Showing posts with label Health Care. Show all posts
Showing posts with label Health Care. Show all posts

Tuesday, January 21, 2014

So What Happened? The Nomadic Expat Hits the Road Again

article from June 24, 2012
By Jamie Douglas

Those of you who have followed my writings may have noticed my silence for the past few weeks. No, I did not get arrested for sedition against the Argentinean turkey-necked vulture Presidenta Cristina Fernández de Kirchner. I was detained for a few hours, but that was much later.

What happened was that I took a Three-Stooges-like fall in our house in Mendoza a few weeks ago. I have absolutely no recollection of what happened or why. It was my Andrew Breitbart moment – without all the cocaine and alcohol. I crashed headfirst into a cement wall, landing on a carafe that we used as a doorstop and crunching my sternum. I was also suffering from loss of eyesight in my right eye, loss of motor skills, balance, etc. A scan done at our local hospital lead to study by the experts, which revealed that further study by more experts was needed.

At the same time, our living arrangements underwent a slight metamorphosis. Also, I had begun to feel the same way about Argentina as I once did about the USA, and we, that is, my wife Julie R and I, decided to once again migrate. We already knew that we could not leave the country with our Renault 12 from the last millennium, due to the Argentinean bureaucracy that prohibits foreigners from taking an Argentinean vehicle out of the country. Taking rentals is permissible. Makes sense, right? In Argentina, it does. So pretty much exactly a month ago, we made a no-brainer decision to use the car to go to the northeastern reaches of Argentina, Iguazu Falls, recently voted as one of the "New 7 Wonders of Nature.”

The cross-country trip was boring as can be, and gasoline had about doubled in price, when we could find it. Some of the cities we had to drive through were absolute chaos. Because of my vision problems, we always found an inn to spend the night at by late afternoon, where we met some wonderful people in really out-of-the-way places. After five days of driving, we stopped 40 km south of Iguazu Falls in a small town named Wanda. That was on Friday. The weather forecast called for rain and fog for the next couple of days, so we stayed in our cozy cabin, which we filled up with all of our belongings.

A couple of hundred yards up the road, we were told, was a lovely Swiss restaurant. We went there with a German couple who are bicycling across South America. We all ordered what would be considered filet mignon, including my until-recently red-meat-abstaining wife. We all agreed that it was the best beef we had ever had. The food was so good that we ate there every day, sometimes twice a day. Prices were below what one would expect to pay for such fantastic gourmet meals.

On Tuesday, we finally went to the most spectacular falls in the world. There is simply nothing to compare to its immenseness. Not even the price of admission, which is a steep Ar$130 plus $30 for parking, could dampen the experience. So for the two of us, it was $290, or, with the regularly falling Argentinean peso, about US$90 - worth every worthless peso we spent.

I have spent almost a month filming at Victoria Falls in Africa, much of it by helicopter, and been to Niagara Falls and various other earthly spectacles, but this filled my bucket list to overflowing. Julie has promised to write more about the falls as well as our travels through parts of Uruguay, so look for that soon. The poor thing is very ill right now, but she’ll be back soon. And I am getting ready to build myself a new computer from two super-motherboards and processors so that we can work independently again.

But back to Iguazu: We decided to stay an extra day with our gracious hosts in Wanda to repack properly. We had hopes to sell our Renault in some larger city down the road for whatever we could get, or failing that, we would drive it to the Uruguayan border and just take a taxi across the border, abandoning a vehicle that has many more kilometers to go. We packed everything neatly, loaded the roof rack with our suitcases and went to say our goodbyes, casually mentioning our plans for the car – at which point our hostess, Marta, stopped us cold. She told us that her husband’s brother was looking for a car. It turned out he did not have the money right then; however, another man did! Later that night, we had dinner at the Swiss restaurant again and related our good fortune to the innkeeper, who lamented his bad luck at not knowing we wanted to sell the car, because he, too, would have bought it from us.

