Renewal of Cedula or Residential Card Accomplished Today

This two-year one expires in May
and the new one is also good for two years.
Then I qualify for a “permanent” Cedula
good for up to 5 years.

To get my first Cedula I used a lawyer and spent a lot of money! This time was less complicated but still involved knowing where to go and what to do and all in the Spanish language which I am still not adept at conversationally. So I used a less expensive source whom I highly recommend, who charges a very fair price by the hour and speaks fluent Spanish. I used a local school teacher, Belinda Seabrook, originally from England. It was a delightful and easy half day trip to Alajuela Post Office where I was interviewed and photographed. Doing this at the Post Office is NEW this year and everyone says is easier than renewing at Immigration in San Jose. BUT . . . you must be prepared and here are the six things Belinda asked me to have for the interview:

  1. My current Cedula
  2. My CAJA or health insurance number
  3. Proof that I have paid my CAJA charge each month for the past 3 months (receipts)
  4. “Comprobante de pension” or letter from my Costa Rica bank proving that I have deposited a minimum of $1,000 a month into a bank here. (I have my SS check auto-deposited here,)
  5. Receipt from a different bank, BCR, showing I have paid $123 USD into a given Immigration bank account number in payment for this new Cedula (within 24 hrs off interview).
  6. And lastly come to the interview with ₡7,515 (=$13.23) cash which might be the fee that the post office is charging for the service, but I don’t know for sure. 
Correos de Alajuela – Alajuela Post Office

We waited less than 10 minutes for one of their 2 interviewers and in maybe another 10 minutes we were finished including the photo. It went smoothly & quickly because I had Belinda with me as a fluent Spanish speaker. Without her I would have been a nervous wreck! I highly recommend Belinda for this essential service for you expats here in the Atenas area. And she has a car which made the trip to Alajuela quicker and easier for me who depends on the buses. Call or email me for contact information on Belinda.

And I was informed that I could pick up my new Cedula at the Atenas Post Office on April 2. I then take it to the Clinic to register my new Cedula with the CAJA medical services. And I have a one month cushion since my current Cedula doesn’t expire until May 13. Until this year we had a separate medical card called a Carnet, but now we use the Cedula for everything! A national ID card of sort. Glad to have this bureaucracy requirement behind me for another two years, though I can apply for the permanent one in another one year if I wish. 
¡Pura Vida!
¡Costa Rica!

Cardiology Doctor Visit Today

So, I waited over an hour but that included having my blood pressure checked, being weighed and measured, and an EKG. I waited longer than that for docs in Nashville I was paying big bucks for! This did not cost me a penny under the government healthcare plan call CAJA (an acrostic for something). Medicare for All is what you guys in the states should do. And as a Senior Adult (adulto mayor) I rode the bus to and from Alajuela for free! They treat us old people nice in Costa Rica, even foreigners! I do pay a monthly fee for CAJA kind of like we do for Medicare in the States and for me about the same price. BUT, this pays 100% of everything, doctors, hospitals, surgeries, procedures, prescriptions!

As I already knew, my arteries were shown to be clear in the angiogram I had in August. I have an appointment (cita) to see Dr. Hernandez (el cardiólogo) again in August 2018 with a separate appointment for the lab 10 days before to get my blood analyzed. And enough prescriptions to keep me on Atenolol & baby aspirin until then. Both Rxs are free for me but I need a new paper prescription each month, only one month at a time supply allowed!—so the doc gave me 10 prescriptions!  🙂   I get them filled at our local CAJA Clinic here in Atenas Central. 

Now back to birding and other fun retirement activities. Life is good! And a trip next week which you will soon hear about! 


Spending the Night in Hospital

Hospital San Rafael de Alajuela
More commonly known as “Hospital Alajuela”
Alajuela, Costa Rica

I spent a couple hours here today (Wednesday) with my translator Jason Quesada with the admissions director telling us at the exact time of our appointment that he was going to lunch.  🙂   Pura vida! We visited and waited an hour with many other persons I assume also wanted admission to the hospital. All along I expected to just get paperwork from this, my home hospital, to take with me to San Jose’s Hospital Mexico Friday morning for my angiogram. I was wrong! Lorenzo said that I would be admitted to an available bed in Alajuela and be considered a patient there for the angiogram. When time for the actual test they will transport me to Hospital Mexico (instead of down the hall) for the test because that is where the equipment is. (14.2 km or 8.79 miles or 21 minutes) Then I would be “transported” back to Alajuela Hospital where my doctor will say when I am dismissed, possibly Friday afternoon, though it could be Saturday.

