Staying Healthy

For the past week or so, Mikkel has been recovering from a bad cold, starting with voice loss, then a deep cough, low fever, stuffy nose, and loss of energy. Because of the deep cough, we were concern that he might have bronchitis. So we ventured off to the Centro Salud, the Pedasí health clinic, which is about 2 blocks from our home. I had been there recently myself to get a doctor referral for a mammogram, thanks to my friend, PB, who helped me navigate through the system. The Salud is by no means anything like health clinics in California with all the bells and whistles, pristine, and modern. You will see old chairs, wooden desks, narrow hallways, and walls that could use a fresh coat of paint. But it is what we have here in Pedasí and in many towns throughout Panama. The friendly staff and doctors are well-trained and I have no complaints. There is a pharmacy, lab, observation room, examining rooms, a dental clinic, and emergency department. We had previously learned that if you need an ambulance to take you to the hospital in Las Tablas or Chitre, you have to come to the Salud; the ambulance does not come to you. And if it is not there, hopefully you have someone with you to drive you to the hospital. A new hospital in Pedasí has been built, but has not opened yet; not sure when that will happen.

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Anyway, being familiar with how things work now, we went to the Salud and were told to come back at 3pm to see the doctor. There are different times, morning and afternoon, when the doctor will see patients; no appointments, just first-come, first-serve. We returned at about 2:45pm and joined the others sitting in the reception area until someone came precisely at 3pm to the window to write up an intake form on each patient. Everyone is basically on the honor system, knowing who arrived before them and after them, and lined up at the window accordingly. After receiving our basic information from Mikkel’s pensionado visa ID, we sat down in the hallway where a nurse would call each person in order to take vitals (weight & blood pressure). Then we sat in another hallway around the corner and waited for the doctor to call Mikkel’s name, again in order received. We then entered a room where the doctor asked questions in Spanish. That’s one reason why I was there, to translate for Mikkel and answer in Spanish; Mikkel has decided to rely on my Spanish understanding and knowledge and translate for him when necessary. After listening to Mikkel’s deep breaths, she determined he just had a bad cold, to our relief. She told him the usual: take Tylenol, drinks lots of water, and rest. For the cough, she prescribed a cough syrup. Out the door we walked, toward the reception window to ask about the bill – $0! Not sure why because it is usually $2; either way, wasn’t going to argue. We do not have medical insurance here in Panama. We chose to self-insure and the main reason is the low cost for health care, even without insurance.

The Salud pharmacy was closed, so we went over to the farmacia in town, about a block away, and bought the cough syrup. We have been there many times before to refill prescriptions I have from my doctor in the U.S. So we know Christian, the pharmacist, who showed us 3 different brands of the same medicine, one for $12, one for $8, and one for $6. Of course we took the cheaper one and with our pensionado discount, it came to $4.95.

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Now in regards to getting a mammogram. For many of my readers, let me first tell you that I was diagnosed with Stage 1 breast cancer four years ago. This was discovered by my annual mammogram which I have done since I was 35 years old when my mother was diagnosed and eventually died of breast cancer. Long story short, after 2 lumpectomies to remove all of the small tumor and 2 sentinel lobes to make sure the cancer had not spread into the lymph nodes, and 6 weeks of radiation, I have since been cancer free. I am a survivor, but I do continue with my annual mammograms, having my last one in June, 2013 before moving to Panama.

So now being in Pedasí for over a year, I was due for another one and inquired around as to where to go. Hence, with my friend’s help, I went to the Central Salud a few weeks ago to get a doctor referral. Then a couple of days later my friend went with me to show me where to go at the Las Tablas hospital to get an appointment. Unfortunately, to our surprise, the soonest appointment I could make was not until November due to a recent campaign to encourage woman in Panama to have one for early detection and prevention. Not wanting to wait so long, the receptionist referred me to a clinic in Chitré. It would cost more, $35 at the hospital, $46.75 at the clinic. (Compared to what it costs in California without insurance, even the clinic cost was a deal.) I was able to make an appointment at the clinic in Chitre by phone and a few days later went, this time with 2 friends, and had the mammogram. Again this clinic, somewhat bigger than Central Salud in Pedasí, was not like the California health centers. There was only one machine in one very small room, unlike the health centers I have gone to in California with 4+ machines! each in a much bigger room. But again the professional staff was very friendly and patient with my attempt at speaking to them in Spanish. Afterwards I was told to return a couple of days later for the results and paid for the service.

