San José, Costa Rica, since 1956

Inhospitable hospitals, patient patients

While I am either pacing and grinding my teeth or, more wisely, reading a book, I look on in wonder at how Costa Ricans can stand in line and wait, no newspapers, no books, no Discmans or MP3 players. They patiently get into formation and wait in banks, in cash register lines, in bus stations; you name it. Most of all, they wait in line at government agencies.

I have always admired their patience in an unavoidable situation; I have always abhorred their complacency when it is an unjust situation.

Kate Galante

Kate Galante

Once, when I was in an “express” bank line for making loan payments, some guy had been loitering at the window, glad-handing the cashier for some 20 minutes while the rest of us stewed. “Hold my place,” I said to the woman in front of me, “I am going to complain.” I did, and a manager duly came to inspect.

When I got back into line, the woman looked at me and said, “Now, why did you, a foreigner, have to be the one to do the right thing and complain? We Ticos just take too much!”

Now, Costa Rica is awfully proud of the Caja, the state social security and health care system designed to be available to all. Unlike in some other developing countries, where people have no health care unless they can pay, everyone in Costa Rica has a right to doctors and hospitals – in theory.

The fact is that some of the worst government abuses in the way of inefficiency, corruption and dreadful treatment in Costa Rica occur in the Caja. Don’t get me wrong; it’s not always shoddy, just usually. There are some excellent doctors and nurses working for the Caja, but there are also lots of stinkers.

I can appreciate that Costa Rica does not have the resources to provide first-world health care, that the system is badly overloaded, and that socialized medicine, as democratic as it may be, has its drawbacks in any country. What I cannot abide is unnecessary inhumane treatment.

As an example, here’s a little story:

The doctora from my EBAIS (public community health clinic managed by the Caja) wanted me to get a stomach examination. When I got the appointment paper, however, I realized that it was scheduled for a year and a half in the future. I thought no more of it and went on to find a natural cure that worked. A year and a half later, I got the stomach flu and some symptoms returned, so I decided to go ahead and do it.

Big mistake.

For reasons still unknown, Cartago, where I had the appointment, is one of the stomach cancer centers of the world, so much so that the Japanese government is conducting a study there. Therefore, there is an extraordinary demand for this particular examination.

I arrived at 8 a.m. to find the facility cramped into a tiny space where some 40 patients were waiting. There were a few seats, but most people were standing in a hot, narrow hall: the elderly, the sick, the exhausted, all of them fasting, all of them expecting a doctor to call their names.

It never happened.

I stayed glued to my Kindle for an hour and a half before I realized that the doctors simply had not shown up – not that anyone was informing the patients about it. And there they were, all these accommodating people, continuing to wait without complaint.

Not I. I got up and left.

This was not by any means an atypical day in the Cartago hospital. It happens all the time, or so everyone tells me.

My point is this: Low on money or not, a hospital like the one in Cartago can take some measures to make things better, to be more, as it were, hospitable. Administrators could find a better space for such a widely held exam, they could bring negligent doctors up short, they could train personnel to be kind and keep the patients up on what’s happening, they could put in a number system so people would know where they were in the line and could go do other things in the meantime.

And the patients, the Ticos, the very people who pay for the system, could decide to not put up with it, to protest, to sue. Whatever.

Part of the reason they don’t protest is cultural. They don’t have the sense of entitlement we Gringos have. They think the government will always win, that there is no hope in fighting it.

Unfortunately, part of the reason is also weariness. There are so many battles to fight here (and not just in the Caja) that it is overwhelming. It is simply easier to accept dreadful treatment than to fight it.

For my part, the next time I need a medical test, I’ll go to a private clinic and put it on my credit card.

I’ll bet none of those people standing in that hot, narrow hallway had that option.

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