That was all new and a surprise to me, as Jason said my face showed! Then Lorenzo (Admissions Office) said I will check you in today at 3:00 (it was 2:15) if we have any available rooms. Otherwise I will guarantee you a room at 3:00 tomorrow. (“Please God, don’t let there be an available room today!” I had no toiletries, extra clothing or phone charger with me.) Soon Lorenzo came out to tell me through Jason that they had no rooms left and he would see me tomorrow at 3:00. Yaay!
We got a taxi in the rain to the bus station and headed back to Atenas where I treated Jason to a late lunch or early dinner of patacones con carne machada. Delicioso! And now I’m back home wondering what it will be like for my first Costa Rica hospital experience. 
NOTE: I will not risk taking my laptop to a hospital and not sure I will have wifi anyway. So you can expect the full report by Saturday or Sunday. Another great Costa Rica adventure!  🙂

Hospital San Rafael de Alajuela

Hospital Mexico de San Jose

One Person’s Healthcare Plan in Retirement

My “Carne” or government
Healthcare Services Card

One of the newsletters I receive electronically is called Retire for Less in Costa Rica and this month’s edition has an article by Rob Evans titled My 2017 Healthcare Plan for his retirement in Costa Rica. If you click it goes to top of newsletter, so scroll way down past their budget stuff to the article. His plan is very similar to mine though I do not have the gym membership or the private travel insurance plan. And I am keeping my Medicare active “just in case” I’m back in the states and have a problem needing care there.  And like him I have no car, walking several miles every day which is part of my healthcare. I’m probably not as careful as he sounds on food choices as I consider retirement a time to enjoy life, including food! And I do! I eat pizza and ice cream unashamedly!  🙂

Discount card for a private hospital.

If Republicans get their way on healthcare, it will cost middle class retirees like me a third to half our meager incomes in the future. The sad condition of health care costs in the states (read the above linked article) was one of the reasons I chose to move to Costa Rica. There are many options here, but I am doing like Rob and taking the public healthcare program with a discount card (at left) at a private hospital to use if I am not satisfied with the service of CAJA for something like long delays or poor service. But so far I have been happy with the public healthcare even if a little slower.

No Angiogram Today

Well, I did not get my angiogram today after two hours at Hospital Mexico (left) and another hour at Alajuela Hospital (my province hospital). It seems that the bigger hospital wants my regional hospital to perform some preliminary tests that they can do before the big hospital does my angiogram which is now rescheduled for 25 Agosto, oh, that’s August 25! And yes, they did tell me that earlier or the doctor scribbled it on the appointment sheet in Spanish that even my Tico friends could not read. Tough luck!

It is all part of the bureaucracy in the government healthcare that Ticos make fun of all the time but are also more naturally patient than Americans. And hey! I have more time than money! So, just another adventure! Plus Jason and I had a great lunch of Mexican food at Jalapeno Central in Alajuela today! They even have pecan pie! (Not something you find very often here!)

The other thing a learned today is how important it is to speak Spanish if you are going to live here as a local and use services like this! Sure wish I had learned Spanish when I was young! I’m a slow learner now! I really needed my translator today, Jason Quesada. My cardiologist will call me next week when he returns from a trip and get it all worked out.  🙂   Pura vida!


And for my fellow readers and literary lovers, you must see this more sophisticated evaluation of Donald Trump that ironically uses a wonderful old Russian fairy tale to describe him: 


Are any of my American friends aware that your president is now the most mocked man in the world? How sad! And even sadder, my cable TV subscription does not include the American NBC network, thus I don’t get to watch Saturday Night Live! Sob, sob.  🙂  And even the YouTube clips are not licensed for showing in Costa Rica, thus can’t go there! I occasionally see little clips on Washington Post or a pirated one somewhere. So funny! 

Third Trip to Hospital Mexico Schedules June Angiogram

Locals most often describe CAJA (the government medical program) as a big bureacracy, and that is true, but it works! If you have patience!

My Atenas public doctor was limited in what he could do related to my heart arrhythmia, so he sent me to a cardiologist at Alajuela Hospital in Alajuela, our provice capital.

Three visits there gave me more tests including another EKG and a treadmill test, but Dr. Hernandez wanted an angiogram which Aljuela Hospital does not have the equipment to perform. He sends me to the biggest government hospital, Hospital Mexico in San Jose with his request for it. Over two months time I have had three very interesting visits, including with one lady who spoke very rapid Spanish and would not slow down, necessitating my rescue by a bilingual medical equipment salesman waiting in line.

