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Medical Insurance: to Have or Not to Have? (Part 2)

When Mike and Jacquie decided to sail south ‘til the butter melts’, one of the questions they were asked is, “Are you going to carry medical insurance?” It was valid question, as both of them are in their late 50’s and Mike’s family has a history of heart attacks. In the first part of their article, they introduced their thinking around medical insurance and shared some details about a medical issue they faced. To conclude their story, they are sharing information about a couple of additional medical issues they had to deal with while cruising and their conclusion on the issue of medical insurance.


Medical Issue #2 – Tenacatita

From La Cruz, we traveled the 11 miles to Nuevo Vallarta, put the boat into Paradise Village for a month and headed back to Vancouver for a week to celebrate my Mom’s 85th birthday. When we returned to Nuevo Vallarta, we provisioned the boat for the next portion of our trip on to Chamala, Tenacatita and Bara De Navidad, about 180 miles south. On the overnight passage, I received 2nd and 3rd degree burns on my hand from coffee ground while making coffee.

Tenacatita Bay

We anchored in Tenacatita for about a week and had planned to spend a few more weeks enjoying this beautiful anchorage. However, I mentioned that my doctor told me I had a 9mm kidney stone. A week after we had been anchored, having great fun swimming, snorkeling and learning to paddle board, my stone decided to move. It was midnight when I woke up Mike and said that I had a problem. I was in a lot of pain, my lower back and stomach were killing me, I was sweating and pale and not really sure what was going on. It didn’t matter whether I lay down, stood or sat, the pain was excruciating on my left side around my kidney. Mike checked the medical books we had on board and told me that my kidney stone was moving, but I was in denial. I did not want it to be the stone, I wanted it to pass and eventually fall asleep.

The next morning, Mike made me breakfast and I was getting ready to go paddle boarding with Carol from  Dragonfly, when the pain hit me again. This time it was so bad that I was doubled over throwing up, pale and in shock. Mike insisted it was the kidney stone on the move and again I tried to deny it. We were nowhere near medical facilities and my options were to dingy to shore, walk to the beach resort and get a cab to Bara de Navidad, 1 hour away, or Mike could take the boat, with me incapacitated, to the marina at Bara de Navidad. Mike called the marina, made a reservation for us, told them I was ill and arranged for the a resort’s doctor to see me as soon as we arrived.

Barra de Navidad is only 11 miles nautical miles from Tenacatita, which for us is 2 hours. We still had the engine on the dingy, in the water and needed to stow it and the paddle board on the boat. Then we could hoist the anchor. None of this could I help Mike with, so we called our good friends on Dragonfly and Lennie helped Mike get the boat ready for the 11 miles to Barra. I was down below, projectile vomiting into the sink, and trying to get myself comfortable enough so that I wasn’t a burden to Mike as he got us to Barra.

My kidney stone must have moved and allowed me to sleep, so I don’t remember much about the 2 hours it took to travel from Tenacatita to Barra. I woke up in time to see us entering the breakwater. I felt refreshed and in not very much pain, just really bad cramps, but nothing that I couldn’t handle. When we got to the dock, I was able to help Mike tie up the boat and we walked to the marina office. The lady was surprised to see me, as she was fully expecting to have to send the doctor down to the boat. The sleep had made a huge difference and I continued denying that it was the kidney stone.

Friends were traveling from Guadalajara to Tenacatita to celebrate Mike’s birthday and I wanted to go back. I was not going to let a little (actually a lot) of pain derail our plans. Mike insisted that wasn’t going to happen and dragged me off to see the doctor. After a thorough exam, the doctor announce I was passing a kidney stone. He prescribed some medication for the pain, antibiotics to help prevent infection, and said that a 9mm stone would not pass.

I texted our friends, told them what had happened and that we were now in Barra de Navidad. After driving from Guadalajara to Tenacatita, Rita and Al checked into their hotel and drove to Barra de Navidad to see if I needed anything. By this time I was feeling much better, the pain medicine was working and I still thought that it was not the stone, even though the doctor said it most likely was. That night, we all went out for dinner to celebrate Mike’s birthday.

