Universal Healthcare during COVID-19 works!

I can’t believe how impressed I am with the outreach to us from our local CCSS clinic. The CCSS is the Caja Costarricense de Seguro Social, commonly referred to as "la CAJA". Yesterday we received a call for John from our local CAJA health center. Since John is language challenged when it comes to understanding people speaking Spanish on the telephone, I took over the call. The caller was a staff member at the local clinic and she was just calling to make sure we are okay and did we need anything health-wise during this time of social distancing. She confirmed our ages, living situation (food, shelter, ability to cook, clean, bathe, and generally take care of ourselves), regular medications we take, and our emergency contact information.

I explained, even though we pay our quota to the CAJA each month, we have always used the medical services of our friend and doctor in town to write prescriptions we have filled at the CAJA pharmacy. Since March we have avoided contact with the public as much as possible and we haven’t wanted to go to the CAJA pharmacy to fill prescriptions. We have been ordering our medications from a local pharmacy via WhatsApp (text message). This pharmacy provides a free delivery service. The CAJA representative explained they would be more than happy to fill the prescriptions for our regular medications and deliver them to our house monthly. She took down the names of all our medications and promised to set up an appointment by telephone with one of the doctors working at the local CAJA clinic. Today, she called back to confirm a doctor will contact us today, or tomorrow, to confirm our medications and submit the prescriptions to the CAJA pharmacy to be filled and delivered. She then proceeded to provide me with the phone numbers I can call to order refills in the coming months.

Some folks complain about socialized medicine, but for us, we find the medical system so much better than what we had in the United States. Granted, elective medical services are not readily available and there is a waiting list, there are waiting periods to see some specialists, but overall healthcare and emergency services are great. Just last week we ventured out of the house long enough to get our seasonal flu vaccination at a venue set up by the local CAJA. Earlier this year, clinicians from the CAJA showed up at our door to take our temperatures, blood pressure, and administer Tetanus booster shots. The system works! ¡Pura Vida!

UPDATE 5/28: The doctor at the local clinic just called to reconfirm our regular medications. The prescriptions will be filled tomorrow and delivered to our door on Monday.
UPDATE 5/29: 30 days worth of medications were delivered at 10 AM. Each medication can be refilled twice.
UPDATE 6/1/20 Two clinicians from the local CAJA office came to check on us for symptoms of Dengue Fever (breakbone fever). They confirmed there is one reported case of Dengue in our neighborhood and she has recovered. Time to inspect the property again to eliminate any mosquito breeding grounds.

Universal Healthcare for all!

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The Great Atenas Wed-In

Never in my wildest imagination did I ever envision being the wedding planner for more than 70 couples!

This all started as a way to work around the discriminatory practices of CAJA (Costa Rica's socialized medical system) toward foreign residents. First of all, it important to state that all resident expats are required by law to belong to the CAJA and pay a monthly affiliation fee. Every time an expat couple has to renew their residency, they also have renew their affiliation with the CAJA, and the dependent spouse has to prove once again they are still married. The proof has to be in the form and a new certified copy of the original Marriage Certificate and this certificate has to be sent to the Secretary of State where they were married to obtain the Apostille guaranteeing it's authenticity. When the certificate is presented as proof, it can't be more than 30 days since it's certification. This is very difficult for U.S. Citizens to pull it off in a 30 day window, and it is almost impossible for many expats from other countries around the world. The cost of this document and courier fees could easily exceed $100 USD,

Citizens of Costa Rica, also have to prove to the CAJA that they are married and eligible for dependent benefits. The difference for a Costa Rican is that they can order a certified copy of their marriage certificate online, and then they can pick it up at a convenient government office for the cost of about $0.10 USD.

So, it was time to find a permanent solution to this problem. We contacted an attorney here that has always been an advocate for the expat community. He researched the problem and confirmed the discriminatory practices. He agreed to accept the case pro bono, and he will be filing law suits with the equivalent of the U.S. Supreme Court to get the CAJA policy changed for the expats' benefit.

But before we can get a ruling, we decided to go ahead and re-marry each other so we can get the marriage registered here in Costa Rica's national registry. We had no idea when we invited a few friends to join us in renewing our vows, that so many couples would jump on this bandwagon. We now have more than 70 couples registered to get re-married in our Central Park, this Sunday, St. Valentine's Day, February 14, 2016.

If you're not doing anything, come out to the park and watch. It promises to be an historic event with a party at our place afterward.
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What's an "emergency" in an Emergency Room?

It's 10pm on the Turd of July.

"There's an elephant sitting on my chest," she said. Her blood pressure had spiked to over 160; she was pale and clammy; her demeanor was noticeably languorous. My EMT "load and go" brain kicked in. We loaded. We went. But we probably went to the wrong place.

"Shouldn't we call Cruz Roja (the Red Cross ambulance)? You're in no condition to drive." she said.

The girl has obviously never seen me totally in The Zone. One might be "impaired" by too much scotch but when it's time to fight and the explosion of adrenaline kicks in, you fight like a maniac -- a very cold, calculating, sober maniac.

