Misadventures in Lima (aka Our Guide to Medical Care in Peru)

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Once again, it’s been a while since the last installment of our South American adventures. Post-border crossing and robbery, we settled into our new beachside apartment. It doesn’t take long to get to know the town of Huanchaco. There was a movie-themed Carnaval parade that didn't take place on Mardi Gras but on the following weekend. But we’ve basically been enjoying quiet days (and nights) and enviable sunsets.

So when Chris was asked by Cuenca friends Karen and Donovan to help them out at a travel conference in Lima, she was happy to take the diversion and go to the big city. She jumped on the 8-hour “Super VIP” overnight bus, and woke up in Lima on Leap Day. This was not her first trip to the town, but the last time she was there was 1999. Not surprisingly, the place had changed…a lot…and for the better. And you know that feeling when you don’t realize you’re missing something until it’s there in front of you... well, Chris definitely found, somewhat surprisingly and maybe pretentiously, that she had missed the “city”. Where people walk at a respectable pace, where restaurants might actually require reservations, and where you don’t just decide which bar you want to go out to but which bar district. Lima may not be one of the world’s great cities, but is undeniably a “city” – one in which she wouldn’t mind spending more time and even bringing Justin next time.

But as most people reading this already know and the blog title implies, the trip wasn’t all fun and games. On day 2, Chris fell. If only this could be a epic heroic story involving saving lost children and malnourished puppies, but of course it isn’t. No, here is the sad true tale in its entirety – when she woke up in the morning and walked to the bathroom, she slipped on four steps and broke her arm. Yup. That’s it. For the record, she wasn’t drunk or hungover (not sure whether this would make the story better or worse); she was just wearing socks on a wood floor.

With a tendency for stubbornness and denial, Chris didn’t exactly admit that something was wrong. She emailed Justin and remarked on the large bruise forming over her elbow and got herself a nice bag of ice, but it took two days, a lot of swelling, and a night of drinking to face the prospect of the Peru hospital. After a particularly low moment when she had to ask a friend to help cut her dinner, the inability to move her arm commanded some attention and Chris wandered into a recommended clinic emergency room near where she was staying.

There is very little more boring than reading about a medical diagnosis. But if you’re biologically related to Chris or Justin (which odds are if you’re reading this blog, you are), then this paragraph is for you. In Lima, the diagnosis was simple – there’s a hairline fracture of the ulna bone near the elbow; here’s a fancy sling and some pain drugs; find a doctor in Trujillo if swelling doesn’t go down within two weeks. We didn't wait two. After a week, including the lovely (i.e. horrible) solo trip back to Huanchaco, the arm was a lot more swollen and purple, so we went to Trujillo’s Clinica Peruano Americana, recommended by locals, guidebooks, and websites and where supposedly some doctors speak some English. No one spoke any English. We were still wrapping our heads around the trauma doctor saying he wasn’t sure there was actually a fracture, which seemed like good news, when he first said, “tiene que estar hospitalizado.” Our first reaction was, “¿Como?” Then as understanding dawned, Chris burst into tears, while Justin looked on because his Spanish translation takes longer. But eventually everyone calmed down and got up to speed. Chris was hooked up to intravenous antibiotics to treat a massive cellulitis infection. After 4 nights in the hospital, reading Murakami’s entire 900+ page 1Q84 (highly recommend) and catching up on the latest telenovelas, Chris was sent home. As if this experience wasn’t already freakish enough, last week she needed to return for surgery to remove “calcified hematoma” that had formed.

This entire adventure has taken place in Spanish. The trauma doctor has tried English a few times, which we appreciated but couldn’t actually understand. But, of course, its not his job to know our language, its his job to know medicine. We’re the visitors, and all things considered, especially a ton of new vocabulary (swelling, sling, stitches, etc), we’ve done pretty well. Our greatest lost in translation moments were not due to misunderstanding language but misunderstanding the system. Trujillo is not the end of the earth. It’s a decent sized place with quality care, but this isn’t Lima or Cusco. The number of tourists passing through is far smaller. We were too clueless to know what questions to ask, and no one around us seemed to realize we needed explanations…in Spanish, in charades, or whatever. So we had to make a few missteps before someone would steer us right. It can be incredibly frustrating and we've had some moments of breakdown, but far better to own your cluelessness and remember that someday you'll find this whole thing funny so why not laugh now.

Hopefully, you’ll never need this info, but here is our guide to medical care in Peru. Our experiences were at private medical clinics, and an experience at the more economical public hospitals would likely be different.


