Better at jumping than waiting...

Thanks, Afriend, I am getting a clearer picture now. 😉

....The only warning the Guide gives is that if you end up needing some sort of medical treatment that isn't available in the USVI, you'd need to be flown to PR or Miami, and that even if your insurance reimburses for that... .

This is if you even have insurance in the first place. Unless health insurance is provided by your employer, government program, or you are an expat, you are going to have a hard time even getting health insurance since there are currently no providers here that write individual policies. So that is a concern for a lot of us.

... but I didn't realize how hard it would be to give up recycling and composting and just throw everything in a dumpster on the way to work. ... No home mail delivery ...
Things I miss-composting, recycling ... drinking tap water ...

You can do your own recycling bit. It's not perfect but every little helps. For instance, I use plastic containers as flower pots for seedlings, heavy plastic coffee containers to store dry foodstuffs (flour, rice, sugar, etc.) and that's just the tip of it. Composting? No problem - everything compostable goes into a big compost bin outside and my plantings are well-fed!

Home mail delivery and potable drinking water are all to do with location. I COULD have home delivery - or at least close to home in a roadside mailbox. But I've had my USPS PO box for over 30 years and no reason to change. Anyway, the PO is a great spot for bumping into old friends I haven't seen for a long time. I've never lived anywhere on STT where the tapwater isn't potable, and now have the added wonderful plus of spring water piped into the cistern if we go through a dry spell and it runs low.

Thanks to all for your observations and insights. A couple of you mentioned concerns about medical care, and I've read about this concern in other forum threads as well. This surprises me, because the USVI Settler's Guide (and we do have the updated version), describes both major and satellite medical facilities on both STT and STX, and goes on and ON about the new and improved patient access, and all of the MANY different medical specialty departments/units in the hospitals (pediatric, cancer, cardiac, etc.), and says that some of these are the only (or largest) units of their kind, available in the Caribbean. I read that one of the hospitals even has a burn center, which not even Nevada had, when I first moved here. The Settler's guide also says that the hospitals are accredited by the Joint Commission (JCAHO), and have to pass stringent OSHA inspections as well...

So I'm curious, in what way (specifically) is the medical care sub-par, compared to the mainland?... to the point that people would actually be moving away for this reason, or wary of raising children on the islands. Is it slow ambulance response time to emergencies, or is there something else seriously lacking about the medical care? I'm not talking about isolated instances of crappy medical care (that happens everywhere!), but about ongoing, chronic problems that are worse than the mainland norm (health insurance issues notwithstanding).

One thing I like about the Settler's Guide (so far, I'm 3/4 of the way through it) is that the book doesn't seem to be trying to paint a rosy picture of island living... the Guide openly exposes and frankly discusses numerous problems/disadvantages associated with moving to the islands and living there. So if the Guide is neglecting to warn prospective settlers about problems associated with getting quality medical care, I wonder why.

The only warning the Guide gives is that if you end up needing some sort of medical treatment that isn't available in the USVI, you'd need to be flown to PR or Miami, and that even if your insurance reimburses for that, you'd have to pay for the flight up-front, and it can be super expensive. I can sort of live with that risk. But my (unrealistic?) expectation for STT/STX would be that there are doctors available who can, for example, read an X-Ray and set a broken bone, or do emergency surgery, and that medical equipment will be in good working order, and that hospitals are reliably stocked with necessary medical supplies. If that's not the case, I don't know how the hospitals there are passing inspections and keeping their accredited status. Any comments welcome, and most appreciated! .

If you are moving with a medical issue, talk to your doctor where you live now about his/her thoughts on your relocation to the VI.

If you then want to proceed, interview doctors and their staffs in the VI prior to moving to see if care will be suitable. We've found them to be responsive.

Like it or not, most evacuation insurance only works for medical conditions not readily treated in the islands.