(On top of being aware of my above "skills," I was determined to take matters into my own hands because I had visions of the Cruz Roja responding at about the same speed and enthusiasm as the Fuerza Publica, i.e., "whenever".)

I decided that we were going to the Caja Hospital de Alajuela. Patricia had received excellent treatment there one night for a bout of pneumonia and my treatment at the Atenas branch for 2nd degree burns had been exemplary. How bad could it be? He said.

During the drive, there were a couple of times she touched my leg as a signal to be careful when I achieved the terrifying speed of 100 kph out on the autopista (63 mph ... pfttt!). Other than that, for your reference, it is exactly a 30 minute drive with the new Coyol connector road between Hwy 27 and Hwy 1. Other than the patient's angst, the trip was uneventful.

So, I wheel up to the ambulance dock at the back emergency entrance of the sparkling new Alajuela hospital and ... nobody there but a sleepy old guard. Oh well.

I help her out of the car and we walk the few steps to the ER reception desk.

"Corazon!" I exclaim, thumping my chest and pointing to her (wishing I had paid closer attention in my Spanish For First Responders class in California.)

The dude says something that doesn't process in my brain but he's pointing to the line standing in front of a door marked "Triage." Noooooo!

But, as part of my extensive Pura Vida training and two years of practice to NOT grabbing clowns by the shirt front and jerking them up over their desk for "attitude training" I simply nodded and we went to the line. Wow!

The Triage office is a very tiny room with one guy in it. It has two doors. One faces the general ER area (a HUGE waiting room) and one faces the ambulance back entrance area, where we were. The line at the general door was long. Our line only had two parties in front of us. Luckily, it seems that the policy is to clear the line on our side while the "walk ins" on the other side have to wait. And, the Triage guy was attentive, if not a little non-chalant about a cardiac emergency. He sauntered out of his office, sat her down and took her blood pressure while asking a couple of questions. He then executed a computer printed form (the ONLY computer or computer form we were to see during this odyssey) and he put a red tag onto the form. Oh boy! A red tag. Now shit's going to start happinin'.

He pointed us to a semi-open doorway, indicating we should "cross over". I say "semi-open" because it was hung with opaque 4" wide, vertical plastic strips, such that you could move them apart and enter but that the people outside couldn't see in.

For good reason.

I said "cross over" because on the other side of the plastic strips we entered a 25 meter hallway that would be a perfect setting for a Stephen King horror movie. Both sides of the hall were lined with gurneys holding the sick and dying off casts. Almost all of them looked terminal to me and all of them were just "parked." Several of them had IV pouches hung above them but all of the pouches were empty. Great way to enter The System.

Undeterred, we pushed through the stygian gauntlet and made it up to the real nurses station. "Now that red tag is going to get me somewhere."

Not.

With a big yawn (10:30 PM) the clerk/nurse/whatever (everyone is wearing scrubs and "corporate" namebadges too small to read) looks at the paperwork, tosses it into a basket on the top of the counter and points us to a line of 8 metal chairs. I think about doing the chest thump and "corazon" pantomime thing again but figure that this is just the Pura Vida system. Let it go. If my darling collapses or suddenly arrests, there's still plenty of time to grab some shirt fronts and drag them out to where she's lying on the floor, I figure.

The line of 8 metal chairs once had 1" thick plastic-covered pads on them. The pads had been upholstered onto a plywood base. But all that's left now are raggedy bits of plastic with a sporadic showing of loose fiber to tease one into imagining how comfortable these chairs must have been ... 30 years ago. There were already 6 folks on the 8 chairs with one end of the line empty -- almost. At the far end of the chairs was a woman in a wheelchair, all bundled up, asleep, with a heavily bandaged foot resting on the edge of the last chair. We made ourselves as small as possible and sat, taking care not to push that blood-seeping foot off the edge.

Presently, a 12 year old kid walked up to the counter and took our file out of the basket. Well, he looked 12 to us.

He read and read. It was a single page. And he read some more. Then he called Pat's name kind of "out there" into the general time-space continuum, as if he didn't know where the line of chairs was. We waved our hands and he turned to look at us, then motioned toward a nearby door. Holy reflex hammer, Batman, this guy's wearing a stethiscope around his kneck and he has a ballpoint pen in his pocket. This must be a real doctor!

Since Pat and I are joined at the hip, we both stood and headed for the door together, whereupon the kid (we promptly began referring to him as Doogie Howser) waved me away and mumbled something.

"He says you can't come in," Pat said. Ahhh. Yet another test to see if my self control system against choking little shits is sufficiently strong to overcome my emotions.

So, they go alone into the sanctum sanctorum room and I'm left outside trying to decipher doubly unintelligible mumbles issuing through the door. Nada.

Pat comes out and states that she's headed (on foot ... no wheelchairs if you're only suspect of being about to die) to the EKG room and I cannot come with.

