Portuguese health care options

The private Hospital Da Luz in Coimbra
Hospital Da Luz in Coimbra is one of the many private hospitals and clinics in Portugal.

Healthcare is a big concern for many people who move to Portugal. The country has a well developed national healthcare system, Serviço Nacional de Saúde (SNS), that is funded by taxes and can be used by all legal residents. They can seek care at little or no costs at the SNS network of health centers(Centro de Saude) in towns and villages all over the country or at public hospitals which are located in the larger towns and cities.

There is also a growing network of private facilities and providers, such as Hospital da Luz, CUF and HPA, available throughout Portugal to those who pay for medical insurance.

These public and private healthcare networks rank well overall. The World Health Organization gave Portugal a number 12 ranking in its 2019 World Health Report.

How does the public system work?

Americans and residents of countries outside the European Union who want to move to Portugal must obtain a D7 visa. In order to get the visa, they must show proof of travel insurance which covers medical costs. (Since January 2021, because of Brexit, people from the United Kingdom must also have a D7 visa to move to Portugal.)

In effect this means that residents of these countries must have private health coverage when they arrive in the country in expectation of a permanent stay.

D7 visa holders can apply to be covered by SNS once they have been granted a residency permit by the immigration and borders service, Serviço de Estrangeiros e Fronteiras (SEF).

Once a person has their residency permit, they can register to be covered by the SNS at their local health center to get the health system’s user number, or número de utente. They will have to show documentation such as passport, tax number (Número de Identificaçao Fiscal or NIF) number and residency permit.

After registering, in theory, you are assigned to a local primary care doctor and will be able to make appointments in person, by phone or online. There is a small fee for consultations and tests, usually less than 20 euros, services are free for those aged 65 years and older. In practice, the Covid 19 pandemic has put a severe strain on the system and many local health centers no longer have a doctor. So people have to travel further for routine appointments and care. Many hospitals are also experiencing staff shortages which have forced them to temporarily close certain departments or services during recent months.

A public hospital in Tomar, central Portugal.
Hospital Nossa Senhora da Graça in Tomar, a public hospital in the Medio Tejo region.
A sign for a local “Centro de Saúde” or health center and the associated pharmacy.

Private healthcare options

Numerous private health insurance options are available in Portugal through companies like Fidelidade, Allianz, Cigna and Medis. Plans cover most or all of the cost of routine check-ups and consultations with private specialists and hospital charges.

Coverage for pre-existing conditions is not typically available through these plans. However, the Association of Foreign Property Owners in Portugal (AFPOP) also offers its members special insurance rates through Medal Seguros. Under certain circumstances those plans will cover pre-existing conditions.

One thing to be aware of is that the cost of different plans increases with the age. In addition, there are very limited options for people over age 65. For those people, private insurance is available from MGEN, Medis (Vintage Plan) through Millennium bank, or Allianz-Medal, through membership in AFPOP.

For more detail on healthcare in Portugal and interviews with people who have moved here, read my article “Portuguese Health Care: Public and Private” on page 83 in the current issue of Portugal Living magazine.

Follow my blog to learn all about life in Portugal

My novel getting great reviews

The cover of my newly published novel “The Power of Rain”

It has been brutally hot in Portugal in the last month and the weather reminds me of New Mexico. That’s where my newly published novel, “The Power of Rain” is set. Like New Mexico, it has been very dry here in Portugal and a little rain would be more than welcome. Especially as we have had many wildfires burning uncomfortably close to where I live.

My novel became available on Amazon in paperback and Kindle format in early June and I am thrilled each time I see a review appear on Amazon or Goodreads. These days authors have to do almost all of their own marketing, so I am hoping to get more reviews (hint, hint) so all the more people will get to enjoy the book.

Here is what some of the readers have said so far:

Page Turner

The Power of Rain is the first of what is hoped will be a series of Digger Doyle mysteries. Set in a city in the New Mexico desert, this novel has all the characteristics of a page-turner –romance, underhanded or bewildered City officials, journalists at work to shine light on bureaucratic dealings, nefarious developers and the power of local people who keep showing up and speaking the truth. Digger Doyle is a journalist who, true to her name, digs in and doesn’t give up. I hope the author is working on the sequel – so many mysteries that need sunshine, and stories that need telling.

 Beautiful cultural insight

This novel brings alive culture and life in New Mexico and puts forth connections between politics, ethics and love. Recommended!

