23% base pay hike, 3.5% annual bonuses, ambiguous statements about health care privatization in the strike-ending agreement

President Torrijos, in Los Santos on December 4 to pass out money, used the occasion to lash out at public sector doctors, insisting that there was no money to pay for the raises they demanded. In the end he coughed up more money than he said he would. Photo courtesy of the Presidencia

Doctors back to work after 39-day walkout
by Eric Jackson

On December 17 doctors and dentists in the Health Ministry and Social Security Fund health care systems went back to work, after the government and the National Medical Negotiating Committee (COMENENAL) reached an agreement to end a 39-day strike over the preceding weekend.

The walkout began in early November with the government insisting that there was no money for any raises at all and the doctors demanding a 60 percent raise. Base pay for starting physicians before the strike ranged from $900 per month for interns to $1,300 for certified specialists. With seniority raises and overtime physicians in the public health care system were averaging $2,430 per month, plus many of them have private practices on the side.

The Seguro Social doctors had walked out during the 2005 strike over Social Security Fund (CSS) changes, whereupon the Labor Ministry voided their president's election and imposed a "leader" of the government's choice. The Torrijos administration then granted the nurses' union, whose leader in the end endorsed the Seguro Social changes, raises that gave some senior nurses higher salaries than some senior doctors.

The tainted cough syrup scandal also added to the acrimony. Although the Torrijos administration sat on information from doctors' complaints about a rash of kidney failure problems from late July until mid-October of last year and that turned out to be a mass poisoning that killed hundreds (about 180 by the official count but prosecutors suspect more than 700), Health Minister Rosario Turner, who was head of medical services for the CSS during the mass poisoning, blamed the doctors and their unions for poor medical services and maintained that raises were out of the question unless medical personnel improved the quality of their services. Coming from that woman in particular, the taunt infuriated the doctors.

As the walkout began the strikers worked just enough to keep emergency services running, but shut down all outpatient doctor visits and elective surgeries. The government responded by refusing to pay those doctors who were working through the strike and threatening to bring in strikebreakers. The only possible source of strikebreaker physicians would have been Cuba, but even though medical organizations in Panama have in the past objected to Cuban medical aid and the Castro brothers' communist government has portrayed the doctors here as spoiled and not so committed to the cause of public health, a Panamanian administration that has signed a free trade pact with the United States was not about to get Fidel and Raúl's help to break a strike. In the end one Cuban physician signed on as a strikebreaker and the government was able to find only about 100 private-sector physicians to replace the some 5,000 strikers.

Meanwhile there was a furious propaganda campaign in all the mainstream media, which was mainly successful at enhancing the profits of the ad agencies that form one of the cornerstones of the Torrijos base of support. The oft-repeated allegation was that the doctors' demands were a recipe for the Social Security Fund's bankruptcy, and the pronouncements of individuals within the administration were even more strident. All of the daily newspapers opposed the strike and blamed the doctors for it.

However, because the cost of living is going up much faster than wages and because the particulars of the charge against the doctors were so questionable, public opinion didn't turn against the strikers as the government had calculated. People tended to be annoyed by the strike, but as the government was promoting a unification of the health care system composed 60 percent of physicians in the Ministry of Health and 40 percent in the CSS and pay for it entirely out of Seguro Social, it was not hard for the doctors to turn the allegation around and point out that it's the Torrijos plan that would cause a CSS collapse. As the strike dragged on that and COMENENAL's charge that the government intended to privatize health care became the main point of public discussion, even as the off-again, on-again talks produced increasing "last best offers" from the government and hints from the unions that they'd lower their settlement price even as they disdainfully rejected the money proposals Turner brought to the table.

Both sides wrangled over structures and personalities during the strike. The government demanded a medical negotiating team with plenary powers to settle, but COMENENAL insisted that any contract had to be voted up or down by the rank-and-file. The doctors insisted that Turner was just an obstructionist cut-out and demanded face-to-face talks with President Torrijos.

Finally on December 10 there was a brief meeting between the president and the COMENENAL negotiators, at which Torrijos gave his assurances that there would be no health care privatization. Dr. Julio García, one of the doctors' negotiators, dismissed those assurances: "This government maintains that the casinos are public," he said, "but managed by private companies. They want to do the same thing with the health system in Panama."

In the end the two sides settled for a 23 percent raise in base salaries plus a 3.5 percent annual bonus, with vague assurances of no privatization and talks to continue about a unified public health care system.

The strike coincided with talks over the minimum wage (the ultimate decree falling short of the inflation rate since the last adjustment) and calls by other labor unions for a general increase in wages. There were suggestions, apparently never too serious, that other unions might join the physicians' walkout.

However, this was the first public sector strike that the Torrijos administration was unable to break. It may presage a period of more labor disputes, driven by higher living costs and a sense that the years when organized labor was on the run may have passed.