Does your talent lie in travel or in living abroad? Though some people are good at both and others not cut out for either, the skill sets involved are surprisingly different.

There’s a great passage about the difference between being a born traveler and a born expat in Committed, Elizabeth Gilbert’s sequel to her astonishingly successful travel memoir, Eat, Pray, Love.

Committed is a skeptic’s look at marriage from all angles, sparked by Gilbert’s decision to wed Felipe, the Brazilian man she meets in Bali at the end of Eat Pray Love. (Javier Bardem plays Felipe in the upcoming movie, which almost makes up for Julia Roberts playing Gilbert.)

The eight chapters of Committed have titles like “Marriage and History,” “Marriage and Ceremony,’ and “Marriage and Subversion.” The event that started Gilbert’s exhaustive look at this hallowed and maligned institution was that she and her boyfriend Felipe were pushed into marriage because the U.S. Department of Homeland Security suddenly decides that Felipe can no longer enter the U.S. Now if she were married to a U.S. citizen, suggests a friendly Homeland Security agent, things might be easier…

But the official hoops they have to jump through and the strains it puts in their relationship are anything but easy.

Gilbert’s experience mirrors some of what I’ve been through—marrying for immigration purposes to a foreign-born lover you’re already committed to, so hey, Why not make it legal so that your lives are easier in the face of capricious and punishing laws? And then the fun (aka trouble) begins, especially if you both have different ideas of just what marriage means.

Although the book is a kaleidoscopic exploration of just that–what marriage means–I’m not finding what I was looking for in Committed. For my tastes, there’s not enough about cross-cultural relationships, or about how a relationship can change (and not always for the better) when you make it official. But of course that’s not the book Gilbert set out to write, so I can’t really fault her for not writing what I most want to read. As many writers have noted, when you don’t find what you want to read, well, then go write it yourself!

What I did find in Committed, on pages 216 – 221, was a sharply drawn description of the differences between a born traveler and a born live-abroader.

Here’s the background: Gilbert and Felipe, her Brazilian honey, are homeless, waiting to have his visa approved so they can both return to the U.S. and start building a life there together. They’re wandering through Southeast Asia, and after six months of such travel and of being with each other night and day, tempers are fraying. Gilbert has been hurrying them from one cheap hotel room to the next, trying to keep their anxiety at bay, when she realizes that that technique doesn’t seem to work for her partner. Gilbert writes:

“Like a fussy baby who can fall asleep in a moving car, I have always been comforted with the tempo of travel. I’d always assumed that Felipe operated on the same principle; since he was the most widely traveled person I’ve ever met. But he didn’t seem to enjoy any of this drifting.

…The reality about Felipe, as I was beginning to realize, is that he’s both the best traveler I’ve ever met and by far the worst. He hates strange bathrooms and dirty restaurants and uncomfortable trains and foreign beds—all of which pretty much define the act of traveling. Given a choice, he will always select a lifestyle of routine, familiarity, and reassuringly boring everyday practices. All of which might make you assume that the man is not fit to be a traveler at all.

But you would be wrong to assume that, for here is Felipe’s traveling gift, his superpower, the secret weapon that renders him peerless: He can create a familiar habitat of reassuringly boring everyday practices for himself anyplace, if you just let him stay in one spot. He can assimilate absolutely anywhere on the planet in the space of about three days, and then he’s capable of staying put in that place for the next decade or so without complaint.

This is why Felipe has been able to live all over the world. Not merely travel, but live. Over the years, he has folded himself into societies from South American to Europe, from the Middle East to the South Pacific. He arrives somewhere utterly new, decides he likes the place, moves right in, learns the language, and instantly becomes a local.”

So how about you? Are you more of a traveler, like Gilbert, or a born expat, like Felipe?

Photo by Erin Van Rheenen

Eat, Pray, Love, Elizabeth Gilbert’s ubiquitous travel memoir, is now a movie starring Julia Roberts as Gilbert. If the trailer is any indication, the film emphasizes the glib aspects of a memoir that teeters between messy real life and staged epiphanies. In the film, our first glimpse of Roberts/Gilbert, reacting to the prophecy of the requisite toothless holy man, shows a flash of Robert’s patented self-satisfied smirk. This doesn’t bode well for the film, which opens August 13.

