[color-box color=”green”]If you’re from North America chances are you’ve been brainwashed. It’s not your fault. For all the time you’ve lived “up there” your reality has been dominated by consistency. You were not prepared for healthcare in Ecuador.
Your experience has largely been that basic services that can be found in Tempe, Arizona you can find in Charleston, Carolina or Vancouver, B.C. As a rule, you don’t have to look too far, or hard, to find the product or service you need at an acceptable level of quality wherever you go.
Let’s just call it “The McDonald’s Syndrome.” [/color-box]
Healthcare in Ecuador
Examining Your Norm
As a teenager in the 1960’s I could go from one end of the U.S. to the other and find communities and even whole states noticeably “behind” my area of the country. Today, standards of living, products and services are pretty much comparable from community to community, state to state. In fact, I’ll go so far as to say that so much of America has become homogenized in my lifetime it has almost successfully eliminated the element of chance!
If you are in the middle class you have access to acceptable levels of healthcare, no matter where you live. Inadequate emergency services are rare. Most towns are similar in their demographics, so there are adequately trained and practiced professionals for each age range, no matter where you go, and what goes wrong. Even “exotic” ailments can be dealt with through networking within reasonable distances.
Additionally, in almost any emergency, you are literally no more than a few hours away from a facility able to handle all but the most critical complications, and there are numerous reliable and timely transportation options to get you where you need to go. If insured, not once must you fumble for cash.
This is the way the world is for most expats. Ease of access is ingrained in day-to-day life. Unfortunately, you cannot afford to continue to think like this about your healthcare in Ecuador.
I get a little annoyed when I read articles geared towards expats and soon-to-be-expats that perhaps inadvertently, perhaps not, play into the North American’s inbred weakness of perception; a few good examples means there must be consistency in hospital care wherever you go and whenever you need it in Ecuador. This is the ‘McDonald’s Syndrome’ trap in action.
This is not meant to discourage anyone. Rather it is a tough-love, heads-up notification, that if you move or live here, your well-being demands that you take maximum responsibility for the management of your hospital care in ways you never thought of in North America (or whatever developed nation you’re from).
If you take time to gather the information you need, to pre-plan for the actions you’ll take in the event of a critical emergency in your household, you will be in a better position to move smoothly through a less serious incident that involves hospitalization.
Hospital care in Ecuador has greatly improved in the last eight or so years. I know of many first-hand accounts of superb, cost-effective service and exceptional practitioners. You can find services today that were unknown not too long ago, especially for the aging expat population. The Public Health system is free for all. Social security through IESS provides comprehensive coverage. Private Health Insurance carriers are much more abundant.
It’s a fantastic system…when it works like you’re used to.
It really doesn’t matter if you believe you’re fully covered when you find out that if your spouse is to get a blood transfusion, YOU still have to get the blood and pay for it! Be prepared to roll with the punches to get what you need and don’t expect to get all that you want. Learn to make your best choice based on what is. Using that caution will actually help you to have many pleasant surprises.
The key piece that is missing here, and is so different than in North America, is that very few of the systems for hospital care are standardized. They are not linked with each other in networks capable of providing uniform service and a well-coordinated “chain of care” from onset of incident through discharge and follow-up. Generally – especially when faced with an emergency – you have to make that up as you go if you desire North American standards. It’s doable, but the path can be quite harrowing.
What and who is available today, may not be available tomorrow. If where you are at is threatening your well-being, the time it will take you to get to another facility, with properly trained personnel, could significantly affect your recovery time. No matter where you end up, you may have to both obtain and pay for life-saving materials. You may need to provide your own translator, personal attendant, and “runner” during a hospital stay. If an emergency places you in a nearby hospital, you may even have to obtain your own food until you can be transferred elsewhere.
Time and place have everything to do with the level of health care you can expect in Ecuador. My point is, the more involved or complicated your medical needs, the more care you must take to prepare, in advance, to manage your progress through the system.
The more money you have makes it more likely you’ll be able to be taken care of at a private facility. In Ecuador, however, you often encounter a whole lot of variables on the way to getting to the right one. Having health insurance does not mean that you don’t have to pay a hospital up front; it could boil down to the mood of the administrator on that day.
The reality is, once reassured that healthcare is available here, and there’s plenty of insurance to cover it, most expats don’t give a second thought about medical difficulties until they’re flat on their faces.[/color-box]
Medical Training Perspectives
All too often I hear expats, new to the area, remark that since they know treatment at the Public Health facilities are free, if they get into trouble, that’s where they’ll go.
