An Update from Ecuador

I haven’t been doing much of anything focused on me personally for what seems like forever. Outside of work, all of my spare time has been spent dealing with my husband’s insurance or doctor appointments, trying to make plans for the future, and completing the day-to-day chores of buying groceries, paying bills, and dealing with the typical challenges of life in Ecuador. As such, I also now realize that many of you who follow me here on my blog or on social media don’t know the full story of what has happened over the past few months.

Our week on the Samba was the highlight of this year.

Fabian has essentially been sick in some form or another since shortly after we went on our Galápagos honeymoon cruise in July. Even then he wasn't feeling 100% but, despite keeping records of the dates of illness and his various symptoms, I just didn’t consider that it could be anything really serious. He, of course, downplayed the severity of the pain and/or attributed the brief spurts of illness to environmental factors like surfing in cold water, seasonal allergies, or using an air conditioner in our bedroom.

But then he had his worst “attack” yet in early August, during which he ran a fever of 101 for almost 72 hours, had upper abdominal pain so severe that he could not stand up, was constantly spitting yellowish phlegm, and, in the end, vomited blood. At that point I insisted we go to the emergency room, but he assured me that he was already feeling better, and besides, what would they do anyway -- while the hospital on San Cristóbal Island is modern, there are limited diagnostic tools and no specialists.

Our last sunset on the island in mid-August.

He did turn the corner that day, but after months of being worried about his health, it was the final straw for me. That, in combination with the demands of my job and, specifically, the lack of high speed internet on the islands, cemented our decision to come back to the mainland.

We searched for and booked an apartment via Facebook Messenger with someone in the expat community and flew to Guayaquil on August 18. We decided to stay on the coast for the first month, because we were in the process of applying for private health insurance for Fabian, and we knew that the waiting period for coverage to kick in was 30 days. So there was no point being in the city, although it did concern me that the nearest full-service hospital was more than two hours away.

There were few sunny days on the coast in September,
but I worked outside when I could.

Throughout our time in Manglaralto we laid low and were super-vigilant over Fabian’s health, especially since he was then suffering from yet another new illness -- some type of inflammatory response that caused an itching sensation all over his body but with no visible signs of infection. We went to multiple pharmacies, tried countless creams and pills, and consulted our friends with medical training. For one entire week, Fabian followed a variation of the BRAT diet, eating nothing but rice, bananas, boiled potatoes, lentils, and baked chicken. But the symptoms persisted for an entire month.

This is how we travel from the coast to the city, a 3-hour ride.

Not wanting to delay seeking medical treatment any longer, we rented an apartment in Guayaquil’s city center for the first two weeks of October and made a series of appointments at the Centro Médico de la Clínica Panamericana. Thus, by the 6th of the month, we had the first definitive diagnosis: Fabian’s gallbladder was full of gallstones and immediate surgery was recommended. Unfortunately, we were not impressed with the administration or facilities at the Panamericana, so we started researching other, more exclusive, private hospitals to ensure a better standard of care for his treatment.

In the meantime, we were in touch with our insurance broker on an almost-daily basis, verifying coverage, policy details, and the process for making claims. She reassured us that, if needed, we could go to the ER at any time and everything would be covered and, if it was not an emergency, we could schedule the surgery for 60 days from policy initiation (so, November 1) and it would be 90% covered as per our plan.

Based on that information and the results from all of the tests done at the Panamericana, we made an appointment with a gastroenterologist affiliated with the well-regarded, fully private, Hospital Clínica Kennedy. During his thorough exam and review of the test results, which also led to a diagnosis of chronic gastritis and a significant bacterial infection, he recommended that we go to the ER should Fabian have even the slightest hint of stomach pain. Thus, in anticipation of his impending surgery and multi-week recovery, we moved to another apartment within walking distance of the hospital. And, a few days later, on October 18, we went to the ER.

Fabian's first day ever as a hospital patient.

This is the point in the story that, even more than one month later, it’s hard not to scream and cry in frustration. Because, in spite of all our efforts to do everything right, Fabian has still not had surgery.

