Medical Care in Costa Rica – Expat Deals With Major Medical Issues

In the middle of 2004 I took a bad fall on a slippery outside staircase and tore three ligaments off of my right shoulder.  At the time I was living in San Diego, CA.

In December of 2006, while living in Costa Rica, I took another very bad fall and ripped the same three tendons partially or totally off of my right shoulder.

In Costa Rica, as in San Diego, the surgeons repaired the damage by stitching and inserting pins into the bone.

In San Diego I had Blue Cross medical insurance which covered 80% of the surgery costs. I also paid $20 co-payments for followup appointments. The surgeon and out-patient care at a major private hospital was excellent.

The doctor was a sports medicine orthopedics specialist and I felt I made the right choice. I believe the total cost of the surgery was over $30,000.

When I damaged the shoulder the second time in Costa Rica I had private medical insurance purchased from the semi-autonomous government insurance company Instituto Nacional de Seguros (INS) or National Insurance Institute.

I paid a 10% deductible of the $6,000 surgery and several $20 co-payments for followup appointments.  The deductable is now 25%.   I found another excellent orthopedic surgeon from Colombia who specializes in shoulder and knee repairs.

My out-patient surgery was performed at a small private hospital in downtown San Jose, the capital city of Costa Rica. The nursing care was excellent. Although the doctor had far less tendon tissue mass to work with than did the San Diego doctor the surgery was a success.

I would rate both surgery experiences about equal but the costs were signficantly cheaper here in Costa Rica.

I’ve recently had yet another bad fall and have partially torn off my bicep tendon from the bone again. I’m not sure as to whether or not it can be repaired. I was told by my surgeon here that I probably don’t have enough tendon tissue left to have it fixed again. I’ll be getting it examined soon and will let you know how things progress and turn out.

In late 2007 my private insurance lapsed and my agent neglected to remind me to renew my policy as he had done previously.  When I realized I no longer had private medical insurance I was short on cash to pay the $1,500 yearly premium.  So I joined the socialized medical system called the Caja Costarricense de Seguro Social (national Costa Rican socialized medical system) and paid a $32 a month premium with no co-payments required so long as I used the government’s doctors and facilities.

Now for the greatest medical shock of my life.  Sometime in middle of January, 2008 I started to notice that the toes of my left foot had gone permanently asleep with the surface of my foot very cold to the touch but the inside the foot burning.

I went to see a local private doctor twice and each time was mis-diagnosed.  I had several sessions of physical therapy and acupuncture, but I got progressively worse and became unable to walk more than 10 paces without unbearable pain and cramping of my left leg.

On March 20th I could no longer stand the pain.  With the help of an half American/Tico friend I went to the Emergency room of Grecia (small regional public) Hospital.

An emergency doctor there quickly realized that I had a critical vascular or circulatory problem and immediately put me in an ambulance to Costa Rica’s best public hospital located in San Jose, Hospital Mexico. The emergency doctors there did further testing and put me on a fast track to discover what my problem was.

On March 23rd, I was injected with radioactive dye directly into my left femoral artery high up on my leg.   The CAJA doctors determined that I had massive blood clots in the femoral artery near my groin.  The following day they performed by-pass surgery and created a new artery in my thigh.

Initial Amputation

Unfortunately, it was too late for my lower leg as it had been without sufficient oxygen for almost two months.  The foot was literally dead and turning nasty colors.  The doctors determined that the foot had to come off before gangrene could set in and recommended that the leg be amputated half way up my shin.

Of course I agreed and the amputation took place on March 31st.  At that point I considered my foot to be an ugly painful beast; an odd thing to say, but that’s how I felt at the time.

After a very painful week in the hospital following the amputation I was released to the care of a friend living near Grecia.  He had a staff of care givers and nurses that had been taking care of his failing father and mother. They cleaned and fussed over me in my helpless condition for two weeks. Unfortunately, the wound never stopped bleeding and oozing liquids.

After two weeks, I was taken into Grecia hospital to have the stitches removed. I had a bad feeling about the condition of the leg because the whole underside flap that was stitched up over the bone to seal the wound was not adhering properly.

Second Amputation

My fears were correct and off I went again to Hospital Mexico’s emergency room.  It was soon confirmed that the tissue surrounded the wound, although without infection, was obstensively dead tissue without the capacity to heal.  The surgical team determined that the only solution was to amputate again, this time above my knee where they hoped the leg tissue was healthy enough to heal.

Needless to say, it was an absolutely crushing blow to me.  I had just spent three weeks of unbearable pain only to learn that more was in store for me. On April 24th a second amputation was performed. During the operation, the surgeons discovered that a major vein had formed a blood clot and was the reason my first amputation went bad.  They also performed an additional by-pass to rectify the vein problem.

The second, and hopefully last, amputation went much easier on me in terms of pain and the pace of healing.  Unfortunately, when I finally was able to get erect again and use crutches my abdominal walls had weakened so much that I developed a double hernia almost immediately on my right side where all of my weight is places on the crutches.

Private vs. Socialized Medical Care in Costa Rica

One of the problems with the socialized medical system here is that is it often overloaded and therefore difficult to get timely appointments and to schedule surgeries other than through emergency care.

I therefore elected to have my hernia repaired privately by my general surgeon who had been overseeing my amputation recoveries.  She performed surgery on me at a private plastic surgery center that had all of the necessary equipment and support personnel.  It cost me around $1,100 and was successful, although I had bleeding complications during recovery because of the blood thinners that I take daily.

Secondary infection in Coronado Hospital in US

I got a urinary tract infection from my Coronado Hospital hernia repair.  It was from a super drug resistant strain of bacteria that took me weeks to defeat. Luckily, I got no such infection from the Costa Rican clinic hernia repair. In fact, although there are occurances of drug resistant strains of bacteria in the hospitals here, it is yet nowhere as prevalent as in the States.

It’s now seven plus months since the second amputation and I’m able to get around fairly well with crutches and occasionally use a somewhat primitive prosthetic leg.  I’m leary of using the prosthetic as it’s already caused me to fall and again blow out my bicep tendon from my shoulder blade.  What I need is a $25,000 C-leg with a computer chip in the knee socket that will make it really hard for me to fall down.  Unfortunately, I’ve tied up too much of my funds in my dream home and until Isell it I won’t have enough money to buy a C-leg.

At the moment, my doctors and I are still clueless as to why I’m such a good blood clot producer.  It’s not from diabetes, smoking or genetic disposition. I continue to search medical reports and studies to find out why and how to put me back to normal. I still don’t have private medical insurance.  Thank goodness all of my medical care has been covered by the Costa Rican government’s socialized medicine.

Learn what prompted Gene to retire in Costa Rica and how he built his dream home for 40% less than he could have built it in the States.

- Gene Warneke is a photo-journalist and a Traveling4Health.com contributor. View photo albums documenting the construction, from the ground up, of his home in Costa Rica. View samples of his photography and videos on Youtube.