Colostomy Reversal Safety in Developing Country - Seeking Feedback

Hi everyone,

I am a US expat who has lived for the past 14 years in a developing "2nd/3rd" world country in Latin America (Costa Rica). I had an emergency colostomy (Hartmann's?) in August 2016 (performed at a public hospital here in Costa Rica) after suffering a perforated colon from previously undiagnosed diverticulitis. I am a 37-year-old male.

I have no other known health problems besides a nasty 3-pack-a-day cigarette habit and drinking far more red wine than is healthy.

At any rate, I am on the (Costa Rican) government waiting list now to have my colostomy reversed.

Long story short, Costa Rica has a nationalized healthcare system for citizens and legal foreign residents (of which I am and have been for 14 years). I was born and raised in the US and maintain US citizenship, but I do not have insurance in the US and basically am not eligible for insurance in the US as I understand it because I have spent so much time away from the US that I am no longer considered a "resident" of my home state in the US (or any other state for that matter). So basically, I HAVE to get the reversal surgery here in Costa Rica as part of the public health system here.

I had no serious complications following my initial operation in August 2016, so I like to believe that the doctors/surgeons here know what they are doing, but there are things that are 'disconcerting' about medical care standards here compared to the US. (For instance, for my 12 days in ICU recovery following my surgery, it was in a small room with 6 other patients WITHOUT AIR CONDITIONING in 95F heat... another recovering patient next to me who was having blood transfusions or something after suffering a near-fatal machete attack - not kidding - would constantly spill blood all over the floor next to my bed that was rarely cleaned up, restrooms that smelled so bad of urine you literally had to hold your breath in there, etc.).

So here I am, contemplating having reversal surgery in that same hospital.

I am hoping to hear from either other people who live in 'developing' countries who have had reversal surgery, and/or doctors/medical professionals who can tell me how 'safe' it might be to have this procedure done in a public hospital in a developing country (specifically, Costa Rica). I found out after my first operation that the doctor that operated on me to give me the colostomy in the first place (and who would be the one to do the reversal), literally does everything from extremely minor surgeries (literally from surgically removing growths on people's skin, to amputating fingers and limbs, to gastro surgery, and who knows what else. In meeting him, he sometimes comes off as so forgetful, unorganized and just plain medium-IQ and/or goofy that you would think he was a low-dollar car mechanic, yet this was the same guy who operated on me during the emergency in August and everything was fine.

The bottom line is, to be honest, I have a severe 'death phobia.' - I almost don't care how arduous the recovery might be, as long as I DON'T DIE.

Can anyone give some feedback? Does anyone have some reliable statistics on MORTALITY (death) during or following colostomy reversals in developing countries like Costa Rica? (Doesn't seem this information is readily available here).

También hablo español si alguien de Latinoamérica quiere responder en español.

Bottom line is, I'm scared to death. In general, in most areas, this country tends to run a few decades behind the US in many ways, so I'm also curious historically, say what the mortality rate for a colostomy reversal in the US would have been say, in the 1970s or 1980s, because that is probably about what we're dealing with here.

Thank you all for your stories about having both successful and non-successful reversals, I really appreciate all of you who share your experiences. I know I am in a sort of unique situation but I imagine I'm not the only one?

Tim

Also, let me add for those of you who know about Costa Rica, I am specifically talking about the government-run healthcare system (CCSS) - I am aware that if you have the there are some exceptional places here like Hospital CIMA but I am not in a position to pay for this in cash so it will be through the public/government system at a CCSS hospital (the one in Liberia, for those who are familiar with Costa Rica).

Also, I now have a peristomal hernia which the doctor/surgeon said he plans to fix during the same reversal surgery using a 'mesh' or something, though I have read that using a 'mesh' puts one at more risk for infection (apparently bacteria tend to grow on them). Again, I am more worried about dying than any agony I will have to deal with, though I am also concerned with how much time I might be laid up post-surgery as I have to work for a living (there is no disability coverage here even while laid up in the hospital).

