It’s never fun to get sick with urinary tract infection. Or an infected toe. But it’s something else entirely to be sick in a foreign country. At home, I know what to do. Here in South America, it’s always a bit of a blank page in the book–I don’t know what comes next. Uncertainly causes anxiety. Now that I have been traveling for seven months (unimaginable but true) I have been in need of medical care seven times!
My maladies in South America have been varied and prolific. It’s been everything from a urinary tract infection to spines in my toes that needed to be pulled out before they caused an infection. Between all my visits to postos de saude (public health clinics in Brazil), public hospitals, and a Colombian clinic, I have gone seven times–that’s pretty much once a month.
I’m not an expert on South American health care, but I do have a number of insider experiences now. There’s a fascinating medical anthropology aspect in getting sick, discovering what the inside of foreign public health clinics and private hospitals are like and how care is delivered. I’ve gotten so interested I wouldn’t mind a project where I travel the world to experience hospitals and do a cross-cultural comparison of health care delivery.
Every time I realize, Oh man, now I am going to have to find a doctor at a public hospital or private clinic, I feel overwhelmed. And almost every time afterward I feel relieved and impressed by how relatively easy and inexpensive it was to get the care I needed. The only exception was in Rio. Granted, I haven’t had cancer or diabetes, long-term or complicated life-threatening conditions, but the access to free or very cheap care has been impressive.
If a foreigner without American insurance came to visit me in San Francisco I wouldn’t know how to advise him or her if she needed urgent care. I’ve gotten good suggestions for private or public clinics where I have been seen rapidly with a minimum of friction.
The first time that I needed to see a doctor during my travels I was in Praia de Pipa, a beach town in Northeast Brazil famous for surfing and dolphins. For three weeks I had a weird hard mini-lump in my armpit that I assumed was a pimple and would just pass. But suddenly it was traveling up the inside of my arm in a thin line. My American doctor told me over email that I probably had an infected abscess and to seek medical care as soon as possible.
The owner of the pousada where I was staying suggested the Posto de Saude (health post) in neighboring Tibao de Sul, a slightly larger small town. I really didn’t want to go. I had visions of knives, being cut open and coming out even more infected than I was. I did everythign I could to avoid going, including having an Israeli friend call his travel advice doctor.
After two days I steeled my resolve to take the bus to Tibao do Sul.
The small clinic wasn’t exactly impressive looking, but there was a desk in the front where a woman did a quick intake. In the US there would be pages and pages of forms to fill out, but all she wanted was to see a document, a passport or a copy of one. It’s been almost unimaginable to me as an American that I don’t have to present an insurance card in order to enter a health care system.
I waited in line behind a pregnant woman. It was a real potpourri of medical conditions awaiting the doctor. Another woman had sand in her ear.
Seeing a doctor in South America often feels more like going to see a financial adviser or a lawyer in these small towns where the patient sits on one side of the desk and the doctor sits on the other. The doctor in Tibao do Sul was fatherly, he examined the abscess and gave the same diagnosis as my American doctor had made remotely. He prescribed antibiotics which I bought across the street for less than $10 and I was on my way. A lot of adrenaline for nothing.
In Brasil, consumers can get antibiotics without a prescription. In fact, they can get all sorts of drugs that we in the US associate with prescriptions without one. So theoretically I could have self-prescribed, but I much prefer the guidance of a doctor.
Two months later I found myself far south at another beach town in need of medical care. This time I had a very unfortunate afternoon at a treacherous beach in Trindade, Praia Brava. That story merits a whole other post or essay, but suffice to say I found myself tossed around on rocks, and on these rocks, I sustained some deep cuts and spines from the rocks lodged themselves deep in my hands and feet while I was scrambling to get off them. After this incident, I went to the ER in Paraty, the town where I was staying, for immediate cleaning of my cuts. That care was totally free and fast. Again, all I had to show was my passport. And even more amazing to me was the follow-up care. One of the horrible things about that incident was the way that those spines stayed deep in my toes and feet, prickly black things that I couldn´t get out. Later I learned that if these spines stayed in my hands and feet they would certainly cause infection (from all the bacteria in the ocean water). So to stop the pain they caused and avoid infection it was important to get them out.
Limping around Paraty and with a bandage on my arm, I went back to the Posto de Saude in Brazil, which is more a clinic than the hospital I visited two days earlier. Apparently there was a woman whose whole job was to wait for people who needed curativos, or bandaging type care. She was waiting by the window when the woman at the front desk told me to go see her. This time I didn´t even present an ID. I just told her I needed a curativo. We entered a room with an examining table, and she gently went to work plucking the spines out of my feet with a needle. I went back two days later and another male curativo-nurse type pulled out more.
There was something profoundly humane and gentle about a medical system where there are people whose job it is to bandage you, pull spines out of your feet–for free. I cannot say whether the Brazilian medical system works for more complicated conditions, and I get the sense from friends that it is still important to carry private insurance. Still, that system feels humane to me. My friend Marcelle in Rio told me he is amazed to hear the health care debates in the US about socialist health care. For him, it is an assumption that health care like education is a human right.
In Sao Paolo my infections from the incident were still flaring up. My couchsurfing host took me to a public hospital, where, even on a holiday, I waited only half an hour and got an emergency shot of antibiotics and a prescription for more. In Rio, finding public health care was more complicated. The public health clinic in my neighborhood Santa Teresa were overcrowded and you need to show up at 7 am to get in line. On one occasion, I got a prescription from a friend´s father who was a cardiologist. On another occasion, I paid $60 to go to a private women´s hospital, where I got good care for a UTI.
In Cali, Colombia, I visited a public health clinic with much the same experience as I usually had in Brazil. Short line, cheap fee, and I only had to show a passport.
The most recent medical experience was the most hilarious. A European friend who accompanied me to the Cali clinic has long been worried that she has psoriasis. She saw a poster for a free psoriasis-diagnosis clinic the following day at a Cali hospital. So the next day we found our way through a complicated hospital complex to the Clube de Psoriasis, where dozens of people were waiting to get treatment for their skin. There seemed to be something very strange about a Belgian woman seeking free, nonurgent care for her skin condition in Colombia. The Psoriasis Clube is not exactly highlignted in Lonely Planet as a tourist attraction. But touring the medical system is one of the things you get to do when you are a long term traveler.
The dermatologist was professional and efficient, and my friend, as it turns out, does not have psoriasis. Whew! Not only does Colombia dole out cheap medical care, but they will invite you to be a member of the Clube de Psoriasis.