Today was just an hour and a half wait in the crowded hospital cardiolgy waiting room where a doctor finally saw me briefly, giving me a piece of paper with a 2 June 2017 date for my angiogram and a promise that someone will call me to discuss the time and preparations. That will likely be an interesting phone conversation if I’m even able to complete it!  🙂  When you start living every day life here you realize how important learning the language is. I’m tired of not understanding or being bumfuzzled! Language-learning motivation!

And for after the procedure, which can include some anesthesia, I have scheduled my friend Walter Ramirez to pick me up at the hospital. Though getting there by bus is easy since the Atenas bus stops in front of the hospital!  🙂  Just don’t want to do that alone after anesthesia! Plan ahead!

First Visit to Hospital Mexico

Hospital Mexico Entrance
It is the largest public hospital in Costa Rica and where most serious
surgeries, tests, and treatments take place; “The Mother Ship” if you please.
There’s a tall building behind this with all the rooms, etc. 

My primary hospital is Hospital Alajuela where I have been seeing a cardiologist (cardiólogo) who now wants a picture of my arteries, an angiogram. Well the only public hospital with equipment for that is the main hospital, Hospital Mexico (named that because it is located in the Barrio México or neighborhood called “Mexico”). It is a huge hospital with lots of doctors, specialists and the ability to do just about anything any hospital can do! And it is paid for by the government healthcare program! I will never have a co-pay or any bill from either on of my two government hospitals. I’m very pleased with my healthcare here and my private options should I ever need them. Just be happier when I can speak better Spanish!  🙂

TODAY – 3 April
I had an appointment to get an appointment. I had to wait and go to three different people which only took an hour which is not bad in a bureaucratic government hospital. One of those was a lady who just created a file on me at that hospital, just like I had to do at Alajuela Hospital to get started there. I’m now one of their patients.
17 April
I have an appointment there with one of their cardiologists who will review the files I have from Alajuela and see if he agrees that I need an angiogram. If so, I assume he tells one of the girls to schedule it. That is two weeks from today which is really not bad. 
Later – Maybe this year or next
I go in for an angiogram (if approved) – Actually I think it will be earlier because I’m gathering that cardiology is considered more urgent, but it could still be 2 months away. We will see.  🙂
Technically, this is my second visit to Hospital Mexico, I did go there briefly in January 2016 on the Healthcare Tour of Costa Rica – which I recommend!

Doctor Visits

Monday I had my first follow-up visit with my CAJA (government healthcare program) at Alajuela Hospital where my cardiologist did another EKG and a ultrasound of my heart. Then he personally monitored a treadmill test of my heart followed by another ultrasound he monitored. It was amazing to me that I was in and out of there in 45 minutes. He told me that the only other test he would like to have on me is an angiogram which he could not order until he consulted at least one other cardiologist there in the Alajuela Hospital because there is not much indication that I would have any blockage. He said he would call if it was approved and then I would have to go to Hospital Mexico in San Jose, which is the only one with the equipment to do an angiogram. It is the primary or main hospital for Costa Rica CAJA or government healthcare.

Well, his technician called me today y hablando sólo en Español. We both struggled through but basically I have to go back anytime tomorrow and get some “documentation” or paperwork from them in Alajuela to take to Hospital Mexico for an appointment for the angiogram. If I understood her correctly, my Mexico appointment is April 10 at 10 AM, but not clear yet if that is when I get the angiogram or, if like most things here, I may just be making an appointment for one much later. I should find out tomorrow.

This is how “single payer” or government or what Americans like to call “socialized medicine” works with priorities given to more serious things, emergencies, etc. It took two months for my first appointment with my cardiologist. No problem for me to wait for this as I don’t believe I have a serious problem. Best of all: No more cost for me now that I have a CAJA card, even if it led to the unlikely case of heart surgery.  I will keep you posted. Dr. Hernandez is basically building a file on me and my heart for any future needs and trying to be responsible for my heart. I appreciate that!

Today I visited my dentist who also speaks only Español and we managed fine for my annual teeth cleaning and checkup by the dentist herself and not a technician. She says once a year is fine and not the every 6 months U.S. dentists request to increase their income. She found the need for one tiny filling which I’m scheduled to get next Tuesday. And that is it for a year! And cheap! Many Americans come here for dental work to save thousands of dollars in what is sometimes called “medical tourism” or even “dental tourism.” A friend in Tennessee has come here twice for his dental work and saved a lot more than his plane ticket and hotel bill. That is for big work like bridges and caps.

