CARIBBEAN MEDICAL TOURISM:

QUALITY CARE, INCREDIBLE PRICES
by Patrick MacDowell

I'm an American, and let me tell you... it’s is a sad state of affairs for some of us living in  the United States.

It seems like we've been at at war forever, the economy is dicey at best, everyone’s homes are losing value, home foreclosures have skyrocketed, there are shootings in schools and shopping malls and worst of all, nothing is happening to remedy these things because it’s an election year!

My business (I’m a self-employed real estate appraiser) has been steadily declining for about a year now, and I can’t really do anything else for a living because I have been saddled with this inguinal hernia for ten years.

HAVE TO GET THIS HERNIA FIXED

Unfortunately, just like 46 million other people in the USA, I have no health insurance, and I can’t afford the $15-20 thousand dollars it would cost to get it fixed here in the USA, and be physically healthy again.

I feel helpless in my quest to be physically healthy again. It is tough to decide exactly what to do and I am strongly leaning toward just selling everything, renting out my house and saying “Adios” to this country.

However, first things first -I have to get this hernia fixed. I had been playing with the idea of going overseas for the operation after reading about "Medical Tourism" in a slightly dated issue of a magazine and was, at first, a little perplexed. I didn't know at that time what the term Medical Tourism meant or how, or even if, this could be a way for me to accomplish my top two goals at the same time.

The goals I'm referring to are first, to get back to good health and good physical shape by having a surgical procedure done, and two, to discover if it would be possible to retire elsewhere in this world that is more affordable than the USA.

After investigating lots of places I came to the conclusion that Latin America looked like the best place for medical care...it offers quality care at bargain prices - that even I can afford.

And, maybe, Latin Amerca might end up being a great place to live, as well. It’s warm, has a lower cost of living than most places on earth, and I’ve heard that medical costs in Mexico, for instance, are much cheaper than in the USA.

Then there’s Costa Rica, Panama and Nicaragua to investigate, as well. All of these places intrigued me, and gave me a place to start - my dilemma was where do I start and how to find out information? It seemed natural to check out the real estate websites for these places to see what info I could unearth.

A few days in to my research, while surfing some travel sites on the web, I found a link to the Medical Tourism Association website. This organization tracks medical care and procedures in many countries around the world. After some email correspondence with Jonathan, a representative, I was referred to the International Patient Department representative, Brad Cook who is employed by the Hospital Clinica Biblica, the largest private hospital in San Jose, Costa Rica.

Brad referred me to Bill Cook, (nah, they can’t be related can they?) who also works in the same department and we exchanged several emails over a month’s time.

After living with, and mulling over the surgery idea in my head, I “sat with it” for about 2-3 weeks, I finally realized that traveling to a foreign country was probably my best opportunity to reach my first goal. So, I was then ready to buy my ticket and set out for a new experience, surgery and travel to Costa Rica.

COUNTDOWN TO COSTA RICA ON SPIRIT AIR

By January 28th, I had booked my flight at Spirit Air with a Feb. 5th departure date. I must say that it was an amazingly easy process to book the flight, pick my seats for the flights and check in my bags, all online, what a world! I was praying that my surgery would go as smoothly!

And to make it all even easier, Mr. Cook and his staff at the hospital had arranged for my lodging at an unbelievably affordable price per day (including meals, 24 hour nursing care, free internet and international calls). He also gave me the heads-up on the weather, which was a very comfortable 70’s during the day and in the 60’s at night. Sure beats most of the winter weather in the USA at that time of year! I was really getting excited about my journey at that point.

Of course on January 29th, I began to develop a cold! It had been a very long time since I have been sick in any way...but of course, isn't that what always happens? Doctors and hospitals don’t like to do surgical procedures when someone is in less than normal good health, and especially they don't like to deal with patients who have a cold or flu. So curing my cold was a new priority before departure.

By February 1st., my cold was lessening it’s hold and I had hopes of being surgically ready after all. Crossing my fingers, I started taking “Airborne”, as suggested by my sister, to help with cold symptoms. It’s a cold remedy formulated by a school teacher and is designed for use when traveling, for hospital stays etc. to protect against increased exposure to viruses and bacteria from being around many people.

When February 3rd rolled around I was left with two days to go, and the thought that I could at least enjoy the Super Bowl that day knowing all I had left to do was pack and get to the airport 3 hours early on departure day. Yikes!

