The Challenge of Healthcare (and then some!)

So you decide to move to Mexico for the healthy living, but you know that it requires more than exercise, good eating habits, moderation in drink, and adequate rest. It requires good preventive medical care, and if needed, good emergency care. We have been here a few months, so it was time to get started on picking a doctor, dentist, etc.

So the first thing we needed to find was a dentist. We heard good things from other expats about Doctora Candy Ugalde who has a small practice in our town…yes, I know, a dentist named Candy. Anyway, we made an appointment about a week out, and went in for an exam and cleaning. The office was clean with all the usual modern equipment, the staff bilingual and very friendly. We were seen on-time, and the visit lasted about 30 minutes. We did not receive any pressure to get x-rays or

whitening. My dentist, Juan, is Candy’s brother, and he said I will eventually need to get an x-ray, but no rush; when I asked about a whitening, he told me about a discount they are offering, but that was it. Total cost for exam and cleaning for two people: 600 pesos (a little over $30 US dollars).  You can see why some expats bring their grandchildren down for dental (orthodontia) tourism. Overall experience: very good.

Before I get to medical care, first I need to explain something about our health care situation that makes us different from the typical expat. Based on my federal service, we have excellent health insurance, based on the US Foreign Service Benefit Plan.  It is one of the thousand or so insurance programs offered by the US government to its employees, and it continues to cover us in retirement.  This program was initially developed to support US foreign service personnel stationed overseas. As such, it is very familiar in dealing with foreign languages, foreign currencies, and working with customers anywhere in the world. When overseas, the program works on a reimbursement basis (100% for preventive, emergency, and inpatient services, 90% for office visits, surgery, and outpatient services), with all doctors and healthcare providers outside the US considered “in-network.”  Deductible of $300 USD each per year. So while we are responsible for paying upfront for care, our health insurance is set up to immediately reimburse us via electronic document submission and direct deposit.

We decided we needed emergency coverage when we are travelling around Mexico, or around the world. Our Foreign Service Plan continues to cover us in these instances, but we wanted coverage that would give us the option to be medically evacuated at our own request (this last phrase is important). Most insurance, even emergency travel insurance, only approves medical evacuation when it is medically necessary, which is a decision of the doctor and the insurer, not you.  We wanted a service which left that decision up to us. We signed up with SkyMed, which specializes in coverage for expats, covers our medical stabilization onsite in the event of a medical emergency, and leaves the decision to evacuate up to us. Many expats here in Mexico sign up for such coverage, so that in the event of a very serious condition, they can be evacuated back to the States to get care.  Here’s where we differ: we got this coverage so we can be brought back to (drum roll) Guadalajara.  We feel the care here in Mexico is so good, this is to where we would want to be evacuated, if we got sick or hurt out traveling in the wider world.

For our family doctor, we chose Doctora Lupita at Integrity Medical Clinic. We had some false starts here. First, we made an appointment one day for the next morning, arrived, and found no record of the phone call or appointment we made the day before. The office called to postpone our second appointment, because the Doctora was having emergency dental surgery (ouch). When we were finally seen, we each had a nice office call with the Doctora, who ordered a standard suite of blood tests. We had these done at the lab across the street, and got the results by e-mail later the same day. Costs were 400 MXP each for the office visits, and a total of 2500 MXP for the lab work, or a total of approximately $230 USD for both of us.

We scheduled to meet back with Dra. Lupita to review our results, and here is where things got interesting, as they say. Judy’s review went perfect, with all normal results across the board.  I knew I had a few lab results which were out of the normal ranges, but the trouble started as soon as the nurse came to take my vitals. She took my blood pressure/pulse four times, using two different machines. Any time the nurse asks you “are you having chest pain?” that is NOT a good sign. Then she asked the Doctora to come in and do it again. I felt fine: thirsty, as I had salty foods for both breakfast and lunch, and I had worked out at the gym for 90 minutes before lunch, but otherwise great.

The Doctora said my pulse was racing (over 100 bpm), and she wanted to do a ECG right there and then. They brought the cart in and hooked me up; a few minutes later, she shared my results, indicating left ventricular distress, possible a blockage. She said she wanted me to see the cardiologist in her clinic on Wednesday (two days hence) for another ECG and consult. Oh, and the lab results said I probably had a gallstone; her ultrasound could not confirm it, since I had just eaten lunch, so she wanted me to fast on Wednesday and she would have a surgeon follow up on that, too.

To say I was shocked would be a severe understatement; in shock would probably be spot on! Those who know me know I was a lifelong, daily runner, in very good shape, and rarely had so much as a headache. Since we arrived in Mexico, I even lost a few pounds, took up an every-other-day weightlifting/stretching/stationary bike routine and hiked once a week up the mountains. I never felt better. I just could not square the results staring me in the face with how I felt. I had 48 hours to kill until the cardiologist visit, so I dug up my old records and took to the internet.

First I learned that gallstones and even a ventricular irregularity could be asymptomatic; meaning feeling fine was not out of the ordinary. Gallstones, although painful, looked like the lesser concern: some never end up causing pain, and surgery to remove the gallbladder is practically routine. So I decided to focus on my heart’s ECG results. Amazing what you can find on the internet: full descriptions of how to read one and what it means in laymen’s terms.

Probably the most interesting thing I learned was that an irregular ECG could result from environmental conditions, such as an electrolyte imbalance.  I noticed after I returned home from the Doctora’s office that I was very dehydrated, and Doctora Lupita mentioned that some newcomers have poor ECG results due to their heart’s difficulty in acclimatizing to the elevation here (5200 feet). I hung my hopes on this slender reed and  prepared to see the cardiologist and surgeon on Wednesday.

To Be Continued…