Category: Healthcare

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Healthcare Tour of Costa Rica

Wednesday & Thursday nights at Adventure Inn in San Jose
A small family-owned, non-chain hotel with good prices!
Adventure Inn San Jose

Because the tour starts at 7:30 in the morning from this hotel, I came the night before like probably most of the participants. Walter’s Tours and Taxis in Atenas takes me for visa renewals usually and so I used his services to get to this hotel today. Door to door friendly and efficient service at a reasonable price and I did not have to fight the San Jose traffic! Saturday morning they will pick me up in San Ramon where the tour finishes. To save money I may use the public bus in future but it seemed more of a hassle with a suitcase and changing buses in San Jose. Kind of nice to be chauffeured!

The tour that starts in the morning (I’m writing Wednesday night) is sponsored by Paul & Gloria Yeatman who do the blog/website/newsletter titled Retire for Less in Costa Rica. One of their posts tells about Healthcare in Costa Rica and this tour description.

Tomorrow night I will report on the first day of the tour, all in San Jose. So keep reading. I expect most of the participants to be people from the States and Canada who are considering retirement here. The Yeatman’s do this in conjunction with another guy who does a relocation tour of Costa Rica, different from the one I took. More about it later too. Tonight I rest, eat in hotel restaurant, do some computer work and play and read. It is fun to be away from home even when you live in a paradise! 🙂

A quote from the founder of my former clinic in Nashville
where caring people still struggle with the
broken American system.
It is good to now live in a country where healthcare and education are
more important than wealth and military. It makes a difference!
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Heart Arrhythmia

The Symptom
A couple of weeks ago I went to Dr. Candy because my right foot had been swollen for several days off and on, mainly when I stayed around the house rather than when walking! Strange?

The Standard First Level Treatment
She gave a diuretic to take for 10 days to see if that would reduce the foot inflammation. It did not.

(Side Note on Heel Spur)
You may have caught my earlier report on bone spurs in both heels but hurting only in the right one. This was taken care of by me stopping my 8 month habit of walking all over town in nothing but sandals. (Like walking barefoot!) I now wear tennis shoes, hikers, or regular shoes with a gel orthopedic insert in the heel. Absolutely no pain or problem now from the bone spur! And two doctors now say my new problem is in no way related except for being in the foot!  🙂

Complete Physical
Dr. Candy, my primary care doc, is very thorough and systematic and said it was time for a complete physical with an EKG because she now thinks the problem is circulatory. And I may have done a post on going to the Atenas Laboratorio Clinico for the blood and urine analysis. I walk these reports back to Dr. Candy and she says everything is normal or healthy including blood pressure EXCEPT that the EKG shows an arrhythmia which she thought she heard when listening to my heart. She emailed the EKG to the cardiologist in San Jose she works with and that doc wants me to come in and get wired with a 24-hour heart monitor.

24-Hour Heart Monitor
That was done last Thursday and Friday for my first two bus trips to San Jose and only saw a nurse to be hooked up and then uninstalled. Today I went back for the cardiologist to give me her evaluation. (Note that with a female primary care I’m being sent to female specialists! 🙂 Dr. Bouzid is so good, professional, thorough and explains everything so I can understand it! In English! Thank goodness! I’m slowly improving with my Spanish but not ready for this! She is a part of CIMA, arguably the best private hospital in Costa Rica. My private insurance covers everything after the first $300 which I reached today only when the ultrasound was added! Wow! medical costs are so much less expensive here! And when I get the CAJA, free! And by the way, some people come here from the states for cardiology including heart surgery. They call it “Health Tourism.”

The reason for 24-hour EKG basically is that it shows my real life and not just a couple of minutes in a doc’s office. I do have Heart Arrhythmia as shown in these two contrasting clips from the 24 hours:

This is a fairly regular rhythm which is good – what we want.

This one shows the irregular rhythm and other pages were worse. 

āˈriT͟Hmēə,əˈriT͟Hmēə/
noun
1.         a condition in which the heart beats with an irregular or abnormal rhythm.
Or for a more thorough definition and more info in a sidebar, see Mayo Clinic
Then a Heart Ultrasound
Then she wanted to do an ultrasound of the heart and like everything else, I am given copies of everything. She pointed to parts of the picture on her computer which was moving or a video and tried to explain why not enough blood was being pumped to my right foot. I did not really understand that, but accepted it. And here is my printout of that which doesn’t mean much to me: 
This is actually 5 photos taped to a sheet of paper.
Ultrasound of my heart today. Whatever it means.

