Learning Uruguay

Every day brings ????

How good is Uruguay’s medical system.

Posted by urufish on June 9, 2007

 

The inspiration for this post comes from David’s recent post about his experience with the medical system here.  You can find it at   http://www.uruguayliving.com/, titled ‘The Lazarus prospect–a medical adventure begins.’  He described it as ‘superb’.  I agree.  Not only that, but it’s the reason we live here now.    

In the past on this blog, and in other posts on other sites, whenever the issue of our reasons for choosing Uruguay came up, we answered with a number of good reasons, but we never talked about the main reason–the decisive factor.  Until I read David’s post, I felt it wasn’t something to talk about.  But his post has given me the courage to speak the truth.  It’s not something to be embarassed about.  Perhaps someone else is in a similar situation and will be better off knowing they’re not alone.  Pain shared, is pain lessened.    We’re here now because our daughter was losing her life in Canada’s health system.  In Uruguay, she is getting it back.     

In the spring of 2005, her behaviour went from strange to scary.  Those of you who know me, know I’m a little eccentric.  I thought she was just following her dad, until her behaviour crossed the line.  Self-destruction is not eccentric behaviour.  We decided to seek professional help for her. 

Patient:  Doctor, doctor, I’ve only got 59 seconds to live.
Canadian Doctor:  Wait a minute please.

Friends recommended us to a well respected psychiatrist.  We interviewed him to make sure he wasn’t crazy, (most we know are) and he agreed to treat her.  We wish he had actually treated her.  Her last session with him, in December of 2005, ended with him telling me that he didn’t want to treat her any more, but if I insisted, he would.  The next day we flew to Montevideo for our yearly, Christmas vacation. 

For the next 2 weeks, my daughters behaviour got worse and worse and a few days before we were to fly back to Toronto, it became unbearable.  A friend of ours referred us to a local, well respected psychiatrist for a 2nd opinion.  Actually, this wasn’t really a 2nd opinion, because her Toronto psychiatrist, in 6+ months of treatment didn’t have an opinion yet.  If we got real lucky, maybe we’d actually get an opinion. 

We didn’t have to wait long.  After 2 days of intensive testing with a team of 3 mental health professionals, we had a dignosis, and a treatment proposal.  This was the toughest decision of our lives together but we decided that our daughter’s best chance of success lay here, in what all my friends back home call the 3rd world. 

Everyone back home thought we were crazy.  That we had gone Jonestown or something like that.  But we felt we were making the right decision and stand by it still. 

The treatment would take 18 months, possibly longer.   Both of us would have to commit to her 24/7.  That meant early, and mostly unplanned retirement for me.  For my wife, it would mean a permanent return to a country that she wanted to summer in–not live in–in her later years.  

That was 18 months ago.  Our Canadian friends still think we were and are crazy.    Our immigrant Canadian friends were and are supportive.  They know that just because it’s not the US or Canada, that doesn’t mean that Uruguay cant have excellent medical care.  My friend from India says if you have the money, (which, fortunately for Uruguay, isn’t that costly), medical treatment is often better outside of North America. 

Neurotics build castles in the sky.
Psychotics live in them.
Psychiatrists collect the rent.

In our daughters’s case, she didnt need 5-star clinics, fancy equipment or $300/hour specialists.  She needed people who have the time and the desire to treat her as a person… not a patient.     

How has the treatment been so far?  As David put it, superb and affordable. 

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18 Responses to “How good is Uruguay’s medical system.”

  1. Brazzie said

    You are both excellent parents and wonderfully courageous human beings!

  2. Shirley said

    I am humbled and inspired by your devotion to your family, your courage to act on your own informed judgment, and your openness in sharing with all of us. Although I didn’t realize it at the time, I actually met your daughter before meeting you. She is a lucky gal! May your efforts be rewarded tenfold, and may you, your wife, and your daughter live long, healthy, happy, and fulfilling lives.

  3. happygolucky said

    A very touching blog entry. We wholeheartedly support your statements about the quality of healthcare here. We are continually impressed by how “gentle” the doctors are and how quickly exams/procedures get scheduled. Another huge plus for Uruguay!

  4. urufish said

    Thanks everyone for the kind thoughts. She’s doing so much better now. We’re very optimistic for her.
    And Shirley, what are the odds of you talking to my daughter by pure chance months ago in the middle of Pocitos? What a small world this is here in Uruguay.