Let’s add some perspective by learning about the training that Ecuadorian physicians go through:
In the first two years, basic sciences. In the third and fourth year, the clinical phase, a combination of theoretical and practical classes. The fifth year is called Externado, because you have classes outside and inside the hospital and work there. The sixth year is called Internado Rotativo, and you are called an intern, that is because you are practically living in the hospital. You are hired by the hospital, receive a salary and are considered hospital staff. (paraphrased from http://globalmedicine.nl/issues/issue-7/studying-medicine-in-quito-ecuador/ )
From there you are assigned to a Rural Hospital or other facility in the Public Health Sector. There are no “permanent” assignments which mean the Ecuadorian system has a moveable cast of characters manning the fort. At some hospitals it cannot be guaranteed that a physician will be on duty 24/7.
According to Andean Health Development, an educational center seeking to raise the standards of care in Ecuador, (http://www.andeanhealth.org/about-2/page-3/residency-nurse-training-program/ ) “Physicians and nurses working in the public sector are generally hired straight from medical school with little or no hands-on training.”
During their last year (in some cases more) training the medical student’s exposure to emergencies is typically limited to a short-term rotation through the emergency room. The new doctor is assigned to the hospital as a whole and will not pursue a specialty in emergency medicine until after their Public Health service.
Non-city areas do have experienced doctors on staff. Their hours actually AT the hospital, however, are varied and limited and they are not always in town. And don’t forget, Holidays are really taken here!
Sometimes, the Public Health doctor will have more experience than their recent graduation from medical school, and there are usually experienced nurses on duty at the hospital.
The important thing to consider, however, is that you cannot count on a consistent level of trained personnel available to you when you have a critical need.
You now have a basic understanding of the system the doctors come through that leads them into other services like IESS and Private facilities. Keep this in mind when you assume the Public Health sector is standing ready to serve all your medical needs.
An earlier article I wrote for Gringo Tree “Understanding Ecuador’s Emergency Medical Services” helps explain in more detail why the needs of the expat population are out of step with the medical needs of the country as a whole.
Backup Plans Are A Smart Move
Regarding IESS, as full disclosure, I myself am covered by it, and will continue to pay into the system, even though I private pay for most of my medical needs. In the three 1/2 years I have been part of the system, I have found it bureaucratically daunting but manageable. The overall care has been good to excellent. Yes, I have been to a few appointments that never happened, and I’ve learned it’s foolish to go without a translator unless fluent in Spanish. However, most important of all, I have a backup plan in place and am prepared to get everything handled out of the system.
Overall, I’d say for non-exotic/non-emergent healthcare concerns, if you’re patient, you’ll get well-taken care of. I even know a couple of people who have undergone successful surgeries including open-heart and have had nothing but praise. I also know people whose lifestyle and medication-complicated emergencies sealed their fate, however, because they didn’t have instant access to equipment or procedures or expertise that they took for granted up north.
Public Health Realities
In 2016 IESS has been under a lot of financial strain. The monthly premium was reduced, apparently to encourage more people to pay in to the system. This is not a rebate due to abundance; it’s about raising the money to meet its subscribers’ most basic healthcare needs. The most recent earthquake has increased financial pressure significantly. My point is, don’t assume you’ll be covered for everything you need when the going gets tough; the going is already tough for Ecuador.
Theoretically, you can have an emergency and go to any hospital in Ecuador and IESS will foot the bill, however, I have recently heard of people who have been refused service in other than IESS hospitals unless payment in cash was made because IESS was in arrears for earlier admissions.
Private Health Care
Private hospitals and clinics are often subject to many of the same challenges that I described above. You honestly do not know from hospital to hospital unless you investigate. The onus is on you to do the research you need and ask the questions you must ask to figure out where you’re going, especially before you are in the middle of an emergency. If you’re moving here and have unusual illnesses or vulnerabilities, make sure you move into the neighborhood of a hospital that can handle you.