More Blood Tests

The cardiologist sent me to Lab San Jose (another Laboratorio Clinico) just two blocks away to check 4 things in my blood related to the heart: NITROGENO UREICO, CREATININA, TSH, PEPTID NATRIURETICO B (BNP) which will be reported to her tomorrow by email. One of these has to do with the thyroid gland which if either over-active or under-active can cause arrhythmia and I’m not sure what the other things are. 
Gave Me a Prescription
I take this for two days twice a day and report to her how I am feeling. This may or may not help. Then
I Go Back to Cardiologist Friday Afternoon
She will then discuss the blood test results and with that may change the prescription or take a different plan of attack. She seems confident that she will get me back into rhythm! 🙂 
And by the way, she says I HAVE A VERY STRONG HEART! It just doesn’t have rhythm!  🙂
🙂  Well, a different kind of rhythm!   🙂
But you should know that they celebrate Elvis’ birthday here!
And most Ticos have lots of rhythm! And love music!
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Small Town Billboards and Healthcare

The closest thing to a billboard in Atenas.
That is my Roca Verde neighborhood in background.

There are a lot of billboards in San Jose and a few on the toll road between here and there, Ruta 27, but I guess that kind of advertising just doesn’t pay in and around the farm town of Atenas. Nice! This sign is hardly as big as a billboard but about the biggest you might find around here. It is on the connector road to Ruta 27 near the Feria or Farmers’ Market. Behind it is one of several hills in the Roca Verde housing development where I live.

The sign is for my favorite of several Macrobioticas in Atenas. They are kind of like health food stores, herb or vitamin shops in the states. You can get lots of food supplements, vitamins, and herbs of all kinds. This particular shop is where I get my Melatonin or Melatoninia, Hierba de San Juan, Tilo, as an herbal sleep aid, kind of like the sleepy time teas I can also get there, just in a capsule form. I do still sleep on a CPAP machine most of the time and if it wears out, my doc can get me one here for Sleep Apnea, but I may lick that too! 

I no longer take any prescription medications of any kind including allergy meds and I am doing just fine! I brought a lot of the senior adult one-a-day vitamins for men from the states (generic Kroger brand) and when I run out later this year, I can get something similar at my Macrobiotica Tienda (Tienda=Shop). I not only feel healthier but also save money! And oh yes, very little advertising bombarding me here which is also healthy!  (Tomorrow I’ll tell you about seeing both my doctor and dentist in two days.)

One of the amusing forms of advertising here (though not allowed inside Roca Verde) are a few cars or vans that drive around town with loud speakers advertising something with either a live Spanish speaker talking on a microphone or a recording that plays over and over. I think it is local businesses more than individual products, but not sure. Cell phone and cable TV also advertise this way. Glad they can’t come by my house! I heard them more in the apartments and of course still when walking in town. People live on their front porches or front yards, so it is a great way to advertise! 

Another fun way some products advertise is to set up a table or booth on sidewalk in front of a store that sells that product, like beers do this a lot, advertising a special price or discount or premium you get with it. They do this with very loud pop/rock music and one or two absolutely gorgeous young ladies in very short skirts or shorts, often dancing to the music and inviting you to dance with them. It is so much fun to experience different cultures!  🙂   Pura Vida!

On my Spanish Blog read about the second Spanish Class I’ve joined which is at Iglesia Biblica. I’m determined to learn español even if doing it very slowly! It is a beginner class also, so a lot of repetition which helps me, but this one uses a Costa Rica produced book which has more local slang and idioms. Bueno!

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My Health Improves in Costa Rica!

At my target weight now!
First time in 30+ years!

After 6 months in Costa Rica I decided to buy bathroom scales for fear I was gaining weight instead of losing or staying at a healthy level. After all, I have been eating a lot here and learned that Ticos have a sweet tooth like me. Who can resist Tres Leches or Coconut Flan? So at the Alajuela Walmart I got a nice looking glass scales similar to what I had in Nashville. I bring it home and weigh for a pleasant surprise! I am averaging between 173-175 which is what the charts say I should weigh for my height, etc. 173-175. In the morning I am closer to 173 and by night closer to 175. I tried to reach that in the states all of 2014 but usually stayed between 180-185, which was better than the 200 pounds the year before!