It turns out that our broker, a woman who has made a name for herself among the expat population in Ecuador for helping them get insurance and navigate the healthcare system, provided us with incorrect information from the beginning. The first, and perhaps most egregious error, is that she continued to insist, even as I sat in the administration office of Kennedy Hospital and had them call Humana (the insurance company), that Fabian’s ER visit and subsequent hospitalization were fully covered by his policy. When, in fact, ER visits are only covered up to $500 and the hospitalization (and surgery) would not be covered at all, because he was still within the waiting period. And second, she reconfirmed that the policy covered hospitalization after 60 days, but the reality is that it has a 90 day waiting period.

By the time I discovered the administrative errors, Fabian had already been in the hospital for 24 hours and was scheduled for surgery a few hours later. The hospital bill, almost all of which would have to be paid out of pocket, was already around $2,000 and would double or triple if he had surgery. So I made one of the hardest decisions of my life by deciding to forego his treatment, and I took him home.

In the month since then, the worry and stress over what has happened have, at times, felt insurmountable. And to make things worse, the insurance broker refuses to take responsibility for her failure at all levels, for which she has now cost us over $3,000. Yes, we can take her to court, and considering we have written and audio evidence to back up our claims I think we would win, but the Ecuadorian legal system is notoriously dysfunctional and corrupt, and I’m just not sure it’s worth the effort. Not only that, but there are strong libel laws here, so I can’t publicly denounce her as I would risk the possibility that she could sue me for slander.

As we had already paid for the apartment (a nonrefundable Airbnb in the Kennedy neighborhood of Guayaquil), we hunkered down for the remainder of our time there and, besides me staying busy as always with work, tried to focus on keeping Fabian healthy, while occasionally enjoying an evening out watching a soccer game or visiting with friends.

At the Barcelona SC museum in Guayaquil.

We also scheduled a few more medical checkups that were covered by insurance, but that resulted in more diagnoses: pterygium (a growth on both eyes that requires surgery to remove); ringworm (a skin rash caused by fungal infection -- no worm involved); and xerosis (excessively dry skin which contributes to the itching sensation).

You may be wondering about a few things, like if Fabian has always had these illnesses. The answer is both yes and no -- yes, because he has had similar symptoms in the past, long before I met him; and no, because he has never been to a doctor, at least not on a regular basis, and thus never diagnosed or treated for them.

That leads to the next question: What about Ecuador’s free public health system? Yes, the country does have free public healthcare, but it’s really only useful for emergencies and the standard of care is generally very low. Anything that’s not a life-threatening emergency requires waiting weeks or months for treatment, post-op care is an afterthought, and medications are not covered. And if it was an emergency, the operation would not be laparoscopic -- it would be a full incision with more risk of complications and much longer recovery time.

Which brings us back to Galápagos. As it happens, we have a good friend in San Cristobal who is friends with the surgeon who works at the hospital on the island. And the surgeon is now qualified to perform laparoscopic surgeries! While there are still no specialists and no in-network insurance coverage (meaning everything must be paid out of pocket and we can apply for reimbursement), the reality is that if Fabian has another gallbladder attack, we can go to the ER at the public hospital there and have the surgery for free. True, it would not be a good situation if there are complications, as we would have to fly him to the mainland for further treatment, but it’s a risk we’re willing to take right now.

Happy to be surfing after more than six weeks in the city.

So with that in mind, we came back to the coast, as we needed an escape from the confinement, noise, traffic, and ever-present threat of crime in the city, but cannot go back to the islands just yet because of my work responsibilities. We rented a small house in Olón for a couple of weeks, but are moving to a mini-suite (basic hotel room with outdoor kitchen and view of the ocean) at a hotel in Montañita on December 1. We will stay there until the 21st, when we’ll take the bus back to Guayaquil and spend one night out by the airport, then fly to San Cristóbal on the 22nd.

That means Christmas and New Year in Galápagos!!! There are still many challenges ahead, and plenty of uncertainties. And we'll definitely have to come back to the mainland in the early part of 2022 for the eye surgery and further medical treatment. But, for now, I am thankful to have a short-term plan and that we can look forward to the holidays at home with our friends, not to mention the sea lions and blue-footed boobies.

We're hoping to see this again sooner than later!