I am shooed back to the little chairs. Like a dog. I obey like a little dog. Oh, woe unto them if I were still a Real Man. Sigh.

But, hey! An EKG! This should change their attitudes and get some action around here!

In no time at all, Pat was back.

"The EKG is negative. He says they have to do a blood test and a chest x-ray"

Well, O.K. Some high blood pressure congestive episodes won't show up on an EKG, I guess. Goodie, let's wait over on the swell chairs. I wonder where you get to the point of getting one of the ER beds and a little medication, etc. Crazy thought.

'Bout an hour later, amidst the chaos of employees stampeding past us to get to the employee break room across the hall from our chairs, an unidentified scrub-clad woman walks up to us with a handful of pills, still in their individual Costa Rican foil wrappers, and dumps the mess into Pat's hand and hands me a plastic shot glass, generously filled with water. "Take these," she says to Pat in Spanish.

I'm starting to think about bolting from Hades and heading to the private CIMA Hospital over in Gringolandia, even if it does cost your life savings to barge through their ER doors.

Pat doesn't think this is a good idea (yet) and I hunker down.

Actually, I stand up because my nether regions have gone fast asleep sitting on the hard plywood-seated wonder chairs.

First thing I do is walk back towards the nurses station to get a peek around the wall beyond which a lot of moaning and stuff is issuing. Holy Crapola! This is a Wednesday night. What happens here on Friday or Saturday nights?

There are 8 open-fronted examination chambers, each with three gurneys, all full; and, there are 3 rows of better looking chairs and wheel chairs, all full. And it seems every single patient has an IV packet -- almost all collapsed and empty -- with a tube running to their arm or hand. Must be the standard treatment around here. "Dehydrated? Plug 'em into a half liter on fast drip." "Broken foot? Plug 'em into a half liter on fast drip." "Influenza? Plug 'em into a half liter on fast drip."

"Heart attack? Nah. They don't need no stinking IV. Stick 'em over in dem freakin ol' chairs we moved over from the old hospital. Maybe they'll croak and that'll rid us of one so we can free up a chair."

With everything full, I count like 50 souls needing attention in the ol' ER on this "quiet" hump night. Maybe a word about the staff is in order at this point.

There's Doogie, of course, and maybe (we're never sure of this) one other guy who might have been a doctor because he periodically pulled patient files from the counter-top basket and read them and read them and read them.

Then there were 6 ladies, all in scrubs, messing with papers, going to the employee break room and occasionally delivering pills with dem little bitty cups of water.

There was Working Man, who must have been a boss nurse or something because as often as he messed with paper, he would also get up and go do something with a patient. He's the only one that I saw change anybody's IV bag. One other of the women inserted an IV needle, that I saw.

Speaking of needles, there was Blood Girl. She came with her little cart full of vials of blood and alcohol wipes and needles. I loved her modern asceptic technique. She walked up to the girl next to us on the chairs, (who spent almost the entire night passed out on her mother's shoulder,) and slipped the surgical tubing "tourniquet" around her arm to pop out a vein. Then, with an alcohol swab, she wipe and wiped a spot on the girl's arm. Then she switched to a clean wipe -- just to be sure -- and wiped some more. Then she dropped both wipes into a bio-haz bag ... and wiped her own nose with the back of her index finger ... then picked up the blood-draw needle between that index finger and thumb and shoved it home. Do you think my eyes betrayed me when my eyelids flopped back over the top of my head upon observing this textbook example of medical safety and sterility? I tried to be good. Minded my own damn Pura Vida business.

Then there was the "escort boy." His job seemed to be going to and from the break room more than anybody else; and, then he was the one who motioned us to follow him (again, on foot -- no wheelchair) across the hospital to the x-ray department. He was a little put out though, that us damn old people couldn't walk as fast as he, because, hey, he had to get back for, um, break time.

The radiology dude was a really funny guy, I guess, because he kept escort boy in stitches the whole time we were down there, regaling him with ... I don't know ... stories or something. Anyhow, it must have been mighty funny material.

Last, but certainly not least, is the cleaning lady. We were there from 10:30pm on the 3rd until 7:30am on the 4th, and she never stopped moving. She'd sweep and then mop. She'd empty waste baskets then clean the employee break room. Never. Stopped. Working. And she was probably getting paid $10 per day.

So, back to the story. We're both pretty sore from the chairs and Pat is freezing. I guess they keep it cold in there to hold down the germs or something because no normal organism could live in there for long without a lot of protective clothing. We noticed that many of the patients were obviously experienced with The System because they had brought their own blankets and extra clothing. Not us. We're stupid gringos.

At some point Pat's blood work came back from the lab and they were mystified. Nothing.

Time for another EKG. Pat came back from that little trip and said that they had decided to run a different type of blood test on her. Ya know, they didn't want to waste a whole extra blood test strip on her the first time around because, well, not every cardiac patient presenting with an elephant on her chest develops the proteins or antibodies or hooper-gloopers or whatever they were not going to test for the first time around. Much better and more efficient to run Blood Girl down for yet another draw, send it back upstairs for processing, checking off another box on another form, running it back to the ER and .... oh, hell. Then they told us it would be at least another 3 hours to get those results. It's 3am.


