On April 3rd, ‘Travelling student’ posted a delightful article on her “Experience with Slovenian Socialized Medicine”. It brought back memories of my own experience with healthcare outside the U.S. So here it goes.

A couple of years ago, we visited the Galapagos Islands. On the last day, I fractured the fifth metatarsal of my left foot; this is the bone that connects the little toe to the heel (via a small cube-like bone unsurprisingly called the cuboid), labeled number 5 in the diagram below.

I fractured #5.

That was bad news because this particular fracture has a high incidence of non-union. If this happens, surgery is in order.


Monte Sinai

Cuenca, a colonial town of red roofs and beautiful cathedrals

The next day, we flew to the charming town of Cuenca, on the mainland of Ecuador. At the hotel, they recommended two hospitals. I chose Monte Sinai, probably because of the comforting familiarity of the name. I also secretly hoped that it had some connection to Moses. Still, I have to admit to being a bit worried. Many years ago, I visited a hospital in Lima, Peru that catered to the poor and the facilities there were not exactly state of the art. Is this Mt. Sinai going to be clean? Is sterility rigorously kept? Are Ecuadorian doctors in this small town any good?

My doubts evaporated the moment we stepped in. The reception room was immaculately clean, tastefully furnished, and a cheerful receptionist led me straight to the ER. No questions about insurance, no credit cards—just honest concern about my injury.

In the ER, I was seen within 5 minutes. The ER doc spent 2 minutes taking history and a quick examination of my foot, and I was promptly transported to the Radiology suite. No waiting there either. Within 15 minutes, I was back in the ER. The doctor was already reading the films…on a computer screen. He identified the fracture and called the orthopedic surgeon on call. Judging by my own experience of getting a consult in the U.S., I settled down for a long wait. I was surprised when the surgeon showed up within 10-15 minutes. But the real surprise came when I struck a conversation with him. Like every doctor, we “feel out” each other with questions of “where did you go to medical school?” and “where did you train?”. You sort of place him on the socio-medical ladder, not very different from dogs sniffing each other—you know where to find out which one of them is the alpha. Well, my Ecuadorian doctor finished medical school in Quito, Ecuador and received his training at The Hospital for Special Surgery in New York. This happens to be the Mecca of orthopedic surgery in the U.S. You get admitted to the program there if you graduated from Harvard, Johns Hopkins, Stanford, and… Quito!

I was prepared to grant the doctor his alpha status, based on “smelling” his medical credentials. I felt completely at ease trusting the care of my poor fractured fifth metatarsal in his capable hands. As he was preparing the cast, we struck a conversation about bones, which meandered to bone metabolism, to collagen structure, and to my questioning of “How do you know so much about such esoteric subjects?”. The doctor replied, “Oh, after my training at Special Surgery, I spent several years in Tokyo doing research on connective tissue, for which I received my Ph.D.” I was blown away; how many American orthopedic surgeons bother to learn about bone biochemistry, let alone do research and get a Ph.D on the subject? Now, that’s not just any research lab. I know the Japanese group where he did his research; this is one of the premier laboratories of biomechanics in the world! A doctor in Cuenca, Ecuador!

The visit was over in approximately 90 minutes, including chatting with the doc about the triple-helical structure of collagen fibers while waiting for the swelling to go down. How long would such a case take in an American hospital? Just the wait in the ER waiting room would be longer.

It was time to pay the bill. A young lady from accounting showed up with a potted plant and said, “This is for you so that your memory of Ecuador will be pleasant.” Pleasant? I was awed!

Oh, yes, the bill. It was a princely sum of $270! I was sure she dropped a zero. Did I get a professional courtesy? Nope. Kaiser, my HMO, reimbursed me for $250 only. Why the discrepancy? Because they don’t cover the pain medication. I love Kaiser; the care I am getting there is second to none (in America, that is). But the difference in attitude between our “exceptional” healthcare system and the unassuming Ecuadorians who make no claims to “exceptionalism” is striking. Food for thought.

Dov Michaeli, MD, PhD
Dov Michaeli, MD, PhD loves to write about the brain and human behavior as well as translate complicated basic science concepts into entertainment for the rest of us. He was a professor at the University of California San Francisco before leaving to enter the world of biotech. He served as the Chief Medical Officer of biotech companies, including Aphton Corporation. He also founded and served as the CEO of Madah Medica, an early stage biotech company developing products to improve post-surgical pain control. He is now retired and enjoys working out, following the stock market, travelling the world, and, of course, writing for TDWI.


  1. In 2014 I would like to come to Ecuador to visit cities of
    Cotacachi and Cuenca with my wife Evelyn. Stay about 30 days
    before going back to California. We would bring our two Chihuahuas.
    Would like to meet Dan Prescher and Susan Haskins who live in Cotacachi.
    Your suggestions for lodging for a month would be wonderful. Our goal may be
    eventually 6 months in Ecuador and possibly another country before returning to CA
    each year. International Living has much to help us. Thanks very much.
    Norm Southerby
    760 534-8823

  2. I am looking for a Orthopedic surgeon that specializes in knee replacement in Ecuador. Any help would be much appreciated.Thank You Randy


Please enter your comment!
Please enter your name here

This site uses Akismet to reduce spam. Learn how your comment data is processed.