The next day, I saw a doctor in town who asked about my medical background, did the same tests, confirmed it was most likely the kidney stone and sent me off to a clinic in Meleque for a urine test. She spoke to the clinic and requested the results by 3 pm. It was just before noon when we arrived in Meleque, a somewhat larger town to the north of Barra de Navidad, with a small hospital, clinic, as well as nice places to provision. By 4 pm the doctor had the test results and confirmed I was passing a kidney stone. She requested an ultrasound to determine where the stone was located within the kidney to determine the next steps. She gave me prescriptions for additional pain medications and one to help the stone pass.

The ultrasound was scheduled for 11 am the next day in Manzanillo, about 1-1/2 hour drive south from Barra de Navidad. If Rita and Al had not driven their car to celebrate Mike’s birthday, we would have been either on a bus or a taxi to to the hospital for the ultrasound. Rita and Al had decided that they were too far away in the original resort, so they made arrangements to stay in Barra de Navidad at the marina resort to be closer if we needed their assistance. They drove us to Manzanillo and I drank lots of water, as instructed, and waited. The 11 o’clock appointment time came and went and I was desperately needing to use the washroom. Rita stepped up to act as our translator, as she speaks fairly good Spanish. What she found out was they were waiting for a technician to arrive at 3 pm that spoke English. Wow, I really needed to use a washroom.

Marina in Barra de Navidad

After sorting out the language issue, I was finally taken to the ultrasound room with Rita as my translator. The first technician could not find the kidney stone. She was trying to tell Rita that maybe it was just a very bad infection. Luckily for us, the English speaking technician arrived. He was a bit more experienced and eventually determined the stone had moved and was blocking flow from the kidney. He also mentioned that it looked like the kidney had a severe infection, even though I was on antibiotics. We figured that the left kidney wasn’t passing urine for at least 5 days.

The stone measured 8-9mm and was not going to pass naturally. After discussing options with the technician, he said we could try to see a doctor at the clinic, or I could go back to the doctor in Barra to blast the stone. This option meant that we would have to go back to Barra, see the doctor the next day, and travel back to Manzanillo to see the specialist the day after. Since I already had a bad infection in the kidney and it was not functioning, I asked the technician if the specialist could see me that afternoon. We were in luck and I had an appointment to see him at 5 pm. If you are either in Canada or the USA, would you have been able to book an appointment with a specialist surgeon on the same day within the hour?

In Mexico, you are responsible for your own medical history, so once the ultrasound was completed, we waited a few minutes and I was presented with my ultrasound radiograph, which I then gave to the specialist to review 1 hour later. The specialist told me that I had several options. Option 1, the least expensive, would be a catheter from my kidney to my bladder to ease the pain and maybe help the stone pass. We could then continue on our travels or travel back to Canada to deal with the kidney stone. The catheter would have to be removed in 6 months. Option 2 was to blast it by laser. The equipment to do this was in Guadalajara and would be shipped to Manzanillo.

The first option was estimated to cost about $800 USD, could be done that evening and we would be on our way. Option 2 was estimated at $4000 USD, but the equipment would come from Guadalajara the next day and would require an overnight in hospital. Option 3 was for me to fly back to BC and to Vancouver General hospital.

We chose Option 2, mainly because my kidney was already infected and had not been functioning for 5 days. The surgery was scheduled for 4 pm the next day. Rita and Al drove us back to Barra and agreed to drop us off at the hospital in Manzanillo at noon on their way home. My check-in was 1 pm so it was perfect. If it wasn’t for Rita and Al and their generosity in driving us around to have the tests, acting as our interpreter and dropping us off at the hospital the next day, this experience would have been much different.

When we arrived at the hospital, I had an IV drip installed and waited for the laser equipment to arrive. At 4 pm when my surgery was scheduled, the doctor arrived and told us that there was a major car accident on the highway coming from Guadalajara, and the equipment was caught behind the accident. My surgery was delayed until the equipment could arrive. Wow I thought, this is it, they won’t be able to do it today. We would have to come back, at least that is what would have happened in Canada. At 9 pm the equipment had arrived and I was prepped for surgery. The doctor had waited and so had his surgery staff and everything was a go.

