My question may be long-winded because I’m sorting out many issues about my decision to move abroad–to Israel.

Here’s my background:  At 26, after completing two degrees in software and engineering-related fields and working full-time for just over 2 years, I quit my job in San Francisco and bought an around-the-world trip ticket. My friend and I traveled from February through July last year. Nearing the end of my trip, I asked myself what things in my life I wanted to do—thing that if I didn’t do, I would regret on my death bed.  One of them came up as living abroad.

Back from the trip now, working freelance, and living at home, it seems like the perfect time to tackle this dream.

I have been to Israel four times in my life, speak enough Hebrew to get by, but have no relatives there, and just a few friends, none terribly close. I always love it every time, and even tried applying for a Fulbright to move there a few years back.  I’ve done all my research on job opportunities (they exist for people in my field) and the benefits the state offers to Jews who would like to move there. They actually pay you to move, roughly $4500 over the first 7 months, free health insurance until you get a job, and 5 months of Hebrew classes, just to name a few of the benefits.  It seems, by the facts, that this should be a relatively easy decision. But it’s not.

What’s nagging me is whether I am running away from a good thing in the States. I have a great education, and lots of well-paying job opportunities. Though I have a free spirit and crave adventure, I’ve learned this year that stability is really important to me.  Needless to say, the transition home has been very difficult for me as I haven’t yet gotten my independent life back.  So one of my concerns is how long it will take for me to really get settled in Israel, and if it’s a process that I can withstand mentally.

The next concern I have is that I’ve been far away from friends and family for a while, going to college out-of-state and graduate school on the other side of the country. This gives me the independence I need to be successful abroad, but also makes me wonder if it’s a good thing to continue to endure the stress it takes to create a new life each time and to be lonely until the new friends become great friends and pillars of support. Ever since kicking off the process to move to Israel in August, I’ve addressed these concerns each month, to great distraught.

Finally, as a seasoned backpacker and solo female traveler, conquering coco huts in 3rd world countries with the best of them, I find myself torn between my material pleasures and my constant challenge to prove that I can live on less.  Moving to Israel would challenge me and my bank account (while their economy is thriving, Tel Aviv is one of the most expensive cities to live in when you compare the rent to the actual salary earned). When I’m feeling empowered and idealistic, I know that it’s worth it. But when I’m feeling a bit more realistic, I wonder who I feel I need to prove to that I can change my life so drastically. And I do have student loans that I need to continue to pay….

I grow jealous of people who have lived abroad and can speak other languages, but I crave my stability and would like my older friends and close family in my life more.  I feel this yearning to be in Israel, yet this body-encompassing lament that I will do it alone, and feel lonely constantly in debating this decision.  Sometimes I wish someone would tell me to stop being foolish and stay, or visa versa.

Did I just pour my heart out to a stranger?  Any advice would be much appreciated.

Torn between the heart and dreams

_______________________

Dear Heart & Dreams,

Your letter got me thinking, and when I think, I write. But although my reply will no doubt be even more long-winded than your question, I’m not going to tell you what to do. I’ve been in your place, wishing someone would make a hard decision for me. But (as you already know) no one but you can make this call. If I tried, you’d protest that I didn’t have the full picture. And you’d be right. The full picture only takes shape in your own heart, and maybe only in the wee hours of the insomniac morning.

For me, decision-making is infinitely more mysterious than rationally weighing pros and cons. I’ll be obsessing for weeks, maybe even months, and then I’ll see or hear something—a line in a book, a scene in a movie, a snatch of overheard conversation in a café—and suddenly the decision in made. (Note the passive voice—as if the decision is out of my hands—a good strategy when pitching the move-abroad idea to employers and mothers).

I like Steven Johnson’s idea that good ideas (and decisions?) come from the collision of various small hunches, some of them residing in different minds. Here’s a cool animated video of that idea.

But back to your letter. As I read, I found myself nodding, thinking, yes, that’s the crux of it, isn’t it? Or rather the cruxes, as there are many axes on which the move abroad question pivots. I’ve got a few decades on you, and yet I must report that the issues don’t really change as you get older. As a serial relocator I confront similar questions each time I make a move.

The question of how moving abroad affects your relationships is perhaps the thorniest of the issues you raise. I know that when I return after extended travel or living abroad, friends and family are not so quick to let me have my old place in their hearts. Even if they were supportive of my move, their lives have moved on while I was away. They’ve adjusted to my absence, and it may be years before they really believe that I’m back.

