Moving to the Dominican Republic with a disability

Oh my goodness, this is a good topic.  I am not disabled  but with almost  16 years here I have seen a lot.

1. This is not a progressive country and there is almost NO support for the disabled.

2. There is even less support for expats who are disabled.

3. Residencia requires a medical checkup however most disabilities should not stop you from qualifying.

4. Buildings are not built to be disabled friendly.

5. Transportation - public transportation is NOT disabled friendly.

6.  Medical facilities are usually disabled friendly but do not expect great care or specialized services to be what you are used to.

One thing I love is that  those who are disabled, elderly or pregnant do get preferential treatment in many many places.  You will not be forced to stand in lines etc. 

Culturally there is a lot of community type of assistance.  People will help whenever they can but it is not a gov't or organized thing, it is how the people are especially if you are respectful and friendly!

The two times I have had casts and crutches people were almost always helpful and kind to me!   When I had chikungunya my neighbors helped me get around,  brought food, juice etc.  Dominicans want to help!

Following...

Great question and topic.

I definitely agree with Planner's assessment of the general situation in the Dominican Republic.

There are all different types of disabilities so I can only speak about our situations and what we have observed from others. But I'll take it from a slightly different perspective of talking about disabilities AND health/quality of life.

At 35 my wife was diagnosed with a series of rheumatological diseases including lupus that left her bedridden and using a cane to walk. We also have 2 children they are on the autistic spectrum and have learning disabilities.

While in places like North American there are plenty of mandated accommodations for disabilities and the access to top quality specialist health care is incredible it's no secret that North Americans are generally not very healthy.

So while in general the Dominican Republic is overall not very progressive, I do think it's overall a healthier place from a total wellness perspective - less stressful, more healthy food, more positive social environment, more positive self-esteem. Culturally, most Dominicans are accommodative of their elders and those with medical challenges. 

Traditional retirement age considerations around disabilities can be very different than say others who are younger but either way if you have pre-existing conditions, improving your quality of life can improve your overall health.

And I have not seen physical disabilities limit people from leisure activities. Quite the opposite. For example in tourist areas, I have witnessed Dominicans literally carry people in wheelchairs to an attraction, whether up steps, onto a boat, or whatever it takes.

Most of the specialists are in Santo Domingo (or Santiago to a lesser extent) so if you live anywhere else you may have to travel a couple of hours.

In our case, she made the determination after spending weeks here at a time that her overall diet, exercise, environment, and quality of life dramatically improved to a point that it was more important for her to live here than it was to live somewhere else just to have access to the 20 minutes every 6 weeks she actually saw her doctor in the US.

When she does has some physical limitations here, she now has plenty of family and neighbors nearby  who provide us the non-medical assistance we need. That alone has taken a considerable amount of stress off our family as we manage her health.

I've been hoping this thread might spur more conversation...but maybe I help spur some.

My disability stems from lower back problems, which now have spread into my hips and sacral areas.  Not gonna kill me, but loads of pain. 

Impacts?  Standing for any length of time, certainly is a problem.  Sitting varies -- some days I can sit at my desk for a couple hours...but other days it is only a couple minutes, or not all.  Walking even modest distances (sometimes a few hundred yards, sometimes just a couple dozen feet-- can result in massive pain...and can lay me out for days, even weeks. 
No surgery is going to solve this, so the docs say.
So, I've been a chronic pain patient for 14 years now.  Medicare rates me 100% disabled. 
With strong medication, lots of physical therapy, a good chiropractor and constant stretching, I'm able to maintain some mobility -- which is a modest improvement over the first several years. 

Here's my questions revolving around this particular disability:
>> Does DR have "pain specialists" or clinics similar to what exists in the USA?   Or does the "pain management" role fall on the shoulders of general practitioners? 
>>  What about chiropractors and physical therapists?  Similar to USA roles and skill levels?  Availability in Santo Domingo?  Las Terrenas or Samana? Other regions?
>> The VA gave me a nice power scooter, which I do need periodically--and definitely to traverse any distance beyond 25 yards--but, are the sidewalks and curbs wheelchair-friendly??  (That was partially answered above, but I'd love to hear additional perspectives.   
>> Are any of the less-urban areas feasible for a wheelchair/scooter?
>> Does the DR have power scooter rental businesses to rent to tourists or longer-term guests?  (There's loads of them in Las Vegas, for example.)

