Public healthcare in Colombia is defined by Ley 100, an important law passed in 1993 that decrees that the system resembles a giant octopus with a grasping tangle of tentacles. In fact, octopuses have some redeeming features such as quick reflexes to avoid capture and the ability to camouflage by changing color.

Our health system does the same: health companies gobble up large chunks of public money then mysteriously vanish to re-open with a new color scheme, name, logo, and shiny brochure promising everlasting happiness.

So how to tackle this trickster? The first tip is not to worry too much about corruption in the system, as this will only lead to high blood pressure. In 2016, in Monteria, a small city near the coast, doctors, politicians and health administrators conspired to steal over US$15 million by creating a company that registered “ghost” haemophiliac patients then charged the state for nonexistent drugs and treatment. The Cartel de la Hemofilia is only now being rounded up.

And the name of their corrupt company? Unidos por su Bienestar “United for your Wellbeing.” Irony aside, no matter how touchy-feely the name of the health entity, it is a business. And in the spirit of free enterprise, its aim is make money out of a human need.

Colombia has forged a complex public-private partnership that has created thriving enclaves of specialist doctors and clinics, but gutted the basic health system of health prevention and promotion done at village health posts, now mostly semi-abandoned.

This is great if you are a health tourist to Colombia seeking out a cut-price nip-and-tuck but hopeless if you are a campesino in a rural area needing follow- up on your diabetes. Which brings us to my second point: The health system works better in urban areas. Like with any business, you can better deal with your clients if they are concentrated in one place.

The downside of this are the queues: All those clients will also be crammed into the same room where you are waiting for your blood test. Being affiliated to a health promotion company, Empresa Promotora de Salud (EPS), can loosely be described as a gateway to the national health service.

In some ways, the EPS works like a health insurer with a monthly quota, but there are some key differences.

Firstly, your payments depend on income and your estrato or socioeconomic standing. Your immediate family can become beneficiaries of the plan, and secondly, an EPS cannot refuse you for pre-existing medical conditions, which helps if you have a chronic illness.

But having paid your monthly quota, you also have to pay an addition- al fixed fee in the form of pre-paid coupons (bonos) for every medical event, whether a visit to the doctor, blood test, scan, or drug prescription. Paying $30,000 pesos for each bono may seem expensive to get some paracetamol, but the same amount will cover a brain scan, three months of physiotherapy, or an operation.

So where is the problem? Sounds like a good system, right? Well, yes, except for the octopus.

Having created the health edifice, the many-armed beast of bureaucracy is now poised to prevent you from using it with one-by-one minor inconveniences; added together they form an impenetrable tangle of tentacles.

I cycle to the local health center to get a prescription filled. Trouble starts in the car park where I chain my bike. “You need a ticket for the bike,” says the guard. I unchain the bike and exit the car park and re-enter through the car barrier to collect a ticket. Another guard shouts at me to stop. “That’s the wrong ticket. You need a bike ticket.” I cycle over to his hut and he issues me a bike ticket.

Back at the fence to chain my bike, the original guard comes over with a clip-board. “You need to leave your ID card with me while the bike is here,” he says, while starting to fill in technical details of the bike in his clipboard. But I need my cédula for the prescription, I explain. “Then you can’t park your bike here.” I unchain my bike again, cycle away, and find a tree.

Upstairs in the pharmacy things are slow going. “You need this prescription authorized,” says the woman at the counter, after I have waited an hour for my turn. “Where does it say that in the prescription?” I say, frustrated that the authorizing – or not – of prescriptions seems a random event. “It doesn’t. Go to the second floor for authorizations,” she says stone-faced while ushering forward the next-in-line.

On the second floor there is a queue out onto the stairwell. “Is this the queue for authorizations?” I ask the person at the end. “No, this is the line to get the ticket for the queue.” Sure enough, the line ends at a desk where someone is giving out tickets for the queue. The waiting room is packed. I give up and cycle home.

That night my neighbor stops by. How is the planned cataracts operation going? I ask. “The EPS said I need to serve them with a legal writ to get the op,” he says. “I told them I just want my eye fixed. I don’t want to pay a lawyer to take them to court.”

It seems perverse that a health “promoter” will advise clients to sue them, but for them, it makes sense since they are legally obliged to provide the operation. Forcing people to take out a tutela (writ) is cheaper than operating. In 2015, a quarter of all tutelas made in Colombian courts were claims for health services, of which 70% were for procedures that the health system should have automatically covered. But many more can’t afford the tramites and don’t bother.

To my surprise, my own eye check-up ends up with an instant referral for laser treatment. I set out on a paper trail to get it all approved. Several weeks later I have a follow-up with the eye doctor.

“Don’t worry it will be very painless, in fact I will do the surgery myself in my own private clinic,” says the surgeon, handing me a business card. A week later the EPS turns down my referral: There is nothing wrong with my eye, they write. This gets even more worrying. Is the EPS giving me the evil eye? Or is the doctor fishing for private business? Now, I am more convinced than ever that a lawyer is key to visiting the ophthalmologist.

I try my luck to get another specialist – this time by phone – and after negotiating the usual menus and pre-recorded messages I reach a human voice.

“We can’t make appointments because the agenda is not open yet, try at the beginning of next month,” he says. I begin to learn about mysterious “agendas” that open and clamp shut randomly like giant underwater clam shells. They are probably allies of the octopus.

When I call in the first week of the following month, another voice says: “Sorry, the agenda is full, you should have called last month. But can I at least make an appointment for whenever there is a space even in several months?” I ask, a bit desperate now. “Sorry, we only open the agenda at the beginning of each month,” says the voice wishing me a fruitful day, before dumping me into an automated customer satisfaction loop.

Phoning the EPS goes better with something small and destructible close by with which you can vent your anger. This brings us to emergencies.

My daughter stubs her small toe on the bed-leg, something we all do from time to time and is usually fixed by a hug and cup of tea. But through some chain of events she ends up in the walk-in emergency department and is whisked away by ambulance for an operation. I get there in time just to see her wheeled off. “An operation?” I say incredulously to my wife. “It’s a stubbed toe.”

“But the doctor is worried it might not heal straight,” says my wife, equally surprised by the rapid turn of events. I still cannot get my head around the fact that my daughter is in surgery for such a non-life-threatening event.

What’s happening to the octopus?

The answer comes later with a surprise bill of $250,000 pesos from the EPS. “I suppose we should be grateful avoiding the stigma of growing up with a wonky toe,” I say on the way home.