Facing up to health care

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Keeping up with routine health care needs isn’t a problem when cruising. It’s rare to be in a place where quality care cannot be found, or reached quickly should an emergency arise. In Puerto Rico we played catch up with dentist and dermatology checkups.

Pinterest health careWe arrived in Puerto Rico expecting to hop-skip-jump across the south coast, continuing (we hoped) to blast our way east to the BVIs, then make southbound tracks to Grenada. In the landfall of Puerto Real, Marina Pescadería’s owner/manager, Jose Mendez, welcomed us like old friends. He had already arranged service from an outboard mechanic we asked after via email, and walked us through extensive recommendations to make the most of a short stay: beaches, restaurants, shops, services. Goodbyes with the Akira crew (their kids with our girls, above) was the only down side of our stop. Everything was easy with Jose’s help, and any concern we had about muddling through a few tasks with our lapsed Spanish evaporated.

Dental checkups

But even just a few days is enough to work in a dental checkup, and the whole crew was overdue; Jose booked us an appointment with a recommended dentist in nearby Mayaguez. Dental care has been particularly easy to meet while cruising: Mayaguez, Puerto Rico, is the latest on our Dentist Around the World tour (Mexico…Australia…Malaysia…Seychelles…St. Martin…Puerto Rico).

All five Totem crew had teeth cleaned by a hygienist and checked by the dentist; two earned bonus sealant treatment, and xrays confirmed Niall’s wisdom teeth have to go…that comes later. Excellent care, nice facility, US board certified dentist…total bill, $300. A bargain, yet at the higher end of what we’ve paid along the way for routine dental care (the exception was Australia, which had prices similar to the US mainland).

Eastbound along Puerto Rico’s south coast, Totem’s engine overheated: the first sign that plans for a speedy trip to the Virgin Islands would be thwarted. Diverting to the port of Ponce, we called Jose for a recommendation. No problem! Despite the fact it was late afternoon on Friday, a couple of hours later Jose’s preferred diesel mechanic, Cesar, was sitting in Totem’s cockpit at 5:30pm sharing his ideas for troubleshooting.

Dermatology checkups

Anticipating a week to deal with what we presumed to be a failing heat exchanger meant enough time to tick another health care item off the list – Jamie and I were due to see a derm, something we try to do annually. A few days later what we hoped to be a routine pass through a highly recommended clinic in Ponce…wasn’t so routine after all.

Jamie’s had a couple of troublesome spots on his face (treated by derms in Malaysia and South Africa); Drs. Villa and Sanchez didn’t like them a bit. My galaxy of freckles and moles turned up a few more suspect spots. Five biopsies, dozens of stitches, and a skin graft later: we are fine, but Jamie had both basal cell and squamous carcinomas on his face (my dysplastic nevi were just that: misbehaving cells, nipped before becoming problematic).

Dr Santaliz sutures Jamie while Dr Villa looks on

Dr Santaliz sutures Jamie while Dr Villa looks on

Most were done in Dr Villa’s clinic, but he felt the carcinoma on Jamie’s nose was best handled by Mohs surgery. With a phone call to his friend in San Juan, we were fit in for 10:00 the following morning—the doctor’s last day in the office before a family vacation (to go sailing in the BVIs, as it happened!).

All told, we had four office appointments; these appointments ran as long as Jamie’s three-hour adventure in the Mohs clinic, which required three passes (and an olive-sized divot) at tissue on his nose before the cell margins were pronounced clean. And then, there was a “house call” when Dr Villa came see us in Salinas (we moved to this sweet little anchorage, more cruiser-friendly and affordable than Ponce) and removed his stitches en plein air…and bring us mangoes from the tree in his garden. When was the last time you heard of a doctor doing house calls?

Healing well, one week after the skin graft

Healing well, one week after the skin graft

All told, the dermatology adventure took a few weeks and cost a freckle under $4,000. It’s a chunk but we can deal (hey, anybody need a quote for a new sail from Jamie?). If you’d like to know more, this post details how we approach medical costs and insurance (cliff notes: catastrophic coverage to avoid financial devastation from a major event, and all routine care paid out of pocket).

Kids, wear your sunscreen!

The sun exposure we get from cruising clearly doesn’t help our situation here, but everyday exposure now isn’t the primary problem. The reality is that Jamie and I are experiencing this not so much because of cruising, but because of a combination of genetic factors and childhood sun exposure. OUR kids benefit from sunscreen; we spent our childhood summers outside before SPF was an acronym anyone knew. A dermatologist checking me, years ago, said we should give up on plans to take off on a sailboat. Well, no. But we can be careful and thoughtful about protecting ourselves from the sun. I’ve written about sun protection while cruising, and the advice is unchanged.

