The Importance of Having Contacts in Costa Rica

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We have made quite a few Costa Rican friends here and they are always available when we need help.

Minor is a bilingual retired EMT who now works for a Canadian company here. He has helped us with medical appointments at our hospital as our translator. He also helped us out during our last move. He arranged for a transport truck to help us move from Puente de Puedra to San Roque de Grecia, where we now live.

Alex is one of our taxi drivers when our car is out of commission. Recently we were parked at Super Rosvil grocery and our vehicle would not start - new battery was dead. Two strangers stopped to help. They gave us a boost but it still would not turn over. I WhatsApp’d Alex and 15 minutes later he showed up in his red taxi and got the car started. We drove straight home and let the car run for 15 minutes, as per his instructions. We continued driving the car as it continued to start and run.

The same thing happened again just the other day. Parked in downtown Grecia - battery dead. Lance flagged down a taxi and the driver got it going with a boost. Home we went. By the way, the taxi drivers are great for boosts and changing flat tires. I once had two Super Rosvil managers change a tire for me. They just came out of the store and did it.

We contacted our mechanic Josué. He recently installed the new battery. He picked up our Subaru at our house and took it to his shop. Turns out it was an electrical problem draining the battery. There were some other problems which he is now fixing and hopefully we will have our car back today. It’s not a new vehicle so problems can be expected.

There’s also Coco, a tow truck driver we know. I can WhatsApp him anytime if we need a tow.

Costa Ricans are great sources of information also. Alex referred us to Josué. Minor found Coco for us. They are wonderful friends. I once had a nice lady (bilingual) come up to me at our Ebais clinic. She offered her help when I saw the nurse and told me to call her any time.

Off Topic

As mentioned in my last blog post (April 2025) we have been having heavy rains. A storm that blew through the other day was fierce. Strong winds were blowing the rain sideways.  It resulted in this heavy mud floating down our laneway onto part of our patio and in front of our garage.

Our landlord Luis arranged for Toño and his helper to clean it up for us, which they did in short order.

Turns out the mucky mess is from a vacant lot next to us that is being developed and there is a lot of dirt piled up. Luis’ uncle lives near us and he is keeping an eye on the lot. Luis lives in Guanacaste (northern Costa Rica).

Why Did the Knee Need a Vacation? Part 1.

Because it was feeling kneedy!!! Yes, groan.

About three weeks ago, I stepped off a ramp at a local grocery and my left knee gave way. The drop off was hardly more then a few inches but the pain told me I had done something bad to that knee.

I made an appointment at our assigned Ebais and the doctor examined it thoroughly, prescribed one shot of morphine and a round of anti-inflammatory meds. Everything was going well until one week letter I further damaged the knee. I was pulling shut a metal gate and I guess I put too much weight on my left leg. The pain this time was quite bad.

I decided to make an appointment with a MediSmart doctor.  MediSmart is a discount medical plan (not insurance) that we use in conjunction with Costa Rica’s socialized medical system. 

On line, you can search for a doctor whose practice is in the area you are looking for and you can further narrow it down to the town/city/province you want that service to be located in. I found a doctor whose qualifications were (I thought) GP - general practitioner - and made an appointment at Clinica Helenica Grecia. This is where I also see my eye doctor and my dermatologist.

The doctor (actually “doctora” in Spanish) was very nice. She took down my history and I explained my knee problem. Then she said, “Well, Diana, we have a little problem. I am a general surgeon and a proctologist!”. We had a good laugh. It was really funny. So much for my “GP” interpretation. She then made an appointment for the next day with an orthopaedic surgeon so I got moved right up to a specialist. And I wasn’t charged for my visit with her.

The next day, I limped into my appointment with Dr. Baltodano. He was excellent and explained everything so thoroughly. Here is the drawing he did to explain how a knee is structured and what can cause knee problems:

Recommended treatment until I had x-rays and ultrasound completed: RICE - rest, ice, compression and elevation. The compression part turned out to be a toe to thigh thick stocking! He also prescribed three courses of anti-inflammatory shots 48 hours apart and five days of pain killers.

