Wednesday, September 5, 2012

Got insurance?

Catalina had to go to the doctor today, and I found myself breathing a prayer of thanks for her timing.  It’s always scary to see your kid throw up repeatedly for no known reason. It would have been even scarier a month ago when we didn’t have health insurance.

That’s right. We spent just over a month in Colombia without a health insurance plan. Coming from the US - where a bout with kidney stones practically causes bankruptcy - it’s amazing that we’ve been able to sleep at night without having coverage.

I am exaggerating, but unfortunately not too much. We’re still in negotiations with a public hospital in Miami over a 2-hour emergency room visit that cost my mother-in-law $10,000 in 2007.  Just one year later, I was hospitalized for three days in Bogotá, and a private room with food and medications set us back $650.  We paid in cash since our US insurance didn’t cover it. What  difference a health care system makes.

That’s not to say that health care in Colombia is ideal.  While there’s universal coverage for everyone, treatment received depends on how much people are able to pay. Everyone who makes any money at all in Colombia is required to contribute to the Plan Obligatorio de Salud (POS), which costs 12% of a monthly income. The system is overloaded, however, so people covered by the POS and nothing else often wait hours to be seen in emergency rooms, and they may have to wait weeks for a doctor’s appointment.  Those who have the means often pay extra for complementary and pre-paid plans that offer additional services like being able to choose their doctors and clinics, seeing a specialist without a referral and receiving preferential treatment in hospitals and emergency rooms.

Since Juan Carlos and I always have worked for employers that offered health plans, we have never had to choose our own company before. The prospect of doing so was both exciting and intimidating, especially with a completely different system that offers dozens of options. I did as much research as I could, trying to find out which plans are financially stable, which plans cover what and how much coverage is adequate for our family.  The POS costs around $100 per month, but complementary and prepaid plans range from $220 to $500 per month in addition to that cost.  On top of that are a variety of copays for doctors visits and prescriptions. Fortunately most of them are cheaper than what we would pay in the US. The primary factor for the reduced cost is a lower cost of labor, though I would imagine that part of it also has to do with fewer malpractice suits.

I have learned some important differences between medical coverage in Colombia and the US. Complimentary and prepaid plans are graduated.  In the first couple months, subscribers can see general practitioners and receive emergency care. A couple months after that they qualify for additional services and elective surgeries. Maternity care isn’t available for seven months to a year after enrollment, and treatment for cancer and other terminal conditions isn’t covered for two years or more.  If someone gets pregnant or sick too quickly or has a preexisting condition before enrolling in the plan, they have to pay out of pocket or seek services through the POS system.  That’s not always a pretty picture. Finally, the deductible and max benefit payments in Colombia work opposite of the way they work back home.  In the US, deductibles and maximum payments are the most that the customer pays.  Here they are the max that the company pays. 

Our company pays up to a max of 120,000 pesos ($66) per night for a hospital stay. We have to pay any amount over that. If we stay in a hospital that costs 100,000 pesos per night that’s fine, but if we stay in a facility that charges 400,000 per night, we’re going to pay a lot out of pocket. Certain medical centers, depending on the name and the area of town where they’re located, charge vastly different rates for the same services and even the same doctors.  We will need to do some investigative reporting ahead of time to know where to send the ambulance! 

The enrollment process was interesting. We signed up on August 22 and paid the POS through the entire month of August. Paying that ahead of time qualified us to sign up for prepaid medicine starting September 1.  Before we could be accepted for the prepaid medicine plan, I had to get a pregnancy test and a pap smear, which cost 10,000 pesos ($5.50 USD). Our representative sent the results via email two weeks later - so much for patient privacy - and sent plan information and ID cards in the mail.  We still haven’t gotten our ID cards. We found out this morning that the POS plan had our mailing address incorrect, so hopefully we don’t have ID cards and plan information circulating in post office limbo.

Having prepagada private insurance helped this afternoon; Catalina saw an appointment within an hour, and the doctor called our house twice this evening to follow up. If we had relied on the POS for service, we probably still would be sitting in a clinic waiting room. Hopefully we won’t have to use most of the coverage we’re paying for, but we still feel better knowing we have it.

