Farmacias, Doctores y Abogados (Pharmacies, Doctors and Lawyers)

Here at the new location of Pilgrim's Rest, we have this week - and next week - been quite occupied with some important short term goals in living here on a permanent basis: getting our prescription drugs refilled at the pharmacy (pharmacies, actually) and getting our indefinite stay visas and Cedula cards - kinda like a "green card" for extranjeros  (Gringos) - that we carry around with us like a driver's license. 

Oh, yes, we can apply for an Ecuadorian Driver's License too, which is given by the national government, not the different provinces - same with license plates here - but it's given in Spanish only.  Since we don't drive here and take a taxi when necessary - and it has been really necessary this last week, especially - we are deferring that task for the indefinite future.  But not the pharmaceuticals and Visa(s)/Cedula(s). . . not at all!

In the US, getting a prescription drug refilled is rather straightforward: you see the doctor, they write a prescription, and you get it filled at the pharmacy of your choice, which nearly always has the drug in question in stock.  Here in Ecuador, you don't usually have to see the doctor, unless the drug isn't on the standard list of approved medications or it is a pain relieving drug that involves cocaine - thanks to neighboring Columbia for that situation - and you simply walk up to the pharmacist to ask for the drug.  That would never happen in the United States. . . too easy, and a measure of freedom here in Ecuador.    

A wrinkle worth noting on getting your prescriptions refilled: different pharmacies and pharmacy chains charge different prices for the exact same drug (same dosage, same number of capsules/pills)!  So I made a price comparison chart for my different prescriptions from three pharmacy chains popular in Ecuador and in Cuenca: Fybeca, Farmasol, and Cruz Azul.  Fybeca consistently had the highest price, sometimes significantly so on the higher priced name brand newer medications.  Farmasol had much more reasonable prices, and the lowest price on two of my meds, and Cruz Azul had the lowest price on all but two of my prescriptions.  So I could just go to Cruz Azul and be done with the decision, right? 

Wrong!  By going to the pharmacy that has the lowest price for the particular drug, you end up saving even more money per month (per use, per dose).  So in my case for my prescriptions I currently take, that means I split up my purchases between Farmasol - the two drugs I found cheapest there - and Cruz Azul.  Both are within walking distance of our condo here (Farmasol a longer but still doable walk), and so eliminating the need for a taxi ride, while getting some exercise in the process. . . as we had planned before we came here.  (We may be taking a taxi back from Farmasol for a while until we get better in walking longer distances, as it is about nine blocks give or take, going on a slight uphill direction back to the condo.) 

Savings by going to two pharmacies: about $65 a month on a total outlay of about $150 + a month (cash payment only, no insurance coverage as yet).  I'd say that is significant, and will continue to do this until we see that future health insurance coverage changes that situation.

Carolyn Anne for her part took the advice of our landlady, going only to Farmasol, avoiding the friendly, helpful, yet pricey Fybeca.  For this one time, that was OK, but we will examine her drug list more closely next time and do a similar thing to how I decided on where to buy my particular drug refills.

Yet another wrinkle: there are a few drugs the pharmacies don't have here, and they send you to a hospital pharmacy for them.  Different system here in Ecuador, to be sure!  So we have taxied our way to Hospital Monte Sinai south of El Centro, near the futbol Estadio Aguilar (and Supermaxi El Vergel for certain groceries and the neat two story mall that is one story underground with the parking garage. . . found a great electronic weight scale in one of those shops for just $19 including IVA - tax)!  We have already made friends with the staff there, and they know I am a Gringo that can help them translate when they have an English language only customer, as happens sometimes in such a business.  We obtained our additional drugs with a doctor's prescription (me) and without one (Carolyn Anne) with no hassles.  They employ a ticket waiting system there, as does the Farmasol Los Nogales location we visit.  Clean, large, modern pharmacies all except Cruz Azul, which uses much smaller storefront locations which are significantly older looking.  Maybe that's how they offer lower prices. . . dunno for sure.

By the end of this week, Carolyn Anne had obtained all of her medications - although one refill is for about ten days, and we still need to get more of it - and I had obtained all but one.  One I got from Hospital Monte Sinai pharmacy after seeing an Internist at that hospital, Dr. Pablo Parra, who is also fluent in English and has an excellent manner. 

