The Bare Necessities of Health Care

28 Sep

“It’s the last place I want to go if I’m sick, unless I want to get sicker,” was my coworker’s concise intent at putting a damper on my enthusiasm. But after several years of my adult life with no health or dental insurance, pretty much nothing could talk me out of my optimism over my new employment-based health (AND DENTAL!) insurance.

I had also very recently become pregnant, so I figured even less-than-ideal health insurance was better than forking over half my paycheck for prenatal care. So while all the non-Pollyanna types around me warned me about the disorganization and the inconvenience, while they griped about the long waits and people cutting in front of you in line, I just listened and nodded, readying myself to collect my own story about it.

Bracing myself to fight for a morning appointment... okay, really it's a gratuitous picture of Lucia and me making funny faces.

Bracing myself to fight for a morning appointment… okay, really it’s a gratuitous picture of Lucia and me making funny faces.

On my first visit, to activate my insurance, I got there right when the office opened at 8AM, ready to fend people off to take my turn. But the other new teacher and I were the only ones in line for the getting-registered service, and it was really easy.  Then we went to wait for the introductory preventative health services, which we were also the first ones in line for. I was feeling extra-optimistic at the mere idea of a check-up. A trip to the doctor when I’m not feeling near-death! Instant triumph, in my book.

All was going well until the nurses were attempting to give me my annual gynecological exam. It was taking way too long and it was starting to make me a bit nervous. There were two nurses- surely between the two of them they could work a speculum? They started whispering between themselves- never a good sign. “Is everything ok?” I asked, barely covered, legs spread, at their mercy. “Yeah, everything’s fine,” they futilely tried to reassure me between covert eyebrow-raising and more whispering. “Have you had an operation?” they asked me. “Um, no.” I told them, much less reassured. I was about to insist that they give me the damn speculum, when finally they got it right.

Things pretty much went downhill from there. I saw blood on the slide and freaked out. I told them I was pregnant and they scolded me for not telling them sooner, telling me I shouldn’t have a pap smear while pregnant (which my gynecologist in the U.S. didn’t tell me when she gave me a pap smear while I was pregnant.) And so began my doubts about the usefulness of my health insurance, although I remained optimistic. But maybe then I was a little less like Pollyanna and a little more like Wendy in Peter Pan- really wanting to believe, but just a little too observant to hope blindly.

The nice, semi-competent but possibly misinformed nurses then sent me to my new consultorio- one of three offices in the building that’s your permanent doctor’s office. There’s no switching doctors if you don’t like one, or changing to a provider closer to you, or any of that business. You are assigned your consultorio 1, 2, or 3, and that’s where you go. Period.

I approached the nurse’s desk for consultorio 1 and told her I needed to set up an appointment because I was pregnant. There was nothing available for a month, but she insisted that I be seen before then. Which meant returning the next day before 7AM to get in line for an appointment the same day. Which meant asking off from work another morning, as well. But at least I wouldn’t lose pay over it! Life was still definitely good.

I got up at 5:30 the next morning so I could leave a little after six. Even though buses and colectivos run at that hour, it was still dark and I was scared to walk past all the mean guard dogs in the dark. So I called a cab and waited on the corner, rock in hand just in case. I figured the cost of the taxi was like a co-pay, so I couldn’t complain. I got there at 6:30 and approached the large group of folks standing outside the doors. “Do I take a number or something?” I asked a lady nearby. “What consultorio are you?” she asked. I told her, and she kindly shouted out for me, “Who’s the last person in line for consultorio #1?” Nobody said anything, so I excitedly assumed I was the first one in line. That meant I was sure to get an appointment.

The doors opened at 7 and everyone pushed and rushed their way in at once. I got to my consultorio and suddenly three other people were there claiming that they were first. “But I was the first one here! A lady asked for me!” I tried to insist. “No, no,” one older lady told me, “I was already here when you got here.” And so it went, and I ended up third in line, which I figured was good enough since it still meant I’d be seen that day. I loathed the idea of having to do it all again the next day, so I decided to be content with third place. We put our little identity/insurance card-booklet things (cartillas) in reverse order on the desk and waited for the nurse to show up. About 7:30 she arrived and gave the first five of us appointments, at 15 minute intervals starting at 8:00.

I’d brought a book, so waiting from 6:30 to 8:30 wasn’t too bad a deal. Finally I saw the doctor, who didn’t introduce herself or ask me my name, either. She looked at my cartilla and made some notes on the computer. She didn’t get up from her desk the whole time, except to briefly feel my abdomen to check uterine size. She told me to make an appointment to leave a urine sample, gave me a prescription for folic acid, and told me to come back in a week.

