Nicaragua: Hospital Emergency Room in the Third World …The COMPLETE Nicaragua Experience

emergencyIt was an “unexpected journey” that Bilbo would have been proud of, except there was no party the night before, no wizard to guide us, and no dragon horde of treasure awaiting us at the end.  But one similarity to “The Hobbit” was the frightening prospect of having to go to the Emergency Room in a third-world country. Fire-breathing dragons seemed tame by comparison. Yet, unlike Bilbo, we were prepared and confident…mostly.

Prior to our leaving the USA, we talked to our doctors and other healthcare providers about healthcare in the third world.  Predictably, each provider would frown with a shake of the head and warn us that healthcare in other countries was not good.  Each would rail about how poorly trained the doctors and nurses were, how there was little quality control, how conditions were not sanitary, don’t drink the water, don’t eat the food, “it’s cheaper for a reason.”  In short, each implied the only place to get first-rate care was in the USA.  Depressing news, but not bad enough to keep us from our adventure.

As precautions, however, we contacted our health insurance and got a “vacation override” for our maintenance prescription drugs so we would have sufficient supply for the duration of our trip (we needed more than the standard 90-day supply).  We translated our lists of meds, including dosages, into Spanish along with a Spanish explanation of the thankfully few health issues we have that might require care.  We wanted to be prepared for the possibility that no one would speak English when we needed it most.  Recognizing that medical facilities, just like those in the USA, can fall into “the good, the bad, and the ugly” categories, we researched the best and worst hospitals in Managua.  Upon our arrival, we located the nearest hospital with the best local reputation … just in case.  In short, we did our research and prepared for any worst-case scenarios related to any medical issues or complications that could be anticipated.  All information was carefully converted to Spanish PDF documents and then stored on both of our telephones, which we always have with us, so the information would be readily available should we need it.  We then promptly breathed a sigh of relief, knowing we were as prepared as we could be for all contingencies.  Almost.

We love having visitors when we travel and Nicaragua is no exception.  Sharing our experiences with family and friends brightens the trip and gives us a chance to broaden their horizons as we broaden ours.  So far, my cousin (and Heide’s best friend from childhood) along with our good friends Sam and Sunny from Maryland have visited us in Nicaragua.  Usually, things go smoothly.  On this trip, however, not so much. We shared more experiences than we intended. In addition to sharing old Colonial towns, smoking volcanoes, stunning Pacific Ocean vistas, we also managed to get 2/3 of our guests sick, along with ourselves, with some version of food poisoning (we think).  For most of the cases, the bout was the garden variety of “Oh, I don’t feel so good” food poisoning. The antibiotic Cipro, plus lots of water and rest, took care of the problem.

But my poor cousin, who shall remain nameless to protect her pride and privacy, had it the worst.  She didn’t have the “garden variety”, but rather the nuclear explosion variety that emanates from every possible orifice known to humankind.  The outcome (and I use that term loosely–no pun intended) was rather spectacular.  The mushroom cloud could be seen for miles. After a night of ejecting things she ate back in high school, she looked miserable, felt dreadful, and was severely dehydrated.  She couldn’t even keep the anti-nausea medication down.  The only thing the nearby Masaya Volcano eruptions had over her was the smoke–and I can’t say with certainty that there wasn’t any.  It became clear that if she was ever to see the USA again in this life, we needed to get her to the ER at the local hospital.

IMG_20160129_093414As luck would have it, the closest hospital to our hotel is also the best in Managua, so off we went, patient in tow, to experience Emergency Room care in the third world (every gringo’s private nightmare).  We pulled up to the Emergency Room entrance but she was too weak to get out of the car.  The security guard got someone from the ER with a gurney, and my cousin was quickly wheeled into the ER.  After a brief explanation, with Heide doing what translating she could while I parked the car, a doctor was summoned who spoke some English.  An IV was immediately started to replace fluids and blood was drawn for testing along with other “samples.”  Within an hour, the results came back as a “food-borne intestinal infection,” and an internist was called in who also spoke English.  Antibiotics were prescribed and administered via IV, but it became apparent that she was not recovering quickly enough, so the decision was made to admit her for observation overnight.

The hospital brought in an interpreter to make sure we understood what was going on with both her care and, of course, the billing.  Medicare does not cover anyone outside of the USA, and the hospital did not work with my cousin’s supplemental insurance.  Her supplemental insurance will reimburse her for the costs.  The forms I signed (on her behalf) were in English and perfectly clear.

I have to say that the gloom and doom portrayed by our USA healthcare providers couldn’t have been further from reality.  The care was first rate; the facilities were as modern and up-to-date as any I’ve seen in the USA.  The ER equipment looked no different than anything I would expect to see back home.  The lab results were back quicker than you could say, “Are the lab results back?”  We did not wait forever for anything.  The hospital was efficient and absolutely spotless including the public restrooms (my litmus test for cleanliness).  Each time my cousin would use the bathroom, amazingly, someone would go in and clean and disinfect it.   In the morning someone came into her room and cleaned and disinfected every single thing in the room–bed, mattress, floors, walls, chairs, everything was wiped down and disinfected.  My cousin was in awe at how thorough they were.  There were more people with mops in the hallways and public areas than there were cops outside trying to give me a ticket.