February 5th , 7:00 AM, The Spirit Air desk tells me the flight is delayed due to fog and therefore I could not make my connecting flight in Ft. Lauderdale at

10:00 AM. Murphy’s Law. Anger and frustration, these are the things going through my mind at this point among other various expletives. Back home, after shooting off emails to Bill at the Hospital Biblica Clinica, my family and a couple phone calls I’m waiting to find out if Bill can somehow salvage “The Plan”.

Feb. 5th, 4 PM , OK , got the email confirming the changes in my itinerary for arrival in San Jose. I’m going directly to the hospital for my exam and tests with surgery scheduled for 8:00 PM on Friday night. Oh man they work late in Costa Rica! Now I’ll contact the family and let them know the details of the changes. We’ll try again on Thursday morning to get out of Myrtle Beach.

Feb. 7th, Everything went as scheduled with my flights and I arrived in San Jose

right on time. I was met by the driver Erick from Chetica Ranch, a medical recovery facility specializing in accommodations for recovering medical tourists.

They were expecting me and everything was all arranged. He had already found the other guest he was to pick up. Natalie from Portland Oregon, lovely girl, wow! More on her later.

By 2:30 PM I am sitting in Bill Cook’s office and had been introduced to his

brother Brad (not related, nah, just brothers) who I only knew through emails, so far. I also met the rest of the office staff for the International Patient Services Dept. for the hospital. Everyone seemed very pleased that I had arrived and wasted no time in arranging for the pre-surgical blood tests, chest x-ray and EKG and I was all finished by 3:30 PM, at which time I was provided a complimentary meal.

INTERNATIONAL PATIENT SERVICES

This Hospital building had some unusual features. Inside the foyer I found
administration offices, two banks and two restaurants that are used not only by employees of the hospital but also people coming in from the street.

While waiting for the driver to pick me up and take me to Chetica Ranch, (www.cheticaranch.com ) I met a young traveler, James from somewhere near St. Louis, MO who had arrived for pre-op tests and for a shoulder surgery. He was going to Chetica also.

He lives with his fiance and faces the same kinds of problems I worried about in the USA. We chatted awhile as if we had known each other longer. We immediately found common ground in our dilemmas of no adequate insurance coverage and the outrageous prices for medical care in the US.

Feb. 7th, 5PM. James and I arrived at Chetica Ranch after the tests and after taking a short detour on route, to the “Super Mercado for some in-room supplies, fruit, cereal, snacks and of course liquid refreshment. It had been a long day and I was more than ready for a cerveza or two.
I was introduced to my nurse, Francis, an attractive Nica (native Nicaraguan) with
a sweet demeanor and a welcoming smile. I also met Ruben Martin and his wife Lorena, the owners along with some of the other staff who live in homes nearby on the 80 acre estate. All were very friendly and made you feel at home. Next came the social hour where I sat with other medical tourists on the tiled, covered patio under a darkening sky, rain is coming. At the time of my arrival there are thirteen guests here for various medical and dental procedures.

After a pleasant evening meal of soup and a vegetable quiche it was time to settle into my cottage, “Old Tuscon”. Each cottage has it’s own theme and they are built in rustic Mexican, Greek and other Southwestern styles of brightly painted stucco or wood with open beamed ceilings, tiled and native wood floors, individual stone fireplaces and finished with an interesting mix of décor.

This 80 acre estate is, according to Ruben the owner, a work in progress. The landscape is one of rolling forested hills and some open areas ready for development. It is circled entirely by a stucco covered, ten foot high concrete wall and gated entrance with guard’s station for security.

Ruben and Lorena not only have nine new Casitas under construction but plans to add a three tiered pool with connecting waterfalls. There are many other improvements in progress.

They presently have the main house, the Casitas, a gift shop, the Buena Vista Social Club which is the dining room, the place where the whole group could relax during and after meals and trade stories about our surgical/dental procedures but also about our own lives. It was a great experience to meet all these people. People from all over the world, all so different yet the same. Time for sleep, we’ll see how quickly I can wind down.

I’m still wide awake.

Feb. 8th, 2:00 AM, still awake, ok deep breathing. 5:00 AM slept restlessly for about three hours. Might as well get up and see what the shower facilities are like, fingers crossed.

6:30 AM, head for the dining room for some coffee. The wind has been blowing
most of the night and it feels cool and damp when I venture outside my cottage for my first day in Costa Rica.