Here’s the trailer:

For those three or four people who’ve never heard of Eat, Pray, Love, suffice to say that it’s self-realization and travel porn for the thinking woman.

Despite my reservations, I won’t be able to resist seeing the film anymore than I could resist reading the book. Critics were less than kind. Maureen Callahan called the book “narcissistic New Age reading.” Lev Grossman said the author was “trying too hard to be liked.” Grace Lichtenstein said the only thing wrong with the book is that “it seems so much like a Jennifer Aniston movie.”

I agree with all of those critics, and yet I tore through Eat, Pray, Love, reveling in Gilbert’s incisive descriptions of far-flung locales and internal states, spouting select quotes to my friends, and giving the book as a gift to more than one (woman) friend. Gilbert is compulsively readable, and if afterwards I felt a little queasy about the fast food feast I’d just wolfed down, in the midst of the meal I thought I was absorbing valuable nutrients.

And the film? Well, Javier Bardem plays Felipe, the Brazilian guy Gilbert falls for in Bali. I’ll go just to hear how a Spaniard tackles a Brazilian accent.

The Institute of Cellular Medicine (ICM) in San Jose, Costa Rica, which opened in 2006 and has treated hundreds of people, recently shut down its clinic.

Stem cell treatments, which introduce new cells into damaged tissue in order to treat a disease or injury, have both been hailed as the new wave in medicine and vilified as a scam preying on desperate people. Such treatments have not been approved by the U.S. Food and Drug Administration, meaning they have not undergone the lengthy human clinical trials that would allow such federal approval.

While the Costa Rica clinic has closed, the company’s Panama City stem cell clinic is still open.

An article on the Popular Science blog says that the Costa Rican health ministry stopped ICM’s stem cell treatments because there is no hard scientific evidence indicating that the treatments work. But a comment on that same post (apparently from someone at ICM) offers the alternate view that “the ‘closure’ of the clinic was a business decision by the company to consolidate operations.”

Popular Science also has an interesting article about stem cell tourism in general, focusing on treatments available in the Dominican Republic. “Droves of patients are heading overseas for stem-cell therapies unavailable in the U.S,” says the article. “ Is it a dangerous scam — or is America just behind the curve?”

Here’s more on the clinic closure from the Guardian.

Dear Miss Move Abroad,

I want to thank you. I read your book [Living Abroad in Costa Rica]  in December of 09. At the time I was going through some rough times (death and divorce), and I decided to travel to Costa Rica to just get some relief. I was dazzled by it. I was there seven days, the Central Valley (San José and the Arenal area), and the mid-Pacific area (Jacó, Quepos, Manual Antonio), and you’re right, it’s a little bit of paradise.

I truly want to live there or try it. I live in Minnesota and except for summer cannot stand it. At present I work as a metal worker. I am a shop foreman in a steel/aluminum plant with 30 men under me. I have always been a man of the left (social democrat, democratic socialist, trade union type). I want to simplify my life, I am done with the rat race, and I just cannot do it any more. I want to live intentionally. If you know any community or communal style living, like a religious or spiritual group, I may be interested.

I am 58, and have about 4 years before I can get Social Security, but have a bit of money in my 401k plan (I lost a fair amount in the stock exchange). How much would I need a year to live, renting a house somewhere in a town outside San Jose or around La Fortuna? I have in mind a smaller two-bedroom home with a small yard for my Collies. Could I find something for $500 – $600 a month? I would also need to buy into the national health insurance; would that be about $60.00 a month? I own two motorcycles–I would ship both to Costa Rica, also mountain and racing bicycles.

Could I do it all on $1,600 a month, or about $20,000 a year?

Thanks,

Dan

To read my detailed answer to Dan, and to see the added suggestions of many expats living in Costa Rica, head on over to my Costa Rica blog.

Photo of footbridge on Costa Rica’s Osa Peninsula by David W. Smith.

Dear Miss Move Abroad,

I plan to move to Panama next year and wanted your advice on how best to bring my possessions with me. I want to bring my cars, my appliances, and most of my furniture. I plan to ship a container from Miami to Panama, but hear that getting a container through customs can be a headache. Any advice?

Canal-bound

_______________________

Dear Canal-bound,

I saw a bumper sticker the other day that read:

DESIRE

ACQUIRE

DISCARD

REPEAT

We all live within that cycle, but we can resist it if we put in some effort.

