Two sisters, one in Lisbon and the other in New Jersey, show how Portugal provides a promising if imperfect model for improving a nation’s life expectancy.
LISBON — On days when the pain in her feet is so intense that she has to crawl from her bedroom to the bathroom,“Sometimes, I call her just to cry, because she understands what I feel in that moment,” Lucilia said.
Overall, experts said, Portugal provides a promising if imperfect model for reaching at-risk residents early and tackling the chronic illnesses that drag down a nation’s life expectancy.Portugal’s temperate climate, healthful diet and communal culture play vital roles in people’s well-being. There are also greater restrictions on guns. Personal drug use has been decriminalized, allowing opportunities to treat rather than stigmatize addiction.
“We are efficient,” said Luis Pisco, a family doctor who retired in August from his position as president of the board of the health system here in Lisbon and the Tagus Valley, one of Portugal’s five regional health administrations. “We cannot say we are perfect. But for the money we spend, we get good results.”Private health clinics, such as this one in a Lisbon neighborhood, are competing with the National Health Service by offering easy access to family physicians.
“I am the opposite of my sister — I don’t like to be at home,” Lurdes said, sitting in the kitchen of her one-bedroom apartment in Union, N.J., which is decorated with lush landscapes she painted to keep her mind at rest.The Costa sisters were both living in the United States when they developed RA symptoms about 15 years ago. They were working long hours providing in-home care, cleaning houses and waiting tables — physically strenuous jobs that did not offer insurance.
Her partner, Beto, nursed Lurdes through the ordeals, carrying her to the shower and bringing her food. But he was also uninsured, trying to manage his diabetes by reducing the weight he had gained since immigrating to the United States, and suffering from discomfort in his groin that proved to be a bulging hernia.
In the United States in the same year, 12.1 percent of people delayed or did not receive needed care because of financial constraints alone, according tofrom the Centers for Disease Control and Prevention. The numbers rose to about 15 percent among Black and Hispanic people.In Portugal, part of the success may stem from the high number of doctors for the population size.
A patient consults with a doctor at the Nazaré family health center, on the coast 75 miles from Lisbon. dental consultations, some diagnostic services, dialysis and rehab in the burgeoning private sector, which offers a wide range of care, particularly in major cities.
Family doctor João Sequeira Carlos speaks with longtime patient Laura Nunes about a bruise on her arm while dining at her Lisbon restaurant. For several hours, the two couples shared stories of their growing children, holding hands like old friends and taking breaks to listen to the nostalgic Portuguese folk music known as fado. Laura Nunes brought out photographs of a 10-year-old grandchild
In New Jersey, Lurdes is doing her best to keep those traditions alive. She has planted herbs and tomatoes in pots outside her apartment and takes pride in the lightly dressed salads and traditional bean-and-vegetable soups she serves at Burnet B.B.Q. IV, the Portuguese American restaurant where she works. But the menu has had to adapt to American tastes, with bigger portions, more french fries and slatherings of barbecue sauce on plates of ribs.
On Christmas Day, her cellphone rang. She was surprised to hear her psychiatrist speaking. He wasn’t working that day, but he was concerned she might be indulging in Mon Chéri chocolates, a traditional seasonal treat but one that carries special risks for Lucilia because the cherry-brandy filling could interact with drugs she takes.The hilly roads of Lisbon provide scenic exercise opportunities for city residents.
Waiting lists at public hospitals for procedures that aren’t urgent, such as joint replacements and even fractures, prompt transfers to private facilities. A few days after his visit to Tasca do Jaime, Sequeira Carlos heard from a friend who had waited five days to have surgery on a hip fracture before transferring to a private hospital.
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