Thursday, October 20, 2016

Healthcare Outside the US - Our First Dental Experience

We were early, nobody in the waiting room but us!
Bruce never complains.... unless it's serious!  So when he began to mention having some pain in one of his right side molars... I took notice.  A friend told us that there was a Dentist's office near the grocery store so on one of our recent grocery runs, we stopped by to make an appointment.  

The receptionist didn't speak much English, but with my limited Spanish, I was pretty sure she said that no appointment was needed, and that the Dentist was only there Thursday's through Saturdays... 

Long story short, after several aborted attempts (only open Thursdays AND Saturdays) due to my ignorance and several weather delays...  We finally made it to the office at 8 am on a Thursday... and the Doctor was IN!

We arrived all sweaty from a muggy bike ride but had plenty of time to cool off as the employees began to show up.  Our experience here was very different from what we were used to back in the US.

My experiences with Dental care/insurance have been long and varied.  I've been treated with and without dental insurance coverage, as has Bruce.  In my experience, it's nice to have dental coverage because after the first year it covers 100% of preventative services, then 80% of things like fillings and other basic things, then only 50% of the biggies like root canals and crowns...  The catch is that there is usually a yearly max of about $2,000.  If you have either really good teeth or really bad teeth, your premium costs can be more than the benefits received, or the only real benefit can be the discount you get for having the coverage...

Wouldn't it be much more sensible to just have reasonable costs in the first place???  That's what we found here in Puerto Rico...  No frills, just decent care at a fraction of the cost with no BS!!!  It began with the sign-in process.  Our names were placed on the first-come-first-served list... then we were asked to write our names and date of birth on one single sheet of paper that had the diagram of a set of teeth... that was our medical record.  That's it.  No other information was required of us.

They realized that Bruce and I were together, so we were called back to the exam room together.  I was asked to sit in the chair and a technician with limited English asked me what we were here for.  I told her we needed cleaning and exam, and that Bruce has had some pain recently.  

We waited as the office staff got going with their morning routine... turning on equipment and such.  I looked over the equipment in the room... There were only a few disposable items, the suction tube and some drapes were disposable, but most of the instruments were not.  

The lights and spit sink had all seen better days.  There was a good bit of rust around the bases of the larger equipment items and the x-ray machine was not protected by any means... It was just a simple machine over by the wall.

The Dentist came in and told us the cost for the cleaning and exam would be $40 each... OK?

We agreed and she left, but soon a receptionist returned with our receipt... Bruce forked over the $80 cash and our treatment commenced...sort of.
The x-ray machine...

The suction power supply was right there in my exam room...
There was a bit of a problem with the suction machine.  My technician flipped the breaker back and forth with no result... She excused herself and went off to another room, the Dentist came in and messed with it, then told me there would be no suction and handed me a small spit-cup.

Left alone for a bit to ponder this... I had to laugh when I thought about my friends back home and how they would take this latest development...  luckily before my cleaning began, I heard the suction tube kick into gear.  Hooray!  They got it worked out!

I was relieved to see my technician change to a new pair of gloves before she leaned me back, positioned the light, hung the suction tube in my mouth and got to work.  She was quick and thorough and as usual, my cleaning went without a hitch.  I am blessed with wonderfully strong teeth and no issues were found.  

Next it was Bruce's turn.  His cleaning went much faster and when the hygienist was done, the Dentist returned to take a look.  She asked us both if we had any problems and I told her about Bruce's recent complaints of pain, but that he was not feeling it presently. 

She took a look and said that she could see two cavities.  She advised x-rays, cost $10 and said that the cavities would cost $35 each to fill. We agreed and they asked Bruce to sit on the edge of the exam chair.

The brought the x-ray machine over put the slide into his mouth and simply took the x-ray.  No drape, no lead room... That was it.  He reclined once more as they disappeared to develop the film.  