My advice to you is to pare down. (If you know now that paring down for you is as likely as rock-hard abs for Santa Clause, then skip to some concrete advice on shipping to Panama).

But why lug your old life with you to a new country, especially when you have to pay so dearly for the privilege? And you will pay–thousands of dollars for shipping, high tariffs (duties on imported goods), and time and energy navigating the bureaucracy.

The easiest way to bring your possessions into Panama is as checked luggage on a flight. But most people–even adventurous souls who decide to pick up and move to another country–have a lot of stuff that they’ve accumulated over the years.

If you’ve lived in one place for a while, I’ll bet that you’ve been meaning to purge your belongings–to have a garage sale or take a few trips to the Salvation Army drop-off station.

It feels good to pare down, and a lot of people who move abroad do so in part because they want to simplify their lives.

You can start simplifying long before you make the move, by thinking carefully about what possessions you can’t live without, then selling or giving away the rest.

“I thought about selling all my favorite things, all the great stuff I’ve collected over the years, and I just couldn’t do it,” says Mary Ann Jackson, who moved to Costa Rica in 2004. “But I wasn’t going to lug it all with me, either. So I gave it all away to friends. Now I can visit my stuff in their houses.”

But ok, if you want to ignore my advice and still bring all your stuff to Panama in a container, then here’s some practical tips on shipping to Panama, courtesy of Our Man in Boquete, a German-born jazz-loving former airline pilot who relocated to Panama in late 2009.

Photo of skateboarders in Panama City by David W. Smith.

If you’re moving to Panama (or anywhere), it makes sense to pare down. But if after the garage sale and the dump run and donating your clunker to your nephew, you’ve still got stuff to ship, here’s some firsthand advice from Our Man in Boquete, who relocated to Panama in late 2009. Scroll to the bottom for advice on shipping cars, though Our Man’s basic advice is: Don’t Do It!

“First, if you already have a pensionado visa granting you residency in Panama, you may import US$10,000 worth of used household goods duty-free. If you don’t have residency, you’ll have to pay customs duty on everything. Basically it’s 5% as far as I know. It depends, however, on the discretion of the customs guys to appraise the value of the goods, so it’s an open field (and subject to how much you’re willing to bribe). It doesn’t help to show receipts from where you bought the stuff; they are free to appraise whatever they want.”

Heading for Chiriqui? Arrange for customs clearance in David

“Try to avoid having customs clearance done in Balboa harbor (that’s the harbor at the Pacific end of the Panama Canal) or in Colon (at the Caribbean end of the canal). If you’re intending to live anywhere in the province of Chiriqui [like the expat haven of Boquete], ask the shipping agent to have the container dispatched to David [after it goes through the canal] for customs clearance. To achieve this it is very important to have the destination in the Bill of Loading read: “To____(the place where you’re going to live) via David” Insist on this with your U.S. shipping agent and/or the local agent contracted by the U.S. shipper.

“There’s a very small customs office near the David airport, and it’s much easier to get the stuff through customs here. There’s a lady named Juana who’s in charge of imports (Spanish speaking only), and a small “regalo” (gift) passed discretely via handshake helps smooth the procedure considerably.”

Don’t sit on your hands

“It is also very important and helpful to be present in person a couple of days before the shipment is due to arrive in port [Balboa or Colon], and to contact the local agent directly. Get involved — don’t leave it to the discretion of your agent! There may be many kinds of problems showing up anytime…and for every day the container stays in the harbor they’ll charge you an additional $125. Again, having the container shipped to David for customs clearance avoids this possible storage problem since the container will only stay in port for the minimum required time before going on to David. Also, David customs most likely won’t charge you exotic fees like “Quarantine exemption fee for wooden furniture” or “Fee for unusually extensive customs inspection” that might (and did, for people I know) occur at those other customs offices. It goes without saying that one should be also present at the customs office where clearance will take place.”

(Not) importing cars into Panama

Our Man in Boquete strongly advises not importing cars to Panama. “From everything I’ve heard,” he writes, “it’s a nerve-wracking and costly procedure. There’s the appraisal problem, where they don’t give a damn about what you paid for your car in the U.S. They will also keep your car(s) in custody for as long as all the necessary paperwork needs to be finished, and that can take months!

“And they’ll charge you storage costs for each and every day.

