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Wednesday, October 29, 2014

Living Legal in Costa Rica - PART II continued

As indicated in my last post under "Living Legal in Costa Rica", both Lance and I now have our carnés (i.e. medicare ID cards) which allow free access to public health care services in Costa Rica. But, it is one thing to have a carné. It is quite another to start using it. To do so, you first have to introduce yourself to the system so that the EBAIS clinic to which you have been assigned by CAJA can meet you, open a file, and start keeping records of who you are and your medical history.

There are many EBAIS clinics located throughout the country. They are at the front line of the public health care system in Costa Rica. They provide basic non-emergent health care services such as quick fixes for minor complaints, prescribing drugs, and generally monitoring and keeping detailed records of each individual’s health. If attention is required which is beyond their capacity to provide, then part of their job is to make initial appointments and/or referrals for more intensive care and attention.

We have now introduced ourselves to the system, but not without some hiccups along the way.

With our new carnés in hand, we first went to the EBAIS clinic in Atenas. After all, this clinic occupies the same complex as the place where we got our carnés and the name "ATENAS" appears on the carnés.

Problem is that the carnés we received did not identify the EBAIS clinic in Atenas. Instead, they identified "A.S. ATENAS EBAIS B. JESUS". As later pointed out to us, this meant the EBAIS clinic in "Barrio Jesus". Arggh!

Note that Atenas (the town/city) is the capital of the canton of Atenas in the province of Alajuela, Costa Rica. Like Atenas (the town/city), Barrio Jesus is a community in the same canton. The name of Atenas as it appears on our carnés is probably a reference to the canton and not the town/city.

Walking into the EBAIS clinic in Atenas, there was a large waiting room, pharmacy windows, an area where you receive your carné, a glassed-in area which I have since found out is where you go to make appointments, a number of hallways and "no admittance" doors.

We were a bit confused about where we should go, so I asked a passing employee as best I could. She looked at our carnés and directed us down a hallway to a separate area - another waiting room with more service windows, doors and hallways. A helpful security guard pointed us to a window where a desk clerk takes your carné, fills out and stamps a form. Our completed forms were placed in a wall file outside a swinging door. In a short time, the forms were picked up. Then we waited.

Eventually my name was called. I went in through the swinging door to a nurse who took my blood pressure. Then I was sent to a doctor's office who coincidentally spoke some English. He first indicated that he worked under supervision and that he was not yet a fully qualified physician. Then he got to the important point - I was in an area where you go for emergencies! Not only that, he looked at my carné and said my EBAIS clinic was in Barrio Jesus, not Atenas.

Lance was up next so I went outside to wait. Not unsurprisingly, he came back with the same information.

Then, like an angel, along comes our friend and neighbor, Vera from Brazil, who speaks four languages that I know of (English, Portuguese, Spanish and German). She said, "What are you doing in emergency?" Don't know! She took me by the arm through the setup in Atenas and showed me where to make an appointment, how to use the pharmacy, where to go for blood tests, etc. Such valuable information - but not knowing that our assigned EBAIS was the clinic in Barrio Jesus.

Turns out that the Barrio Jesus EBAIS clinic is not that far from our house, closer than the Atenas clinic. So, a couple of days later, off we went by taxi to test the waters in Barrio Jesus. It was a very positive experience.

The Barrio Jesus clinic is plain and simple - nothing fancy but the job gets done. It has a waiting room with television, a records office, a doctor's office, a nurse's office, an examination room, and so on. We walked into the waiting room and a housekeeper who was cleaning the floor at the time directed us back to the window of a receptionist at the entrance. The receptionist took our carnés and, in hardly any time, we were cleared to go back to the waiting room. There was one person ahead of us.

My name was soon called and I went into the nurse's office. In my best baby Spanish, I said good morning, how are you, and I apologized for my limited Spanish ("mi español es poco"). Then I handed over a Spanish translation of why I was there. Doing this saves a lot of misunderstanding. She weighed me, measured my height and took my blood pressure and pulse. My very own file was opened.

Back to the waiting room and soon I went in to see the doctor. She outlined a treatment plan for me, she prescribed medications and is arranging for a mammogram, plus I was given a requisition for routine medical lab tests (blood workup, etc.). One note - CAJA does not necessarily use, or is able to access, medications available in Canada and the U.S. It is a socialized medical system and leans towards the use of less costly generic drugs when possible.

My appointment over, the housekeeper gestured me outside the waiting room - or so I thought. Actually, she was gesturing me back to the receptionist to get a follow up appointment with the clinic. Lance eventually came out from the doctor, also with a requisition for lab tests - his appointment likewise finished. We both have appointments in four months on the same day - very convenient. As we now understand the system, when you once visit your assigned EBAIS clinic, they will always provide a future appointment if only for routine monitoring - typically three or four months later.

Our next visit will be a breeze now that we know the procedures and protocol. We have been assigned Hospital San Rafael in Alajuela - that's where I'll go for my mammogram. It's also the next step up on the health care ladder.

All the staff at the Barrio Jesus clinic were women (except for the records clerk). Remarkably, the receptionist, the nurse, and the doctor all spoke at least some English.

A few days later, it was off to the CAJA in Atenas to have our prescriptions filled and to make an appointment for lab tests. At the pharmacy window, we stood in a small line to hand in our prescriptions and, most important, a receipt showing that monthly payments to CAJA were up to date. We were each handed a number and an estimated time when the prescriptions would be ready for pickup.

We then headed to another waiting room for lab tests. The receptionist there seemed to say that we were much too early for lab tests because our next appointments with the Barrio Jesus clinic were not until February and our doctor would want more current results. To make sure we understand, I'm going to ask a friend who uses CAJA.

Decided to go out for cold drinks while our prescriptions were being filled. There is a small soda next to the Cruz Roja (Red Cross) building beside CAJA and we enjoyed iced teas. I was wishing I had not already had breakfast because those cooks were turning out some great things - casadas, corn tortillas, scrambled eggs.

We went back to the CAJA pharmacy about an hour later, took a seat, and our names were called in a very short time. That was it .... prescriptions in hand and the mysteries of the CAJA and EBAIS clinics revealed to us!

Everything new and unfamiliar can seem intimidating at first. My initial instinct is to just jump in and see what happens - that is probably why we ended up in Emergency. Lance is more steady and thoughtful. Living in a foreign country is so interesting - we are always learning something.






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