Everybody’s favorite topic – medical care for nomads!

It’s been two years since Capt. Mike and I have had medical insurance in the USA. Part of our travel plan for 2020 was to fit in a little medical tourism trip to Cancun to get dental work, blood work, and recommended cancer screenings done. But…. it’s 2020….all plans are off! Instead, we spent 6 months in Grenada so we tried our best to find healthcare providers to take care of our needs here.

Although there’s a massive medical school on the island, training America’s future doctors, there’s not really a robust healthcare system or a modern public hospital. There is a small private clinic, St Augustine’s Medical Center, or SAMS, that’s a good option for emergencies. Our friend Cheryl on SV LeefNu had a good experience there treating broken ribs. But I don’t think I’d want to undergo a major surgery here if I had the option to go elsewhere. Many residents, who can afford it, also travel off island for significant medical care.

We started out with the easy stuff – a dental cleaning. Well, I THOUGHT it would be easy! Of the 5 or 6 dentists recommended in my local cruisers FaceBook group, most were taking appointments 4 months out! So I went with the only one I could see within two weeks. I found that the quality of the dental care was….ok. COVID precautions were in place (masks, hand sanitizer, chairs blocked off in the waiting room). A very pleasant young woman dentist, working out of a faded old fashioned office, gave us a thorough exam and a good cleaning. However, no X-rays, and no measurements for gum disease. She pretty much just poked at our typical American teeth and said “everything looks good.” There’s no lab to fabricate crowns on the island, so dentists must order such devices from the US and that takes another three months turnaround. I guess “Replace slowly failing crown” will stay on my to-do list for another year.

Cost for routine dental exam and cleaning = 165 ecd or $61US

Look at those pearly whites!

Up next, annual skin cancer screening. We are two very pale people, living outdoors in the Caribbean, so we make it a priority to get every spot checked out every year. There’s exactly one dermatologist in Grenada, Dr Jenny Issacs. The directions to find her office are “go to the downtown vegetable market, walk up the hill, look for the hand-written sign on the wall next to the used book store.” Again, covid precautions made us feel safe. We even had to bring our certificate from the health ministry stating that we’d passed a covid test and completed quarantine. Dr Issacs has been practicing in Grenada for over 30 years, and she’s licensed as a GP as well as a dermatologist. She’s very kind and thorough, and she listened to all of our concerns and requests for prescriptions to top up the boat first aid kit, writing us prescriptions for antibiotics and my thyroid pills. She examined Mike’s bald head and told him “you have so little melanin in your skin, you should be cruising in Scandinavia”, lol. She wrote him a prescription for Efudix, a cream used to treat pre-cancerous spots. We carefully followed the directions for a two-week treatment, and it seemed to work great! No more rough, red spots! She found one tiny irregular dark spot on my cheek and recommended a biopsy “Out of an abundance of caution”

  • Cost per person for dermatologist appointment = 150ecd or $55US
  • Cost for large tube of Efudix = 460ecd or $170US

Prescriptions are kind of expensive here… But so is everything imported, I suppose! It seems strange to me that prescription meds are priced by the pill, rather than by the month or by the dose. I take a very common generic thyroid medicine, but in the entire time I’ve been in Grenada, I could not find the dose I need in a single pill. Is there a conspiracy in all of Grenada’s pharmacies to make twice the money by selling twice the pills?

Cost of generic thyroid meds = about 55ecd or $20US per month

So that dermatologist appointment led to a biopsy appointment. Sheesh. The spot was so small, I had to point it out to the nurse. The surgeon was very nice – also a sailor who plans to retire and move into a boat in a few years (although he said his wife wouldn’t want to live in one as small as ours). I was nervous about the procedure (after all, it was on my face) but Capt. Mike was there to take care of me, and it really wasn’t bad at all. Three days later and I had the stitches out. Two weeks later, I got the biopsy results – negative – and I could pretend the whole thing never happened. Don’t forget your hat and sunscreen!

Cost for biopsy: including surgeon fees, lab fees, facility fees, initial consultation, and suture removal = 780ecd or $289US.

In addition to these doctors appointments in Grenada, I saw a doctor in Antigua to follow up on my shingles case, and to get routine bloodwork and a cervical cancer screening. So all in all, I got quite a bit of medical care outside the USA this year! If you are used to $20 co-pays and $10 generic prescriptions, these out-of-pocket expenses might sound like a lot. But, when you consider that the premiums alone on my high-deductable ACA plan were over $900 per month, and compare that to the emergency-only international plan that we currently have for about $2600 per year, we can pay for a lot of doctor’s appointments and prescriptions and still come out ahead! Maybe I’ll finally get around to that crown in 2021?

