Saturday, October 17, 2009

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.