Healthcare in the Boonies

In case you are not familiar with the word “boonies”, the following is a definition I agree with.

American, colloquial word for wilderness or places in the middle of nowhere, far from any civilization

When it comes to Panama, I consider the boonies some place remote from a real hospital. There are many areas in Panama that are lucky to have a clinic and often to get to a clinic could take you an hour.

I mentioned the other day that my friend Malcolm, had a recent healthcare experience. Malcolm was on his finca (Finca Tranquila), and slipped in the shower. Hey, it happens to all of us as we get older.

Some how he managed to rip his elbow open and realized that his home medical kit was not going to be enough. His nearest clinic was in Almirante. He told me that he was lucky because the water was calm and it was only a 20 minute boat trip to get there.

Had it been in the middle of a storm, it might have been a minimum of an hour and he would have been thrown all over the boat.

He was pleased with how he was attended to and the quality of the stitching and was allowed to go home. Over the next week, pain increased, he became weaker, and eventually had himself transported back to David and to Chiriquí Hospital.

By the time he got to the hospital, he was in a serious condition. He was told that, had he waited much longer, he might not have survived. It seems that the elbow has a special sack that helps protect the elbow. If it gets ruptured, great care must be taken to avoid infection, because the fluid of the sack would be a conduit for the infection to spread through the entire body. Continue reading

Some Updates

I have been tied up for several days and still don’t have my head completely above water. The other day I, and other Wardens in Chiriqui, met with the New Chief of the ACS Unit for the U.S. Embassy in Panama City. He was in Chiriquí doing prison visits.

I have also been assisting a US citizen who was in Hospital Obaldia and that will probably be another post at some time for lessons learned by me.

Also, My good friend Malcolm Henderson, has had some healthcare experience, that I will share soon.

Now for some feedback that came as a result meeting the new ACS Chief and correspondence resulting from that meeting.

You may remember that I posted a scam warning had been posted on Chiriquí Watch the other day. It appears that what was reported is actually a Panama crack down on people living here on the tourist visa, which allows a visitor to stay 180 days at a time.

Cases have been reported of a people trying to exit on the 181th day, resulting in a huge fine and being advised to get a real visa. This should be considered to be a “Heads Up” for others.

Several people have been required to buy return tickets and provide proof that $500 was in their possession or credit cards to demonstrate financial viability.

All of this implies that those living in Panama using the tourist visa should be prepared for major annoyances at the Panama border.

Another item I have learned is related to converting US driver’s licenses into Panama driver’s licenses. I was advised to remind everyone that the US license must be Apostilled by the Panamanian government before the actual license can be applied for.

That means taking the document that the US Embassy certifies to the MFA on Tumba Muerto in Panama City. Therefore, if a US license is certified by the Embassy at an Outreach meeting, it would still require the person to make a trip to Panama City.

I was also told that they have recently also started to require all first time persons to go to the Sertracen location at Plaza Carolina for their driver’s licenses.   Renewals can be done anywhere, but first-timers need to go there.  You may want to check your local location to see what they say about that requirement.

Some might make the decision that, if that is the case, they might as well just to take the test in David and avoid the trip. My advise is spend the money and have your US license turned into a Panama license. I know of people that have spent two years taking classes and multiple exams and still don’t have their license.

More to follow, when I catch my breath.

Blood Donors/Receivers

Maybe this is worth posting since many are moving to Panama. If you have never paid attention to your blood type, it is worth knowing that Panama is not known for having blood on hand in case of emergencies.

This is even more critical during holiday seasons, because an appropriate donor might be away on vacation.

I am going to post a graph that reflects who are eligible donors and receivers for each blood type.

Other restrictions are often imposed by some hospitals in Panama, but some restrictions, such as age, are waved in an emergency.

Because of the fact that blood is not banked in Panama, it is important to be aware of such groups such as the Boquete Hospice & Health Foundation. They keep a registered list of donors and have helped many people, foreigners as well Panamanians.

Remember if you need to make a request, please provide the following information in order to receive assistance. Other requirements are on the Hospice website.

  • Blood Type
  • Hospital
  • name of recipient
  • Doctor requesting the blood

Following is a graph that shows who can donate for what blood type.