If you take away one point

If there is a single takeaway from our health care adventures in Puerto Rico, it’s this: that quality care is available away from the comfortable range of home. If I can press a second point, it’s that care is generally quite affordable. It may not always be cheap, but along our travels–and a working annual budget that puts us below the poverty line in the USA–it is manageable, and strengthened a sidelong view on the insanity of insurance rates and medical costs in the US.

Meanwhile, our quick pass through Puerto Rico easily became a month. That’s fine. Sure, it’s added some stress as the hurricane season heats up, and a progressively growing series of “waves” off Africa trying to spin up into Caribbean hurricanes. That, too, has slowed progress as we take the prudent steps to remain near hurricane holes instead of pressing forward regardless. But taking care of health was the priority, and along the way it enabled myriad experiences by spending more time in Puerto Rico…

…like enjoying beautiful vistas from the mountains to the sea while driving to the dermatologist outside San Juan.

mountain vista puerto rico

A rental car to get to doctor’s appointments provided easier day tripping to explore the history in Old San Juan…

castillo san juan

Niall offers scale for the fort's walls

Niall offers scale for the fort’s walls

girls at fort wall

…to visit the breathtaking, and imminently approachable, Ponce museum…

Shoes required

Shoes required

…to find out of the way cafés, and indulge in a survey of pressed sandwiches (the best: at El Balcon del Coliseo in Ponce…WOW); recommendations from the doctors for the best roast pork, and a detour through the central ridge to find the perfect place to enjoy it.

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tripleta sandwich

Meanwhile, here we are about a month later, and you have to look up close to know Jamie’s had a hunk taken out of his nose.

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Come meet up at the Annapolis Boat Show!

Want to learn more about health care or other hot topics for cruising? In October, I’ll be at the US Sailboat Show in Annapolis—talking formally and informally to anyone with interest and time about their cruising questions! One of my six seminars at Cruisers U is specifically about health care, and will dive into much more detail than this post can cover.

  • October 5-8: staffing the booth at L&L Pardey Books, signing copies of Voyaging With Kids and telling anyone who will listen how inspiring Lin’s books are.
  • October 6: Cruising World Workshop: Prepare to Cast Off (register here)
  • October 9-10: Cruising Women seminar (part of Cruisers U): two full days, including a morning spent aboard a boat.
  • October 11-12: Cruisers U: delivering seminars on a half dozen topics –including health care! Also: on-board communication tools (satellite and radio), passagemaking, common new cruiser errors, dollars & sense (cruise budgeting), and more.
  • Fee for show entry; additional fees/registration for seminars. For more information see the Annapolis Boat Show website. Let me know if I’ll see you there!

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16 Responses to Facing up to health care

  1. Jim S/V Amity August 16, 2017 at 1:45 pm #

    Very informative and reassuring. The quality of care you received matches anything find-able in the US… and speedier too; Jamie’s nose being proof for all to see. Stateside medical cost drivers appear to be bureaucracy & politics… a lethal mix.

    Regarding medical records, x-rays, medications, vaccination history & such, is there a secure on-line repository for them or do you just keep everything in a folder? Lastly & a tad off topic, for emergency meds you carry aboard which have expiration dates, how do you arrange for refills? How are prescriptions managed?

    Hope Totem finds some useable slots in the weather to get closer down to the Windwards. West Africa seems to be getting down to serious business.

    Planning to make Annapolis for at least a day.

    Merchandise feedback (cont’d): Hat continues to serve faithfully and keeps Totem on my mind. Cheers!

    • Behan August 17, 2017 at 7:37 am #

      We tend to have physical copies of medical documents but a cloud-based storage location probably makes the most sense – less risk of being lost/damaged. Prescriptions aren’t hard to come by outside the US, there are a few strategies, but we’ve gotten refills and sometimes you need a local Rx. No prob. Glad the hat is serving you. See you in Annapolis, I hope!