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Unexpectantly, I received a call from the clinic in Chitré a couple of days later asking me to return for more X-rays. They couldn’t tell me much more than that, only that I needed to come back a week later. Well, reminders of the emotions and feelings from the past began to rise up within me. I tried to tell myself it was probably because they did not have all the past medical history and records, and they probably saw a lot of scar tissue in the mammogram. Nevertheless, I spent the next week in prayer and asking others to pray as well. I remembered how prayer really helped me when I was first diagnosed with cancer, feeling great comfort and assurance that God would see me through this. He did then, and He did this time as well. I also called the medical records department of the doctors and hospital in California, asking for them to send me my records regarding everything about the breast cancer. They emailed me a form and after paying $15, they are mailing a CD with the records and X-rays. But I probably won’t receive it for about 3 weeks. The day finally came, and I decided this time to arrange for a translator who I have used previously so that I would really understand what the doctor and staff tell me. And, of course, Mikkel came with me as well. Immediately, the technician explained that they were just taking more mammograms of the one breast to make sure that what the pictures showed was scar tissue from surgery, nothing else since they did not have any base X-rays to begin with. I now took a big deep breath, relieved that the doctor was just being thorough. Afterwards, I saw the doctor who assured me that all was well, giving me written results in both English and Spanish, along with the X-rays. Doctors and clinics usually give you all the results of the medical procedures and service for you to keep for the future; in other words, you store your own files. I came away very satisfied and will return in 6 months to the clinic for a requested follow-up.

So I thought I would share some of our experiences with health care in Panama. Many of our friends asked about it when we had decided to move here. Yes, things are done differently than what we are used to, having lived in California all my life. But this is my home now and I accept these differences. I know it is not for everyone, even for some who live in other areas and cities in Panama. I do believe since we have moved here, we are healthier-more fresh fruits and vegetables replacing junk food and fast food; more exercise; more fresh air; and less stress. If there ever comes a time one of us needs more consistent medical care, we will cross that bridge when necessary. In the meantime, God has bless us with overall good health and we are happy with what is available for us now where we live.

9 thoughts on “Staying Healthy

  1. McMoller says:

    Hopefully that will not happen. I really have no experience, but you would probably be transported by ambulance to a Regional Hospital (unless you have health insurance). It depends on where you are. In the Pedasi area, there is a Regional Hospital in Las Tablas and another in Chitre. From what I have heard from others, the costs are very low, but other hospitals (such as in David) may be more. At a Regional hospital verses private, basics such as sheets, blankets, and meals may have to be provided by your family or friends, along with daily basic care. But the medical care is just as good. We have a friend who needed emergency intestinal surgery. He went to the hospital in Las Tablas. Ended up with two different surgeries and a 6-week stay. He says the doctor was excellent, checking on him daily and more concerned about getting him better. Told him not to worry about the bill. At the end when his wife went to pay the bill, it was $100 total.Most doctors have received their training in the U.S. Most have to work in a hospital sometime each day and if they have a private practice, they come to their office after they finish their daily duties at a hospital. So many doctor appointments may not start until 3-5 pm. depending on their hospital shift.
    There is insurance available in Panama, but for us it would be too costly due to both Mikkel and I having pre-existing conditions. So we chose to be self-insured for now. Mikkel has VA and has his meds shipped to our MailBoxes etc. address in Las Tablas. He goes back to the states for a checkup once a year. I am not eligible for Medicare yet, but it is not accepted in Panama anyway.
    Some hospitals offer their own insurance as long as you go to theirs; we have heard that some private hospitals require a $5000 deposit. These hospitals are in or near the big cities-Panama and David.

  2. Tom says:

    Good morning Connie
    That’s unfortunate about the lack of staff for not opening. Another question about health care. The cost of general every day heath care seems quite affordable. What happens when your out for a ride and have a serious car accident with severe injuries or a heart attack that requires hospitalization and you have no insurance what happens? Tom

  3. McMoller says:

    Unfortunately the hospital has not opened. Although the President of Panama came and dedicated the new hospital, and eventually the equipment has been delivered, there are not any doctors and enough staff to actually open it up. A problem throughout Panama is a shortage of doctors, and Panama will only hire Panamanian doctors to practice here. Recently my husband had food poisoning (his own doing thinking he didn’t want to waste food and smothered slimy turkey lunch meat with pickles wouldn’t hurt). I convinced him he had to go to the Centro Salud (local health center) after he had a fever and shivering under a blanket in our warm weather. There we paid $2, he received a checkup by the doctor who ordered him to be hooked up to an IV with 3 meds including anti-biotics, and 2 other prescriptions plus pedialite for his diarrhea and upset stomach which cost $17 at the local pharmacy (less expensive at the Salud pharmacy but it was closed). The Salud has an urgent care unit with beds and lots of equipment and is opened 24 hours. And the staff is very friendly and helpful as we try to communicate with our limited Spanish that is no where close to theirs.
    There is a free clinic tomorrow, April 12th, for all people over 40 years at the Salud offering full medical and nutritional evaluations, lab tests, medications, referrals to specialists if necessary, and breakfast afterwards.
    It does not matter what your income is or if you have any insurance. Everyone is charged the same. And jubilados (seniors) get a 20% discount on prescriptions and other medical costs.
    I understand that in Panama City and David, the costs are much higher, but here in the interior, we receive very good care for a lot less.

  4. Tom Dumas says:

    You have a great blog and I’m working my way through each month. Has the new hospital opened and do you have any new experiences of the health care in the area? Tom

  5. mcmoller says:

    Everyone goes to the clinic as far as I know. There are doctors in Las Tablas who have a private practice, although many work at a hospital and see patients outside their hospital hours. Mikkel has previous seen an internist for his driver’s license, but his appointments are in the evenings at 5-6pm.

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