The Good, the Bad and the Ugly: Health Care in Puerto Rico

Whether you’re a tourist visiting the island or a resident, you can rest assured that Puerto Rico has top quality doctors. For whatever reason there are still well qualified doctors who choose to remain or return to the island. “Brain drain” is well known here. Companies entice university graduates to well paying jobs in the states; NASA picks students from UPR, Mayaguez like ripe grapes on a vine, but there are a variety of doctors and specialists all over the island 'doing medicine" and doing it well.

From my personal experience: an ectopic pregnancy, pre-eclampsia in another pregnancy, a basal cell carcinoma on my lip which could have left me looking like Stacy Keach under the knife of a not too steady dermatologist, I have gotten excellent medical treatment. I know both friends and family who have survived breast, kidney and prostate cancer, all receiving medicine at its best.So that’s the good news. From broken bones to root canals, modern medicine is on the island and doctors know their stuff!

The bad news is that you may die waiting for treatment. We’ll start with a typical situation for a non life-threatening stye. You call the office of the ophthalmologist who says to come between 7am and noon. You arrive around 7:30 and sign the list (number 20) and figure you have time to go for coffee at the truck outside. While you’re gone, your number was called so you lose your turn…finally you are called and you move to a secret waiting room to wait some more. After about 5 hours you see the doctor and are prescribed antibiotics to reduce inflammation and told to return for another appointment. For your second appointment you forgo your coffee and stay firm…you wait 4 hours and are told your stye looks better but come one more time…if it’s not gone, you’ll get it cut out. The next appointment is ‘cutting time’ so you have to go. You wait 2-3 hours and in 5 minutes your highly skilled doctor removes your stye. You have spent approximately 12 hours to get a simple stye removed and have done extensive damage to your back sitting in the office chairs. This doctor is highly recommended for cataracts and all other eye diseases; you decide you’d rather go blind.

I’m not sure where Latinos get their hot headed fiery reputation…maybe in affairs of the heart. I have never seen more patient people waiting to see a doctor. I bring a book or two, some magazines, then I watch TV and talk to the other patients. When my bony butt gets too uncomfortable, I get up and start pestering. I have a mini tantrum stomping my feet and grimacing trying to see the doctor and get through the receptionist who should block for the NFL.

I’ve often asked doctors why they won’t make appointments and they say people don’t show up. That’s when I say that I’m a Gringa and I promise to arrive 15 minutes early and I’ll never stand them up. Pleeeze let me make an appointment by phone…they smile and ignore me. Some offices are more adept than others. My dermatologist makes you sign in and the receptionist can tell you about what time to come back. If you’re not deathly ill, if you have some shopping to do, or if you live nearby, a doctor’s visit doesn’t have to make you crazy. Some offices close for lunch…I arrive at my dentist at 12:30 and sit on the steps with a sandwich til 1 so that I get ‘first’ in the afternoon (and apologize for the pastrami in my teeth). My gynecologist no longer delivers babies so his office has gotten better. Even though he makes appointments with dates and times, there is no way to gauge how long it will take. I honestly don’t know how people can go to medical appointments and hold down a job. So that’s the bad news…and for me, it’s very very bad.

The ugly is as ugly is everywhere…the costs, the insurance, the mess. The fact that my insurance covered a hip replacement operation but not the hip, nor the rehabilitation is ridiculous. The fact that my prescription discount card can reduce a $200 prescription to $140 is a joke. Who knows what ailment is around the corner? I am confident that I can find a competent doctor on the island to treat my problem although I’m not sure I have the mental wherewithal to do it.

If I can only get a doctor to TJ Ranch one time, I’m sure I could get future house calls. I could lure him/her with the food…I could tempt him/her with the privacy of no cell phone service… I can see it all now…the doctor tells his/her receptionist to pass any call through from that crazy Gringa just so she/he has an excuse to leave the office and get away….doctors tell their friends, other doctors …and soon the word spreads and we never have to come off our mountain. Oops…excuse me…I just nodded off…. must’ve been dreaming………..gotta go….they just called my name….J o a n….K???

Here are some pictures of the good ole days when our vet made house calls.

Hats Off to TJ Ranch Guests

I’ve been thinking about how much our guesthouse and guests mean to me. I usually do this kind of refection around Thanksgiving, but I’m thinking about it now because I realize how important it is for my psychological well being.

I’ve lived twenty-five years in the “boondocks” of Arecibo. The first four years were spent in a physical quest planting our farm, tiling the house and making a life in my jungle home. Then came children and I spent the next eighteen years shuttling the kids up and down the hill or if not physically taking them around then mentally focusing on their well being.