Just an afterthought, Idlewood4, but by "potable" do you mean "safe"? I'd be very surprised if your tap water wasn't safe to drink. You may not care for the taste of it (if, for instance the cistern hasn't had a good cleaning in several years or either none or too much clorox is added to it regularly) but the only way to determine whether or not it's potable/safe to drink is to have it tested by a certified water testing lab. I've only ever lived in one place where the water just didn't taste good - but it was tested monthly and was potable.

... Is it slow ambulance response time to emergencies

I've certainly found that to be an issue for a few older friends who've left. If you have (or develop) a chronic medical condition which could suddenly erupt and require immediate transportation to a medical facility and where time is of the essence, you can have a problem here - at least on STT/STJ. I can't speak for STX. The mountainous terrain slows down the response time, we only have one 24/7 facility and those friends who have left have found peace of mind living in a stateside community where round the clock medical facilities abound close by.

Afriend's comments are spot on, in my opinion! There is NO WAY I would have ANY major medical procedure done on this island!! And, it is a concern to me if we experienced an emergency here that EMS would actually show up in any semblance of a timely manner and actually know what they were doing! I also don't feel that our hospitals (particularly on STX - sorry but my opinion here) are equipped to handle even things like broken bones well. I had a friend in a motorcycle accident who broke his tibia/fibula and it was set incorrectly - so, up to the States he went and 3 surgeries later, he thinks it has been fixed properly. The 3 surgeries were due to the horrible job that was done on the initial first, emergency surgery! Not cool!! My husband broke his hip, and though I am not grateful that it happened, I AM grateful that it happened when he was in Ft. Lauderdale for the boat show and NOT here!

I think there are some good doctors and dentists here (on both STT and STX - can't speak for STJ) for routine things, but any specialized issues...nope! And, as many have said previously, health insurance is a big issue for many. I had an individual policy when I first came here - that's when they were still writing policies for us here in the VI - then, had to do without for a couple of years (the first time in my life I was uninsured!!). I now have insurance through my husband's company, fortunately. Do your homework as far as whether your stateside insurance policy would cover you here...nobody can answer that except for your insurance carrier...

Re: The hospitals... There is not a burn center on St Thomas, and I would be surprised if there was one on St Croix. There are orthopedic surgeons out the ying-yang, thanks to tort reform limiting the amount they can be sued. So if you have an accident, break a limb, yes, there are x-ray machines and folks to set it. However, there are specialists that we do not have. Cardiac and neuro surgeons. Rheumatologists. Pediatric surgeons. So, if your accident includes a head injury that requires emergent surgery, you are in trouble.

As stjohnjulie says, you need to have insurance to be air lifted. You have to have an accepting hospital and physician and everyone has to be in agreement that the service cannot be provided here. On the other hand, I have heard of people with no insurance who have gotten on a commercial flight (in bad shape) and gone straight to an ER in the states.

Some people fly to the states for planned treatments, evaluations, and surgeries. It is the unplanned ones that you have to deal with. The difference is that in Big America, you can get just about anything done by driving somewhere. Here it's a much longer distance. P.S. If you get sent to Puerto Rico, you may find the language barrier difficult.

There is also a paucity in long term care for the disabled, mentally ill, etc.

I paid for MASA when on STT for 'air lift' insurance. I now have SkyMed. Never used either one but it makes me feel better to have the coverage...just in case.

When my sister was hospitalized for her 2nd surgery on her broken elbow early this year, after the 1st surgery resulted in an infection setting in, within a week, her roommate in the hospital was a woman who had been run over by a taxi van, along with her husband, in Red Hook, while crossing the street.

Due to the damage to both her legs/hips, she was told that her necessary surgery could not be done on island. Luckily (or not), they were on vacation
and had excellent healthcare insurance. She was waiting for coordination of various services to have both her and husband, transported back to the states for their respective complicated surgeries when I met her. It took a few days to accomplish this.

My sister ended up having to have a 3rd surgery on her elbow as the 2nd surgery was not performed properly and there were issues. She opted to do this 3rd surgery, stateside.

As a business owner, she had insurance, here, luckily.

