This topic is about a 37-year-old U.S. expatriate living in Costa Rica who is waiting for a colostomy reversal surgery through the country's public health system, known as CCSS. The person is concerned about the safety and conditions of the surgery, especially given some personal health risks and experiences with the local healthcare facilities. Here are some insights and advice shared on the topic:

- The individual had an emergency Hartmann’s procedure in 2016 due to perforated diverticulitis and is now on a waiting list for reversal surgery in Costa Rica. Returning to the U.S. for the procedure is not an option due to lack of health insurance and residency.

- Personal health risks include heavy smoking and high alcohol consumption, although the person is otherwise healthy. The main fear is mortality during or after the surgery, rather than postoperative discomfort.

- There are negative impressions of the CCSS hospital in Liberia, where the surgery will take place, including poor sanitation and unprofessional behavior observed among staff.

- Concerns exist about the surgeon, who is a generalist and appears forgetful, although the initial surgery was successful without complications.

- The individual is seeking statistics or firsthand experiences regarding mortality rates for colostomy reversal in developing countries, particularly Costa Rica, and comparisons to historical U.S. mortality rates.

- The surgery will include a repair of a peristomal hernia using mesh, which raises concerns about potential infection.

- There is anxiety about the phrase “Si Dios quiere” used by surgeons, which translates to “If God wills,” and the individual is worried about the time needed for recovery, as no disability payments are available.

Advice and insights shared include:

1. General vs. Specialist Surgeon:
- Many colostomy reversals in the U.S. are performed by general surgeons. A successful emergency surgery outcome is a good sign of the surgeon's skill.
- A specialist title does not necessarily ensure safety; trust in the current surgeon is important.

2. Decision-Making Framework:
- Consider the pros and cons of having the reversal now, living permanently with the ostomy, or delaying the surgery until it can be arranged elsewhere.
- There is no rush; proceed when you feel comfortable.

3. Experiences with Reversal:
- Some people find the reversal easier than the initial surgery, with recovery taking days instead of weeks.
- Others have chosen to live with an ostomy for years and find it manageable.

4. Managing Infection Risk:
- Hospital-acquired infections can happen anywhere. Consider using Anasept antimicrobial spray to reduce infection risk.
- Family and friends can help maintain cleanliness and a positive attitude.

5. Mesh Hernia Repair Concerns:
- Discuss infection-control protocols with the surgeon, as mesh can harbor bacteria.

6. Psychological Coping:
- Take time to reflect and make a reasoned decision; don't let fear dictate your timeline.
- Understand that “Si Dios quiere” is a cultural expression, not a lack of responsibility.

7. Lifestyle Factors:
- Reducing smoking and alcohol consumption can improve surgical outcomes and recovery time.