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Medical emergencies in Cuenca: What I learned the hard way, so you don’t have to

Editor’s note: This the second in a series, Medical Emergencies and End of Life in Cuenca. To read part 1, click here.

By Miriam Drake

As the caregiver for my stroke surviving husband, I learned as we went along how things work or don’t in Cuenca.  Here are a few good things for you to know:

In the event of a time sensitive emergency, don’t call 911. Call your taxi driver, or the fire department. Both will get you to the ER pronto. You only call 911 if you can afford an hour wait before arriving at the hospital and your Spanish is good.

It’s important to have a U.S. trained registered nurse on a consultant basis to advocate for you with medical personnel in private settings and in the IESS system, and to help you make medical decisions. I have authorized my registered nurse consultant to be my “poder for healthcare” (power of attorney for healthcare). She has the ability to make medical care and end of life decisions for me if I am unconscious and/or otherwise incapable of making these decisions. As with all professionals whom you hire, if they work any part of an hour, pay them for the full hour. Everywhere in the world, you will earn invaluable brownie points when you show that you respect the people working for you. I recommend Betty Alderete, R.N. in my book, “Expat Medical Emergency Preparation Manual, the 2020 revised edition”.

Health insurance is a joke in Ecuador although it’s possible things have changed since 2014 when I needed it.  Back in 2013 and 2014, we discovered that health insurance is not what we call insurance in the U.S.  We were scammed. They took our money and provided no benefit when we needed reimbursement of medical expenses.

Having the proper paperwork is critical in end-of-life situations. Be sure to keep careful notes.

I was paying $100 a month for my husband, Fernando’s, so-called health insurance in addition to his healthcare costs. We signed up with an insurance company out of Quito because Fernando’s brother in law, a Quito physician urged me to. Guillermo actually took me to their branch office in Cuenca and sat with me while I listened to the pitch and filled out the application! This was a “reputable” large insurance company. I followed the company’s rules, which kept changing, sent all the receipts into their Quito office as directed, and got the run-around for two months, costing me an extra $200 of bogus premium payments, before finding out they would not pay a penny of our claims. So, I cancelled the insurance and licked my wounds.

When it comes to health insurance, beware. Investigate thoroughly by talking to other expats who have submitted claims to “insurance” companies in Ecuador. If the insurer is paying claims, you may actually have found a real insurance company.

FASEC, the nonprofit palliative and hospice care service in Cuenca, is a good place to die — and I don’t mean this as dark humor aside, it really is. They take excellent care of the patient. My husband spent the final two weeks of his life comfortable and clean, while his life ended in FASEC’s care. It was a good experience for both of us. It’s a nonprofit, worthy of donations of all kinds, by the way.

Take these two steps today: There are two critically important documents all expats in Ecuador should complete as soon as possible after moving here: The “Declaracion” and “the 5 Wishes” form.

FASEC administrator Marcello.

1) The “Declaracion” is a legal Ecuadorian document that is prepared for you by an Ecuadorian attorney. This is the official document needed at the time of death in Ecuador that tells the local professionals what you want them to do with your body after you die, and it authorizes them to do so. The body will not be cremated or buried without it. So, get this done pronto. You may think you have all the time in the world, but my advice is to do it now!  If you do not have an Ecuadorian attorney yet, contact me and I will send you the name and email address of mine.

2) The other document, the “5 Wishes”, is a U.S.-conceived form, legal in the United States but unheard of here. It specifies how you wish to be treated while you are dying, how the body will be cared for after death, and the things you would like your family to know. You will need this document in Cuenca solely for the purpose of informing your caregivers, registered nurse (who is probably your healthcare power of attorney), medical personnel, power of attorneys, and loved ones of your wishes so that they know what you want done as your life is drawing to a close. Complete peace of mind is what the “5 Wishes” will give you. Having this form gave me the backbone I needed when the time came for my husband’s end of life process.

End of life is an emotional and stressful time. Better to have this with you! I include a version of the form in my book for use in Ecuador. You can also get a download of the U.S. version from 5wishes.org for $5.