The last medication, Flecainide, is simply not available in Ecuador and not on any dispensary lists here in the central pharmaceutical centers in Ecuador, according to Dr. Parra after some inquiring on my behalf.  He referred me to Dr. Ricardo Quizhpe, a cardiologist at Hospital Santa Inez, not too far away - but not very close either - to Hospital Monte Sinai.  I was able to get an "appointment" - more on that in a bit - the same day I called, Friday.  Dr. Quizhpe has office visit appointment days on Monday, Tuesday, and Friday afternoons/evenings, btw.

To see a doctor, you call or visit to find out when their office visiting hours are.  Then, you come to the hospital reception area for that floor/area near the particular doctor's office.  You pay her $30 in a typical hospital in Cuenca, a bargain compared to the USA - and get a numbered slip.  The number determines who gets to be seen first, second, third. . . and so forth.  So you end up waiting longer here than in the US for a doctor's consultation.  Come early - you wait and get an early number like I did once and see the doctor sooner than the rest; come later - you wait and see the doctor after they have seen the patients ahead of you in number.  Fair but less exact system than in the States.   

After a friendly but focused office visit with the young cardiologist, he will be able to supply the necessary drug similar to what I have been taking - and likely will make some small adjustments to my two other heart rate controlling drugs - after getting my EKG and ECG records, as well as my medical history.  *Thank God* I have all this available through the forethought of Dr. Sameh Gadallah and staff back in Lancaster, California where I had been a longtime contented patient (I'd recommend Dr. Gadallah in a heartbeat!).  I need to download my US medical records - available to me unlike the practice of most doctor's offices in the United States - from Dr. Gadallah's website, and either make paper copies of them, or put them on a flash drive.  Another task to do - and soon, as my remaining supply of Flecainide is only seven days remaining - but I am confident I can find someone (like my landlady's grandson Adolfo) to get it done. 

Last Wednesday, we saw our lawyer, Dr. Galo Cardenas, who is the founder of the Coloaustro law firm in Cuenca.  As mentioned in my last post, we are in the process of getting our Visas and Cedula cards.  Yesterday, Friday, we saw his office again. We were seen by Merci, the bilingual assistant/receptionist, and Javier, one of the staff members of the firm.  We paid the $750 payment to the law firm for services rendered (will render) and an extra $80 - $40 plus $40 - for notary services regarding our USA passports.  They don't spell it all out at the beginning, and so you have to come prepared for additional charges like that.  So $830 paid in all Friday.  

Thursday afternoon, after me not finding our USA passport photos from Costco in Lancaster, we visited a hole in the wall photo shop next to Hotel Milan in El Centro where we stayed last Spring several days.  The proprietor there took our color photos for the Ecuadorian Visa - not passport, we assured him - and I got a typical Latin American photo taken in one shot, with me in a slight frown.  I guess that made me look tough or something. . . it's the culture here.  Carolyn Anne's photo had a slight smile with teeth showing just a bit.  Cost: $2 a photo, $10 total.  We also delivered these to Merci and Javier while at Coloaustro Friday.  

All that remained to do was to sign the application documents.  Javier, who spoke some English, misspelled my first name not once but twice!  David is on my USA Passport, and David it shall be on my Ecuador Visa application papers, *not* Dave.  There!  Gotta watch all the details when taking care of business with a law firm.  After retyping the document *twice,* I signed my signature to the application in blue ink (black is not allowed in Ecuador for legal documents for some reason).  Carolyn Anne did the same to hers.  Her name was not misspelled.  I checked!

In a month to a month and a half, we need to travel to Quito to go to the Ministry of Immigration to sign our documents there in person.  Don't ask me why. . . it's undoubtably the Latin American way to duplicate and "red tape" things such as this, imho.  So we will need a dogsitter then.  Don't know who would do that for us just yet. . . please pray.  Monday we need to get what is termed (in English language) a Migratory Movement Certificate from the Immigration Ministry office here in Cuenca on Ordenez Lasso (west end of town by Hotel Oro Verde) that shows how many days we have been in Ecuador.  We will hotfoot that Monday to the Coloaustro law firm so they can hotfoot it to Quito and get the proverbial ball rolling with the government officials there.  

So, as you can see, we have several tasks to do in the air, so to speak.  Please pray with us for my medication change situation, as well as the Visa/Cedula application process detailed above.  Thanks again, everyone for your kind support of us ordinary people living for an extraordinary God!