Soon the Dentist returned and told us that the fillings would require a bit more... one was "two surface" and the other would be more involved with "three surface" filling required.  The added cost would be $45 and $55 respectively...  We agreed, a receipt was produced and we forked over the additional $110.  

We were moved to another exam room where the anesthesia was administered... We waited for it to take effect...  Meanwhile we watched as the staff moved efficiently and happily around the office.  Other patients were brought in and we could understand a little of their complaints and treatment.  There were no rooms, just simple stalls in which the chairs and equipment were really only partially hidden from general view.  Privacy was nonexistent, but then who cares???  We're at the Dentist's office... everyone can pretty much guess why we're here!!!

The staff were all very nice as they went about their morning routine, moving patients in and out as their cleanings and exams were executed... It all worked like a well-oiled machine...  The Dentist fluttered in and out of the different rooms checking this, exam here, instructions given there...  Finally it was Bruce's turn again and we were once more moved to a different chair. 

He leaned back and the Dentist got to work.  Her assistant stood on the other side with a syringe with which she irrigated the work area as the Dentist drilled.  I was actually glad for the blocked view!  All the while they kept up lighthearted conversation some in English and some in Spanish.  The Dentist questioned me about our life on the boat... she had recently sold her power boat because they never had time to use it.  Her husband started raising Lovebirds and they never went out to the boat anymore...  

The chit-chat was such a change from what we are used to back in the states, and I have to say that the overall atmosphere and level of happiness displayed by both office staff and patients alike, marked a startling difference compared to US offices.  It was all just so relaxed and free of politically correct, HIPAA BS...  Just get over it people!  

Bruce experienced no pain and very soon, we were almost done.  I hadn't had my exam yet.  The Dentist asked me if I was experiencing any pain, I referenced a couple of spots and relayed to her what I had been told previously about my one trouble spot.  She further explained some things to me and took a look.  She pronounced me cavity free and we were done!  

Things that would not have happened in the US:

There would have been a LOT more paperwork
We would have been separated into enclosed exam rooms
The x-rays would have been done in a different place and we probably both would have had x-rays before anything else was done.
We would not have witnessed any of the inner workings of the office equipment malfunctions
We would not have seen or heard any of the other patient's problems or care
The equipment would have been newer and more plentiful
We would have learned of the total cost after the visit
We would have been reschedule to come back for the fillings

There are people who may read this in horror!  It's not safe! It's not private!  But that is just evidence of the decades of propaganda we've all been bombarded with causing us to live in fear.  What we need is just simple care at a decent cost.  A total of about three hours of our time and $190 cash were the cost today.  We were both thrilled.  Once again the walls of a lifetime of medical propaganda are steadily crumbling down... 

Thursday, September 29, 2016

Keeping Connected - Update

Our days here in Salinas have admittedly been somewhat lacking in adventure...  Being stationary provides us with a mailing address... which makes it very easy for us to spend money.  We've ordered things we've needed for a while, and things to make our lives a little easier using our Amazon Prime membership until I'm starting to feel a little guilty.

But I've rationalized that once we leave here, it may be some time before we have this opportunity again... so....  We've also rationalized ourselves into getting a new phone plan.  So far, our Plan-for-keeping-connected has worked very well.  But very soon we will be continuing on to islands where we may stay only briefly.  Sure we can still get sim cards for our iPad but with the added obstacle of a new foreign language... Spanish was difficult enough but throw in French?

So we rationalized that if we deduct the cost of iPad data... we could do what so many other cruisers have done and sign up for a T-Mobile One account.  Our old iPhone is dying.  We terminated our long-time AT&T account when we left the states... but we kept our phone number... the one that connects our entire lives... and ported it through Google Voice.  The problem with Google Voice is that it needs a phone # - a Plan - to forward to... So we set up Skype.

The Skype has been great with a couple of drawbacks.  We have to have either data or wi-fi for it to work... and we have to be on the computer or iPad to hear it ring.  So we've missed calls.  It gives us great transcripts of voice messages via email... but it was still a missed call.