 This is such a fun read!

It’s a treat to follow the beautifully drawn character, Digger Doyle, in her investigations. Wonderful to see New Mexico, with it’s unique culture and magical landscape, shining so brightly. Can’t wait for the next one. And by the way, this would make the first of a perfect Amazon Original series. Just sayin’.

This Goodreads review from a Dutch reader living in Portugal

As a resident in a region in Portugal that is upset by developers that had support of a mayor that didn´t factor in drinking water (of which there is an enourmous shortage), not to mention the damage to nature, this story resonated with me. 
The main characters are likable and developed, the story is multi layered, the pace is fast and as a reader you go through all kinds of emotions. I especially appreciated the wittiness. I laughed out loud several times when the author described people.
Can´t wait for the next book in these series!

Famous Portuguese book store

A couple of days ago I learned that the historic and very famous Portuguese bookstore Livraria Bertrand, is now selling the book in English. Livraria Bertrand was founded in Lisbon in 1732. The original store in the Chiado district of Lisbon has been declared by the Guinness Book of Records as the oldest operating bookstore in the world. Livraria Bertrand also has branches in Coimbra and Leiria.

The entrance of the original Livraria Bertrand bookstore in the Chiado area of Lisbon. The store has a wide selection of books in English as well as Portuguese, French and other languages.

The novel was inspired by a lot of the weird and wonderful experiences I observed as a reporter in New Mexico. Now I am retired in Portugal, I am working on another Digger Doyle mystery. Follow my blog to learn more!

Portugal burns as temps soar

Half-burned oak trees are all that remain on a scorched hillside in central Portugal.

Portugal, like much of Europe, has been sweltering under a prolonged heatwave for most of the past two weeks. Temperatures remained over 38c (100F) for days and soared in some parts of the country as high as 47C or 116F. With the hot temperatures came the wildfires.

Fires are common in Portugal each summer but they popped up with a vengeance in July this year. Each time I spot a plume of smoke billowing in the distance I worry. During two decades living in New Mexico I saw the smoke from several deadly fires that consumed tens of thousands of acres and took weeks to extinguish. And this spring there was the Hermits Peak and Calf Canyon which become the biggest fires in the state’s history.

But the Portuguese seem to have learned a valuable lesson from a disastrous fire in 2017, which claimed dozens of lives near the central town of Pedrógão Grande. The Portuguese firefighters, Bombeiros, spring into action almost as soon as the smoke appears. Usually all signs of the blaze are gone within a few hours.

This year has been a test

Between July 5 and July 11, multiple fires broke out within 5 km to 15 km of where I live near the towns of Ferreira do Zezere and Tomar, in central Portugal. Bombeiros units from all over the country rushed to the scene, officers from the Guarda Nacional Republicans (GNR) controlled roads near the area. They even closed some major highways temporarily.

Thanks to the swift response, most of the smoke would be gone by the next morning. But as the temperature rose again and the afternoon winds kicked in, the ominous clouds of grey, brown and dirty yellow smoke would reappear. News reports attributed the new blazes to wind-blown embers which ignited tinder dry vegetation in the surrounding areas. At one point, I drove toward a nearby village and saw a line of cars stopped by the roadside. The occupants were standing watching the flames burn a hillside about 2 km, roughly 1.5 miles away.

During the evening, friends and neighbors sent messages back and forth checking on each other. Two of my friends had to evacuate for a couple of nights because the flames came within a half mile or so of their homes. I kept a suitcase packed with vital papers and other important items by my door in case I too had to leave. Luckily it didn’t happen.

Aircraft bring water to extinguish the fires

The drama in my area of central Portugal lasted for about four days. During that time planes and helicopters rumbled overhead all day long, carrying precious water from a nearby reservoir to douse the flames. I say precious, because Portugal is in a drought situation. Everywhere the lakes, rivers and reservoirs are seriously depleted.

Thankfully, the fires have now calmed down. A friend of mine who lives near a forest that has been mostly obliterated was deeply grateful to the Bombeiros when they told her that her home was safe. The Portuguese regard their firefighters, most of whom are volunteers, as heroes. I wrote about them in a recent article in Portugal Living, the online lifestyle magazine I’ve been freelancing for.

A burned hillside near the villages of Travessa and Quebrado do Cima, in central Portugal.