Someday I will think about taking a photo at one of these places! It just hasn’t been on my mind with everything else to do like getting there and communicating!  🙂

My first free prescription!

Waiting in line for my “free” prescription
at the local government Clinica Farmacia.
The right line is to give them the prescription & left to pick it up.
Depending on work load, 1 to 3 hours wait. I just left and returned later.

My local private doctor diagnosed me with heart arrhythmia and through an expensive private cardiologist in San Jose I was given an expensive beta blocker at about 60-80 bucks a month. My local private primary care doc found a generic version at about half that price, but I talked to my government primary care doctor anyway. As reported earlier, he sent me to a cardiologist at the Alajuela Hospital where I would go with emergency heart problems on the government plan. And the really nice, 30-something cardiologist checked me out and said he could give be a prescription at no cost but it would be different from what the private doctor gave me (a 3rd brand of beta blocker). It is Atenolol and after researching it online I discovered that it is the most used med for arrhythmia in the U.S. or all around the world right now. So I am just now experiencing one of my big savings through CAJA, the government health plan.

As I think I explained earlier, I am keeping my foot in both doors “just in case” because some hospitalizations, surgeries, or other procedures have long waits in the government program unless an emergency. i.e. Hospital Alajuela will be my government hospital where I have a cardiologist already. Next Monday I have a consultation at Hospital Metropolitano San Jose which will be my private hospital of choice when the public hospital is not available. I joined a discount program with them and will save up to 80% off many services there compared to other private hospitals. At my age, regular private insurance is just too expensive, so this is my self-made plan and I plan to use the public services as much as possible as in this case with heart medication, but if needed, I have a private option that I hopefully can afford. 
When you are an immigrant in another country, it takes time to get all the details worked out. But it feels good when you do!  🙂

And after stirring up people on Facebook with a comment about Trump, I’m going to stay focused on BEING an immigrant and not telling people how to solve the immigrant problems in the states!  🙂

Cardiólogo hoy

Cardiologist today (cardiólogo hoy) for the appointment (1 pm) I started making 4 months ago.

10:15 – Left the house walking to bus station
11:00 – Bus to Alajuela then taxi to Hospital Alajuela
12:15 – In line to check in on 4th floor Cardiology Department (cardiólogia)
12:30 – Behind the gray screen for weight and blood pressure
12:35 – Wait in front of Door 8
1:00 – Called into Door 8 where she asked questions in español of course. Then created an EKG (ecg) and then sent me to Door 4
2:00 – Dr. Hernandez calls me in behind Door 4. My first and only person of the day who spoke English. We mixed it up, Spanish/English, as he created a little heart-related medical history of me to begin my cardiology file. At one point he had me both sit and lay down on the examining table where he listened to my chest and back and then felt around in my abdomen. He read and wrote notes on the reports I brought from the private cardiologist I had seen earlier and the medication she had prescribed. He told me he would have be back for an ecocardiogram along with blood and urine workup to give him a total picture of my health to help him better monitor my heart. I feel very good about making this young (30-something) cardiologist my primary heart doctor with the government healthcare program generally called CAJA here.
2:50 – I go back to the front desk with really nice young adults who only speak Spanish to make my appointments (citas). The young man had to use his phone to translate to tell me I must first go to the first floor to a desk and have them make a file on me, mi experiencia, which took a while to find the right desk where I took a number and waited.
3:20 – I took my beautifully created large folder for all my medical records there back to 4th floor where the young man called me past the line and put everything in the folder except my two appointments for March 24 & 25 and multiple copies of my prescription for a different but similar treatment of my arrhythmia.
3:30 – Got a taxi to bus station
4:00 – Bus to Atenas
5:15 – I’m eating one of Chef Dan’s Meatloaf Dinners before watching ABC news.

Now all of this cost me exactly $0. The prescription is good until my March visit and it too is FREE! While the prescription from the private doctor even in generic form costs me between $40 and $50 per month.

Yeah, this first visit cost me most of the day and I had to wait a few months for it, but my heart will be monitored and cared for until I die at no other cost than the required $100 a month CAJA cost which is required if I live in Costa Rica, use it or not. I’m going to use it! Save money! And I like most of it even if rather slow! 🙂 Later I will explain how I plan to work the free government system with some limited private system healthcare and a great little local insurance for a private hospital if or when ever needed for just $12 USD per month! Later!