“If you’re willing to cough up a couple of grand it may speed up the procedure but why do this? Cars in Panama are reasonably priced and readily available, so unless you’ve hung your heart on a very special car it really doesn’t make sense to import a car here.

“One more note: Although by law you’re entitled to import a car duty-free every two years if you’ve got a pensionado visa, hardly anybody is doing it. Why not? Well, although you won’t have to pay customs duty, they’ll charge you a 5% “sales tax” based (again) on their free-ranging appraisal of the car’s value, plus storage fees and the whole shebang.”

Parting advice

“Basically, I’d advise to scale down the amount of stuff to be shipped. Moving to another country also is some kind of a new beginning, so why carry all that old baggage with you?”

Miss Move Abroad agrees.

It’s not a decision made lightly, and it’s not, as some might imagine, usually motivated by politics. But more and more expats abroad are giving up their U.S. citizenship, fueled by frustrations over tax and banking questions.

The U.S., for example, is the only industrialized country to tax its overseas citizens on income earned abroad. That income is often also taxed in the country where it is earned, which means the incoming stream is dipped into not once but twice.

Double taxation is not the only problem for American expats abroad. New banking regulations have made it harder for expats to keep bank accounts in the United States and in some cases abroad. The regulations are intended to curb tax evasion and (under the Patriot Act) to help prevent money from flowing to terrorist groups. “Some U.S.-based banks have closed expats’ accounts,” according to an article in the New York Times, “because of difficulty in certifying that the holders still maintain U.S. addresses, as required by a Patriot Act provision.”

The numbers

In the last quarter of 2009 (the most recent period for which there are statistics), 502 expatriates gave up their U.S. citizenship or permanent residency status. Though it’s a tiny percentage of the over 5 million Americans the State Department says live abroad, the number is more than twice the total for all of 2008, when just 235 people gave up their citizenship. For all of 2009, the number was 743. And, reports the New York Time, “waiting periods to meet with consular officers to formalize renunciations have grown.”

What about you?

If you’re a U.S. citizen living abroad, have you ever considered giving up your U.S. citizenship?

by Randall Wood

Don’t worry if you’re not familiar with the West African nation formerly known as Dahomey: it is infrequently mentioned by the international press in a continent where no news is good news. A French colony until the 1960s, Benin is a tiny nation tucked under the Elephant Ear of West Africa, and is best known for being one of the continent’s stronger democracies.

I live in the city of Cotonou, whose name in the local language (Fon) means “River of Death.” And regardless of what Cotonou is today, it will forever retain the soul of a slaving hub at the mouth of a river that carried an unfortunate cargo down to the waiting slave ships.

For the moment, Cotonou is my home, and this message comes to you live from the River of Death.

In the three years I’ve lived here I’ve drunk whiskey with kings, been the victim of a mob throwing coconuts, surfed a couple of decent waves, and rubbed elbows with a culture that three years later, I still barely know and perhaps never will.  This is, of course, the thrill of travel and of living in a foreign country.

The expat life in Cotonou isn’t bad. Benin is essentially a safe country, especially compared to Nigeria, our neighbor to the east.  Here, you are at constant risk of annoyance, hassle, and occasional petty theft, but physical aggression is rare, very rare and frankly, I’m safer here than I would be in any large American city (see exception at end of article).

Cotonou is less a city than a large village; large parts of the streets off the principal arteries are sandy and potholed. “Downtown” is little more than a few dozen shops and a traffic jam, and most Africans do their shopping in the sprawling, chaotic Dantokpa Market, at whose heart lies a vibrant Voodoo fetish market.  We can get better tasting croissants and pastries here than in Washington DC, but we’ll wait for weeks before one of the local supermarkets has cream cheese.  We’ve got talented leather workers, tailors, and artists, but can’t get the parts to fix the air conditioner. And though we successfully dodge the bullet of the European winter, it’s frequently so hot outside that we sweat while toweling off from the shower.

Cost of living

Benin is expensive. The country produces little in the way of agricultural products, and as a result, most of what we consume has been imported at great expense. I’m speaking about expat staples like milk, wheat flour, jam, butter, breakfast cereal, cookies, and such: they’re not cheap. The dependence on imports makes just about everything expensive, from gasoline to bread to shoelaces to butter: it all comes in on ships.