But things are different now. Our youngest is driving and independent. So here I am…spending more time at home with never ending chores to occupy my body, but what of my mind? The guests at TJ Ranch have been my life line to the outside world. I hear about things going on and meet people I probably would never have met, even living in a metropolitan area.

How would I have known about “Green Gas” if I hadn’t met Efrain? Please check out his website at www.greengasllc ....it’s important stuff. Or where would I have met Allison, the Mormon mother of seven, traveling with her eldest son for a week before going back to Augusta to home school her brood. Hey, Rick..thanks for telling me about your father’s 40 acre almond farm and the “shaker” which shakes the trees to harvest the almonds. How come they haven’t tried something like that for coffee? Daniel, the Frenchman who studied in Spain…oolala what an accent! Thanks for fixing our telescope…guess aeronautic engineering has some hands on applications. I just wrote to Steve, the firefighter from Arizona, to see if he went to California to fight this year’s fires…not this year wrote his wife, Nikki…although he’d like to… Don’t let me forget the Boricuas, traveling from other parts of the island. The trip for Carlos and Waleska from Naguabo probably took as long as a flight from Florida to come see us. They had a relaxing weekend celebrating his recent return from Honduras. And good luck to Clarys who needs to make some hard decisions in order to deal with her debilitating lupus condition. I hope the days at TJ Ranch gave her the rest and fortitude to persevere.

And so…keep on coming TJ Ranch guests. Not only do we need you to survive economically, but I need you in order not to go brain dead. Each of you is truly unique and has made my life in the mountains as rich and diverse as that of any city dweller.

(photos included have nothing to do with our guests...just some of the TJ Ranch family)

Rethinking Coffee

In 1989 we planted 3000 coffee trees, spacing them according to the government’s instructions, only to find out that they were too close together and we had to remove about 700 trees.

In 1990 Hurricane Hugo flattened our crop, but they were so young that we could stake them up and they were fine.
In 1999 we removed more trees to build our guesthouse, but we maintained two major areas devoted to coffee.

We enjoy being farmers. We are city folk transplanted in the country, learning by trial and error…Green Acres revisited. We followed the coffee process from start to finish. We picked, skinned, dried, shelled and roasted our beans, although usually we picked the coffee and sold it “uva” to the local cooperative which would then sell it to the various processors. We’d gather a crew together during harvest and pick coffee from early morning until we could load the sacks in the pick up and take them off to some remote location to sell. We were coffee farmers and although we never made much money, our hearts were in it.
Now it’s twenty years later; our coffees are old and so are we. Broca, a world wide coffee plague has come to our area, diminishing the quality and price of coffee and requiring more attention and money. So it’s time to rethink our coffee. Just as we’re approaching a new age in our lives, so must our farm.

There’s no such thing as fallow land here. The jungle has its own life and takes over all in its path. Our cottages would soon disappear, covered by vines of ñame if we were to leave things alone. And so we’re thinking…without investing a lot of money we’re trying to come up with a plan for the future. I’ve heard that the government has reforestation programs, encouraging people to plant trees and leave them for ten years, but it involves government loans and lots of paperwork.

We’ve come up with a preliminary plan. In the past year or so we’ve interspersed some plantains in our coffee plantation. We also have various kinds of citrus trees ready to plant. I even have a fig tree started in a pot. We have a row of asparagus and a row of papayas planted among the coffee. So I think we’re going to continue our various plantings… label them so that our guest can walk around and see….space them so that we can cut the grass with the mower or the tractor and perhaps at some point the trees would provide some shade that would inhibit undergrowth.

So that’s our idea…keep some coffee for “show and tell” but try converting the area to a variety of trees…maybe some ‘exotics’ (vanilla? Venus fly traps???) so that we can maintain our groves, eat from the trees and wander through paradise. Anyone want to trade some bulldozer time for a couple of nights in Eden?

WINDOW CAVE – CUEVA DE LA VENTANA

You don’t have to go to the Camuy Caves (Cavernas de Camuy) when you’re visiting the North/Central part of Puerto Rico. In fact , last week one of our guests tried to go there two days in a row and for various reasons he couldn’t get in…not even to the parking lot on the park grounds.

We have a cave in the neighborhood which is easily accessible and free! Window Cave has been known to the locals for quite awhile but has recently been “fixed up” with an identifiable mowed path leading to the attraction. The cave has an exceptional view looking onto Rt. 123, a bridge and cow fields. It’s unbelievably beautiful…so much more so than on ground level traveling the road, although that view is nice.