My butt is killing me and I've got a plan.

"Hey, since it's going to be "forever" to get the results back on this test, why don't I run back to Atenas and get you some warm clothes?"

"But it's so far."

"Oh ... but I want to," I'm saying, thinking of the rather plush-ish drivers seat in our Subaru and the hour away from hell that such a trip would entail.

So she assented; and, I went.

Now, I need to do a quick little back story here to put the following into perspective. We had just paid to have two little gated fences built on either side of our main house so that we could confine our dogs to the back yard/side yard areas, keeping them away from visiting guests of our casita and away from any gates to the outdoors. You see, they love to jump up on strangers and they love to get out of our compound and run around the neighborhood. When we left for the initial hospital run, we had put the dogs out behind the new fences. (Plenty of dry shelter areas, water and doggie beds but no way to run off and no way to irritate anybody.

So I pull off our neighborhood street and into our long driveway (3:30am) and waaaaay of up the drive way I see two glowing eyes. Then the eyes are bounding down the lane in big gazelle-like leaps of joy. In the fog of my brain and darkness something is circling the car like a ... well ... crazy dog. It's our mini-pin, Goose. Happy as a pig in poop and you can just about see the laughing smile on his face saying, "Haha. You can't keep me penned up." We still haven't figured this one out. He has never figured out how to get out of the back yard before. He had to either climb the 2 meter back yard fence or he had to climb the new 1 meter gate and then the front 2 meter fence. Baffling.

Anyhow, I grabbed clothes, snacks & drink and ran back to Alajuela.

Back with Pat it's back to sitting. And sitting.

Then, 6am. It's obviously shift change as new faces roll in and old faces start to gather up their personal stuff to go home. Damn. This is certain to add an hour or more to the stay because the newbies won't be up to speed and won't know Pat's history and ....

CLUNK!

The pneumatic tube drops into the nurses station a package full of test results. Oh, could we be so lucky?

Working Man retrieves the tube and starts leafing through the reports. He looks over and gives us "the look" meaning that our results are in. He staples them to our now-considerably-thick pile of papers and STICKS THEM INTO THE "TO DO" BASKET!!! Hot damn! We're either out of here or Pat gets a bed and some action.

Shift change here entails lot's of laughing; chatter; hugs; leering male something-or-others-in-scrubs checking out the butts of the newbie female something-or-others-in-scrubs; and ... one 20-something is braiding the hair of one 50-something as several others observe. This just ain't the time for reading charts, yo.

But then Doogie comes back. We thought he'd gone home. He grabbed the pile from the To Do basket and he read and read and made notes and read and read and made notes and read and read. Then he called out the name ... of someone else. That patient and he left the area together. Pat had heard the intake of that patient during my 3am absence as someone also having chest pain issues.

"But he was way behind us in line!" I say, beginning to think that maybe we're in the gringo line and that guy was in the tico line. Plus, that guy looked to be about 30. Where's the fabled "taking care of seniors first" treatment?

They come back. Doogie disappears. Now it's pushing 7am.

Doogie reappears and picks up the files and reads and reads ... well, you get it. Then HE CALLS PATRICIA'S NAME!" Then he takes her away because he wants to do another EKG. (Somebody's cousin must own the EKG-paper vending company that supplies this hospital. Is this the 3rd or 4th one?)


I'm shaking my head, muttering and generally looking like a genuine curmudgeon when a really tico-looking man about my age squeezes into the chair beside me.

Just then, a guy and girl, in scrubs, come walking up with the apparent intention of moving down the line of chairs taking everyone's blood pressure. As they get to me, they ask indecipherable stuff and I can only say, "Mi esposa," and point toward the EKG door. Then the guy next to me says something to them in Spanish and they move along. I'm a little confused by this until he leans over and whispers conspiratorially into my ear, in perfect unaccented English, "If you think this is bad, you should see the Caja hospitals in Guanacaste and Limon. They really are nightmares compared to this."

My head could have exploded. Worse than this? And who is this "masked man" who came at just the right time to save me with his perfect Spanish and perfect English? Turns out he is a dual national with 18 years of residency in the U.S. and the rest of his 60-something years in Costa Rica. Then he gave me a little taste of how "good" things could have been for us during out fun vacation to the hospital.

"I've been peeing blood for 3 days. Yesterday I started sitting here at 6am, having nothing to eat or drink since midnight the day before yesterday because they needed my system totally empty to do a kidney ultrasound. Then, they delayed the ultrasound until late yesterday afternoon. It was so late that the only doctor who could read the results had already gone home. So they told me to go home and come back today for the results. I figure that I'll be here all day today before I learn anything."

Oh, good, now I'm ready for all kinds of good things to happen.

Pat returns.

