Even in the midst of pain, there was one really humorous situation that I thought would be a good way to restart my missives here.

Those who are residents here know that you need your Cedula (National ID) number for EVERYTHING, even more than one uses a social security number in the US.  The Cedula is used in business as well as the government and the same number is used on your driving license and even passport.

Because of that, and because the numbers are simply issued in order, my Cedula number is relatively high, reflecting about 50 years less than my age–this caused a really funny incident some months ago.

I was having some health problem or another so one of the staff here called SEMM, the Ambulance/traveling doctor service connected with my health insurance at COSEM.  The SEMM operator didn’t bother to look at my file, but assigned a doctor based simply on my cedula.  As such, they sent a pediatrician, (it’s a good thing that Cedulas don’t indicate sex or they might have sent an obstetrician).

When the doctor arrived at the main gate she asked “¿donde esta el bebe?”   Someone explained the mistake, but the doctor said that since she was here, she would take a quick look at me to ensure the next doctor sent was the correct one.

As she came into my room, my assistant explained the foul up and after greeting the doctor, I told here “Soy el bebe grande.” (I am the big baby).

Later that day another doctor appeared better qualified to treat “el bebe grande”.

(To those who speak better spanish than I, I apologise for any acentos I have missed or mistakes in translation–perhaps I have simply become too accustomed to “masomenos”.

But there is a catch:  directors of corporations cannot participate in the BPS connected health insurance plans, even though they pay into BPS.  So much for socialist fairness.  Directors have to pay for private insurance–what a great way to encourage new business in Uruguay.

So, even though the owner/director pays into BPS for himself and his employees, he is barred from benefiting.  I wonder who thought this idea up:  Larry, Curly or Moe (or maybe Shemp or Curly Joe)…

However, there is a way out.  You can set up an Uruguay domestic company and then hire nominee corporate directors from outside the country.  Those directors can then give you a total power of attorney to operate the company, bank accounts etc, as an EMPLOYEE, and thus eligible for health insurance.

Another way is to set up an unipersonal, a sole proprietorship, but that has other issues.

This is one more example of why I say I love living in Uruguay but hate doing business here.  Sometimes I think the government is trying to intentionally keep Uruguay poor…

I was the “guest” of Ospidale Italiano (Hospital Italiano)for two weeks, during which time I had two surgeries.
The most amazing thing about my two weeks there was that everyone seemed to really care about my health and about doing their respective jobs properly, and, even cheerfully!
I suspect there is some infinitesimal grain of truth in the claim that I am “not the easiest patient” one could have—though I can’t imagine on what basis such could be claimed.  Nevertheless, the nursing staff were unfailingly pleasant, every during the most difficult periods—nurses in the US would surely have strangled me with my bed sheets or at least smothered me with my own pillow.
One night, I even received a visit from the Chief of Surgery at Hospital Militar.  He heard I was in hospital at Hospital Italiano, and since he had another patient there, he stopped in to chat with me for 15 minutes or so.  I was incredulous.
Perhaps even more amazing was that two or three times during my stay (I can’t remember which due to the medications dripping into my veins) a representative from COSEM stopped in to make sure I was satisfied with the care I was receiving!  I cannot imagine that happening anywhere else.  If I had told a US insurance company that I was pleased with the care, they would have moved me to a cheaper hospital that afternoon.
I could go for pages with the random acts of kindness I received, and which I never experienced in hospital anyplace else in the world.  I simply do not understand why anyone would want to go to the US when they have a medical problem and endure its faceless, money-driven bureaucracy.
Since then, I have returned to Hospital Militar to have the balloon removed from my stomach (after having lost about 35kgs), and my plans included several more hospital stays in the coming months.  All will be in Uruguay, and while I don’t exactly look forward to them, it is easy to face them optimistically.

Providentially for me, I enjoyed decent health until the accidents that crippled me in 1998. By that time I was living outside the United States, so I was able to afford health care even without insurance. (Admittedly, some of the health care was provided by practitioners whose credentials might be considered by some–anyone with an IQ above 30 –as suspect. I remember that on the island of Nevis they only had one class of physicians, and consequently even Chiropractors could prescribe drugs- “take two of these pills daily, and return three times a week forever”. The the university degree of the chief health officer of the island, a doctor whose name I do not remember, was R.N.)

But all of that changed when I came to Uruguay! Every legal resident who pays Social Security is entitled to choose from among several HMOs which are totally paid for by one’s Social Security contribution. In addition, there is also a government health service to care for the needs of the poor, and private health insurance as well (for which I could not qualify because of my pre-existing conditions).

