often need to be proactive, carrying their medical records from one doctor to another. This can be a bit of a hassle, especially for those of us who are used to more integrated systems.

Cost of Care: Accessible but Varied

One of the biggest attractions of healthcare in Ecuador for many expats is the cost. Generally, healthcare costs are significantly lower compared to countries like the US. However, the structure of payments and insurance can be quite different.

In Belgium, healthcare is a right for all, funded through a social security system. Patients typically pay only a small co-pay for services, with the rest covered by their insurance.

“A GP’s office visit in Belgium was about $30, but the patient had to pay only $4. The rest was covered by social security.”

In Ecuador, there’s a mix of public and private healthcare. Public healthcare is free, and there’s the IESS system, which is a form of social security that people pay into. Private healthcare, on the other hand, is not free but is still relatively affordable.

“My standard fee is $40, which is accessible. In public centers, it can be as low as $7.”

Prescription Costs: A Mixed Bag

Prescription medication is another area where Ecuador offers significant savings, though it comes with its own set of challenges. While overall costs are lower, the distinction between generic and brand-name medications is less clear, and quality can vary.

“In Belgium, we only prescribe generics. Here, I started noticing issues with blood pressure medications fluctuating when patients switched brands. Sometimes, it’s cheaper, but not always better.”

For example, while routine medications like those for diabetes or high blood pressure are affordable, some specialized treatments can be costly.

“For conditions like rheumatoid arthritis, the cost can run up to $5000 a month here.”

Insurance: Navigating the Maze

Insurance in Ecuador can be a bit tricky to navigate. Most expats opt for private insurance, especially since it’s now often required for visa applications. However, not all insurances cover preventative care, and the approval process for claims can be cumbersome.

“A patient who was newly diagnosed with hypothyroidism had her claim denied because she couldn’t prove she hadn’t been diagnosed before. It’s absurd, but they wanted two years of medical records showing no diagnosis.”

This highlights the importance of keeping detailed personal medical records and understanding your insurance policy’s intricacies.

A Touch of Humanity: The Personal Touch

Despite these challenges, there’s a heartwarming side to healthcare in Ecuador. The sense of community and gratitude can be quite profound.

“Sometimes, people bring fruits or vegetables from their garden as a thank you. It’s so touching. I’ve been paid in fruits here in Ecuador, and I love it.”

This sense of personal connection and appreciation is something that can be deeply fulfilling for healthcare providers and patients alike.

The Payment Process: A Reality Check

My initial shock at the payment process in Ecuadorian hospitals was quite intense. After undergoing surgery, you’re literally not allowed to leave until you’ve settled your bill. This process, while understandable from a business perspective, feels quite harsh when you’re in a vulnerable state.

“When you go into the hospital for surgery you have to fill in dozens of papers you have to have credit card numbers or debit card numbers you have to show that you have the money to pay for some people like if you go in through emergency where it’s nothing planned and I feel they have only done that an expat that’s just my personal opinion, of course.”

In emergency situations, patients are often required to pay a substantial amount upfront – sometimes as high as $5000. This can be a significant barrier for many, especially if the situation is unexpected. The alternative, as Maité suggests, is to head to a public hospital where the costs are much lower, though you might need to provide some supplies yourself due to budget constraints.

Communication with Doctors: A Pleasant Surprise

One of the biggest surprises for me was the level of direct communication available with doctors. In many countries, reaching out to your doctor outside of scheduled appointments can be difficult. But here in Ecuador, the experience was vastly different.

“I was shocked the first time that I was there with Michelle and she was WhatsApp her doctor I think it was like 8:00 at night and I was like, in horror I was like, what are you doing you know, the doctor’s going to bar you they’re never going to talk to us again. And then, lo and behold, she actually got some sort of response that night.” – Jason

Maité explained that this level of accessibility is because there’s no structured guard system in place. Doctors manage their own availability, which often means responding to messages late at night. While this is incredibly convenient for patients, it can be overwhelming for doctors.

“I do have colleagues that say, but why are you responding to your patients and why are you doing just bringing them up to the appointment?” – Maité

The Balancing Act: Availability vs. Overwhelm

While this open line of communication is beneficial, it also requires doctors to set boundaries. Maité mentioned instances where she had to gently remind patients to book appointments for detailed discussions rather than relying on text messages for continuous advice.

“Sometimes I do, yeah, sometimes I say but it’s enough, please come to the appointment and then I don’t hear from them anymore.”

It’s a delicate balance between providing exceptional care and managing one’s own time and energy. Patients, too, need to understand and respect these boundaries.

The Quality of Care: High and Efficient

Despite some of the challenges, the quality of healthcare in Ecuador is impressive. Tests and imaging results are often available on the same day, and the flexibility in ordering these tests is commendable. You can directly request an MRI if needed, without having to go through multiple steps as in many other healthcare systems.

“You order tests in the morning, you have in the afternoon, you have already the results.”

This efficiency and flexibility are significant advantages, especially for those needing timely diagnoses and treatments.

Birth and Beyond A Conservative Approach

One area where we’ve faced challenges is finding a gynecologist who aligns with our preference for natural birth. There seems to be a conservatism in the medical community here, with a high rate of scheduled C-sections.

“There is a misconception about giving birth here which you think in Ecuador should be all-natural, right? But if you go to the communities and little towns, they won’t talk about C-section. Everything is natural, but then you go to public health, this is not the IESS. It’s natural until you can. But you go into the private sector where doctors are used to planning their days.”

This trend is driven by various factors, including the convenience for doctors and perceived lower risks. However, it’s something that expectant parents should be aware of and plan for if they have a strong preference for natural birth.

Embracing the Positives

Overall, the healthcare system in Ecuador has its quirks, but it also offers many benefits, especially in terms of accessibility and quality of care. As Maité aptly puts it:

“I for one, I’m glad to be part of this healthcare system and I will be for as long as I can. It is, it’s, it’s, I see a lot of expats and they are so impressed as well with how things work it is a good place to come for healthcare.”

Navigating a new healthcare system can be challenging, but understanding these nuances can help expats prepare and make informed decisions. So, while it might be a bit of a culture shock initially, there’s a lot to appreciate about healthcare in Ecuador.

Wrapping Up

Dra. Maité Depreeuw’s insights into the healthcare system in Cuenca are invaluable for anyone considering a move or already living in this beautiful city. Her holistic approach to medicine, dedication to patient care, and understanding of both local and international healthcare practices make her an exceptional resource for the expat community.

Feel free to contact Dra Maité Depreeuw via WhatsApp at +593 98 212 3992

If you have any questions about healthcare in Cuenca or want to share your experiences, feel free to reach out to us at YapaTree. We’re here to help you navigate your journey and make the most of your life in Cuenca. Stay tuned for more episodes of the Curious Cuenca Podcast, where we continue to explore the many facets of life in this incredible city.

Thank you for listening, and a special thanks to Dra. Maité for her time and insights. Until next time, stay curious and keep exploring!

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