Where there’s no Amazon Prime 2-day Delivery

Hurricane season is our down time on Sanitas. We hunker down someplace safe, and we work on the endless list of repair and maintenance projects that have piled up during the Caribbean Cruising season. And…we shop. A lot. We shop for boat parts, we reprovision canned goods and paper products, and we replace the many, many household items that have rusted, ripped, broken, or otherwise wore out through daily use in a hot and humid and salty environment. But this year, for the first time, we couldn’t return home to the US, aka the Land of Plenty. No Walmart, Home Depot, or West Marine. Not even a short trip home, leaving with empty suitcases and coming back with them filled with oil filters, new hatches, and anchor chain. So once we’d made peace with the idea of spending the entire hurricane season in Grenada, we decided to bring the mall to us.

When you wear the same two pairs of shoes every day for over a year, they definitely get worn out! So happy to receive replacements!

I’m not gonna lie, it can be expensive and intimidating to order goods to be shipped to Grenada. Back in July, we shipped the supplies for our custom canvas project via air freight (essentially FedEx) which charges by weight and volume and that adds up quickly. Also, imported goods are subjected to both import duties and VAT – the sum of these taxes is 35% to 45% of the value of the item 😳 But, I learned there are two tricks to making this somewhat affordable:

1) We found a shipping company that uses sea freight. Yep – putting a cardboard barrel or box on a ship and sending it the slow way across the Caribbean sea from Miami to Grenada. For sea freight, we paid one price of 600 xcd (about $200) for shipping and handling based on the volume of the container, not on the weight. So it was in my best interest to order enough goodies to fill that box to the very top with the heaviest items possible, don’t you think? The guys at West Tech were great – they even sent us a photo of our box as it filled in Miami.

Almost full! It’s time to put this baby on the boat!
(Don’t blame me for the blurriness)

2. I worked through the red tape and paperwork to certify that the items we bought were all “transiting ships stores.” In other words, none of the boat parts, electronics, or clothing would stay in Grenada, but would be leaving with us when we continue to cruise north after hurricane season. Getting a C-14 form to certify this took a massive spreadsheet, lots of invoice tracking, half a ream of printer paper, and a lot of time at the Customs office. But it’s worth it – it reduced our overall duty from 45% down to 2.5%

You know how you order 6 things from Amazon and they ship them in 5 different boxes? We’ll imagine that frustration over a dozen Amazon orders. In fact, we ordered so much within a 48-hour period, after ordering nothing since last November, that Amazon locked our account and canceled an order because we triggered a fraud alert. TWICE. And that’s another reason for my massive spreadsheet. I tried to track when each package had arrived at the warehouse in Miami, so I knew when to tell the shipping company to go ahead and close up our box and put it on a boat. I now know the formats of UPS, USPS, and Fed Ex tracking numbers by heart!

You know how you hear stories about slow downs at the US Postal Service? Well we finally got bit by that chaos. Our final package was an envelope of documents that had to travel from Jacksonville, FL to Miami, FL. And it took three weeks. And apparently it only ever made it to the Miami post office and not actually to the address of the warehouse. Which means it never made it into our great big box. Good grief!

All the effort was worth it because last Friday Capt. Mike and I took a day off from the boatyard to celebrate Christmas in September. Our E-size shipping container was delivered right to our apartment where it was entirely too big and heavy to fit up the stairs, lol. So we spend the rest of the day shuttling shopping bags of boat parts to the boat and kitchen items to the kitchen and perform a fashion show of my new Skirt Sports wardrobe, and try out the new Soda Stream and really do feel just like kids on Christmas morning.

It’s a BIG box!

Was it worth it? Hard to say. When you add up the cost of shipping items within the US, and then across an ocean, and then pay import duty on top of the US sales tax, it’s sure no Amazon Prime free 2-day Delivery. But it allowed us to acquire a bunch of specialized spares and maintenance equipment for Sanitas. And it allowed me to replace the pair of sandals I’ve worn every day for two years until they are falling apart at the seams. And if all else fails, and I need a dry place to live, I’m pretty sure I could sleep comfortably in my size-E shipping container cardboard box!

How do we vote from our Sailboat?