When my sister was hospitalized for her 2nd surgery on her broken elbow early this year, after the 1st surgery resulted in an infection setting in, within a week, her roommate in the hospital was a woman who had been run over by a taxi van, along with her husband, in Red Hook, while crossing the street.

Due to the damage to both her legs/hips, she was told that her necessary surgery could not be done on island. Luckily (or not), they were on vacation
and had excellent healthcare insurance. She was waiting for coordination of various services to have both her and husband, transported back to the states for their respective complicated surgeries when I met her. It took a few days to accomplish this.

My sister ended up having to have a 3rd surgery on her elbow as the 2nd surgery was not performed properly and there were issues. She opted to do this 3rd surgery, stateside.

As a business owner, she had insurance, here, luckily.

This is a perfect example of why many of us will do whatever it takes to go off island for any medical care serious medical need. I even get my regular check-ups back in the states.

Just about everyone I know opts for going stateside.
I wish my sister had.
Would have saved her many months of excruciating pain.

Who operated on her?

I've left island for two surgeries, one just in July, and would leave again if I need surgery. I'm blessed as I know this is not an option for everyone. Three trips stateside for pre-op, surgery and soon my post-op trip back to Arkansas is not cheap or covered by insurance, I do have insurance. Sad that we can't get stateside healthcare here, but, it is what it is. I'm staying!
I will say having had both post-op PT here, as well as in the states, we have top Physical Therapists who do a great job right here on STX!

Wow! This generated a lot of comments 🙂 I had about three glasses of wine and was feeling antsy. I am an adventurer, and I've been in one place too long. I start getting bored. But I know I can't just jump down there right now with a daughter who is a junior in high school and very involved in her life here in Tampa. I will be hiking the AT for 5-6 months though after she graduates and after that... I am fair game for a totally impromptu move to the islands....savings account and work from home job in hand. All else will fall to the wind and moon and stars. In reply...

@mtdoramike- thanks but I don't have cable. Or TV. I can't stand the 24 hour news that is the norm now.

@OldTart- I get the "it's never a done deal." I expect to live there awhile. Stay if I want. Find a new adventure if I want. I will find my forever home. Whether or not it is there remains to be seen.

@Vicanuck- What is your business?

Lots of info about medical care here!

Sounds like a plan.
Come check it out, see how you like it.
Stay if you do, move on if you don't and enjoy all you can!
Good luck!

i had an emergency trip to the hospital in january and was extremely satisfied with the care i received. my issue was worse than just a broken bone.

now i also know someone who had an injury ( broken ?? to their arm ) and now has permanent damage possibly due to the care they received.

my husband at the moment would not have any procedure done here.

i guess its just the luck of the draw. but of course everywhere you go people complain about their local hospitas

Afriend's comments are spot on, in my opinion! There is NO WAY I would have ANY major medical procedure done on this island!! And, it is a concern to me if we experienced an emergency here that EMS would actually show up in any semblance of a timely manner and actually know what they were doing! I also don't feel that our hospitals (particularly on STX - sorry but my opinion here) are equipped to handle even things like broken bones well. I had a friend in a motorcycle accident who broke his tibia/fibula and it was set incorrectly - so, up to the States he went and 3 surgeries later, he thinks it has been fixed properly. The 3 surgeries were due to the horrible job that was done on the initial first, emergency surgery! Not cool!! My husband broke his hip, and though I am not grateful that it happened, I AM grateful that it happened when he was in Ft. Lauderdale for the boat show and NOT here!

I think there are some good doctors and dentists here (on both STT and STX - can't speak for STJ) for routine things, but any specialized issues...nope! And, as many have said previously, health insurance is a big issue for many. I had an individual policy when I first came here - that's when they were still writing policies for us here in the VI - then, had to do without for a couple of years (the first time in my life I was uninsured!!). I now have insurance through my husband's company, fortunately. Do your homework as far as whether your stateside insurance policy would cover you here...nobody can answer that except for your insurance carrier...