  5. Lisa said

    This is so touching … and I do think it is important to share this sort of experience. I chuckled when I first saw your intro on Brazzie’s blog/forum… where you described yourselves as “a married couple (with hija), of good characters”… however, I’ve seen you prove this statement over and over through your blog and comments. Your daughter is so lucky to have you. I wish the best for her health… but most of all I hope that you and your family find that these difficult choices have lead you “home”.

    Best regards – Lisa

    P.S. Again, the fact that you have a blog category of Love is just about as sweet as it gets!

  6. Enzo said

    Thanks for sharing this personal information. It is great to know that the medical professionals in Uruguay still care about the patient and not just the compensation. Best wishes for health and happiness.

  7. la vieja said

    Hola fish,
    We are hugely impressed with your post. We hope you will be rewarded many times over for your strength of character and devotion to your daughter.
    I have worked for almost 45 years as a healthcare professional in the US. I am ashamed of the deterioration of the practice of medicine and its transformation into a money pit for corporate interests. This is so far from the oaths we take as to render the professions unrecognizable. It is good to know that the humanity of medical practice is still alive and well in Uruguay. Your decisions regarding healthcare for your family are commendable, well thought out, and the greatest gift of love parents can give. Blessings to you always!!

    We will be coming “home” July 1 and are very much looking forward to meeting you.

  8. urufish said

    I believe there are many people in healthcare up north that really do care about their patients. But the system doesn’t let them practice that way.

    The doctors that I knew, (several), were competent and skilled but frequently pre-occupied with material wealth and in my own little world, lowering their golf score.

    Up north, if you give patients more time, you make less money. I never met a doctor who had a yearly number that was ‘enough’. It was always as much as possible, which meant long hours, several rooms and a carousel mentalility. The idea of asking your patient how their mom or dad or child was doing could lead to a long conversation which would reduce income.

  9. ann said

    Hi, so nice to read your blog! We have been thinking of coming to Uruguay for a school year w/our 12y.o. daughter. Do you know anything knowledge of the high schools. Do they have all girl private high schools?
    Annie

  10. Steve said

    I just want to commend you on your dedication to your family. I hope that your daughter will find a husband that has the same values as you do and that they will pass that on to the next generation.
    Steve in Texas

  11. urufish said

    Hi Ann…. Here in Pocitos, and environs, there are private schools everywhere. I personally dont know of an all girls (or all boys) school here. I asked one of our friends and she says, she thinks most of them have gone co-ed because equality of the sexes is a very big thing here.. even at young ages. Tomorrow she will call a friend who works in a big private school here and ask her which ones are still around.

    The best school here for english speaking foreigners is the American school. I believe the curriculum is in English with intensive spanish as a 2nd language. All the the private schools I checked out (for my daughter) taught core subjects in Spanish, with a strong emphasis on English as a 2nd language.

    The American school has very high standards. IMHO, I wouldnt place a midrange student there… peer pressure may not be kind… but a good student should excel in that environment. Considering most diplomats send their children there, it’s a great place to make international friends for life.

    My recollection is that it’s expensive, by Uruguayan private school standards. I believe the interview process was several thousand unrefundable dollars. Tuition varied by year taken. The website is
    http://www.uas.edu.uy/. The most inclusive list of private schools I know in Uruguay is at
    http://www.todo.com.uy/guia2.php3?nidrubro=128004&nidpadre=128000.
    Colegio means private primary school. Liceo or secondaria, means high school. which includes prep (college prep).
    In my opinion, the largest concentration of private schools is in Pocitos. Carrasco has some too, but I think there’s a better selection here (Pocitos).
    One final comment. Children are more like children of our youth, then children of the current generation (in the north). More innocent (for the most part). Definitely, more respectful, in particular, to their padres (parents).

  12. gaberoo said

    I echo the sentiments of Brazzie and Shirley wholeheartedly. Your daughter is lucky indeed to have such dedicated, generous, and loving parents. I do hope Uruguayan medicine continues to meet your expectations and that the country and its people have given you additional reasons for staying there.

  13. urufish said

    Thanks gaberoo.. If we succeed at this, I’d have to give faith all the credit. The doctor told us it would be 18 to 24 months for her treatment to finish. At the end of that period, they would have done all they can. Her condition at that point would be the best possible we could expect. As bad as that sounds, Toronto’s doctors didn’t even have that much for us to go on.
    Up until about a month ago, progress was slow and often the 2 step forward, one step backward deal. In frustration, they put her on a different medication, not used in cases like hers.. and it was like a miracle. In a period of 2-3 days, she completely changed.
    Once you make a decision to put your faith in something, I believe you have to stick it out, to the end.
    We’re hopeful this is the ‘magic’ bullet.