To get to the cave, park at Bosquebello Texaco on Rt. 10 between Arecibo and Utuado, buy some water and goodies and say hi to Jr., the owner, and walk up the path next to the wooden kiosk at the side. Be sure to bring a bag to carry away your garbage and any other garbage at the site. This is not maintained by anybody but us, so let’s keep it clean! Also bring a good flashlight. The cave isn’t very long but it is very dark. Walking inside Window Cave is easy. There is another cave, tucked behind tree roots, which meets the Window Cave entrance which is a little more difficult to move through and involves some climbing.

All in all, a visit to the cave is well worth it. You can make it a quick trip or linger and have a relaxing time in the mountains. Stay at TJ Ranch and we’ll lead you there!

Surfer Mom

Sometimes I wish I could be an actual surfer… or perhaps a boogie boarder, because even getting up out of bed is a struggle for me at this point in time, but I’m afraid that’s not in the stars. Taking a tumble at Jones Beach, when I was a kid ruined me for life; sand in my suit, tossed around not knowing which way is up, gasping for breath…it’s an experience I don’t want to repeat. Even now I need my sister, or some other person I trust, to take me past the break and tell me what to do. My heart pounds as I look behind at the wave approaching and yell, “What do I do?” “Jump”, my sister says…or “Dive through it!” Exhilarated and panicked, I’d wait for the next one…but that was years ago. Nowadays I’ll stick to the beach.

Sometimes I would bring a cheap boogie board to the beach…just in case. Just in case meant that if something went wrong, I would leap in the water with my boogie and save my child, Bay Watch style. My motherly instinct would overcome my fear and I would save the day!

As the years went by, my fear diminished as I saw my boy’s body change. He became a surfer. No longer a bony “flaco” (skinny boy), he had broad shoulders and fit arms. He paddled, duck dived, and rode the waves. He wasn’t a grouchy teenager; he became a nicer person when he surfed. It had some sort of “Zen” effect on his being. I spent more time reading and relaxing at the beach and I often missed him riding a good one. Soon he was driving on his own and he didn’t need me to take him to the beach. My only rule was that you should never surf alone and that someone should always be on the beach. I don’t know if he paid any attention.

I miss my days as Surfer Mom. I live up in the mountains a half hour from the beach. There’s a different climate where I live. It could be raining a downpour at home and sunny at the beach. I have to make sure I continue my beach trips. I too feel my “Zen” at the beach. No longer clad in a bikini, not even a bathing suit; I go fully dressed with a hat and a shawl to cover my sun damaged chest and I leave my white legs peaking out from my capris to try to get a little color. I bring my books and magazines and feel like I really live in the Caribbean. It’s been over twenty-five years and my mountain jungle is definitely my home, but the sun and the wind and the blue water is island life. Even without my son or my daughter I have to make time for the beach. I’m a Surfer Mom and pretty soon I might be Mom to the Arecibo locals as I make my way to the beach alone.

A Perfect Wedding in Puerto Rico

It's the perfect place...a bride's dream: romantic with flowers all around....and I think the groom would feel probably the same: a casual setting in the open air in which there were lots of nooks and crannies to hang out ... or hide?).....

Hacienda Siesta Alegre in Rio Grande is a private Mexican style house on a horse farm in the hills of El Yunque Rain forest. A picture's worth a thousand words so check it out....From the entrance path up to the main house, to the grass walk down to the ceremonial altar, Siesta Alegre is beautiful...bouganvilleas abound overflowing from the clay tile rooves.




After the ceremony the guests were ushered through the house with cocktails passing the lit fireplace. As evening approached, the fire warmed the cool crisp air of El Yunque. The dining tables surrounded the open air patio dancing floor and music filled the air. There were no down pours, but there was a sprinkle of showers on and off that did nothing to inhibit the party. There are various hotels in the area and the bride and groom were wise enough to hire a van to drive their guests to their hotel where the party continued.

And so now you know...if you're looking for the perfect wedding locale in the Caribbean, check out Hacienda Siesta Alegre....and then enjoy your honeymoon at TJ Ranch....just ask Carlos and Melissa. They ended their week long travels on the island at TJ Ranch and then were ready for getting back to the "real world."

We may not leave the farm often, but when we do it's worth our while. This was a wedding to remember!!

Best wishes for a happy life together, Carlos and Melissa...you had a great start!!! Felicidades!!!




(Please excuse the graphic layout of this blog...I can't seem to post the pictures the way I want ...and can't get them to move around!!)