As example, one person I knew had an apparent heart attack. Four hours, thirty miles and two hospitals later he went into cardiac arrest in the emergency room of a private hospital. They could not find a defibrillator in the hospital that worked. He died. Another with chest pain had to go to four hospital emergency rooms before she could find someone versed in cardiology, this in a town of about 150,000.[/color-box]
Health In Your Own Hands
Among the top five major reasons that expats leave Ecuador are challenges with the health care system. I would hazard to guess that “inconsistency” is a major factor leading to that decision. Ecuador, the land of “You never know” is on an economic roller-coaster once again. It hasn’t had a period of stability long enough to get all of the parts of its healthcare system coordinated as can be found in developed nations.
Please don’t get me wrong. I believe there are many aspects of healthcare in Ecuador that are SUPERIOR to what I’ve experienced in North America.
A major reason things are so homogenous in healthcare “up there” has been litigation. Although it appears to be a safety net, in reality it has taken self-determined, community-based healthcare out of the hands of the individual and placed it into the hands of a costly machine.
Once you accept that you’re on your own down here, and subject to a system with many human foibles as opposed to a well-oiled machine, you just have to take the time and responsibility to prepare to work around the inconsistencies within the system.
My Mother, the last two times she was in US hospitals, getting the best care money can buy, they have made serious (mostly life-threatening) mistakes over and over. I prefer the Ecuadorian health-care system, where I can access first-rate care (AND get second / multiple opinions before deciding anything!) affordably. I appreciate your eyes-open appraisal that shows you appreciate the many advantages we have here, including ready access to a wide range of alternative therapies!
Who ever wrote had a slat to their article. I prefer people tell me what was wrong with their system so i could try and work around it because i am flexible. I would rather have suggestions on where to go best doctors best hospital best service and ignore the digging into agitation. I already know places here will not every become constant it just impossible. Its like asking a Latin man to stay calm don’t work. I have lived here a long time. I come with a book, a drink and a plan to sit and maybe something will happen. Now one comment showed your feather comparing American hospitals to McDonalds. I stay in Ecuadorian hospital for 2 weeks i was the only person that spoke English I didn’t eat for 2 weeks. Only saw 3 doctor and we couldn’t communicate so i could get mad but it was not good. I never yelled or said a work i let go. But
The IESS hospital has fallen in the economy and it is not what it was before. No $$$$$ and that can ruin a hospital. The doctors are not polished in any way. I could tell stories where they almost almost killed me.
They do not like gringo’s i am sure and it is on the face its ok. But one nurse was so rude to me the Spanish women in my room let her have it wow. So there are a few people that know it is not always the north American way.
Rude, selfish and told my friend who is black we are not operating on her we are going to make her sit. She did not realize the black women could speak Spanish hahahah she sat there waiting for the operation and the doctor came out late where were you??? She told him what the nurses had done and she has been there
Since 7:00 am wow. He apologize and rearranged the operation and promise the ladies would not be there when she comes back. The doctor was wonderful mine bad twice. So i rather read about how you handle the
I was never told you bring your own toilet paper in iess and kleenex and toothpaste and and and. I would suggest a pillow and an extra blanket especially with lung problems. I would suggest sorry but every day you have to send someone you know to a pharmacy to get medicine? Surprise every day. I never said a word
Pneumonia and they couldn’t find a antic biotic to work i had no operation no real communications and the bill was $2000.00 i went from size 16 to size 9 so you know we were so thrilled to leave. Please don’t address other countries or compare one another it depends on hospital and doctor/ so in return i was sad
To learn in Ecuador if a family doesn’t want your excellent health care they can cancel it and buy private health insurance which i have and have a choice to go to 3 hospitals and they will come and help me with language wow. First doctor they sent me to was excellent and on time i was very impressed unlike iess which we all know is falling fast no $$$$ out of money. Oh i could get meaner but no reason i am here
For weather low cost of living and the charm but the charm does ring out all the time but that is ok
I rather have them be racist to me then me be racist to them i am past that completely.
Its sad when professional people give a bit of advice and it would make their life better in wendy’s if they tired it. We never grow when we don’t listen obama learned that one too. I think you slipped over everything and didn’t look from different angles. American hospital make a lot of mistakes as does Ecuador they both have problems but they different. But again no place has consistence no where restaurants, oh i have found an unbelievable excellent pharmacy top of the line i am thrilled and robert is a charmer and knows his stuff he even emails me and i order early wonderful i have recommend 20 people to him and they all are so happy.
