Spent a small fortune at the pharmacy…But not as much as…One week and counting…

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All of that packaging resulted in this small pile. The pharmacy provided the bottles and labels at no extra cost. We will carry the original prescription if we are questioned at any point.

Travel often brings us face-to-face with contrasts. Sometimes it’s the scenery, the shift from arid bushveld to lush coastline in a single day. At other times, it’s cultural, such as the way a meal is served or how greetings are exchanged. And then there are those moments when the difference lies in something as practical, yet deeply personal, as the cost of healthcare.

This past week, we experienced one of those moments in Komatipoort, South Africa, a small but busy town that hugs the border with Mozambique. Our mission wasn’t to stock up on souvenirs or local crafts but to tackle something far more essential: filling prescriptions that will carry us through the next year of our travels.

When the pharmacist tallied up the total, ZAR 29,000, or US $ 1,629, my heart skipped a beat. It felt like such an enormous sum, handed over in one swipe. The stack of neatly packed boxes and bottles was daunting, filling up three big plastic bags. But then, as the shock subsided, we reminded ourselves of the bigger picture. This was a year’s worth of peace of mind, a year’s worth of uninterrupted health, and a year’s worth of freedom from worrying about whether or not we’d be able to find what we needed in the next country.

When compared to the United States, the difference is almost laughable. The same medications were available there, even with insurance, but would have cost several times what we paid. Since we don’t live in the US, there was no sense in buying a pharmacy plan when we could only get three months of drugs at any given time due to insurance restrictions.

These inhalers are for allergies and in the event we get a cough/flu..Two EpiPens are included, as we are both allergic to bees and wasps. Many medications have different names in South Africa, but they are the same as brand-name medications in the US.

In the U.S., prescriptions are a monthly reminder of how expensive it is to stay well, with bills that keep piling up, appointment fees added on, and insurance companies deciding what is or isn’t “covered.” Here in South Africa, we paid upfront, yes, but we walked away knowing the next twelve months are accounted for, at a fraction of the American cost. What felt at first like a fortune suddenly seemed more like a bargain.

There’s a psychological comfort in that. As travelers, we live with a certain level of uncertainty. Where will we be next month? Will the Wi-Fi be strong enough to stay connected? Will we find a place to stay that feels like home? Those unknowns are part of the adventure, but health is different. Health is the foundation upon which all those adventures are built. Knowing we have what we need neatly tucked away in our luggage allows us to embrace the journey with less worry and more joy.

I thought about how many people in the U.S. don’t have that option. Even retirees, who should be able to enjoy their later years without constant financial strain, often find themselves paying shocking amounts for the medications they need. It’s one of the strange ironies of our travels that moving through countries where people sometimes have less materially, we often find greater accessibility when it comes to healthcare. South Africa may not be perfect, but the availability and affordability of medication is a lifeline not just for locals but also for travelers like us.

Of course, spending ZAR 29,000 in one go isn’t something to brush off lightly. It was a big line item in our travel budget, and I’ll admit we were a little shocked.. But when you consider what that figure represents, the decision made itself. It isn’t just a transaction; it’s an investment in our ability to keep going, to keep saying yes to new places and new experiences without the nagging worry of running out of something vital.

There’s also a strange sense of gratitude that comes with moments like this. Gratitude for the pharmacists who took the time to patiently gather everything we needed. Gratitude for the fact that South Africa’s system makes it possible to buy in bulk. And gratitude that, as nomads, we’ve learned to adapt to different systems, to figure out what works and what doesn’t as we cross borders.

Doc Theo wrote us prescriptions for several preventive medications in case we become ill on the upcoming cruises, including Tamiflu, Prednisone, respiratory drugs, and various antibiotics suitable for norovirus or the cruise flu/cough. If we’re lucky, we won’t need to use some of these. Also, he explained we can WhatsApp him if we need guidance on which ot these we should take, leaving us with tremendous comfort with the concept of our “doctor-traveling-with-us.”

These three bags contain all the packaging material from which we removed the pills. Yesterday, we popped out over 1800 pills from blister packs. Our thumbs are sore today.

Walking out of that pharmacy, bags in hand, I couldn’t help but feel lighter, even if the luggage itself was a bit heavier. It wasn’t just about the medicine. It was about knowing that we’d taken care of ourselves in a way that allows us to keep chasing the life we’ve chosen. The freedom of the open road, the constant stream of wildlife outside our door in Marloth Park, and the endless discovery of new places —all of it — is sustained by these practical decisions made quietly in a small town like Komatipoort.

Yes, ZAR 29,000 is a significant amount of money. But it bought us more than pills and prescriptions. It brought us reassurance, continuity, and the ability to keep moving forward without pause. And when weighed against the alternative, the spiraling costs and stress of the American healthcare system, it feels less like an expense and more like a gift.