Since I am working and paying social security I now have health insurance. Santiago researched the various plans and chose COSEM because it was reputed to have the best doctors and the newest facilities.
Eight days ago I went to COSEM for the first time to see a general practitioner in order to get a referral for a specialist. I was impressed with the modern facility. I did have to wait about an hour to see the doctor, but I have waited longer than that in the US and then had to pay $120 for the privilege. This visit cost me nothing. The doctor gave me a referral to a dermatologist to deal with the skin on my left leg which had been ravaged by a seven-year long staph infection.

Perhaps the most impressive thing was that the doctor did not tell me to put Dr. Selby ointment on my leg–in Uruguay Dr. Selby is the equivalent of “take two aspirin and call me in the morning”.

Santiago went to the front desk to make the appointment for me. He was told that there were no dermatologist appointments available for more than a month. However, the general practitioner had marked my need as “urgent”, so the scheduler told Santiago he would find an appointment for me quickly and call us with the time and day. That was Friday, March 7.

My appointment with the dermatologist was on Tuesday, March 11. I don’t think I could’ve gotten in that quickly in the US under any circumstances short of third-degree burns covering 80% of my body.

When the day came for the dermatologist appointment I cleared my calendar just in case there would be a long wait. To my pleasant surprise, there wasn’t. I was the second person on the list, and don’t think I waited more than 10 minutes. The dermatologist was knowledgeable, and gave me some prescriptions that have helped me tremendously. I started seeing improvements very next day. Some of the things the doctor prescribed were available right there at COSEM’s pharmacy and were extremely inexpensive. The rest we had to buy at a local pharmacy, but the price there was discounted as well because of my COSEM membership.

The whole process was easy, and frankly, encouraging. Virtually every encounter I have had with physicians in Uruguay has been positive.

I say virtually because there was one doctor that I had to endure who started out with the tired old litany of “you’re overweight”. Gee, really? I didn’t know that: I thought I was the perfect weight for someone 7’6″ (2.25 m). That encounter was actually pretty funny because, as she was talking, in Spanish of course, Santiago became visibly upset. He told it was because he knew I would not like what she said. I told him that I would absolutely not be angry or upset because I intended to ignore her completely.

Those who know me even casually know that I am a libertarian/right-wing nut. By rights, I should hate the medical system here. But I can’t, because even before I am a libertarian, I am a utilitarian; and Uruguay’s medical system WORKS!

The Doctor charged US$300 for he and his team.

The Hospital charge me US$400 for the private room, the srugical suite and miscellaneous items.

The US made balloon for my stomach cost US$1700 and we bought it directly from the medical supply house, it was NOT marked up by the doctor or hospital.

Hmmmmmm…..

In the morning of Thursday July 6^th, at 0:dark:30, my entourage assembled for the procession to Hospital Militar.  The Southron was accompanied by Borko, Santiago, and our newest assistant Oscar.  I was wearing my usual very stylish sweat  suit with a fishing vest for added protection against the cold.  My entourage was all in coats and ties, and the four of us looked as if people should be addressing me as Godfather.

The trip for the house to the hospital should have been easy.  However, since the Land Rover decided to start overheating 12 hours before, we decided it was more prudent to go in two taxis.  Consequently arrangements were made for a relatively large taxi.  It was big enough to accommodate Borko, Oscar, my wheelchair and me.  Santiago had prudently asked the taxi driver who brought him to the office to wait and take him to the hospital as well.

The trip to the hospital was uneventful; though we saw an entirely new route there.  The taxis took advantage of the fact that we were the only people awake in the whole city and flew through side streets that provided the most direct approach to the hospital, but which would have been unthinkable had anyone else been on the streets.

We arrived at the hospital unscathed and ahead of time.  (I am not sure that there is a word in the Spanish-language for being early–it is simply not needed.)

For some reason there is no interior connection for the public between the two sides of the hospital complex that merge at the Emergency Room entrance.  The door to the right leads to the lobby and the tower on Avenida Centenario where the examination rooms and administration offices are located.  The door to the left leads the tower on Avenida 8 de Octubre where the patients’ rooms and operating rooms are located.

The Portera answered the bell and let us into the Octubre building.  Then Santiago went back out so he could go into the Centenario building to get me checked in with the administration offices.  A few minutes later he returned with a nurse’s aide, who escorted us all to my room.

