National Preventive Health Census comes to rural Cocle

San Juan de Dios
While the US Congress was working on how many millions of Americans to deny health care, Panama’s socialized medical sector — we also have private practices here — was reaching out to determine the unmet needs of people 40 and over. Photo by Eric Jackson.

The editor’s sore left wing

by Eric Jackson

About a week before, two men appeared in front of the house in El Bajito, with leaflets announcing a free health fair, with transportation, breakfast and lunch thrown in. So, was it part of President Varela’s back stretch goodies distribution campaign in the province, touted by the Twitter hashtag #CocléProgresa? Perhaps, but officially not. This was part of a national health care census for those over 40, with blood work, measurements of body dimensions and weight, blood pressure checks, oral examinations, medical history, inoculations, health analysis and whatever medicines might be prescribed.

It had been irresponsible years since my last checkup, at which I was found just under the line of being diabetic. Then, the doc ordered me to cut the sugar and lose weight. I did both, but then I gained the weight back, lost it again, picked it up again and… so far about a 30-pound net loss. Not enough, and if the sugar has largely been cut out of the diet, sugary fruits and especially greasy and salty stuff remained a concern. Was I going to have to start shooting insulin? Was I a stroke waiting to happen?

The leaflets said to bring vaccination records — but I didn’t have any. I had not taken any such shots for more than 25 years, since before I moved back here from the USA.

I did not feel faint when they were taking blood. Sometimes I do. Then to the height, weight and waist size measurements, which reminded me that even if my belt is down to the skinniest hole, it’s still an ultra-gordo-sized belt which I didn’t find the first few places I looked. Then, to the inoculation room. The two women interrogated me, not about the little wound on my hand, but how ANYONE could be without shot records. Was I one of these organic hippie anti-vaccine guys? (Organic hippie, I try to be. Anti-vaccine I am not, although I am quite conservative about which medicines I will take. Sensible shots, yes, some pharmaceutical company’s new experiment, not unless absolutely necessary.) So it was the flu, etc., in the right arm, and a tetanus shot said good for 10 years in the left arm. Your editor still has leftist politics, but the tetanus shot left him with an aching left wing — even a couple of days later as this was written.

On to breakfast. Breakfast was ham and cheese on white bread, Panamanian white cheese, sugary fruit cocktail and sugary fruit drink. Ever the balance — many folks would not eat healthier fare, with which they would be unfamiliar.

Then to the blood pressure lady, then to the oral examination lady. The latter session was embarrassing. I need some dental work, including extractions, fillings, dentures and a good cleaning. She recorded all of this and advised me of where to go for inexpensive work in Anton district.

Then another wait, and lunch. The event, in the school in San Juan de Dios, brought in about 150 people from the Anton district neighborhoods of Juan Diaz (mine), Jaguito, El Jobo, La Colorada, La Tortuguilla, El Corotu, La Chapa, El Salado, El Chumical, Las Peñitas and Santa Elena. Among this overwhelmingly cholo crowd I was one of two fulos and there were a couple of afrodescendientes as well. Lunch was rice with guandu, stewed pollo de patio, a bit of plantain and a piece of corn cake, with bottled water.

A bunch of neighborhood dogs, who looked healthy and were wandering freely around the school, got wise. I was one of the first to give my chicken bones to one of the dogs, and people started to give those, and that part of the rice that they did not care to eat, for the doggie feast. Then they started calling numbers again — I was one of the last — and when mine came up I fell in line to see the doctor.

It’s a demographic trend that I have known about for a long time, but it was on striking display. By gender, there was close to parity among the senior physicians. The younger doctors were overwhelmingly female. It’s part of a national trend in which our politics and economy are oppressively male dominated, but women are much better educated on the whole than men and are coming to dominate almost all of the learned professions.

So the middle aged woman who examined my case asked more medical history questions, said that my blood sugar was fine, well below the diabetes threshold. However, cholesterol was now a problem. She prescribed a month’s course of fenofibrate, which was given to me for free in the form of a box of 30 tablets of 250 milligrams each, made by Abbott Laboratories. Looking it up online, the US list price for this medication runs over $100, although the generic versions are much cheaper.

Yep. Isn’t socialized medicine horrible? No wonder they have gated communities for the rich.

The thing is, Panama’s parallel socialized medical systems, the Ministry of Health and the Social Security Fund, drive down the prices of private health care. A lot of the professionals work in the public system but have private practices on the side. Is there gringo pricing for obvious foreigners? That does exist, particularly in the upscale hospitals.

We have problems in both our public and private health care systems. If we don’t have pervasive and often frivolous malpractice litigation and high insurance for that, we also have little accountability for injuries caused by health care mistakes. The Americans get way too exercised about the rule of law, while Panama hardly has such a thing. We are a poor country. Our public institutions, including in the health care sector, are prone to corruption and the inefficiencies of a political patronage system. All that said, however, Panama has a decent and caring system presided over by decent and caring professionals. At some point I will have a health crisis and die — all of us do. Death in the care of the Panamanian health care system is not something about which I lose sleep.

Gracias, doctoras.


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