Friday afternoon, when we arrived at the hospital, it was decided that Jim and I stay outside in the parking lot while Oliver and Erika took care of the paperwork inside. The thought was that if the Billing Office saw that there were Americans involved with Yamuleith, then the price would automatically increase. El Hospital Bautista is a private hospital and although it isn’t the one that most of the Americans prefer, I think the care and treatment there is much better than the government hospitals.
Every now and then, Oliver would come out to the car to update us on what was happening with Yamuleith. The ER doctors had taken one look at her and indicated she needed immediate care. They saw the infected pressure wounds on her backside and said that she needed surgery right away on the area to remove the diseased tissue.
They began prepping her for surgery while Oliver and Erika went to find out how much we needed to pay for the admittance fee. We were told before we arrived at the hospital that it would be between $400 and $500 to admit her and then we would have the ambulance fee on top of that. We were also told that the room charge would run about $125 per day plus we would need to pay for any testing that would be done, all medications used and the doctor’s fee. We didn’t feel like we had any other option and so we had told Oliver that we had the money to get her checked in and to pay for the ambulance and to pay for her first day there plus any meds.
We waited and waited. About 30 minutes later, Oliver called my cell phone and asked me how much money could we pay. I wasn’t sure I understood him so I repeated what we had and what we could pay then and that right then, we would pay $400 admittance fee, the ambulance fee, her first day there and any meds that were used. He told me that wasn’t what he wanted to know. He said the Admissions Office said it was going to be much more than that and wanted to know how much we could pay. I told him I didn’t know at that moment. And I asked him again, how much it was going to be. He said he would ask and he hung up.
A few minutes later, he called again. He said in a very panicky voice that we needed to start praying right then, that God would do a miracle. I became scared when I heard his voice and wondered if something had happened to Yamueleith. I asked him what was the matter and he told me again, we needed to be praying. I asked him yet again, what was wrong and he told me that the regular supervisor in that office was on vacation and so was the doctor who had seen Yamuleith there last year and that the man who was working in that office said that we needed to pay $4000 for the surgery and we would have to pay it right then or they wouldn’t perform the surgery. Oliver had told him we didn’t have that kind of money and the guy was calling his supervisor to come talk to Oliver.
We hung up and Jim and I began praying fervently, begging God to soften hearts and that they would see that Yamuleith needed their care and that they would be drawn to meet the need. We prayed and prayed…and then, Oliver came out to the car. He said that the man would not change the figure and that if Yamuleith was going to be treated there, then we had to pay the $4000 right then. I was sick. We didn’t have $4000 with us and we knew that even if we did, that it was going to be a drop in the bucket of the charges that would soon follow. I didn’t know what we were going to do.
Oliver said that the man told him we had two options. We could pay what they wanted or if we couldn’t do that, he said he could help us out by calling one of the government hospitals (El Hospital Manolo Morales) and making sure she would be accepted there. He said that they would transfer her in their ambulance so that she would get there okay and that he would talk to them to let them know what they felt like she needed to have done.
The only thing we could figure is that either Oliver or Erika felt challenged that they wanted to admit Yamuleith to a private hospital (the admissions personnel would be able to tell simply by looking at Erika and Yamuleith that they couldn’t afford such a place on their own) and possibly told them that Americans were paying the bill or else the ambulance attendants told the ER people that we were at the house and were following them to the hospital. Either way…that definitely was not a time when being an American here was a benefit.
I was afraid that our choice was not a choice. But I called Karen and Dwane on my cell phone…I’m so thankful I had enough minutes…to tell them what we had been told. We all agreed that as much as we did not want her to go to the other hospital, we knew that was really the only direction we could go. Again, I felt sick. I’ve not yet been in a public hospital here that I felt was giving the best of care or would even attain the level of a mediocre facility. There’s no doubt America’s health care has certainly colored our vision here.
Oliver said we needed to come inside then and pay the bill for the care that Yamuleith had received in the ER plus the ambulance charges. He said it was going to be $50.00. We figured that it no longer mattered if they knew we were paying the bill so we went inside with him. We waited and finally Erika got the paperwork to do the transfer. I knew she was upset and I tried to explain that we just didn’t have the money to pay that. She didn’t say much but just nodded her head. I felt so awful that she knew that Yamuleith’s care was going to suffer because we couldn’t pay what was asked. Or maybe I should say, we chose not to pay it. I think we could have but I’m not sure how rapidly or how much the bill would have grown over the following days. It was a lousy position to be in…and a lonely one.
