Well . . . maybe three, but for purpose of this blog I’m going to lump together the two private hospitals we have in David, Hospital Chiriqui and Mae Lewis. What stimulated this post was going to the women’s room the other day at Mae Lewis hospital in David. Now all of this needs a little explanation.

Clean hands and a pure heart?

Well . . . maybe three, but for purpose of this blog I’m going to lump together the two private hospitals we have in David, Hospital Chiriqui and Mae Lewis.  What stimulated this post was going to the women’s room the other day at Mae Lewis hospital in David.  Now all of this needs a little explanation.

Clean hands and a pure heart?

Why the women’s room?  Well, I’m not sexist.  In the waiting area for doctor’s offices at Mae Lewis there are two tiny, one person bathrooms, one with a female cut out on the door and the other with a male cut out.  I had to go and the male one was occupied.  Now frankly I don’t really see the difference except sometimes, although not in this instance, there will be a urinal in the men’s bathroom.and if there isn’t a urinal the seat will probably (hopefully!) be up.  Other than that?  Hey, I’m all for uni-sex bathrooms.

So inside the tiny women’s bathroom on the back of the door, in Spanish, very detailed with pictures is a poster from the national health department showing what I call on board ship “the Princess-approved hand washing method”, which is the universally recommended method to stop disease.  Abbreviated, wash thoroughly with soap and water, dry, then use paper towel to exit using the towel to avoid picking germs up off the door handle.  Fair enough.  Except not only was there no soap, or paper towels (not even a dispenser).  By this time I was getting curious and the men’s bathroom was free so I checked it out: no poster, no soap, no towels.  And this is in the hospital!

Yesterday, back at the hospitals, this time at Hospital Chiriqui.  New bathroom in office tower was clean, no poster, but it did have soap and towels, however the single waste basket (for used toilet tissue) was beside the toilet and there was no receptacle for paper towel near the door.  Older areas, hit or miss, generally no soap (dispensers, but no soap) or towels.  Very hit or miss.

None of these bathrooms have hot water.  Hot water just isn’t customary in much of Panama.  And, incredibly, in all these bathrooms there is a light switch and usually a sign requesting that you turn off the lights when you leave!   Dah!  What a fantastic way to spread germs.

UPDATE 1-30-15 – I revisited the bathrooms in both hospitals.  The posters were down, but both had lights that turn on and off automatically (no hands), liquid soap, towels (which could be used to turn the old-fashioned door handles when exiting), and Purell-type dispenser outside.  Way to go!

This is Panama

OK, this is Panama!  And it is and there is often a disconnect in Panama such as evidenced by the hand washing poster but no soap or paper towels.  This is Panama!  And that is exactly my point: it IS Panama.

So why all this time running around hospitals?  My brother, who is in one of the only two assisted living homes we could find (non-medical as we couldn’t find any medical assisted living homes in Chiriqui – I’m all ears, tell me if we missed something!) has been losing weight dramatically and we have been running around to doctors scattered between the two hospitals and getting a myriad of tests.  This has stretched out over months because it is difficult to get hold of doctors, tough to make an appointment if you don’t speak the language, and when you do get an appointment it’s not really an appointment but a day when you go and sit three or more hours waiting to see the doctor.  His “insurance”, MS Chriqui, now MS Panama [Oh, and that’s another story.  When we came here 8 years ago they were touting MS Chiriqui to all the newly arriving retired Gringos.  It never was really insurance, more like a major medical discount plan.  Unfortunately no one ever ran the numbers as to how profitable or sustainable it was to “insure” a single population group, like Gringos over 60 . . . so it’s been rescued by MS Panama with  new rules and policies which no one seems able to quite explain, at least to my satisfaction.] . . . So MS Panama allows one test per month, so with MRIs, various oscopies, ultrasounds, yada yada this has stretched on for 4 months now.  Hopefully next week we’ll return to the original doctor and he will have a better  opinion than “Interesting, but it doesn’t show anything.”

So there are things that we like about medical care in Panama, and over the years I’ve talked about many of those.  Doctors aren’t rushed and will take whatever time is needed to consult with you, never-mind all those folks sitting for hours outside waiting for their “appointment.”  The cost of medical care IS cheaper than in the US, although like everything else in Panama the cost is rising.  A doctor visit which used to be $20 is now $45.  And just as a point of comparison: a cerebral MRI is $510 at Hospital Chirqui.  Now I realize MRIs vary and pricing in the US varies, but based on my quick online search the cost in Panama seems to be a little less than in the US.  [Again, I welcome you input!]

