Expat shares her hip replacement surgery experience in Cuenca: the good, the bad and the ugly

Mar 23, 2012

Editor´s note: Christine Collins and her husband moved to Cuenca in August, 2011, after vacationing here several months earlier. They had lived in a large expat community near Lake Chapala, Mexico prior to relocating. She is thrilled to report that they have just received their residency status and cedulas and can finally ship their household goods down from Mexico. Christine has no affiliation with any physician, hospital or other business in Cuenca. She believes that it is important that expats understand that they can arrange for surgery or other medical needs themselves, without paying added fees to a medical tourism company.

By Christine Collins

Imagine this. Only twenty-three days after moving to Cuenca last summer, I was flat on my back, counting ceiling tiles and shivering, as chattering orderlies rolled me into surgery. Although I had planned for the surgery, it still felt as though I was shooting craps with my body as the dice! We had no support system of friends here, we were not fluent in Spanish, and we did not use a medical tourism company. I was flying solo on this one.

So how do I feel about the whole experience six months post-surgery?

In a nutshell, it was worth it. Although surgery is not a “sexy” subject, stick with me as I share details of my experience, the good, bad and ugly.

Remember the 1970s? Disco, funky and far out? Unfortunately, that was also the time when I was involved in a bad car accident. As a result, my hip began to deteriorate, although I was unaware of it at first. Later, the pain began. My coping reality included taking daily pain meds and having occasional cortisone injections. I knew my liver was saying “enough already!” Eventually, I had to face it. It was time for a total hip replacement (THR).

 “Word of mouth” was the way I selected my surgeon. A neighbor of mine in Mexico had flown her elderly mother here to Cuenca to have hip replacement and she highly recommended Dr. Marco Carrion who is associated with Mount Sinai hospital. In addition to his excellent surgical skills, Dr. Carrion spoke a sufficient amount of English so that we could communicate clearly. Being the overly organized person that I am, I initiated an email relationship with him before we moved to Ecuador. He emailed a video link of the surgery to me, as well as a link to the hospital where the surgery would occur. We set the initial consultation date for two days after our plane touched down in Cuenca.

What happens during the first appointment?

Dr. Carrion examined my hip and took my medical history. He discussed the type of prosthesis he recommended based on my age, height, weight and hip deterioration, what would happen during surgery, the recuperation period, the risks involved, and, of course, an estimate of his fees in addition to the hospital charges. We chose a tentative surgery date for two weeks later, dependent upon the outcomes of the pre-surgery tests he ordered.

The first order of business? Get an updated X-ray of my hip. Then, there was a cardiologic exam and blood and urine tests. Due to Cuenca´s high altitude, the blood test must show a sufficient hemoglobin count and the urine test must show that you are free of infection. If it´s required, I recommend you take the urine sample in the morning and bring it with you to the lab (by the way, you will need to go to the pharmacy to buy your own urine specimen cup).

The surgeon requires that at least one unit of blood be available on the day of surgery. Whether you decide to donate your own blood (as I did) or buy a unit, you will be dealing with the Red Cross here in Cuenca (the only blood game in town) Be advised that on the morning of your surgery, you will need to 1) go to the Red Cross;  2) pick up a unit of blood (either the one you donated earlier or another matching blood-type unit); and, 3) arrive at the hospital with the blood in hand, literally. We hired a translator to go to the Red Cross with us. He stayed with us until the surgery was over and he was wonderful!

My surgery had some pros and cons. Dr. Carrion was excellent, so my neighbor’s recommendation and my instincts turned out to be right. Unfortunately, I wasn’t able to meet the anesthesiologist before I was rolled into the OR. For hip replacement surgery, you receive local, not general anesthesia. The anesthesiologist spoke little English and, of course, the translator could not accompany me into the OR. A communication breakdown occurred at this point. Although I am of normal height and weight for a North American female, I am bigger than most Ecuadorians. The anesthesiologist did not take that into account, evidently, and I did not receive enough of the initial “relaxation” medication. Essentially, he stuck the big needle into my spinal column without me first having the benefit of being at the “feel no pain” stage. My scream did not need a translation. He quickly injected more “relaxation” medication. I remember being rolled onto my left side, a clamp being placed on my right ankle and then, blessed oblivion.