Cost of this visit: 55,000 CRC (about $139 U.S.).

Cost of the injections and medications: 35,000 CRC (about $88 U.S.).

It’s important to mention that Dr. Baltodano is bilingual. When one’s Spanish skills are not up to medical terminology, this is very important.

Stay tuned for Part 2 - x-rays and ultrasound!

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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".

Unique Health Care System in Costa Rica

In my blog post earlier this year regarding Covid-19 (March 15, 2021), the numbers indicated that Costa Rica was doing better than Canada and the United States. The focus was on mortality. If you caught Covid-19, what were your chances of survival compared to Canada or the United States? It appears that Costa Rica continues to do better.

As the table below indicates, this continues to be the case:

Back in March, I speculated that this might be because on average those who live in Costa Rica spend more time exposed to outside air than those who live in Canada or the United States. I did not clarify, but I had in mind that one or the other or both of central air conditioning and central heating is relatively common in both countries. This might not provide a particularly healthy environment for controlling the spread of the virus.

Now comes to light another possible reason why Costa Rica has been faring better. It has a unique health care system. Specifically, Costa Rica has a health care model which combines a tiered universal medicare system with an unrestricted private care system: see Atul Gawande, "Costa Ricans Live Longer Than Us. What’s the Secret?”, The New Yorker magazine, August 23, 2021.

While Canada has a universal medicare system, it is not tiered like that in Costa Rica. Moreover, Canada severely restricts the services which can be provided by private enterprise. In the United States, the private care system is essentially unrestricted as it is in Costa Rica. However, while the United States has a medicare system, it is restrictive and far from being universal. Neither Canada nor the United States has a health care system which reaches down to individual households in a proactive manner as described by Atul Gawande.

We have experienced the proactive approach in Costa Rica. Two examples: (1) as described in my blog post on March 19, 2021, Lance got a personal telephone call out of the blue from a doctor at our local EBAIS to schedule an appointment for our first of two Covid-19 shots. I might be wrong, but I doubt that any person in Canada or the United States ever got such a call from any health care authority. (2) shortly after moving to Grecia/Hacienda El Paseo in 2018 and signing up with our local EBAIS, we were surprisingly visited by two medics.

As the New Yorker magazine article indicates, these medics are referred to as “ATAP" (Asistente Técnico en Atención Primaria) - trained community health care workers. They wanted to give us flu shots which we respectfully declined because neither of us had ever had flu shots (or ever had the flu over a period of decades). They also gave us pills for intestinal parasites - very common in tropical countries.

They also inspected our property indoor and out for cleanliness, etc. Their only recommendation was that we get rid of an outdoor pool of water which could provide a breeding ground for some mosquitos that are responsible for dengue fever - a fever which is survivable but not pleasant. We got rid of the “pool”. The pool was a relatively small plastic, rectangular container on the ground filled with water (usually rain water). Various species of birds found the pool and relished the opportunity to take a bird bath. That’s why we kept it until advised by the medics not to do so.

Urgent Doesn’t Necessarily Mean Urgent

On Tuesday of this week, I had a routine appointment at our assigned EBAIS so the doctor could assess my latest blood work results and write new scripts for the drugs that I take.

I take the meds to control a couple of medical conditions I have had for years and years. I won’t go into them because it’s boring for everyone, including me. I’m only writing about this to explain how we coped when sent to emergency or urgency at our hospital.

Here in Grecia where we live, we have our own hospital, Hospital San Francisco de Asis. It’s about a 12 minute drive from our house. This is one of the advantages of living in Grecia as opposed to Atenas (where we first lived). The assigned hospital for Atenas is in Alajuela, about a 30 minute plus drive away (and horrendous parking).

So, my last blood work results were not altogether good, with elevated potassium levels probably/maybe due to one of the latest drugs I had been taking. The doctor told me that  elevated potassium levels can cause damage to the heart.