"Well, Doggie did 3 EKG runs and then 3 blood pressure tests. My blood pressure is back up a little but the EKG is negative." she says, mournfully. "Oh ... and the new blood test is negative so he's just going to prescribe a different type of blood pressure medicine and aspirin."

And here I'm thinking of that ancient old joke punchline of a doctor saying, "Take two aspirin and call me in the morning." Maybe I should give him a "punchline" of my own.

Ah, no. Pura Vida.

So Doogie writes and writes and writes into Pat's chart. Then he chats with some of the newbies for awhile. Then he writes some more. Now it really is 7am. Finally he fans out a handful of prescription scrip and waves Pat over to his throne desk.

We're free! We can leave. Or not. It seems that the scrip written at this caja location is no good in any other pharmacy other than theirs, which is over on the other side of the hospital and generally good for another hour of "waiting to be served".

But finally, the gods are smiling on us and there are fewer than a handful of peeps ahead of us at the Ye Olde Dope Spot and we're out o' there in less than 20 minutes. Record time for once.

Drove home wide awake. Rustled around with Pat and made breakfast of some sort. Sat down and jotted a little stuff on the computer ... and then ... the big crash. Not the computer ... my brain and body. Pat's too.

With only a few minor interruptions of phones and people at the door, we both slept the 4th of July away. Hope we didn't miss much. Hope we don't EVER need an ER again. If we ever do, I'm thinking of heading straight to CIMA. What the heck. A little bankruptcy never hurt anybody.
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Health Warning! What happens to household goods in storage for a year!

A week ago I felt what I thought was the onset of a cold. I started taking the usual OTC meds, but this nasty bug immediately settled in my lungs. I had to sleep upright in a recliner just to breathe. By Saturday, John insisted I go to a doctor to get this checked out, and the search for cause and cure began.

When we first moved to Atenas, we were not yet covered under Costa Rica's national health care system, Caja Costarricense del Seguro Social (CCSS or CAJA). So we affiliated with a a local health care provider called "Linea Vital." They offers private English-speaking medical care for the Atenas community. Clinic staff provide home visits, emergency care and general medical services.

Saturday, I saw Doctora Candy and when she listened to my lungs she said, "Muchos Gatos" (or many cats)! She put me on 4 nebulizer treatments, gave me an injection for inflammation and sent me home with antibiotics, inhalers, and a bunch of other meds to try to assault whatever was attacking my lungs. She told me to come back on Monday and meet with Doctora Hernández, who would be filling in for here for a few days. By Monday, I was still the same, or maybe a little worse. Doctora Hernández gave me 3 more nebulizer treatments, another injection and changed the antibiotic to something stronger. She suspected pneumonia of some type had set in. Since we are now members of the national health care system all of our medical is covered, so she sent me off to the local CAJA clinic for blood work and x-rays. I was handed the results for the blood work in 30 minutes, but it would take two days to get results for x-rays. Yesterday, We opted to go to a private facility in Alajuela (about 30 minutes from us) and get the x-ray done and receive the results the same day. It took us about 3 hours and we were back to see Doctora Hernández with all the results. She diagnosed bacterial pneumonia due to the raised white blood cell count and some cloudiness she saw on the x-rays. So, she sent me back to the local CAJA clinic with an emergency referral for treatment.

At the clinic they took me right to the head of the line where I met with the intake nurse and doctor to assess the treatment so far. This doctor started thinking Asthma and put me on a course of 4 rounds of nebulizer treatments, i.v. drip and more injections. He called in another doctor to consult and they decided I still needed 3 more nebulizer treatments and another i.v. injection. Now, let me tell you during all of the this treatment, they have my blood pressure all over the map, the highest I have ever seen it in my life and I've got the shakes due to the drug induced tachycardia. My pulse rate was over 115. By 4 p.m., the local clinic was getting ready to close for the day, so the attending doctor check my status a determined there was still no improvement so they needed to transport me to the big hospital in Alajuela for treatment and off I go...

John went back to the house to take care of the dogs, pick up some stuff for me that I might need and arrange for someone to guard the house. During the trip to the hospital, I called my dear friend Maritza, an R.N. that recently retired from this same hospital. She wasn't home, so I explained what was going on to her husband, Vinicio. He said he would update her as soon as he could.

We arrived at the hospital emergency room around 5 p.m. and they immediately took me to the head of the line to see the intake nurse and attending physician. The doctor, reviewed all the the previous results, checked me out and decided I needed more nebulizer treatments, blood pressure meds, more blood work and antibiotics.

So, off I go to the "Sala de Asma" for nebulizer treatments, etc. I sent John a text message telling him where he could find me when he arrived at the hospital. As soon as he got to the hospital, they sent him right in to see me.

I met with another doctor in the Sala de Asma and it turns out he lives in my neighborhood of Atenas and knew me as the neighbor that had provided all the electricity and water for a recent fiesta in the plaza across from our house where they held bull racing, horse racing, dances, etc. He was bragging to all the rest of the patients about what a good neighbor I am. Small world.