One of my favorite dinners is a green salad with Avocado
slices (a whole one this time but sometimes a half), a big 
glass of water and a fruit fresca made from pulp concentrate
this time, but sometimes fresh fruit in blender – yummy! 
And sometime I add a dash of bottled Sangria or 7up. Salad is
seasoned with fresh-squeezed limon and herbal seasoning in 
that little shaker bottle at top. 1 slice of whole grain toast and 
a little guava marmalade for the last bits of toast not finished
with the salad. Reasonable dessert! Some days I have saltine
crackers with either salad or soup. I do cook chicken, fish, and 
some pork with vegetables and/or salad. Eating out less now.
I’m doing okay with homemade veggie soup and gallo pinto, 
a special Costa Rican seasoned beans and rice, and I’ve always
done great scrambled eggs as a messed up omelet!  🙂 And 
unless after dark, I eat all meals outside on my balcony. 
Which I think is also a healthy addition to my life! And that
black book is my Kindle Fire, my companion for most
meals! I’ve read more than 20 books in 6 months!  

To what do I contribute this? The same two things most people do, eating and exercise. I eat more fresh fruits an vegetables here than I did in Nashville, even living for 10 years across the street from Nashville Farmers’ Market. We have no American fast food restaurants in Atenas! Nada! Now, I can get a burger, pizza, or fried chicken from some Tico restaurants, but rarely do; only pizza or a good hamburguesa. I haven’t had fried chicken in many years! Don’t like it anymore, though popular here, especially with the young. I’m also learning to eat more sensible sized portions most of the time though some restaurants don’t help there, but now I’m eating at home more and that helps.

The best thing to happen to me exercise-wise was to decide not to buy a car, though the temptation pops up every once-in-a-while. I walk almost everywhere in town and when I take a bus to San Jose or Alajuela I walk most places when I get there. I’m averaging 3 to 6 miles every day. Part of the key there is “every day.” If I get a large order of groceries, then I take it back by taxi for about $2, but I’m learning to grocery shop little at a time every-other day which gives me more exercise as I can carry smaller loads and I have fresher stuff!

Walking 3 to 6 miles every day is maybe the healthiest thing
I do or at least equal with eating better. And yes I mostly walk
in sandals, but sometimes tennis shoes. My dress shoes may 
never get worn here! Tennis shoes are hot and sweaty! That
leads to athlete’s foot, so sandals better in the tropics for me, 
except for some hiking and even some yard work.   

I am still debating a bicycle which would be quicker than walking and still be good exercise. The two negatives are the one big “killer hill” between Roca Verde and downtown AND the narrow streets with sometimes sloppy drivers of cars. It could be dangerous! Peligroso! So I keep walking!   And probably will not get a bike.

OTHER HEALTH FACTORS:

  1. I have Costa Rican Private Health Insurance and got to cancel that expensive U.S. Medigap insurance. A big savings!
  2. I have a private practice doctor who speaks good English. (Sorry! Meant to get a photo of her office with an ambulance out front. Her assistant is an EMT, so they can come get me if they need too!)  🙂 I have heard that most of the government doctors speak English too when I eventually go on that program next year. But hope I’m speaking Spanish by then!
  3. Hospitals are all highly rated throughout Costa Rica at half the U.S. prices! Everything from heart surgery to cancer treatment is done here with great competence. I feel secure.
  4. Few weather extremes in our Atenas “perfect climate” which contributes to good health.
  5. Less stress than in the States and not having a car helps with that even more!  🙂 Actually, driving here is the most stressful activity I have done and it can be as stressful as in the states, though maybe people get used to it. Well, opening a bank account was a little stressful, but I’m getting used to bureaucratic paperwork now and to just “go with the flow!”
  6. Surrounded by nature. My cure for everything!  🙂
  7. A relaxed, laid-back culture helps one to slow down and “go with the flow.”
  8. I have slowly tapered myself off the drugs U.S. doctors gave me, first to sleep at night, I’m now using simple, healthy herbs to help with sleep. I get that from one of the local Macrobioticas or health-food (supplements) stores here. Feeling better and sleeping as good! Also stopped all the allergy meds and doing fine without them! (Sorry! Meant to get a photo of my favorite Macrobiotica at the Central Market.)
  9. But eating healthier and walking a lot are still the main reasons for my better health here. I turn 75 Saturday and expect to live a whole lot longer here!  🙂

SOMETHING NEW: I’m finding it harder to write without using some Spanish (or Costa Rican) words. So you will know, I am going to try and put all Spanish (Costa Rican) words in red. Tell me if that is distracting or helpful. 