We also have the option of the local food.  The Beninese diet is similar to the cuisine across much of the continent: starchy pâte, a sticky, doughy blob usually made of pounded yam, corn, or manioc, over which a spicy vegetable or meat sauce is poured.  It’s spicy, and too heavy for every day, but not bad when I do eat it.

Dinner parties, orange sand beaches, and infinite minor hassles

Cotonou’s two biggest defects are that (a) everything is harder to accomplish than it should be, and (b) there’s not a whole lot to do.  We don’t even have a movie theater (and never will, given the thriving market for pirated DVDs).  As a result, the expat community takes care of itself in the old way: endless dinner parties, cocktail hours, and invitations.  I’m not complaining, and it’s a healthy reminder of how communities behaved in the days before everyone sequestered themselves in their personal pleasure palaces with their video game consoles, broadband Internet, and other toys.  It’s a revolving community as the expats rotate through, but participating in such a diverse and friendly community is pleasant.

Weekends I’m at the beach surfing (there’s a halfway decent bar break along the coast), or relaxing on the orange sand beach. Evenings I walk the dogs around the neighborhood’s sandy streets, read and write. It’s a simpler lifestyle than the one I lived back in the States, but it has its advantages, and I personally find elegance in simplicity. I also experienced the Harmattan for the first time here, an awe-inspiring meteorological phenomenon born in the Sahara desert: the wind turns 180 degrees during two months and comes from the Sahara, bearing a fine sand that settles everywhere and darkens the afternoon skies.  I sometimes think that experiencing things like this are why I travel, although putting down a shot of whiskey with a king is a pretty cool reason too.

The fact that everything is harder than it should be, though, is the one that slowly eats at your soul: parking, driving through chaotic traffic, arguing with the same people over the same prices every single time, dealing with lousy service, bureaucratic processes that seem both pointless and endless, and the infinite minor hassles that accompany every single transaction is tiring.

Tiring, too, are the repeated power outages, water outages, cell phone outages, the system resets at the Internet provider, the fast broadband that’s actually slow, the saturated cell phone networks, and the phone lines that don’t permit easy calls.  I think back to the days before these services and remember I should be grateful.  But the constant outages are wearing, and in sum lead to the only remedy possible: travel to someplace else once every 4 months.

Benin: birthplace of Voodoo (aka Voudoun)

I mentioned Voodoo. It’s Vaudoun, actually, but yes, Benin is the birthplace of the world’s most misunderstood religion.  Haitians are the second most populous followers of Vaudoun, but it’s because the slave trade carried Beninese to the Caribbean island that Haiti gained the religion.  If you’re thinking “Serpent and the Rainbow,” you are way off; Vaudoun at its roots is an animist religion with strong ties to the natural earth, and a belief in good and bad forces that would be recognizable by anyone who ever watched a Star Wars movie.  Large parts of Benin believe in Vaudoun, but there are lots of Christians and Muslims as well, and everyone seems to live together in a peace much of Africa (not to mention the Balkans!) should envy.

Legacy of the slave trade and modern-day slavery

But there’s no escaping the legacy of slavery here.  You see it in the disorganization, the mistrust, the difficulty with which the Beninese work together toward common goals.  As a white American who experienced the story of the slave trade in middle school textbooks and who thought of the whole story as ancient history, it is eye-opening to see the impacts of slavery in the 21^st century, and to learn that slavery is in no way ancient history in one of the countries that experienced it first hand.

In fact, slavery continues to this day, and not just in Benin.  Throughout Africa, families “lend” their children – sometimes permanently – to construction projects in the city.  These children are poorly paid, sleep on the ground, and remain uneducated for their entire lives.  Call it what you like, but slavery in some form remains a real part of life here.

An elegant austerity

But let’s go back to the fact that three religions and a half dozen ethnic groups have been able to live in relative harmony in one of Africa’s stronger democracies. Benin: quiet, mostly unnoticed, little understood.  It has suffered mightily, and never makes the headlines. Life as an expat here can be frustrating, but not necessarily dangerous. It’s expensive and somewhat boring, but in its simplicity and sparseness it brings elegance to austerity. And from the point of view of a foreigner trying to get a job done, I’d say that being at the center of such a whirling, swirling mass of humanity trying to better its situation is amazing. Life at the mouth of the River of Death is actually pretty peaceful.