A New Hospital In Bugaba

I was in Bugaba the other day and was shown a new hospital that is under construction. It looks like will not be finished this year, but it was started under President Martinelli.

This hospital is large. It will be a public hospital. It looks like it will be a fine addition to this area.


I think the Panamanians always complain about whoever is in office, but I have seen more accomplished under Martinelli than I did in the two previous administrations.

I see that the Google Map won’t help much, but I was standing HERE when I took the photo.


Another Healthcare Reflection

After writing the previous post and reading some of the comments, I am going to follow up with another point to consider.

I realize it is easy to think only of one’s self when it comes to living. It is natural. Most people think of what it takes to make them happy and little on how their happiness may affect others.

When I moved here, for a person to qualify for a pensionado visa, they only had to provide proof $500 a person. Now it is $1,000. If I am not mistaken. many that came with less than a thousand a month are now struggling. Yes, they would be struggling in the US or most other countries as well.

Obviously most foreigners that come for the pensionado visa are 60 years of age or above.This is the age that places the biggest burden on any healthcare system. Many of my age group grew up when smoking was the norm. All movies and TV programs glamorized smoking. Luckily, I never fell into that group.

Because of smoking or other kinds of hard living, many come here in less than a physically fit condition. Many find themselves in need of significant healthcare and many wind up in the Regional Hospital. This hospital is by far the cheapest hospital in Chiriquí and I would say much cheaper than a US hospital.

Even with that, a couple weeks stay can turn into thousands of dollars. Many of the third tier age group wind up dying or needing to return to the US to tap Medicare for their rest of the care. Too many times, either of these situations result in the hospital having a bill that doesn’t get paid.

I can’t tell you how many times I have heard the gringo community (all white non Panamanians are considered gringos) being bad mouthed because of a medical bill that was not paid.

This is one of the reasons that many of the local private hospitals will not take a patient, requiring surgery, without having a large amount paid up front. Insurance or not, they want their money up front. Also few will take on the burden of collecting from insurance, they want you to pay and you to collect.

Now based the fact of many leaving without paying, I can understand the hospital’s point of view.

I had an american contact me a couple months ago that was treated in Hospital Regional and had a hip replacement. She was going to have to return to the US because she could not get the therapy she needed in Boquete. She had been released from the Regional Hospital with an outstanding bill.

She had contacted me to see if I knew a way she could pay the hospital in payments from the US and had been unable to get the answer from the hospital. The Regional Hospital is not equipped to handle international payments.

I finally agreed that when she got to the US she could deposit payments to my stateside account and I would make a local payment for her. Why would I do that you ask? Because I don’t want the perception of gringos running out on healthcare debts and that perception causing problems for other gringos.

Now getting back to my previous post. This is one big reason why I don’t want foreigners coming to Panama with potential health problems. One of these day, I may have to tap the healthcare community here and I want friends in that community and not enemies.

A Caution Before Moving To Panama

I was reading a post by my friend Larry, who recently left Panama to return to the states for health reasons. During his military career, he had developed a form of tuberculosis and was having repeated trips to the hospital.

He finally read the writing on the wall and realized that his condition was only going to continue to worsen, if he tried to stay in Panama.

This is the big caution I give everyone. If you are moving to Panama, have a good physical checkup and make the decision to move only after you get a clean bill of health.

This is not to say that you can’t get treated in Panama for most conditions, but the more complicated the problem, the higher the risk and the closer the bill will match treatment in the US. Add to that the fact that in most hospitals, you will not be getting state of the art treatment. Plus, Medicare is not honored in Panama and insurance is not any cheaper here. It is also much more difficult to get reimbursed.

Now if you are healthy when you move and you come here and get on the healthy diet that Panama can provide you, one containing fresh fruits and vegetables grown just a few miles from where you live. toss in a regimen of good exercise, which can be obtained by walking around this beautiful country, then you might outlive your expectancy in the US. (That may have set the record for the longest sentence I have ever written in this blog)

Certainly the stress level is less here, as long as you don’t mind waiting in long lines to pay your bills, and you don’t get too frustrated because your communication skills are not as good as they ought to be.