I also learned throughout this process the way we’ll be covered if we have one of the most probable emergencies we’ll face living in this city - automobile accidents. Damage from car accidents, and any resulting medical care and disability pay, is covered by the Seguridad Obligatorio de Accidentes de Tránsito, obligatory insurance for transportation accidents.  That will cover us if we get hit by a private motorcycle or a public bus. Ironically, on the way out of the insurance building,  I got hit by an SUV, a lady backing down out of the parking garage.  I screamed and she stopped, but when she tried to pull back up, her standard transmission car popped out of gear and she ended up backing into another car. I was fine, but I was happy to know that the SOAT is in existence. I also recommitted to the fact that we need to buy an automatic transmission car.  More about that in another post. For now I’m going to check on Catalina and kiss her poor little tummy.

Wednesday, August 22, 2012

Finding a Routine

Tomorrow we celebrate our one-month anniversary in Colombia.  It’s been an interesting time, full of ups and downs, and while we’re feeling much more settled, there is a lot of adjusting left to do.

We’re still living with my in-laws, Rubén and Gaby. Their new condominium was supposed to be ready on August 17, but the family who is vacating that condo is unable to move into their new building because there were problems with the remodeling.    Having Rubén and Gaby’s belongings at our house has been helpful, however, because we are still waiting for our dishes, clothes, toys and other household items to arrive on the ship from Houston. The boxes that left our house on June 28 arrived at the Port in Cartagena just last Friday evening, and they should be moving through customs sometime this week. After the port agents go through the stuff, and charge whatever they want for processing, the pallet will make the 700-mile trip up the mountains to Bogotá. The shipment we originally thought would take 3 weeks and cost $5000 will end up taking three times the time and nearly twice the cost we anticipated. The good news is that we didn’t ship furniture!

Living with Rubén and Gaby has been helpful in more ways than just borrowing their things. They have both been a tremendous help to us in caring for Catalina and Gabriela. Rubén makes Catalina’s breakfast every morning, heating the the milk on the stove, cutting fruit with careful precision, and serving the bowl when she says, “Abuito - quiero avena.” (“Grandpa, I want oatmeal.”)  Gaby can’t get enough of her namesake. She pushes Gabriela around the house in the stroller and makes her fruit and veggie purees.  The baby is much more comfortable with both grandparents now and, though she still prefers Mommy over anyone else, her eyes light up when she sees them.

We found a great preschool for Catalina just a block away from the house. Cometas (kites) is located in a big Spanish-style house that has interior and exterior green space visible from every classroom. We knew it was a good fit for Catalina when we went to visit the director, and our daughter didn’t spend a minute by our side. She explored the playgrounds, read the books and helped all the teachers set up their rooms. She was an instant hit with the teachers, and they all greet her by name every day. Unlike in the US, where Catalina was always one of the smallest kids, she’s the tallest in her class. She’s slightly older than most of the other 13 students in her group. Some of them haven’t turned four yet, and those who turned four last winter and spring have moved on to pre-kindergarten at elementary schools. We think that having Catalina in a preschool close to home is a good move for the next few months. Being taller and older than the other kids help give her the confidence she needs while she improves her Spanish skills and adapts to the culture. She’s learning new words every day, and she’s come home happy, carrying the arepa she made in cooking class and showing us moves she learned in beginning ballet.  One day she attended and English class, where the students learned about the letter A.  They made alligator masks as a craft, and Catalina came home talking all about her “cocodrilo.”

Though I don’t quite have the home, work, childcare routine down pat yet, I have found a great place to exercise. (Those who know me know how important that is!) There’s a big gym called BodyTech about five blocks away from us, and it’s the closest thing Bogotá has to the 24 Hour Fitness I left in Houston. Body Tech is big on monitoring the medical progress of its patrons, so Juan Carlos and I both had appointments with a doctor when we signed up, and personal trainers developed exercise routines for us. We have the routines on a paper, and we’re supposed to take them to the trainers so they can follow our progress. Being monitored is a little strange for both of us, who are used to exercising on our own, but I guess it’s a good system to keep clients both safe and motivated.

As in most countries I’ve visited, the first activity I participated in at the gym was group exercise classes.  It’s always interesting to me to see how the classes reflect the culture.  Classes here start 10 to 15 minutes late, so I’ve stopped bothering to arrive on time. Students and instructors greet each other with kisses, and there is more stopping for chatting and drinking water than there are in most US classes. Also, the aerobics instructors here seem to be more concerned about having participants learn the routines than in getting a good workout for themselves. They stop frequently to make sure the students know what comes next, and sometimes they sit at the front of the room or walk outside while we do the entire routine by ourselves.