So, rationalization again... with the T-Mobile One plan, we can have a US phone number where people can call us... we can still use the Skype to  receive calls on our old phone number that everyone knows... they'll just forward to our new phone through Google Voice.   I know... complicated.  But once it's all set up, it works very well.

But what about the added cost of the new phone number?  How do we rationalize that?  Well, we only shut down our old AT&T account because we wouldn't be able to use it in the islands.  With this T-Mobile account, we WILL be able to use it... throughout the Caribbean.  We've added a data line for the iPad and splurged with the T-Mobile One PLUS, which speeds up our data.  So we can have a mobile hot spot through the iPad to run our computers... and it's unlimited data.

Friends who are already down as far as Grenada tell us that while there are some places that have no coverage, it has been pretty good overall.  And I would say that "pretty good overall" is better than nothing!

So we're paying for a new phone number and iPad (high speed) data for about $115 per month plus taxes...
We're paying for Skype services for less than $100 per year (allows us to keep our long-time phone number through Google)
 And what are we getting?  Well, we have basically three phone numbers that will all ring to our phone... We get high speed unlimited data on the iPad with mobile hot spot functionality in the states and throughout the Caribbean... We get unlimited text and data throughout the US and Caribbean...  This allows us to tether data service to our Macs and our Apple TV.

Now... if only we could figure out a way to stream US video services outside the US without paying for a VPN... Well guess you can't have it all!

Sunday, September 18, 2016

Test Driving The Tribord - A Gear Review

Setting out to test the Tribord
Love 'em or hate 'em... when I was researching the many different brands of full face snorkeling masks out there I found that the reviews were as polarized as they are about politics and anchors!  Some people love them and others hate them.

I found that the haters all sounded like hard core types who don't consider that there are people in this world who just want to float around on top of the water and gaze at the scenery below without ever diving deeper than a few feet from the surface.  For those people... give the Tribord a pass.  But for the others... people like me... this is what you've been waiting for!

Looking for just the right snorkel spot... no... not here!
We'd already had an opportunity to handle one of these masks ourselves when a nice woman rose from the waves pulling one off of her face one afternoon while we were walking the beach on Culebrita.

That planted the seed... but after speaking to my Dive-Master-Brother about it... I was not ready to commit.  He said that we wouldn't be able to dive beneath the surface because it would be impossible to clear our ears... and for that reason alone we shouldn't buy them.  So I waited.  And I mulled it over.

Some weeks later a Facebook friend posted a comment about hers and how much she loved it.  After questioning her extensively and watching the video on the Tribord Easybreath website... I was sold!  I went online to Amazon, read lots of reviews and found several videos that answered that one nagging question about diving below the surface... And then I ordered two... a pink one for me, and a blue one for Bruce!

This spot looks just right!
I will admit... some of the negative reviews got to my subconscious and actually gave me nightmares while I waited for our masks to arrive.  It would be a pain in the butt to have to return these things and I really wanted them to work.

Finally they arrived and we ripped open the boxes and tried the masks on.  They felt really funny but seemed to be made well.

My guinea pig...He's always willing to go first!
I remembered several of the reviews mentioning that they received "used" masks that had sand on them... I inspected both very thoroughly and found them to be in pristine condition.  Well that's one nightmare shot down by the light of day!

We wore the masks for a little while to see if we felt any restrictions or if they had any sign that the breath we expelled wasn't exiting the mask sufficiently like some of the reviews said... nope.  They seem fine.  I was a little worried that I had ordered mine too large because I could feel air flowing out the mask up around my forehead when I blew out rapidly... I hoped that it wouldn't leak.  Maybe the force of the water will push the mask closer to my face to make a better seal...  Maybe I should tighten the elastic straps...  A full two days passed before we had our chance to go out and give them a try!