Hi Tim,

I'm not familiar with Costa Rica and what goes on there, although I do my share of research on different things. CR hasn't been in my sights. I do wish you all the best with your reversal. All I can think of about this doctor is if he got you this far and you have no real reason to doubt his skills, then what can you do given your situation? Did this doctor tell you to come back in a certain amount of time to talk about a reversal? I'm not a candidate for a reversal, so I'm not sure how that conversation goes.

Hi Mrs. A,

Thanks for replying. Basically, from the time I left the hospital in August, I almost got the impression that the reversal was 'assumed'. Like I didn't really have much to say in the matter, although of course I could elect to not have it done. I would like to have it done and be put back to 'normal' so to speak, but not at any significant risk of death. I can deal with pain, recovery, extended hospital stays, whatever it takes I can deal with that, but I have a true phobia of death... even general anesthesia, in 'general', terrifies me because I'm afraid I won't wake back up. And despite the fact that this country has been my home for 14 years, I somehow just feel that there are increased odds of something going 'wrong' here, as the doctors here are stretched to their limits under the socialized public health system. At the same time, despite conditions during my first operation(s) in August that would never, EVER be allowed in the US, Canada, etc. - I felt that the doctors and staff did 'care' quite a bit for patients... though the constant term "Si Dios quiere" (literally, 'if God wants it to be') used by everyone from the surgeons to doctors etc... rather than finding comforting, I felt a bit disconcerting, as though surgeons were basically putting it 'in God's hands' rather than their own; if a surgery fails, well it was meant to fail," etc. Perhaps being an agnostic and not even too sure in a God or afterlife is what makes me so scared and apprehensive. I would love to just "believe" but it isn't that easy for me, and quite frankly surgeons saying "you'll be okay IF it is God's will" doesn't lessen my fears, it increases them. :(

Living with Your Ostomy | Hollister

I should also say that while the ICU recovery area I was in for 2 weeks was completely unacceptable by US/Canada standards, the view I had of the actual operating theatre before being put under seemed quite sanitary and *decently* equipped, though I literally noticed that one of the surgeons or perhaps an assistant was literally watching a soccer match on their phone, in the operating theatre, as I was dozing off into the abyss... (I would like to think he turned off the soccer game once they got down to 'business')... so maybe I shouldn't worry that much... maybe just a clean operating theatre, rather than a clean hospital, is all that matters, obviously along with the skill of the doctors/surgeons... but I wonder if a surgeon who literally does everything from removing a skin lesion to amputations to knee surgery to apparently colostomies and colostomy reversals is really the best option (even though, quite frankly, I'm not sure if I have any other options)

If I had a choice about having surgery in a Latin American country, probably Costa Rica would be my one and only choice, from everything I have read or heard. Having said that, you have described some pretty ... questionable ... conditions. I have no statistics to offer you, only a consideration. You might want to find a quiet place with no interruptions and a fine view of the scenery where you can be completely calm and objective. Take some time to reach this state. Then take 2 sheets of paper, because you really are weighing the pros and cons of two different courses of action. On one sheet list the pros in one column and the cons in another of having the reversal IN THE CONDITIONS YOU DESCRIBED. On the other sheet, list the pros and cons of continuing to live with the ostomy. You might even consider a third sheet - Courses of action and a timeline that would lead to the surgery occurring in the US or any other first world country (grants, loans, philanthropist, Kickstarter - get imaginative and think outside the box). Once you have everything dispassionately down in black and white, you can more reasonably assess your course of action. Like you said, you can actually choose whether or not to have the surgery there. Only you can say what your quality of life is like with your ostomy. For what it's worth, when I first got my ostomy, I was ASSUMING it would be reversed, and had little desire to even consider any other course of action. Having lived with it for coming up to 2 years in a few months, and having experienced the complications that have come along, and looking realistically at the complications that will almost certainly come from the reversal, I am seriously considering not bothering with more surgery. Life with the bag is a bit inconvenient, but really not that bad at all. In fact, I just finished a 2-week solo vacation to drive from Kentucky to Louisiana to visit my mother and never had a lick of trouble. Just a thought.