Here's the good news:  we will snowbird in DR only 3-5 months per year.  So, we don't need a perfectly--accessible apartment or town to live in -- but the better the accessibility the more likely we are to get out and do things.

I know Medicare can't be used overseas--fortunately, as retired military I do have Tricare For Life, which CAN be used overseas, at least in reimbursement mode. 
>> But, do DR and US medical systems use the same diagnosis and treatment codes?
>> I know there are a few unofficial "VA clinics" in the DR -- and I am eligible -- but onlinw research thus far suggests they are pretty limited in treatment scope.  Anyone familiar with them?
>> Are opioid-level pain prescriptions available in DR?  (Only legal prescriptions, of course.  I always stay 1000% legal and legit.)

There's many more questions, but I hope these will generate some dialogue. 

All info, opinions and advice appreciated!! 

Jim
ExpatRusher

Velcro - what a great post. You painted a picture for us and that is really helpful to many!  I am glad that your wife can have better quality of life here.

Some answers for expatrusher:

Pain. Meds are highly regulated and require special prescriptions to get. If only coming for months you will want to bring your prescriptions with you.

Chiropractor and therapists: will unlikely be at the same.skill level and availability as you are used to. Things slowly changing.

Wheelchair access is spotty at best.  In many cases you will be limited by our infrastructure but people are incredibly helpful! 

Are motorized.chairs available for rent: I am not sure but I have not seen any. 

Medical billing codes:  highly unlikely they use the same or any for that matter.  It will be hit and miss at best!

ExpatRusher,

I can only speak for Las Terrenas, Samana but since there are thousands of international expats  here there are a lot of total wellness solutions here that we didn’t expect.

The new international hospital here has a lot of competencies that are geared around physical disabilities. (Private hospitals are VERY different than local Dominican hospitals. We won’t even let our local family here go to Dominican clinics anymore it’s that bad.)

We have put together a “mobility and pain management” team here for my wife (and ironically it took less time to do it here than it did when in the US). And that team is in communication with my wife’s primary and specialist doctors in the US.  (They have already electronically sent her files to her new doctors here.)

The doctors have been very good – no problems with skill level or translation of medical condition, treatment, etc. In fact, doctors here tend to also recommend or encourage complementary total wellness solutions where in the US there seems to be a stigma on “holistic medicine”. For example there are certain local fruits and plants here that in North America would be classified as “exotic” that have known medicinal qualities like reducing inflammation.

Has done wonders for my wife’s lupus flare pain and inflammation for example. (And sometimes it’s as simple as sharing a bottle of Dominican rum when nothing else works that day!)

My wife used to be a pharmacy tech in another life and has always been impressed w/ the pharmacists skill set here.

The pharmacists here are extremely knowledge and prices for many things are a fraction of the cost in the US while some are about the same. Probably 5-6 pharmacies in a 1-mile radius. One is run by a pharmacist from France who now lives here permanently.

Part of our local DR team includes a chiropractor, physical therapist, dermatologist. There are also trained professionals from all over the world here that have chosen to live here and do private practice. They even come to our house and do in pool therapy with her. And as my wife said the other day, “it’s cheaper than our monthly family YMCA membership was in the US!”

Due to my wife’s particular issues beyond the pain management – they also coordinate with her dentist and eye doctor. Since most people in general in DR communicate regularly via WhatsApp, her primary doctor here actually set up a WhatsApp group with our “team” so my wife doesn’t have to say the same thing to 8 different people or follow-up to make sure the chiropractor actually didn’t forget to update the primary. Believe me – this one thing alone has taken A LOT of stress out of our lives because as you know – when you are in pain you really don’t feel like talking to a lot of people!

I did see a medical supply store here with a scooter but I don’t know much about that side of things but I will ask. When I say medical supply store I want to manage expectations. It’s about the size of a phone booth lol   I will check it out for you and let you know.

Also keep in mind that it’s much easier now to get packages shipped to DR from the US now.  My wife orders stuff she needs medically off of Amazon or wherever and just has it shipped here. Takes a few extra days but saves us from having to drive to Santo Domingo just for some of her speciality stuff.

What I'm about to say will make some expats here laugh and others cringe but here in Las Terrenas there are a number of people (both Dominican and expats) who use wheelchairs and motorized medical scooters in the street.

As crazy as traffic is in DR in general and Las Terrenas is no exception – drivers always give way to them. Been watching this for 6 years here – the locals in wheelchairs even have nicknames!