OK, now that’s Panama, at least as I’m experiencing it.  In all fairness I did run into a friend from Boquete in the chaos of the waiting room at Hospital Chiriqui who had surgery on both of her feet in Panama City at Hospital Paitilla.  Hospital Chiriqui had told here she would have to be hospitalized 3 days for an operation on one foot, then another 3 days for the second operation.  She had both done in Panama City at the same time and spend 1 night in the hospital.  She had her MRI done at Hospital Chriqiui because it was cheaper than in Panama City.  She thought Hospital Paitilla in Panama City was fantastic.  My wife, Nikki, had an angiogram at Hospital Paitilla and stents put in several years ago and she thought, except for baths in cold water, it was fantastic.

Now, about that other hospital . . .

In April my wife went to Seattle to help out my daughter whose pregnancy leave had expired and needed to go back to teaching for two months in order to remain with her job in the same school.  Rather than have our new, now 6-month-old, grandson put in day care, Nikki went to Seattle to help out Noelle.  Having just turned that magic age where one is eligible for Medicare in the US, and honey, I’m not telling anyone your age here, and having a history of heart disease, thought it prudent to take Part B of Medicare and sign up for an Advantage insurance supplement.  She did a lot of research and ended up with a Blue Cross based plan affiliated with Virginia Mason Medical Center in Seattle.

As a new patient they wanted to do a number of introductory examinations including, given Nikki’s history, a cardiology exam.  Amazingly in one week she was able to get an appointment with a cardiologist at Virginia Mason.  [Now in fairness Virginia Mason happens to be one of the top hospitals in the Pacific Northwest and the Virginia Mason Heart Clinic is ranked as one of the top in the US.]  At this point things started moving very rapidly.  In summary Nikki had major blockage and needed treatment.

You’re not in Panama any more . . .

There were some major challenges and complications, but . . . as the Panamanians all say, “thanks be to God” she is doing fine.  But all this has demonstrated to me amazing differences between a top US, first-world medical center, and the hospital care available in Chriqui.  Virginia Mason is amazing!  It is “Team Medicine” with everyone on board from the top cardiologist to the guy maintaining the rest rooms.  The staff is friendly, winsome, eager to help, obviously  enjoying their jobs.  Yes, I know it is the Pacific Northwest and there are different cultural attitudes, but . . .  Staff are trained to make eye contact, to see people (not see through them), to greet people . . . I could go on, but I have never experienced such a well run organization with such well-trained people.  Package this stuff, put it on a cruise line and the cruise line would rule the seas!  And it is good medicine!

Everything is there: one stop “Team Medicine”. It’s a big campus, but well-marked and easy to get around and if you get lost, as I did, and look lost, even a physician walking by in the hall will offer assistance.  Nikki was allergic to aspirin and needed to be desensitized which it turns out is a very tedious and risky process.  The Allergy Clinic was two floors down.  No running around town or major waits.  Nuclear stress test?  Next Monday.  No problem.

And, they spoke our language. English. [And just for the record they do have 24 hour Interpretive Service for non-English speaking patients.]  I think often we gloss-over the importance of having a lingua franca when dealing with sensitive and perhaps life-threatening medical issues.  Sure it’s Panama and we should speak Spanish.  But if you’re not fluent in Spanish just keep in mind that most of the medical folks with whom you come into contact don’t speak English.

Yes, not all US hospitals are Virginia Mason.  Health care and hospital care in the US is obscenely expensive.  I agree that the system is largely broken.  So everything in the US is not necessarily “better”.  [Just look at the medical comparisons of the US with other countries.]  And things, although maybe cheaper, aren’t perfect in Panama either.  News flash: we don’t live in a perfect world!

With eyes wide open . . .

I do think that when we promote Panama, as I do, and talk about the joys of living here,  we also need to be realistic and honest.  That’s something I try to do in my book and here on my blog and it’s something that, based on reviews and feedback, that folks appreciate.  But it is easy to brush aside medical questions and concerns with easy answers caught up in the rosy glow of paradise, sunsets over the rain forest, and tropical beaches and islands. It is, and should be a concern that is addressed with eyes wide open.  This is Panama.

Why the women’s room? Well, I’m not sexist. In the waiting area for doctor’s offices at Mae Lewis there are two tiny, one person bathrooms, one with a female cut out on the door and the other with a male cut out. I had to go and the male one was occupied. Now frankly I don’t really see the difference except sometimes, although not in this instance, there will be a urinal in the men’s bathroom.and if there isn’t a urinal the seat will probably (hopefully!) be up. Other than that? Hey, I’m all for uni-sex bathrooms.