Whatever you decide, it needs to be YOUR decision. Just realize, whatever you decide, it can also be on YOUR time schedule, not necessarily THEIRS. Good luck, and God bless.

My emergency ostomy operation was like the Vietnam War. My reversal was like the Grenada conflict in 1983 (lasted 3 days). I hope this helps. I would go for it, man. I really would. My reversal was a walk in the park compared to the diverticulitis surgery. I was sick from infection and all the pain. First recovery took weeks, second recovery took only a few days. Jay, Richmond, Virginia, U.S.

Tim, I would agree with Dana. There is no rush to go forward. Take your time. Find your peace.

I had emergency surgery here in Texas by a general surgeon from Nicaragua or El Salvador. I actually chose him over the other surgeon offered because he spoke Spanish, the nurses spoke well of him, and he had small hands. (I figured small hands messing around in my guts were better.) I had lived in Mexico for 20 years and he made me feel a kinship in that scary hour. (FYI, I am not Latin American). He did an excellent job and took good care of me.

I am not sure if I can be reversed, but I have opted to wait and see. It has been 5 years and I am doing better every day. I figure medicine may progress and make it easier to have a better outcome should I ever decide to be "reversed". You are still quite young. I would recommend that you take your time. There is no hurry. This I know! Wait until you are at peace and feel sure. Being in fear is not helpful. And the saying "Si Dios Quiere" is a very common Latin American saying in many countries. Do not let that cause you too much anxiety. Doctors cannot ethically promise a certain outcome, so maybe in these countries it is a way of offering some comfort regarding the unknown. My own surgery was a 50/50 chance of survival....both of them. I really had no choice because of it being an emergency, so I made my peace about whatever outcome God chose for me. I did place it in His hands and I am still here!!:)) Yours is not an emergency. Take your time.

I send you love and light to illuminate your choice.

Blessings

Tim, many an ostomy surgery is performed by a general surgeon, even here in the states. Considering the emergent situation that you encountered, and the positive outcome, it seems as if you were lucky in your surgeon. I had a colon rectal specialist who did not mention God's hands, just behaved as if he thought he was God. The "NEED" for my surgery was brought on while in hospital for two surgeries for a leg blood clot. I was prescribed meds to which I am allergic (it was in my records) for a disease I did not have (as records to which he had access showed/proved), and those meds created a severe blood loss, colon inflammation, and diarrhea. When I begged the surgeon who came uninvited into the ICU to tell me who prescribed the meds that I had now refused to take orally, he refused to help me find out who, telling me "I am not your doctor, I am your surgeon". I only was able to obtain the records proving that he had done this two years after my surgeries. He had also put into my records (two days before we even met) that he would perform an open abdominal total colectomy with end ileostomy without ever having a discussion with me about this and w/o reading my records of no past colon issues at all in my 60 years. After two days of no oral meds, my reactionary symptoms stopped and I was feeling better. I was to be released from the hospital by my vascular surgeon. BUT the prospective colon surgeon determined I "needed" TPN as the blood and nutrient loss had been severe from the meds (4 units). However, he also had the pharmacy put those allergen meds back into the TPN without my knowledge/permission. These meds once again caused a severe blood loss and diarrhea causing another 4 unit blood transfusion. He intentionally withheld from me the pathology report from Mayo Clinic that the blood loss was a likely reaction to and causation of the allergen medications and determined as self-limited colitis would right itself after the medications were stopped. He had this data in his possession TWO DAYS after the initial reaction to these meds, ten days earlier. Instead, he informed me and my very traumatized spouse that if I did not allow his surgery, I WOULD DIE. He let me suffer catastrophic potentially fatal blood/nutrient loss in order to have a "reason" to perform my surgery. Many years later I TRUST NO DOCTOR OR HOSPITAL. Monetary compensation IS NOT ENOUGH. The damage to my ability to trust is irreversible and has affected me in ways I never could have imagined.