  2. Curtis Edwards August 16, 2017 at 3:01 pm #

    I would agree with the outpatient experience Jamie and Behan expressed in the article. In their situation, relatively young couple w/ children who are basically healthy, the subject of chronic health issues or inpatient hospital care are separate from the discussion. Waiting to get to first world medical care that is elective (and less expensive than U.S.) definitely works. It’s the emergency that plagues the cruiser and is the reason I advise all cruisers (including Jamie and Behan when they took my cruising med course) to invest in evacuation and catastrophic medical insurance. It’s wise to have a comprehensive medical kit aboard and a good first aid text. Dr. Edwards

    • Behan August 17, 2017 at 7:38 am #

      Thanks Curtis. I fear we are falling out of the ‘relatively young’ category quicker than I’d like 😉 — and yes, catastrophic insurance + comprehensive med kit as a support to good training…like we had with you!

  3. Richard August 16, 2017 at 5:27 pm #

    In the US, nobody is willing to “face up to medical care.” Of course if you have insurance that pays 100% of your medical expenses (the kind that costs $15+k per year per person) you can receive excellent medical care. If you need a significant surgery and have typical insurance that requires you to pay 20% of the cost plus a big deductible it is cheaper to fly half way around the world to Thailand than to use your American “insurance.” And by all reports you will receive better and more personalized care.

    I now live in the Idaho mountains near Jackson Hole WY. This spring I had a previously repaired root canal start acting up. My local dentist referred me to a specialist in a nearby regional city. When I asked for an estimate of the cost, they quoted $1380. The next morning I was on a plane for Puerto Vallarta Mexico. Cost for a short notice flight plus a week in a nice hotel at a marina: $902. Cost for a root canal replacement at an office at least as professional as the one in the US: $280.

    When I lived in Colombia 40 years ago it was a medical nightmare. The country is just now emerging from 50 years of civil war and Narco violence and is by no means as wealthy as the US or Europe, but its health care system ranks #22 in the world while the USA is 37th in spite of spending nearly twice as much as any other country in the world.

    In the state of Wyoming, Obamacare health “insurance” premiums are increasing by over 50% next year. The number of uninsured will likely be even higher than before the Obama Cluster**** came on the scene. Must make all the uninsured very happy to be taxed for the privilege of not having insurance. See why I call the American system the Medical Extortion System?

    • Behan August 17, 2017 at 7:39 am #

      A perfect example – how its cheaper to fly out of the US to get quality care than to stay stateside for it. :-/ It’s a major reason I wonder if we’ll ever live in the US again

  4. Michael August 16, 2017 at 7:24 pm #

    Thank you for the very great info. I especially appreciate that you mention your economic station in life so that the rest of (similar) us can better interpret that info for ourselves.

    One question, how do you travel from your trip south and thru the canal back to the east coast in October?

    • Behan August 17, 2017 at 7:40 am #

      Our route is very uncertain – right now we’re just focused on getting to Grenada! Still intend Canal early 2018 and then northbound on the west coast from there for a spell.

  5. Laurence Phillips August 16, 2017 at 11:19 pm #

    On a lighter note, I’m glad to have seen 10 years of photos because otherwise I’d be very confused about the twin sisters…

    • Behan August 17, 2017 at 7:44 am #

      Crazy isn’t it?! They are asked all the time if they’re twins.

  6. Jennifer s/v Luna Sea August 21, 2017 at 12:38 pm #

    That nose repair is pretty impressive! Nice job, PR docs. Thanks for sharing the details – it’s always a gray area for us, as we also pay out of pocket. So seeing hard numbers is helpful!
    See you in Annapolis!

  7. Brad August 29, 2017 at 7:43 pm #

    What about vaccinations? Do you or the kids get them? If so which ones?

    • Behan August 30, 2017 at 6:10 pm #

      We’re all vaccinated as appropriate for the places we visit. It’s impossible to suggest a blanket recommendation for cruising, as what’s right for you is a mix of destinations and choices. You don’t need to load up before you go; get what you need as you need it. That said, Hep A is one most cruisers should get and a booster is required so that’s one non-standard vax to plan ahead with before your departure.

  8. Melissa Gifford August 31, 2017 at 7:56 am #

    Wow, that nose repair is impressive! I am so glad you received great advice re: doctors/surgeons. Phew! Good margins are always key.

    xo
    M

  9. Graham Schelter September 5, 2017 at 7:55 pm #

    I just spent some time catching up on a few of your posts. Your perspective on the ports/ countries you would consider moving to is fascinating. Your criteria of: friendliness; affoardability; culture; healthcare; food and natural beauty (I’m paraphrasing) makes a lot of sense. What would be your top five ports where you would want to “live.” It sounds like Puerto Rico is on the list.

    • Behan September 9, 2017 at 10:54 pm #

      Puerto Rico is DEFINITELY on the list! What in incredible place. Picking top five ports though… impossible still! Must see more!

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