Who Is Your Angel?

The time is 6:12 A.M. as I begin to write this post. I haven’t been able to sleep since my cell phone rang at 5:30 A.M. This post may ramble a bit, so bear with me. If there are a lot of errors, forgive me. I will edit it more later.

Let me begin by asking each of you that have moved to Panama or who contemplating moving to Panama to ask yourself one question, “Who is my Angel?”

You probably remember that I posted a request recently about a missing person. In doing it, I only posted a photo because the U.S. Embassy could only grant me permission to post the photo and not the name. I should also mention that my post came four days after the Embassy had originally called me asking for help, because it took that long to get authorization for me to use the photo.

I even got some grief from a Boquete Ning group because the Embassy was asking for help and would not give the name. I have to admit that it annoyed me to read the comment, which I look at as an attack on the Embassy when any intelligent person would have looked at the photo and said I know him or I don’t. If I’d don’t know his photo, what good would me having read his name have done. Not a damn thing.

The post, however, did it’s job. I received one call from the U.S., from my friend Tom McCormack, who knew him and told me where he typically hung out and where I might find him or friends that knew him.

I received two other emails from people that knew him from one of the local gringo breakfast locations. One of those emails contained the cell number of the individual’s girlfriend, who only spoke Spanish.

With that information, I called the number and talked to an understandably frightened person for being called by an individual, she had never heard of, who was telling her he was a warden with the U.S. Embassy in Panama City. For the lack of a better name, let me just call her Angel.

We got past that hurdle and she connected me with the missing person and I talked to him. On the phone he spoke coherent and said he was happy I was checking in on him and he was scheduled to return to the U.S. on the 28th and to pass on the Embassy and his US family that he was OK. I hung up thinking the story was over and called the Embassy.

Yesterday morning I received a call from Angel. She was very distraught and asked if it would be possible for me to come see her boyfriend, because she was very concerned about him. I told her I would, but I couldn’t come before 3:00 P.M.

At 3:00 P.M., Lilliam and I arrived at the residence and this diminutive little lady came out to meet us. She took us to the apartment and we waited until she could help her boyfriend come talk to us.

When he came out of the bedroom, it was obvious that the left side of his body was not functioning well. He still spoke coherent and and thought he would be alright to return by bus to San Jose to make his appointed return to the U.S. on the 28th.

He had recently had lab work done to determine his problem and Angel pleaded with me to help her get the lab results and have them interpreted by a doctor. I said I would and we got her boyfriend dressed and headed to the lab. Getting him in my small car was no easy matter.

When we got the lab results, I asked who the doctor was that had requested the tests and it was the emergency room at Hospital Chiriquí. Rather than go back and get another doctor on call, I elected to go to my personal doctor, who I will refer to as doctor #5. That may make sense to those who keep up with this blog.

That examination determined that the most likely cause of the problems was a stroke. A CAT Scan was prescribed and since money was an issue, doctor #5 suggested we go to the Regional hospital to get it done because it would be cheaper. It is now a little after 4 P.M.

If you have never been to the Regional Hospital, then I will tell you it is an experience. In all fairness I have to tell you that the same doctors that are treating patients in Mae Lewis and Hospital Chiriquí are also seeing patients at the Regional Hospital. In any of the hospitals, anyone admitted needs family to see that attention is given when it is needed. Being alone in these hospitals is a recipe for a death certificate.

The Regional Hospital is over crowded and there are lines of people waiting to be seen. We became part of the queue. After waiting longer than I could handle, I talked to one of the doctors and told them I needed them to expedite the CAT Scan so I could contact the U.S. Embassy who would have to contact the family for guidance. Using the Embassy’s name sometimes helps and sometimes doesn’t.

In this case, I watched the doctor walk in and search a stack of forms and move our patient’s form to the top of the pile.

While Lilliam and I were waiting in the crowded waiting room, we got into a conversation with a lawyer who was waiting for his father to get a CAT Scan for a similar type of condition. As I often do, I exchanged cards with the lawyer. He was telling me that one thing that often happens is that if some doctors get involved, they see a opportunity to make more money if they can transfer patients to the private hospitals.

