We arrived in Cuenca, Ecuador feeling a little under the weather and suffering from travel fatigue.  Four months of rental apartments, budget buses and unfamiliar things were taking their toll.  At home in the upper midwest, Fall had arrived.  The pictures and descriptions of the changing colors and football games and all things pumpkin flavored were taunting us and making us homesick.

Our lethargy wasn’t helped by the fact that we had stumbled upon what is surely the most comfortable apartment in all of South America.  Owned by American expats who live full time in Cuenca but were visiting family in the US, it featured all the comforts of home and then some.  The apartment had a ginormous master bed that my husband actually could fit into, with high thread count sheets and snugly blankets!   There was a media room complete with reclining chairs and a VPN that enabled us to watch our favorite shows on a big screen!  A maid came once a week to vacuum and dust and clean the bathrooms!  The kitchen had granite counters and every small appliance and spice a cook would ever need!  We settled in and lost all desire to explore and venture forth into the city.  We grew lazy.

After a week of isolation and endless TV watching, we forced ourselves out of this cozy nest and discovered Cuenca.

An old city, it was inhabited by the Cañari until around 1500 AD, then the Inca until roughly 1550.  Both groups had abandoned the area by the time the Spanish arrived in 1557.  As seems to be the case in all of South America, the Spanish immediately set about building lots and lots of churches.  Cuenca has some amazing examples of colonial architecture, but luckily also retains evidence of Incan and Cañari cultures.

The city perches in the Andes at 8400 feet elevation and has pretty mild weather.  We were there for nearly a month straddling September and early October when the days were mostly sunny and warmish, with a few grey and rainy ones thrown in for variety.  Nights were crisp and cool and we found ourselves using jackets and sweaters that hadn’t before been out of our luggage.

There are four rivers which flow through town and are surprisingly (for a city of this size) quite clean and beautiful.  The river Tomebamba has a nice paved pedestrian and bike trail that we spent a lot of time meandering along.  The people of Cuenca, especially the university students (of which there are MANY) seemed to spend a lot of time along these banks as well and there were always couples canoodling and groups of people just hanging out.

Making this journey with young kids means that we always take time to locate the parks in any city we visit.  Cuenca had a couple that impressed us.  Parque de la Madre had tons of playground equipment that was well maintained.  Parque Paraiso was framed by two rivers and had lots of green space, playgrounds, ponds and interesting areas to explore.

Cuenca is famous in the world of American expat retirees.  Constantly at or near the top of lists of the best international retirement cities, there were about 4000 Americans living in this city of 350,000.  It was easy to see why.  It was safe.  They use the dollar.  The weather was always reasonably decent.  There were scores of restaurants, many catering to gringo tastes.  Healthcare seemed plentiful and affordable.  Indeed, for better or worse we saw more gringos here in one week than we saw in the entire two months that we spent in Quito.

A lot more.

I had the opportunity/misfortune of trying out the healthcare in Cuenca while there.  I discovered a lump in my breast just after we arrived in town, and thought to myself, “Awesome!”, because what’s better than making a discovery like this while traveling, without local health insurance, no idea about local doctors, and not fluently speaking the local language??  I don’t know!

Not knowing anyone to ask for a doctor recommendation, I promptly took myself over to a clinic and hospital (Santa Ana) that was conveniently located one block from our apartment.

My spanish speaking skills are….ok.  I definitely feel more confident speaking to people in person than on the phone, so I went directly into the clinic to try and make an appointment.  The first thing I did was ask the lady at the front desk if any doctors there spoke English.

She looked at me sternly over the edge of her glasses.  “Your Spanish is fine.  Go upstairs and make an appointment with one of the gynecologists”.

This both flattered and terrified me, but no time for worrying so I found the fifth floor and approached the secretary.  I stretched the limits of my vocabulary and did a lot of pantomiming to explain my situation.  She made an appointment for me for the very next day with a gynecologist.

(I will describe my experiences with this doctor and this clinic because I think a lot of people, especially retirees, would be interested to see what exactly the healthcare system is like in Cuenca.  However, this is obviously only one person’s experience at one clinic, and should be taken with a grain of salt.)

Upon my return for the appointment, the secretary collected $40 in cash from me.  At the time, I wasn’t sure what exactly this was paying for, but as it turned out I returned to see the doctor two more times (without an appointment!) and this fee covered those visits as well.  The doctor was cordial and professional.  His office was….masculine.  There was dark wood paneling, modern furniture, and a very large painting of a nude woman gracing the wall.  It was all very classy and expensive looking, but I had to suppress a giggle imagining how well this decor would go over in much more uptight North America.