Travel teaches us to value experiences over possessions, but it also teaches us to recognize the worth of what drives us forward. This time, it wasn’t a spectacular view or a cultural encounter that left the biggest impression. It was a simple transaction at a pharmacy counter, reminding us once again that sometimes the greatest luxuries are not material, but the peace of mind that allows us to continue our journey through the world.

Today, at 4:00 pm, we’re meeting Rita, Gerhard, and Inge at Amazing River View for river watching, sunset viewing, and dinner.

Be well.

Photo from ten years ago today, September 7, 2015:

Pond view at the Cattana Wetlands in Trinity Beach, Australia, taken on our last day before moving on. For more photos, please click here.

Fully insured…What a relief!…A pharmacy plan?…

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Silver and brass teapots and decorative items are sold in the souks in Morocco.

No words can describe how relieved I am to be fully insured as of March 1, 2024. After 11 years of unreliable travel insurance, we paid out of pocket for my four surgeries in South Africa in 2019. The freedom of knowing I am fully covered, minus a one-time-per-year $240 deductible, gives me peace of mind I can hardly describe.

I didn’t choose a pharmacy plan since the cost was prohibitive and required I purchase my few medications in the US. Plus, the copay and using US pharmacies also didn’t make much sense. I currently take a costly blood thinner, Eliquis, with a retail cost of $594 per month.

Sure, with some Medicare pharmacy plans, one can buy this drug for considerably less. But, if we’re traveling, it will do me no good. I won’t be able to walk into a pharmacy and buy this drug at a reasonable price in most countries. In South Africa, the average cost of this medication is $65 per month.

However, I will order this drug from Canadian Pharmacy Store before we leave the US again in June. Since I began taking this drug, I have been taking Apixaban 5 mg (the generic version, but the same drug) and will order from this company as follows:

Apixaban 5mg Tablet

90-day supply (180 pills at 2 tablets per day) is $71.99.

At this rate, a 90-day supply will average $23.30 per month, a far cry from any of the above. Of course, one needs a prescription from a doctor. It’s essential to check if you live outside the US to see if they will accept prescriptions from your doctor in a country other than the US.

This is another significant relief for me. Thus, before we leave the US, I’ll order enough to get me through the next several months. How long we’ll be away will be predicated on my heart test results on March 27.

As for insurance outside the US, my Plan G supplement with Aflac allows for a lifetime maximum of $50,000, so adding an emergency evacuation plan may be necessary while we’re outside the US.

There was so much research required to come to these final decisions. Also, it was good that we were in the US these past several months to ensure we could get all the paperwork done promptly. With snail mail an issue in some countries, it would have been challenging to process everything since documents have been sent to us via snail mail.

Now, as we complete the paperwork for Tom’s claim with the law firm for his lung damage (pulmonary fibrosis) from 42½ years of exposure to asbestos while working on the railroad, yesterday we received a snail mail package with 20 documents that must be notarized. We’d never have been able to do this outside the US, using a foreign notary.

Thank goodness we were here for all of this, including when Tom flew to Chicago for the required pulmonology appointment with a designated doctor. Many of our readers have inquired why we’d chosen to be in the US for this extended period. Aside from the necessity for me to have the cardiac ultrasound in a few weeks, for which I had to wait until I was fully insured, these other situations dictated the length of our stay.

Soon, when we leave for Arizona, we’ll have our taxes for 2023 done with the help of our Nevada accountant, insurance in place, the heart scan completed, and Tom’s paperwork situation under control. Hopefully, we’ll also have good news on my scan. This will be a relief when these items have been on our minds for quite some time.

Today, we’ll enjoy our delicious pizza leftovers and a big salad. All is good in the world with us! We hope the same for you!

Be well.

Photo from ten years ago today, March 10, 2014:

This was our favorite photo of the night in the Big Square in Marrakech, clearly depicting the color, light, and energy occurring at night in the Big Square. For more photos, please click here.

Warning to all tourists taking prescription drugs…Could result in a Costa Rica nightmare…

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Yesterday we shared a photo of an Owl Eyed Butterfly, and today, we have a winking Barn Owl.

“Sightings from the Veranda in Costa Rica”

Ulysses was creating a perfect trim on the hedges at the villa.

After yesterday’s scathing tongue lashing on Monday’s less than a pleasant attempt at renting a car, we hesitated to go down a somewhat negative path two days in a row.

For the majority of tourists, today’s post will have little significance. You book a vacation/holiday in Costa Rica, staying at a resort for a week or two. If you take prescription meds, you bring along a sufficient amount for your entire stay. If innovative, you bring enough for an additional few weeks in the event of some mishap or delay in returning to your home country as initially planned.

Creatures in Costa Rica are colorful, including this massive spider in her web.