You will also need a “Poder” (meaning “to power”) which is the Ecuadorian version of a Power of Attorney document used in the U.S., Canada or your country of citizenship. It can be general or specific.  You will need three copies, one for healthcare, and the two others for general powers which you give specific folks you trust to utilize when you are unable to care for yourself.  I will go into this in more detail in another article. It is also prudent to have the Attorney documents for those times when you need things done for you in the old country.  So, one set for Ecuador, one for the U.S. or your country of citizenship.

A personal note: On both occasions when my late husband needed to be in Intensive Care under careful watchful eyes, the hospital I.C.U.s were full. This meant he was up on a “med-surg” floor right after the massive stroke and right after the complicated gallbladder surgery. The floor nurses had no idea why he couldn’t speak or what had happened to him. Making things more interesting, there was no monitoring equipment in the hospital room, only a call button which was almost useless. The afternoon after his stroke, when my husband had fallen out of bed and was on the floor vomiting, I pressed that button three times over the course of 15 minutes. Finally, two young girls arrived and exclaimed OMG! Can you imagine how I felt? This is why it’s good to have volunteers sitting with the patient all the time and to help you get things done!
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For more information and guidance, place your order for your copy of the newly revised 2020 edition of “Expat Medical Emergency Preparation Manual” by writing Miriam at: expatmedassist@gmail.com.  The book is downloadable, and costs $15, payable via PayPal and Venmo. Miriam Drake, M.Ed., L.M.H.C., is the expat counselor who offered the Expat Medical Emergency Preparation Seminars from 2015-2018.  She is available for counseling and guidance by Zoom and Whatsapp.

8 thoughts on “Medical emergencies in Cuenca: What I learned the hard way, so you don’t have to

  1. I feel your pain but have had very different experience here in Cuenca. I had a medical emergency about two years ago due to shingles virus which had inflamed my brain. Luckily I had a wife and good friends who got me to the Santa Inez emergency room where I was treated expeditiously and admitted. All in all, I ended up being there about three weeks and was treated at least as well as I ever was in the USA with twice a day doctor visits by both my GP and my specialist neurologist. Nursing could not have been better with the nurses visiting/treating me numerous times per shift and coming quickly every time I pushed the call button. And, when I was discharged, Salud SA Insurance reimbursed me for 80%+ for the total costs. Salud has continued to reimburse me for prescriptions and doctor visits, although I pay my monthly fees to them about the same amount as I was paying in the States (it’s not cheap!)

  2. What you went through sounds horrific, however:

    Health insurance is a joke in Ecuador .. we
    discovered that health insurance is not what we call insurance in the
    U.S.

    Well that’s because you’re not in the US. As a European, I wouldn’t turn up to the US and expect the health care system there to work like it does in Europe, to assume so I would be making the same kind of post as this. And that is in the worlds leading super power. To move to a 3rd world country and assume things work the same as they do in your developed, home country is a mistake.

    We were scammed. They took our money and provided no benefit when
    we needed reimbursement of medical expenses.

    Scam? Then you have legal recourse. I imagine you were not scammed, just don’t know how things work.

    I’ve had experience with the health care system here for various things, for myself / wife / kids. Public / private and been happy in all cases. No things are not like my home developed country in some cases, but I do not expect them to be

  3. I agree with Jim. I have insurance with Confiamed and, on my first visit, Fybeca Pharmacia processed my prescriptions in 10 minutes and only charged me the deductible. About 6 months ago, I noticed someone who was drunk and drinking beside his car. In the car was a child of about 2 years old. I called the Emergency Services number and began, as I usually do, by saying “Hablo ingles y mi español no es muy bueno …”. The voice on the other end of the line interrupted me and said, “Un momento,” and I was immediately transferred to an English-speaking individual. Whether that was luck of the draw or a planned part of the program, I couldn’t say.

    About 4 or 5 years ago, I attended one of Miriam’s seminars and found it very informative and many people in the group shared stories of undue hardship in dealing with the healthcare bureaucracy in Ecuador. I think in many areas that continues to be a challenge. However, since the mandatory requirement that expats purchase health insurance, barring a few missteps, it is my impression that things have improved greatly here. I have never needed an ambulance but one I saw parked with the rear door open appeared to be well-equipped. Presumably, the attendants know how to use it.

