Dominical Dot Biz

There are no private rooms in the public Costa Rica hospital, at least that I know of, just these “salas”, or rooms with people grouped by gender and ailment. We were next to the old-guy room, lots of old guys there walking around with catheters on wheels.

My room had 8 beds in it, each providing healing and sanctuary for a variety of ailments. I was given the bed just inside the door on the right. The room has 4 walls, one of which is a window from about bed height up to the ceiling. This way, as people walk down the hall, they can look in and see how everybody is doing. My bed was right next to the window, so I was well cared for by not only the hospital staff, but also all the visiting family members of my fellow interns.

It didn’t take long for me to figure out the routine of healing in the hospital…

They would come around at 9:00 or so in the morning with coffee and bread. Being as we live in Costa Rica, the coffee that they serve in this free hospital is great. The bread was awful. I think that it’s main ingredient was air. Every bite you take, the crispy dry crust would explode and throw crumbs all over you and into your bed. But oddly enough it was OK. They would even smear a little bit of cream cheese on it from time to time. This was the social time in the sala, when there was a lot of talk and laughter. There was visiting time around 12:00 and that lasted an hour or so. Only a certain number of people are let in to visit, and they need to get a pass from one of the windows on the main level. One pass can accommodate a few people.

With my fair skin and relatively large size, I became a bit of a novelty. I got the impression that a number of my sala-mates had never had the opportunity to talk with a “norteamericano”, “estadounidense”, or easiest: “gringo” before. There were a couple of brave ones there that were quite assertive in approaching me in conversation. Generally they like to talk about the States. Almost all have someone in the family that has gone to there. I have kind of gotten the impression that families will get together and decide who has to go. Then one member goes and works and sends back money to supplement what they make here. Then when the stint in the States ends, there is usually enough money in the family to purchase a car and a few other amenities.

I found it interesting that getting into the hospital can be a bit difficult for some. Those that need elective surgery, or semi-elective, like getting an appendix out, or getting a bone re-broken. I heard tales of having to wait months to get in due to the shortage of beds. I never did really figure it out, but considering my ease of admission, I am assuming that they must keep a bed open at all times for emergencies. Or maybe I just lucked out and came in on a day when a bed freed up, effectively making someone’s wait just a little bit longer outside somewhere.

There was a young man of about 18 in the bed next to mine. He laid there for a few days, getting injections every night and goofing around during the day. He seemed fine to me. I asked him what he was doing in the hospital. He showed me his arm, which had a noticeable bend in it. He was going to have it re-broken since they had set it incorrectly when he originally had broken it. This scenario was repeated with another young man after I had been there for a few days. He came in and proceeded to wait for days until they could take him in to re-break his leg.

So it is difficult to get in to the hospital for some, yet once they do get in, it would take a few days to get into surgery. An interesting situation when there is a shortage of beds.

As a family we have generally adopted a policy of not criticizing Latin America and the inefficiencies that we have seen since being here. And so it is really not in a critical spirit that I write these things. It is in an effort to share the experience. This was the most intense “Latin American” experience that I have had here, and I wouldn’t trade it for anything. The beautiful fellowship that exists between men here is something that anyone would envy. There are many wonderful aspects of these experiences that could not be duplicated in my country of origin. Without knowing what all is involved with administering a hospital in Costa Rica, where it appears that everyone is overworked and underpaid, it is impossible to criticize with any sort of certainty. The observation of a bed shortage condition, and people laying around in beds waiting to have a surgery that could be done in an afternoon with no hospital stay is just that: an observation.

Rodolfo had cut himself with his machete. He had been working on his finca about 3 hours south of Perez. He was using his machete to square up the walls of an irrigation ditch, holding the knife by the handle and jabbing down into the dirt of the wall, like one might normally do with a shovel. The machete is a multi purpose tool here though and this is exactly one of the uses that it is intended for. The slight problem though of the handle being slick with mud caused Rodolfo’s hand to slip off of the handle when the blade hit the dirt. When the hand slipped off of the handle, it had nowhere to go but forcefully along the blade, cutting through the man’s palm and severing several of the tendons there. He was one of the truly jovial ones in the sala and so I was drawn to him to find out about his situation. He was from way down south. After cutting himself, his family had to bring him to the hospital to wait the few days until his surgery. During his wait he had his hand bandaged up into a ball so as not to further damage the tendons. As soon as he got out of his surgery he was able to go back home.

Off to the hospital:

A public hospital in Costa Rica is a truly interesting experience. It is essentially free medicine. Not totally free, since we do pay insurance. For our family of 5, we pay around $15.00 a month in health insurance. A neighbor comes by once a month and collects the payment and we carry around a little “carnet” or doubled over thick paper card that is our insurance card. With this we have access to the country’s public health system. Compared to anything that we had experienced in the States though, this was ‘free’. Sounds great, the thought of free medicine, and it really does provide a wonderful service to a country where a large number of people are agricultural and self sufficient, but short on cash.

The people around San Isidro live on farms well removed from the centro where you find the markets and shops and the hospital. They raise rice, beans, various fruits and vegetables, and have plenty of meat around in the form of chicken, pigs and cattle. So for these folks, although certainly not needy, they would likely not consider the monthly payment free.

The hospital in San Isidro is around 25 years old. Imagining the vast growth that has taken place in the area in the last 25 years, one can imagine the congestion in the hospital. Spend some time at the Emergency Entrance and you are likely to see a never ending line to the admin window, as well as the constant presence of the sick and recently injured. The frequently arriving ambulances disgorge their cargo of the un-well at what seem to be constant and nearly regular intervals. These are oftentimes gurneyed into this main waiting area where they too wait. The press of people and needs are such that it is nearly impossible to establish priority. The hospital workers are capable people, but are simply working in impossible conditions. Oddly enough though, it works - sort of.

When we arrive with my swollen, hot, red ankle, I am told to wait in the line, which I can’t do since to have my ankle down for any length of time is excruciating. So I sit while my wife waits in line. Typical Latin America: there are any number of topics being considered by the various waiters, and one gets that feeling that the line really doesn’t matter since there is so much to be discussed. The wait evidently gives the waiters an opportunity to get caught up on the latest with whomever they happen to be near. Everybody knows, or is related to, everybody, unless of course, you are a foreigner. So there we were, doing what us Gringos don’t do so well, waiting.

We came here to live in a different culture, and to enrich our lives doing so. I reminded myself of this as I waited, and decided to join in. So I look over at the person next to me and commence to conversing with them about life in Costa Rica, the weather, kids, my affliction, their affliction, what its like to be a gringo, and before I know it, my wife is signaling to me from the window that I need to get over there.

The person at the window checks my carnet, and asks to see a recent receipt of payment of my insurance, which we had with us thanks to previous experiences. She then directed us to a room where a doctor eventually came in and looked at my ankle and informed me that I would need to stay at the hospital for an intravenous antibiotic program. I was then given a robe that tied nicely in the back, and escorted up to the Men’s Orthopedic Room.