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The Heavens and a Great Kiskadee!

The heavens declare the glory of God,

and the sky proclaims the work of His hands.   

Psalms 19:1 HCSB


January 31 Sunset from my Balcony – Right out of camera, no messing with it!

Today was spent in San Jose for a physical exam for Pricose Healthcare Insurance to get my application approved. Snapped a few shots on phone in San Jose, for later maybe. Also had a flock of Great-tailed Grackles on the lawn this afternoon that I’ll show later. First new bird in awhile! I did get a new and better shot of the Great Kiskadee yesterday on the back balcony of my neighbor’s apartment, so this one is for Urs & Ima from Switzerland:

Great Kiskadee

As always, click a photo to see it a little bit larger with more details.

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The Autopista del Sol to San Jose

Well, I splurged today and hired a private driver to drive me to San Jose for my residential paperwork appointment and to sign up for medical insurance. Part of the way we drove on the Autopista del Sol (official site), or the newest, access-controlled highway from San Jose to the Pacific Beaches. See also a Nosara Surfer’s Report on the Highway. Here’s three phone photos, then I’ll tell you about the experience in the big city.

Out our way is beautiful scenery driving up the central valley.
Further from the city is only 2 or 3 lanes, but . . .
In and near the city are 6 and 8 lanes, toll plazas, and bumper to bumper in rush hour.

I have a wonderful attorney, Jose Pablo Carter Herrera, the son of another attorney with the Association of Residents of Costa Rica, a service organization for expats living in the country. I’m still waiting for an Apostille on my proof of income which Social Security in the states refused to help me with. The embassy here is supposed to do it easily, but it didn’t happen today! The only unfriendly, unhelpful place I’ve been in Costa Rica is the U.S. Embassy. I wasn’t too surprised that they wanted me to make an appointment but they would not let me make it even though I was there standing at the guard station. The correct procedure is to do it over a certain phone number between 8 AM and 11:30 AM, no exceptions! So me and my driver wasted time there. (The embassy in The Gambia was just as haughty and difficult to work with, but you have to work with them!)

The good thing I did not expect was I got my application for health insurance started and within the next week or so I will receive a call from the doctor to schedule my physical for the insurance company. I’m covered by my Medigap Policy for the first 90 days or until March 24. My Pricose agent, Juan Colero, says I will easily have it secured by or before then. It usually takes about 5 weeks after the physical. So I wait for the doc’s call on this. Then pay a whole year’s premium at once, then after a $300 deductible, 90% of everything is paid. It costs less than my Medigap and Rx insurance in the states. But when my residency is finalized I get the even cheaper government medical service if I wish. 
Tomorrow I will dutifully call the correct embassy number during the correct hours and hopefully get an appointment fairly soon. Jose can’t file my residency application until I get this last legal document. Then it will take from 5 months to more than a year, depending on which bureaucrat is assigned my application in the Immigration Office. It is all part of the laid back life of Tico-land and I will not worry about it after I have done my part. The private insurance can go on indefinitely and I could decide I like it better than the Caja or government health plan – we will wait and see. But government medicine and a long-term Visa are the reasons I’m applying for residency.

After back around 1:00 I had lunch at a new place for me, La Trilla Restaurante. I compared their Casado con Pollo with La Carretta’s and it was very similar, though they add a piece of cheese and some black bean dip and chips. I also drank another Guanabana drink, this time con leche. Muy bien! Now back to my birds!  🙂 And my study of Spanish!

P.S.
Someone asked about the inside of the apartments. During the first two weeks I linked to a photo gallery of the downstairs apartment #4. I have a smaller gallery of my upstairs apartment, since much is the same, all built-ins, granite counters in kitchen, carved doors etc. But anyway, here are the links to the Inside Apartments Galleries:

I’ll figure out how to photograph the balconies soon. They are not super grand inside, but more than adequate for me. When my boxes get here, they might get clutter or crowded.  🙂
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Major accomplishments this week for Pura Vida!

