When you decide to move abroad, it’s tempting to do a little bridge burning before you go. It can be satisfying (if childish) to say the equivalent of “Take this job/relationship/country and shove it.” But remember, you may want to come back to your job, or, even better, to freelance for your former employer while abroad. Think of the job you’re leaving not just as something you’re giddy to be rid of, but a source of invaluable contacts (among your peers if not your bosses).

Lifehacker has a short article on how to leave a job gracefully, with an interesting thread of comments from people who’ve left jobs well and (more commonly) with some clumsiness. I know I’ve been guilty of clumsiness and bridge-burning—it seems to go hand-in-hand with being a serial relocator. Most of us tend towards one of two poles: the smoother-over, who never wants to make any kind of break or change, and the bridge burner, who’s always itching to strike that match.

Over the years I could have used some of the following tips, adapted from Sandra Naiman’s book “The High Achiever’s Secret Codebook: The Unwritten Rules for Success at Work”:

1. Give two weeks’ notice. Both your past and future employer will consider it a plus.
2. Explain that you are leaving because of growth opportunities, not due to dissatisfaction, even if it’s not true.
3. On your last day, write your boss and colleagues a thank you note about how much you enjoyed working with them.
4. Offer to train your replacement, and if possible, be available after you leave to answer questions.
5. Make sure your work is caught up before you leave and write notes, when relevant, to guide and inform your replacement.
6. If you have external customers or colleagues outside of your company or organization, work with your boss on how to transition them to your replacement.
7. When telling customers or external colleagues you are leaving, say only good things about the company and your experience there.
8. Let people know you only want to leave the job, not the relationships you have built.

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.

As an American expat in China, James Fallow wondered  “how much long-term damage foreigners do themselves” by living in “smoky, urban China.” He decided to find out.

He asked doctors and public-health experts what they thought of how expats fare in China, where, according to World Bank estimates, 750,000 people die prematurely each year just from air pollution. “Alarming upsurges in birth defects and cancer rates are reported even in the state-controlled press,” notes Fallow, in his “How I Survived China” in the November issue of The Atlantic.

The air quality is so bad, writes Fallow, that he and his wife joked with friends that now was the time to take up smoking, since their lungs would never know the difference.

A foreign-trained doctor in Beijing told Fallow, “Just using your eyes, you know this can’t be good for anybody.”  Fallow continues,

Another way to know this is via a clandestine air-quality station that the U.S. Embassy has built in Beijing. The Chinese government does not report, and may not even measure, what other countries consider the most dangerous form of air pollution: PM2.5, the smallest particulate matter, tiny enough to work its way deep into the alveoli. Instead, Chinese reports cover only the grosser PM10 particulates, which are less dangerous but more unsightly, because they make the air dark and turn your handkerchief black if you blow your nose. (Spitting on the street: routine in China. Blowing your nose into a handkerchief: something no cultured person would do.) These unauthorized PM2.5 readings, sent out on a Twitter stream (BeijingAir), show the pollution in Beijing routinely to be in the “Very Unhealthy” or “Hazardous” range, not seen in U.S. cities in decades.

Other doctors and fellow expats told him, “you get over it” (bouncing back once they return to more healthy settings), and that he should “worry about something else.” A Chinese doctor told Fallow, “I tell my patients, the most important ‘medical’ step you can take is to put on a seat belt in a car, wear a helmet on a bike, and run for your life in crosswalks.”

But Fallows ends on a high note, quoting a Western-trained doctor pointing out that China “is an exciting place. It’s a historic time. People seem to feel alive.”

“That made sense when I heard it,” writes Fallow. “In China I had felt terrible, but alive…and that makes me say that foreigners who want to go should not be deterred.”

Photo: atlasnetwork.org

The movie Outsourced features a relationship between an American man and an Indian woman

Don’t worry, I’m not going to go all tabloid on you, but South Carolina governor Sanford and his Argentine honey’s high-profile affair shines a light on something most travelers and live-abroaders already know: that cross-cultural romance can be more than tricky, even if you’re not a governor.

Sanford and Belen Chaper should head over to the web site Expatwomen for some cautionary tales (and success stories). Take, for example, the Danish woman and her Japanese boyfriend who met while he was working in Denmark. The woman writes that when the couple moved to Japan, everything changed—and not for the better.

‘It seems that the man I fell in love with has transformed into a different person. He acts differently, he dresses differently and worst of all; he treats me in a different way. I feel I have been put in a different role since we got here, and somehow it seems I don’t fit into his life anymore. To make matters worse, I am not working here and feel completely disempowered about the whole situation.”

The move abroad stories are all from a woman’s point of view,  and are often set up in advice-column format, from My teenagers aren’t adapting to the move to Pregnant in Vietnam, who’s worried about the medical system there.