It’s 7:00 am and I am hitting redial on my phone as though the local radio station is giving away $1,000,000. I wish – instead I am trying to get a follow-up appointment with my doctor. Added to the list of things that are just different in Cajamarca, is healthcare. Not necessarily worse in all respects, just different.
My situation started last week when I decided it was time to see a GI doctor for my on-going stomach issues. I got a name from a friend and toyed with having Matt’s school nurse make the appointment for me, but I decided to be a grownup and do it myself despite my anxiety over talking in Spanish on the phone. I called last Monday around 9 am and was told that the doctor’s appointments were full for the day. Fine, could I please make an appointment for another day that week? After asking for the response to be repeated several times, I thought I was being told that appointments could only be made for the day one is calling. When I asked when I should call, I was told “earlier.” As this seemed bizarre and inefficient to me, I assumed I was misunderstanding and asked Matt to have his nurse make the appointment for me. He came home and said she would be calling the next day. Apparently, my Spanish was dead on and you have to call on the day you want the appointment. The nurse did so and my appointment was for 8 pm on Tuesday.
We had been to the doctor once before (the nurse made the appointments and those were in advance, go figure), so we knew that we needed to get to the clinic early to pay and check in. In this respect, the Peruvian system is better, at least with our school-provided insurance. You pay upfront for everything, so there are no surprise medical bills 3 months later. My co-pay for the specialist visit was $12.50, and this amount includes the follow up visits as well. I pointed out to the clerk that I was a woman – my form listed me as a man – and she told me it was the insurance company that incorrectly coded me and pointed to their office and told me to talk to them but not to worry about it for the appointment. The insurance clerk was busy, so we stepped aside and waited with everyone else.
We soon noticed that a nurse was coming out of a door and calling a few patients at a time. They would step inside for a few minutes and then go down the hall and wait by various other doors or go to another floor. We deduced that she was likely taking the basic information: temperature, blood pressure etc. Miraculously my name was called after only a few minutes. But when I stepped up, the nurse looked startled, asked me if I was a woman and, when I confirmed that was the indeed case, told me to wait a little bit. A little bit stretched into 20 minutes and my anxiety rose. One of our friends waited for her doctor appointment for an hour the prior week only to be told that the doctor had gone home because she was his only appointment. I didn’t want to have that happen to me although the place was teeming with patients.
By now we had figured out that I missed my first chance because the nurse was calling men back into the room. So the next time she came out and called for another woman, who arrived long after I did, I stepped up and said that I had been waiting. The nurse was very apologetic and I went in with the other lady. We were seated next to each other and all of our vitals were taken (is it bad that I was happy that I was taller and weighed less?). After living and breathing HIPAA, this was a very odd experience! The nurse then walked me to the doctor’s office, but it was empty and she placed my file in the middle of a stack of files and told me to wait in the hallway. At this point, we were standing in a narrow hallway with a bunch of other people. Thankfully, many of them had infants and we surmised that they were all waiting for the pediatrician, not my doctor. Once the doctor arrived, things moved pretty quickly. The first guy went in for a little while, came out, and called the name of the next in line – again, no HIPAA concerns here. It also became apparent that all appointments were made for 8:00 pm and you wait your turn (designated when you made your appointment) beginning at 8:00.
My turn came and I met with Dr. Albán who shook my hand, chatted with me about my symptoms and prodded my abdomen a bit. He ordered some labs, gave me a prescription, shook my hand and sent me on my way. Later I realized that there were no gloves, no sink in the exam room, no Purell, no paper on the table… no sanitary measures whatsoever! And he only poked my tummy – where did he poke the guy prior to me? I shudder to think…
We had to go back to the check-in line to pay for both the medication ($1.80) and lab work ($4.50) and then take the receipts and paperwork to the pharmacy and lab, respectively, to get what I needed. Again, no health care cost surprise down the road.
Pros: Kind workers, upfront costs, no fake HIPAA privacy (come on, if you are all sitting in the waiting room, you are seeing each other, right?).
Cons: Inefficiency in appointment making and waiting times (although overall the waiting was not really worse than in US and maybe it is better to wait in a hallway with your clothes on than in the inevitably freezing waiting room in a paper gown).
Disgusting factor: Lack of sanitation. I noticed on the follow up visit that the bathrooms have no toilet seats, were filthy, have no hot water and no towel/dryer for one’s hands. UGH. It is no wonder that I have stomach issues here!