Will we next see vacation home for swarms of winter-evading European retirees?  Not likely.  It’s the kind of place that sends you eventually on your way with more questions than answers, and the conviction you understand less of the world than you did when you arrived. In short, Benin will change you, as it has changed me.

——-

(1) There’s one notable, horrible exception.  Peace Corps Volunteer Katie Puzey was assassinated in her sleep in March, 2009.  A stellar volunteer, well-loved by her community and extremely well integrated into the village where she lived, the motives for this atrocious murder are not yet known, and to date, justice has not been rendered.  We will not forget!

Randall Wood is the co-author of Moon Handbook Nicaragua and Moon: Living Abroad in Nicaragua.  He currently manages a $300M development program in Benin and has lived overseas for over a decade.  This article appeared simultaneously at www.therandymon.com).

Though Rosy Rios and Doug Ancel of Reno, Nevada, knew they wanted to run a B&B in Costa Rica, they never intended to build one from the ground up. But that’s what happened on the way to their Hideaway Hotel, which opened in 2008.

First, they chose the place, driving the length of the Nicoya Peninsula, looking for a beach town with enough tourist infrastructure to run a business but without the overbuilding and overreaching that can spoil a place.

They came equipped, with backgrounds in business, real estate and construction, and a chunk of savings that would let them take a good shot at their dream. Rosy spoke Spanish, and Doug was learning.

Looking to Buy

Once they settled on Playa Samara, halfway down the peninsula and with a sweeping half-moon beach washed by waves gentle enough for swimming, they had local realtors show them what was on offer.  They looked inland, “in the jungle,” but it was too hot. Places in the town of Samara were “too noisy—roosters, cars, and chain saws,” says Rosy. And when they liked the location, the building didn’t seem right.

They remember that one realtor showed them a hotel, assuring them, “If you buy this, I guarantee you’ll make your money back in 5 years.” Being familiar with the ups and downs of real estate and business, Doug and Rosy knew that a realtor should never in good conscience make such assurances. They put their guard up even higher.

Howler monkey at the Hideaway Hotel, Playa Samara, Costa Rica; photo by Doug Ancel

One day, after months of searching, they turned off the coast highway onto a one-lane road that ran straight to the southern end of Playa Samara. Wouldn’t it be great, they agreed, to have a place within walking distance of the beach? But there were no hotels for sale on that road.

A little later, in April 2004, they heard through the grapevine that a German woman was selling a 1-acre parcel of land on the very road that inspired their ‘wouldn’t it be nice’ musings. It wasn’t listed with any realtors.

Doug and Rosy looked at the land and loved it. But it had no structures on it; their dream had been to buy and renovate an existing hotel.

The location, however, was perfect, and the price wasn’t half-bad. And so, after checking to make sure they’d have easy access to water, electricity, and phone line, and after some back-of-envelope calculations and late-night soul-searching, they decided to go for it. They did what most people moving to a new country or starting a business have to do at some point: change the master plan in order to accommodate an opportunity that may not come your way again.

Building a dream, from the ground up

Anyone who’s ever built a house or a hotel knows what comes next. It took Doug and Rosy a little over four years from purchase of property to opening the Hideaway Hotel in July 2008. I’m sure they could write a book about those four years, but here are a few high (and low) points.

Building the Hideaway Hotel in Playa Samara; photo by Doug Ancel

They knew what they wanted-a clean, contemporary design, high-quality construction to North American/European standards, and about a dozen spacious rooms. They wanted a pool, landscaped grounds, and a modern wastewater system that would allow them to irrigate the grounds with gray water and to give North American guests the privilege of flushing toilet paper instead of putting it in a waste container next to the toilet, which is the Tico style.

They got a good lawyer (key to getting anything done in Costa Rica), who introduced them to an architect who had a good reputation. “But he didn’t deliver,” says Rosy, so they set up meetings with several architect/ builder pairs, chose their favorite, and got to work. “The design process took some time,” continues Rosy “We wanted to be sure to choose the finishes, tile, granite, etc. ourselves.”

The permit process was also challenging. “We were held up in SETENA for 6 months,” Rosy says. “Apparently SETENA [the Secretaria Tecnica Nacional Ambiental] was backed way up at the time.”

“We were ‘next in line,’” adds Doug, “for a good 5 or 6 months.”