And, like you, each time I go I ask myself if I’m running away from ‘real life’ and wonder how many more starting over’s I have in me.

I don’t have answers to these questions, but I do know that each question is a world onto itself, and that even the way we frame the questions betrays an array of assumptions that (for me) are revealed and sometime subverted by brushing away all my fears and making the move abroad.  Let’s take the ‘running away from real life’ question. Is our idea of real life so narrow that it can’t include interruptions of the proscribed life path—school, more school, work, family—that so many of us are on, or think we should be on?  Are we running away or are we lurching towards a life that is far my real than our habit-bound workaday existence, where daily repetition has dulled any sense of wonder or possibility?

Reading the particulars of your situation, I was struck by how you seemed to be trying to talk yourself into (or out of) something. I, for one, have never been paid to move anywhere, and there are often meager job opportunities on offer where I end up. You, on the other hand, would be paid to move to a country you already know you enjoy and where there are jobs in your field. The timing for you seems perfect, as well. With no apartment and no fixed job, you don’t have much to extricate yourself from. You didn’t mention anyone you’d be sorry to leave behind, so I’m assuming there’s no significant other. If there is a sweetheart in the picture, then you’re not telling me (or yourself) the whole story. Sometimes we want that sweetheart (or potential sweetheart) to hold us back from a radical move, to prove that they really care.

Another thing about timing: Often the 20s are considered a time to get travel and living abroad “out of your system,” after which you will presumably settle down and never stir again. But for those who are drawn to new experiences and new cultures, the ‘right time’ will come again and again, at various turning points in your life. Throughout my life I’ve been drawn to travel or living abroad when I need a new perspective, when I feel mired in the everyday, when things are closing in and I can’t see the forest for the trees.

If you’re having serious doubt about a move to Israel right now, it’s not as if this will be your last chance. You could even move to Israel, spend a few months there, and then decide to come back to the US. Would that be so bad?

If we look at the urge to move—to hit the road, get the hell out of Dodge, start fresh—not just as an individual impulse but a global one, we might say that it’s time to stay put and to stop running. Time to stop burning fossil fuels on our own personal long-distance quests. Time to face up to who and where we are, time to get our own house in order.

On the other hand, in most of nature, stasis is not an option. Animals roam far and wide to find food, shelter, and mates. Humans add to that the search for work, for recreation, and for that ineffable quality of brand-newness that reminds us that we’re alive and that the world is, despite all the fiber optics connecting us, a very big place. Big enough to get lost in.

And as the writer Andre Gide says: One doesn’t discover new lands without consenting to lose sight of the shore for a very long time.

Sincerely,

Miss Move Abroad

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).

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.

“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.

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

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.

She’d been very active in a few local nonprofits, and she scaled back her commitments, quitting boards and letting people know that she’d be putting her energies elsewhere for a time.

And dammit if she didn’t write that book! In a year. I’m beyond envious—I’m positively inspired. I keep looking at little huts on the side of the road or up on top of mountains, thinking, Now there’s a good place to hole up and write.

The book is Evelio’s Garden: A Memoir of Costa Rica. It centers around a garden on her land on the shores of Lake Arenal, an organic garden a longtime friend, Evelio, tries to create out of nothing. Evelio is a local, born and bred in the Arenal area, and he has a natural talent for planting and tending. But trying to garden organically, and on a plot ravaged by the winds off the lake, turns out to be more than he–and Sandy, as his enabler/landlord/cheerleader–bargained for.

Sandy describes the ups and downs of the gardening project, but more than that, she details how the achingly beautiful land around the lake is at risk of devastation. Not incidentally, a portrait of expat life emerges, as we learn of Sandy’s neighbors from Europe and North America and Costa Rica and see how they all coexist, sometimes peaceably, sometimes contentiously.

It’s a book about how we live on the land, how it nourishes us and how we should nourish it. It’s beautifully written and has a strong sense of place. I’m honored that Sandy let me read it and that she’s allowing me to publish an excerpt here.

Excerpt from Evelio’s Garden: A Memoir of Costa Rica, by Sandra Shaw Homer

All land has a history, and the history around here goes back a long way.  Satellite images have picked up old roads all over this canton, long grown over, made by the indigenous peoples of pre-Columbian times.  One of these roads runs along the south shore of the lake, uphill from the current road and downhill from the ridge that links Tilarán with the tiny villages of Silencio and Río Chiquito.  I have ridden my mare along one stretch of this old road that runs behind San Luís and Tronadora, much washed out and crowded with second-growth forest, and it took a man on horseback with a machete to cut open a way for us to pass.  Artifacts of the native people show up everywhere.  When the lake is low, you can go out in a kayak or canoe and explore along the naked shoreline for pottery shards.  In town, there’s hardly a house that doesn’t sport a metate, or corn-grinding stone, that turned up when the foundation was being dug.  It usually has a potted plant sitting on it.