This is the first year since we sold everything in 2017 and moved onto our sailboat, Sanitas, that we won’t be visiting friends and family in the USA in the fall. You know – COVID. 🤬 So how do we vote when we’re “stuck” in the tiny island country of Grenada 🇬🇩 with no access to the good old USPS? Well, it took a lot of research, a bit of trial and error, and about $15 but I think I’ve figured it out!

When we sold our house in Colorado, we established residency in Green Cove Springs, FL. (Yep. You can go ahead and call Capt. Mike “Florida Man.”) Florida is a no excuse vote-by-mail state. That means any registered voter can request a vote-by-mail ballot, without needing to prove a hardship or disability or that you’ll be out of town on Election Day. And, regardless of what the Pres says in his tweets, there’s no difference between an absentee ballot and vote by mail in Florida. in fact, in 2016, Florida removed the words “absentee ballot” completely from all government websites, ballots, and documents. When we registered to vote in Clay County, we ticked the box requesting to vote-by-mail and each time we return a ballot, we tick the box again stating we want to continue voting in this manner. That’s all well and good when we’re in the US, and we can get our mail forwarded to us, but what do we do when we’re overseas?

There’s an excellent government website called the Federal Voter Assistance Program or www.fvap.gov that provides tools and links to help US citizens vote from overseas. Being the government, it’s all acronym alphabet soup. First, we filled out the Federal Post Card Application (FPCA) to certify that we’ll be living outside the US on Election Day and requesting our ballots by email, rather than USPS mail. It required filling out and printing a form, then signing it, scanning, and e-mailing it back. In just a couple days, I received an e-mail confirming that Clay County received the form, and we were good to go on e-mail ballots. Step 1 successfully complete!

FVAP also does a great job of providing the election timeline for each county, including deadlines to register, request vote-by-mail, to return your ballot, and more. It even provides contact info for each county board of elections. This might just be the most useful government website ever! And now I’m slightly embarrassed about how much I’m gushing over a government website.

On September 18, we received our ballots and voting instructions in an e-mail – right on schedule! I hopped on a local minivan bus and traveled to the only shopping mall on the island, where I found a business center and printed our ballots and instructions for 10.50 ECD ($4USD) Back home, I used resources at Ballotpedia.org and the League of Women Voters lwvfl.org to research candidates and constitutional amendments on the ballot. When we were ready, Capt. Mike and I marked our ballots, signed them, and filled out a fax transmission sheet.

Florida doesn’t allow you to return a ballot via email (some states do!) so we also signed a waiver acknowledging that our faxed ballots wouldn’t be private. And then I set off in search of a fax machine – remember those? I spent about a day and a half walking back and forth between the boatyard and the Budget Marine chandlery with a folder full of paperwork trying to make it there during business hours (Island time is no joke!) and trying to find one with a fax machine that would function correctly and stay connected for 5 whole pages. I phoned Clay County directly a couple of times and spoke to a lovely, polite southern woman who checked that the fax machine was indeed turned on, and even gave be a backup fax number when the first one didn’t work. You gotta love that southern politeness! Finally, and after paying 2ec per faxed page, success! My mantra is, “Well it’s a heck of a lot cheaper than FedEx!” I have fax transmission sheet to prove my ballot went through. Now, fingers crossed that my signature from 2020 matches the one I gave them when I registered back in 2017 and I should be confident that Capt. Mike and I did our part to make our votes count and our voices heard. Even from the islands, mon.

What’s next for the crew of Sanitas?

That’s a great question! When you figure it out, could you let us know? 🤣 Just kidding. Sure, we’ve found a calm spot in Antigua to wait out coronavirus quarantine and curfew. But we can’t stay here forever.

Our 90-day visa expires on 22 June. Even more importantly…HURRICANE SEASON IS COMING! (Say it in your best Robb Stark, Game of Thrones voice). Hurricane season in the Atlantic Ocean and Caribbean Sea officially starts 1 June. But as I write this on May 15th, tropical storm Arthur is already forming between Florida and The Bahamas. Insurance companies usually require boaters to be safely outside the hurricane box during this timeframe, and they define the hurricane box as the area north of St Vincent in the eastern Caribbean and south of the Chesapeake Bay on the US east coast. This doesn’t mean you can’t get a hurricane outside the box, but they are much less common. If your geography is a little bit rusty, Antigua is smack in the middle of that box. 😲 Hundreds, if not thousands, of sailors plan to spend the summer in Grenada or Trinidad in order to get “outside the box”. But with borders closed to prevent the spread of coronavirus, all those boats are stuck in place and chomping at the bit to move south as soon as Caribbean governments allow.

