By Miriam Drake
Photos by Miriam Drake

It is challenging anywhere in the world to care for a husband whose health has deteriorated to the point that he cannot speak, one side of his body is completely paralyzed, and he has no sensations in his core. In Cuenca, Ecuador it is beyond challenging. When that happened to us, one of my major early discoveries was that all the hospitals here are designed around the assumption of large family groups with a male at the helm. My Ecuadorian-American husband used to be at the helm. Without warning, one morning I became the one at the helm, armed with my high school Spanish and a will of steel to keep him alive, safe, and improving. I was alone, and I was not prepared for this. Think minefield.

My late husband was hospitalized for a massive stroke followed a week later with a failing bladder. Then four weeks after that because of a mistake I had made, the huge, infected gall bladder was discovered, and a surgeon saved his life. All of these medical emergencies occurred within 10 weeks. It was a shocking explosion of stress and fear!  By week 10, I was beyond burned out. 

CITIZEN JOURNALISM ARE YOU PREPARED?Without medical training, I learned new things every day about medicine and about the emergence of new medical problems. For example, I learned how to clean a wound that would never heal. But I made mistakes—it was always something.  My medical Spanish grew with each problem. I invented the wheel every day as I climbed the steep learning curve that had become our life. I was perpetually scanning the horizon for problems and heading off catastrophes. And it would have helped if I had known things and been prepared. Stress, fear and burnout became my everyday reality. Dark gallows humor became my best friend. “Now what?” became my mantra.

CITIZEN JOURNALISM ARE YOU PREPARED?I learned many things from the day of my husband’s stroke through the finality of his peaceful death a year later. After he was gone, I was overwhelmed with grief. And in that fog, I realized that no one would want to go through what I had experienced. Knowing this, I began making notes and organizing everything I had learned. I developed a to-do list, checklists, a medical Spanish list and a list of useful and reliable healthcare resources. All of my notes eventually evolved into a book and half-day seminars, which I offered during 2015—2018 for expats who wanted to prepare a structured support system for themselves. 

There are several things I would like to stress to the reader. Get to an Ecuadorian attorney and draw up a Declaracion document, Poder for Healthcare (Power of Attorney for Healthcare), two general Poders, and a Testamento (Last Will and Testament).  Hire a US-trained registered nurse on a consulting basis to manage your care within the healthcare system. Complete a medical history form and review it with your nurse.

CITIZEN JOURNALISM ARE YOU PREPARED?Find primary and specialty care physicians who are top-notch. (Don’t select doctors or attorneys just because they speak English—that is not wise.)  Hire a translator. Complete a Five Wishes form. And form your very own large expat family group, which I call a “care community” in the book. In order to survive medical emergencies, incapacitation, and end of life in Cuenca and ensure the best possible outcomes, we need to prepare our own personal systems. I go into detail regarding what you need to know in the book, “Expat Medical Emergency Preparation, the 2020 revised edition.”  Be wise and prepare!  Now you have the tools.

Place your order for your copy of the revised 2020 edition of “Expat Medical Emergency Preparation Manual” by writing Miriam at The cost is only $15 payable via PayPal. 

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