My doctor said she was sending me to the hospital for observation (we were communicating through my phone translator). She printed out an “urgent” requisition for the hospital. The receptionist looked at it and said I was to go there “ahora” (now).

Phooey. So off we went. We did not know exactly where to go in the hospital so we showed the paperwork to the guard at the emergency entrance. He pointed to a small lineup outside a door just down the street from him. Showed my requisition to the guard at that door and he sent me in right away.

Whenever I wasn’t sure where I was to go, I just showed my paperwork to someone and I was redirected. Everybody was so helpful. Ended up at an admittance window where my info was again entered into a computer.

After that, we were sent further down the hall to another room where my BP, temperature and oxygen levels were taken. Further info entered into the computers. Then directed to sit in the waiting room. What seemed like chaos to our eyes at first then became controlled organization as we sat and watched everything around us.

There are doctor consulting rooms all around. We actually didn’t have long to wait before my name was called. The doctor was really nice - the translation app on my phone is invaluable. All my medical history is immediately available on the computers for any doctor/EMT, etc. to look at. 

She did an ECG and sent me off for bloodwork. I didn’t have to stay for observation. We were not sure where the blood lab was and a very kind and cheerful young lady took us right there and handled my requisition at the counter for me.

So now we know how to deal with this section of our hospital. Lesson - just show your paperwork to anyone who works there! It’s obvious we are foreigners and Costa Ricans are always willing to help out.

I was happy to be sent home, knowing that if there was a problem I would have heard about it by now. But if I had been admitted, I would have had no concerns about the level of care I would have received. It’s top notch.

P.S. The guards that are all around the hospital are not there because it’s a dangerous place to be. They are invaluable for keeping lineups orderly (especially now with Covid), directing people to the right place and so on. I always go to them when I am unsure about where I should be.

Interesting Stuff That Happens To Us

We are quite fortunate because Costa Ricas always seem to be helping us out when we get stuck. I think it is in their very nature to be kind and helpful.

Recently I received a parking ticket. Parking in our town of Grecia is a system called elPark. You pull into a numbered parking spot, pull up the elPark app on your phone, enter the stall number, the minutes/hours you want to park for, and pay for the time on the phone (using a preauthorized credit card number). Then I get an email from elPark with my parking details.

The ticket was incorrect and I had the emails to prove it so off we went to City Hall. The guard at the front gave me a ticket to see an agent and I guess it was a ticket for old people because I went right to the front of the line in a crowded room of folks waiting to see an agent. The agent looked through my paperwork then directed us out of the room and down somewhere else. We couldn’t find “somewhere else” in the building. In consultation with the building guards, a Costa Rican came to our rescue! 

This shaven haired, very muscular and tall man indicated we should follow him. We walked and walked - I whispered to Lance that we were following a complete stranger to who knows where. Into the Mercado Municipal de Grecia we went (a huge indoor market in the middle of town). Past all the fruit, vegetable and meat venders to a set of stairs. Up we went - turns out it was the office of elPark so our stranger knew exactly where to take us. We thanked him and my ticket got sorted out.

Another example: we recently renewed our cedulas (residency ID cards, everybody has one) and had to wait for them to arrive - they expired on March 29. Since our association with the CCSS (socialized medical system here - if you have residency you must join) expired on the same date, we had to reassociate with the CCSS. This meant taking our new cedulas and all associated paperwork to the affiliation wicket in the CCSS medical clinic building in Grecia. You sit (or stand if there are no chairs) at the end of the line and wait. On this day, we waited three hours but I’ve heard of longer and shorter wait times. Finally our turn came but it quickly became apparent that we were totally at sea what with the ambient noise around us and the rapid fire Spanish from the clerk.

To our rescue! Costa Ricans! One lady in the lineup saw our predicament and sent her husband over to help us. He was bilingual so thanks to him we got through it all. It’s nerve wracking because you never know if you have all the correct paperwork and if you don’t, away you go to get it and come back and line up again. We were asked if we were married and thankfully I had our Costa Rican marriage license with us. There’s a reason why we remarried in Costa Rica. I won’t go into it here but I did a blog post on it a few years ago.

