Last year, my Brazilian fiancée discovered a growing lump at the opening of her vagina. Concerned, she went to the local public hospital, where all medical care is free, to see a gynecologist. It was determined that she had a Bartholyn cyst, a fairly common and normally benign problem, that nonetheless would require surgery. The gynecologist explained that the options would be to remove or drain this cyst, the difference being that removal was a more invasive surgery with a longer recovery time while drainage was less invasive but in 10% - 30% of cases the cysts return within a few years. We had to make these choices in Brazil.
My wife didn't want to be operated upon in the public hospital, and I couldn't really blame her. The gynecologist was impersonal and otherwise treated her questions dismissively. He was very experienced and well-renowned as a surgeon, but my wife understandably wanted nothing to do with him. Moreover, care in the public hospital tends to be impersonal and dispassionate, and patients recover in large rooms with other patients. My fiancée wanted to be operated upon in a private clinic but, with no health insurance, we would have to pay for it out-of-pocket.
Our only alternative was to to go a private hospital. Five blocks from our house there is a new and brightly-painted private hospital with hyper-clean waiting rooms and the air of a private clinic. We were able to arrange an appointment with an excellent gynecologist within a week, and my wife and I attended the consultation, although she underwent the examination alone. The gynecologist's office was new, bright and spotlessly clean and the doctor was attentive and respectful.
He explained that he always removed Bartholyn cysts rather than drain them, because that settles the problem with no chance that the cyst will recur. The procedure would require an overnight stay in the hospital and the services of an anesthesiologist. Without insurance, we were apprehensive about the cost, but the doctor was willing to negotiate. Although he and the hospital usually charged a flat fee of 750 Brazilian Reais ($375.00 USD) for all of the these services combined, in our case they would accept 600 Reais ($300.00 USD). Although the fee would have to be paid at the time of service, as is standard at private hospitals in Brazil, they would agree to be paid half of the total in cash at the time of the operation with the other half in a post-dated check.
So these were our choices in Brazil:
(1) We could have the operation done for free in a public hospital with no choice of doctor and a large shared recovery room or,
(2) We could have the operation done in a private hospital with an excellent and personable gynecologist, and a private recovery room for a grand total of $300.00 USD, that we could afford in two payments.
I weighed the price of the surgery the way any computer-geek would: as a percentage of the price of a new computer. If we went with the private hospital, the operation and private recovery room, all told, would cost one-third the price of a new computer. 600 Reais is a lot of money in Brazil, equal to two months of salary at the Brazilian minimum wage. But, I had the money available and it was important to my fiancée to do it this way, so we went with the private hospital.
I was concerned about my fiancée being anesthetized, because there is always a risk involved. She had three children, and we were already living together as a family, so I could easily become a single parent of three step-children if anything went wrong.
After the operation, as the anesthesia wore off, my wife was terribly cold and shivering feverishly and I thought she was going to die. These were, apparently, the normal effects of anesthesia. The nurses wheeled my fiancée to her private room where I held her hand until she fell asleep, and then I crawled into the bed next to her, and I fell asleep as well.
The nurses were kind, polite and considerate. The hospital was quiet at night and we were both able to sleep peacefully.
The next afternoon, at check-out time, we met the doctor and he reported that all had gone quite well. He handed us the cyst in a plastic vial, about the size and color of a beef wanton from a Chinese restaurant, floating in a bath of formaldehyde. He suggested that we have it analyzed, although experience dictated there was little risk.
Although I had initially felt very suspicious of this doctor, who preferred invasive overnight surgery when a day procedure would have been possible, I had to admit that the total bill for the gynecological surgery, anesthesiologist and a private recovery room, all of which we paid to him directly, was quite reasonable. What can you get medically in the United States for $300.00 USD after all? And the operation had been a complete success.
Thinking about it that way, I was so pleased with the experience that I decided to pay the entire bill at once, in cash. I counted out the 300.00 dollars, shook the doctor's hand and took my wife home in the waiting cab.
I'm grateful to have had the money for private care that was very affordable, but I am also reassured to know that free public care is available from the Brazilian Government should we have to rely on it, with no pre-applications, pre-qualifications, income guidelines or immigration restrictions. Someday, I hope affordable medical care will be just as available in the United States.
For another Manic Lawyer diary on health care in Brazil, see "Doc, Where's the Cash Register?"
[ http://www.dailykos.com/story/2006/9/23/221929/065 ]