So far, in the eight or nine different classes I’ve taken, all of the instructors have been men. There are many more male participants here than in the US, and I’ve never seen men so good at step aerobics! The step classes here, not surprisingly, are less athletic and more choreographed than their US counterparts, and that has been an adjustment for me. I get strange looks when I put the step up higher than everyone else, but I know I have to do that to get my heart rate up. Though the step and dance-based classes aren’t very physically challenging for me, they do give my brain a workout. There is a lot of syncopation, with twists and turns that would leave most Americans dizzy. I’m determined to leave my gringa-ness behind though, so I keep going until I can do the classes without having to think so hard. Fortunately, we have Body Pump, spinning and kickboxing at the gym too, so I can get some intensity when I need good stress relief. 

Some stresses are different here; some are the same. Just like in the US, Juan Carlos and I keep each other in check and put the everyday nuisances and frustrations in perspective.  Fortunately, that’s not difficult to do. We’re blessed to have a supportive family, a lovely home and two children who are God’s greatest gifts to us. We’re humbled by and grateful for the opportunities we have and the chance to make this once-in-a-lifetime journey together.

Saturday, August 4, 2012

First days in Bogotá


It’s Saturday morning in Bogotá, and there’s a blue sky with white puffy clouds over the mountains to the East. That means no downpours, so it’s sure to be a good day.

Nearly two weeks ago now, we made our big move from The Woodlands, Texas to Bogotá, Colombia.  It’s been a whirlwind really, completing paperwork completed and opening accounts, getting used to horrible traffic, high altitudes and wearing sweaters in July.  

I’ve once again gotten a taste of what it’s like to be a foreigner. My blonde hair and 5’ 6” stature help me stand out in a crowd of people who tend to be shorter and have darker hair than I do.  More than once people have asked where I’m from, and they seem to be surprised when I speak Spanish. Our 9-month-old Gabriela has blonde hair too - at least  the little hair that she does have - and her blue eyes stop people on the street. Every time we take her to the store or anywhere else in public, women and men alike smile and tell us what beautiful eyes she has. Our 4-year-old, Catalina, has light brown hair and brown eyes, and she could pass for Colombian easily if she didn’t talk to everyone in English. After ordering food in English, saying “hi” and “thank you” and asking kids, “Do you want to play with me?” she’s finally starting to realize that her vocabulary won’t work well here.  Slowly, her Spanglish is starting to include more Colombian words, though she still gets frustrated that she can't communicate everything she wants to say in Spanish. “I don’t speak español,” she tells me. She’ll get it eventually, especially when we get her enrolled in preschool, hopefully sometime next week. We'll all be happier when she can get out of the house and spend time with other kids a few hours a day!

Juan Carlos, both a Colombian and US citizen, is coming to grips with readjusting to the culture he left behind 12 years ago. He’s frustrated by the way people drive on crowded streets, by the time (and number of times) it takes to go to the bank to complete simple transactions and by the slow, unforgiving pace of bureaucracy.

We had a good taste of bureaucracy this past week when we registered both girls as Colombian citizens. After four lengthly trips to the notary - being told to bring more and more documents - and presenting certified, translated versions of birth certificates and results of lab tests confirming blood type - we finally got the Registro Civil, the official documentation for Colombian children. The documents are still completed on a typewriter, and when the notary makes a mistake, she has to start again. Getting the two papers typed up took an hour, both because of the technology and because of the fact that the notary stopped to visit with everyone who stopped by the window.

My documentation was even more involved. Like in the US, foreigners can get residency in Colombia if they’re willing to pay, and to be patient and persistent.  Juan Carlos has been working on the process for months - obtaining certified copies of the marriage license from Alabama’s Secretary of State, having it translated by an approved Colombian translator, then having the document notarized, certified and registered. (I still don’t understand the difference.) We took that documentation along with my passport to the Foreign Ministry and applied for a visa for me. (US citizens can enter Colombians as tourists, but they have to get a visa within 90 days.)  We originally planned to apply for a Spousal Visa, which must be renewed annually, but a helpful lady at the Foreign Ministry told us that, since I’m married to a Colombian and have Colombian children, I automatically get a Resident Visa.  That was fantastic news. Now I can stay legally in Colombia as long as I want as long as I don’t leave for more than 23 months at a time. I can even apply for citizenship in two years if I choose to do so.