We made a reservation ages ago to store Sanitas in a boatyard in Grenada and we planned to fly back to the USA for the summer. We also put a deposit on a boatyard here in Antigua as a Plan B. But now, like everyone else, all of our summer plans have been canceled. And we don’t know when flights between the Caribbean and the States will resume. If we do make it back to the States, we don’t have a home to go to, and we don’t know when we’d be allowed back to our boat after the visit. A recent study suggests Covid-19 has been contained within the Caribbean, but many countries view visitors from the US as high risk to their health and safety because so many new cases are still being identified there. Heck, what if we do make it “home” this summer and one or both of us gets sick? We sure can’t afford a hospital stay under the US health care system. I don’t think our international medical insurance covers us for Covid-19 treatment if we travel back while State Department “Do Not Travel” warnings are still in place. That alone makes it feels safer to stay in our small island bubble that to get on an airplane back to New York.

The Marine and Yachting Association of Grenada has been working behind the scenes on a proposal to the Grenadian government on how to open the borders to incoming yachts safely while protecting the residents of the country from importing coronavirus. We’ve been waiting impatiently to learn the results, but things are finally looking positive! Over 1100 boats have registered in a database to state that they want to travel to Grenada when borders open. Yesterday, MAYAG posted the first details on the plan. Of course the cruising community was immediately abuzz with excitement. Here’s the plan as we understand it so far….

We had a meeting today with the various authorities in Grenada who we are coordinating with and have agreed on an implementation protocol for arriving yachts. This needs to be approved by cabinet, which will be one of the final steps before we get the go ahead.

  • All yachts intended to come to Grenada need to complete the Maritime Health Declaration Form 48 hours ahead of your scheduled arrival.
  • A designated quarantine area has been set up. The GPS coordinates of this area will be given to you.
  • Quarantine will be 14 days with no shore leave granted and this will be on your yacht in the quarantine area. Provisioning supply chain has been set up for you during this time but we advise provisioning as much as you can before you leave for Grenada.
  • After the quarantine period you will be required to take either a PCR test or a Rapid Test. The cost will be EC$200 for the PCR Test or EC$75 for the Rapid Test. There will be a Statutory Regulation published requiring you to do this. If you object to taking this test then please make alternative arrangements as you will not be able to clear into Grenada.
  • There will be an arrival schedule set up where yachts will book an arrival date and be expected to arrive within 48 – 72 hours of that date. There will be a small admin fee of US$20.

That all sounds pretty reasonable, don’t you think? It’s still gonna be a little bit tricky. If we can’t stop in any countries between Antigua and Grenada, we’re looking at about a 300 nm passage, taking us about three days in good weather conditions. Capt. Mike and I will have to take turns on watch for the entire time – it will be our longest passage so far. I’m sure glad this isn’t our first cruising season! And we’re not really looking forward to another 14-day quarantine on our teeny tiny boat. Especially in the designated quarantine zone which is going to be crowded, rolly, poor anchor holding, and filled with lots of other frustrated and cranky sailors 🤪 But we’ll make the best of it because we also want to ensure that our Grenadian hosts can stay healthy and safe. I guess this is our Plan A for now, and we anxiously await news from Grenada on our scheduled arrival date. I hope we remember how to sail after sitting at anchor for so long! Wish us luck!

It sure ain’t Instacart…

So we’ve been under a 24-hour curfew to limit the spread of Covid-19 here in Antigua since April 2. And as of yesterday, it had been 10 days since I’d set foot on land and gone shopping for groceries and other supplies. Talk about self-isolation! On the plus side, Capt Mike and I are pretty confident that we’re cornavirus-free after such a long period of social distancing. But on the down side, our fresh food stores were down to a cabbage, a few carrots, and a lime. So, a few days ago, I had a brilliant idea…..In a Facebook group for cruisers in Antigua, I found an advertisement for a business that is willing to deliver fresh vegetables to various parts of the island. So I sent a What’sApp message out into the void letting Farmer George know I wanted a delivery to North Sound Marina which is located about 2.5 miles by dinghy from our remote anchorage. I let three of four friends on nearby boats know that I planned to place an order. Then…BOOM! Everything got a little bit crazy. The word spread quickly, and I was suddenly receiving veggie orders via FB messenger and What’sApp and SMS text from 13 boats, most of which I hadn’t even met in person yet, and several who don’t speak english as a first language. Some submitted orders in pounds of each type of veg, some in quantities of each kind of veg, some added “wish list” items that weren’t even on the price list! I buckled down and created a spreadsheet to track the orders and estimate the cost for each boat. I created a What’sApp discussion group to keep everybody informed. And I walked a thin line between harassing the veggie delivery rep, Petra, and trying to be polite and understanding because she said she was sooooo busy managing individual deliveries during lockdown and leading up to Easter weekend, that she was only getting a few hours of sleep each night.

