Emerging From the Sausage Machine.

Shabby and far from chic, but it works.

I had my second cataract surgery yesterday, in a purpose built state of the art eye clinic – the pride of the CAJA – the Costa Rican version of the British National Health Service.

The other eye had been dealt with at the San Juan de Dios Hospital in the centre of the capital…a maze of structures dating from the nineteenth century, constantly undergoing the construction of new buildings on a restricted site, where departments live hugger mugger, offices stuffed into Victorian cubbyholes while the ‘working’ stuff wallows in comparative luxury in areas dating from the thirties to the present day

We know San Juan de Dios well….with all Leo’s problems the joke among his specialists is that the only departments not treating him are gynaecology and the morgue.

Having finally achieved an appointment for cataract surgery at San Juan de Dios I had jumped through all the hoops – electrocardiagram, blood tests and Covid test – only to arrive at 6.00 am on the morning of the appointment to be told by the secretary that I had not, in fact, done any of them.

Th secretaries are the curse of the CAJA.

As the jefatura – the office – did not open until 9.30 am I messed off home and complained by e mail.

Another appointment…no electrocardiagram but another Covid test – with the same nurse, who wondered why I was there. We agreed that the secretaries were both incompetent and hostile and I returned for the next appointment.

Same gravy.

This time I was prepared. I had the surgeon’s e mail address.

Shortly a young doctor arrived, entered the secretary’s office, and voices were raised. He emerged, red in the face, and informed me that my surgery would go ahead.

Fine, except that I was now last on the list.

From there all went well. Nurses checked blood pressure, checked that that the lesions on my leg were not infected and helped me undress and put on the theatre garments.

Staff, from porters to nurses, talked to me while I was waiting and thus I was relaxed going in to the theatre where the surgeon explained what he was about to do at each stage so I knew what to expect, and before I knew it it was finished, with the surgeon explaining the follow up procedure.

Here the background staff took over, transfered me to a waiting area where they gave me coffee and biscuits, helped me dress and gave me eye drops to use in the following week to complete the process.

I had to return the next day for a check up and, as no secretary was involved, all went well. I was on the list for treatment for the other eye.

A year later came a telephone call from the blue, summoning me to the specialist eye clinic for tests – the next day.

With the new government has come a certain improvement in the standards expected of state institutions and the new health minister – duly loathed by the medical establishment – has set about the old Spanish practices in the CAJA. Good luck to her! I will know that she has won when the secretaries do their jobs rather than expecting the patients to do them themselves.

Operation backlogs are to be tackled….thus, I suppose, the surprise appointment.

I duly toddled off, had the tests, and had the date of operation confirmed. All hunky dory.

Until the day.

I turned up before time, was second in the queue, and awaited the formalities.

Oh dear…the secretary did not have my papers.

I – not she – would have to go to the Admissions office to retrieve them.

The snooty young lady at said office told me that surgical admissions could only be dealt with from 4.00 pm onwards. 4.00 pm being the time of my appointment.

Conveyed this to the secretary whose response was that I had better be at the office on time, then.

Had the state of the eye not been so bad I would have told her where to go and that she would find the papers where the monkey kept its nuts, but, faced with a further wait for treatment, I simmered in silence.

At 4.00 pm there was a queue at the Admissions office, and the sulky lump who had replaced the snooty young lady announced that we would all have to wait while she caught up with her backlog.

Half an hour later she wa still ‘catching up’ when I caught sight of the lady who had sorted out my papers when going for the preliminary tests and asked her if she could help.

She could. She entered the office and blew the sulky lump backwards bow legged, then said she would give me my dossier herself, but I would have to return to the office to get the all important slip of paper authorising the op.

Duly returned to the office where the sulky lump was still ‘catching up’. I would have to wait.

Went in search of the helpful lady – now dishing out documents to the others in the queue – who came back to the office and repeated the blowing backwards bow legged performance until the slip was produced.

I was, by now, last in the queue.

No help to get changed here…..wheeled off in theatre clothing to sit in line with those now ahead of me. The staff involved in their own chatter, ignoring us all.

Finally wheeled to the theatre, where music was blaring, and up on the table. No clamp or headrest…just ‘stay still’. Luckily I had undergone the process previously and had some idea of what was to come as the surgeon’s voice was drowned out by the radio.

Process completed, handed a bag with eye drops and paracetamol and wheeled back to change.

That was that. Coffee? Biscuits ?Time to recover? No chance.

A check up? No one mentioned one but one there must be as on the slip of paper in the bag with the eye drops was a list of dos and don’ts – no cooking, lifting, exercise, etc. – and a reminder that the plastic eye cover applied after the op must be returned at the next appointment.