The lawyer warned to beware that this corruption factor was a business between some of the doctor’s and the private hospitals. What a prophet he was.

As we were talking, Angel came out with a prescription for some medicine normally used for stroke victims, saying that the hospital was requesting we buy the prescription. Lilliam, I and Angel headed out to get the medicine and some items Angel needed to spend the night. Our patient stayed the night at the hospital along with a friend of Angel’s.

After picking up Angel’s necessities and the medicine, we headed back to the hospital. I was parking as my cell phone started ringing. It was the lawyer I had been talking to in the hospital. I handed the phone to Lilliam, because I have a harder time understanding Spanish on the phone than in person. The lawyer told Lilliam that the patient had been taken by ambulance to Hospital Chiriquí. The lawyer’s prophecy had been fulfilled.

If one were really cynical, he might conclude that the request for obtaining the medicine was only a ploy to have Angel taken away so that the CAT Scan could be done in the more expensive location. I confess that I sometimes get cynical here in Panama about these sort of things.

Nothing to do, but await for the return of our patient and to get the results. It is now somewhere around 9 P.M. and the ambulance pulls up. More waiting and then they take our patient in for another X-ray. We were told it might be the morning before I would have the information to send the Embassy. So around 11:30 P.M., we told Angel, we were going home and to call if she needed us.

Around midnight, I just got out of the shower and was ready to go to bed and my cell started ringing. I saw Angel’s name on my phone and handed the phone to Lilliam. Angel said she had the results and could we please come and get them so the Embassy could have them as soon as possible. Desperation was in her voice.

I got dressed and we headed back to the hospital. Angel was in tears. She lead us back to talk to the attending doctor, who had the results. The CAT Scan had found a tumor that needs quick surgery. I asked if they could give me a copy of the diagnosis, so that I could send it to the Embassy for them to translate into English and send to the family in the U.S., which would be the preferable location to have the surgery done.

Of course the document needs to remain with the file and can’t be released until the case is finalized. I pressed and finally got them to let me have the document to get it copied. There is no copy equipment in the hospital.

Since I need to send this to the Embassy anyway, the best thing was to return home and use my scanner. Scanning a bad copy would not help anyway. I head to the house and Lilliam stayed with Angel.

I scan the document and printed a copy to verify that it is good and head back to the hospital. Lilliam is consoling Angel, who is beside herself with worry. Tears were flowing and it was a very emotional time.

Around 1:00 A.M., I said we needed to go so I could send an email to the Embassy. It was about 1:20 A.M. after the email was sent and I hit the bed. I was beat as was Lilliam. Just in case, I placed my cell phone next to the bed.

At 5:30 A.M., the cell phone was ringing. It was Angel. She probably had not slept and was thinking about the currently scheduled reservation that her boyfriend had and was wondering if it could be canceled and said she would have to search for the reservations.

After hanging up, I could not go back to sleep, and finally got out of bed at 6 A.M. to start putting my thoughts down in this post. When I opened my computer, I had an email from the U.S. Embassy thanking me for the information. I guess it was good I sent the email before I went to bed. I called the Embassy and found out that they needed a release from the patient to call his sister.

I just got back from the hospital getting that permission.

So that is more information than you probably care to know about problems that can happen living in Panama. Still I think there are lessons to be learned by sharing this experience and I want to review a few of them.

Lets start with you putting yourself in the place of the individual that is in the Regional Hospital. If that happened to you, WHO IS YOUR ANGEL?

Many gringos come to Panama thinking they are invulnerable and nothing can happen. Many get involved with young things that say they will take care of you and they love you, but when something like this happens, they wash their hands and move on to another $ prospect.

That was not the case with Angel. I can’t speak high enough for how instrumental she was in seeing that care was given. She gets 4 stars in my book.

If you happen to be one of the gringos that meet for breakfasts at the Multiple-cafe, have you made plans for having a problem and who knows where you are and will notice if you are missing for a few days?

I recommend everyone have their emergency contact list prepared and you all check up on each other. Sometimes, as in this case, you may not be able to judge your own condition and determine the correct plan of action.

If you come here, plan for the worst thing happening and know how your designated emergency help can get money for you. Hospital Chiriquí has never run a test for me without my paying up front. What are you going to do if you can’t go to the ATM yourself?