The surgery went well and I was in the hospital for four nights. The room was spacious and contained a futon bed for my husband to spend the night. The nurses did not speak any English but, fortunately, I was able to communicate with most of them with my minimal Spanish and body language. I had to provide my own walker (for bathroom trips) as well as my own elevated toilet chair. The hospital did not provide this “extra” type of equipment. Be sure to have a cell phone with you in case you need to reach the doctor, your translator or significant others.

Another “ugly” American? Not me! My cultural sensitivity radar is always set on high because I have lived for years in countries other than my native U.S. So, even in pain, I knew how to behave myself.

However, having had surgery previously in the United States as a basis for comparison, I found that “patient care”, post-surgery, was not a prevalent concept for this hospital’s nurses. It also seems that “pain management” is not yet a medical specialty in Ecuador. This was my experience. Others may be different.

On the day I was released from the hospital, would you believe my husband literally pushed me up Solano Avenue in a wheelchair to the temporary apartment we had rented? Although a few angry horns blared at us, no one hit us! (a good pedestrian day in Cuenca!). Call us crazy but it seemed necessary at the time. I am tall, so I could not bend my hip enough to fit into a taxi. What gringo would know that you can rent an ambulance for the trip home from the hospital?

Once home, pain pills, antibiotics and anti-coagulants littered our kitchen table for days. Amazingly, the surgeon came to our apartment to check on me a few days after discharge, something that would never happen in the States!

My stitches were removed 18 days after surgery and I was able to have my first real shower (it had been “Marine Corp bathing” up to then). I learned that there can be pain after hip surgery, so be prepared.

Teresa, my physical therapist, showed up the week after my surgery and she was fantastic! Although she didn’t speak much English, we became friends. The visits were $20 each and she came three times a week for the first month, with visits tapering off after that. I faithfully did all of the exercises that were recommended and I’m convinced that this was a big factor in my positive recovery. Three weeks after surgery, Teresa had me walking (with my walker) up and down the apartment corridor two times a day, counting my steps. Four weeks after surgery, she taught me to use a cane. I cannot say enough good things about this wonderful Ecuadorian woman and her healing skills.

So how much did it cost? The surgery, prosthesis, and hospital stay was $6,000. I am very happy with the results. Six months later, if you pass me in Parque Calderon, you would not know that I had recently had a hip replacement. Today, I am walking well with no cane and no limp although occasionally my hip aches (especially when I’ve walked too much or climbed the famous 89 Escalinata steps in search of ice cream).

Having surgery in Cuenca was definitely worth it for me. It cost significantly less than the same surgery would have cost in Mexico or in the U.S. I feel great and am relieved that my hip pain is finally gone!

My advice for those considering having surgery in Cuenca? Once you have performed your due diligence and have made an informed decision, don´t second-guess yourself. And remember, if you don’t feel a sense of confidence or connection with the surgeon after your first meeting, look for someone else.

My suggestions on things to buy, rent or borrow before THR surgery in Cuenca:

1) A wheelchair (we rented mine) plus a foam “eggshell” cushion to sit on
2) A walker
3) An elevated toilet chair (very important, as toilet seats can be low and you cannot bend easily)
4) Some type of hard plastic shower seat
5) If you are not fluent in Spanish, hire a translator to help at the Red Cross when you pay for the unit of blood and to be on hand right before you are wheeled into surgery.
6) A Kindle or plenty of books
7) A loving and considerate care giver
8) A sense of humor and a smile

Good luck — and go for it! Your body and your pocketbook will thank you.

Photo caption: Christine celebrates after her surgery.

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