Medical Care in Manta

 On my flight from Quito to Atlanta, I found myself in Comfort plus, courtesy of my husband and his tireless fanagling of airline points, miles, status, etc.  I never am one to spring for more expensive seat, but Brian is 6'3, and does not easily fit into the "knee gobbling" general seats in Coach.  For much of the time, I was not terribly sympathetic, because I'm generally cool being uncomfortable of a few hours to save money, but one one overnight first class flight he had so kindly set up for me, I found out what it was like to fly for hours in a seat designed for someone of a very different height.  I did not have the correct knee to hip length to be able to comfortably seat, and spent the flight having to hold me legs out in front of me.  It was torture.  So now I get it.

My traveling companion ended up being a tall plastic surgeon from Connecticut, who, while fit, was too big for the coach seats on an overnight flight, and was separated from his team, from what I can only assume was an attempt to not be miserable on this overnight flight.  He and his colleagues had been in Ecuador in one of the underserved regions as part of a medical charitable organization, similar to Doctors without Borders.  His job was to repair cleft lips and palates.

Expats frequently laud Ecuador's "free" medical care while not recognizing the downfalls.  So before I talk about some of the good stuff, access to care, especially in the rural areas that serve the indigenious population can be severely lacking.  

So my post will be about Manta more specifically.  In general, the cities, particularly Quito and Guayaquil, have the most specialist and the most comprehensive care.  Manta is decent.  But there are plenty in Ecuador left without good access, and I would be remiss without acknowledging that.

One of the most important pieces of the puzzles I have already lectured on at length, and this is general community health, which includes plenty of affordable housing, strong family ties, plenty of affordable fresh produce, rice beans and eggs, (and fish, here in Manta) free fun community activities, free community exercise groups and a general sense of personal responsibility, responsibility towards family and community, and a community dedication to health.  Examples are everyone masking and getting vaccines during the mandates, and those with public facing jobs are maksing to this day.   The ushers at mass greet everyone with handsanitizer, the ritualistic cleaning of hands for the celebrant during the Eucharist is replaced with a ritualistic and practical cleaning of his hands with hand sanitizer, masking while he serves, and the removal of Holy Water from the fonts, and having the priest sprinkle everyone with it at the end instead.  This is a very powerful message from what the community sees as the highest authority.  This is about Covid in particular, but it reflects a deeper attitude of responsibility to each other.  The upshot to all of this, is there is less illness in general to worry about.

Next there are 2 type of hospitals public and private.  The public ones are open to the community, free of charge.  Private you have to pay for and private insurance may reimburse, although getting them to do so is more challenging than the US, I think and the insurance does not take pre existing conditions.  The upshot is I have an expat acquaitance who needed cardiac bypass (CABG).  She had a triple done in the US, and needed a quad, but her insurance (I think Medicare) would not cover the 4th vessel because it wasn't bad enough "yet" instead making her wait until it became bad enough, and undergo a second CABG.  This blows my mind, but by that time she was in Ecuador and it was of course a pre-existing, so the public hospital did it completely for free, and she did not owe anything.  She said the care was decent.  Her biggest concern was they would not let her have her phone, which makes translating very hard.

But she did have a caveot - although overall the experience was positive, you have to pay for every supply you need, so her husband was buying a lot of things that would just be provided here.  It was not a lot of money, but it was a scavenger hunt to find stuff.  Also, they run out of medication A LOT.  So people have to buy it on the "other" market.  If they can find it.

60For example, our doorman was bitten by a stray dog.  He needed the rabies vaccine.  He went to the hospital and received good care for the extensive bite.  However, they did not have the vaccine on hand.  Brian tried to look through his private contact, but fortunately the hospital was able to get a dose in and he did end up getting it.

One time Spanish class was cancelled.  Our teacher was translating for an English speaking friend who was having a baby.  Baby and mom were healthy, but the system was definetely described as cumbersome for non Spanish speakers.  He did not elaborate.  It's not the same as the US where we are obligated to provide medical translation for non English speaking patients.

Health care insurance is very, very affordable, but again, does not cover pre-existing conditions for a while.  we are still using Brian's work plan which will cover care here, but at a lower percentage.

One the private side, however, things are very nice for basic needs.  When Brian needed to be tested for Covid on two separate occasions - one was negative, the other time he actually had it - a technician, and later a doctor showed up at the condo.  Doctor is English speaking.  A house call is $60.  Labs are equally inexpensive.  Medication is very affordable.  It is a much more pleasant experience than trying to access the same care in the US.  However, for some specialty needs, you have to go to a larger city.  For others, like extensive cancer care, you need to return to the US.  Overall, I would say the population here is healthier than Portland, and there is decent access to care, but medications shortages are real, and much more of a problem if you are relying on the public system, and have limited funding.  And specialty care may not be available.  And if you a child born in a rural community with cleft palate, you may be waiting a few years for a surgeon from the US.....not ideal, obviously.

My next goal is to speak more with Ecuadorian health care providers, and I hope to work on that when I get back.