Jacquie after surgery

When I woke up in the private hospital room, Mike was there. The doctor explained that the surgery was successfully, but as had been explained, I would stay overnight and be released the next day. My kidney was almost abscessed, the infection was severe and a catheter had to be inserted to allow it to drain. I was put on stronger pain medications and a higher, more intense 60-day dose of antibiotics. The catheter could come out as early as 1 month, but could not stay longer than 6 months. Mike was able to sleep on the small. built-in settee in the room with me. It had a private bath with shower and a door out to a small courtyard.

Overall, the experience in the Manzanillo hospital was excellent. I was served a full breakfast and lunch with enough food that Mike and I were able to share. The nurses, doctors and surgery staff were great. Most spoke reasonable English and with Google Translate, we were able to communicate our needs.

We returned about 3 weeks later to have the catheter removed. The total cost, including consultation with the surgeon, surgery and medications, came out to about $4,000 CAD instead of the estimated $4,000 USD or approximately $5,000 CAD.

We decided that my recovery would be best done at the pool at the marina resort at Barra de Navidad, so we booked in for the month and had a blast. While at the pool, I slipped and fell, nearly breaking my shoulder. Luckily it was only badly sprained, but I became known as the walking disaster.

Medical Issue #3 – Chacala

Having recovered from the surgery, it was now time for us to start moving north to Mazatlán, where we would be prepping the boat for summer storage for the hurricane season. Along the way, we stopped at a beautiful anchorage of Chacala. It has wonderful beach palapas, great long white sandy beach for walking, and a famous snorkeling location at the islands just within the anchorage.

It was calm enough to take the dinghy, about a 20 minute ride over to the islands, to go snorkeling. The snorkeling is wonderful, with beautiful clear water, loads of sea life and hundreds of spiny sea urchins. You already know where this is going… I am new to snorkeling, having only learned in La Paz a few months prior. I was blissfully snorkeling, looking at all the fish, aware of all the spiny sea urchins, but not really paying much attention to the little bit of surge in the water. A surge picks me up and sends me towards the rocks and to my astonishment, closer to these spiny sea urchins. I stupidly try to stop myself from getting pushed up on the rocks by putting out my hand. My right had lands right on a small spiny urchin.

I saw blood and quickly surfaced. My palm and several fingers were punctured in five locations and my hand was going numb. I called Mike over and we headed back to the dingy. We were snorkeling with our friends from Nelly Jo, James and Deena, so explained what I had done and that we were heading back to the boat to treat my wounds. The bleeding had stopped but my hand was numb. We didn’t have any emergency medical supplies in the dingy, something we will now rectify, but I found a safety pin so while bouncing back to the boat, I tried to dig out the sea urchin spines. My hand was numb anyway so I couldn’t feel the prick of the safety pin.

Back on our boat, we sterilized my hand and tried to see if there were any spines in the wound. All around the punctures, it was a lovely shade of dark purple, almost black. We thought there was still something lodged in the wounds, but couldn’t really tell. We had tweezers on the boat, but no scalpel to cut out spines if we found them. Deena and James appeared and James tried to use a vacuum venom extractor to remove the spines, but to no avail. I got bundled off in the dingy and taken to shore in search of a doctor.

Again I was in a strange new town, trying to find medical help and don’t speak Spanish. We went to the local pharmacy with visiting hours for a local doctor. However, it was the weekend and there was no doctor at the pharmacy. As we walked around town, I notice that the local tourist information office was open, so we went in and were told the location of the local government-run hospital. It was 3:10 pm and the hospital closed at 3 pm, but the doctor’s car was still parked outside,  so we took a chance and knocked on the door. A lovely young female doctor answered, speaking very good English. We explained what happened and she took us into the emergency area, cleaned my hand and inspected it. She carefully probed the wounds looking for spines, and finding none, gave me a topical antibiotic and sent us on our way. Total Cost $0.

Conclusion

We did not have Medical Travel Insurance, but found that the medical services and care in Mexico are excellent and the cost of these services is reasonable. We spent less than $5,000 CAD for all of my mishaps. Insurance would have cost us about $14,000 CAD. We will travel in Mexico without medical travel insurance again. Whether this is the right choice for everyone depends on one’s comfort level traveling without insurance, and with the level of care provided in foreign countries. These are things that need to be determined individually, but based on our experience, I would definitely trust the level of care I received while in Mexico.