Given the two experiences, shabby San Juan de Dios beats the shiny sausage machine hands down.

P.S. The ‘no cooking’ instruction has somewhat ruffled the domestic dovecot, but the resident Dr. Strabismus (whom God preserve) of Utrecht, otherwise known as Higher Authority, has a solution. I have been presented with a wrap round pair of goggles, which, I am assured, will keep the steam out.

He is getting sandwiches, notwithstanding.

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You Need To Be Fit To Be Ill In Costa Rica

I had set the alarm for four in the morning….Leo had an appointment at San Juan de Dios, the main hospital in San Jose, at six and we needed to be off betimes in order to avoid the traffic jams which render the road to the capital impassable for hours in the morning rush.

I had been optimistic. Long before the alarm went off I had been roused from a deep sleep by something heavy and hairy breathing into my ear while sharp claws raked my head.

Sophie wished to go out and I had forgotten to leave the door open.

The door opened and Sophie released, followed by the other dogs who were now feeling the need to pee after being so rudely awakened I thought there was no point in disturbing Leo by going back to bed so washed and dressed, boiled eggs for the baby chicks’ breakfast and enjoyed a peaceful half hour with a book and a cup of tea. The alarm went off as planned and Leo was ready to roll by the time that Danilo arrived to feed the livestock by torchlight before setting off.

We were lucky with the traffic. The buses were picking up the workers with an early start as we headed for the capital and although we were half an hour early arriving, the streets on the approaches to San Jose were already becoming crowded with cars and commuter buses, their exhaust fumes knocking out the scent of the flowering trees which line those routes.

We had agreed with Danilo that he would drop us at the main doors…the nearest entrance to the department we wanted…and he would then go to a car park from which we could summon him once Leo was released. We rehearsed using his mobile ‘phone and all seemed well. We were organised.

I pushed Leo’s wheelchair into the Preferencial line…eye pads, plaster casts, crutches and wheelchairs…on one side of the entrance, while the mere walking wounded waited in line on the other side. The Preferencial are admitted five minutes earlier than the others to give them an advantage in the Gadarene rush to secure the chairs in the waiting areas before the late comers arrive.

The first roadside fruit seller arrived, paying off the porter who brought his load down from the market, and was soon doing a trade with his offer of eight mandarin oranges for aproximately a quid. Looking up through the branches of the roadside trees, the moon, which we had seen the morning before like a golden orb sinking over the hills into the sea, floated in the dark sky, silvering the clouds she wore as shawls about her chilly shoulders. For Costa Rica it was chilly at ground level too, and many in the queue wore those Peruvian hats with ear flaps making them look somewhat hieritic as they stood immobile in the half light.

The doors were opened and the Preferencial launched their asault. Through the general waiting area under its glass roof and off into the corridors which link the old buildings and gardens of its foundation with the various monstrosities of clinical blocks added over the years.

The department we sought was on the right as we we entered….but it was closed and a noltice announced that it had been temporarily transferred to the pharmacy building.

Fine, except that the pharmacy building was outside the hospital grounds, two blocks away, and Leo was in a wheelchair.

Others were similarly affected, but after a swift discussion it was agreed that the best thing to do was to head off down the low ceilinged corridor that led to the original part of the hospital, turn left past the laundry and out through the gates at the rear of the complex which gave onto a park used by Nicaraguan rough sleepers, then along the road to the next block

It was a spectacle worthy of treatment by Bunuel.

The halt and the lame, with wheelchairs and a flourish of crutches, surged through the hospital and out of the back gates…where we found Danilo. The car park had not yet opened and he had prevailed upon the security guard to let him park opposite the entrance to await our arrival. Just as well…the high speed hirpling through the hospital had exhausted me so Danilo was a godsend as the horde encountered the pavement which had not been repaired since the time it was built and invaded the cycle path alongside…yet another bright idea of the San Jose council to tick the boxes of eco virtue signalling while doing sweet Fanny Adams about the basics.

At the junction traffic stopped to allow us to pass…more from bewilderment than from obedience to traffic lights…and the horde moved on to the pharmacy building…an oversized garage on two levels with offices on its periphery.

Needless to say, our department was on the upper level….accessed by a ramp which needed oxygen, crampons and ice picks to assault. Those on crutches held onto the wheelchairs, rather in the manner of the infantry clinging to the stirrups of the Scots Greys at Waterloo while the helpers doubled up to push them up to the top where all concerned stopped to draw air into their lungs….and grab the seats.

The health service in Costa Rica has more ways than one of making you fit….