I believe healthcare is the first thing you have to feel comfortable about before you pack up and move to Panama. If you come here and like it, then you may decide that this it the place you want to live out your life. However, I have run into many people, through my visits to the hospitals, that are wishing they could figure out how to get back to the states because they know they are going to die in that hospital if they don’t.

I miss Larry being here. I enjoyed his sense of humor. I know that there are many things about the US that didn’t set well with him and he really wasn’t happy about having to move back, but from his recent post, I can see that he knows that moving back was the only way that would allow him to enjoy more tomorrows.

A Small Observation

Over the last week I have had to take several tests. On the whole, Mae Lewis has been cheaper than Hospital Chiriquí. As an example one test was $186 at Hospital Chiriqui and it was $140+ at Mae Lewis.

What this showed me was that it may be worth shopping around before having some procedures run.

Also for women, Hospital Obaldia is cheaper than both Mae Lewis and Hospital Chiriquí.

A penny saved is a penny earned so to speak.

My Latest Project – Me

OK. Time for some serious talk. As we get older, I turned 70 in October, part of our mechanics start to fail or at least need more attention. Years of neglect, fast food, hard living, business travel, bad relationships, etc. start to take their toll.

I had mentioned a while back that one of my eyes needs attention and that is being scheduled to get looked at. However, my feeling is that with the mileage on this body, I needed a professional take a look and make recommendations that would promote a longer and continued active life.

Moving to a Latin American country is also a reason to take active prevention. It is definitely easier to get injured in Panama than it is in most places in the US.

For example, walking is much more dangerous here. I can’t tell you the number of times I have fallen in David while walking downtown. People that come from the US are not used too the the sidewalk making an abrupt 2 inch change between stores. No transition, just a mini step that is easily missed when you are concentrating on store windows, vendors and other people walking.

The same is true when walking in the morning in the neighborhoods. I have walked the streets in Santa Lucia in Boquete, Volcan, Cerro Punta, David and others and this is never a walk you can take with out being extremely cautious.

Pavement in Panama is never well maintained and there are continually potholes, jagged edges and just plain drop-offs. You have to keep your eyes on the ground and since there is rarely a good sidewalk, you have to be aware of cars that never are going a reasonable speed.

To avoid the pitfalls of life (or should that be potholes) living in a Latin American country requires a little planning and that is what I am doing.

One of the big things we all need to do is to remove all the negative things and people from our lives. I fell fortunate to say that there are NO negative people in my life.

OK, back to the preventative maintenance phase of myself, I have engaged the serviced of Dra. Hilda Gómez Goff. She is an internist specializing in geriatrics. Whether I want to admit it or not, I am no longer a spring chicken and I believe a doctor who specializes in the problems of those of us that are more young at heart than young of body is probably a wise investment of my time and money.

I will have to say, I was very pleased with Dra. Goff. She is Brazilian and English is not her first language. We handled the interview in Spanish. She scheduled a couple special tests along with the normal blood work needed for my annual physical.

She also administered an equilibrium test which required me to extend my arms to the side, close my eyes and place either the right or left foot forward. Not as easy as it sounds.

In general I think we will find out that I am in pretty good shape for the shape I am in, but she did advise a regimen of exercise. She advised me to walk in the mornings, but after breakfast, not before. I probably need to take more advantage of pool time and get the old heart pumping.

Most people move to Panama only thinking about the climate and cost of living. My advice is to consider the health side of living here. Get to know your doctors before you have no option. Talk to others and get recommendations. Consider that you may have a heart attack at 2 AM in the morning and have to see a doctor within 20 minutes minimum.

I use sort of a twist on the old P5 axiom. This is my 4PD plan. The P5 axion is Proper Planning Prevents Piss Poor Performance. My 4PD plan is Proper Planning Prevents Premature Death.

Incase you are interested in an internist specializing in Geriatrics, I am including Dra Hilda’s card.


A Smiling Way to Start My Day

This morning I had a mishap with my glasses and popped the left ear piece loose from the lens. Luckily Opticas Metro is not far from me.

I got there at 9:30 just as they were opening. Dra. Ines asked how I was. I said I am blind and showed her my glasses.

She just smiled and said she fix it. Her photo follows.

DSC00687Not only is she great with fixing and prescribing eye-ware, but her smile brightened my day.