The winds were down today so we got the outboard going and motored slowly out of the protected waters of our little bay.  We were looking for just the right spot, someplace with no big waves and good visibility...  There was a lot of boat traffic with this being Sunday... but we found a spot on the eastern end of Cayo Matias and threw out the anchor.

Within seconds Bruce was in the water and swimming away as I watched anxiously for signs of sputtering or choking... All GOOD!

I pulled the elastic a little bit tighter on my mask and put it on.  One tiny irritation:  the elastic runs up the center of the head which is right where my ponytail is... Not a big deal, but if this is a review, it is worth mentioning.  Otherwise, the mask feels very comfortable.

I joined Bruce in the water and asked him if he could swim beneath the surface with the mask on.  He immediately proved to me that not only could he do that... but he could also dive down to the bottom... some six feet or so... with very little noticeable difference between this mask and the traditional kind.

With two thumbs up... off we went to see the sights!

The visibility wasn't the greatest... but that wasn't Tribords fault!  In fact, I think this mask greatly improved our experience.  Snorkeling here would have been dismal with foggy vision further decreasing visibility with a traditional mask.  After a very brief adjustment period we both just swam along marveling at how comfortable the mask is.

I have always had a problem finding a mask that would accommodate my nose.  It's big.  AND since having a deviated septum surgically altered some years ago, my nose can not tolerate any type of pressure.  The discomfort I normally feel where the snorkel mouthpiece pushes up against the mask beneath my nose is usually what ends our snorkeling.  I just can't take it for very long.  Today... I felt ZERO discomfort in my nose OR mouth.  The awful mouthpiece I'm used to wearing while snorkeling is a distant memory...

I happily paddled along in disbelief!  I can breath through my NOSE!  I don't have to breath through my mouth anymore.  No more will I struggle with a throat so dry I can't even swallow!  I can swallow all I want!  I can even burp!

Unfortunately Bruce can NOT understand me when I speak to him wearing the mask under water... But then maybe he's faking that.

There were some strange sounds that were a little disconcerting at first.  They seemed to correspond with my breathing so I assume the sound is caused by the air traveling up through the sides of the mask and maybe the little mechanism inside the snorkel.  I got used to it quickly and it wasn't a big deal.

After snorkeling for some time, I began to feel the pressure of the mask on my face between my cheekbones and nose.  The one remotely negative thing I can say about the Tribord is that it left warpaint-like red marks on my cheeks from the way the mask fit my face... This might be different for other people, but Bruce experienced the same thing.  But I would gladly trade the pressure I'm used to feeling from snorkel and mask for this small amount of discomfort... in a heartbeat!

Bruce was already in the dinghy when I returned and I asked him what he thought.  I can't remember the last time I've heard this much enthusiasm in his voice over anything!  He was ecstatic.  He said he would never use the old type of mask again!

Back to the boat for one more test...
He did say that he had a small amount of water leak in, but he has a beard and the seal on the mask isn't as good as mine... But then he was also a lot more active than me... and it was still less leakage than he gets with a traditional mask.  He said that he accidentally tipped his head too far down and submerged the snorkel and it simply closed up... When he brought his head back up it immediately drained and he was able to breath again.

We both agreed that keeping our faces dry and having absolutely no salt water in our mouths is the best part!

The final test will be to see if Bruce can use this mask to clean the boat bottom...  Reviews mentioned that the increased amount of air inside the mask creates additional buoyancy which can limit your ability to remain underwater for long.  When Bruce does the bottom, he usually wears a light weight belt... but we will see...

While I washed my gear he gave it a try...  He said that he did have a bit of trouble staying down and that he had hit the snorkel on the bottom of the boat causing water to leak in.. So maybe he will have to use the traditional style mask again after all...  But since he usually uses the hookah-type compressor and regulator, he was going to do that anyway.

We can't be happier with our new toys and we wish we had bought them sooner!  If you aren't an avid skindiver and are happy with remaining relatively near the surface, we think you will love the Tribord Easybreath!

We have no affiliation with the Tribord Easybreath... we are just happy users!