NIL BY MOUTH
Buenos dias Patrick, buenos dias (I speak some Spanish) Francis as she is standing outside the main house speaking to Rufus who was here for some dental work and is leaving this morning. Francis tells me she has spoken to the hospital and I must be there by 3:00 PM to prepare for surgery. She also explains to me in the way a nurse will, that I may have a little something to eat and some tea before 7:30 AM and nothing after. I think about this for a second and tell her that I will only have coffee this morning. So I go to the dining room and request my coffee negro. Carla the cook, another of the five Nica (Native Nicaraguan) girls who live and work here at Chetica immediately calls Francis to
get her ok for me to have coffee, it’s ok, thank God!

So I’ve had my coffee and I decide it’s time to bring this tale up to date and get it on paper, so to speak, so I return to Old Tuscon and now I sit at my laptop hoping that I can convey in a colorful way to others what I have experienced to this point. I think that I will spend some time taking some pictures of the ranch before I head to the hospital.

Feb. 9th 1:00 PM, James and I leave for the hospital for our respective appointments. He is supposed to have shoulder surgery due to an injury from lifting weights.
This guy is built like a Greek god and I can’t imagine anything that could hurt him. I arrive at one of the Hospital’s entrances to see a modern structure with a large stained glass panel that filters sunlight into the waiting rooms on each floor level. It was a great picture so I took it with me.

At the hospital’s International office I discover that everyone is busy but not too busy to greet us like royalty. Roger, who handles billing, tells James and I we should maybe have a massage while we wait for our appointments.

He also tells us that we also have the option to have manicures, pedicures or even a haircut all at their expense. We look at each other with looks of amazement and say, “why not”, so we do. James goes first and Roger later takes me down the street a couple of blocks to the spa just as James is finished. The young girl who is my massage therapist, is a gorgeous Tica (Native Costa Rican gal) and I thoroughly enjoy this experience because remember readers, this is my first surgery and this massage thoroughly relaxes me. Perhaps when I’m feeling myself I’ll go back and buy her a meal.

Feb. 9th, 8:00 PM, It’s time for pre-op and I’m getting more and more nervous by
the minute. Starlyne, who stays with me well into the night, takes me up to the surgical ward and I lose my clothes and don the standard “see my butt” hospital gown. I do my best to tie up the back but it’s useless, oh well, seen one seen them all.

So here I am on a gurney waiting to be taken into surgery, finally, after dealing with this hernia for almost ten years, and now there is no turning back. The anesthesiologist, a young woman of about 30 years old is standing by my bed and asking the usual questions about allergies and such, she is smiling all the time and says that she will take good care of me. I tell here that this is my first surgery and she is surprised. I don’t know why. Just talking to a smiling person calms me a little bit. Much later I discover that she is my surgeon’s wife.

At about 8:30 PM they wheel me into the operating theatre and it really is a theatre as there is an observation window at one end of the room and I can see what I think is another doctor attending to some kind of equipment that I cannot see from my location on the bed, under the large lights the doctor will use to illuminate his work on me.

Next the IV is inserted as an attendant secures a large strap around my upper legs and my arms are secured with what looks like a small bed sheet that he wraps around my arms and then tucks under my back. I feel helpless as I am totally immobile and pinned to the operating table. Oh great! Another form that needs to be signed that the admitting staff forgot about. It is another release form and I can’t move my arms, so I chicken scratch my name with one free hand and from then on I remember nothing as the IV begins doing it’s thing.

Later on, back in my hospital room, the doctor tells me I was talking like crazy, raving about how I love this country and all the nurses and that I’m going to move there as soon as possible. It’s ironic, all the things I supposedly said, turn out to be true.

Feb. 10th, 2:00 AM I realize for about 2 seconds that I’m out of surgery and in my
room and what a room it is! It looks brand new with fresh paint, modern equipment, tile everywhere, a flat screen TV and very clean. I ask the nurse what time it is. She says, 3:30AM, what? I wake up again and it’s 4:30 AM this time and I ask when is breakfast?

WHAT TIME IS BREAKFAST?
I must be more awake now I think to myself because I suddenly realize that it’s been almost 36 hours since I’ve eaten anything. My stomach feels like my throat’s been cut! I am so hungry, so I ask for water and they bring me a 1.75 liter of bottled water. The orderly pours some in a glass and I say leave the whole thing, todo por favor. I fall asleep again until about 5:30AM still no breakfast. “What time is breakfast”, I ask, 7:00AM, oh my god I’ll never make it until then, I fall asleep again, I can’t help it.

