It is hard not to single out the Caja Costarricense del Seguro Social, better known as the Caja for ineptness and waste.

Recently I have had a personal experience, at both the primary care unit, Ebais, as well as the Emergency Room at the Hospital San Juan de Dios. Indeed both were a comedy of errors and frustration, especially when you realize that we do, indeed, pay for the services.

Remember, all expats and Ticos pay into the Caja as do the employers. It is not far from free. The facilities and resources, including personnel, are operated by government supported institutions and not by private hospitals. The good intentions as they might be, are offset by Peter Drucker’ rule, ….the second most reason organization fails, is they outgrow the ability to manage it.” (The 1st is being underfunded which may also apply to the Caja as it burns money like gasoline.)

My blood pressure was considered sub-par and my pulse the same. Into the ER at Hospital San Juan de Dios I was taken.

The Ebais was more than willing to have an ambulance take me, but then my wife and I thought, “how do we get back?” So we drove, or rather she drove, my guiding light.

Apparently, there are two ERs at San Juan. One for gun shots, stabbings and all those life threatening things, and another that survives on waiting, endless waiting.

During my eleven hours doing nothing and four EKG tests later which all came out similar if not the same, we were ready to go home. At that very moment, somebody said we needed a blood test but we only needed to wait two more hours for the results. (I guess nobody came up with this idea earlier.)

There must have been eighty or more people, including me, held hostage in a wheelchair. All but two of us were orthopedic patients. Every chair had broken legs, arms, wrist, etc. wrapped in and waiting for the “go home” call.

There is only one co-ed bathroom for all of the wheelchairs. Unfortunately, little thought was given to how this doorway to a wash basin and toilet would accommodate wheelchairs. Ergo, those who needed to pee had to crawl out of the wheelchair and on broken limb limp to the wash basin and finally to the toilet, plus return.

Many just held it!

After all the EKGs and finally blood test not to mention a constant flow of people taking my blood pressure, a doctor. A real live doctor came to me and said that he did not know what to do with me, something is wrong but we do not know what? “Just stay on your meds, okay?”

At that time I realized that I had been measured, stabbed and examined not by physicians, but students from UCR, UACA, ULACIT which, according to the physician’s best guess comprised 40% to 60% percent of the staff. Not nurses, not doctors but students. Everyone owned or rented a stethoscope. wore official looking gowns and acted with great authority. However, in truth, they were just learning and we were just another learning tool.

Whatever happened to my exams, questionnaires, blood test….who knows? In the end, a real doctor just told me to go home and make an appointment with a cardiologist.

By the way, he was in his residency and the entire non-bloody ER was an earn-while-you-learn program.

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