However, suppose travelers like us plan to stay for an extended period. In that case, it’s an entirely different scenario when no prescription drugs (including non-narcotic meds) may be shipped into the country. Also, no vitamins or supplements may be shipped into Costa Rica and will also be confiscated.

Why is this? These are stringent drug laws, coupled with Costa Rica’s intent to create a revenue source from selling their prescription medications in the local and chain pharmacies. As a result, other than prescribed narcotics, mood-altering, or brain function medications, most medicines are sold over the counter without a prescription.

I take low doses of three non-narcotic meds for the following conditions (bad genes); hypertension, thyroid, and a hormone…fairly innocuous items, all typically requiring prescriptions from a doctor in the US.  (Other country’s laws may vary).

It was frustrating, taking photos through the fences, but these birds weren’t ready to return to the wild after their rehabilitation.

When I noticed my supply dwindled these past months, I decided to purchase over these next few months from ProgressiveRX, where I’ve been buying refills regularly over these past five years through their online service, comparable to buying from any online pharmacy in Canada.  

Easy as always? So I thought. This has never been an issue in any country in which we’ve lived over these past years. So I’d make the online purchase well before I needed them (slow delivery times) and have them shipped to wherever we may be at any given time. 

Although one shipment was lost while we were in Italy, the company happily replaced the lost items at no additional charge. Luckily, I’d planned the shipments months before I needed the pills and never missed a dose through the lengthy process of replacing the lost items.

Three Barn Owls at Zoo Ave, the bird and animal rescue facility in the Alajuela Valley.

While in Australia, for the sake of convenience, I received new prescriptions from a doctor we’d visited for physical exams while in Trinity Beach. But, unfortunately, I couldn’t get more than a six-month supply, which is typical, even through online pharmacies. 

Thus, again with a several months supply on hand, I ordered more from ProgressiveRX, which we had shipped to us in a box of supplies from the US from our mailing service.

I’d also considered making the purchases of a few month’s supply while here in Costa Rica since both of us must have physical exams no more than 60 days before the upcoming cruise to Antarctica. So we’d have the necessary exams and purchase my meds while here at any pharmacy.

Three Barn Owls were sharing a tree branch.

On Monday, the day of the rental car fiasco, I’d brought along the pills in the bottles with clearly marked labels to the Walmart Pharmacy. As it turned out, I’ll run out of two of the meds before the time we leave on November 22nd, thinking they could easily be replaced by some Costa Rica versions of the same frequently prescribed drugs for these conditions, common throughout the world.

Oh, foolish me. Walmart could not supply me with any of the three meds without changing doses and brand name components. One of the meds required the brand name when I tried alternates to no avail in years past.

After the pharmacist and I counted what I had left, we discovered I’d run out before leaving. “Local pharmacies don’t carry what you need,” explained the kindly pharmacist. So it’s a lost cause. I contemplated my options which included taking wrong doses and wrong meds and decided against it.

These birds were too high up to get clear shots without a tripod.

During the last month, when I’ll run out of two of the three meds, I’ll take doses every other day.  Doing so should not be life-threatening, although it may create some unpleasant symptoms. I’ve experienced worse. I’ll be fine.

In the interim, I’ll place an order from ProgressiveRX to arrive at our mailing service in September or October (at the latest) and have them shipped in a box of other supplies we’ll be sending to our hotel in Miami, where we’ll stay one night before boarding the 30-night cruise to South America.

How will we ensure the proper timing? We’ll have the shipment arrive from Nevada to Florida at least two weeks before our arrival on November 22nd. The hotel will hold the package for us until we arrive. 

Parrot sitting atop a perch at Zoo Ave (Ave means “aviary” in Spanish).

At that point, I’ll have enough to hold me for a few months until I place another order for a shipment to South Africa. That will work. We received a shipment while we were in Marloth Park in 2014 without incident.

The result…bring enough medication with you when you come to Costa Rica unless you’re confident you can purchase refills from a local pharmacy of the products/brands/doses you typically use. You are allowed to bring a regular supply into the country commensurate with your stay, plus extra for unexpected events.

Did I learn a lesson? I suppose regarding Costa Rica, I sure did. And, of course, in the future, I will check if there will be an issue receiving medication by mail from countries where we aren’t quite sure. But, after five years of world travel, this is the first time we’ve run across such a situation. 

A bit blurry from afar but a pretty parrot nonetheless.

But, like the rental car situation (BTW, we did get a refund from rentalcars.com for which we’re relieved and pleased), one never knows what may be encountered in unfamiliar territory. Neither of these scenarios would be an issue for a typical short stay by most travelers. 

Our unique nomadic lifestyle can be challenging at times. And we continue to learn as we go.

Be well.

Photo from one year ago today, August 30, 2016:

Shorter than he’d usually prefer, Tom’s buzz cut in Phuket Thailand held through the 33-night cruise, which began on October 31st. For more details, please click here.