What the US / South America / Europe gets right and Reflections on a Year Abroad

So now that I've been back in the states for a few months, and fully reminded of its joys and horrors - and after spending a year each in Latin America and Europe and America in the past 3 years, let's look at where the U.S. "gets it right," and where Latin America and Europe get it right.  Keep in mind this is, of course, fairly subjective, but I will TRY to be as objective as possible.  Also keep in mind that if I had done this same exercise, say, 40-50 years ago, things would be DRAMATICALLY different (esp. in regards to the U.S.).

Let's start with HEALTH CARE. Most folks will not be shocked to find the U.S. fails at this miserably - and in almost every marker: access, cost, quality. Sure, if you're filthy rich you can BUY better health care, but the U.S. remains woefully behind every single modern country in this regard. I accessed health care at multiple levels/disciplines in Ecuador and, again, ACCESS/wait times and cost were WAY better - and quality was comparable, if not better.  Ditto for Europe.  Mexico was a little more spotty, but it wouldn't take much to get established with quality providers once settled there. 

COST OF LIVING. Again, no surprise here: even in "cheaper" areas like Oklahoma, the U.S. remains insanely expensive compared to Latin America, and outside of wealthier countries in Europe where I wouldn't be able to retire anyway, more expensive than there. The biggie is rent, of course, and since that's folks' #1 expense.... As mentioned, health care is way cheaper abroad, groceries are cheaper, eating out, entertainment, etc. About the only thing I found that may be of similar cost is electricity - and still cheaper than Oklahoma.

CHOICE: So I did wanna throw in one area where the U.S. still excels. I remember when I was in Peace Corps/Kazakhstan a fellow volunteer showed some kids a pic of his mom in the grocery store (medium sized store in medium size town). The kids asked what was on the shelves. Bill told them, "Looks like jelly." The kids: "What else?" Bill: "Jelly. Just lots of different brands of jelly." Kids: "Why so many different brands?" Bill: "Um...."  So, yeah, the U.S. has more choice/options, but you quickly find you don't NEED 50 diifferent brands of strawberry jelly - especially since Latin America and ESPECIALLY Europe doesn't allow the absolute SHIT that America allows to be put in its food. Boo hoo, there's only one KFC in town?  Well, at least they offer veggie tenders that are not only way healthier, but actually REALLY tasty and I preferred them to the regular/real chicken.

SAFETY/QUALITY OF LIFE: Again, not even close. The everyday stress here is insane. The ignorance, The violence. The hate and racism. The greed. The entitlement. The complete disregard for the environment. I could go on and on. Not too long after we got back here, both DJ and I started having stomach issues and I'm having to spend limited funds on good probiotic supplements to keep us (relatively) healthy. And don't get me started on the possibility of being gunned down in public by some rando angry white dude.

So, on the whole, while it's nice to see family, and nice to have more (CHOICE) of Tex-Mex restaurants, I'm pretty unhappy to be back in this shithole country and am counting the days when I can leave for good/retire. So with THAT in mind, what am I thinking right now?

Firstly, I was very pleasantly surprised with Ecuador. I could totally live in Quito if need be, BUT in a year or two, I plan on going again and checking out Cuenca, which is supposed to be an even better fit for expats and is even cheaper than Quito, and lower elevation wise which would be nice. And strong expat community.

I could totally live in Porto, too, and loved the vibe, the outdoor culture, etc. But I'd probably wanna share an apartmnet with someone there as it's more expensive than Ecuador. But Europe is still the goal for travel options. The one biggest takeaway from my year exploring is that Ecuador is an even better option than I originally thought.  I would also consider a quasi-nomadic life where I go in with someone and buy a home "base" in, say Cuenca or Porto, and then sublet it when I'm traveling, maybe doing trans-oceanic month long cruises, etc.

That being said, to help me be sure, once I can get this little monster stabllized, I'm planning on one more scouting trip abroad to check out: Medellin, Colombia; Cuenca, Ecuador; somewhere in Spain; Estonia and/or Lithuania; eastern Europe (Georgia, Romania); and possibly Hanoi, Vietnam (apparently one of the few places in Asia where it's not ungodly hot/humid most of the year - AND so my little monster can see his "heritage.").

Health and Medical Care in Ecuador

So I put off by a few months my latest teeth cleaning as I wanted to see what it was like in Ecuador. By luck of timing, I also needed a specialist follow up with an opthalmologist, DJ needed a Pediatrician and an Optometrist/glasses, and I also needed a dermatologist.  We also ended up needing multiple prescriptions.  

Luckily, all went well. I got a suggestion from an expat group here for a "pricier" dentist highly recommended so I forked over a whopping $25 to get an exam and cleaning. Their office was in a modern high rise near Carolina Park. I arrived 5 mins before my appointment and was immediately whisked in to a super moden, super clean exam room with a view of the park while she did the cleaning. And yes, using the modern water blasting tools and not those horrid needle like diggers/scrapers.  Of course she did try to sell me some teeth whitening sessions, but I played off the "no habla espanol" and got in and out within a half hour.  Score.

For the specialists/medical, again relying on the advice of other expats, we chose Veris, which is a medical org here with multiple locations. They had one a couple blocks off a metro stop just one past our usual stop at Carolina park for eating out, movies, and shopping.  The appointments for the dermatologist, the pediatrician, and the opthalmologist were between $35 - $40 each. Every time, we got in right at our scheduled appointment time, with the exception of waiting 5 mins. for DJ's pediatrician appointment due to the previous patient being late for their appointment.

The Veris offices are also super modern, super clean, all the latest technology, etc.  We each got multiple prescriptions that were between $2 - $10 each. None of the doctors spoke fluent English (altho my opthalmologist was close), so we used Google translate. Finally, the optometrist was the most pricey, but even then it was just under $180 for the exam, frames, and lenses with UV and blue light protection/coating. We could have paid about $20 less for different frames, but I let him "splurge" a bit for the holidays. lol  Obviously, these costs would be lower/disappear if I elected to move here and got insurance.

I really have nothing negative to say about our experiences, and in fact I was VERY happy about the lack of wait time. Whenever I scheduled an appointment, we could get in within a few days, and as mentioned above, ZERO wait time beyond our scheduled appointment times - it drove me INSANE to get to my doctor's appt. in the states at the appointed time and then wait. And wait. And wait. More than once, I left doctor's offices in a huff, telling them my time was just as important as theirs and I would need to reschedule.

In other health news, I've lost nearly 20 pounds since leaving the states not quite 8 months ago. This wasn't necessarily by design, it's just a result of eating less junk, drinking less soda, and walking more.  I did a little research and from a UN site found the following interesting comparisons--Ecuador is on the left and the US on the right:

Skill and competency of medical staff		Very High 81.17		High 72.22
Speed in completing examinations and reports		High 78.44		High 69.85
Equipment for modern diagnosis and treatment		High 79.10		Very High 84.27
Accuracy and completeness in filling out reports		High 77.71		High 72.72
Friendliness and courtesy of the staff		Very High 81.08		High 73.42
Responsiveness (waitings) in medical institutions		High 72.80		Moderate 58.66
Satisfaction with Cost to you		High 73.28		Moderate 46.60
Convenience of location for you		Very High 82.67		High 78.49
In terms of the overall health care index, when comparing the U.S., UK, Germany, Italy, France, Japan, China, and Russia, Ecuador was tied with Japan for highest score (the US only beat Russia and Italy).