Life in Portugal: where push means pull and a dog is a cow

A sign outside a house in my village in central Portugal warns people to beware of the dog. Cão, pronounced ”cow” means dog in Portuguese.

I have been living in Portugal for almost three years now and I still hesitate when I come to an entrance door and see the sign ”puxe”. You see, the letter ”X” in Portuguese is pronounced ”sh”, so if you say the word ”puxe” it sounds like ”push”, but really it means pull!

The Portuguese word for push is ”Empurre”. To the native English speaker, this is so visually confusing. So I stand at the door and think ”push or pull?”

One of the other words that just seems weird is the word for dog; ”cão”. It is pronounced “cow”, or more correctly, pinch the top of your nose as you say cow and you will get the proper nasal sound that is used when you see the letter combination ”ão” in a Portuguese word.

Portuguese is full of nasal sounds. Bread is ”pão” which sounds like pow, again, holding your nose. Hand is ”mão”, pronounced mow, to rhyme with a nasal sounding “wow”.

You get the idea.

I’m fortunate to be one of those people that loves words. Learning languages is kind of a hobby with me. Some people like knitting or quilting or cooking. I like learning how to communicate with people in the countries I visit or have the good fortune to live in.

In my experience, the English speakers who come to live in Portugal tend not to become very proficient in Portuguese. Probably because many Portuguese are only too willing to speak English. Often when they say they only speak a little, you find they can quickly wax eloquent on all kinds of subjects. The Portuguese are good at explaining things in great detail.

English speakers often say that people who speak a different language talk so fast. We forget just how fast we normally speak. Try watching an evening news broadcast on your local TV station. We also forget how many variations of English there are. Think about the differences between “British” English and ”American” English, and then break those huge generalizations into the innumerable local accents in the UK and the US. Add in Canada, Australia and New Zealand–remember listening to Jacinda Ardern– and you’ve got a vast range of linguistic variations.

I went to University in Dublin, Ireland, and a lot of my friends were from Belfast. I can’t even begin to try to give a phonetic rendering of how people from Northern Ireland say ”cow”! Watch ”Derry Girls”.

The Ascensor da Glora in Lisbon. Emblematic of a scene in the Portuguese capital city.

My novel hits Amazon! Woohoo!

Cover of my newly published novel The Power of Rain.
“The Power of Rain” is a political mystery set in New Mexico

It’s been a long journey with a lot of ups and downs, but seeing my novel finally up on the Amazon website is a thrill! It’s a mystery set in the fictitious city of Las Vistas, New Mexico where hotshot reporter Elizabeth “Digger” Doyle has a nose for exposing intrigue at City Hall — And there’s plenty of that in a city where politicians are cosy with developers whose projects damage the environment.

I’d like to thank all the friends who helped encourage me to keep writing, and those who read the manuscript and gave me invaluable feedback. All those comments helped me keep working to come up with better ideas and to polish the writing.

A bit about the author

I’ve wanted to write ever since I can remember. When I was a little girl I used to tell my brother stories as we walked the few blocks to elementary school in El Cajon, Calif. I had freelance articles published when I was a student at Trinity College Dublin. I got my first real job as a journalist when I lived in Norway, writing and editing for the English language newspaper The Saga Weekly. Later, when I had children, one of my favorite things was to make up stories for them at bedtime. They always preferred my made up stories to books.

I was fortunate enough to land a job as a staff writer with the Albuquerque Journal, New Mexico’s largest daily. During the 18 years I worked there I wrote thousands of stories covering an array of business, political, environmental, police and feature topics. Some of the shenanigans I observed provided the initial inspiration for this novel.

It is now available in paperback and kindle format from Amazon. If you live in Portugal you can get it through Amazon.de. I hope you will enjoy it!

And you can find out more on my Amazon author page.

Thoughts on Uvalde, a year later

Morning Glories in my Portuguese garden.

(Author’s note: I wrote this blog post almost a year ago, after I had read about the horrific events at Robb Elementary School in Uvalde, Texas. Sadly, so much is still the same. Gun violence has become more prevalent and nothing is done to address the real problem–the prevalence of weapons of human destruction.)

LOSING A CHILD is the most gut-wrenching experience that can happen to a parent. It isn’t supposed to happen. Your children aren’t supposed to die before you. But it does happen sometimes, and we become members of a club no one ever wants to join. 

