A DOCTOR A DAY…

Keeps the apple away??? Ok, so it’s been a confusing couple of years, right? Though everything is relative for sure. Others have had/are having it much worse. Still, a tough enough year (since last April) that I’ve found it quite hard to sit down to write. Anything. Not only did Covid put a hold on socializing and motivation, but Ben has been dealing with multiple health issues, bringing pretty much everything else to a halt for a few months. 

Navigating the medical system here, especially compared to my comfort level with the US system (even its foibles), has been a major learning curve. People always ask when they find out we’re here – How is the medical care? It’s a 3rd world country, right? So how could it even be decent? But it is. In fact I would say the only thing they lack in some cases is organization. It’s been frustrating to go in for an appointment only to be told you were down for tomorrow, not today. Even when you have the card they wrote on to prove otherwise. Computer scheduling systems don’t seem to exist. Or does it?

But mostly it’s been ok. 

The toughest part I’d say is dealing with specialists who come only once or twice per week from Guadalajara. Sometimes appointments book fast and you’re left with either waiting weeks or traipsing into the city of 6 million, hoping your GPS works accurately. (Ours didn’t recently and we were 45 minutes late for an appointment. “No problem” the doctor himself said when I called to let his office know. “We’ll wait. And I’ll send a map to your WhatsApp”. Would that ever happen in the States?)

WhatsApp is a big deal here. For all kinds of businesses. It’s the best way to communicate with some doctors, though busy as they are they may be slow in answering. In a recent encounter the doctor let me know that she only reads her messages in the evening and we need to call (WhatsApp) if it is urgent. Links to office information and directions are often done on WhatsApp when Guadalajara is involved. In Ajijic and the surrounding Lakeside area phone calls and sometimes emails suffice.

Lab results are emailed to you and your doctor usually in a timely manner though there are times you have to remind them. Delays are sometimes blamed on computer issues which can certainly happen with an overload on local systems. Diagnostic test results are handed to you within minutes. Colonoscopy, CT scans, etc. You pay your bill and leave with results in hand. It’s up to you to follow up with the doctor who ordered the tests.

In hospital you are not discharged until your bill is paid. Some accept cash only, others (higher end) accept credit cards. Your IV remains in your arm and your medicines stay in the nurse’s drawer until you return to them with your stamped receipt.

Insurance. Some take Medicare Advantage plans for emergencies. We haven’t experienced that yet. We’ve paid out of pocket for everything. Consider that a colonoscopy costs as little as $390. Doctor visits run $17-50.

We bought a MetLife policy here through a local agent but it requires obtaining facturas, an official receipt that office staff are totally annoyed by. Good luck convincing them to get it to you. And if it’s from last year – or even last month – forget it. We finally realized we were drowning in papers trying to make it all work so we made an appointment with our agent. Why didn’t we call before? Looks like – we’ll see – they’re going to do most of the work of tying it all together and submitting it. Of course, then you have to wait and hope for approval. (Last year when Ben needed a procedure, approval was taking too long. The doctor himself told us to meet him in the ED of a specific hospital in Guadalajara then insurance would HAVE to pay. The doctor and the hospital were paid on the spot. We’re still waiting for reimbursement for tests, consultations and medications.) If you forget to get each receipt, medical order, lab and diagnostic results, good luck. There are no connecting computer systems here that I’m aware of. Now, after the fact, I’d say collect it all in a very systematic manner. Organize. Organize. Keep good records. Keep everything. Ask for help along the way. Someday maybe we’ll get the hang of it.

Most doctors here are trained in top notch medical schools in Guadalajara or Mexico City. They speak excellent English (though the accent can be a problem if you’re hard of hearing-take someone with you to interpret), treat you like an equal, and for the most part are adept at explaining everything, including costs. You definitely don’t get much of that in the States.

We have friends whose doctors have actually taken them to Guadalajara facilities for tests. Friends whose doctors have made house calls to administer IV fluids. Our GP came to the house last year to test us for Covid after we’d been exposed. Hospice doesn’t really exist in this area. Families take care of their elderly and doctors handle palliative care in the home. I’ve recently learned of a home health agency for the gringo population and a large “continuous care” facility is well underway nearby. This is a retirement community and everything revolves around that. If you have the local government insurance here (similar to Medicaid), you are eligible for government run hospitals. We’ve been told that you must take food, blankets, and a companion for those hospital stays, as well as purchasing things like wound care products and sometimes even surgical “parts”. Lines and wait times can be quite long.

As a former nurse I’ve wondered what wages are here. A recent conversation with a radiologist was a bit shocking. For “half time”, as he called a 7-8 hour shift, 5 days/week, he earns 30,000 pesos per month or about $1500. The result is that professionals add extra duties (like coming to Ajijic clinics and working weekends) to increase their income. I have no idea what medical training costs are or if they have loans to be repaid as in the US. Mexico is pretty much a “pay as you go” country. I asked my dermatologist this week if medical training here is expensive. “I went several years ago,” she said, “and I think I paid the equivalent of $100 US dollars per year. And the training was excellent.”

As for routine care, there is a wide variety of GP’s, some Mexican, some not. There’s also a small hospital in the center of town that acts as a clinic. We’ve had diagnostic tests done there (again, can’t leave til you pay) and checkups for sinus infections, minor injuries, etc. Adequate, thoughtful care in a simple, clean facility.

The private hospitals in “Guad” are generally very nice, even hotel quality sometimes. Two privately owned hospitals have been built here in Ajijic since we arrived. Targeted for gringos. Like Anywhere USA, reviews are mixed. There is a functional medicine doctor here now and an acupuncturist or two. GP’s are somewhat versed in herbs and vitamins and happy to recommend according to your interest. (My gut issues have recently been soothed by guava leaf tea on my doctor’s advice.) As more gringos come to town demand increases and services arise to accommodate. It is an ever-changing world. In more ways than one.

I wrote this several months ago. Since then our interaction with the medical system increased dramatically. The biggest barriers were language and insurance approval. It’s a long story. Perhaps for another time. I will only say that in the end, though the medical care was topnotch and – according to a close friend and Physician’s Assistant in the US – right on target, Ben succumbed to Multiple Myeloma on July 3rd in our home surrounded by friends and caregivers. The last 3 months of his life were incredibly difficult but the support we received was, and is, overwhelming.