The doctor did his own ultrasound examination (also included in that initial $40 fee!), but afterward requested that I go to the laboratory in the clinic for another more comprehensive one.  I asked if I should make an appointment but he assured me that wasn’t necessary.   It was now approaching 6:30 pm, and I was shocked to find that the lab was still open and ready for my ultrasound!

This was a surprising thing for me about not just the clinic but all of Cuenca as well.  They very much follow the schedule of taking an extended break from about 12-3 pm, and then returning to work until late in the evening.  The entire clinic (minus the emergency room) closed from 12-3 everyday, but you could find doctors and technicians working until 8 or even later at night.  We found that many businesses all throughout town would follow this pattern, even museums and stores that catered more to the tourist crowd.

The ultrasound cost $35.  I also got some blood work done which cost $12.  After consulting with the doctor the next afternoon over the results of these tests, he sent me next door to a different clinic that offered mammograms.  I went there and got the test done immediately, but was told to return four days later to meet with the doctor there to go over the results.  My $45 fee at this clinic covered both visits, AND the third ultrasound that they did when I returned for the results.  In the end, everything turned out fine and no further testing was necessary.

All together, I saw three doctors, had three ultrasound examinations, one mammogram and one blood test for the price of $132.  I have had the same tests done in the US and can honestly report that the care (from a patient’s perspective) seemed comparable.  The only major difference (besides that everything was done is spanish of course) was that this Ecuadorian doctor took a much longer time to talk with me and discuss my medical history and was always available without delay when I wanted to discuss the results of my lab tests.  He never seemed rushed or frazzled.  I’ve always been happy with my doctors and healthcare in the states, but this difference was profound and hugely appreciated.  Finally, he sent me on my way with copies of all of my tests and told me, “Tranquilo, enjoy the rest of your trip and do not worry“.

As for food, we try to stick to local joints with local fare both for the experience and the prices.  We do like to try out the more gringo-friendly places (especially brewpubs) occasionally, but found that many of these were out of our price range in Cuenca.  We found a Mexican food/burger joint that had decent food and an expat poker tournament on Thursdays that my husband enjoyed.  The one brewpub we found unceremoniously asked my husband and son to leave as they didn’t allow children (first time that has ever happened).  The central market had a great selection of fresh veggies and fruits, but was a bit far from us to utilize frequently.  We found amazing tamales for 50 cents each, and ate our weight in them.  There were good almuerzo spots all around town with great all inclusive lunches for around $2 or $3.

So, why wasn’t Cuenca our new favorite city?  I risk getting a lot of hate mail about this one….but I have to be honest.

The gringos in Cuenca were aloof, to the extent that it was really kind of strange.  The Ecuadorians were outgoing and warm, and went out of their way to make us feel welcome, but anytime we saw other gringos on the streets or in restaurants they pointedly ignored us.  A few times I approached expats to ask where they were originally from or how long they had been in Cuenca, but I  got the cold shoulder nearly every time.  This contrasted greatly with the almost aggressively friendly expat culture in Boquete, Panama (another expat haven), and frankly surprised the heck out of us.  There were a few friendly exceptions to this rule and we did meet some nice folks, so perhaps our overall impression was just a biased perspective based on our travel-fatigued state of mind (or maybe the gringos in Cuenca are simply tired of all of the other gringos), but the experience wasn’t delightful.

My other complaint was that the traffic in Cuenca was heavy, frantic, and difficult to navigate around as pedestrians.  We try to walk almost everywhere and while the city was quite compact, the river walk was lovely and the sidewalks were good, crossing the street was gambling with your life.  I was frequently reminded of that atari game I played as a kid – frogger.  There were buses, but they were stuck in the same traffic jams as everyone else and it always seemed easier just to try and get there on foot – carefully.  We were told that Cuenca has plans to build some sort of train or rapid transit system, and that the city is planning to close the streets around the square to traffic, so hopefully that will alleviate some of these problems in the future.

In summary, Cuenca seemed to be a lovely spot with a lot of wonderful things in its favor.  It was safe and beautiful and had many resources to offer its residents.

We enjoyed our time, but realized that we are more inclined to retire in a place with abundant public transport, more pedestrian friendly areas and perhaps less of an intrenched expat community.  Onward to the next city!