17-24 June 2013 Medical challenges.

During the last week, Doug and I have had the opportunity to experience much of what Clinica Belen has to offer….plus some.

Monday we drove to Piura to visit Doug’s doctor for a routine monthly visit.  Here in Peru, the doctors prescribe medications for the month.  When you need more, you have to go back for another visit.  Doug needed to have some lab work done before his appointment, but we realized we had forgotten the order for the lab.  We called the doctor directly (yes, he gave his phone number) and told him we needed him to write another order for the lab work.  He was in the hospital until 8 pm and he agreed to meet us in the clinic at that time to give us the paperwork.  We ended up spending the night and Doug had the lab test early in the morning.  When he asked when he could have the results, the lab tech said 5 pm.  Doug explained that he had an appointment at 12:30 and would need them by that time.  The tech agreed and the results were indeed ready for us when we arrived at 12:30.

After Doug’s appointment, we checked in for an appointment with an internal medicine doctor who has been treating me for a chronic stiff neck.  Since I had little relief after a few sessions of physical therapy and muscle relaxers, he wanted a second opinion.  He thought I might need an MRI and referred me to a neurosurgeon.  Yikes, that was scary.

As we were traveling to Piura (a two+hour drive) we decided that I should find a cardiologist in Clinica Belen since all our other docs were there.  This way my chart would have the notes from the cardiologist as well as the other notes.  We also decided we should try and coordinate our appointments so we could come once a month.

So, after Doug’s appointment, I checked in at the reception desk and paid for an appointment with a cardiologist.  I was instructed to take the receipt to the doctor’s office and give it to his “secretary.”  She had arrived before the doctor and the door was ajar.  I poked my head in and gave her the paperwork.  Since I was a new patient, she told me the doctor would want me to have an EKG.  She wrote EKG on the paperwork I had just handed her and was sent back to reception to pay for it.  Once I had my receipt I went back to the office and handed the secretary the paperwork.  She asked me to wait outside which I did.  After a while, she called me into the office and she performed the EKG.  The machine had a ticker tape that spit out the beats and whatever else the EKG looks for.  I was then sent back out to the waiting hall and waited for the doctor to arrive.  I waited my turn and saw the cardiologist.  He told me there was no evidence of an arrhythmia.  He wanted an echocardiogram to determine whether the arrhythmia had a physical cause.  He also quadruples the dose of cholesterol meds.

We next walked back to reception to schedule the echocardiogram.  At this point, the gal at reception no longer wanted my insurance card or passport.  I joked with her that she was always there at the clinic and that she must have a bed in the back room.  I also joked about how we were getting to be such good friends.  She told me that the insurance would have to approve the echocardiogram.  She kept the paperwork and told me someone would call me to let me know if the insurance would cover the test.  Finally, we walked to the pharmacy in the clinic which filled our prescriptions.

That worked out to be three doctors in one day….all in the same clinic fortunately.  And fortunately our insurance pays 80% across the board.

The next day we went back to the clinic for Doug’s appointment at 12:30 and I made an appointment with a neurosurgeon for 6 o’clock in the evening.  I also checked at reception to find out about the echocardiogram since I had not received a phone call.  She sent me into another part of the clinic to a woman at a desk under the stairs.  She had the approval and handed me the paperwork.  So back to reception I went for an appointment with the cardiologist.

Once again, I waited my turn and met with both doctor’s.  The cardiologist actually performed the echocardiogram himself in his office.  Afterwards, he told me my heart was fine; no physical problems.  He recommended that I stop taking the arrhythmia medication.  The  neurosurgeon recommended an MRI and wrote an order for it.

So, once again, back to reception we went.  Once again, she told me that the insurance would have to approve the MRI.  However, this time she sent me upstairs to the second floor where we encountered an open room with three desks.  The desks were for three different representatives of three different insurance companies.  I stood in line waiting for our insurance representative.  When it was my turn, I handed her the paperwork and told me she would review my file and paperwork and someone would call me back.

Finally, we drove home Tuesday night.

