Healthcare in a Foreign Land: Our Experience of Portugal’s Healthcare System as Expats

It was the stuff nightmares are made of — a dark and stormy night in a small village perched at the edge of the world. Far below a tumultuous ocean smashed against the rocks as the lonely lighthouse flashed its light in warning thirty miles out to sea — danger. Just up the road we sat huddled in our new house, wondering if we should have ventured five thousand miles away from home. The wind howled against the doors and the halls echoed as if haunted by ghosts. I doubled over in pain and let the tears roll down my face, mirroring the rain against the glass of our bedroom window. We didn’t want to go out in this weather, and we had no car. We were miles from the nearest hospital and there were no taxis in this tiny village on the cliff. But there was one thing for certain, I needed a Dr.

We had only been in Portugal for a short while, a matter of weeks, and earlier in the day my husband suggested we go see a doctor as I clearly wasn’t well. As an American, I could envision the hundreds of dollars and the myriad of headaches that would ensue in exchange for one brief visit with a doctor, who would turn out inevitably not to be a doctor at all but a nurse practitioner — who would just tell me to drink plenty of fluids and get lots of rest.

“Did you hear me?” My husband asked.

View of Cabo da Roca from Azoia
View of Cabo da Roca from Azoia

I looked outside. The day was sunny and, along with the soothing blue of the sea and the flowers dancing gaily in the wind, I figured I’d be fine. I looked at my husband, shook my head in determined defiance, smiled lightly and said, “I’ll be fine.” Famous last words.

As the day rolled on the wind grew in intensity and dark clouds came tumbling in from across the sea. Then came the rain, first just a drop here and there, then a torrent of water rushing and pelting the roof and then hitting the windows with each strong gust of wind. In the distance thunder rumbled and in my arms, our little dog shook and whined. This was no ordinary storm, and I had no ordinary stomach ache. The pain assuaged me now, my insides felt as if I were being stabbed from within and I could no longer sit up. I lay in the fetal position sure that I would die that very night, that once the angry wind and curtains of rain had faded and the sun rose once again, I’d be gone.

O.k. So I might have a slight tendency toward the dramatic.

Rainy Window

Yes, my husband was right. I needed a doctor. And now, the bill would be even higher as it was the time of night when the emergency room would be our only option. My husband took my screams to mean there was no time to waste and quickly dialed the number of the woman who managed the house we had rented. She lived several houses down and was banging on our door before I’d managed to put on my shoes. We woke up our son and piled into her little van and worked our way through the storm and toward the closest hospital. Her van had only two seats, so my husband and son were clinging on for dear life from the floor in the back as she hurdled in true Portuguese style around the corners of the Serra and down toward town. By the time we’d climbed down the mountain and found ourselves on the freeway the rain had stopped. There were few cars other than us rolling past the soft yellow glow of the streetlights on the wet road, but suddenly, our savior/driver slammed on the breaks and pulled to the side. My pain erupted all over again and I fought back a squeal.

“There’s a dog!” She exclaimed as she started backing up along the shoulder of the road.

“What?” I was confused as the pain had it’s grip on me and I was having a hard time concentrating. Before we realized what was going on, she’d hopped out of the car and enticed a staggering pup into the back with my husband and son. Soon we were off again, heading toward the hospital with her explaining in broken English that the dog had surely been abandoned as people ‘did that here’. I was horrified.

What had we done? We’d moved to a country we had only been to once, and it had been years before and for just a short time. A country where they regularly abandoned dogs on the freeway? My head was racing, and fear was taking hold. What sort of country was this really? What was this hospital going to be like?

When we arrived, my husband took me by the elbow and helped guide me in. We found a dimly lit room — and about the air hung a kind of bluish-green hue, the sort that so often finds its way into scary movies set in places like Maine, where every scene was dim and the edges of scenery blurred. The waiting room was filled with rows of plastic chairs which held what must have been half the population of Lisbon. People in varying degrees of pain occupied nearly every seat. They stared blankly up at screens with numbers scrolled across and various Portuguese words…I could only assume I’d have to wait for hours to be seen. I didn’t think I could make it. I wanted to cry. I wanted to be back home, not the house perched above the stormy sea, but home-home — where things were familiar and I knew what to expect.