  14. gaberoo said

    We’re all hoping with you. I hope it makes a difference.
    I hope your daughter is liking Uruguay (in case your stay becomes permanent or semi-permanent). It’s great that you have so many friends in Uruguay (and on these websites) that can help you and your family with this difficult situation (in a sense maybe like an emotional cushion which breaks the tough falls should they occur).

  15. urufish said

    We’re treating this as permanent unless something extraordinary happens. Having many friends here sure does help.

  16. sara said

    Dear urufish:

    When I met you I had not read your blog. I admire the honesty and strength with which you are facing his heartbreaking problem. I hope your daughter’s treatment is going well. I would love hearing about it, if you feel like writing.

    We also went through a difficult time with our only child, a daughter too, when she was in her teens. Nothing like your case, but i do know what it is to lie awake at night tossing in bed wondering whether I was doing too little, too much, too late, too soon, or whatever.

    I do hope your daughter gets better. As I said before, she’s very lucky to have your.

    Best regards from your forum pal,

    Sara

  17. Anonymous said

    I received a link to this blog post from our mutual friend Shirley.

    I am from the US and have been living in Uruguay for two and a half years.
    I have a 16 year old daughter (living with her mother) who is not doing well in her current situation. She has got into drugs and may have other issues that contribute to this use.

    I would like to bring her to Uruguay with me. Does your family speak Spanish, or did you find counselors and psychiatrists that speak English? Do you happen to know if there are 12 step programs? Any advice, tips, or suggestions are much appreciated.

  18. urufish said

    My daughter’s Spanish was marginal when we started treating her here. Although she was raised exclusively in Spanish from 0-5, (even I talked to her in Gringlish), once she hit grade school in Canada, it atrophied. Her vocabulary was grade school level or less in 2005. My wife is fluent. I’m challenged still.

    Her psychiatrist’s English is job specific. We can talk shop at a pretty good speed but if we go conversational, I speak words, not phrases. Speakng to me she’s pretty good. But unlike up north, the psychiatrist doesn’t play the ego role down here, at least not ours. She neither thinks she’s G-d nor G-dlike. A refreshing change from my experiences up north. The key professional in my experience here is the psychologist. This is the person the patient spends most of their time with. It’s the relationship between psychologist and patient here that is the most important. The psychiatrist’s role is to assess information provided by their psychologist, confirm it in sessions once or twice a month with the patient and prescribe medication as needed and as changes take place.

    The psychologist doesn’t judge. The psychiatrist may. In my daughter’s case, they’re playing good cop, not so good cop. The psychiatrist has to judge, ergo, she may not be so good all the time. Our psychologist is fluent in English. I asked her to sit in when my daughter sees the psychiatrist which is twice a week, not just to assist my daughter to express herself when her vocabulary is lacking but to help me because we get the last 15 minutes or so of the consulta.

    In my daughter’s case, we work as a team. The psychiatrist medicates and makes the tough decisions but is not cold to her. More like stern. The psychologist forms a strong, personal relationship built on trust and honesty (frowned upon in the north). My wife and myself are part of the team, talking with the psychologist and psychiatrist at the end of the sessions most of the time.

    I think this system has significant advantages over our northern system in these cases. Health professionals here dont consider ‘professional distance’ as the holy grail of the patient/doctor relationship. Uruguay is still a ‘human to human’ country. Even in the big city, there is still a very, very strong connection between people. Could be that’s why some of us call it home from 50 years ago. We remember when neighbours knew each other and strangers were just people we didn’t know very well yet.
    Another difference is there’s little or no ‘churn’ in Uruguay. I see this everywhere here–not just in health care. But in health care, security (trust that the person treating you will be there tomorrow) is the 2nd most important factor in treatment, (the first being professional competence). In our daughter’s case, this is a long haul project. We didnt want to worry about the consequences of her psychologist getting a ‘better offer’ somewhere else and starting all over again.

    It would be best to take this off line if you want more information. There’s a lot more to share. You can either PM me from the Southron website or reply with a request for me to email you at your paradise address..

    I feel very strongly about the work they’ve done here for my daughter. It’s been 3 years and both myself and my wife believe we still made the right decision. Time tells.

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