Love this article. I work in the healthcare system in Canada and the same applies in our country about doing your homework about the services in your area, in particular, if you have pre-existing conditions. For example living in one of our smaller, coastal communities in BC with a serious heart condition may not be a wise choice. They may have exceptionally trained staff, however not have the expertise or diagnostics to deal with a stroke or heart attack. They will often have only 1 or 2 nurses on staff at any given time, which is not exactly called a ‘code team’ . These communities are also prone to being ‘snowed in’ during periods of time, making medical transport challenging.
The same applies here in Ecuador (without the snow issue of course!). If you choose to live in a smaller coastal pueblo with a known heart condition, from a medical standpoint, it may not be the wisest choice of locations for you. They are not bringing in the Medical Chopper to take you out to a larger center if you present with chest pain. You might have available an old ambulance…. the important word being ‘might’.
We are lucky here in the Santa Elena province to have some hospitals that handle a variety of conditions, like orthopedic trauma for one example. however, the track record for Heart & Stroke and Internal Injury is debatable and I would recommend transport to Guayaquil for any of those conditions which delays treatment by nearly 2 + hours.
Russ, great information and a great reality check for those coming here.
Thanks for the good article Russ. We have been through two life-threatening medical situations where we have been both lucky and have learned from past experience that we have to be aware and navigate health choices as skillfully as possible. As an aside, health care Stateside may not be as homogeneous as you think. Doctors seeing too many patients for too few minutes at at time, supposed cost-lowering hospital diagnostic protocols, and other factors can lead, particularly in smaller communities, to misdiagnosis and/or mistreatment. Depending on state laws and organization – legal recourse is not an option in some areas, as hospitals will simply out-lawyer you, bringing in ‘experts’ to support their case.
I just read the article about health care in Ecuador. We lived in Quito from 2010-2014, and we moved down there with our eyes open, since my stepson had lived there since 2000. We took out a private health plan with Cruz Blanca and were very pleased. While there, I developed 5 blood clots in my right leg, at the same time, was treated expertly by a vascular surgeon, later had an emergency appendectomy, hospitalized at the Cruz Blanca clinic in Quito, again with expert care, private room/bath/shower, and walked out in two days paying $128 cash. Again, expert surgery and no complications. The physician who diagnosed it had come to our apartment for $25 cash. Our premium was $300 a month, with a young Ecuadorian boy on the plan (required). Co-pay for all visits, even general ones, was $2.50 cash. But…we knew that if anything major happened, we would be put in the Hospital Metropolitano in Quito, with equivalent U.S. prices. That would deplete savings in a hurry! We had to return to the U.S. for further health concerns, where we now have Medicare and we took out private Medicare supplements to cover all costs, but…we ended up with around $750 per month in premiums. We were very pleased with the medical services in Ecuador and felt the physicians were as good as any in the U.S. With plenty of money to cover any accidental medical costs, I would not hesitate to move to Ecuador, at a reasonable age. Mary Jane Bryan, Author.
Sam, Dodie, Steve and Mary Jane. Yes, it is true that there is inconsistency in treatment up North, perhaps it’s not quite as homogenized as I portrayed. Just like Ecuador, perhaps, you can find yourself at the wrong place at the wrong time. However, the information/propaganda that we are fed “up there” is that you never have to worry; that the “system” will take care of you. When you bring that belief system down here and do not take complete responsibility for educating yourself about #1) your own medical needs, and #2) what services, personnel and skills you have available to you IN YOUR IMMEDIATE AREA, you’re setting yourself up to blame Ecuador for your complications. One of the first things reported to me is how, almost as a matter of course, when expats come here on the (typical) 8 + medications they are used to receiving at “home” the doctors immediately bring them down to a manageable few. This alone requires a sea change in one’s thinking and an adjustment period where lifestyle change becomes paramount. Bottom line, Ecuador requests, if not demands, that you start thinking differently, and nowhere is it more apparent than in how you handle your healthcare needs.
WHAT? I have to THINK! And be RESPONSIBLE for my, WHAT, I have to make CHOICES??? And TAKE CARE OF MYSELF??? What kind of no-nanny-state is this turning out to be!
Next, you’re going to say I have to deal with reality like the rest of the world. Come on, this is a joke, right? Tell me there’s a public health care system out there that’s cheap and fast, with perfect people, equipment, protocols, procedures, materials, transportation and even food. Sort of like a,a…McMedical fantasy island?
Ok, sorry. I’m better now. That caught me feeling a bit smarmy at the moment about how easy most of us Americans have it compared to the rest of the world…and how much we tend to take that for granted.