Erika stood at the payment window and the cashier told her that it was going to be $50. I reached in my purse and handed Erika a $50 bill. She gave it to the cashier. The lady looked at Erika and then at me and back again at Erika. I had told Erika I would need a receipt for what we had paid. She told the cashier that we needed a receipt. Suddenly someone else came in to her little area and the two talked very quietly. I could see what was coming. I’ve seen it before.
The lady told Erika that the bill was going to be an additional $44. Erika told me that she needed me to pay the extra money. I took a deep breath and reached in my purse once again. As I pulled it out, I asked Erika why the bill was now $44 more. She shrugged her shoulders. I told her I thought I knew and I said it was because I was a gringa. Again she shrugged her shoulders. The attitude that American’s have unlimited resources permeates this society and a large percentage of the people here think that it is their “right” to charge us more. If that weren’t bad enough, the fact that even some of our friends have a very similar attitude upsets me even more. I paid the money and fumed.
I was furious that Yamueleith still was not receiving treatment. I was angry at the outrageous admissions fee. I was tired of the “rich American” judgments. I was seething that the bill almost doubled at the sight of white skin. And I was tired that every single thing we do here takes so much time and effort.
We finally got everything taken care of and then headed on over to the Hospital Morales. We got there about 20 minutes before the ambulance and the parking lot was full. We tried to park alongside the drive back to the ER but the Security Guard wouldn’t let us. Oliver tried to argue with him, telling him he was a doctor, but evidently, the guard was tired of arguing with people wanting to park there and he basically threatened Oliver by calling over another Security Guard.
The two guards finally said we could park in the doctor’s parking lot since Oliver was a doctor. We then had to walk out and around to the front door of the hospital. There was a small crowd gathered there and we asked Oliver why there were so many people standing outside and he said that they were waiting to go inside to see their family or friend but they didn’t have a permit so they were waiting there in hopes someone would give them one. I was trying to process that procedure in my mind as we walked on around to the back of the hospital to go to the ER area. It was a repeat of what we had seen at the front door.
When the ambulance arrived, Erika and Oliver went inside to the ER with Yamuleith. We weren’t allowed in through the iron bar doors, so we stood outside for some time and waited. It didn’t take long for me to start doing what I love to do in such places…people watch. But, it was a little difficult to do as it seemed like everyone was watching us! At first it was disconcerting but before long, I began to return the stares we were receiving with a smile. A few smiled back but most just continued to stare. That’s an uncomfortable feeling but I suppose it was a little unusual to see a couple of gringos hanging out at the ER entrance to a government run hospital, waiting for news on our loved one just like all the other folks.
There are opposing rows of concrete benches outside the ER and they were filled for the most part. Most folks sat or milled about, but there were a few who were curled up on the bench, sleeping. I wondered how long they had been there, just waiting to hear how about their loved one’s condition.
I guess I need to explain this a bit better. The hospital is a public hospital meaning it is totally supported through government funds. This also means that there is always a shortage of something…nurses, doctors, supplies, medicines…everything. The only thing that is abundant is security personnel. The hospital has rules and there is to be no deviating from the rules. Only those needing immediate treatment and one of their family members or medical personnel are allowed in to the ER. Once a patient is admitted and taken to a room, which contains as many patients as is feasibly possible, only one person can be in the room at a time.
This is controlled (theoretically) through an admittance pass system. There is only one visitor card per patient and this card contains the patient’s name and room number. This is the only way past the security guards who are stationed at the doors. You have to show the card before you can be admitted and then, again, only one person is allowed in at a time. I say this is how it is theoretically as I’ve seen patients with more than one person there to see them but because it is a government hospital, there seems to have been a stricter standard applied to Jim and me.
At one point, I had counted over 75 people waiting with us outside…most were waiting on family members but many were waiting to be seen in the ER. Some would leave and others would arrive but the numbers seemed to remain pretty constant the whole time we were there. They came on foot, by taxi, by ambulance, by bicycle and by private vehicle. Some were dropped off and others were carried in. Some looked to be in pretty good condition, others appeared to be in bad shape. All had to wait their turn for treatment…the idea of triage didn’t seem as though it was being put in to practice. I was very thankful that we had the help of the people at the Hospital Bautista to facilitate getting Yamileith admitted.
The thought occurred to me that this was such a good snapshot of what our “new and improved” health care system in the U.S. could dissolve into in the not so distant future. Socialized medicine always sounds so good in theory and of course, it appeals to those who are in need, but what we’ve seen here is far from what had been visualized and purported as an ideal system. It is a broken system that runs on empty promises and good intentions with the funding having run out long ago. Patient care suffers tremendously. I don’t have the perfect answer…but I sure don’t think this is it. I think man’s natural greed and selfishness gets in the way and interrupts such lofty plans. That’s the end of my political commentary for the moment.