A branch of the Savegre River, Costa Rica, 9/2014
Photo by Charlie Doggett – Click photo to View

Pura Vida!
Here’s a summary of things I’m working on now for the move and at least one sorta funny story in it. This could especially be helpful to those of you considering a move as you see what I actually did on some of the steps I outlined earlier. Pura Vida explained at end of this post.

FIRST, THE CORRECT APARTMENT LINK
The email version of last night’s post had the wrong link for the apartment I’ve settled on, let’s try again because it is a good website with lots of photos I can’t copy:  Hacienda La Jacaranda and I just tested it and it worked, but just in case, here is the address:  http://www.atenasapartment.com/ And yes, I have a two bedroom, so a guest room for you!  Knowing I can get off the plane and go to my new home is the first big relief! Pura Vida!

MY “TRAVELING” BIRTH CERTIFICATE (Arkansas Bureaucracy)
My one certified copy is old and I need to keep it, so I ordered a new copy that will be sent to Costa Rica. I finally got a real person to talk with and told her I needed my birth certificate with an Apostille (An international seal of certification) on it. “Oh, I’m sorry sir, we don’t do that in this office, but I will transfer you to the person who does.” Riiiiinnnng. “Secretary of State Office.” I again explained what I wanted. “Oh yes sir, just send your Birth Certificate to us and we will place an Apostille on it.” I then explained that I needed a new one and asked if the two offices could work together to place the seal before mailing it to me. “Oh no sir, I’m sorry, you will have to personally mail it to us with a cover letter and $10.” So I ordered the birth certificate online (fairly easy) and got it Express UPS in 2 days! Then I added my letter and check for $10 which is better than the $40 for the certificate! It has now been sent back to Little Rock in another Express UPS envelope ($20). When it is returned my birth certificate will have made three trips between Little Rock and Nashville before I send it to San Jose. I remember complaining how bureaucratic the Gambian government was (and have been warned to expect with Costa Rica), but I think we are just as bad in the states! Pura Vida! 
SOCIAL SECURITY, TALKING COMPUTERS (and one real person) 
Yesterday I spent more than an hour trying to get a certified, signed letter proving I make at least $1,000 or more per month. The SS Website is confusing and after talking computers, the recording for live customer service says “an hour or more wait, so press 1 for a call back.” They never called back. I did find a “statement of SS Income form online and printed it, but it’s not a letter and I’m afraid not official looking enough to satisfy the Costa Rica government. 
So this morning I talked with a real person quickly at our local Madison SS Office and after one minute of data collecting, he very business-like said “I’ll get that out to you today sir.” No discussion, excuses or wasted time, just done! Hey! I like that! So the second document needed for my residency application is on its way. (I hope!) Police report on me is next job to tackle. Pura Vida!
BIG JOB OF SELLING STUFF, DOWNSIZING
I started with some videos on eBay and plan to add some books and other items there as I go along. McKendree Village is starting a “Village Treasures” Shop on October 11, in one of the unused cottages up front, which is just what I need since we are not allowed to have yard sales. It will more often be used for older people who move to nursing home or die and need to dispose of furniture and household goods. I’m already boxing up household goods for them and will pick some art or some of my many framed photos. I’ll have Jane & Scott come over and assess my stuff soon. This is in many ways the biggest job, because I want to limit what I put in storage and maybe later ship to Costa Rica. But life is not stuff! Pura Vida!
NEW REVELATIONS ON INTERIM MEDICAL INSURANCE
I plan to go on the more affordable government health plan called CAJA after I gain residency, which will take 6 months to a year. The most affordable interim option presented to us in the seminar (though not real cheap) was a PRICOSE private INS Health Insurance. I’ll do it for a year until I can get the CAJA. I wrote the PRICOSE representative who talked at our seminar, telling him I wanted to enroll before January 1 to be covered as I arrive. “Sorry,” he says. I will have to be in country and apply in person with a local attorney’s affidavit, a full physical by one of their doctors including a $130 EKG. The whole process will take about 5 weeks after I arrive. Brick wall I thought! Okay, so now I have to arrange for about two months of overseas or travel coverage until I can get their coverage. I’ll call “One Exchange” today.

