Nothing makes you long for “home” like getting ill while traveling. I’ve been sick in many countries, almost to a one with food borne illnesses. It is a miserable time, exacerbated by needing to encounter an unknown medical system in a developing country. Last night I got an immersion course in Colombia’s health care system.
The last time I needed urgent care I was in Bangkok, and for me it was about like being home. I knew the health care system, and I had a hospital that I had been using for many years for my basic medical needs. When I got food poisoning there and was doubled-up with pain, at 2 in the morning, I got myself a taxi and was to the emergency room in 20 minutes.
This time was different. Being in Colombia for about a month, I knew nothing about the healthcare system except what I had read and heard. It is essentially a socialized system, but one that is fragile and inefficient. Delivering adequate healthcare to a large, and largely poor, clientele, would be a challenge anywhere, but here there is an inadequate tax base and too much corruption. The system covers everyone. I don’t think it is intended to cover foreigners, but effectively, it does.
This was research I didn’t intend to do. On Friday afternoon I had a large meal at a fairly well known restaurant. It is in fact the nicest restaurant I’ve been to in Colombia. The meal was mediocre, maybe because it was at the end of the afternoon meal time. By 8:30 I was good and sick. I got worse through the evening, and by the middle of the night I asked the owner of the hostel for help. He made some phone calls, and then said I needed to go by ambulance to a clinic. This seemed a bit extreme on one hand, on the other, taking a taxi in my condition in the middle of the night is a bit risky.
The ambulance arrived about 50 minutes later. The hostel owner helped me to the ambulance and the driver asked him for money. There is a sign in the ambulance that says that you do not pay for an ambulance, and he didn’t. My vitals were taken, and then we sat in the ambulance for about 1/2 hour for some unknown reason. Finally we took off, me weakly on a gurney in the back, not strapped in at all.
45 minutes later we arrived at a very modern clinic. I was wheeled in and planted next to a wall across from the admitting desk. The attendant from the ambulance stayed with me and was my only contact. The rest of the people of the clinic aggressively ignored me. After over an hour, the ambulance attendant said he was taking me to the hospital. They loaded me up again in the ambulance and drove for 45 minutes to the public hospital. Wheeled in, and planted again next to a wall, I went through the same experience. Other patients walked in to the emergency room or were brought in by ambulance, and seemed to be in excruciating pain, falling on the floor and crying for help. They also got little attention. I clearly wasn’t being discriminated against, or for, as a foreigner. We were in this together, and suffered the same indignities and level of service.
A couple of hours later, by now 8 AM, things started moving a bit. I was told I would get an IV. I said I wanted to see a doctor first. A crowded under-served old emergency room is not a place to be unmindful about things like needles. Around 9 AM I saw a doctor. I think all of us were waiting all night for the morning doctor to come on shift. Wisely they had treated the worst patients first, so I was about 4th in line. The doctor was young and competent, and spoke a modicum of English. With my less than a modicum of Spanish, we managed. I got examined, diagnosed and got prescriptions in about 20 minutes. All smartly and efficiently. When it was my time with the doctor, I had all the time I needed and did not feel pressured or rushed.
I had meanwhile called my friend/former hostel host from Villa de Leyva and he advised me a bit. He offered to have a friend come and help me and take me back to my hostel after I was done at the hospital. He said I was in a very bad neighborhood and I should not go on the streets. Instead of putting his friends out, I had the hospital call a taxi for me. 45 minutes later I was on the road home.
I’m feeling better today. The meds are doing their job and I’ve been making up for lost sleep and the stress of the illness.
Conclusion about my healthcare in Colombia:
I was treated as well as anyone else here, which is marginally adequate but I was treated. If I were to show up at a hospital in the US as a foreigner, getting treated at all would require a ton of paperwork and a lot of money upfront. I could easily be turned away.
My out of pocket expenses?
- $12 to the hospital (the hostel owner was outraged-he said I should not have been charged at all)
- Nothing for the ambulance. Remember, the attendant stayed with me for hours, in addition to the total at least 2 hours ride
- $3 for 3 prescriptions
- $6 for the return taxi, only because we had to drive around to find and ATM and drugstore
Yes, in a developing country, socialized medicine is a struggle, but one based on the principle that health care is a human right. The drunkest, most belligerent, ancient toothless old man got respectful care, and poor mothers with small children were able to walk in and get care, after waiting a long time.
Yesterday morning I would have given anything for a nice bright efficient US clinic. But even with insurance it would have cost me a lot of money, money that the drunk and the poor mother don’t have. Even with Obamacare there are still “deductibles” and out of pocket expenses. Now in retrospect, even just a day later, I am grateful for the care I got and for the experience of the system. It was a sobering experience, but a useful one.