Unfortunately having a resident visa isn’t enough to function here. Anyone who wants to do anything in Colombia, must have a cédula, national identity card, which serves as a driver’s license, photo ID and form of registration for everything from supermarket discounts to gym memberships.  Apparently they don’t worry much about identity theft, because the cédula numbers are everywhere! After getting my visa, we had it “registered” at the Immigration Office. I had to give 14 sets of fingerprints, hand over three photos of myself and have another one taken in the office. After all that, I did get my cédula number, but the card itself won’t be ready for 15 business days. It will actually be closer to a month because we have two holidays in August.  Until I get the cédula, I can’t open a bank account, buy a car or have a cell phone account in my name. Fortunately, Juan Carlos and my in-laws are here to help me, but I can’t help but wonder what foreigners do when they come here without family.

Though the first couple weeks have been an adjustment for us, we’ve all had a very good time.  My in-laws Rubén and Gaby are thrilled to death to be with their granddaughters; both girls melt their hearts like butter. Thanks to Skype, we’ve been able to have face-to-face conversations with relatives in the US, including my grandmother - whose smile looks exactly like Gabriela’s - and my parents. I got a lump in my throat a few nights ago when Papa Greg told Catalina bedtime stories, and she finished his sentences for him.

I feel tremendously blessed to live in the same city as my sister Abby, who is working with churches and families in Bogotá. Last week, Juan Carlos, Catalina and I accompanied her to a feeding program in the slums outside Bogotá. I was impressed by  her servanthood and her leadership as she taught English, passed out food, and hugged the children whose eyes lit up when she walked in the room.  I also enjoyed celebrating Abby’s birthday with her. We went shopping and had fun whispering outsider observations about the people and things we saw. Our favorites included the store Solo Blusas (Only Blouses), which advertises specials on jeans, and a two Chinese import stores that have the strangest collection of fabrics and prints we’ve ever seen. When I had visa photos taken and they offered me a coffee mug, I asked Abby what one had to do with the other. She smiled and said, “Some things just go together, like the makeup samples they gave me when I bought a washing machine.”

I don’t know how long both Abby and I will be in Bogotá, but I’m grateful for the time we have together. These are once-in-a-lifetime experiences, and we’re committed to learning all we can from them.

Monday, July 30, 2012

Hitting the Reset Button


Here I am again. A blonde girl from Georgia sitting in a South American capital city, struggling to keep up with processing everything she sees.  It’s a situation similar to what I faced nine years ago, when I left my home in Birmingham, Alabama to pursue graduate studies in Caracas, Venezuela.

In August 2003, I was 22 years old. I’d just finished college and wanted to see the world. I went to Caracas without knowing anyone, yet never looked back on what I was leaving  behind.  In July 2012, I am 31, and have a husband and two young daughters. We knew what to expect and had family waiting in Bogotá.  But the anticipation of knowing what lay ahead brought heavy realization of what was being left behind.  

In both situations, the ultimate choice to leave was mine. In both situations, the logic seemed strange to outsiders. In both situations, O knew this was the right thing to do.  This time, the man I love came with me.  This time, the choice was more difficult to make. The stakes are higher, but the reward is greater. 

We arrived in Bogotá last Monday, weary from our red-eye flight from Houston but happy to know that we were finally moving forward with our life.  This decision has been a long time coming.  Experiencing the worst year of our lives and the birth of our second child, my husband Juan Carlos and I knew something had to change.

We aren’t sure exactly when it happened, but sometime five or six years into our marriage, the neat little world we’d built for ourselves started to fall apart.  We both had important jobs in respectable companies and, as a result, lived in a nice house in a great city. Our beautiful toddler, Catalina, went to a great preschool and had more than everything she needed to be happy and healthy.  Unfortunately, our drive to excel in our jobs, to be productive all the time and to and provide for our daughter led to workaholism that left everything out of balance. We stayed long hours at the office and came  home exhausted. We stopped taking vacations because we “couldn’t get away.” When we were physically present, our minds were elsewhere. We paid more attention to emails than to each other, even when we were supposed to be having “family time.” I remember pushing Catalina on the swing while looking something up on the iPhone. The two-year-old turned her head around and said, “Mommy, put your phone in your pocket and play with me.”

Finally a series of personal and professional struggles, both in our lives and others, forced us to reexamine our priorities and to rebuild our lives with the proper foundation.

We started to heed instructions given by our pastor, Kerry Shook, who said to “be all there” and to focus on relationships more than accomplishments.  We learned from our  Bible study friends that it is possible to honor God with our jobs, to work with all our heart without losing our souls in the process.