About this time, Maritza called and said she was coming directly to the hospital. Maritza is one of those "take charge" kind of people, that instills the belief that everything will be fine. She holds several advanced degrees in nursing and retired at the pinnacle of career in health care. She has seen it all. I have known and loved this woman for longer than I have known and loved my children. She was born 3 days before I was and I consider her the twin sister I never had.

In walks Maritza, and of course all the staff members are delighted to see her, hugs and kisses for everyone. She talks to me, takes my blood pressure and then talks with my doctor. Suddenly she turns around to me and says she knows exactly what has caused this pulmonary episode. She said she was sure it was a combination of dust, mold, mildew and bacteria.

Maritza reminded me that we had just started to unpack all of our household goods that have been in storage for a year. In spite of all the care we took with everything, our stuff arrived in a sea container last August, in the middle of the rainy season and immediately went into a garage and attic for long term storage. We had to store everything while the new Casa was under construction. We finally moved in a couple of weeks ago and we have gradually been moving the stored furniture and boxes into the new casa before opening them. Bad move! All we did was release all the mold spores and bacteria into the new house.

Well the doctor pretty much concurred with Maritza's medial assessment and decided the nebulizer treatments weren't going to cure this, but he wanted to see the blood work first to see if the antibiotics where improving anything. The results came back and the white blood cell count was down somewhat. They finally cut me loose from the hospital with more meds and instruction to see my local CAJA doctor in a week, or sooner if I get worse.

Last night, instead of trying to sleep in what is probably a mold infested recliner, I opted for our bed with a large stack of super clean pillows, and I finally got some rest after a sleep deprived week.

So, the bottom line... I think I may be on the road to recovery. As a word of warning... don't ever think you can put all of your belongings in an storage facility where the environment is exposed to the elements of nature. Especially here in Costa Rica's tropical climate. The jungle will always try to take over and claim your stuff as it's own.
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We have a new address!

Front door - Inside

We have a new address! It's about 40 meters (131 feet) South of where we had been living for almost a year. Yes, it's official, we moved out of the casita, and into the new Casa last week. There are still lots of things that are not done, but we just couldn't live in our 300 square foot (28 square meters) casita any longer. We had the single car garage packed from floor to ceiling. Last August we stuffed as many boxes into the small attic as we could and when we ran out of space there, we crammed everything else into every nook and cranny we could find in the casita. The only space left was a pathway from the front door to the bed, the bathroom and a tiny workspace in the kitchenette. I'm amazed we were able to live like this for the past year.

Our new Dutch door

Even though we are lacking a number of amenities in the Casa, we decided it is workable "as is" and we will live without until the finishing touches are completed. Here is a short list of the things we still need:

• Kitchen Cabinets
• Kitchen Counter tops
• Kitchen Sink
• Master Bathroom Cabinets
• Master Bathroom Counter tops
• Master Bathroom Sink
• Master Bathroom Towel Bars
• Guest Bathroom Cabinets
• Guest Bathroom Counter tops 
• Guest Bathroom Sink
• Guest Bathroom Towel Bars
• Interior Doors (9 of them)
• Replacement of defective water heater
• Pantry shelves (almost done)
• Laundry room shelves
• Internet service

The Terraza

In the interim, we are using the laundry room sink for everything from preparing meals and washing dishes to brushing teeth. It's a little awkward to use a bathroom toilet and then go to the laundry room to wash hands, but it's workable.

My gas range is installed in the kitchen, along with our new side-by-side refrigerator. Wow, is it nice to have lots of freezer and refrigerator space. When we sold our home in Houston, the new buyer talked us into selling him our "almost new" side-by-side refrigerator. We waited until now to buy a replacement. I've have really missed not having the ice maker and water dispenser in the door for the past year. Our new Samsung refrigerator has all that and I think it even works better than the one we left behind. At least it doesn't shoot ice out all over the place like our old LG. The LG had a hard time dispensing ice into a glass... we considered ourselves lucky if only half of the ice cubes landed on the floor. We've setup a couple of folding tables for workspace and stainless steel wire shelving (on wheels) for temporary cabinet space, so I guess you could say I've got a workable kitchen.

Decorative Wrought Iron Windows

Our king size bed is where it belongs, along with our armoires (wardrobe cabinets). John finished the build out our closet with shelves and clothes rods, so we have plenty of space for hanging clothes and storing shoes.

The living room sofa and our Lazy Boy recliners have been unwrapped and moved into the new living room. John hung the big LCD TV last week and Saturday, CableTica showed up in the rain to hook up cable TV. They said they would be back this week to hook up the modem for internet service. Eliécer, one of our builders, stored our living room coffee and end tables in his workshop last year. He said he would bring them back to us one day this week.