Thanks, Russ, for the eye-openers and reminders. And everybody else for your contributions. I’ll take my ball and go home.
Russ, I don’t know what planet came you from. I don’t know how long have you been living overseas. I don’t know what your high expectations are when you leave your golden nest and move to another place that is not of your liking, such as an UNDERDEVELOPED COUNTRY. But if you move to an extrange place, do your homework and before hand ask, read, study investigate their culture and traditions, their services, security, etc, etc. Learn their language so you can communicate and understand their ways of living. And if it does not fit your high standards, stay home. do not move. I have been living in the USA for a long time, my children were born here. and I can tell you of some very bad personal experiences with the health system in the USA and I had to deal with that, because it happens everywhere not only in UNDERDEVELOPED COUNTRIES, as you call Ecuador. If you are not happy in one place, move.
That’s exactly what I did, Hernan. My personal medical standards were better met by Ecuador precisely because I had to take responsibility for myself in a more wholistic way. This is not a pharmaceutically oriented system. It is not costly machine-dependent, nor is it ruled by litigation. The point of my article is to make other expats more aware of some of the adjustments they will need to make in their thinking to adapt to a system that does things differently. The truth is, and as I’ve explained in other articles noted, the age, general state of health and accustomed treatment regimen of the typical North American Expat is simply out of step with the demographics and most pressing needs of the Ecuadorian people. Ecuador is not the problem, nor is North America. The problem is with those who refuse to understand that things are done differently where they are as opposed to wherever “home” is.
I think Americans need to dispossess ourselves once and for all of the notion that American health care is healthy. In addition to Mike’s reference above to the US being ranked 46th in the world…
-The Journal of Patient Safety study, Evidence-based Estimate of Patient Harms Associated with Hospital care, documents that 400,000 American deaths *oer year* are associated with preventable harm done to patients in hospital settings. These aren’t infections people would have caught anyway. They are mistakes that cost lives.
-Hospital errors are the *third-leading cause of death to Americans* after heart disease and cancer.
-Hospital errors *kill three times more Americans than HIV*.
-Hospital errors *cause one-sixth of all deaths that occur in the US each year*.
In 2010, the Department of Health and Human Services said that *bad hospital care contributed to the deaths of 180,000 patients in Medicare alone!* Source: http://www.npr.org/sections/health-shots/2013/09/20/224507654/how-many-die-from-medical-mistakes-in-u-s-hospitals
Beginning in 2009, *more Americans were killed by drugs than motor vehicle accidents*. Source: http://articles.mercola.com/sites/articles/archive/2011/10/26/prescription-drugs-number-one-cause-preventable-death-in-us.aspx
About 570,000 people die annually in the U.S. due to pharmaceutical drug use. That compares to:
-480,000 deaths related to tobacco
-about 31,000 due to alcohol
-nearly 22,000 due to overdose from illicit (illegal) drugs, and
-close to 23,000 due to overdose from prescription pain relievers.
If you do the math, the American health care system must kill-off the *equivalent of the population of Ecuador* about every seven years.
n fact, on an international scale, the Ecuador health system was ranked in the top 20 of efficient healthcare systems by the most recent Bloomberg analysis of World Health Organization (WHO) information— In contrast the United States is ranked 46th.
Personally, I agree with the facts; that healthcare in the U.S. manufactures more illness than it corrects. It also makes tolerable living with chronic, age-related maladies. But making comparisons of the U.S. to Ecuador is not useful. You have to remember, the demographics of the U.S. are wildly different than that of Ecuador. About 60% of the population in Ecuador is under 30 years of age. It’s medical system is quite efficient for the needs of its population. When you talk about expats, however, who are predominately in their 60’s plus (please refer to my article https://yapatree.com/understanding-ecuadors-emergency-medical-services-ems/ ) you’re talking about a completely different set of needs that have become dependent on a pharmaceutically and device-oriented medical culture that doesn’t exist down here. You will not have access to the volume of trained practitioners, meds, and equipment down here that you have learned to depend on up North. All that means is that you can’t leave your medical needs to chance. You must investigate and learn which facility/medical staff are equipped to handle what you have BEFORE you run into an emergency. Especially for those who assume that care for those of advanced years who have largely lifestyle-related illnesses is comparable in the two areas, don’t forget that you’re a square peg trying to fit into a round hole.
I really appreciated this article Russ. Learned some valuable things. Definitely an important counter perspective to what one would read in International Living for example.