So inside the tiny women’s bathroom on the back of the door, in Spanish, very detailed with pictures is a poster from the national health department showing what I call on board ship “the Princess-approved hand washing method”, which is the universally recommended method to stop disease. Abbreviated, wash thoroughly with soap and water, dry, then use paper towel to exit using the towel to avoid picking germs up off the door handle. Fair enough. Except not only was there no soap, or paper towels (not even a dispenser). By this time I was getting curious and the men’s bathroom was free so I checked it out: no poster, no soap, no towels. And this is in the hospital!

Yesterday, back at the hospitals, this time at Hospital Chiriqui. New bathroom in office tower was clean, no poster, but it did have soap and towels, however the single waste basket (for used toilet tissue) was beside the toilet and there was no receptacle for paper towel near the door. Older areas, hit or miss, generally no soap (dispensers, but no soap) or towels. Very hit or miss.

None of these bathrooms have hot water. Hot water just isn’t customary in much of Panama. And, incredibly, in all these bathrooms there is a light switch and usually a sign requesting that you turn off the lights when you leave! Dah! What a fantastic way to spread germs.

This is Panama

OK, this is Panama! And it is and there is often a disconnect in Panama such as evidenced by the hand washing poster but no soap or paper towels. This is Panama! And that is exactly my point: it IS Panama.

So why all this time running around hospitals? My brother, who is in one of the only two assisted living homes we could find (non-medical as we couldn’t find any medical assisted living homes in Chiriqui – I’m all ears, tell me if we missed something!) has been losing weight dramatically and we have been running around to doctors scattered between the two hospitals and getting a myriad of tests. This has stretched out over months because it is difficult to get hold of doctors, tough to make an appointment if you don’t speak the language, and when you do get an appointment it’s not really an appointment but a day when you go and sit three or more hours waiting to see the doctor. His “insurance”, MS Chriqui now MS Panama [Oh, and that’s another story. When we came here 8 years ago they were touting MS Chiriqui to all the newly arriving retired Gringos. It never was really insurance, more like a major medical discount plan. Unfortunately no one ever ran the numbers as to how profitable or sustainable it was to “insure” a single population group, like Gringos over 60 . . . so it’s been rescued by MS Panama with new rules and policies which no one seems able to quite explain, at least to my satisfaction.] . . . So MS Panama allows one test per month, so with MRIs, various oscopies, ultrasounds, yada yada this has stretched on for 4 months now. Hopefully next week we’ll return to the original doctor and he will have a better opinion than “Interesting, but it doesn’t show anything.”

So there are things that we like about medical care in Panama, and over the years I’ve talked about many of those. Doctors aren’t rushed and will take whatever time is needed to consult with you, never-mind all those folks sitting for hours outside waiting for their “appointment.” The cost of medical care IS cheaper than in the US, although like everything else in Panama the cost is rising. A doctor visit which used to be $20 is now $45. And just as a point of comparison: a cerebral MRI is $510 at Hospital Chirqui. Now I realize MRIs vary and pricing in the US varies, but based on my quick online search the cost in Panama seems to be a little less than in the US. [Again, I welcome you input!]

OK, now that’s Panama, at least as I’m experiencing it. In all fairness I did run into a friend from Boquete in the chaos of the waiting room at Hospital Chiriqui who had surgery on both of her feet in Panama City at Hospital Paitilla. Hospital Chiriqui had told here she would have to be hospitalized 3 days for an operation on one foot, then another 3 days for the second operation. She had both done in Panama City at the same time and spend 1 night in the hospital. She had her MRI done at Hospital Chriqiui because it was cheaper than in Panama City. She thought Hospital Paitilla in Panama City was fantastic. My wife, Nikki, had an angiogram at Hospital Paitilla and stents put in several years ago and she thought, except for baths in cold water, it was fantastic.

Now, about that other hospital . . .

In April my wife went to Seattle to help out my daughter whose pregnancy leave had expired and needed to go back to teaching for two months in order to remain with her job in the same school. Rather than have our new, now 6-month-old, grandson put in day care, Nikki went to Seattle to help out Noelle. Having just turned that magic age where one is eligible for Medicare in the US, and honey, I’m not telling anyone your age here, and having a history of heart disease, thought it prudent to take Part B of Medicare and sign up for an Advantage insurance supplement. She did a lot of research and ended up with a Blue Cross based plan affiliated with Virginia Mason Medical Center in Seattle.