Do you have insurance that will cover you in Panama? You can see from the part of the story about the medical corruption above, why the U.S. does not honor Medicare and Tri-Care outside the U.S. If you think medical fraud is bad in the U.S., you haven’t seen anything.

Many come to Panama to live and never let the U.S. Embassy know where they are. They prefer to remain anonymous and don’t want the U.S. Agencies meddling in their affairs. See what happened in this case. The family in the U.S. contacted the Embassy because they had not heard anything from this individual since Carnival. What can the Embassy do? They contact the Warden network to see if it can learn anything.

This time we were lucky. We got a hit because some of the Chiriquí Chatter readers responded. If you don’t plan on checking in with the Embassy, I suggest you reconsider. I normally get contacted by the Embassy after they have been called by the police for a death or the hospital for an unconscious gringo in intensive care. Don’t let either of these be you.

My angel is Lilliam. She has helped me with many Embassy requests when my Spanish is not sufficient. I have my Angel. Who is yours?

UPDATE: April 16, 2011 – I think you should know that I was receiving emails from Tania (my primary contact in the U.S. Embassy) written at 10:00 P.M. last night. I know that the U.S. Embassy never gets the credit for the work that it does and often its hands are tied by regulations that don’t hinder an individual. For Tania to be working on this project at that hour shows real dedication.

39 thoughts on “Who Is Your Angel?

  1. Don, I have a feeling you are the Angel of so many here in Panama!

    Bravo to you and Lilliam!

  2. Good for you, Don. Having just gone through this health system and being shuffled off to that sad excuse for a medical facility, I feel for you and your charge. Once we find a corporate sponsor for Nutre Hogar, we should tackle the Hospital Regional. What a blight on otherwise a wonderful country.
    Bob

  3. Very eye opening story.

    FYI, I do some mystery shopping and usually the clients wish a copy of the receipt. I take JPG fotos and they are very readable. Usually the foto stabilization setting works for best color but the landscape setting works ok – the flash setting totally fades out the foto. Obviously, some good lighting helps tremendously. Then any computer can look at them with the viewer that comes with Windows or whatever they choose.

  4. Don… you are an amazing man that does so much for others. When I get to Panama..end of May, I want to take you to dinner. I will meet you soon. dede & byron basden from Dallas, Texas

  5. Great article Don. I have two Guardian Angels, my Panamanian Wife and my adopted daughter (11 years old). I know that I would not be able to survive here without them. Again, an out-of-the-ballpark article that all foreigners should pay attention to.

    Patrick

  6. Thanks for the comments. The situation is ongoing. The Embassy is in consultation with the family and I guess I would say it is in a holding pattern. We checked the individual out of the Regional hospital to lower costs and have located a male nurse to help until the family can take over.

    I should add that I verified that the cost of the CAT Scan was priced at the Regional Hospital rates and not those of Hospital Chiriquí.

  7. Don you are a champion for all of us and this experience should ring a few bells. The hospitals in Panama have started playing a very vicious game of gringo bingo. It is a growing problem and one I keep hearing about.

    My best wishes for the gentleman who is the subject of this story.

    Please do not take offense at me and others who asked for a name on ning. Some of us do not do well with photos, names help. Once you made it clear you could not release the name, that was done.

  8. Don Ray:
    Good job! I hope this gringo can come to US soon to have treatment. You did the right thing in consulting with YOUR doctor first.
    When an american goes to a private Hospital in Panama, some people, not all of them, see this person as “rich”, which can be true for some panamanian standars. The capacity of many american to pay and the lack of knowledge on the way the system works makes this easier.
    I have a friend who in an Interventional Cardiologist in Panama City, and he gets calls every now and them when a cruise line has sent a passanger with chest pain to the Private Hospital where he works, and he needs to do an angiogram. He tells me he insist that the Hospital do not ballon the cost of the procedure and hospitalization. He feels this is creating a bad reputation for Medicine in Panama. I agree. By the way, he only works his Private Practice, not with the state run Hospital.
    Jaime^

  9. Nice work, Don. I know other people like you, and yes, they are angels as well….

  10. Don Ray,

    You help so many people, you are truly an angel. I have a story about Mae Lewis and Hospital Chiriqui which I don’t think is appropriate to post on your web site. If you are interested you can email me at Aquabroad@juno.com.
    Thanks for your care for the community.
    Marion

  11. Long time ago doctors used to be dedicated professionals who cares more for the people and money wasn’t to much important. They took the Hypocratic oath….but that was then…..