Returned to the cabañas, we unpacked the car and waited for the guy to show up on Friday morning to go to the notary to transfer ownership. When he did not show at the appointed time in the morning, I became worried. But he showed about one hour later, so we went to the notary and – ¡que milagro! – it was more or less a done deal. After jumping through a series of bureaucratic hoops, we were free to go back to Uruguay with a few grand more than we expected. We gave all the household goods that we were not quite ready to part with when we left Mendoza to the housekeeper, and I traded my printer for three days stay at the cabañas and made arrangements to take a bus south on Saturday night to the border town of Colón, across the river from Paysandú, Uruguay.

This is where things got a little complicated. The bus we took, a Singer Line bus, was the most luxurious ever (though the food sucked, as always), but they decided that since we were the only two passengers getting off at this town, which was 16 km from the highway, they would just drop us off on the shoulder of the freeway in the dark, from where we had to climb over four sets of guard rails with all our belongings and hike to a Shell station. We had coffee and croissants, and they called us a taxi, which took us to the Colón bus station.

It being early Sunday morning, there was no bus to Paysandú until about 9 pm. So, after short deliberations, we decided to take a taxi across the border. Our driver, a surly woman sucking on her mate, was none too happy about all that luggage, explaining that her car was brand new. When we got to the border checkpoint, she was even less happy when they sent her to a holding area while we were interrogated for an hour or so. After a few hundred pesos changed ownership, however, we were finally allowed to leave the country, and we reentered Uruguay precisely three years to the day after we first entered in 2009.

The adventure called Argentina is over for us, but the continuing drama of the circular history of that poor country continues. Corruption and ineptitude must have been written into their constitution. The current president is even less capable that Juan Peron’s second wife was – much dumber; but having surrounded herself with a bunch of crony yes-men who are currently slowly working on having the constitution changed to allow her to run again, a Supreme Court that is stacked and both the upper and lower house majority, she can run roughshod over the population ...but more on all that in future personal attacks on the imbecile woman.

We have ended up back at our beloved beach house under the lighthouse in La Paloma where, as I write this, I listen to the gentle waves lapping at the shore while a small fire is keeping me warm. Our canine friends Vito and Luna where very happy to see us back, recognizing us even after two and a half years. I was amazed at how excited they were when they saw us. And two human friends we had left behind here just recently moved back, as well.

For those of you who were considering whether to move to Santiago, Buenos Aires, Asuncion or Montevideo/Punta del Este (yes you A.L.), they had a coup d’état in Paraguay a few days ago, and there is a new guerilla army that is growing by the day. I forecast changes for Chile as well. Some of you might remember my predicting, many months ago, that Angela Merkel’s lapdog, French President Nicolas Sarkozy, would be defeated in the French presidential elections, which started a shit storm from Francophiles. Well I am sorry to tell them, but “I told you so.” We are living in very unsettled times, and changes are coming at us with blinding speed. Latin America is still the evolving child of the old Spanish Empire. Uruguay, at present, is a good place to be. Will it stay that way? Only the shadow knows!

Jamie Douglas
No more Malbec Wine. It’s back to Tannat.

[All photos by Jamie Douglas and Julie R Butler]

I encourage you to write me at cruzansailor [at] gmail [dot] com with any questions or suggestions you may have. Disclaimer: I am not in any travel-related business. My advice is based on my own experiences and is free of charge (Donations welcome). It is always my pleasure to act as a beneficial counselor to those who are seekers of the next adventure.

Another Reason for Learning Spanish: Medical Emergencies

article from May 14, 2012
by Julie R Butler

Recent events have highlighted an important aspect that anyone considering living in a country where a different language is spoken should add to the list of things to think about – especially for those who are getting up in age or have medical needs that will require attention at some time or another.