• Everything is pay as you go. If you need an x-ray, you pay for it (about $25). If you need to consult a doctor, you pay for it ($75 for initial visit, $20 for followup). If you want to watch TV in your hospital room, you rent the remote ($2). Everything is paid up front and in full (but unlike the States, people can actually answer you when you ask how much is that going to cost)



• That is except of course when they don’t know how much because they don’t exactly know yet what they are doing. In these cases you pay a deposit. When Chris was admitted to the clinic, the first step was the line at the register to pay a $185 deposit in order to be assigned a room. Likewise surgery admission began with the same. At the end of each, we had to settle up whatever the deposit didn’t cover before they took out the IV (final totals were about $75 per night of hospital stay that included 3 “meals” and about $325 for surgery including fees for both surgeon and anesthesiologist)



• These fees do not include medications and supplies, which you have to purchase in advance. Each day the doctor gave Justin a list that he then took to the pharmacy to buy. The pharmacist gathered everything and gave him a grocery bag filled with everything from the antibiotics to the saline solution to the syringes to the actual IV tubing. The surgery supply list even included the disposable gloves for the doctors. (cost was about $30-50 per hospital day for pharmacy supplies)



• Generally speaking, the patient cannot pay for these things. It’s expected that a relative handle all of this. At one point when Justin had gone out to get food for himself (lucky for him, his meals weren’t included at the hospital), Chris needed a blood test. She had money to pay for it, but they wouldn’t let her do it and waited for Justin to return. (That said, in Lima, Chris was able to handle things on her own but she wasn’t actually admitted. And of course, if you ‘re just buying medicine at the pharmacy, you can buy that yourself)



• For Peruvian patients this is rarely an issue since they all bring an entourage of family with them. Certainly in some cases, this is entirely understandable, but this doesn’t just apply to the most severe cases. In a place where extended families are often living in one house and almost always in the same town, when someone goes to the hospital the whole gang goes. Poor Justin had to do the work of 10 relatives all by himself



• There is insurance at the medical clinics, but odds are that if you are staying temporarily, you don’t have this, so we won’t get into how it works. What you do need to know is that every time you pay for something, they will ask if you are paying “seguro” (with insurance) or “particular” (privately). Your answer is particular. If you have travel or other secondary insurance that covers medical care, save all of the plentiful paperwork and receipts to submit for reimbursement afterwards – no one is billing the insurance as is done in the US.



• If you are an American blonde who doesn’t eat some of the food in your hospital meal, the nurses may conclude that you are a Mormon missionary with dietary restrictions they don’t understand. An actual missionary would probably have also declined the pork dinner not because Mormons have issues with pork (as several other much larger world religions do) but because they have taste buds. (And for the record, Mormons do not drink caffeinated coffee which Chris drank plenty of while there)



• Follow-up doctor “appointments” aren’t so much appointments as office hours like a university professor. They’re more of an agreement that the doctor will be there around that time (except that sometimes he’s not). You get there and wait in line for your turn. Whatever your worst overscheduled waiting room experience is, you should expect to wait longer here. Also unlike US appointments, most of these office hours are in the late afternoon or evening



• The waits are worsened because, while there are nurses helping in the hospital, there are few medical assistants helping doctors in their offices. Every dressing change and check up is done hands on by the doctor. So if, for example as happened twice to us, the doctor is called into emergency surgery as trauma doctors sometimes are, there’s no alternate doctor or assistant in the office. You just better have a book to read while you wait.



• Waiting rooms can be crazy because that family entourage comes along, even for routine appointments. At least there is people-watching while you wait



• Anesthesia may render whatever Spanish you know useless. This may cause the surgeon to try nonsensical words that he believes to be English and the anesthesiologist to resort to screaming in your ear because he inaccurately believes you are deaf. Don’t worry the Spanish will return along with the feeling in your arm



• Care at the private clinics is clean, kind, and generally quite good. No one will confuse a Peruvian hospital room with a hotel stay (except that unlike in the US the per night price is about the same). Things feel less automated. Beds adjust with cranks rather than electric buttons. Nurses come check your pulse, temperature, and blood pressure rather than machine monitors. Records are certainly not computerized. While the experience visually resembles the hospital scene from The Godfather, when it comes to the stuff that matters, we never felt that things were lacking. We may not have always understood the doctor 100%!b(MISSING)ut he clearly understood what he was doing. And our vast webmd medical knowledge confirms that treatment in the US would have been very similar, including the hospital stay. There might have been less waiting around for stuff, but we would now be spending the next 6 to 12 months arguing with an insurance company about who should pay the $30,000 bill



So that’s it – a whole lot of info about doctors appointments – but that’s primarily what we’ve been doing for the last month. Chris’ stitches come out on Monday. There will be a scar – so she can spend the rest of her days telling people about the stairs that came out of nowhere.
Monday is also Justin’s birthday. We’re both looking forward to a better April.

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