Experience with the Updated Healthcare System in Costa Rica - Should You Retain a Translator?

As I have previously indicated in this blog, the healthcare system in Costa Rica is quite unique. The country has its own government run public sector system which provides coverage for all medical procedures, prescription drugs and other benefits. This is provided to citizens and ex-pats alike, the latter of whom have been in the country long enough to acquire legal residency status. There are a number of public hospitals and a network of public "Ebais" clinics throughout the country. Overall, the public system is commonly referred to as "CAJA" which is short for "Caja Costarricense de Seguro Social".

As well, the country has a private system which is also able to provide high quality healthcare services. Many doctors in this sector speak English and have received training in the United States, Canada or Europe. There are four major private sector hospitals in Costa Rica.

Some private sector doctors are also affiliated with CAJA. They work part of their time in private practice and the remaining part for CAJA. If you find a doctor in CAJA who also has a private practice, it sometimes may be helpful to consult that doctor in his or her private practice. If you meet them once in CAJA and are happy with the experience, there is no assurance that you will ever meet them again in a routine appointment in CAJA.

Over the time we have lived in Costa Rica, Lance and I have relied on both the public and private healthcare systems - whichever seemed most convenient or expedient at the time. But, it can be a challenge to navigate the public system if you are not fluent in Spanish. Some CAJA doctors are fluent in English or speak at least some English but many are not. The same is true of nurses and administrative staff. Unlike the private system, you are unable to choose your doctor in the public CAJA system and you may be met with different doctors at different times.

Recently, Lance got fed up with a persistent bad back problem which can act up whenever he twists himself the wrong way or lifts something too heavy using his back instead of his arms. He decided to get an appointment at our local CAJA Ebais clinic in Puente de Piedra (less than a 5 minute drive from our house). Today, if one is able, this is done by having the EDUS app on your computer or phone. EDUS stands for Expediente Digital Unico en Salud (unique digital health record) and this is where you make clinic appointments, see your medical history, drugs, vaccinations, etc. You look at a calendar for available dates and select a convenient date and time. CAJA then responds with an email which confirms the date and time.

After getting the appointment, we decided to engage a translator ("Minor Villalobos" - see his contact information below) to be present during the appointment. Our understanding of Spanish is limited to day-to-day stuff and does not include technical medical terminology. He is fully conversant in English and Spanish. He has a paramedic background and is familiar with medical terminology. 

The appointment went seamlessly. The Ebais doctor decided that some lower back x-rays were in order. But, they had to be taken at the local hospital in Grecia (not the Ebais clinic). The doctor provided a requisition to get a hospital appointment to facilitate that purpose. 

Normally, without the translator, we would have had to drive to the hospital, find somewhere to park, and navigate to the right location in the hospital to submit the requisition. We speculated that this could be a real chore. Minor said he would do it. With the requisition in hand he drove off to the hospital and we drove home. About 1 hour later he arrived at our home with the x-ray appointment.

The x-ray appointment was on one morning at 8 a.m. We decided that we did not need Minor for this purpose because we had a good idea of where to go and the x-ray technician would simply follow the Spanish language instructions in the Ebais requisition. We were right. Shortly after arriving at the hospital and knowing where we had to go, we left with the x-rays.

We surmised that we should deliver the x-rays to our Ebais clinic. This was wrong. The receptionist at the clinic indicated that we needed to get another appointment (going online, etc.) and hand them over to the doctor at that appointment. We left the clinic with the x-rays went home, and once again went online to get an appointment.

Lance got an appointment. We then contacted Minor to determine whether he could attend. As it turned out, he could not. He had a previous commitment. So we went online, cancelled the appointment and got a new appointment which worked for both Minor and ourselves. In cancelling the appointment, we were asked to provide an explanation and said that we were doing so because our translator was unavailable at the scheduled time. That turned out to be good enough. There was no problem getting a later appointment.

With the latest appointment, Lance and Minor once again attended our Ebais clinic. The doctor (who was not the doctor that prescribed x-rays) reviewed the x-rays and decided (a) that there was nothing particularly urgent and (b) nevertheless, the attention of a specialist was in order. There were two bone spurs at or near the lower spine which the doctor indicated should be controlled and that a specialist should be consulted for that purpose.

As a result, the doctor issued a requisition for an appointment with a CAJA specialist. Minor is currently handling that. By reason of non-urgency, it may be a few weeks before we get any feedback including an appointment with a specialist.

The above is in contrast to how a medical issue might be handled within the private healthcare system in Costa Rica. Whether urgent or non-urgent, whatever issue you might have may be handled much more promptly in the private sector. Lance is laid back. He does not care very much except when his back acts up.

Despite the bureaucracy of CAJA, we remain convinced that the healthcare system in Costa Rica is second to none throughout the world. The bureaucracy and the available options are designed to serve both the poor and the rich, and those in between, and so it should be.

For those who may be interested, the contact information we have for Minor is:

Should you retain a translator in dealing with CAJA? In our experience, a competent translator like Minor can be very helpful. So, the answer is "yes".