Things We Take For Granted...

Emergency Services (or lack there of)

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This article was not written to denigrate Costa Rica or to cast this wonderful country in a disparaging light.  I write it to inform potential expats that life in a foreign land can and will be very challenging.  We take so much for granted living in North America and something as simple as calling for help and receiving it may not be available.  Tread carefully and do it with your eyes wide open.


On New Years Eve, I received a frantic call from a friend.  A friend of hers was in the throes of experiencing a potential stroke. 

If she was in the US I would have told her to CALL 911 IMMEDIATELY... but wait, she is in Costa Rica!


I hate to say it but all bets are off when you live outside the protected borders of the good old US of A.  Speaking as an ex-paramedic, I was able to offer my friend advice as to what should be done until the ambulance arrives, but calling 911 was the first thing that needed to be done.

North Americans take for granted many of the basic necessities we rely on each and every day.  For example, we know that if we dial 911...

  • The phone will be answered by a trained professional who (more than likely) speaks your language

  • Once you give the operator your address and describe the nature of your problem, the proper emergency response will then be dispatched

  • Generally within 4-5 minutes, the proper police, fire or EMS services will arrive at the scene and highly trained professionals will then render the appropriate aide.

  • The emergency equipment that arrives will be properly maintained and stocked with all the tools necessary to initiate a satisfactory conclusion

  • In the event of a medical emergency, one will be transported to the nearest, fully accredited medical facility that can address the related health issue

Such is NOT the case in Costa Rica and I speculate that this may be true for many other, non first-world nations.

As a potential newcomer to a Costa Rica, you need to understand that if you call 911...

  • Your call (if answered at all) will be answered by a Spanish speaking individual. 

  • Assuming that the call is answered, that individual will NOT be trained to the extent of which you are accustomed back in North America.

  • You will NOT be able to give the 911 operator you address because you wont have an address.  You will need to give directions as to where you are physically located.  For example, you may have to instruct the operator that you live "300 meters west of the church and 200 meters east of white fence."  Be advised, the fence may no longer be white or even there.  Plus you will have to do this all in Spanish!

  • Depending on where you live in Costa Rica, response times for emergency services can vary from 10-15 minutes (in highly populated cities like San Josť) to an hour or more if you reside in less populated areas.  And it is even highly conceivable that there may be no response at all.

  • In many cases, private doctors will make house calls but don't plan on them providing much help in the event of a life threatening situation.

  • Sometimes an ambulance may show up with only a driver.  The trip to the hospital then turns into a "load and go" scenario with nobody providing medical assistance while en route to the hospital.

  • Once you get to the hospital, unless you are going to (one of the four) North American style hospitals, you will find yourself stepping back in time to medical facilities resembling those of the late 50's and early 60's in the U.S.


Why Am I Telling You This...

On New Year Eve, a friend of mine collapsed.  His wife immediately called her friend who then called me.  After asking a couple of key questions, I was able to determine that my friend was incoherent, verbally non-communicative, sweating and lethargic.  His pupils were reactive to light but were unequal in size.  He was not able to follow simple verbal commands.  Based on this, he needed to be kept still, put on oxygen and transported to the nearest hospital for a CAT scan.

The following chain of events took place.  Is this sort of thing routine or just a rare situation?  I am likely to think it is more routine than not.  However, I'm certain that there are parts of Costa Rica where emergency services are top notch... perhaps the neighborhood where our President lives! :-)

  • My friend called her private doctor but he was out of town for New Years.  He advised my friend to call his back-up doctor.

  • The back-up doctor was summoned.  He immediately called for an ambulance and then proceeded to go my friend's house.

  • The doctor determined that my friend's blood pressure was high and that he may be having a stroke. 

  • The doctor asked if they had any blood pressure medicine in the home.  Unfortunately, the answer was NO.

  • When the private ambulance arrived, oxygen was immediately administered, however within minutes, the tank was empty.  The doctor sent the ambulance driver to the local pharmacy to purchase the needed blood pressure medication.

  • The nearest hospital was 40 minutes away in the town of Liberia but unfortunately the hospital's CAT scanner was out of service.  The only other option required a trip to CIMA Hospital in San Josť, a four hour ambulance ride away.

  • Realizing the criticality of the situation, an air-ambulance, located in San Josť was ordered. 

  • While awaiting the ambulance driver to return with the blood pressure medication, the doctor started an IV line but did not have any IV fluids to administer.

  • After awhile, the ambulance drove to the Liberia Airport to meet the air ambulance.  For some strange (and unknown reason), the doctor sat in the front seat of the ambulance next to the EMT driver.  The wife sat in the back with her husband, the patient.  In all my years as a trained paramedic, I have never seen this done.  Leaving a potential stroke patient, unattended, in the back of a moving ambulance is stupid, irresponsible and potentially criminal.

  • The ambulance (eventually) arrived at the Liberia Airport, where they met the air ambulance, started a real IV and flew to San Josť where a ground ambulance took them to CIMA Hospital.

  • Once at CIMA, my friend was attended to immediately and received top notch medical care.


In Summary...

It was determined that my friend may have suffered a mild stroke, but is expected to make a full recovery.  But one needs to ask the important questions...

  • What if my friend were alone and his wife was not there?

  • What if he didn't have the $7500 fee for the air ambulance?

  • What if the back up doctor was busy?

  • What if the ambulance never made it to the house?

As North Americans, we take for granted the high quality emergency medical care we have back home.  Automatically, we expect the same quality of care anywhere we travel.  For those of you wanting to relocate to a Costa Rica or similar type of country, make your decision with your eyes wide open.  Ask lots of questions, not just of the residents who live there but of local doctors and pharmacists.  Before you make the decision to move to a particular location, know what it will take to summon assistance.  But in the end, if you have medical issues, you need to understand the risks.  If you are not willing to accept those risks... PLEASE STAY HOME!



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