Freddy's broken ankle and an adventure into the national health care system

Freddy and his broken ankle

A former neighbor and good friend of ours, Freddy, used to be a semi professional soccer player here in Costa Rica.  In late July, at the age of 60, he was playing in an adult soccer league and suffered a serious ankle fracture that would require surgery.  He was in the hospital in Liberia for three days after having had his surgery and was eventually sent home to Nuevo Arenal, about two hours away.  Both of his sons were going to be busy with work meetings on the day he was scheduled for his six week follow-up appointment so he asked me if I could take him.  I happily volunteered to go.

We left very early in the morning and after picking up one more friend who also had an appointment, we drove approximately 2 hours to the main regional hospital in Liberia, Guanacaste.  I was eager to gain more appreciation for what the hospital might be like.  As expected, it was very busy even at 7 o'clock in the morning. The hospital itself appeared to be clean, well organized and open to the outside though not extremely fancy, at least according to standards to which I'm accustomed to in the United States.  I was most impressed with how calm and patient everyone appeared to be while waiting.  We encountered a long line of people who were waiting for bloodwork. We checked in at a desk and received a slip of paper so that he could obtain an x-ray.

Busy line for bloodwork

After waiting a few more minutes, we went into the x-ray suite and stood in another line for another 10 minutes or so.  During our time waiting, Freddy encountered no less than four people that he knew.  We spoke with one young gentleman who had a knee surgery around the same time that Freddy did.  Another patient had lost a few fingers in a work accident.  They both had follow-up appointments.  The remainder of the folks that we met were his friends from Nuevo Arenal.

The x-ray itself did not take more than a couple of minutes.  It seemed to be a modern system similar to what I've seen, though not completely digitized.  Next, we were told to go and wait at another window where we would be able to pick up the x-rays themselves in about 20 minutes. Eventually, with the films in hand and with Freddy's urging, we took a quick peek.  To my best judgment, everything looked similar to what is done in the States.  The bone alignment and hardware also looked great.

"Hold still for just a second"

We then proceeded to wait in line yet again, outside his surgeon's clinic. Once inside, the surgeon looked at the films and did a quick exam, while exhibiting the apparently universal stereotypical demeanor of an orthopedist (apologies to any offended).  After a brief discussion, he wrote prescriptions for more Ibuprofen as well for physical therapy.  Freddy was most excited to be able to slowly begin walking again.

Ready for radiation

The last stop was the physical therapy office where his therapy appointments were scheduled.  An ambulance (more similar to medical transport) will transport him from home two hours each way, three times a week for eight weeks for physical therapy!  All told, we were in the hospital for about four hours.  Though it was a long time, I was pleased with the relative efficiency of the system and what was able to be accomplished.

On the way home, we picked up his prescription for ibuprofen.  These pills, his surgery, follow-up appointments as well as his physical therapy with transportation is 100% completely free for him.  No strings attached.  Freddy is a part of the Caja, the national healthcare system in Costa Rica.  Because he is of retirement age, he and his wife pay NOTHING to be a part of the system.  Though not perfect, it seems to me that the system works very well for a patient of relatively limited resources, like Freddy.  Understanding how this process worked for my friend in this country underscored the absurd complexity of our system in the United States.  Very interesting indeed.