The reason they send an escort is to prevent missing persons reports being filed on people wandering lost through the maze:  down a short hall, turn left, go to the end of the hall and turn right, go past the steps to the elevator and go up a couple of floors, get out, turn left wander down the hall a piece, take a dog leg to the right into a large corridor, turn right into Sala 6 and take another elevator up a few more floors.  Then I got worried.  If my Spanish was even half correct, the sign said I was going into the maternity ward—hmmm…

We finally reached the nurses station at which point Santiago entered into a colloquy with the nurses.  After some discussion, Santiago and a very attractive blond nurse wandered down the hall looking for a room into which they would lodge me.

After an indecent interval, Santiago beckoned and our waiting trio sauntered towards room 17.  It was now 0645 and I was due in surgery at 0715.  We had time to spare.

At 0705 I began to worry—we had been told the operating room was booked solid the rest of the day after me.

At 0720 Santiago decided it was time to see if he could find out what was going on.  Ten minutes later he was back.

Doctor Piazze and his team were waiting for me in the surgical suite—we were waiting for them in my room.  The people who were supposed to transport me from the one place to the other were nowhere to be found.

I took an executive decision and had Borko push me to surgery—after one abortive attempt in the surgical ante room to load me onto a gurney that cracked and sagged dangerously; all agreed that Borko would take me to the operating room doors and shove me through them into the waiting hands of the operating room staff.

Dr. Piazze introduced me to everyone and after an exchange of pleasantries I clambered up onto the operating table, which gratefully, did not sag or even creak.  I settled onto my left side, a needle was put into my right hand for the anesthetic, a plastic bit was put into my mouth to keep it open wide for the procedure, and the last thing I remember before going out was something resembling a garden hose being shoved down my throat.

I don’t remember getting back to my room.

Later, I heard people talking about a garden tractor and trailer in the halls, but decided I really did not need to know.

I slept most of the rest of the day.  I did not feel any pain.  There was an obvious mix up in food services—I was left 4 dry saltines for dinner.  (Had I been in the States I could have tried to eat them and then sued the hospital when everything went wrong.)  Instead, Borko got me some peach juice and that seemed to suffice.

The next morning the Doctor checked me and said I could go home.  Since then I have done pretty well.  I have had a few problems with vomiting—more with a feeling of being bloated—lots of gas and loss of appetite.

Maybe the maternity ward wasn’t a mistake…

]]> http://www.uruguayliving.com/2007/07/17/a-day-in-the-maternity-ward%e2%80%a6/feed/ 2 http://www.uruguayliving.com/2007/05/19/the-lazarus-prospect%e2%80%94a-medical-adventure-begins/ http://www.uruguayliving.com/2007/05/19/the-lazarus-prospect%e2%80%94a-medical-adventure-begins/#comments Sat, 19 May 2007 18:01:56 +0000 The Southron http://www.uruguayliving.com/2007/05/19/the-lazarus-prospect%e2%80%94a-medical-adventure-begins/ Last week, I took the first small step in what will surely become my biggest adventure in Uruguay to date. As my regular readers know, after seven years of torment, the Staph infection in my leg is finally gone. The two worst results of these long years of infection and rigorous treatment have been a ravaged immune system, and a doubling of my weight.

The short story is, that unless I want to stand before the Heavenly Throne in very short order, I need to shed 100 kg (about 220 lbs) of weight–in other words I need to lose more than an entire Copperhead in body weight. At this point, the only way to achieve that is through surgery. My body has just been too messed up by the years of infection and powerful drugs to admit of any other course of action.

I’m not going to go into all the medical details, because this is not a medical blog, it is a Uruguay blog. Nevertheless one of the big things on the minds of so many people considering a move to Uruguay is: “What is the quality of the medical care in Uruguay?”

From my perspective, it is superb!

It is very different from the medical care to which people in the US have become accustomed. Treatments here are based primarily on the science and art of medicine and NOT on insurance companies’ actuarial tables or anticipatory defenses against lawsuits by junkyard dog attorneys.

The first thing one notices is that the attitude of a doctor here is infinitely less haughty than most of his American counterparts–their bedside manner is more that of a trusted advisor than some kind of Aeschylapian demigod. In reality, they come across as very much like the ‘good old local doctor’ of days gone by, before medicine in America was taken over and destroyed by the insurance companies and the government.

If this judgment sounds too harsh to you, let me tell you about my last two doctors’ appointments, and you can judge for yourself.

Last Thursday, I had an appointment at Hospital Militar to consult with a doctor about the possibility of weight reduction surgery. I met with Dr. Luis Taroco, who it turned out, was the Head of Surgery at the hospital. He was a chubby man of average height and the first words out of his mouth were, “you are expecting someone skinny?” That put me at ease, at least I wasn’t going to be faced with a lecture on my weight from a “body Nazi”. He spent the next 45 minutes detailing the options in front of me and explaining which one he thought was best and why. He told me the entire process through which I would have to go, and he even told me how much it cost. (I can’t remember the last time a Yankee doctor deigned to mention money.) That consultation costs me a total of 237 pesos Uruguayos, about 10 Yankee dollars.

