Cost of living, climate, leisure time activities, banking options, nearby schools, shopping, housing options, reliability and quality of infrastructure and last but not least accessibility to quality healthcare are some of the many things one must consider when selecting a new retirement home outside the United States or Canada. It would be tough enough to figure this stuff out if all of the items carried equal weight, but they don’t. Some items are clearly more important than others and each person has their own ideas as to the importance of each item and where compromises can be made.
Few would argue that cost of living should be at or near the top of anyone’s list, especially for those on a fixed retirement budget. After that, the order of importance can vary wildly from person to person; one person claiming that being near the mountains or the beach is of the utmost importance while another proclaims that a particular climate or altitude is most important or the absence of mosquitoes (Yep…I’ve heard that more than once). A couple of folks have even factored in the cost of beer and wine as a decision maker. I’ve not heard many, however, say that proximity to good quality emergency medical care makes their top three priorities but maybe it should!
As Ecuador is consistently ranked among the best places to retire, you would think that the weight assigned to good quality medical care would be significant. After all, folks who have reached retirement age usually have a few health issues. I’ve come to believe that those who provide these rankings have substantially missed the mark when it comes to Ecuador’s healthcare system.
To begin, Ecuador does provide free medical care for all who cannot pay. This system is provided by Ecuador’s public healthcare system. However, the care in these hospitals is often marginal with broken equipment, limited supplies and minimal staffing at the root of the problem. There are private hospital options available for a fee and the fee is substantially less than what one would pay in the states but these private hospitals are not widely available throughout the country. Additionally, one can purchase health insurance here at far lower rates than is available in the states. BUT, it is the quality of the available care and access to that care that is truly the issue, regardless of who pays or how much it costs.
Let’s start with routine medical care; you know… a doctor’s appointment for a routine exam or ailment. Almost every community will have a number of doctors who have earned the business of locals and expats alike. Their fees are a mere pittance compared to what most of us have paid in our previous homeland. Many of us have grown accustomed to seeing a doctor on a regular or semi-regular basis, particularly as we age. We need the doc to provide his note that we then take to the pharmacy and retrieve the necessary pills and potions to assist in repairing the ailment. But come on! If we have high blood pressure, we know we’ll get a note from the doc authorizing us to purchase some pills to lower our blood pressure. Skin condition? Another note from the doc and another trip to the pharmacy. Arthritis or an infection somewhere? Yet another note, one more trip to the pharmacy and so on and so forth. After some many years of going through this process, most of us have learned what medications will be prescribed for each ailment as we dutifully followed protocol and process to receive the meds we needed. Things in Ecuador can be much different.
I don’t see the doctor often. As we are well into our second year here, I’ve only seen a doctor once and that was to have a small “thing” examined and removed from the top of my ear. It isn’t that I don’t have health issues. In fact, I have a number of significant issues with an impressive and thick medical file through the VA system back in the states. It’s just that I’ve already been diagnosed, take a number of required medications and just move forward day to day without issues. There is no need to see a doctor to have my prescriptions renewed as is the case in the States; a for-profit system designed for maximum profitability.
In Ecuador, one can simply go the pharmacy and buy what is needed each month without any prescriptions. The cost of medication here is literally pennies on the dollar compared to U.S. prices. So, I find that I really don’t need a doctor for much of anything…unless, of course my life needs saving. And that brings me to my point.
Ecuador’s medical care is a mixed bag!!! In the major cities of Cuenca (deservedly ranked as a top contender for a retirement destination), Quito and Guayaquil, modern hospitals with capable staff and functioning equipment do exist. If one should have a medical emergency that requires top-notch treatment and equipment, those three cities can save your life. That is not the case throughout the rest of the country.
In other cities and smaller communities throughout Ecuador, what passes for a clinic or hospital is often poorly staffed, marginally equipped and ill-prepared to deal with true, life-saving emergencies requiring trained staff, functioning diagnostic equipment, adequate blood supplies and basic trauma care.
Diane and I have received the up-close and personal looks inside the hospital system in Ecuador and while our experiences have been limited (meaning we have not been to every hospital in the country), I will share what we have experienced.
Several months ago, we were hosting a family of five who had come to Ecuador for a vacation and to assess Ecuador as a possible retirement destination for the future. The matriarch, carrying a small child, slipped off a curb and badly injured her ankle. The swelling and discoloration beginning immediately. It was a Saturday and we were in a small community away from our hometown. There was no hospital in that community so we asked where the local and best hospital was and received directions to the next nearest town. We set the GPS and arrived at the emergency entrance in about 20 minutes. The doors were locked. After some pounding, a nurse opened the door and two attendants came out to retrieve our injured passenger. Once inside, a doctor completed the examination and told the injured woman to come back on Monday when the X-Ray technician would be working. The woman was supposed to catch a plane home in just over an hour. After the injured woman agreed to pay a fee, the X-Ray technician arrived to take the X-Ray.
Most recently, the small granddaughter of a local expat suffered a head injury after a fall. The child was unconscious and had a seizure and was taken to the “better” of two hospitals in Bahia de Caraquez. The doctor explained that the hospital did not have the proper equipment to do the necessary diagnostics to determine if the child’s brain was bleeding. The parents were directed to another hospital in another city about an hour away, Portoviejo. Once there, it was learned that their equipment was broken and the diagnostic test could not be provided. The child was discharged with best wishes and worried parents.
Perhaps a year ago, another person was pleading on Facebook for donations of blood for a relative as local blood supplies were not adequate for a common blood type.
If you are the sort who might be comforted by a great bedside manner, a pat on the hand and a Latino doctor who speaks some English, there are a number of those around the country and I’m sure they are quite capable of caring for common ailments. That is not what I am talking about.
The point I am trying to make is that LIFE SAVING care for those having a heart attack or stroke or trauma care required to diagnosis and surgically repair a damaged spleen or liver after an automobile accident or the diagnosis of a small brain bleed is NOT readily accessible throughout Ecuador.
I am absolutely certain that there are some private clinics located in some locations that have done and continue to do great things, saving lives and improving others’ health on a daily basis. They, however, are the exception and not the rule.
Finally, I want to end with a chance encounter I had with a local physician a few months ago. I had settled in to watch the Pocket Babe’s tennis lesson, leaning against a pole as an Ecuadorian man wandered by and joined me. His English was a bit better than my Spanish and he began a conversation.
Turns out, he was a physician with an office in Bahia de Caraquez and another in Portoviejo. He said that he graduated from medical school in Cuba and then did his residency and advanced training in the United States. He went on to describe his dilemma and his disappointment with the state of the medical care system in Ecuador.
He said he possessed the benefit of outstanding training and yet, he was unable to perform to his abilities. His patients, he said, were dying needlessly because the hospitals did not have the proper equipment and if they did have the equipment, it was often broken. He also said that needed supplies were often not available.
As I said in the beginning of this post, medical care in Ecuador is a mixed bag. We are very much enjoying our lives here but, at the same time, recognize that our decision to live on Ecuador’s beautiful coast and not in one of the three cities with great hospitals does mean we are rolling the dice with regard to our health care options.
Just yesterday, I bought an entire month’s worth of my meds for $80. And I take a lot of damned pills as a heart patient. No prescription required. That’s great!!! Routine care is cheap and functional. That’s also great! But should Diane or I suffer a heart attack, stroke or severe trauma here in our chosen city, well…..The End! Our choice, for now.