The web site costaricalaw.com explains, “the sole mission of SETENA is the administration of the process to review and evaluate environmental impact considerations. Builders and real estate developers cringe when they hear the word SETENA.”

“But our building permit didn’t take much time,” says Rosy. “You just present plans to the municipality and pay the fees.”

The pool before it was a pool at the Hideaway Hotel in Playa Samara; photo by Doug Ancel

Once construction got underway, Doug stayed on site as much as possible to oversee the work. The builder went over budget, and there were construction delays. But when the Hideaway Hotel opened its doors in 2008, it all seemed worth it. “Local realtors couldn’t believe it,” says Doug. They said, ‘You guys actually opened! So many projects end up unfinished ruins.’”

Their hotel is indeed no ruin; it’s a lovely place with the sort of amenities you really appreciate after having been on the road for while, from the spacious shower to the mini-fridge to blackout curtains for the times you need to adjust to jet lag or turn in early to make a wee-hours flight the next day. A hundred feet from your poolside breakfasts are trees often full of howler monkeys.

Advice on opening a B&B in Costa Rica

I asked Rosy and Doug if they have any advice for opening a B&B or a hotel in Costa Rica.

“Find one that’s been built,” Rosy laughs ruefully, although she also says she feels proud of how well their from-the-ground-up building turned out.

“It takes time to grow a business,” says Doug. “So you need operating reserves to tide you over. We planned not to make any money the first years,” he smiles, “And so far, we’re right on plan.”

But even in the months after I visited, their was an uptick in guests, and the hotel is getting great press in guidebooks and online-when I last looked they were the #2 Samara hotel on Trip Advisor. I have little doubt that the next few years will bring even more visitors and a return on their investment, both in financial and life-satisfaction terms. After all, they dreamed a dream and then, with hard work and imagination, they made it happen. It’s all part of the (somewhat flexible) master plan.

Photo of finished version of the Hideaway Hotel by David W. Smith

With the new immigration reforms that go into effect in Costa Rica on March 1, expats who are legal residents in Costa Rica must enroll in the national healthcare system called the Caja, which gives them low-cost access to neighborhood clinics, pharmacies, and public hospitals.

Some Costa Rica expats are satisfied with Caja (public) care; others opt to supplement or replace it with private care, paid out of pocket or through national or international health insurance.

One whole-hearted and one half-hearted fan of the Caja (Costa Rica’s national healthcare)

San Ramon-based expat Stephen Duplantier, 65, is a Caja fan. “We are very happy with it,” he said recently. “It’s US$18/month (a discounted rate through Association of Residents of Costa Rica–the ARCR). We go to local EBAIS (a neighborhood clinic), where there’s an excellent doctor and excellent nurses, plus all pharmaceuticals are free. Recent surgeries, diagnostic tests, ER use, pharmacy, etc.–all are totally free and high quality, and the waiting time is equal to our experience in the States.”

I agree that the Caja can be great for routine care, but when I found I needed surgery, I moved from the public to the private realm. I’d been part of the Caja system, paying around $60/month at the age of 41 and happily using their neighborhood clinics for routine care, tests, and medications. But when it became clear that I would need a major procedure, I defected to private care, opting to pay out of pocket (I’d let my U.S. insurance lapse). I was happy with the care at private Clínica Bíblica, though the final price for my stay, while quite low in comparison to U.S. prices, was still more than twice what I’d been quoted in a formal estimate.

Two that had bad experiences at public Costa Rica hospitals

Others are not so happy with the Caja.

After a motorcycle accident in Costa Rica, Matt Hogan sampled both public and private hospitals. Photo: David W. Smith

Take Matt Hogan, 35, co-founder of Finca Bella Vista, a sustainable treehouse community near the Osa Peninsula. In late 2009 he had a motorcycle accident, and was taken to the newly opened public hospital in Ciudad Cortéz. “All the newspapers had been boasting about the brand-new, state-of-the-art facilities and medical equipment, 300 clean new beds, and the rest,” says Matt. What the newspaper accounts failed to mention, according to Matt, was that all those new beds were serviced by only a few doctors who showed up only once in a while.

