Update on Minga: Visit with a Psychologist

There is apparently some sort of protocol in the public health care system in Panama for dialysis patients. They get an appointment with a nutritionist, and another with a psychologist. Minga is about a month out from starting dialysis, and she just had her psychologist visit. The psychologist took an emphatic stand, saying that for her overall well-being, Minga must be returned to her home in the village and get dialysis there.

If the family didn’t feel enough guilt before, they certainly feel it now. They know perfectly well that Minga misses her home and her neighbors terribly. But the health system doesn’t support that choice, and they haven’t been able to figure out how to make it happen.

Friend Phyllis and I have been going back and forth in the Comments section about the public system in Panama. Phyllis has been to Panama with me several times, and knows Minga well. Phyllis remarked that if any of us were assigned a dialysis appointment at 10pm and hour and a half from our homes we’d be screaming bloody murder. But the poor in Panama don’t get to scream, or demand. They have to accept what the free health care system is willing or able to give them.

I have a couple of observations about the free system. One is that it isn’t very well coordinated, in the sense that a social worker in Aguadulce says one thing: “Forget even thinking about a dialysis spot here or in Penonome — the system is completely overwhelmed.” Dr. Felipe can say another thing: “We should try to get Senora Dominga a place in Penonome.” The psychologist says Minga must go home. The rotating cast of nephrologists who see her in the clinic say she must continue with the regimen as it is, or she will die. At the moment, the family is having difficulty getting an accurate read on whether Minga’s numbers are acceptable. One doctor says that for someone her age undergoing dialysis, they are good enough. Another says her levels are still quite toxic. Both, of course, could be true — but no one has made an explanation to her or the family.

The second observation is that the poor in Panama accept the stark imbalances between what they get through the public system and what is available to people who can pay with remarkable grace. Minga never decries what others have and she does not. She feels that God has given her the miracle of feeling better. She wishes He would extend the miracle just a bit more and make her kidneys work again. But she is not angry at God, or at the system, or at having to stay up half the night three times a week to get treatment. Phyllis and I might well be angry. But Minga is not.

Even Gloria, who has a bit more of an edge, talks about the inequalities with a sense of dark humor more than any real anger. She says she knows that being poor is God’s plan for her. She simply wonders why it is God’s plan that she and her family always come in last when economic benefits accrue.

I am close to having dates in November to go to Panama for a few days, to spend time with Minga and hopefully to go with her to one of her dialysis treatments. She would never say she needs me, never ask if I can come. But I can anticipate the joy in her eyes when I walk through the door, because I have seen it so many times.

4 thoughts on “Update on Minga: Visit with a Psychologist

  1. And sad to say, Pam,. as a “wealthy” American you may be able to get answers that no one else can. I hope so!

  2. for Ada: What I can do it take her for a private appointment with Dr. Felipe, and pay for it, and get his full attention. That I surely will do.

  3. I am so glad you will be able to do that. I have been intrigued by your comments on the health care the poor get in Panama, not to mention the seeming condescension. I have no idea how people on Medicaid get treated here. However, there is a new twist here – we are on Medicare and have Medigap insurance as well. However, we have a couple of really wealthy friends who, wanting to be able to contact the doctor right away and not to have to wait for an appointment, have chosen this new trend, the concierge doctor. Wondered what you thought about this. It does create a more privileged system for those wealthy enough to access it.

  4. for Ada: I’ve known about concierge medicine for some time — interesting concept. Of course it creates a more privileged system, although if you have a serious illness or injury and enter the larger system, I’m not sure having a concierge medical practice helps much. I remember in Panama, when I made an appointment for Gloria and her son Luis to have his clubbed foot seen and treated, she was astonished that people actually get to go to an air conditioned office and be seen at a specified time. They were used to waiting in the public clinic, all day sometimes, for a turn — which sometimes never came because of the crush of patients. It was like a bakery or a deli: take a number and wait to be served. I think I’m for a system of basic preventative and routine care for everyone, then something you pay for to get more catastrophic coverage — with the option of paying a lot if you want a lot of care. Is it unequal? Yes, but concierge level care for everyone simply isn’t going to happen.

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