It is easy to assume that when it comes to medical attention, doctors, who are obviously well-educated individuals, will have some English skills. Well, they usually do know some very basic English. But unless you are in a well-established expat community or a medical tourism destination where English speakers are specifically catered to, if you do not have a good command of the local language (or know someone who does who can go with you to the hospital at a moment’s notice), you may be putting you or a loved one’s very life at risk.

Medical tourism

There are many medical tourism destinations in Mexico that are located in the major cities, tourist resorts, expat hotspots, and just over the border. In Central America, San José, Costa Rica, and Panama City, Panama, are major medical tourism destinations, as well as serving the large expat communities in those countries.

In South America, São Paulo is a well-established mecca for cosmetic surgery, while doctors in Buenos Aires took advantage of the fall of the Argentina peso in 2002 to establish the city as an attractive destination for international aesthetic tourism.

In recent years, many other major cities throughout Latin America have also been striving to grow their medical tourism infrastructures, offering the medical services that people will travel to from more affluent countries in order to take advantage of lower costs or receive care that may not be readily available in their home countries. The services that are on offer are, of course, elective procedures that generally fall into the categories of dental, cosmetic, and therapeutic.

Beyond medical tourism

It is important to realize, however, that these medical tourism services are only one part of the medical infrastructure of any given place, and outside of these areas, there is no guarantee that English will be spoken by medical professionals in hospitals or clinics. In fact, it is highly recommended that medical tourists inquire into what will happen in case of an emergency by looking into the general state of health and medical facilities there as well as ascertaining whether or not language assistance will be extended by the medical tourism facility. The US Department of State travel website has an assessment of medical care in every country.

For expats who are not living in established expat communities or in locations where English-speaking is an important component of the medical system, it is a good idea to learn or at least know where to find some medical terminology. A good place to start is this Medical Spanish Dictionary. The site is easy to use, with both English-to-Spanish and Spanish-to-English dictionaries, a listing of medical vocabulary, anatomical illustrations, useful phrases for talking to a medical professional, and basic Spanish vocabulary words that are not medical but will be needed in a health care setting.

It is not easy to learn a foreign language, and many of us manage to get by at a level that is sufficient for everyday life. But perhaps the prospect of needing to be relatively competent in a moment of panic will be motivation for you to get to work on that Spanish!

Julie R Butler is a writer, journalist, editor, and author of several books, including Nine Months in Uruguay and No Stranger To Strange Lands (click here for more info). She is a contributor to Speakout at Truthout.org, and her current blog is Connectively Speaking.
email: julierbutler [at] yahoo [dot] com, Twitter: @JulieRButler

Is the New Peru Better for Expats?

article from October 20, 2011
By Jamie Douglas

So maybe 2010 Nobel Prize winner for literature, Peruvian writer Mario Vargas Llosa was being overly dramatic when, earlier this year, he reluctantly endorsed Ollanta Humala in the runoff for the presidency of the Andean Nation. Humala was running against Keiko Fujimori, the daughter of the disgraced former President Alberto Fujimori, now deservedly rotting away in prison. The highly respected Vargas Llosa summed the runoff up as the Peruvian people having the choice between AIDS and terminal cancer.

The Lima Stock Exchange must have felt that one of those unenviable descriptions fit Ollanta Humala, as it experienced its largest drop ever upon his win. Unfounded fears of Chávez-style socialism had been spread by the opposition, to the point where they apparently started believing their own propaganda.

During the campaign, I received several communications from US and British expats living in Peru, all of them telling me that it was over in the event that Marxist/socialist Humala would win, and they would leave the country. I would love to hear from them, to see what their view is now!

Humala surprised his opponents when he appointed many moderate technocrats with many years of experience to his cabinet, and the stock exchange quickly recovered. The mining companies, which provide a nice chunk of income for the state, agreed to a reasonable upward adjustment in royalties, and a portion of that is to go toward helping the very poor who live in the remote areas of Amazonia and in the Andean highlands – we hope!