Finally, I got a hold of Petra and submitted an order for approximately $900 Eastern Caribbean dollars of produce to feed thirteen families. At 2:00 am Thursday morning, I received a message from Petra: “We should be there by 11:30. Given the volume of orders, we need a tight turnaround. Add 70.00EC for delivery. And the eggs are”…..Yep. That’s where it ended. I hoped we were both talking about 11:30 on Thursday. I hoped we agreed on meeting at the marina. I had no idea the total cost of the order and how many hundreds of dollars I had to bring in cash. And the Antiguan government had just announced that 24-hour curfew was extended for another week, with absolutely everything on the island closed down on Friday through Sunday for Easter. So this Thursday morning was go time!

I sent an email to the Marina, letting them know we’d be coming in for “essential business” to buy food for our families, so they wouldn’t get us in trouble for breaking curfew. Chuck on SV Virtual Reality and Jason on SV Mimzy have the biggest, fastest dinghies in the anchorage, so the three of us donned mandatory face masks, grabbed shopping lists and cash, and headed ashore. We got there about a half hour early so we could speak to the boatyard manager and find our way through the huge yard to the front gate. And then we sat in the shade by the side of the road and waited. And waited. Now remember, I hadn’t heard from Petra since 2am. Chuck made a little side trip to talk to some local fisherman, and ended up buying us 10 pounds of mahi mahi fillets!

By noon (when we were all supposed to be back in our homes for the strictest form of curfew) I still hadn’t heard from Petra, and the number of cars and trucks passing by had slowed to almost none. Then I got a What’sApp message! Hooray! She said the eggs we’d ordered showed up really late, and she was headed back to pick the up. So we settled in and waited some more.

At 1:00 I sent another nessage, “Hi Petra, are you still coming?” and I got a terse response back – “yes”.

At 1:15, she messaged me “No tomatoes today. Someone stole my box. Sigh.” Now, we had ordered a total of 33 pounds of tomatoes, so I knew I was going to have some grouchy sailors! So I responded, “Please feel free to substitute something else. Spinach? Cucumbers?” At 1:30 Petra said “Heading to you now. 12 to 15 minutes” We had to move to a new spot in the dirt, because the sun had moved so far across the sky, the shade had moved!

An hour later, at 2:30…. “I am on the wrong side….coming.” A few minutes later….”I went to the wrong place…coming.” I walked over the the security gate for the marina and asked the security guard to call her and give directions. FINALLY, at almost 3:00, after sitting by the side of the road for four hours, Petra arrived! Hooray! Her little 4-door sedan was absolutely stuffed with cardboard boxes FILLED with fresh picked fruits and vegetables!

We had her drive as close to the dock as she could get and my big burly guys took turns hauling heavy boxes to the dinghies. It barely fit! We unloaded it all onto the stern of Mimzy, a big spacious catamaran, and set up a human assembly line to call out the orders from my spreadsheet, weigh pound after pound of vegetables, and load everything into shopping bags. Finally, I sent out the long awaited message – “The veggies are here! Come and get them!” Dinghies zipped in from all corners of the anchorage and we had the pleasure of handing heavy bags of pumpkin, carrots, cucumbers, spinach, zucchini, onions, lettuce, and thyme to quarantined sailors who were getting close to risking scurvy. 😜

I left Sanitas at 10:30 in the morning, and got back to the boat around 6:00 pm. It’s sure not as easy as going to the local Whole Foods. Or ordering quarantine groceries to be delivered from Walmart or Instacart. But all of our veggies were grown right here on Antigua – picked that morning or the day before. And we’re supporting a local business that’s trying their best to survive the closure of restaurants and resorts by figuring out how to switch to an individual delivery model. And we’ll be eating like kings and queens for the next week of curfew. After that, who knows? Maybe things will go back to normal and we’ll be able to visit grocery stores again. Or …. maybe I’ll be planning another epic trip to meet with Petra. There are about another half dozen boats in the anchorage now. I’ll bet some of them want fresh vegetables!