Do-It-Yourself Health Care in Ecuador

When considering whether to live in another country, the availability and cost of quality health care is always a big consideration. My wife and I have had personal experience with this in Ecuador, and all-in-all we have been very happy with our results. It is a difficult issue to compare, because it is almost impossible to do an “apples to apples” comparison.

From the very start, Ecuadorians look at health care differently. Here the goal of doctors is to keep you well, rather than to treat your symptoms. If you go in to see a doctor complaining of stomach pains, he will probably give you a prescription for drugs, but he will also spend some time talking to you about your life and your eating habits, how much exercise you get, how you’ve been sleeping – and then give you suggestions on how to change these things to prevent a recurrence. They also do not prescribe much in the way of pain medication above what we would think of as Tylenol PM. How do you know you are getting better unless you can feel the pain decreasing, I think if the reasoning here. The pain is your body’s way of keeping you informed, and preventing you from hurting yourself worse.

Now I say “prescription” here, but that is really another difference. The doctor does not give you an RX, as much as a shopping list and instructions for taking the medication. When you show the list to one of the many farmacias, they give it back to you when they are done. You can use it again as much as you like. You can also just walk up to the window and ask for whatever you like, without a note. Or tell the pharmacist what your problem is, and ask them to recommend something. Part of this is because they don’t have the heavy painkillers or psychotropic drugs, but you can still get antibiotics and such without a note from the doctor. Even if you ask for hypodermic needles, the only questions are how many and what size?

This is part of the Ecuadorian health system’s tendency to make YOU personally responsible for your health. A doctor will prescribe and maybe offer a followup visit, but if you decide you don’t need it, that is your choice. They may recommend tests and procedures, but you are responsible for going out and getting them, you pick up the results, and you bring them to the doctor to examine. They are then returned to you for your safe-keeping.

I have found that I like that approach. I like having the test results and films so that I am completely informed of my own situation. Also, if I want a second opinion, I have everything I need to easily get one.

We’ve lived here long enough, and had a few medical procedures (even surgery) here, so that I thought that I had fully experienced this DIY system and could not be surprised. I mean, we’ve had a doctor come to the house to examine my wife (yes, they make house calls here), and had him leave us with glass ampules of medicine and a couple of hypos, with instructions to break off the top of the ampule, draw it into the hypo, and inject it about here once a day for three days. OK, fine, no problem. But recently, I took it to a new level.

I had a sore throat that made my life miserable for about a week. At it’s worst, it not only hurt to swallow, it hurt in between swallows. I had our house call doctor stop by, and he diagnosed laryngitis and gave me some meds. The next morning it was even worse, so I went to the nearby military hospital – yes, it takes walk-ins from the general population, don’t need to be military to get service – and shelled out $12.80 for a second opinion.

This doctor agreed with me, it was not laryngitis, but a bad infection. She gave me a shopping list for some mega-antibiotics and a few other things to help with the symptoms. This time, I was noticeably better the next day, and after the ten-day course, everything was back to normal. Almost. A week after I finished, I still had a light tingle that wasn’t going away. The topper was when I also started feeling a little pressure in my right ear.

So time for the big guns. An Ecuadorian friend of mine recommended his Eye, Ear, Nose and Throat guy in Guayaquil. We took the bus out to meet our friends, and they took us to the appointment.

The doctor talked to me for a while, then did a thorough exam. He also used some kind of hot wax to clear out my ears. He confirmed the diagnosis of the military base doctor, and explained it was just a particularly tough infection. He suggested in addition to a different antibiotic, that I also use an atomizer to inhale medication three times a day to get it deep into my throat and lungs (pictured above).

Sounded good to me. He told me I could find the atomizer in any drug store, and then he gave me my shopping list, along with a recipe. That’s right, a recipe. Silly me, I assumed I would get some sort of liquid medication I would put in the atomizer, and snort away. No, this is DIY health care!

We stopped at a Fybeca in a Guayaquil mall and picked up all of my supplies, had dinner with our friends in a nice Peruvian restaurant, and headed back to Salinas to do some alchemy.

First, I needed a sterile glass container to do my mixing in. Something not too big, but easy to clean. What else, a shot glass!

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Next, add a measured amount of saline solution. The pharmacy filled my list by providing a saline drip bag, and a hypo for extracting measured amounts.

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Twenty drops of the next ingredient, this one at least with an insert that allowed only a drop at a time.

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Ten drops of the next part of this cocktail, this time with an eye-dropper.

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Now the fun one – add the full dose, but of course it is in a glass ampule, so you need to carefully break off the tip first.

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Slosh it around a bit, and use another hypo to extract, and insert into the chamber of the atomizer.

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And voila! Houston, we have mist!

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Can you imagine this happening in the US? A doctor actually trusting you to mix your own meds? Well, the happy ending is that it also totally worked. Although I of course continued the full seven days the doctor ordered, all symptoms were gone by the third day and have never returned.

And if it ever does – hey, I still have my shopping lists!

 

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6 Comments

  • Jo Alice Mospan says:

    Now this post was extremely interesting to read–and what an eye-opener.

  • Peri says:

    I also have been delighted with the Ecuadorian approach to health care. More personal, more caring, and involving more patient responsibility. I am returning to the US, and I will miss the excellent, inexpensive private healthcare here!

  • JRN says:

    Yes, such a difference.

    Recently, my health care practitioner (not an MD) thought it would be a good idea for me to have an abdominal ultrasound to be sure I was just experiencing a strain and not something more serious. Off to the Clinica Bolivar in Cuenca where I gave the referral note to the woman at the information booth. I was given a number and directed where to wait. There were 2 others before me. About 45 minutes later I was in the doctor’s office having the ultrasound – conversing in my bad Spanish and with the use of a translation program. Thirty minutes later, the doctor – and a woman I later discovered was a Venezuelan physician displaced by their economy – had finished the test, given me the results (all was fine), a recommendation to follow up with my own doctor if the pain continued, and given me the customary kiss on the cheek as I left.

    Same Day
    Immediate Results
    Cost – $35

  • Lori Bonicelli says:

    Great article!
    $35!!! I had bronchitis last week and could not sleep for days because I could not stop coughing. 2 day wait to get into any doctor, then 3 hours to get my prescription, Cost: $35 for the doctor visit co-pay, $75 for 15 doses of Cheratussin DAC, $20 for some antibiotics, $15 for albuterol inhaler. That is all on top of my work subsidized $600/month Kaiser health plan. I don’t understand North Americans. We pay for Medicare, Medicaid and then pay for our own private health coverage and THEN have to still pay out of pocket. Ugh… just a few more years and I am outta here.

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