To make what seemed like an eternity go quicker, let’s just say I spent all day long waiting to see my doctor, who makes two visits to check on my condition (unheard of in the USA), taking a shower unassisted and eating meals with the spaces in betweeN filled with Spanish TV.

All in all my short stay at this hospital leaves me very impressed with the level of care, the friendliness of all the staff and a lot of relief to know that there is actually wonderful medical care available in a hospital founded back in the 1920’s.

Finally it’s time to leave, it’s 6:00PM or so and I can’t wait to get out of here.

Erick from the ranch picks me up in the van and we head back to Chetica. That night I barely get myself into bed, Carla, who is on duty, gives me my pain medication and I am instantly asleep. I wake up a couple of times during the night but have no trouble going to sleep again.

Feb. 10th, 6:00 AM, I ’m alive! And I can actually move!, where’s the coffee?! I
get up, take a shower, which is surprisingly painless, get dressed, also surprising that I can move around this way without any real pain, and then go down to the dining room (Buena Vista Social Club) where one of the gals hands me a wonderfully smelling hot, dark cup of freshly brewed coffee, I’m in heaven!

Several of the other guests are there and I really don’t remember much but I know that we all exchange our stories, I am introduced and still don’t know anyone. I’m in a fog. Later I re-meet and start to remember names of the other guests.

First there’s James, we’re becoming good friends by now as I had seen him in recovery just as I was going in, his shoulder is feeling pretty good. Kenn from Canada, who’s a pharmacist, has had a gastric sleeve (bypass, I guess) and he says he’s feeling the best he has since surgery. That is just what I‘m hoping to hear from these people, that I‘ve made the right decision to come here, great news!

Debra from Wisconsin who has had a tummy tuck and a face and eye lift. I find out later that she got a post surgical infection that was giving her trouble and that our favorite Angel, Francis, and the owner Lorena made middle of the night visits and stayed right with her during some of her more serious rough patches.

The people here are amazing! Shawn-Marie, a self-employed ultra sound tech from South Carolina came here for surgery to her midsection and you would never know it by the jokes her and her Mom Jan are beating me up with. “Por favor, no comica“ (no jokes) I tell them in Spanish, it hurts to laugh, but I do enjoy them anyway.

Oh yeah, then there’s Natalie, who I first saw at the airport. She’s a lovely gal, an executive secretary from some big firm in Portland who had a deviated septum repaired and laser resurfacing on her beautiful face. I couldn’t for the life of me see what was wrong. She looked like she had a wicked sunburn after the treatment and wouldn’t come out of her casita for three or four days. We told her forget about it and join us! She did and she was a real pleasure to know.

The day I went to the hospital to prepare for my surgery I rode into town with another patient, Brenda. She was headed for a dentist appointment. This gal has been an electrician for many years, has pretty good insurance, but is here anyway because her costs with insurance were still too high in the States.

She’s had her whole mouth rebuilt by some fantastic dentist. She can’t sing the dentist’s praises enough all during our ride to the hospital. All the while I’m talking to these people I’m thinking, Patrick all these people were looking for better solutions just like you, and you have made the right move to come here!

I now have until the 15th, Friday, when I return home to simply recover at my own pace, listen to the melodic sound of Francis as she tells me “good boy” for taking my medication at the right times. Man! She is thorough and beautiful!

I take walks during the day around the estate hoping to see some native wildlife. I can never stray too far from the`courtyard without my new buddy Nita, a young golden retriever, one of four I saw at Chetica wandering the grounds, playing and paying just the right amount of attention to all the guests. He was a great comfort to me, having man’s best friend trot up to me, ask for a pet in his own special way and then go about his business just happy to be near.

I hitched a ride into town on the Thursday before I returned home to say a big
thank you to everyone at the hospital, and at the spa where I had my massage. I also took the opportunity that was offered by the Brothers Cook (Brad and Bill) to do a short video which they recorded about my experience for the hospital. Oh my, real video,

Oh boy, I’m nervous all over again. I make a stop at my surgeon’s office and he gives me the once over, some different instructions for my recovery and then hands me a CD with a recording of a portion of my surgery. I laugh right out loud, and so does he. This guy is a God!

NEVER HAD TIME FOR THIS AT HOME

The rest of the time passes slowly back at Chetica and that’s fine with me. It gives me time for reflection. Never any time for this at home.