Matt says he suffered serious neglect and misdiagnosis (they told him he was fine). Feeling anything but fine, he had himself driven by ambulance to San José and checked himself into private Clínica Bíblica. There he was found to have one collapsed lung and the other in mid-collapse, as well as severe internal bleeding in his chest cavity. The doctors at Bíblica said that if Matt had waited another day to seek proper care he most likely would have suffocated.

Matt was very happy with the care he received at Bíblica, adding with a smile that “all the nurses were very attractive young Ticas.”

Alex Murray after being released from a 20-day hospital stay.

In another example, Alaska native Alex Murray, 72 at the time of a fire that burned over 20 percent of his body, endured an extended hospital stay that also allowed him to compare private and public care in Costa Rica.

“While expat friends with residency have had important procedures successfully performed at slight cost in the public system,” he says. “I recommend avoiding it in life-threatening situations if at all possible.”

Alex was burning garden trash at his home in the Lake Arenal region when he spilled some gas, causing the fire to flare up and burn him over much of his body. Alex spent the next 20 days in two hospitals in the capital city of San José, first at the public Hospital San Juan de Dios, and then at private Clínica Bíblica.

“Of course,” he admits, “it’s a foregone conclusion that such a comparison is unfair to the underfunded public hospital, but the devil’s in the personal details.”

Alex was first picked up by a Red Cross ambulance and taken to a clinic in nearby Tilarán. Then he was moved to the public hospital in Liberia (about an hour north), where the doctors decided to send him to the burn unit at San Juan de Dios (a public hospital) in the capital city of San José, 4 hours away.

“Arriving in San José,” says Alex, “we should have directed the driver immediately to Bíblica or Clinica Católica [two private hospitals], but, ignorant of the quality of the public hospital and anxious to get treatment, we let the driver take us to the teeming mystery that is San Juan.”

Hospital San Juan de Dios in Costa Rica

Three days at a Public Hospital: San Juan de Dios

“In our three days there,” says Alex, “no doctor ever consulted us, though one led a group of students into my room each day. The nurses, male and female, sometimes seemed like the proverbial five or six workmen who stand around a pothole gabbing while one guy fills the hole. For the most part, they were not dedicated, not attentive, not very competent, and not sympathetic. They seemed the dregs of the nursing schools. A friendly nurse assigned to draw blood samples spent three days drilling mostly dry holes all over my landscape, partly due to my extremely low blood pressure. One rough middle-aged nurse told me that I was not much hurt nor in pain. I finally had to yell at her, “Don’t touch me. Don’t touch me.” She desisted, smiling to herself, it seemed.

“A night crew came on and half-heartedly started to bathe me and change my dressings. Three stood on one side of the bed and made little come-hither motions with their fingers. Two stood on the other side and made little shooing gestures. Finally, they decided to help me turn.

“They would not let my wife sleep in one of the three extra beds crowded into my room. Instead she spent her nights trying to sleep in a plastic chair. In the not-very-clean bathroom, she found bloody bandages in a corner.”

Clínica Bíblica in Costa Rica

Seventeen Days at a Private Hospital: Clínica Bíblica

Alex and his wife decided that they needed to move him to a private facility. “When I was admitted to Clínica Bíblica,” he says, “I recognized immediately that here was a competent staff. The emergency room nurse quickly found a vein and soon had a set of color-coded vials filled with my blood. All staff were purposeful and attentive.

“The next evening I began to rave and tried to tear off my bandages and leave the hospital. A doctor soon arrived and said my actions were due to a lack of oxygen to the brain. I was then moved to intensive care where a coma was induced and I was intubated, remaining thus for five days, not a reassuring sight for my four daughters who arrived from points around the globe.

“I doubt that these measures would have been taken at San Juan de Dios. Three doctors tended me at Bíblica, one a burn doctor, one a plastic surgeon who moved skin from my thigh to my hip, and one a staff doctor. They each came by almost every day to talk with us. The nursing staff was a no-nonsense but friendly and attentive group, evidently the better graduates of the nursing schools. Midway through my stay, physical therapists began visiting daily to exercise my wasted muscles. When I left, I had lost 14 pounds and could walk only a few steps unassisted, but I was recovering.

“And throughout my stay, my wife was permitted to sleep on a narrow built-in bed or cot in each room. “

For more information on health care in Costa Rica, see Living Abroad in Costa Rica by Erin Van Rheenen, or visit www.livingabroadincostarica.com.