So suddenly, Peru is back on the radar for expats. Lima always had a sizeable expat community, and lately there have been a number of new arrivals, many of them professionals working for multinationals. For expats who require some safety and comfort in their lives, Lima is not inexpensive. One-bedroom apartments in the center will run you from US$400 to $800 per month. Food prices can vary wildly, depending on where you buy. Fresh fruits and vegetables at the market are the most economical and healthiest, while supermarkets tend to be much pricier.

If you are looking at Arequipa or Cusco, your cost of living will be lower. The rents in Arequipa are substantially lower, with a three-bedroom apartment in the city center averaging just over $400 per month.

Health care is actually something that brings some retirees to the area, as the cost is very reasonable, and there are a number of doctors and clinics that specialize in eldercare. I see that as a growing specialty field, as more and more Baby Boomers find themselves priced out of the US market or are tired of the mediocre care afforded through Medicare, which is only good in the USA. Dentists are also very reasonable and good. Just make sure that, in either field, you have a reputable professional taking care of you.

For those of you with school-aged children, there are a number of choices available. If you want that your kids to become fluent in Spanish so they can help you with shopping, the bureaucrats and the mechanic, send them to a good Spanish-speaking private school. There are a number of them. It would probably be a good idea to find a good school before you rent or buy a home, as the daily to-and-from can be a grind in Lima’s traffic nightmare.

As far as your utilities are concerned, it depends mostly how big your refrigerator is – and how efficient it is. Expect to have to pay between $150-200 for everything, including water, gas, electricity (220 V, 60 Hz), broadband Internet (6 GB flat rate) and telephone. For making international calls, use Skype, which is free between Skype users, or do as I do and get a low-cost subscription with a US number that your friends and loved ones can reach you on at no cost to you.

If you need domestic help, it is also available for $200 and up per month. Inform yourself of the labor laws. Knowledge of them is protection, for if you have reason to dismiss you helper after paying them under the table, they might just turn you in.

Would I recommend Peru? Hell yes! It is a very fascinating country that is full of surprises – and not just Machu Picchu. Just south of Lima, there are intensive archeological excavations under way. A quick flight over the Andes will take you to Iquitos in the Amazonian rainforest, where you will have a chance to explore and see incomparable fauna and flora, as well as visit with the indigenous inhabitants.

Jamie Douglas
San Rafael, Mendoza
Where fortunately, the pisco sour is NOT the national drink!

[Image of Arequipa Yanahuara, Peru, via Wikipedia]

I encourage you to write me at cruzansailor [at] gmail [dot] com with any questions or suggestions you may have. Disclaimer: I am not in any travel-related business. My advice is based on my own experiences and is free of charge (Donations welcome). It is always my pleasure to act as a beneficial counselor to those who are seekers of the next adventure.

Monday, January 20, 2014

2011 Immigration Requirements for Argentina

article from June 27, 2011
By Jamie Douglas

For many citizens coming from the US and Canada, as well as Europeans, Australians and Chinese, not to mention the hundreds of thousands of indigents from neighboring countries, Argentina has become a magic destination, where people seek to find peace or better incomes, opportunities for their children, perhaps a more mellow existence and for some, a Utopia or Shangri La of sorts.

In this article, I will concentrate on the first four groups of potential immigrants, the ones most likely to be my readers. First off, I will give you the figures for what it will cost you to arrive in the country. When arriving on international flights at Ezeiza International Airport in Buenos Aires, US citizens are charged a reciprocity fee of US$134, while Canadians pay about $71 and Australians about $102. These amounts may fluctuate slightly with the currency exchanges. Citizens from the European Union as well as our Kiwi friends are exempt from those fees. Your entry entitles you to an automatic stay of 90 days in the country, which you may extend at any immigration office in the country for another 90 days for 300 pesos, or about US$75. After a one-time extension, you must leave the country, which, depending on where you are, may be simple or it may be expensive. If you are in the greater Buenos Aires area, a quick daytrip on the Buquebus, the ferry across the Río de la Plata, will give you a 90-day entry into Uruguay for free, but you may return the same day.