I am so stress free I feel empty, like I don’t know how to enjoy myself just “being”. At one point I remember thinking, “oh yeah, I had surgery, almost forgot. It’s a whole “nueva vida” new life now and I’m going to have to readjust my thinking, my entire self. I guess I feel this way because now, after my recovery is complete, I’ll be able to do all the things that I haven’t been able to do for a very long time. I will be able run, hop, jump, skip and generally cut-up like I used to. I can’t wait!

Pictures in my head of me playing golf with a decent swing, softball, swimming and even working in my yard are running through my head like mad and the excitement is almost overwhelming.

Just think, no more doing the “Napoleon down low” with my left hand in my pocket trying to keep my injury from popping out.

No more Napoleon, he was a short guy just like me.

It’s my day to leave and already I’m missing these people and this quiet haven with a great and dedicated staff. I get a promise from Lorena for pictures as we leave for the airport, again three hours early just to make sure. Lorena and I speak about my stay, up in the office briefly and I realize that I don’t really want to leave. Later on as

Erick is getting the van ready, we shoot pictures exchange hugs and kisses and we all promise future email contact. All goes smoothly at the large modern airport in San Jose and as I view the rugged rainforests of this beautiful country from my window seat I realize that this could be the place that I will go for retirement. That’s a very different story from this one.

ESTIMATE OF SAVINGS

Back in 2003 or 2004 I took a serious look at the actual expenses locally for the surgical procedure described in this story about Medical Tourism. It was to be Lapascopic (check my spelling) same as in Costa Rica, with surgical expenses that were a reasonable $1,000. Anesthesia was about $450. It was the Operating Room expense, computed in 15-20 minute increments, that was the real “deal killer”. That was, as I said, a few years ago, but $7500 to 10,000? I mean Really! Total cost was approximately (rounded up for the heck of it) $10,000, more with time lost from my business. And what did I pay in Costa Rica? Check this out;Air flight round trip: $340.00

8 nights/lodging & Transport/Chetica Ranch $750.00

Pre-op/post-op exams, Dr. Consultation;

Surgery procedure; Anesthesia; all medications $4,000.00

Total $5,090.00

I spent an additional $200 on personal expenses such as airport fees ($26 exit fee to leave Costa Rica) food and beverages at the airports (way expensive) and for gifts like coffee to bring back home.

Some of my fellow Medical Travelers were kind enough to share their cost comparisons, things that helped to “cinch the deal“ .

Kenn C., from Manitoba told me that he priced a ‘Lap Band” surgery which is a close equivalent to his specific procedure which was a “Gastric sleeve“ and was an unbelievable $7,500.00 USD in Costa Rica. In Canada it was $18,450.00 CAD.

Debra from Wisconsin had a Tummy tuck and face lift and eye lifts and told me that she paid $ 7,400, approximately 40-50% of the cost versus in the States.

James from Illinois had a Lapascopic repair of his shoulder, cartilage, muscles or soft tissue of some kind and his costs were still cheaper than insurance coverage in the USA. He paid a grand total of something like $5900 as his trip was arranged as a package through Med Journeys. Triple his figure and we’re probably close to USA costs.

Another traveler, a registered diagnostic medical sonographer or RDMS for short from South Carolina was Shawn and her procedures were a breast lift and something similar to a hip lipo and posterior thigh lipo. Her trip was a package deal also from Med Journeys, a Medical Tourism travel company. She did not offer what the package deal costs. Shawn did tell me that she was not aware of individual procedure costs but as she told me while sitting in the dining room after our evening meal, “I have no clue how much it was but I do know that all that was done was cheaper then what my Tummy Tuck and Hip Lipo alone would have cost in the USA“! which was? I wanted to reply, but didn’t.

Remember Natalie, from Portland, I mentioned her at the beginning. She paid approximately $3,500 for all medical costs associated with a CO2 laser facial resurfacing and repair of a deviated septum.

Considering all the information that my fellow travelers gave me I would say that the general costs associated with going to Costa Rica to have normal surgical, dental and cosmetic procedures is somewhere in the area of 35-50% of USA costs. That percentage includes air fare and lodging.

Considering the modern medical facilities, the complete care and services offered and the positive results encountered, in all it is really something to seriously consider for one's medical procedures.

Author: Patrick MacDowell. Patrick is a self-employed real estate appraiser living in coastal North Carolina. Orginally from Central New York, he has also lived in Portland, Oregon where he did real estate appraisal work and rehabbed a homes for six years. After enjoying tremendous business growth and success for several years, the past two year slump in the USA real estate industry has convinced him to look for a new beginning and search for a better place to live. This story is his first step in to his new life and his new beginning.