Alexander, the security guy, came and installed a state-of-the-art alarm system for us. This system arms 19 windows, 4 doors and 3 motion sensors. It has a voice dialer feature that is really slick because we can program up to 5 phone numbers that are called in sequence when there is a security breach. We can also call the home phone and arm the system from the road if we forget to set the alarm. The system lets you arm the doors and windows when you are home so the motion sensors don't set it off, and when we go to bed, we set it to "night time" so the motion sensor in our bedroom won't trigger the alarm we get up to go to the bathroom, but it will set off a siren if John raids the refrigerator.

We've programmed our voice dialer to call our cell phones for now, because calling the "policia" here is a joke. We are usually in the neighborhood and could get here pretty quick if there is a security breach. We have friends that live close by and we will use them as a backup whenever we can't get here quick enough.

Gustavo, the gate guy, came and installed an electric motor on our beautiful wrought iron gate. It comes with two remote controls and there is a switch in the Casa that we can also use to open and close the gate. It work really great, as our dog, Gus (pronounced "goose" in Spanish) can attest to.

Today, I was trying to label all the switch plates in the Casa, so I would know what switch powers what light fixture, fan, etc. Xiomara, the woman that helps me with the house work, was helping me and she pressed the switch for the gate. Immediately, it started to open and Gus made a run for freedom on the streets. John yelled, "Close the gate" and she pressed it again, causing it to close and catch Gus on his way out. Gus yelped in pain with his shoulder pinned between the gate and the support post. I pressed the switch again and it opened releasing the poor little guy. Needless to say, we were all worried Gus had sustained significant injuries, so John and I rushed off with him to see the vet. Our vet wasn't open yet, so we found another vet that was. John stayed in the car with Gus, while I went in to see if the doctor could check him out. As soon as John opened the car door, Gus bolted and ran down the streets of Atenas, with the two of us chasing after him. Obviously, the injury wasn't much if Gus could run like that. Finally, instead of running after Gus (he thought we were playing a game) John just sat down in the street near the central market. Immediately, Gus ran to John to see why he wasn't playing anymore. John scooped him up in his arms and we walked back to the vet's office. The doctor said Gus has some swelling on his right front shoulder, but it was mild. He checked Gus out and said to keep an eye on him for the next couple of days, but he thinks our little rescued street dog will be just fine.

Rodolfo, one of our builders, is here today with a helper, re-installing the sprinkler system they had to remove when they started construction on the Casa. Once the sprinkler system is up and running again, we'll have Mario, our gardener, bring in a truck load of top soil and new grass sod. I can't wait until we have grass growing again. You just wouldn't believe how much mud two little dogs can track into the Casa in a day. I'm also looking forward to planting shrubs and flowers in the garden and along the walkway.

We haven't started unpacking yet, because we really don't have anywhere to store the stuff until all the cabinets and shelves are in place. In the meantime, we have stack of boxes in the dining room and spare bedroom. The great thing about being retired is there is NO deadline to meet... there is no reason we can't take our time unpacking. We can unpack at our leisure, if that means we live with stacks of boxes everywhere, so be it. The first priority will be the boxes in the dining room so we can have friends over for dinner. The rest of the stuff can live in the spare bedroom until we are ready to deal with it. Finally, we have all the room we need.

In other great news, John's "Residencia Permanente" was approved last week by the Ministerio de Migración. One of the requirements for residency is participation in CAJA, or Caja Costarricense de Seguro Social. This is the national medical care system. We applied for John's CAJA carnet last week and we just picked it up this afternoon. Now all we need to do is schedule the appointment with "Migración" for later this week and they will give him is Cedúla, the national identity card. With his cédula, he will have all the rights of a Costa Rica citizen with with exception of voting. This is the equivalent of a foreigner in the United States that has a Green Card, granting them legal status.

Well folks, that's all the news for now.
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Is the U.S. population being over medicated on purpose?

Before we moved to Costa Rica, we stock piled several of our daily medications knowing it would be months before we would be eligible to obtain prescription drugs from the CAJA (the "Caja Costarricense de Seguro Social" is Costa Rica's socialized medical system.) All foreigners are required to join the CAJA to obtain legal residency. It costs about $49 per month for a couple over 55 to have complete medical coverage. Not all medications are available through the CAJA, so there are a few things we have to purchase from independent pharmacies. One of these just happens to be for acid reflux disease, and John and I both take the same medication. Both of our U.S. doctors had prescribed each of us a dosage of 40 milligram capsules, once a day. Last month we depleted our stash of this particular medication and we discovered this is not a drug available to us at the CAJA.

So, off we went to the local independent pharmacy to buy the medication and discovered 40 milligram capsules are not sold in Costa Rica. The same pharmaceutical company that sells this drug in the U.S., sells to Costa Rica, but only in a 20 milligram dosage. I asked the pharmacist if they could order it in a 40 mg. capsule and she said no, only 20 mg. because that is the normal recommended dosage.