Nicaragua may be a poor third-world country economically, but the care we witnessed at the Hospital Metropolitano Vivian Pellas was first-rate.  I don’t wish a hospital stay on anyone, but if I had to go myself, I wouldn’t hesitate for a second to go to this hospital.  And the total bill for the emergency room care and the overnight stay in a private room, including all medications and doctor fees, was just $1,407.55.  That amount in the USA wouldn’t have covered the hospital meals, and the care would have been no better.

My cousin was back with us the next day and ready to go right back into the dragon’s lair — the wonderful world of potential food-borne illness known as “restaurantes.” Her first question was, “What’s for dinner?”

Nicaragua: I fought the law…and the law won…TWICE !

Policia_Nacional_De_Nicaragua_LogoThe vagabond life is never boring and two weeks ago was no exception to that rule. Navigating the legal system in a foreign country can be challenging. Much more so when you only understand a little of the language. In the United States (at least in Pennsylvania and Maryland), a U-Turn is permissible unless there is a sign prohibiting it. As luck would have it, Nicaraguans don’t waste a lot of money on road signs. No street signs, no route numbers, there are speed limit signs and appropriately placed “Yield” and “Stop” signs (Ceda el Paso and Alto respectively) but there are few signs of any other kind. And, where there once were signs that had gotten stolen, they still enforce the phantom sign anyway.  A puzzling system.  Not that that excuses my run-in with the law…twice.

We took off on a road trip in search of the Bavarian Delickatessen in Managua. Sauerkraut is not common fare in the grocery stores here apparently and I just had a hankering for some. The Bavarian Delickatessen was found and the sauerkraut was sold in bulk–not in cans or bags but by the wad.  We also found a little bakery next door that had some decent breads (Don Pan–pan meaning bread)–they do something to the bread down here that makes it crumbly without that wonderful bread smell and taste. We suspect the flour here is of a different variety because it seems to be fairly consistent everywhere we go. In any case, we were thrilled with our purchases and were heading back to our apartment when I took a wrong turn and needed to head in the opposite direction on the Masaya Road (Route 4). Just as I would back home (legally, BTW), I came up to a turn lane at a traffic light with no sign barring a U-Turn and, when the left turn light went green, executed a perfect U-Turn that would have brought tears to the eyes of driving aficionados everywhere. Alas, about 200 meters or so down the road and unknown to me at the time sat two Transito Policia–who observed my perfect driving with great interest.

As I approached where they were stopped along four lanes of traffic, one of them casually walked out into the third lane (MY lane), put his hand up, and motioned me to stop and pull over. I knew I was humped.  I wasn’t the only one pulled over but that was little comfort.

The real challenge, however, was yet to come.  Unlike Costa Rica where you can easily find someone who speaks English, Nicaraguan English speakers are few and far between and, apparently, it’s not a requirement for the police force.  Consequently, the entire conversation took place in Spanish–I use the term “conversation” loosely.  Pretty much, he talked, I listened.  When he got tired of talking to me he called his partner over to finish the conversation–still all in Spanish.  I may need hearing aids or a universal translator from Star Trek but the only word I clearly understood was “teeeket.”  With great flourish, he also kept motioning that he would keep my driver’s license, put it in an envelope and I would have to pay the fine at bank and then take the receipt to the police station on Monday to get it back.  He did this four or five times with a smile.  My only ace in the hole was “Lo siento.  No entiendo, señor.” (I’m sorry.  I don’t understand, sir.).  Don’t get me wrong–my ace did nothing for the shitty hand I held and I got the “teeeket” anyway but the police officer couldn’t have been nicer about it.

When we got back to the hotel where our apartment is, I threw myself on the mercy of Evelyn at the front desk who speaks English well.  She made a phone call to find out the procedure and made arrangements for a car service driver (Alberto) to take me to the police station and help me navigate the system. Alberto was a god send.  We were in and out in mere minutes instead of the half day I expected to spend there.

The Crime
The Crime

What I never realized was that there was a hidden message in what the police officer was trying to tell me with a big smile.  Just like in the movie Jerry Macquire, “Show me the money” and “Help me help you” were the actual themes of the conversation I didn’t understand.  His repeated motioning and explanation that my license would go into an envelope and I’d have to go to the police station to retrieve it were veiled attempts at soliciting a payoff.  Oh, dopey me….  Had I slipped him a few Cordobas, the entire episode would have evaporated into a “warning” without the hassle of keeping my license (“Help me help you”).

Not to be limited in my desire to give money to the police, I got stopped a second time a few days later for an “illegal lane change,” a bullshit charge but fairly common here in Nicaragua.  In any case, I now had a better understanding of what the officer was telling me.  He even drew a diagram showing what a shitty driver I was (see diagram).

Show Me The Money...
Show Me The Money…

He then showed me a folded card that indicated the fines for various offenses and pointed out the one that pertained to my high crime.  On the paper on which he drew the diagram he wrote “$40” and showed it to me with a smile.  Jerry Macquire came to the rescue as I “helped him help me” for 500 Cordobas (about $20).  I tried to hand it to him but he made it clear I should put it inside the “fine card” and hand the card back to him–thus, no money was seen being handed out the window.  He returned my driver’s license with a smile and we were on our way.

I swear that rental cars here have an invisible Bat Signal on them that only the police can see.