Wednesday I received a call from the Resocenter who scheduled an MRI for me on Thursday afternoon.  We drove back to Piura for the MRI on Thursday.  The MRI went smoothly.  I was told the test would have to sent to Lima to be read and I could pick up the results on Saturday.  I explained that we would be back on Monday to pick  them up as our doctor probably wouldn’t be in his office until Monday.  (Many of the doctors here do have Saturday office hours, but I wasn’t sure, so opted to wait.)

So, once again, we drove to Piura on Monday.  We picked up the results at the Resocenter and carried them to Clinica Belen.  We checked in at reception, greeted our now familiar receptionist and waited our turn for the doctor.  The neurosurgeon looked at the films and told me I have three herniated discs in my upper back and neck.  These are not correctable with surgery so he recommended heating pads three times a day and medication for three to six months.  He also recommended physical therapy, but when I explained the only physical therapy available to me in Organos is a chiropractic/acupuncturist, he told me that kind of therapy could be dangerous.  So, since I wasn’t willing to travel to Piura daily, or move to Piura for three months, the physical therapy option was dropped.

It has been quite a week of travel and doctors.

Notes on our experiences:

Checking in at reception is like the elbowing that happens on Black Thursday at the  bargain bins at Macy’s at five in the morning.  When I commented on the mad-house in the line at the receptionist’s window, she told me it was because some doctors only have four appointments available in the evenings.  Since it is first come, first serve and the reception window opens at 4 o’clock, the line usually begins to form at 3:30.  Sometimes when I arrive there is one line.  If a second window opens up some people might move over to the second window and form a second line.  Usually, this results in a disruption of the first come, first served rule and arguments break out.  One woman began yelling at the receptionist because she had waited in line and now people who were behind her had moved into the second line, and were now getting served ahead of her.  Another time, when the second window opened up, the woman behind me asked if there would be a second line and I said, “NO,there is only one line!”  This managed to travel down the line and everyone remained in one line.  They have now opened the reception desk  after lunch so the crush isn’t quite as wild.

Another time, I was waiting in a line that curved between the people sitting and milling around waiting for to hand in their paperwork to the secretary who then queued patients for the different doctors in that hallway; again, first come, first served.  I was probably eighth in line when everyone in front of me rushed to the other side of the desk behind a second line which had formed over there.  I moved too and suddenly found myself about twentieth in line!  Everyone was asking questions and elbowing their way into line.  What a mad house!  When I finally reached the counter to turn in paperwork, the secretary put me on the list for my doctor.  Totally crazy.

The clinic is somewhat divided in to sections.  Each floor might have three or four sections.  Most of the sections are hallways with doors to doctor’s offices lining both sides.  Patients wait in the hallways, often with standing room only, waiting for their turn.  Some doctors have their own secretary, others rely on the gal at the desk in the hallway who queues patients.

Different doctors have different office hours.  Some have a few hours in the morning and more in the evening.  Some have a few hours during the middle of the day and more in the evening.  Some are only there in the evening between 6 and 10 pm.

Here in Peru when you have lab work or test done outside of the doctor’s office, you have some hoops to jump through.  First you have to take the doctor’s order to the lab or test site to find out how much it will cost.  Then you order with the cost is taken to the reception desk where you actually pay for it.  Then you take the order and the receipt for payment back to the clinic and they do the test or schedule it.

All the lab work for Doug cost us about 40 soles. (close to $15).  Each office visit was 35 soles (close to $13).  The EKG cost me 6 soles ( about $2.25).  The prescriptions were very inexpensive as well; ranging from $1.50 to $5.00 each after insurance.  The MRI cost me a little over $25.

When you have lab tests done, you collect the results yourself and take them to your appointment.  The doctor does not keep the result, you do.  This was true of the MRI as well.  I have the films and the report at home.

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3 Comments

  1. Well, it sounds much less expensive, but the time and leg-work sounds horrible. uess there are plusses and minuses in everything. We would welcome you back in Grant County but for a lot of things you would still have to go to Bend or Boise or Portland. Love you both. Take care. Joan

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  2. Hi Karen n’ Doug. Holy Dina! Lots of travelling back n’ forth. But good to hear that everything happens in one clinic. You guys should be getting to know Piura pretty good now. Three herniated discs in your upper back and neck! Good god! Sure hope that subsides n’ you feel better soon!
    Miss you guys! xo

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