Panama 2019 Day 15: An Overstressed Medical System

As Tia Phyllis, herself a nurse, pointed out in the Comments section, the response of the doctor to Fani’s attempt to get more information about the possible change in Gabrielito’s echo was outrageous. With the assumption that the people who are taking their rotations in the charity care level of the medical system are not all bad people, I try to understand how overstressed they must be every day, trying to get through the patient load.

There are two sources of stress, at least. One is the sheer number of patients hoping to be seen.  I got a glimpse of that at the hospital where Minga was receiving dialysis — a facility one rung above where Gloria and her family receive care. At the entrance is a large room where maybe 50 people sit on hard plastic chairs waiting to be called for the various clinics. They will have gotten there early in the day, and taken a number. There are no advance appointments; you simply wait. There is no triage based on severity of condition; you simply wait. Not everyone will be seen before the clinics exhaust their numbers of openings for the day. Years ago, when Gloria’s son Luis had on a full leg cast, a piece of metal from one of his club foot surgeries had worked its way through the skin and was rubbing under the cast, causing pain and bleeding. She took him to Panama City, arriving at the clinic at 6am, having left Rio Hato at 4am. They sat there all day, and were not seen. If they had returned the next day, the’d have had no priority, just whatever number they were able to get. I called in favor from a wealthy client I was then working with in Panama City, and got them into a private orthopod. The fact that young Luis was in pain and  bleeding meant…. not much until we got him into the private system for that one time.

The other source of stress is the limitations of the system. I asked Gloria what happens if Gabrielito needs expensive medications. She said that if the seguro social has them, he will get the meds for free. If the seguro social doesn’t have them, because they are too costly or rare, the family will have to pay in full or he will go without. Period. Even if he dies as a result. Imagine being the provider who has to look a young mother in the eye and tell her that.

It’s a lot of stress to work with every day. I still think the response to Fani was outrageous, agreeing with Tia Phyllis on that, but I hardly know where to direct my anger.

2 thoughts on “Panama 2019 Day 15: An Overstressed Medical System

  1. I realize we are used to a very different health care system in the US. Providers who serve low-income people or provide charitable care also need to meet quality guidelines and standards, and have been educated to some level in the interpersonal/educational aspects of care. Does Panama have the equivalent of a “Minister of Health” or someone in the government who sets the stage for health care? Does anyone say there are different ways to run the system? Does anyone think that there needs to be more services and sites, given that current ones are overcrowded? Do citizens protest poor care? Are there legislators one can speak to? What about funding? Where are the advocates for better health care? Or does Panama’s system just go on the way it always has?

    I’m sure we could easily re-design their system, but it seems like there are so many gaps for correction that we take for granted. I can understand why Panamanian health care providers are so stressed in this system……..but am curious as to why they don’t do anything abut it. Or perhaps they do and it falls on deaf ears.

  2. for Phyllis: Panama does have a Health Ministry, and a medical school and a mentoring system where some of this should be taught. I think the people receiving charity care are so beaten down in so many ways, it becomes hard to push back. As an example, Gloria had an appointment to have her glaucoma checked. She left Rio Hato at 3am to get to the clinic early to get a spot. When she got to the window to register, they told her the eye clinic was closed that day because of some equipment malfunction. No apologies were made for the time and expense she had to put in for an appointment that never happened … just “come back another day.” That kind of day to day disrespect is at minimum what they all deal with. Fani apparently came across a young female cardiologist with a lot of attitude, and had a much worse experience. There don’t seem to be many advocates from any other part of the system.

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