Modern local history dates from the late nineteenth century, when there were gold mines south of here in Las Juntas and Líbano.  It was rough country then, virgin forest, and the only way in was by horse or mule.  The gold was shipped out in ox-carts.  (More recently it was taken out in helicopters!)  Gradually settlement drifted north, and people carved farms out of the ancient forests, establishing a fiercely independent, frontier life-style.  Even in the 1930s, it could take the better part of a week to get to San José – from Tilarán on horseback (oxcart took longer) to Cañas, where you waited days for a small boat to take you down the Bebedero to the Río Tempisque and the port of Puntarenas, then by all-day train up to the Central Valley.  The Inter-American highway wasn’t completed along its northern reaches until the sixties.  There was no paved road around the lake until the eighties.  (It’s still not finished.)  I have met retired school teachers in Tilarán who remember four-hour treks on horseback to get to their one-room school houses on the lake, sometimes in mud up to the horses’ knees.  The niece of one of these teachers told me that her grandparents owned our farm in those days, and that it was a much bigger property.  A lot of the farms around here were broken up when ICE acquired the land for the reservoir.  Since then, the process of development has been inexorable.  As long as there’s someone to buy, sooner or later a farmer will face the economic conditions that force him to sell, frequently just a small piece at a time, enough to give him ready cash to get along until beef prices go up, or the weather improves enough to let him get a good crop in.  There are still some fair-sized farms around the lake, but since the early nineties development has speeded up and been gringo-ized. (At least in Tilarán, the word gringo can refer to Europeans as well as to non-native-Spanish-speakers from north of the Río Grande. Our nearest neighbors are Germans.)

Earlier this year an 18-wheeler parked its trailer by the side of the road just uphill from Cinco Esquinas, smack in your face where the first grand view of the lake should be.  It was a mobile office with the name of an international real-estate company painted in large letters on its side.  This was beyond ugly, but it never opened.  Instead the world-wide recession brought local real estate sales almost to a halt.  Still the trailer sat there, month after month, until finally some locals couldn’t resist jacking the thing up to steal a pair of off-side tires, leaving it listing crazily on a slender pile of cement blocks.  Just the other day it finally disappeared.  How it was moved, nobody seems to know.  But nobody was sorry to see it go.  This little story – especially the part about getting that trailer out of there – is no doubt already brewing up into a local legend.

We’ve been here long enough to see people come and go.  Some can brave the remoteness, the vagaries of the weather and the strangeness of the culture, and some can’t.  Some people get attached to the land, and some don’t.

When I was growing up, my family never lived long enough in one place for me to become bound to the land.  We lived in some beautiful – and not so beautiful – places, both rural and suburban.  From my early twenties until I came to Costa Rica, I moved almost as frequently, living exclusively in cities.   It was a little shock to realize, when we started building this house five years ago, that I’ve lived on Lake Arenal, and on this particular plot of ground, longer than I’ve lived any place else in my entire life.

You can’t get attached to the earth in Philadelphia or New York.  How many millions of people never do?  It’s this attachment that fires my desire to protect it – but not just my attachment to this particular plot of ground, but to the whole thing, the planet.  It’s not such a giant leap of the imagination from the sight of a growing young forest to the image of a tiny blue speck in the vastness of the universe.  So, finally, it is the sense of place that has captured me and pinned me to the planet.

It is gratifying to be part of the history of the land, to be growing a farm instead of shrinking it, to be building a forest instead of cutting it down.  Here, in one tiny corner of the planet, the question becomes obvious:  do we add something by our tenancy of the earth, or do we take it away?

Puerto Viejo, Costa Rica

The last winter Alaine Berg spent in her native North Dakota was the coldest on record. Fleeing the snow, she moved to Houston in 1995 to work for the Earth Foundation, “the only environmental job in that big polluted city,” she says.

But Houston wasn’t far enough south for her tastes and in 2001, she headed to Puerto Viejo on Costa Rica’s Caribbean coast.