    I am pursuing end of life arrangements now, and I believe they are very important if you care at all about the people who will have to deal with the aftermath of your demise. If you are all alone in the world, I suppose it might be fair to consider that your remains will be someone else’s problem and let things be. If you have family or close friends or any kind of estate worth mentioning, you probably should ease the way and the pain for those left behind.

    1. Thanks for your contribution. In my experience here, you’re doing lots of smart things, preparing, learning for yourself how things work here and taking time to think about end of life planning. Very important Stay well.

  4. I have been signed up with IESS for five years. It costs me $70 a month. i dont have to wait for reimbursement for anything. i just dont pay for appointments, procedures or prescriptions outside of my monthly fee. I have had one emergency and one “must see specialist ASAP” experience. Both were expidited quickly.. I have always been treated very well.. In fact when I was in hospital in may I found my care to be exceptional. I also found that Ecuadoran staff in hospital, mostly have a great sense of humour and have deep appreciation for your patience and own sense of humour. Surgeons are surgeons anywhere – i dont think they are fully human!
    Cautions: I would agree that if you need transport immediately do call a friend or taxi. 911 doesnt seem to be that efficient. Since taxis are cheap it is the most efficient process and wont break the bank
    Also unless you are in severe pain or cant breathe well PLEASE dont demand attention.

    1. Hello, Karen : Very clear, helpful information — for many of us with lighter pockets — i.e., no big $$ to pay for private insurance (SALUD-SA or CONFIAMED etc etc) IESS failed me terribly once in Ecuador in 2016 when I had a neurological emergency. However, I have heard positive stories like yours several times and signed on for the IESS $70 mo plan in January 2019 because I need fallback coverage. A lot of primary care I pay out of pocket as needed.

      I have worked in healthcare as a medical social worker and psychologist in U.S.(California –Kaiser Permanente ID teams and OHSU Hospital and rural district hospitals in Oregon) for 15 years, trauma care, ED, palliative and hospice care. Seen it all –or seen lots in the broken U.S. system … In Ecuador 10 yrs 2021. I lived in Chile 3 years earlier in 2000’s — had a lung infection –a local contagion – medicine then in Chile was first-rate & I did well.

      With Ecuador– and widespread COVID-19 currently all bets are off… I should say there may be NO BEDS soon( pun intended) available and care will be very challenged or non-existent for those with presenting disease or illness like heart, kidney, liver, diabetes, obesity or other co-morbidities . I also know from the clinical perspective, the fatigue and practical issues the docs and other frontline workers experience is terrible, anguishing really. That is a huge issue that will get way worse in a small country like Ecuador .
      I recommend what I am doing, preparing and planning, cutting way back on social media, eating healthy and lightly, building inner resilitence and other inner resources to reduce stress. IOW, taking the best care of myself that I can and leaving the rest to the God of my understanding.
      For me, as a non-rich U.S. Medicare recipient, I am giving thought to an alternative plan to return to Oregon, my state to use Medicare this early Fall. Oregon is doing better crisis management overall than many other states and family is nearer! Best of luck to you, Karen.

  5. We are learning quickly about health insurance plans and medical care here in Ecuador but, not inexpensively. On recommendation of the company that handled our visa and Cedula process, not too well or inexpensively either, we signed up for a plan with Confimed. Big mistake!! We were paying $400 per month for a plan which did not reimburse us for drugs which are costing us over $300 per month out of pocket and we constantly ran into the “they do not cover pre-existing conditions for 2 years” excuse. We have dumped Confimed and are now in process of signing up for IESS for around $90 per month on recommendation of our attorney. Also, greatly appreciate the information provided by these articles by Miriam Drake. Will definitely get the book.

    We did not expect a seamless or easy transition to the necessities of living here but, have been surprised at the amount of misinformation, conflicting stories and generally ‘screw the expats’ behavior we have encountered when dealing with so called “professionals.” Also, learned a quick but expensive lesson about the Banana Republic legal system here in dealing with landlord tenant disputes even when the breach of contract is blatant on the part of the landlord. The general public have been very friendly and helpful however, these so called “professionals” are just as corrupt, untrustworthy and money hungry as the ones you find in the US.

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