As a new patient they wanted to do a number of introductory examinations including, given Nikki’s history, a cardiology exam. Amazingly in one week she was able to get an appointment with a cardiologist at Virginia Mason. [Now in fairness Virginia Mason happens to be one of the top hospitals in the Pacific Northwest and the Virginia Mason Heart Clinic is ranked as one of the top in the US.] At this point things started moving very rapidly. In summary Nikki had major blockage and needed treatment.

You’re not in Panama any more . . .

There were some major challenges and complications, but . . . as the Panamanians all say, “thanks be to God” she is doing fine. But all this has demonstrated to me amazing differences between a top US, first-world medical center, and the hospital care available in Chriqui. Virginia Mason is amazing! It is “Team Medicine” with everyone on board from the top cardiologist to the guy maintaining the rest rooms. The staff is friendly, winsome, eager to help, obviously enjoying their jobs. Yes, I know it is the Pacific Northwest and there are different cultural attitudes, but . . . Staff are trained to make eye contact, to see people (not see through them), to greet people . . . I could go on, but I have never experienced such a well run organization with such well-trained people. Package this stuff, put it on a cruise line and the cruise line would rule the seas! And it is good medicine!

Everything is there: one stop “Team Medicine”. It’s a big campus, but well-marked and easy to get around and if you get lost, as I did, and look lost, even a physician walking by in the hall will offer assistance. Nikki was allergic to aspirin and needed to be desensitized which it turns out is a very tedious and risky process. The Allergy Clinic was two floors down. No running around town or major waits. Nuclear stress test? Next Monday. No problem.

And, they spoke our language. English. [And just for the record they do have 24 hour Interpretive Service for non-English speaking patients.] I think often we gloss-over the importance of having a lingua franca when dealing with sensitive and perhaps life-threatening medical issues. Sure it’s Panama and we should speak Spanish. But if you’re not fluent in Spanish just keep in mind that most of the medical folks with whom you come into contact don’t speak English.

Yes, not all US hospitals are Virginia Mason. Health care and hospital care in the US is obscenely expensive. I agree that the system is largely broken. So everything in the US is not necessarily “better”. [Just look at the medical comparisons of the US with other countries.] And things, although maybe cheaper, aren’t perfect in Panama either. News flash: we don’t live in a perfect world!

With eyes wide open . . .

I do think that when we promote Panama, as I do, and talk about the joys of living here, we also need to be realistic and honest. That’s something I try to do in my book and here on my blog and it’s something that, based on reviews and feedback, that folks appreciate. But it is easy to brush aside medical questions and concerns with easy answers caught up in the rosy glow of paradise, sunsets over the rain forest, and tropical beaches and islands. It is, and should be a concern that is addressed with eyes wide open. This is Panama.

Reader response . .  .

When I first posted this blog [July 2013] I received the following comments from readers:

Carmen Rodriguez on July 3, 2013 at 9:54 am said:
Always enjoy your blog.
I do not think that comparing Chiriqui Hospital to Mae West is comparing apples to apples.
If you are thinking about moving to Panama as an older expat (at this stage of your life, everything seems to hurt), it is very important to set your priorities.
You can move to Seattle and have Mae West and the cold, the snow and the gray days or you can move to Panama City, have Hospital Punta Pacifica, have sun, a lot of rain but no cold or snow. You can also move to Boquete, which may be everything you are looking for except for the medical aspect.
If you are looking for the perfect place you may need to wait for the next step in your journey, that would be Heaven.
Our last experience in Hospital Punta Pacifica was a colonoscopy. I will start by saying that the total cost of the procedure was $1079.00. No insurance. A friend of ours in Gainesville, Ga had one six months ago and his bill was for $6000. As I had mentioned before, what impresses me the most here in Panama is that doctors give you their cell phone numbers and actually answer the phone. My husband called a friend to get a recommendation to have the procedure done. He gave my husband the doctor’s name and number and told him to call the doctor in five minutes. When my husband called, the doctor was already waiting for the call. Gave him an appointment for the next day. Had the procedure done within a week and when we went for the results, the doctor greeted us at the counter where the receptionist sits. Spent half an hour going over the video of the procedure and just chatting. No pressure, no rush. Talk about two minutes with actual face to face in a doctor’s visit in the US, unless you are friends. I know. I am a pharmacist and the worst part is that patients come to discharge all their frustrations on us. Don’t worry. We are used to it.