The main roads here are filled with motorcycles, ATVs, and scooters/pasolas than regular size cars and SUVs. Dominicans and Europeans tend to be more comfortable riding the smaller pasolas. There are no traffic lights in Las Terrenas.

The main roads here are in good paved condition compared to a lot of places in DR. And it’s possible to find an affordable 1st floor walk out apartment either near the beach where the roads are going to be paved. My wife is actually considering buying a used golf cart to get around since the seating is more comfortable for her. Plenty of those here rolling around the streets.

Also Las Terrenas has a food delivery phone app where you can order food to your house. As you get to know people you can trust (both expats and Dominicans), you can actually find supermarkets and motococho drivers that will coordinate picking up supplies for you and deliver to your place. It’s only a 20 pesos (less than US$1) to have them shop at the store AND deliver it to you house!

My wife goes out and does things more things independently here than back in the US where we had instant access to multiple transportation options including Uber. No Uber in Samana but the motoconcho network here and WhatsApp on your phone is basically the same thing. You can get a ride to almost anywhere in Las Terrenas for 50 pesos / US$1.

Lastly, by nature and culture, Dominicans are very social, curious, and want to be helpful. We have found the medical professionals tend to be the same here. It took us 3 years to find the right “team” in the US. It took us 3 months here because our dentist here who we love, called a doctor who is her friend, who called the chiropractor, who recommended the dermatologist. 

Hope this gives some additional perspective on day-to-day reality of pain management here. Congrats on snowbirding here. We’re still figuring things out but we will get back to you on the medical supply store bit.

Velcro

What an amazing post. Thank you for taking the time. 

Some of what you say surprises me and some has me nodding my head, yup!! 

It's a smaller network there and I am so glad to hear how this all works for you and your entire family!!!

Again, thank you for sharing!

Very welcome. We have been helped by so many people on here to get to this point.

I should add that being friendly, nice, and showing interest in people goes a longggg way here!

Velcro55:

Thank you so very much for your extended post in response to my questions. 

Most helpful, but the biggest help is the hope provided.  Certainly, Las Terranas just moved up on our list of places to  "investigate" for our snowbirding!! 

Jim
ExpatRusher

Expatrusher,

You're Welcome.

One of our doctors just directed us to the US Embassy in Santo Domingo website

https://do.usembassy.gov/

If you type List of Doctors and Medical Services in the search box you will find it also includes Tricare approved facilities and specialists, and phone numbers.

planner wrote:

Some answers for expatrusher:

Pain. Meds are highly regulated and require special prescriptions to get. If only coming for months you will want to bring your prescriptions with you.

Chiropractor and therapists: will unlikely be at the same.skill level and availability as you are used to. Things slowly changing.

Wheelchair access is spotty at best.  In many cases you will be limited by our infrastructure but people are incredibly helpful! 

Are motorized.chairs available for rent: I am not sure but I have not seen any. 

Medical billing codes:  highly unlikely they use the same or any for that matter.  It will be hit and miss at best!

Planner,

Thanks for another  superbly helpful post.  Much was already suspected, but your confirmation is quite helpful. 

We have experience snowbirding already, we've been going to Las Vegas for 1-3 months each winter for several years.  LV isn't the warmest place in January, but definitely warmer than SE Idaho!! 

I'm starting to wonder if there's an opportunity to start a power scooter/ wheelchair rental business there.  We usually rent a power scooter in LV, rather than drag mine down with us (saves gas, which pretty much covers the rental cost.  The point is:  potentially, an untapped market. 

As far as the restrictions on pain meds -- exactly as expected.  We've dealt with the same challenges while traveling in the States.  Prescriptions for opioids written in one state can't be filled in another.  We've coped by having relatives fill prescriptions back home and ship them to me -- but I am quite hesitant about shipping them across international borders. 

The thing about asking such practical questions is that some folks automatically presume a legal prescription opioid patient is, well, just another addict seeking a way around the legalities.

I'm not, of course.  If anything, I am under-proscribed for my pain levels.  But without the prescription, my pain become totally debilitating within a few days.  Thus, I must live with the embarrassment of asking these questions.

Sorry, guess I got off on a tangent there. 

Thanks again for your advice!

Jim
ExpatRusher

Glad to help.

So, no you can't ship opioid to this country.  We can connect your doctor with a doctor here to help you get the prescriptions here!

Interesting business idea, it's not  a bad one!!