Expat residents must now enroll in Costa Rica’s medical system: So how is it? Four views

A public hospital in San José, Costa Rica

With the new immigration reforms that go into effect in Costa Rica next week, it looks like expats who are legal residents in Costa Rica must enroll in the national healthcare system,  the Caja Costarricense de Seguro Social. Known  as the Caja, the system gives its members low-cost access to neighborhood clinics, pharmacies, and public hospitals.

Some Costa Rica expats are satisfied with Caja (public) care; others are most definitely not.

Visit Miss Move Abroad to read one whole-hearted and one half-hearted endorsement of the Caja, and two accounts of what can only be termed ordeals at public hospitals.

Fast boat to Nicaragua: Just us, the crew, and a dead man

Everything goes by boat on the Rio Frio: sheep, travelers, and (read on) a coffin; photo by David W. Smith

After we’ve waiting 3 or 4 hours at the Los Chiles muelle (dock) for the boat the Nicaragua, not one but two boats arrive: the bote publico, and the lancha from Esquina del Lago lodge. A big group from the U.S. is being shuttled from the lodge to Los Chiles after a few days of tarpon fishing on the Rio San Juan in Nicaragua, and we’re catching a ride back to the lodge.

But first, the crew helps the returning clients through Costa Rica immigration (easy as pan dulce), gets something to eat, and has a good long smoke or two.

Finally, the captain saunters back to the boat.

“Hay un problemita,” he says. There’s a little problem.

How little? I wonder.

“Hay un difunto,” he says in a low voice. “There’s a deceased person.”

So that was a coffin in the back of the pickup that puttered by while we were waiting for the rain to stop. And it seems the difunto needs to go where we’re going. In our boat.

No hay problema, I say. “El es muerto. Somos vivos.” There’s no problem. He’s dead. We’re alive.

The captain cracks a smile.

“Pero espero que no tenemos que hablar con el,” I add. I just hope we don’t have to talk to him.

“Porque es dificil converser con los difuntos,” says David. It’s not so easy to converse with the dead.

“Son muy serios,” the captain agrees. They’re so serious.

Loading a coffin onto the fast boat to Nicaragua; photo by David W. Smith

It’s not quite as funny when they start to load the coffin into the boat. It takes up a whole row—six molded plastic seats and the aisle—at the back of the long and narrow lancha.  A young man accompanies the difunto, and his face shows fresh pain.

We later learn that the dead man, the young man’s uncle, was a Nicaraguan who crossed the border to work in Costa Rica, in Puerto Viejo de Sarapiqui. He died of a puneleado—a knife wound—he’d suffered in a fight. The young man came down to Costa Rica to claim his uncle’s body, and to bring him home.

We start up the Rio Frio at dusk. Swallows swoop close to the water, picking off mosqitoes. A flock of parrots flies overhead. Herons and egrets stands sentinel along the river. Howler monkeys add their deep-throated call from the branches of dense trees.

Cormarants along the Rio Frio; photo by David W. Smith

David and I stand at the front of the boat, enjoying the cool wind as if dries our sweaty clothes. As we pass under a leafless tree full of black cormorants, it feels as if we’re part of a funeral procession.

The lights of San Carlos, Nicaragua, at the confluence of the Rio Frio, the Rio San Juan, and Lake Nicaragua; photo by David W. Smith

In less than an hour we see the lights of San Carlos across the water. We’ve arrived at the confluence of the Rio Frio, the Rio San Juan, and Lake Nicaragua (also known as Lake Colcibolco). The boat noses up to a rickety wooden building right on the water: immigration. We step out onto the wooden walkway and approach the lighted window.

Immigration office in San Carlos, Nicaragua

There’s no line to enter Nicaragua here, and the only other action is a policewoman, in heavy eyeliner and dangling earrings, asking the nephew of the dead man for his paperwork. No matter where you die, it seems, there’s paperwork before you can leave this world behind. We heard that most boat captains would have charged $150 to transport the body from Los Chiles to San Carlos, but since the Esquina del Lago boat was already making the trip, they charged only for gas.

As we present our passports, fill out forms in the dim light (where are my glasses?), and pay our $7 a piece entry fee, a tall pale man appears, floating over the heads of the smaller, darker Nicaraguans. It’s Phillipe Tisseaux, expat Frenchman, serial relocator (he’s lived in France, St. Martin and Costa Rica, to name a few places), and owner of the Esquina del Lago Lodge, where we’ll be based for a few days.

There’s silver stubble on his cheeks and his blue eyes are kind. “Do you understand what happened?” he says in English softened with French. He’s talking about our fellow passenger, el difunto.

Yes, yes, we assure him. We understand. People die. They need to be brought home. It was the least we could do, to share a ride with someone who needed it a lot more than we did.

Did you notice the name of the boat in the photo? The Amen.

Waiting for the boat to Nicaragua

The muelle (dock) at Los Chiles, Costa Rica

After a delicious Thanksgiving dinner with all the gringo trimming (thanks to Christine at Desafio Adventure), we left  La Fortuna early for a half-day wildlife tour of Cano Negro in northern Costa Rica, in part to get a ride up to Los Chiles.

