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.
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.
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!
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: firstname.lastname@example.org. 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.