Health Care Providers

Reminiscing about our first three years living in Portugal after relocating from the USA, I remember when we went to see a doctor for the first time.

No, nothing was wrong; our health, thankfully, was fine. But we had just about exhausted our medicines and needed to renew and refill our prescriptions.
Which meant a visit to the doctor.

Consulting friends and acquaintances associated with us through the local online expat groups, a variety of suggestions and referrals were offered. Basically, they came down to these two:

(1) Find an English-speaking “private” doctor through our insurance plan, pay for his/her time and services (“quite reasonable,” we were told), and leave with the needed prescriptions to take to our local farmácia; or

(2) Begin using the Portuguese health system by visiting our town’s “Centro de Saúde,” where our primary physician would be located, and explain that we would pay directly for the services we needed now.

Of course, everything would rely on Google Translate, since the number of Portuguese words we knew – and could pronounce – back then only had expanded from five to nearly ten. Plus, we are Americans who, unlike our EU brethren that arrive in another Schengen nation with health cards and coverage from their homelands, we only had emergency medical coverage through our travel insurance. And, although we had been here for a month already with residency visas affixed to our passports, it would be another 20 days until our SEF appointment, when (hopefully!) our residency visa and required paperwork would provide us with proper permits—at least for a year or two, to begin with. This residency, in turn, would enable us to register for the needed number to avail ourselves of the low-cost Portuguese health care system … even if we were to pay out of pocket or be covered by our private health care insurance.

Since I was retired and not earning income from either the USA or Portugal, I didn’t need to register, first, at the Castelo Branco Social Security office before requesting my health care number; later, Russ would learn, that – since he was working remotely with USA-based clients – he should have registered at Social Security and, then, sought his health care number.

We decided to take our chances, first, and visit our village health center. Armed with a print out of the Google-translated document explaining (in Portuguese) who we are and why we were there – along with our NIF documents, passports and visas, medical records, and empty prescription pill bottles – I ventured a try during a day and time the sign posted on its door said the health center would be open.

Only a nurse was there that day.

Using her best ten words of English interspersed with Portuguese, which I responded to with my only ten words of Portuguese interspersed with Spanish, I understood that she was telling me to come back the following Tuesday, after 10:00 AM, when the doctor would be there.

Unfortunately, the following Tuesday was one of those holidays to which the Portuguese people are entitled and they take quite seriously. So, of course, the health center was closed.

Attempting again two weeks later, we entered the health center to find a raucous group: people of all ages and medical conditions standing in the entry way or sitting in the waiting room, expecting to be seen by the doctor or nurse. The administrative assistant had taken a break to get some coffee from a café down the road a bit; we’d have to wait to talk with her before we could proceed any further.

Despite our introductory letter translated into Google’s best Brazilian Portuguese, the keeper of the files and records was at a total loss as to what to do and how to process us … after all, we didn’t have those specific numbers her computer program required to grant us access to the sanctum sanctorum. After discussing our situation with other patients waiting to register for the doctor (or nurse), she picked up the phone and dialed someone somewhere … raising her voice with each question she asked and every answer she gave.

After hearing her say, “Tá bem, tá bem, obrigada, obrigada, ciao,” she turned to me and managed to explain that we needed to go to the regional medical center in Alcains – about a 15-minute drive – at 15:00 and ask for Sandra, who had been made aware of our circumstances.

Sandra knew exactly who we were and why we were there. But figuring out which boxes to tick and how to input our personal information was a challenge that required 40 minutes and the help of three other people seated with her in the reception area. Finally, the printer spat out two pieces of paper from which she cut off the bottoms, stamped each with a seal, and signed them. “That will be nine euros,” she said, about US $10, “€4.50 each for the doctor’s consultation.”

She also gave us forms whose many boxes were populated with numbers now.

“The next time,” she explained, “You will go to your own health center in Lousa and show them these papers. They will now have the information they need to serve you there.”

“Muito obrigados!” we replied, effusive in our gratitude.

The doctor, who had been sitting there throughout the entire episode, motioned us to follow her back to her office. Seated behind her desk, she entered some information into a computer and gathered each of our medicines needing refills. Click, click, click. Out from the printer came official forms containing our prescriptions … along with the maximum amount we could be charged for each.

We left the Alcains medical center and headed for the pharmacy.

All told, we had prescriptions for 20 mg Cectoconazol (30 g) cream with three refills; fifty-six, 20 mg Omeprazol capsules (sold over-the-counter without a prescription in the USA), also with three refills; 120, 1 mg Alprazolam (generic Xanax) pills sold in “blister” packs, requiring a new prescription to refill; a blister pack of 60, 15 mg Meloxicam pills; and another blister pack of 60 pills combining two separate prescriptions – 20 mgs + 15 mgs of Olmesartan medoxomilo + Hidroclororotiazida (one for high blood pressure, the other a diuretic) — also with three refills.

The combined cost for all these 13 boxes of medicines, some of which will last us for six months?

Fifty-one euros.

Less than US $60.00.

And that’s without insurance, co-payments, or deductibles.

The same supply of pharmaceuticals – even with Medicare or health insurance – would easily cost us hundreds of dollars more (at least) in the USA. Because Portugal and Spain subsidize their health care, taking a major burden of their people: citizens and residents.

Believe it or not, the same Portuguese prescriptions cost even less in Spain!

Exceptional, low-cost health care is yet another reason why we do so love Iberia.

It’s patience that we still need to develop.

Shared here are personal observations, experiences, and happenstance that actually occurred to us as we moved from the USA to begin a new life in Portugal and Spain. Collected and compiled in EXPAT: Leaving the USA for Good, the book is available in hardcover, paperback, and eBook editions from Amazon and most online booksellers.

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