Why Costa Rica, and why the less-visited eastern coast of that country? Alaine had studied Latin American culture at North Dakota State, and Noble, her “husband figure,” as she puts it, had a longstanding connection to Puerto Viejo, having visited his father there every summer since 1975. So on their one-year anniversary, Alaine and Noble moved to “Old Harbor” – Puerto Viejo.

Almost immediately both became involved with ATEC (Asociación Talamanqueña de Ecoturismo y Conservación, or Talamanca Association of Ecotourism and Conservation; the southern Caribbean coast area is also called Talamanca. ATEC’s office in Puerto Viejo is also a bookstore, internet café, and a place to arrange for eco- and community-friendly tours to nearby national parks and indigenous reserves.

Miss Move Abroad asked Alaine about ATEC and about her life in Puerto Viejo.

Tell me about your involvement with ATEC.
Noble’s Dad, Mel Baker, was one of ATEC’s founders. He wanted to retire from running the show. For a couple of years he looked for someone to run the office, but could find no locals with the right skills who’d do the job for so little money. The position was one 3/4 time job for $400 a month. That 3/4 time job would mean a 36-hour week as the work week in Cost Rica is 48 hours. But the job can be a 170-hour work week when things get going.

Noble and I interviewed for the position over beers at a local restaurant and were both hired to fill the one position, for the one salary. Noble is the computer geek–running the internet café part of the office, and I guess my title is Project Manager. A local woman, Ivette Grenald, is office director, so I work mainly in environmental education. For instance, last year another local lady (Susana Schik) and I had a grant through ReciCaribe, the Association for Recycling in Talamanca. We invited 12 schools and community groups into the recycling center in Patiño, gave presentations on the three R’s and responsible consumerism.

Right now my main projects are with ReciCaribe (working to get another grant to expand the recycling center and do another push of environmental education) and ADELA (the Action for the Fight against Petroleum; www.grupoadela.org). With ADELA we’re trying to put a positive slant on the organization. Rather than keep on saying NO NO!–No to petroleum exploitation, No to pollution–we’re trying to say Yes. Yes to job growth in Talamanca. Yes to a bio-fuel project called Klean Air Fuel, a technology developed by a Costa Rican that uses leftovers from the banana plantations to produce a clean bio-fuel.

With the Talamanca Institute (www.talamancainstitute.com), ATEC is designing courses for visiting students in Sustainable Development, Migratory Bird Monitoring, Sea Turtle Conservation, and even one in Comparative Religion.

Do you travel much, or get back to the U.S.?
Noble and I go back to Texas for three months every spring to help with his mother’s project, Eve’s Garden Organic B & B and Ecology Resource Center (www.evesgarden.org). It’s in the high desert, so we can dry out for while [the Caribbean coast gets a lot of rain and tends to be humid]. Without a little break from here, I wouldn’t appreciate it nearly as much.

What do you like best about Costa Rica?
I love Talamanca. It’s tranquilo [peaceful] and green. With the national park, the wildlife refuge, the indigenous reserves, and the private reserves, 82 percent of Talamanca is protected! And Talamanca has the most cultural diversity in all of Costa Rica. People here are real. For example, I come back from vacation and they tell me I’m fat, or when I vex the women I work with, they tell me. I love my work here and the people who work so hard together to protect this place.

What do you like least about Costa Rica?
I don’t like so much change so fast. Yes, I’m a stranger here too, but I lived here for years before I thought about buying land, and I still haven’t bought land. One of the reasons ATEC formed was to help local people survive with all of this foreign investment coming in. Foreign investment has changed things dramatically and rapidly for the people here.

Foreigners come in and expect gringo-landia. They fall in love with the tranquiloattitude, the amazing forests and the uncontaminated sea. They end up getting pissed about how slow things go, or get frustrated with the mañanaattitude. They fall into the corruption, they try to do things the quick way, use the wrong type of lumber in building, for example, make un-smart choices, get thieved, get fined, and get angry and leave a big chunk of land that they were in love with all destroyed. I’m trying to get over my “holier than thou”-ness. But people need to just come and rent for a while, get to know things, and to learn that there is no paradise on earth.

Any advice for people thinking of moving to Costa Rica?

Oh yeah. Here’s a start.

• Rent first.
• Hire locals and pay fair wages–better than fair even. Support local business.
• Examine your intentions for wanting to invest here. If you’ve got an idealized image–rethink it, or you’ll get disappointed.
• Learn about the area, the language, customs, history–it shows respect.
• Cultural Sensitivity!  English is not the national language.
• If you want to come here and make it just like home–just stay home.