I sat down on one of the empty plastic chairs. I tried to ignore the pain, breath through it and look around. For the first time, I thought adventure was over-rated.  I sighed and was thinking I might as well just resign myself to my fate, when our driver pulled me to the intake window and translated a few things for me and before I knew it, I was sitting in an exam room off from the waiting room. A nurse came in and, from what I gathered, asked me to get undressed and sit on the bed. I scanned the room for a gown and saw none. At this point I was in too much pain to much bother about it, so I did as I was told and sat on the cold table in my underwear, well aware of the fact that the door was not locked and that on the other side sat a huge crowd of people with nothing to look at but numbers on a screen. I supposed that if someone walked in, at least I’d provide some entertainment.

When the doctor came in, thankfully, she spoke enough English to get us through the exam and I was promptly sent on my way with a prescription for some medication. I met up with my husband at the window to pay and found the woman sitting there beside herself with apologies. My husband had just explained that we did not EU insurance. She said she was so sorry, but that we would have to pay full price for our emergency visit. Prepared to receive a bill for hundreds of dollars, if not more, my husband took a deep breath while he studied the bill, and then glanced at me with a puzzled look.

“What is it?” I asked.

“It’s eighty euros.” He smiled as the woman behind the counter continued to apologize.

I had been to the emergency room in the town we lived in in Washington state before we moved and the bill was well over six hundred dollars, and that was with insurance! Once I was over my illness, and able to think clearly, we discussed our good fortune. The healthcare system in Portugal had given us our first taste of what it was like to live in a country in which one can visit the doctor and not have to take out a second mortgage on their home!

Since that faithful stormy night we have had many visits to doctors offices. A typical visit to our doctor costs fifteen euros. Yep, that’s it! Of course, once you have your residence card you can get free healthcare, yes Free! We signed up recently for the free healthcare in case we need it, but in our case we decided to take out a policy that would cover ourselves while traveling outside of Portugal. We have one of the best packages available, and it only costs us 200 for a family of three. Not only that, but the experience I had back on that stormy night has never been repeated. I think that the severe pain I was in must have colored everything in a tragic light. I remember the place as depressing and strange. But, we now know that the hospitals are clean and modern and on par with other countries in Europe, despite Portugal being one of the poorer countries. Our doctors speak fluent English, which is a great help because despite our desperate attempts, after four years of living here, we still do not speak Portuguese well enough to describe the intricacies of various pains and worries regarding our health. I recently had to wear a heart monitor for twenty four hours as I had done once in the states. What cost hundreds of dollars in the states, cost exactly eleven euros. And we have countless examples from x-rays to mammograms, and everything in between…excellent healthcare is just plain cheap here. It is one of the many aspects of life in Portugal that has been positive.

And for those of you who may be wondering about the dog who ended up riding with us on the night we went to the emergency room, he’s fine. And, though, as a general rule, the Portuguese don’t seem as enamored with their dogs as folks in the states do — you don’t see near as many dressed up or being pushed about in prams — it’s important to remember that there are people who abandon animals all over the world and I don’t want you to think that it’s worse here. It’s a sad part of life. That being said, there are many Portuguese who offer their services to help stray and abandoned animals

Cabo da Roca Lighthouse from Hike
Cabo da Roca Lighthouse from Hike

Life in Portugal has become our new normal and when we travel back to the states for a visit, it feels foreign. It is 2020, and things are hard everywhere, but the states are in crisis. I can’t help but think, that if they would just over-haul the healthcare system and make it affordable for ALL, that so many other aspects of life in the U.S. would improve. Perhaps they can study places like Portugal and get some pointers.

Happy Travels!

Avatar for Hollin Stafford

Hollin holds her degree in Sociology and was a flight attendant for United Airlines up until the time she had her son. She, her husband and son are now happily living with their three dogs in Portugal. Hollin home-schools so they can explore the globe, and teach through experience. When not writing about travel, Hollin’s focus is on writing fiction. Her work has received rave reviews from critically acclaimed agents and editors. She has a unique voice embodied through rich...read more

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