The only easy thing in those three tasks was getting my folic acid. There’s a pharmacy on site, and whatever they prescribe you is free. So at least there was that. Of course there were no appointments a week later, so I was told to come back for the same jockeying-with-the-other-sick-people wait as that morning. And to make an appointment for a urine sample? Lab appointments can only be made at 2 in the afternoon. You go and take a number and wait to get your appointment assigned, and then you go back yet another day for the lab appointment. On the day of your lab appointment you take yet another number to see when you’ll be able to turn in your sample. And it’s not the same day as your doctor’s appointment. And they don’t even supply you with the cup to pee in! I was starting to see why this insurance might not be all that I’d imagined it to be.

After those first few awkward, getting-the-hang-of-the-system appointments it started to get better. At least I know what I’m heading into. And as long as I don’t get sick with less than a month’s notice, I can just go to my scheduled appointment with no pushing my way through the crowd. Although after that first visit, I got better at dealing with the take-a-number-without-a-number game. So it’s something. ]

And I can handle all the inconvenience. It’s still free health insurance, and it’s still better than nothing. What does bug me, however, is the doctor’s bedside manner, and the fact that I have no other options, unless I want to pay big money for a private doctor. Conan accompanied me to my most recent appointment, and when I asked him what he thought of the doctor, he shrugged and said “She spent more time looking at the computer than at you.” Which pretty much sums it up, except it’s even worse than that because I think she hates that I ask so many questions.

For example, when she gave me the form to schedule my second ultrasound, I tried to discuss it with her. I wanted to know what it was for, for one. “So, you don’t do the 12 week ultrasound that checks for some abnormalities, then?” I asked, since she was giving me an ultrasound date where I’d be 18 weeks along. “Here at this insurance,” she explained, “you get three ultrasounds throughout your pregnancy. Every three months,” she tried to spell out for me. “So, if I only get three, can we wait on this next one until I’m 20 weeks? So they can do the whole anatomy check?” I asked. “No, no, this will be fine.” She said, trying to close the conversation. “But will they be able to check all of the anatomy and all of that?” I tried to explain what I meant, the reason they do this second-trimester ultrasound in the U.S.* “No, this will be fine.” She told me again, definitively ending the conversation. This is a good example of a typical conversation between us. I try not to antagonize her because she is my only choice. But I refuse to stop asking questions, too.

This is how Lucia and I feel about apathetic care providers.

This is how Lucia and I feel about apathetic care providers.

I am making the best of it. I have health insurance, which is way better than nothing. I appreciate the fact that I don’t lose time at work for going to the doctor. That I’m going to get some paid maternity leave (something y’all in the U.S. mostly don’t have at all!)

The Pollyanna that’s still left in me is also extremely grateful that I had a fantastic doctor for my first pregnancy. She always asked how I was doing, explained everything in detail, asked if I had any more questions even after I’d gone over all the doubts scribbled in my notebook. She gave me options, she gave me tips and tried to prep me with all the general info that I’d need between that and my next appointment. There was a phone number to call for emergency questions and doubts in the middle of the night. And, thanks to the way that insurance works in the U.S., if I decided my doctor wasn’t right for me, I could change at any time.

It seems so distant from this service I’m receiving. What I’m getting is bureaucracy. Health care that doesn’t give a damn. But I remind myself that there are lots of crappy doctors in the U.S., too, that hate questions and patients who read books. There are lots of long waits and inconveniences and probably even nurses who can’t find a cervix. It could be worse.

I think I was never meant to last long as Pollyanna. In this scenario, I’ve even given up on Wendy and wanting to believe in a free lunch. At this point, my goal is just to be a good enough person that I don’t cut in line in front of anybody else, that I don’t have to try to screw anybody else just to get mine. I just want to take care of and appreciate my individual body (and its growing individual parasite in my uterus) in the face of all the paperwork and bureaucracy. I want to push for the best and most individualized care that a bored, passionless paper-pusher of a doctor could possibly give. I want to advocate for myself without purposely antagonizing or insulting, and I will commit myself to shelling out the cash to go elsewhere when it’s called for. So maybe I’m a determined optimist after all. Maybe I’m like Baloo in the Jungle Book movie, and I can be happy with my bare necessities in health care; as long as they’re the ones I decide I need.

*I think that they don’t have the equipment to do the same kind of anatomy scan like they do in the U.S. around 20 weeks. 18 weeks is far enough along to have that check, but they did a much simpler, quicker version, and I think it’s because of their equipment. Although the ultrasound tech was really grumpy so I didn’t bother to ask him. He almost wouldn’t even do the ultrasound because I had lost the paper my doctor had given me to turn in to him. I had to go get the nurse at consultorio 1 to finagle me another copy at the last minute. Such adventures!

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