[Just to clarify: Mae Lewis and Hospital Chiriqui are both hospitals in David, Panama. Virginia Mason Medical Center is in Seattle, WA. Punta Pacifica is a hospital in Panama City, Panama.]

Sharon Oaks on July 3, 2013 at 10:19 am said:
This is a great post. We keep reading about the excellent and affordable medical care in Central America but I’ve never read a comparison dealing with anything more than costs and the fact that the doctors don’t rush. This is very helpful and tells me that keeping our Medicare supplements might be a good idea so we can take care of certain things when we visit the US.

I also want to say that I love your book. We aren’t sure if Panama is for us, my husband is a beach fanatic and I would love Boquette, but your book has so many things that will apply to other countries as well. I am currently reading it for the second time and will write my Amazon review after that. The first time I went through quickly without making use of the questions and tools, this time I am doing that. Thank you for providing us with your honest information about Paradise. I hope to at least visit Boquette one day and hope I will meet you then so I can thank you in person.
David Lane on July 3, 2013 at 11:13 am said:
I appreciate your honesty and frankness in discussing the healthcare situation in both Panama and the state of Washington. So many people promoting Panama as a place to relocate and retire have not presented a realistic comparison of U.S. healthcare vs. Panama health care. As we age our systems tend to require more attention including the need for sometimes more than one specialist. If we have chronic issues such as diabetes, heart disease, COPD etc. we require carefully coordinated care. While hospitals in all parts of the world may be able to purchase sophisticated equipment for diagnosis it really boils down to the expertise and skill in the interpretation of the testing results and being able to determine the course of action needed for a particular person. Third world countries have not demonstrated that they have all of this available currently. Sure you can say in Panama City you have a somewhat developed hospital that has an affiliation (consultancy with a highly acclaimed medical center in the U.S.) but that does not mean that it has all the resources and staff that the U.S. hospital has. The hospital in Panama City is NOT Johns Hopkins. Some people seem to misunderstand this concept. We travel frequently to Latin America including Panama. We are in our early 70s and have complex health issues including heart related issues. We both require coordinated care for our conditions. Should we ever need to be hospitalized we would want our care to be provided in the United States and particularly at Winter Haven Hospital, Winter Haven FL. All our records are available in one place (the hospital and Bond Clinic) where all our physicians have an affiliation. We subscribe to a program called Medjet Assist which provides medical transport service including care all over the world. In an emergency requiring hospitalization we would be flown back to the U.S. and even to our hospital in Winter Haven promptly and with expenses and arrangements made by Medjet Assist. I feel anyone traveling should have this particular coverage. I can remember a number of months ago maybe last year you had a blog on emergency transfer from Boquete to David hospitals. Your representation did not present a picture of coordinated care or rational approach. Perhaps you should share that blog with your readers again. Thanks again for your frankness and honesty. Good healthcare costs money and there is no alternative to that if we truly want and need 21st century care. Things will cost more in Panama for medical services as you point out. If prices do not go up there is no way they will ever be able to provide top-notch care. Physicians are a profession and simply will not remain in countries where they are not able to earn money. They will relocate to where the financial opportunities exist. Obamacare is on the way. There will be many opportunities for bilingual physicians in the U.S.
Carmen Rodriguez on July 4, 2013 at 1:32 am said:
Sorry, Richard. I meant to say comparison between Chiriqui Hospital and Virginia Mason.
I want to clarify that I am not Panamanian and I do not promote relocating to Panama. My opinion is that if you are thinking about relocating anywhere out of your comfort zone, you should move and rent for a year.
Regarding medical care, first of all, the doctors I see here are Board Certified in the USA.
Second, the world is over-populated because people are living longer due to better medical care and they do not all live in the USA.
And third, people in Panama that can afford Hospital Punta Pacifica have better sense than thinking that it is Johns Hopkins. Not that at Johns Hopkins and in the hospitals in the USA more people die of nosocomial infections that in Panama. But again, the beauty of Panama is that in 2 and 1/2 hours you are in Florida.

Ron Couturier on July 4, 2013 at 12:48 pm said: Edit
Excellent article Richard!! I truly appreciate your candor as any major cultural change should be well researched. In fact, I purchased and just started reading your book. I’m only a few chapters in but I feel like I’m sitting by a fire in deep conversation with a good friend!! I will definitely write and post a review when I finish. I wish we were ready to move right away because I would be asking about the availability of your cottage… My loss!! Thanks again, Ron Couturier, Charlotte, NC