Click here to subscribe to daily news sent to your inbox!
Click here to subscribe to our weekly eNewspaper sent to your inbox!

Expat Life

Let’s talk about it: Medical emergencies and end of life planning for expats

By Miriam Drake, M.Ed., N.C.C.

When my husband and I moved to Cuenca in 2011, our plan was to create a new, fun, life adventure together. Medical emergencies, incapacitation, and end of life never even entered our minds. In other words, we were completely unprepared when all of these happened to us.

Miriam Drake and her late husband, Fernando Paez.

If you are living in Cuenca, or considering a move to our fair town, consider taking the seminar I have created, “Expat Medical Emergency Preparation”. Not a glamorous name, but this seminar will give you information you can use to build a plan for yourself and your expat friends in case of medical crises. Based on the actual experiences of my late husband Fernando and I, this practical, boots-on-the-ground information can help you to understand and think about how you can create a workable system that will see you through your time of need.

Three months after my husband died in Cuenca, after a year of a series of medical crises, I began thinking that no one would ever want to go through what I went through, alone and without preparation: my husband’s massive stroke, incapacitation, four emergency hospitalizations, two emergency surgeries and the final stroke in FASEC, the nonprofit hospice care center.

That year taught me many things. I was completely unprepared to deal with the health care system here. I was unprepared to attend to the huge number of unpredictable changes in my husband’s health status and in caring for him in a changeable and foreign environment. There was also the coping and adjusting to the way things work or don’t work here. The details, stresses, decisions, and overwhelm were ever-present. Back then, I was alone dealing with all of this. Some friends helped in whatever ways they could, but it wasn’t enough. I had no knowledge, no strategy, no documents, no assistance, and knew very little Spanish. Our families were abroad, and no one would come to help me. I desperately needed another person by my side all the time. That never happened.

The learning curve, the reinvention curve, and the desperation curve were steep. I literally had to figure things out in my sleep, and as I went, minute by minute. If you have ever been a caregiver, you know what I mean.  Caregiving in a developing country is an added bonus (a little dark humor here).  We were the first in our group of friends to go through this, and it was an eye opener for all of us. Fortunately, there were several physicians on whom I could depend. They took a personal interest in us. These physicians saved my husband’s life twice, fixing the problems other doctors had created.

During the year after Fernando’s death, I began brainstorming with friends, and putting ideas together. I wrote up lists and procedures. I began compiling strategies and organizing details. I realized that we, as expats, must set up an informed system of guidance and support for ourselves so that others will have a better experience and outcome than we did within the healthcare system here.

In May, 2015, I was invited by Wendy Carrell to join her in speaking to an audience of expats interested in hearing about medical crises and end of life in Cuenca. It was then that I realized that a seminar with step-by-step information would be helpful to many people. Over time, this seminar, Expat Medical Emergency Preparation, and the workbook were born. The seminars I give are dedicated to the memory of  Fernando Raphael Paez Navarrete, my late husband, U.S. and Ecuadorian citizen, U.S. Army Veteran, and successful businessman.

The seminar, Expat Medical Emergency Preparation, contains the following topics and resources:

  1. A list of ten steps, your “to do list” to complete now to prepare yourself.
  2. Steps to take in the event of an emergency. This is a guide you can turn to when a medical emergency presents itself.
  3. Assisted Living, Palliative and Hospice Care resource guide.
  4. End of Life information, including steps to take to register a death with the Ecuadorian and U.S. authorities.
  5. List of local resources that expats have found helpful, from doctors to physical therapists to medical supplies.
  6. Workbook with worksheet you can use:
  • Medical history form
  • Poder worksheet considerations
  • 5 wishes worksheet
  • Confidential data worksheet for power of attorney
  • Needs assessment worksheet
  • In-hospital care provider contact list
  • Questions for my specialist and caregivers while in hospital
  • Questions for my doctor after I have left the hospital
  • Planning the hospital discharge

Definitions of terms that may be unfamiliar to you

10 Steps to Complete Prior to Medical Emergency or Hospitalization

  1. Meet with a U.S. trained R.N. in Cuenca and complete a medical history form.
  2. With your R.N. consultant, select a primary care physician.
  3. Complete your Declaracion document with an Ecuadorian attorney.
  4. Choose 2 or 3 people in your new country to whom you will give Power of Attorney, for general and medical decision-making.
  5. Organize your Power of Attorney thoughts, and then complete the documents with an Ecuadorian attorney.
  6. Locate a verbal translator.
  7. Locate 2-3 service-oriented, reliable and caring taxi drivers.
  8. Set up a group of 10-15 reliable expat friends for mutual assistance and support in times of need.
  9. Start thinking about setting up a co-housing residence with your new friends for mutual benefit.
  10. Begin learning the language of your new country.

The next seminar will be offered February 1, 2018 , 9 to11:15 am. at theVegetable Bar restaurant, 3 de Noviembre y Jacaranda, in Cuenca. Two weeks later there will be a discussion and completion of the 5 Wishes form and end of life processes.

By RSVP only due to space limitations.  Write to expatmedassist@gmail.com and let Miriam know how many are in your party.

Cost of the seminar, which includes the book and the 5 Wishes discussion group is $25. Please bring exact change.
__________________

Miriam Drake, M.Ed., N.C.C. is a National Board Certified Counselor with over 20 years experience serving adults. She also has experience in healthcare administration for many years in Seattle, Los Angeles, and San Diego areas. Currently, Miriam provides “New Life Coaching and Counseling” to help expats adjust to their new experiences. She can be reached at: expatmedassist@gmail.com

  • Linda

    This is a valuable seminar and I’d take it again. However, it’s helpful going in to know it is geared towards those in private insurance and couples. (There are attorneys who will do half-price documents for those of us over 65.)

  • MountainHombre

    My wife and I attended of her earliest meetings. We highly recommend attending if you are a couple and want some excellent insight and ideas.

    Nobody wants to think about the death of a loved one, but that doesn’t stop it from happening. So, take a deep breath, and make a difficult time a bit easier when it does happen.

    • StillWatching

      Truly sage advice.

  • Juanita Ruth One

    This is an excellent seminar and the workbook she offers is golden. One thing not addressed that I would like to see the expat community address is some sort of emergency alert system installed into the apartments of seniors living alone. My apartment in Riverside Condos has 24/7 concierge coverage and two phones that connect to the front desk. However, if I fell, broke something and was unable to stand up, I would not be able to reach either phone. I haven’t heard of anything in Ecuador similar to the MedAlert bracelets and pendants available in the states. Anyone else share this concern? There are quite a number of elderly single women living alone here in Cuenca (men, too)! cuencanajr001@gmail.com