I personally recommend taking the ferry to Colonia del Sacramento, and make it a multi-day excursion, as this is one of the historical cradles of Uruguay. Large portions of the old town are beautifully restored to its ancient glory. Montevideo is a secondary destination if you look for variety on multiple visa-renewing trips, offering a large selection of cultural events, great restaurants and a vibrant nightlife. Of course, a constant back and forth will eventually come to the attention of sharp eyed immigration officials who may advise you that you will not be allowed back in, as has happened to an acquaintance. Therefore, there is option B: Not leaving the country until you have to, and then paying a 300-peso exit fee, which is the same amount as extending your visa.

If you find yourself having settled close to the Andes in Mendoza or Patagonia, your choice may be to go to Chile, where you again have to pay that reciprocity fee for getting the permission to enter their country, but the stamp you get is valid for the life of the passport.

As far as actually settling as a rentista, or retiree, the income requirements went up from about US$500 to $2,000 per person per month, funds that must be banked in “trustworthy” financial institutions in Argentina, the same institutions that the average Argentinean avoids like a pestilence. When they are not on strike, they are out of cash.

The cost of living in the large cities can be compared to pretty much the rest of the world, with energy costs leading the way and some consumables being a little less expensive. But medical care generally is much more affordable and very good. If you know what drugs you require, simply go to a pharmacy with box in hand, and you will get what you need, except for narcotics. Diabetic care, blood pressure medication, and general maintenance medicines are freely available from a friendly pharmacist near you. Be sure to ask for generic medicines, as they are much more affordable.

As always, I urge potential pilgrims to come down and spend a few weeks or months here before taking the plunge, as I have seen too many dreams shattered for good people who were seeking out an alternative lifestyle, only to discover after a few months or a couple of years that this was not the beautiful life they had hoped for.

If, on the other hand, you have sufficient funds to come in as an investor, a mere 1.5 million Argentine pesos, or about US$368,000, and a working business plan plus approval from the appropriate ministry will get you residency, no problem. (If you have that kind of money, please consider making a donation to this writer and his wife and various dogs.)

The last option is a student visa, which requires you to have been accepted by an accredited school prior to getting your residency.

Argentina is the eight-largest nation in the world and has something to offer to almost everyone, so give it a whirl. You just might fall in love with the country and its friendly people.

Note that the rules and regulations are constantly changing, so be sure to contact an Argentinean Embassy or Consulate and do your due diligence. You can start with our Useful Expat Resources page.

Jamie Douglas
San Rafael, Mendoza
Where the Malbec Wine is Always Fine!

Photo by Jamie Douglas

I encourage you to write me at cruzansailor [at] gmail [dot] com with any questions or suggestions you may have. Disclaimer: I am not in any travel-related business. My advice is based on my own experiences and is free of charge (Donations welcome). It is always my pleasure to act as a beneficial counselor to those who are seekers of the next adventure.

My Name is Jamie Douglas, and I Am a Nomadic Diabetic

article from December 9, 2010
By Jamie Douglas

Wow, I finally got it off my chest! (Pancreas more likely.) I have been a nomadic traveler for most of my life, always healthy as can be. (Almost said “as a horse,” there, but I had horses, and they are not always that healthy.) From my childhood in a family of avid travelers, to my epic adventure across North Africa in my trusty Land Rover, to photographic explorations in South America, to my time sailing the South Pacific, to my various driving adventures that stretched from Canada to Panama – this is what I am talking about when I say, “Been there, done that.”

By the middle of 2010s, long after I ever planned on being around, I was still going strong, living on the road with my wife, Julie, moving from place to place, making and selling jewelry at festivals all over the United States. We were maniacs, driving long distances to bigger and bigger events, dealing with all kinds of situations, sometimes making loads of money, other times losing our rear ends.