While waiting, only one person actually dared to talk to us. She was a vendor trying to sell pieces of gum. She had asked us earlier to buy gum and we had told her no but she continued to ask. Since our fifteenth “No, gracias” seemed to be as firm as our first one, she finally wandered off to ask others. I had pretty much forgotten about her until sometime later, I saw her heading right over to where we were sitting and she asked us again to buy gum. I noticed, she hadn’t asked anyone around us.
Once again, I told her, “No, gracias.” Normally, I would have gone ahead and bought some gum from her but I didn’t feel comfortable bringing out money in the area we were in. It was dark and the crowd seemed to be a bit rougher than it was when we first arrived. The vendora then reached for a piece of cardboard and held it for me to read. It was in English and it was asking for money so she could buy food. She didn’t look any more impoverished than most of the other people among us. I read it and again told her no but added I was sorry that I couldn’t help her. I’m sure my voice didn’t sound sincere as I was irritated that she was targeting the gringos in the crowd.
She asked me if we had someone in the hospital or if we were waiting to go in. I told her we had a friend in the ER. She looked shocked. She then asked me where we were from. I told her we were from the U.S., but we lived here. Again, she looked shocked. I know her mind had to be racing. Gringos wait at private hospitals for their friends…not at public hospitals. She asked why we lived in Nicaragua and I told her we were missionaries and this is where God had brought us. Her expression again changed and her voice took on a tone of excitement. And I noticed the conversation all around us had ceased.
She asked if we were Christian missionaries. I replied that we were and I was reminded of just how many other “missionaries” are here. Nicaragua has an abundance of Jehovah Witnesses and Mormons who are extremely active and devoted in their efforts to recruit new members.
I thought for a second if those of us who know the Truth would only choose to be as committed to sharing the Gospel of Jesus Christ as those who are deceived are in sharing their propaganda…wow! What would our world be like? Would children like Yamuleith suffer as she has? Would the Nica people struggle as they do just to have enough beans and rice to make it through another day? Would missionaries continue to live behind concrete walls and serpentine wire? Would hearts change? Would ours?
The vendora interrupted my thoughts. She then asked if we were evangelicals. Now this can be a loaded question and can have a negative connotation or a positive one. I took my chances and just said yes, that we were. She smiled and told me that she was glad that we knew Jesus and that she would pray that He would keep us safe while there. I thanked her and off she went, asking others to buy gum.
In some respects, I felt badly that I hadn’t given her money but my own desire to keep us safe kept my cross body purse closed and firmly locked in position in front of me. As if to ease my mind, a few minutes later, I heard some noise at the little fritanga (a very small curbside type of restaurant) near the hospital. I saw the vendor, eating a plate of food and talking with some of the hospital employees. A little bit later, she was back at the ER area, once again trying to sell her gum. I was glad she had eaten and maybe I was justifying it, but I was glad I had kept my purse closed.
Oliver finally came out and told us that Yamileith was being taken to a room and that they were not going to do surgery that night but just get her settled in. He said he was going to stay there with Erika for awhile and then he would go home. Erika had brought all the necessary things with her that she would need to stay the night with Yamileith. He told us we might as well go home as we couldn’t get in to see her. He asked if I could come the next day and stay with Yamileith so that Erika could go home for awhile. I told him I would. We gave him 200 cordoba so that he and Erika could get something to eat from the fritanga and it would leave enough if Yamileith felt like eating, they could buy her something as well.
So, we left. It was almost 8:00. We were hot, tired and worried. So much had happened that day that I couldn’t even begin to process it all. We stopped and got a sandwich and went home. By that time, it was about 9:00. We called Karen and Dwane and updated them. Jim turned on the water tank and we took our showers…it felt good to stand in the shower and just let the tears flow. It was the first time that day that I had a moment alone and felt like I could do that. And flow they did.
There was a sense of relief that she was in the hospital but also a sense of unease that she wasn’t in the private hospital. I felt guilty and sick at my stomach…should we have gone ahead and gotten the money to pay the $4000 admittance fee at the Baptist Hospital? Should we not have insisted she go to the hospital at all? What kind of care was she going to receive there? Would she have been better off at home? Stories of people leaving a public hospital in worse shape than when they arrived are all too common. The questions just kept coming. And I had no answers. It was another fitful night of sleep.
Next blog, I’ll tell about my visit with Yamileith.
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