“One Exchange” is the proxy for health coverage plans for LifeWay Retirees. They mainly help you pick out a policy that they sell you for their percentage. I talked to two people, the last of whom kept putting me on hold while she talked to her supervisor. They are all ignorant of what to do and even though I told them what my research indicated was possible through a Medigap Plan for 60 days, they knew nothing about it and said they would have to research it and get back with me. A big waste of 45 minutes!

Then I call my Medigap Insurer, Mutual of Omaha, and told them what my research showed and asked if my Medigap was one with the overseas coverage. They were the opposite of One Exchange. Misha was knowledgeable, polite and helpful. In just a few minutes she confirmed my research and told me that my Mutual of Omaha Medigap will cover me overseas at 80% for the first 60 days for all medical expenses that Medicare would cover in the states with a $250 deductible and $50,000 maximum. That will give me 60 days to get the Costa Rica policy I was told would take 5 weeks (35 days). I will not cancel my Mutual of Omaha Medigap Insurance until AFTER I have the local policy in hand as recommended by Mutual of Omaha and common sense, in case something doesn’t work out. (If INS took longer than 5 weeks and I have an emergency, I can fly home and be covered as I am now.) I am so relieved about something that was beginning to be a concern. There is now a plan in place to keep me with medical insurance at all times during the transition. I believe I will make it through this move just fine! Due diligence, planning and proper timing pays off!

Pura Vida! (A Costa Rica slogan, literally meaning “Pure Life” but used to express the joy of life, happiness, greetings, etc. The above efforts are part of my cost to soon gain Pura Vida!)

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The Decision is “Yes”

Most people I’m around already know that, but the purpose of this blog was to lead up to the decision and now future blogging will be on my “Adventures” blog. That is what this will be whether I stay only a year or the rest of my life, everything about Costa Rica is an adventure!

I did a four-page Excel spreadsheet giving various categories of life 1 to 5 points in column for the U.S. and for Costa Rica. I will not attach the spreadsheet. Be aware that even though I was trying to be objective, it is probably still more subjective and my heart is probably leading more than my mind, though I am still trying to be “rational.” In this tally Costa Rica won 76 to 68 which is actually pretty close!

IN SUMMARY

It is nature that has been attracting me to Costa Rica for years and what I loved best about the four times I have visited. Birding, hiking, nature photography is simply better here than anywhere I have been. My #1 reason for going. Because it costs all of my fixed income to live in the States, I have been, maybe foolishly, using savings for these trips, which must stop, thus . . .

Financially I have figured out how I can live for less there (where I like to travel) and save for trips or future emergencies which I haven’t been doing a good job of in the States. Now be aware that my cost of living will be lower there only if I live like a local. It is actually the most expensive Central American country, mainly because of the high cost of imported goods (especially cars). Thus I will try to “eat local” which will cost less and be healthier. Shopping too much at Walmart (which is there) could blow my budget!

Weather is a big trump card for Costa Rica. Atenas, where I am now considering an apartment, was declared by National Geographic as “the best climate on earth,” averaging 72 year-around or always between 65 & 85.

The culture/people is the best I have experienced anywhere, friendly, welcoming, often rated the happiest country on earth, no ethnic/racial conflict, religious though differently than me, educated, conservation-oriented, economically sound, democratically elected government, and a good blend of the modern and the historic. I am a follower of Christ wherever I live and there will be a fellowship of Christians I can become a part of and it could even be Baptist, but may not be.

Super public transportation which will replace my car and another way I will save money.

One of the best healthcare systems in the world with choices of both private and public programs.

Volunteer opportunities abound including IN Bio which may replace my beloved Nashville Zoo and of course schools, church, other conservation efforts.

Language & Stuff are two challenges. I’m in a Spanish class this fall in Nashville and will get in one in C.R. soon after arrival. I will again downsize, getting rid of some stuff and storing the rest for at least a year before I decide on what if anything will be shipped to Costa Rica.

What will I do? Nature photography, more photo books, maybe sell to tourist shops, writing, reading, hiking, helping other people in multiple ways, and finding new ways of worshiping God. I have never been without something to do and always love the experience of adventure. So from here on, you may follow my adventures on my Retirement Adventures Blog. It begins now in preparation for the move. And every once in awhile click on one of those ads on my blog. I get paid a few pennies for every click!  🙂

And remember, I lived three years in The Gambia, West Africa, my favorite place to have ever lived, and it is a true 3rd world country with pitiful healthcare and corrupt government. So Costa Rica will be a real vacation for me!