Reader’s sad experience reflects on Caja competency

In order to obtain any type of residency in Costa Rica, one is required to obtain at least voluntary medical insurance with the Caja Costarricense de Seguro Social. So why not use its clinics and hospitals?

My wife was diagnosed with cervical cancer, treated as an outpatient in the Caja and was very happy with the outcome with no trace of a tumor at her third post-treatment check-up.

Shortly thereafter, she was diagnosed with an intestinal occlusion, said to have been caused by over-radiation during her cancer treatment. This was re-confirmed after a surgery to remove one meter of lower intestine rendered useless, while the condition of the remainder was said to be poor but could recover. A “temporary” ostomy was performed and a second procedure planned to reconnect the digestive system in a four to six week period.

Just 11 days after surgery my wife was sent home. Her surgeon was not happy with this and emphasized the importance of returning her through Emergencias if anything went wrong. After two days, due to a crisis we returned her and she spent a traumatic night on a gurney in the passageways of Emergencias until being sent to a ward the next day.

Her condition stabilized although gradually, as she was being treated for abdominal infection with antibiotics. On the Thursday before Semana Santa, the surgeon announced he would install a catheter to feed her in order that she would lose no more weight. He said she would need to remain hospitalized for a total of two more months. He then went on vacation.

The following Monday, instead of a catheter being installed, a female doctor removed my wife’s intravenous drip and told her she would go home that day. Alarmed, my wife called me, and I spoke with the Jefatura, where the same information was given to me. Although finally she was not sent home, she was severely dehydrated during the following week despite my protests to nurses and to those in charge. When the surgeon returned on the Tuesday after Semana Santa, he was horrified at his patient’s deteriorated and dehydrated condition and by the unbelievable amount of weight she had lost. Either he had left no details of his plan for his patient, or others simply ignored them.

The catheter then was finally installed, my wife stabilized once more but then started to have
severe fevers. It was established that the catheter was infected and was the cause. Yet more weight was lost, and her immune system was reduced to zero by the constant use of antibiotics. A replacement catheter was installed, but the infected one was not removed until some days later, such that the infection and fevers continued to consume my wife.

When we noticed that the second catheter had been disconnected, we were informed that it was feeding a resistant bacteria that she had acquired in the hospital and that her chances of survival were minimal due to both her reduced weight and compromised immune system. They were correct, and my wife died five days later with multiple opportunist infections accompanied by massive fever.

A total failure to coordinate and manage her treatment robbed my wife of the chance to survive. There was on the part of some of the nurses a clear expression of not caring and a strong disdain for foreigners. My wife was even afraid of some of them for the rough manner in which they treated her. Also, surprisingly, not one of the people who took her many blood samples ever used gloves.

The way in which her death certificate was written, in an almost illegible scribble, was a final gesture of contempt, just as one might crumple and toss away a badly drafted document. Her untimely death and their failure meant absolutely nothing to any of those involved, only to their victim, my sweet little wife who fought so valiantly for her life against all their errors and incompetence and to her heartbroken and insulted family.

Yes, we are required to enroll in the Caja, but use the services at your peril. The careless attitude of the Tico rules therein, and those to whom I have spoken about this, just say you have to accept it like all the other shortcomings that reflect their sad philosophy. Everything is, after all, God’s will, and He gives us the strength to carry on. There is no need to deal with anything, just like everyday life here.

*Mr. Richardson of Esterillos Oeste asked that the Central Valley Caja hospital involved not be named pending his study of the legal issues. He is a 15-year resident of Costa Rica and a former advertising associate of A.M. Costa Rica.

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