Their little faces remain forever young in the photos that surround you, haunting you, like phantom pieces of your heart.

I lost my 11-year-old son to a rare and devastating illness many years ago and I am still haunted.

There are so many emotions; pain, despair, rage. The questions; why them? Why now? What did they/I/we do to deserve this terrible thing happening?

When numbness finally comes it is a relief from the pain, but it is always with us, like a severed limb that will never regrow. 

I write this not to gain sympathy but to draw attention to what the parents of those 19 children in the small Texas town are facing. It will affect not only them, but their other children, their nieces and nephews, their grandchildren. It will ripple out throughout the families and neighborhoods, and eventually to the next generation.

The parents in Uvalde will live the rest of their lives asking the questions. And the terrible thing is; that despite so many of these hideous incidents, and their increasing frequency….. NOTHING substantial has been done to prevent them. Why the lack of courage to make change? Americans pride themselves on living in the land of the free. Where is the freedom in having to go to school surrounded by armed guards? Having to live in constant fear?  Is that freedom? 

I moved to Portugal three years ago and feel safer and more free here than I ever did in the US. 

My son Max: February 18, 1988-June 6, 1999.

Cycling adventures in Portugal

bicycle riders
Cycling on the Portuguese coast near Figueiro de Foz

Before I came to Portugal in 2019, I had been an enthusiastic cyclist in New Mexico. Every weekend saw me out riding with the New Mexico Touring Society bike club. Rides were great opportunities to see parts of Albuquerque I would never have explored by myself, or get out of town on rural routes. We shared coffee, lunches and many social occasions. The club became my extended family.

So, when I moved to central Portugal I hoped to find kindred spirits. Unfortunately, it’s been hard. But through the wonders of modern technology–think Facebook groups–and sheer persistence, I have found a few cycling companions. It has meant driving a lot farther than I was used to in Albuquerque, but it has given me the opportunity to see different areas of the country, like the coastal town of Figueiro de Foz and the mountainous region around Figueiro de Vinhos, near Coimbra. Some of my best rides have been with Jean-Remi Chapelon who runs an adventure tour company called My-Green-Break.

Challenging Terrain

I live in a hilly area of central Portugal which means lots of climbing if you’re on a bicycle. As you can imagine, this poses a challenge to the legs and lungs. I mentioned this to my brother, who is also a keen cyclist. His response was, “Oh but you used to live near the Sandia mountains, so what’s the big deal?” True, I did live close to the Sandias, which are part of the Rocky Mountain chain, but the difference is that there are hills everywhere here. They may be short, but they are very often steep–an 8 percent to 12 percent grade is not uncommon!

Nevertheless, I have grown to love the different style of cycling I can do in Portugal. I have met some wonderful people, enjoyed some great coffee, pastries, lunches and conversations. I have also learned to appreciate that a bike ride doesn’t have to be about killer mileage or training for some exhausting event like a century or the Iron Horse Classic, all of which I did while living in New Mexico.

Bike Friendly Drivers

Portuguese drivers are tolerant of cyclists, something I very much appreciate. Even though I ride mostly on narrow, winding country roads, there is so little traffic that I never feel in danger. Another wonderful thing about Portugal is the absence of broken glass on the roadside. Drivers in New Mexico had a habit of tossing beer bottles out the window. And, there are no goat heads, those nasty little seedpods with the wickedly sharp thorns that were deadly to bike tires.

National Cycling Guidebook

My interest in cycling also gave me the change to pitch a story to Portugal Living, the online lifestyle magazine I have freelanced for since 2021. On page 26 of the summer issue of the magazine is my article about Paulo Guerra dos Santos and the Ecovias Portugal, National Cycle Tourism Network. Dos Santos, a 49-year-old engineer with a passion for cycling, has created an online guidebook which has downloadable maps of cycling routes throughout Portugal. He researches the routes and updates the guidebook annually. The 2022 edition of the guidebook now has maps of more than 6,400 kilometers of bike routes.

There are 19 long distance routes complete with maps, advice on towns and accommodation and cycling specific technical information. Cyclists can follow trails that take them to historic towns,  past rivers, beaches, through hilly areas or the gently rolling countryside of the Alentejo south of Lisbon or among the orange groves of the Algarve. Santos divides the routes into segments of 30 kilometer s (18.6 miles) to 50 kilometers (31 miles), so cyclists can have ample time for sight-seeing and enjoying a coffee or meal along the way.  