From Los Chiles the plan is take a boat up the Rio Frio into Nicaragua, where we’ll spend a week or so exploring the Rio San Juan (the watery border between Costa Rica and Nicaragua), an old Spanish fort called El Castillo, and the Solentiname Islands, where in the 1980s Sandinista poet-priest Ernesto Cardinal taught locals his own fiery brand of liberation theology and also encouraged them to paint pictures of their surroundings. They’re still painting, and I’ve also heard that they are some of the staunchest Sandinista supporters in the country.

But good things come, apparently, only to those who wait.

The afternoon started off deceptively easy. Immigration in Los Chiles is the fastest I’ve ever left a country. We filled out a short form (the clerk loaned us his pen), got our passports stamped (there was no line), and we were on our way…to the town dock, where we would wait, and wait, then wait some more.

It was around 1 pm, and there was a chance that a boat would come for us at 2. Or so Phillipe, the French expat owner of Esquina del Lago lodge in Nicaragua, had emailed me. But he’d also outlined other options involving the bote publico (the pubic boat) from Los Chiles, Costa Rica, to San Carlos, Nicaragua. This boat, which costs $10, leaves at 10:30 am, 1:30 pm, 2:30 pm, and 3:30 pm. Unless it doesn’t. Maybe there aren’t enough people to make it worth their while, or the captain needs to run some errands in town.  And even if the boat does go, as the 3:30 boat that day ended up running, it probably won’t leave until 4 pm or so. Unless, of course, it leaves early.

Waiting at Los Chiles for the boat to San Carlos, Nicaragua

Meanwhile, we wait. A group of boat captains lounges at one end of the cement pier. One half-heartedly tries to get us to take his boat to Nicaragua instead of waiting for the public ferry. Someone asks David where he got his sunglasses. Ebay, David answers.  At the other end of the pier teenagers with drooping pants act out some sort of antic scenario that is supposed to distract us from noticing that they’re eyeing our bags. When they slouch by and disappear upriver we’re relieved but soon miss having them to look at. A tarpon jumps out of the green-brown river and slaps back down, making a surprisingly loud noise. The locals barely look up, but one informs us, “Sabalo” (Tarpon).

Thirty minutes later, an aguacero (downpour) relieves the boredom for a few minutes. Even under a corrugated tin shelter, it feels as if we’re in the eye of storm. It’s coming down so hard it’s bouncing off the cement and onto our legs, and then a sudden wind blows the sheets of rain horizontal.  Water floods the slab that is the pier, and we have to move all out bags onto a narrow metal bench right on the water.  The corroded pole that serves as a backrest barely keeps the bags from toppling into the river.

A young man with a sweet face smiles and shrugs, as if to say, “Wadya gonna do?”

A man peddles by slowly, one hand on the bike’s handlebar, the other holding an umbrella.

Ten minutes later, an old pickup truck with wood plank sides drives by with an oblong  box in the back. It’s swaddled in plastic tarps so it’s hard to tell what it is, but I imagine it to be a casket.

Two o’clock, when the boat from lodge was supposed to come, is long past. It’s looking like we’ll take the 3:30 bote public.  But it’s nearing that time and there’s no sign of anyone boarding.

A diversion drives up—another plank-sided pickup with a tarp roof, this one full of sheep. Two muddy teenage boys hoist themselves out of the back, where they’d been riding with the livestock, and make a run for the river, yelling and laughing. They dive in fully clothed (the one with rubber boots pulls them off first), no doubt to rinse off the sheep dung and mud.

Sheep about to head upriver on the Rio Frio

The driver gets out, stretches, calls mocking greetings to some of the boat captains, then motions for a kid captaining a lancha, a narrow wooden boat with ten or so rows of plastic seats in its hull, to take all the seats out. He does, and the man starts loading sheep, one by one, into the boat. They’re worth $150 each, we later learn, and they’re destined for a ranch upriver. The man knows just how hold the sheep so they don’t squirm out of his grasp or kick, but one unruly one gets in a pretty good kick.
When the boat takes off, he yells out, “Bon voyage, hijueputa!”

Have a good trip, you son of a bitch!

Photos (except of David) by David Webster Smith

Costa Rica Blog

You’ll find the latest on Costa Rica right here, whether I’m posting from the (muddy & pot-holed) road or from my (marginally less muddy) desk back home. Check back often for news on politics (Costa Rica has its first female president!), real estate, immigration, health care (medical tourism is on the rise), and expat life, not to mention the fun stuff like art, music, surfing, yoga, treehouses, hot springs, wildlife, volcanoes, national parks, hotels, and food.

I lived in San Jose, Costa Rica in 2000-2001, researching my book, Living Abroad in Costa Rica. I’ve been back twice a year since then, often for months at a stretch. I recently returned from a whirlwind road trip in Costa Rica, my 9th such trip. I also explored Nicaragua and Panama–you know a place better if you also know its neighbors.

Photo of a frog clinging to a bathroom mirror by David W. Smith.