When I was seven months pregnant with our daughter Gabriela, Juan Carlos and I took a quick vacation by ourselves. During the trip, we wrote a vision for our family,  which included functioning as a united team, living with an attitude of thankfulness and service and maintaining a healthy home environment characterized by communication, understanding and acceptance. We committed to live out that vision, whatever the cost.

Seven months later, Juan Carlos resigned from his well-paying 70+ hour-per-week job at an oil company and committed to join his father’s consulting business in Bogotá, Colombia.  The change would allow Juan Carlos to manage his own schedule, spend more time at home and be closer to his parents that he left behind when he left 12 years earlier. It would give the girls a  chance to spend time with their Colombian relatives, to experience a new culture and to speak Spanish fluently. I would have the opportunity to live in the same city as my sister Abby, who works in Bogotá as a missionary. We hadn’t lived in the same city for 13 years.

A move to Bogotá would also bring some sacrifices. We would leave our beautiful home in The Woodlands, Texas, a comfortable community 25 miles north of Houston. We would give up wide roads, ample parking spaces, efficient government services and Walmart.  We would leave good friends and my parents, who moved to The Woodlands to be closer to us and had an incredibly special relationship with the girls. I would leave behind a successful career in public health and emergency preparedness and a professional network that I had been building the past six years.

But throughout the weighing pros and cons, Bogotá always won. The move gave all of us a chance to hit the reset button, to restructure our professional, family and spiritual lives and to align them better with our family vision.  Juan Carlos would be working for himself. Starting a new company, in a new city would provide a great opportunity to work as a united team.  Living in a developing country would provide plenty of opportunities to serve others and to be thankful for all that we have been given. Spending more time at home and managing our own work schedules would help us to build a better home environment and to communicate better. 

The biggest concern Juan Carlos had about the move was how happy I would be in Colombia. I had a good career in the US. My parents were close, and I lived comfortably with all the conveniences I needed. But no matter how great the temporary sacrifices would be, I knew this was the right decision for all of us. 

The moment we decided to make the move, doors began to open. Juan Carlos’s dad became deluged with contracts, though he didn’t solicit a single one. I started to get a sense of release at my job as well. I finished some major projects, delegated responsibilities to others and felt my time with the company was coming to a close. Our closest friends, from Bible study, applauded our decision and supported us along the way. One of the women works as a property manager, and she offered to take care of our house if we leased it while we were away. Her husband runs his own business and told us continually that deciding to work for himself was the best decision he ever made. During our time of transition, the other couple left their jobs and started a new business and began the process of selling their house and relocating. The parallels in each our of lives were amazing, and they helped us all grow together.

My company was supportive of my resignation, and they allowed me to work through July 6. That gave the opportunity for me to transition responsibilities and have insurance coverage for the family through the end of the month.  We decided to lease our house, and put it on the free online classifieds section for our area.  The first couple to inquire about the house ended up leasing it, and they moved in on July 1. Best of all, they wanted the house furnished, so we didn’t have to worry about selling or shipping furniture. We sold our cars  quickly as well and were relieved to not leave them as a burden for my parents to bear after we left. My parents were there for us while we were houseless and carless. They shared their vehicles and their upstairs with us, and we had a temporary home with them during our last three weeks in the United States.

Now we’re spending three weeks with Juan Carlos’s parents. They’ve graciously given us their 3-bedroom condominium in the northern part of Bogotá, and they will move to another building a few blocks away. We’re all staying together until their new place is ready, and, while it’s a little crowded in here sometimes, it is great for us to have help with the girls. The fact that our shipment was delayed a month has turned out to be a blessing. There wouldn’t be space for people if we had 250 cubic feet of clothes, toys and personal belongings stuffed in here. 

Hitting the reset button has not been easy. There have been plenty of hassles and heartaches, and there will be more to come. But in spite of the struggles, I have a great feeling that we’re doing the right thing.  Starting over is hard, but it’s also liberating. It’s easiest to paint a picture of your life when you’re starting with a new sheet of paper.

I’m reminded of the great passage from Isaiah 43:18-19.

“Forget the former things;
    do not dwell on the past.
19 See, I am doing a new thing!
    Now it springs up; do you not perceive it?
I am making a way in the wilderness
    and streams in the wasteland.”

We look forward to seeing what this “new thing” brings for us. We don’t know how long we’ll be here or what is in store for us. But we’re in this together, and that’s all that matters. We truly are blessed.