Navigating The Brazilian Medical System

As some of you may know, I have started getting serious about running again. After a really poor marathon in 2015, I decided it was time to get back out there and have a good marathon experience.  I have been training hard through the first half of 2017 and had some good success in shorter races at the beginning of the year.

When I started looking at marathons, I thought it might be fun to do one while we were in Sao Paulo. After much struggling with the requirements for foreigners I registered for the Sao Paulo City Marathon on July 30 (the weekend after my work assignment in Brazil ends).  I was doing a great job of training while in Brazil, relying on a combination of our hotel’s gym and the wonderful park a mile from our place.  I was able to go on some really nice runs in Rio de Janeiro as well.

Copa
Run along Copacabana and Ipanema

Unfortunately, while running two weeks ago I experienced some very bad pain in my hamstring. Bad enough I had to bail on my run and couldn’t get back to it for several days.  After giving the hamstring a break with no improvement, I decided it was time to explore the Brazilian medical system. Fortunately, EY provided international insurance (ISOS) for the duration of the trip. ISOS has a team of specialists on-call 24/7 with a range of language specialists to help book appointments and navigate local health care issues.  While the team at ISOS has been great, it is challenging at times to get a hold of them, as it can only be through calls to U.S. numbers (extremely difficult in Brazil) or email (slow response time when I am standing at a hospital trying to make a future appointment).

So I called ISOS to book an appointment. Despite assuring the team at ISOS that I needed an orthopedist, I was told that I had to go to a generalist first. I was impressed they were able to set up an appointment the same day. I headed to meet my new doctor at the lovely Centro Medico Sergipe building. Centro

There are very few people in Brazil that speak English, even in comparison to places I would not expect large English speaking populations like Peru, Vietnam, or Cambodia. I try to speak Portuguese with everyone I meet, but sometimes that proves to be a losing proposition as well. I have found that if I admit I don’t speak great Portuguese early in a conversation, most people won’t even try to understand what I am saying. However, if I never admit that I don’t speak Portuguese, people will generally work harder to understand me.  It’s weird. Regardless, through my broken Portuguese I was able to get in to see the doctor.

The one criteria ISOS used in booking my appointment seemed to be finding an English speaking doctor – so once I got into his office things went pretty well. But, for medical purposes the doctor’s English as a second language combined with my bad Portuguese still left something to be desired.  After an hour of conversation and mild poking and prodding, it was decided that I did have a hamstring injury (who would have thought). This meant a further referral to the orthopedic specialist as I requested in the first place. To add to the fun, my insurance would not cover the orthopedic specialist the general practitioner (chosen by my insurance) referred me to.

Which is how I found myself at Albert Einstein Hospital on a Monday night.

floricultura-cemiterio-velorio-hospital-albert-einstein-morumbi-sao-paulo

One thing about Brazil: everything requires an extra degree of security. Whether that be to get off on a specific floor in your hotel, to visit the ID processing building, or in this case to visit the hospital. I had to have a photo taken, share my Brazilian and U.S. documentation, and have a finger print taken just to get in the door. I find this level of security adds a sense of stress and…heaviness to every day activities. Sort of highlights that you’re not in the U.S. anymore and things are maybe not quite as safe as you’re used to.

The nice things about Albert Einstein Hospital: it’s a gorgeous new facility and they maintain English speaking hospitality staff to escort dumb Americans.  So I was given a personal interpreter for much of the evening.

Eventually I was able to see the orthopedic specialist (after my helpful English speaking guide ditched me). The doctor spoke some English, but things were a little muddy in our communication. The ultimate result of our conversation was a “prescription” for an ultrasound and 10 physical therapy sessions.  I thought it was odd to get assigned physical therapy before seeing the results of the ultrasound, but I guess I am not the doctor here. The ISOS folks don’t have a local number to call, so I could not immediately schedule the ultrasound (I wasn’t going to pay BRL$700 on the hope I could get reimbursed). However, ISOS took care of it quickly the next morning when I was able to call and scheduled my follow up doctors appointment and physical therapy too!

So now I am now at my third Brazilian medical facility awaiting my ultrasound. I am honestly quite impressed with how fast and helpful the ISOS team has been (minus not having local numbers to call). The other remarkable thing is that I have not had to wait for medical personnel to see me. Appointments have started on time, every time.  Which is a nice change of pace!

Hopefully, the ultrasound shows no major issues and I am able to get back to running soon!

 

 

 

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First Trimester Screening

On March 22, I had a 45 minute ultrasound at the fetal medicine clinic as part of the first trimester screening. They will do the second part, blood tests, at my next doctor visit. I was waiting to post until I heard anything, but I got tired of waiting. The screening evaluates the risk for chromosomal abnormalities, specifically Down Syndrome (trisomal 21) and extra sequences of chromosome 18 (trisomal 18). At the ultrasound, the tech took pictures of the heart, facial bone structure, neck, and brain.

Twin B was putting on a show, actively waving and kicking and even squishing Twin A! Twin A was very comfortable laying as if in a hammock, which made it a little harder to measure the nuchal translucency (the amount of fluid in the neck). They both looked like they may have been sucking their thumbs, and it was adorable to see them laying as if they were in bunk beds. I guess we know a little bit about our Twins’ personalities already!

 

Early Ultrasound

On Friday February 26, we were excited and nervous to finally visit the doctor for an early ultrasound. I was 8 weeks and 6 days along; I had suffered from indigestion and nausea, Derek had suffered through my restless nights and mood swings, and the dogs were used to me laying on the couch in the fetal position. Derek and I were definitely read to see our little raspberry that would make these past 2 months and future 7 months worth it!

The doctor’s office didn’t make us wait too long, and we were quickly ushered into an ultrasound room by the tech. Almost immediately she said, “Well it’s a good thing you two are sitting down because you are having twins!” I laughed out loud. Derek and I had joked about having twins, and growing up, I had always wanted twins – a boy and a girl. Derek and I were both still excited and in shock, as we watched the tech check out each baby. It was an incredible experience to see both babies, and we were thankful to find out they had healthy heartbeats and sizes.

We decided that it was time to tell our families. While our parents knew we were expecting come September, our siblings and extended families still were in the dark. Most of our family members took some convincing that yes indeed we were actually having twins. Only about 4% of babies in the US are born as multiples, and twins tend to run on the maternal side! While, I am predisposed to twins due to genetics (maternal Great Grandma Goodendorf’s mom was a twin and paternal Grandfather Kimutis had twin sisters), we do not have any of the other factors (Factors that Increase the Odds of Having Twins).  On Friday evening, the reality of the pregnancy, risks of multiples, and the cost of multiples set in.