Turns out our rescuers are also our neighbours - they live not far from us in the same complex. They rescued us a second time, the very next day. Now that we were reassociated with the CCSS, we went to our newly assigned Puente de Piedra Ebais so I could make a doctor appointment. We had been told to be there at 0800 but the receptionist was telling everyone to come back at 0900 the same day. Our angels somehow talked the receptionist into giving me an appointment for the next day right then and there.

The next day, back at our Ebais clinic and waiting to be called by the nurse and then the doctor. The Costa Rican lady next to me started to chat, in English! She showed me photos of her husband and children. We traded names and phone numbers and it turns out she lives not far from us. She even went into the nurse’s office when my name was called, saying “venga, venga” to me (“come on, come on”) like they do when calling little kids. She stayed and translated for me which was a blessing because there were lots of questions about my medical history. We had some good laughs when none of us could make ourselves understood - pointing at private parts and so on. You will always see a nurse first before the doctor - they take your height, weight and blood pressure. Everything is entered into the computer system and the doctor pulls the same info up on his computer.

Fortunately, the doctor was bilingual.

The Puente de Piedra Ebais clinic is much larger and more modern then the Barrio Jesus clinic we were assigned to when we lived in Atenas. The nurse and doctor offices are large and the nurse has an electronic blood pressure machine and electronic scales, not what they have in B. Jesus. It’s also very close to our house - a five minute drive. Grecia has its own hospital - Hospital San Francisco de Asis. 

Another Visit to Our Medical Clinic

This morning we had our regular four month appointments at the Barrio Jesus EBAIS clinic. Unfortunately, there was some misunderstanding between the Atenas blood work clinic and our assigned appointments at the Barrio Jesus EBAIS.

No problem, our doctora said we can come back in four months and gave us enough scripts to carry us through.

Sitting in the Barrio Jesus EBAIS clinic is always a lesson on learning how to live here. Apparently a nasty insect was sitting on my arm and a Tica swatted me and killed whatever it was. Then she showed me her hand ... a dead, bloody insect ... and she went and washed it off.

They have a TV at this EBAIS, cooking shows and soap operas, in Spanish. An elderly woman came in on the arms of two people and the nurse looked after her. It's just very laid back and really nice.

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Using the CAJA on an Urgent Basis

CAJA = Costarricense de Seguro Social (aka Costa Rican Social Security)

EBAIS = Equipos Básicos de Atención Integral en Salud (Basic Teams of Global Healthcare)

Recently I had the misfortune of pinching a nerve in my lower back. Anyone who has experienced this knows how painful it can be. I put up with it for a few days before deciding it was time to see a doctor.

We taxied to the EBAIS clinic in Barrio Jesus. This is the clinic we were assigned to by the CAJA. It is the first step in the ladder of treatment.

If your Spanish is weak like ours, at least for dealing with medical problems, a good idea is to translate your problem from English into Spanish and print it out. Hand it to the receptionist and then the doctor - although our doctor speaks English.

I must have appeared to be in some significant pain because I was seen almost right away. The doctor wrote down my problem in my file and prescribed a pain relieving injection, muscle relaxants and anti-inflamatories - all STAT.

Another taxi ride into Atenas to the EBAIS clinic there to hand in the scripts at the prescription counter. You will need to show your carnet (medical card), proof that your CAJA is paid up to date (receipt) and your cedula (ID card). Then you sit and wait until your name is called to pick up the drugs. In the case of scripts for injections, these are filled at the prescription area and a nurse comes by regularly to pick them up. Your name will be called and you head into a small room for the shot. Neither Lance or myself heard my name being called but a young lady came to get me and I don't know how she knew who I was. Or maybe it was obvious - I guess we stand out because anyone can tell we are not Ticos.

So now we know how injections are dealt with and where we have to go. Every visit we learn something new. Although things seem confusing at first, it becomes clear that there is a smooth running system in place.

 

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