Hummm.... Well, this got us to thinking, why not try just 20 mg. a day and see what happens? We have now been on this lower dosage for 2 weeks. Guess what? Neither one of us has experienced any acid reflux. So, what does this tell us. I think the pharmaceutical companies are pushing doctors to write prescriptions for high dosages of medicines just to increase their profits. How can the normal dosage in the U.S. be 40 mg. and the normal dosage for Costa Rica be only 20 mg? That just doesn't make sense. I think the U.S. population is being over medicated on purpose, for the benefit of the pharmaceutical companies, without regard to the long term side effects of taking a "larger than needed" dose of medication. What do you think?
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Day 60: The Rancho Construction and Residency

The rancho construction is coming along nicely. After a long hard week, the construction crew took the day off today. Monday, they will be back to tie the lines into the septic tank. Now that all the support beams and headers have been poured, they are ready to start on the roof and floor. We've already picked out the tile for the floor in the rancho and in the bathroom.

They installed decorative cement block vents along the top edge of the bathroom walls and this week the glass blocks you see here will be installed. The glass block window will measure about 3'x3'. Since the windows faces to the east, it should provide a substantial amount of light in the bathroom.

The crew staked out the shape of the rancho's floor and removed all of the sod. Now we can really get an idea of it's size and this rancho is going to be much bigger than we had originally envisioned. What a great place this will be to socialize with family and friends. I can't wait to host a party!

On another topic, I received some great news this past Thursday. The Republic of Costa Rica has made a final resolution in my residency case and I have been approved for permanent residency based on family linkage: A 1st degree relative of a Costa Rica citizen (my adult children.) For those of you in the United States, this is the equivalent of being granted a Green Card. In the next few days, I will need to pays some fees to Migracíon and join CAJA (Costa Rica's socialized medical program). Then they will give me an appointment to get my Cedula (national identity carnet)

Now that I've been approved, the next step is to apply for John's residency. He will be traveling back to the U.S. in a couple of weeks to gather all the certified documents he needs to submit his application.

It is so nice to no longer be considered a tourist in Costa Rica!
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Early 7/14/08: Yeeeow!

Whilst using the microwave to boil water for coffee, in the casita of Atenas, I decided to test the structural integrity of a certain polymer-to-glass joint which was keeping the coffee pot handle attached to the coffee pot. Several things were learned during this investigation.

Lessons:

• Coffee carafes that are filled to the brim with water are heavy.
• Coffee carafes that are filled with boiling water are hot.
• Heat softens polymers and the glues that bind them to glass – especially low-bidder polymers & glues, made in China.
• Softened polymer and glue joints will not sustain the load imposed on them by coffee carafes filled to the brim with boiling water.
• When held at an elevation of 16-inches above a stone countertop, glass coffee carafes are not strong enough to withstand a drop to said countertop when, due to heat-weakened polymer and glue, the handle departs from the Made-In-China carafe’s side.
• Boiling water refuses to hold the shape of a coffee carafe when the carafe is suddenly, explosively, removed from around the water upon striking a stone countertop.
• Even a possibly former CIA agent with the reflexes of a pissed off Jedi cobra cannot remove his 300lbs of lard from the suddenly expanding frontal area of boiling water, once said water is free to assume whatever shape and form gravity deems fit to impose upon it.
• Two quarts of boiling water, engaged in near-supersonic flight through the air, are able to saturate the front of “Outer Limits” jammie pants at an alarmingly rapid rate.
• Even former possibly world-famous CIA assassins don’t still have the strength to rip open BOTH jammie legs at once – only one; therefore, leaving one saturated jammie leg still attached around the world-famous possible killer’s left leg.
• Even former possibly international men of mystery and superheros cannot do the hippity hop dance into the shower fast enough to turn on the cold water quickly enough to chill-flood the affected left leg and avoid all injury.
• That much boiling water is able to convey a great deal of thermal energy into the leg of even the most possibly formerly hardened, evil, black hearted pirate, thus doing serious localized damage.
• Pat, with her fluency in español and her calm demeanor, is a great one to have around in an emergency to help you navigate the system at the Caja Costarricense de Seguro Social and obtain excellent emergency medical care.

All in all, the second degree burns only covered the top of the left quad area about the size of my hand with spread fingers, plus a dinky area about the size of a credit card, below the knee. Uhhhhhglee! The right leg only had a big ol’ sunburn (1st degree) of about the same size.

I tell you what. This here burn stuff … it’s really fun. You get all kinds of cool goop to smear all over everywhere, and shots, and pills, and really really good drugs, man. Doesn’t hurt a bit when the drugs are good enough!

Maybe from now on, I’ll be avoiding the ol’ Hecho en China label whenever possible. Ya think?

Followup: Due to the excellent care of the CAJA clinic in Atenas and intense followup with creams, etc., by the end of July, the burns are down to looking like sunburn with no sign of scarring or stiffness. Oddly, the 1st degree burn area peeled and looked horrid, compared to the 2nd degree area, which doesn't look like it will ever go through a peeling stage. Maybe this is because all the surface skin that could have peeled away was burned away the first day? (The blisters washed away in the shower from about day 3 to day 6.)
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