It was during this time when I started noticing that, while driving at night, I was seeing Newtonian rings around streetlights and the oncoming headlights. When I related this to a fellow vendor in Florida, she immediately suggested I see an internist, as that, along with several other conditions I described, was symptomatic of diabetes. I promptly made an appointment, and sure enough, I was diagnosed with type 2 adult-onset diabetes. I was put on a couple of medications, made some lifestyle changes, and was able to lower my blood sugar levels.

I continued to travel and vend, then at the end of 2006, we took a great leap across the Pacific Ocean, flying non-stop from JFK in New York to Faaa, on the French Polynesian Island of Tahiti, then to Moorea, and further out to Huahine, where we spent a blissful few weeks swimming, photographing, exploring the islands, eating exotic dishes and drinking that fabulous Hinano beer and those surprisingly affordable French wines. Then it was off to Sydney, where I fell to debauching on Aussie beers and chicken schnitzel. We took a four-day train ride across the continent, continuing to debauch, followed by two months in Western Australia, where, yup, you guessed it, we debauched some more. Then it was off to Adelaide, Tasmania and the Gold Coast, and, you know...

It was as if I was on a culinary suicide mission, and I almost succeeded. We returned to the States at the end of January, and by early spring, I had gone from an overweight 195 pounds down to 120 and I needed four pairs of those cheap Wal-Mart glasses just to see my hands. But I was happy that I had gone on the trip of a lifetime, as I was obviously going to croak soon. So I did the unthinkable: I went to see a specialist, who told me I came just in time – my long-term outlook was very short, indeed. He put me on a radical regimen of medication, and within a short while, my eyesight returned to normal and I gained weight again. I don’t wear glasses now, and except for a couple of lapses, I have been in very good health.

Then we moved to South America. Before I left the USA, I went to the hated Wal-Mart, where, for about $100, I got a one-year supply of all the drugs I needed. When Julie went to the USA five months later for her father’s funeral, she brought back another six-month supply. The truth is that Wal-Mart’s decision to sell certain generic drugs at low, low prices to get people in their doors was a strike of pure genius, as the lines at the pharmacy attest to, so tell your doctor you will be traveling and see if you can take advantage of these prices.

Being well stocked and living a healthy lifestyle of walking a lot, eating plenty of fresh produce and wholesome foods, and enjoying that lovely Uruguayan Tannat, I was doing great, until about three months ago. At that point, we had relocated to a very different situation in the countryside in the Andean foothills of Patagonia, where we need our car to get anywhere. The Patagonian winter set in, our selection of good, fresh produce became severely reduced, and then I ran out of my medications. But being the stupid cheapskate that I am, I did not go to a doctor until long after I should have.

When I finally went to an internist here, he tested me thoroughly and prescribed me the same medications I had been on before, informing me that I could now just go to a pharmacy and get them without a prescription. My A1C went from 17 to 5.5, and my blood glucose levels dropped from 600 to below 100. The drugs are reasonably priced, and not needing the doctor’s visit for a prescription makes a big difference.

So what I am really trying to say is that, even if you relocate to the end of the world, say, Patagonia, your medications are readily available, at affordable prices. The test strips are about the same price everywhere, as they are made in the USA, Germany, Switzerland and Canada. So don’t be afraid of a little type 2 diabetes abroad.

I must stress, however that I do not recommend my wanton lifestyle to others, and the advice here is NOT for people with juvenile diabetes, about which I wish I understand much more, as my lovely daughter Heather passed on at the age 30 from that dreaded disease.

Live now! ...and read our blog. You never know what you might learn.
Jamie Douglas in Patagonia

I encourage you to write me at cruzansailor [at] gmail [dot] com with any questions or suggestions you may have. Disclaimer: I am not in any travel-related business. My advice is based on my own experiences and is free of charge (Donations welcome). It is always my pleasure to act as a beneficial counselor to those who are seekers of the next adventure.