At the end of the consultation I thanked the doctor and gave him a copy of my book about living in Uruguay.

Later that evening, I received an e-mail from Dr. Taroco thanking me for the book and sending me an article in English detailing everything he had told me during our consultation. I was really impressed–I think that’s the first e-mail I’ve ever gotten from a doctor that was attending me.

Yesterday I had an appointment with Dr. Taroco’s partner, Dr. Pedro Rivero Amespil, in order to actually initiate the process that will lead to my surgery.

Their offices were located just a block off of Bulevar España in Parque Rodo. The building was an example of the fine, well preserved, classic architecture so often found in Montevideo. Marble floors and real wood paneling displayed the wealth of a previous time.

Santiago (a.k.a. Jimbo) and Borko (a.k.a. Bubba) were with me: Santiago, to translate and Borko, to drive and push the wheelchair–Borko is proud that he is one of the few people who manages to “push me around” on a regular basis.

Amazingly, for a medical office in a country that is so polite, and is so friendly, there was no handicapped ramp. Instead, I was greeted with three marble steps. Borko took the wheelchair and went in first, and I followed tottering along on my canes. It would have been sheer hell had I not been able to do so—I think a derrick would have been required…

The lobby was spectacular: more marble and wood dominated by an antique fireplace. On the left was a steep metal staircase that seemed entirely out of place, and that I was afraid I would have to try to scale.

We arrived 15 minutes early, so I expected a good long wait. To my surprise, a white coated gentleman descended the stairway within a minute or two, got a key from the receptionist, and led us back to an outside consultation room on the front landing of the building. The hand-made double wooden doors were opened to admit my wheelchair.

During the next 30 minutes Dr. Rivero went over much of the same information previously discussed with Dr. Taroco. He went on to tell me that their goal was for me to be the very first patient using a new laparoscopic surgical procedure which is far less invasive, hence far less dangerous than flaying me like a catfish. (I think its because I am the biggest person they have ever had squeeze through their doors.) I was told that tests would commence next week with the goal of surgery around the end of June.

Again, as with Dr. Taroco before him, I was impressed with Dr. Rivero’s manner–I really felt like I had gone back in time 40 years. The meeting ended with handshakes all around and that was that. There were no charges; there were no tests–the purpose of this meeting is simply to get acquainted.

Wow!

So, if you ask me in the future, “wouldn’t you feel safer getting your surgery done in America?”, and I just laugh and walk away, remember this post.

This is a full-sized, 8½ x 11 inch paper back, with color covers and black-and-white inside. Because of its large size is much easier to read than the pocket-sized edition produced locally.  The price for the full-size paperback is the same as the retail price for the e-book, US$30. For payment, lulu.com accepts Visa, MasterCard, Discover, American Express and PayPal.

One other note: there was a Yankee Naval vessel holding station a few kilometers offshore for my house–obviously they were here in connection with that politicians visit.  I didn’t mind the ship that much, until I noticed that as I went from room to room its weapons readjusted accordingly…

We also had a scare this morning when one of our group had to go to the hospital because of seizures.  Again, I am happy to report that he is home and doing well.  Tomorrow one of our depots BiPAs (bilingual personal assistants) will accompany them to help organize insurance to do with future problems.  This is good news as well, because this is the start of one more UruguayLiving program.

My plan is to self publish–we already have an ISBN number for the book and we are talking with a few big places about selling it. But before we can get to that, we need to do two things: set a price, and find a way to get paid. Paypal seems to be the answer to the second question, and I am hoping you can help me with the first.

To help you better make that judgment, you can download the first part of the book, the cover page through the entire first chapter from this post. This includes a very detailed table of contents for you to study.

Free Intro to The Southron’s Guide to Living in Uruguay

(From MS Internet Explorer right click on the above link and select Save Target As… and copy to your computer. You will need the Free Adobe Reader to open the file. You can get it at http://www.adobe.com/products/acrobat/readstep2.html)

Or go here:  http://www.uruguayliving.info/free.htm 

My plan is to also offer the book at a reduced price to retirees on limited incomes. I also will provide free updates during the first year to all registered purchasers. AND the book will be set up to allow printing at 120dpi.

I hope you will help me price this fairly. The “Owner’s Manual” published elsewhere is being sold for US$69/on sale for US$51. If this edition of The Southon’s Guide is successful, I hope to write a far more complete 2nd edition next year.