We have a man here in Cotacachi who is very, very ill. In fact, he is likely in his last days. He has no family we know of either here or in the States, is one a very low income, and (this is the very hardest) can't remember his PIN for his bank account so someone else could take his money out to get care for him.
People here, both friends of his and other concerned people, are cooking food for him and visiting with him for several hours a day, making sure he gets the correct meds, cleaning his sores, and helping him bathe. We took up a collection for his rent for May. Now what happens? People will help care for him for quite a while but it's a difficult thing to do for any length of time, especially for people who have other things they do in their lives. I can't help right now because I'm going to a pet sitting assignment tomorrow that is out of town and it would cost me money to get to and from and that's not in my budget--not to mention I would have to leave my little charges to their own devices while I was in town.
A friend who is very interested in this from the standpoint of being a nurse and thinking in the longer-range terms of what about the rest of us talked to me yesterday about what my plans are and whether or not I had considered these issues before coming here. She told me she has talked to quite a few people who came here with the understanding that health care is free here. Uh, sort of.
OK, first, here's my plan, part of it figured out before I got here and part of it as I have discovered more about what is and isn't available here.
There is a nursing home for women here and IF they have a space available, the cost is only $300 to $400 a month plus prescriptions and clothing and such. Even I can afford that. Two issues are the space available thing and that it's only for women. We can't take that man there even if we could access his money. So, assuming I would know when I was getting closer to needing care, I could get on the waiting list at the nursing home.
I am setting aside money for emergency medical care and/or for someone to come into my home to care for me until I can get in the nursing home.
Someone here has contact information to all my people in the States and keys to my house in case I can't get to the door to let someone in.
People know my wishes after I die. I think the most sensible thing is for me to be buried in the local cemetery In the States I wanted to be cremated but that's more costly here than burial. For one thing, they allow a pine box here and that would be my preference.
There is a plan in place and it's one that I hope will cause as little hardship to my friends here as possible and won't require my family to try to come up with funds for anything when this happens.
Someone asked what I would say to people who plan to come down here who will possibly have fairly serious medical conditions when they arrive. Here it is:
- If you can afford medical insurance, get the best you can. High end stuff is only about $120/mo. and that is just a fraction of what it costs in the States.
- Have money set aside for a medical emergency that either goes outside you medical insurance coverage or if you don't have coverage.
- Have a fund set up to help with long term care, whatever that might include. It might be extra help at home or a residential facility.
- Research what is available for long term care, whether it's locally or further away (like Ibarra or Quito).
- Make sure someone in the States knows what to do if they get a call in the middle of the night saying you're in the hospital.
- Make sure someone here has access to you home and knows how to contact someone in the States.
- Make sure several people know how to gain access to your money. I'll give my PIN to someone here but if you don't have a person you have that much trust in, perhaps having a family member or attorney keep that information for you and can give it to someone if you become incapacitated.
- Have a doctor here who knows you and your history and can prescribe medications appropriately even if you can't share your medical history or what you're currently taking.
This isn't a complete list but mostly what I'm saying is to give all of this some thought. None of us are going to come out of this life alive and just as we need to make plans in the States, we need to make them here.
Oh, I said something at the beginning about free health care. Yes, there is care available that costs no money. I know someone who was in need of stitches and went to the local hospital where they sewed her up very nicely. That was good. If you are in a free hospital here, you are expected to provide your own food and medications. Everyone here (locals) have friends or family who will bring them everything they need in that situations. We may not all have that. It's my understanding that the ambulance is pretty much a van that takes you to a place that has additional medical facilities--no EMTs. There are other stories to tell about the free care here but suffice it to say that it's not what any of us from most other countries are accustomed to and may not be adequate care for many, many situations.
Social Security is available here and it's available to expats as well as locals. Since we haven't put any money into the system, we have to pay for it and it's around $60/month. You need to go to specific clinics and hospitals and it may take up to three months to get an appointment. It's very good to have and they pay for many meds we might be taking but it's definitely not fabulous. Better than free and definitely better than nothing.
It's always good to keep in mind that Ecuador is a developing country. It has come a long way towards having the kind of care we may be accustomed to but it requires lots and lots of research before you can feel comfortable about living here with serious health issues and potential medical needs.
There you are, my observations about me and what I think is important for anyone planning to move here to think about.
Let me know if you have questions or just what you think about what I've said. I always look forward to hearing from my readers.