The National Touring Guidebook is available online and appears in Portuguese and English. The 2022 edition sells for 64 Euros or $70. (Purchasers get an 80 percent discount on future guidebooks.) The guide is downloadable as a ZIP document which includes the road book and GPS tracks, there is also a PDF file with a general map of the network. Each route section can be downloaded to a smartphone and used with a GPX-capable app.  

Paulo Guerra dos Santos

My novel coming out this summer

This is the cover of my novel “The Power of Rain” a political mystery set in New Mexico.

It’s really happening! The Power of Rain, the fictional novel I wrote inspired by the strange political shenanigans I observed as a reporter in New Mexico is going to be available in paperback and ebook form this summer.

There are devious developers, ambitious politicians, a fight over a mysterious Spanish chapel, hectic newsroom scenes, a nasty election campaign, a heartwarming romance and the unpredictable vengeance of desert rain.

I’ll be writing a lot more about this as it gets closer to publication date. Watch this spot and sign up to follow my blog!

Visiting family outside Portugal 

Toddler eating an easter cookie.
My eldest granddaughter, Annie, eats the sprinkles off an Easter cookie.

At the end of March I flew back to the US to spend a few weeks with my son and his little family. More precisely, I came to help take care of my two lovely little granddaughters while my son was away on an army exercise and my daughter-in-law started a new job. 

I am exulting in the total immersion experience of caring for these two adorable little girls, but I am only here for a short time. I have enormous admiration for what their parents have to go through for the next few years. When you have had your own adult life for a few decades you forget just how exhausting caring for a toddler and a baby can be. 

It’s the constant need to be aware of all the potential dangers that lurk in the seemingly harmless home environment. The sharp edge of a cupboard, the hard surface of a floor for a baby’s head should it lose balance while sitting, the endless tiny objects possibly within reach that pose a choking hazard, the hazards of a staircase and on and on. 

Then, there is the colossal challenge of dealing with a two-year-old’s mercurial mood-swings–one moment all smiles and laughter–the next, ear-piercing wails and screams. The innumerable battles of will over demands for a favorite food or toy, only to have it rejected or go uneaten. 

And did I forget, wrestling with a wriggling baby who has deposited something very stinky in their diaper/nappy. I can’t understand why they haven’t substituted velcro for those irritatingly fiddly snaps on onesies. And don’t get me started on car seats. Yes, in the last 25 years I am sure technology has improved their safety, but oh are they hard to fasten and unfasten, especially when a little person is not happy about being clipped in. 

Yes, folks, little children will stretch your patience beyond anything you ever imagined. But humankind keeps having them and–let’s face it, they are so darn cute! 

Baby sitting on the floor.
Baby MJ loves to laugh.

Ukraine plight brings offers of help

Portuguese President Marcelo Rebelo de Sousa expressing solidarity with groups of Ukrainians who gathered outside the Presidential palace in Belem a few days after Russian troops invaded Ukraine.

A little more than two weeks ago, the Russian troops massed on Ukraine’s border began the invasion of that country. In the days since then, there has been near non-stop coverage of the horrors. Pictures and videos have shown droves of people fleeing the conflict zones. It’s scarily reminiscent of World War II movies, but this is real and it is now.

Portugal has a sizable Ukrainian population. According to government statistics, there were around 27,000 Ukrainians living in Portugal in 2020, making them the fifth largest group of foreigners living in the country.

Almost as soon as news of the fighting broke, Portugal and its people stepped up to offer help in many ways. The Portuguese president appeared on the CNN Portugal news broadcast speaking to a Ukrainian group to declare support and solidarity with their cause.

Soon after, the government declared a temporary protection program to help Ukrainian refugees obtain residence permits and access to the country’s healthcare system. There will also be help for Ukrainians to find jobs when they come to Portugal. Many Portuguese lawyers have offered their legal services pro bono to help the Ukrainians.

All over the country people are posting on Facebook groups and other media outlets to publicize the help efforts underway. People are offering space in their homes, making donations, organizing fundraising drives and gathering items to send to the beleaguered country.

While it is heartening to see this outpouring of support. We all hope and pray that the hostilities will end as soon as possible.

The city of Leiria has transformed this sign in its central square with the colors of the Ukrainian flag and the message “We are all Ukraine.”