    I heard some doctors arguing and justifying that theirs is an economic profession and that they took too many years “quemandose las pestanas” studying. That their career was so expensive and because all the efforts, years of sacrifice and cost of the career they deserve to have a very good salary as any other profession like engineering or banking. Well, I didnt have an argument to fight back… they made their point…more or less.

    Some doctors have good salaries working at government hospitals and also works on private hospitals and clinics. That is ok but the problem is that they dont work the amount of hours they should give to the public hospitals. The attention to patients is terrible, very bad, but what a difference when you visit them at their private clinics or hospitals. Powerful gentleman is Mr. Money…….

    We couldnt do too much with the attention we received at public hospitals but… that is a different story when it has to do with private clinics and hospitals.

    It is illegal in Panama to have two or different rates or fees: one for locals and other for gringos or expats. I think that it is a good case for ACODECO. It also goes against the ATP (tourism authority) that tells tourist and expat residents that medical cost are not expensive in Panama.

    You are residents living in Panama and believe it or not you have rights. I suggest that you all start complaining and filing denuncias to ACODECO regarding this subject. They have solved in favor of consumers with some claims done before to some clinics and hospitals before. Talk to your head doctors or the doctors you have trust and confidence about this subject. Show your discomfort and your concern about this bad business practice and ask them for opinions and alternative.

    Roger

  12. Hi Rodger,

    No one has said that they have different rates for gringos and for Panamanians. The charge the same rates to both based on the hospital rates. The rates in the regional hospital are cheaper than those in the private hospitals.

    When we checked the patient out, I verified that the rate being charged was the CAT Scan rate for the regional hospital even though they did it at Hospital Chiriqui. Had the rate been the Hospital Chiriqui rate then I would have complained.

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  15. I have linked this important post from http://www.boqueteguide.com/?p=6286

    In my research I have received confirmation from two knowledgeable sources, one a hospital in Panama City, the other insurance company in Panama that indeed doctors are using a different rate schedule based upon the ethnicity of patients. I have been told it is unethical but not illegal. I have asked for a legal opinion on the question but unless both sources are wrong it is reality.

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  18. HI Don

    You mention in the post above that the US does not honor Medicare or Tricare outside

    the US. If you send in your own claims with email attachments or fax Tricare will

    reimburse you at whatever their

    allowable rate is. I had a colonoscopy at Mae Lewis that Tricare paid in full a couple of

    months ago.

    Thanks for all your good work.

    Phil

  19. Hi Phil. Thanks for the update on Tricare. I thought I had been told that Tricare was not honored for some hospitals. If it now is honored for all hospitals in Panama, then that is good. Medicare is not honored outside the U.S.

  20. Thanks for the info. I am a retired wounded VietNam vet that plans to move to Panama this year, so I need to cultivate some friends. I hope you will be one of them. Thanks, Dave

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  27. If you search for Tricare in the search area in the top right of the blog, it will take you to some posts that might help. The comments may have information related to Tricare too.

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  30. We are considering retirement to Panama and I am having a difficult time getting good information regarding medical and medical insurance. The main issue that we have is that my husband had a kidney transplant in 2011. He’s doing great but he is on several medications. There is also the question of what we we would if something did go wrong.

  31. You are wise to check this out ahead of the move. Medicines that are available in the US are often not available here. Medicines may be here for some time and then get removed from the list and no longer allowed to be sold here.

    These are definitely questions you should resolve before making any permanent plans to move. I always recommend that anyone considering Panama as a retirement location, live here at least 6-8 months before spending any money moving. A year is even better.

  32. Don, great work. I might add however that newbies bring enough meds to last the duration of their visit. The VA does not send meds to Panama because they are confiscated by someone here. So, don’t count on someone mailing you renewed meds.

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