The moral, Tim, is a specialist DOES NOT IN ANY WAY guarantee a "good" outcome. Your comfort level with your general surgeon, and the care you feel he extended you is INVALUABLE. Trust your instincts. If you are not ready, wait. There is no hurry. As far as the hospital conditions, most infections happen in hospital settings. ALL HOSPITAL SETTINGS, even here in the states. I had contracted CDIFF years earlier from a dirty scope used in a routine colonoscopy. Do yourself a favor and go online and purchase some Anasept spray cleansing spray. It KILLS MRSA AND CDIF, the only thing on the market that does. Anaconda Technologies is the manufacturer and you can purchase it online for about 29US at Jet.com. Spray your bed rails, food tray table, and IV stand and ANYTHING else you can spray that you might come in contact with while in the hospital. You can also purchase it as a gel for wound care for your surgical cuts. (But discuss this with your doctor so he knows what you are doing). It is worth the money, and NO I have no affiliation to this company. I just know from use that this works and I have turned my own PCP and pharmacist on to this product and they have been amazed. I also use it for my diabetic father every time he is in the hospital or rehab as he has contracted MRSA multiple times, but never since using this.

Good luck with your decision.

Adamnyankee

Thank you everyone for your comments, they are appreciated more than you know. I'll keep you guys posted on what happens..

That is encouraging, thanks for sharing!

Adamnyankee,

Thanks so much for sharing all you have been through, and I'm sorry you had to go through so much hell.

I have been thinking about this a lot more (as it comes closer) - and I think what you and others have said are making things a lot clearer for me - I think I need to consider more the care I already received (this surgeon did, after all, save my life once already, and at least this time around the operation won't be under emergency circumstances) rather than the 'appearance' of things here, in a sense. So much of the healthcare system in the US is superficial almost... "beautiful" hospitals with all the latest tech and gizmos - but none of that will make any difference if you have an incompetent doctor or surgeon!

Also, with the system we have here, there is no 'financial incentive' for hospitals, doctors, surgeons, etc. - to do anything more, or anything less, than to try to make their patients healthy again, as there is no profit/financial motive involved at all. I'm not an advocate for or against any particular "system", but I do find that idea appealing that the surgeon won't do anything additional or unnecessary 'while he's in there' in order to add an additional 'billing code' or two.

Also, I think it might even be true that at the end of the day, with doctors and surgeons here not having the luxury of all the latest high tech gear and everything, that might in fact result in them perhaps being even more skilled than their US counterparts. Who knows!

At any rate, I'm pretty sure I'm going to go for it. I'll post again here when able, and thanks again for sharing - and reminding me that the US medical system is far from perfect itself.

Thank you so much for replying. Just to be clear, my apprehension has NOTHING to do with having Costa Ricans - (of whom are my best friends, my neighbors, and my wife, in a country I have called home and fully assimilated into for the past 14 years) - being the ones operating on me. In fact, I would PREFER it. My apprehension stems more from the less-than-desirable conditions in the hospitals here and the sometimes limited resources they have with which to work. However, as I responded to another commenter here, I think I might be basing my apprehensions on some things that, at the end of the day, may be more 'superficial' than issues likely to affect my surgical outcome. A beautiful hospital with the latest tech and gadgets (and air conditioning in the ICU!) in the US is no guarantee that the surgeons and doctors in said hospital are necessarily competent.

That said, I remember many years ago when one of our own presidents here in Costa Rica required a major surgery (I don't recall what it was)... and rather than using our public health system, chose to have the operation done in the US (or actually, it might have been Canada.. but at any rate, just saying).. even knowing how unpopular that would likely be amongst the electorate :)

TiminCR, I'll keep good thoughts for you for a successful outcome to your surgery. As I mentioned, there are a few things you yourself and your family members can do to help alleviate the fears you have regarding the questionable conditions that you have witnessed. Just take care to do your best to avoid contact with bacteria as best you can but remember, some of the worst conditions man has lived through have been on the battlefield during our human conflicts and yet we manage to survive. Stay clean, as comfortable as possible, and keep a positive attitude. Your family and friends can help with these things so be sure not to shut them out.

Peace

ADamnYankee