I’d known for nearly 20 years that I would spend my retirement years south of the Rio Grande. Where, exactly, I wasn’t sure. After having spent three months on the Rio Dulce on my wonderful Nancy Dawson I thought it would be in Guatemala. I seriously thought about Mexico, too. As followers of this blog know my final destination has been Panama.
Invariably when telling people of my plans they would ask: “What if you get sick down there?” My response was, half flippantly, “you either get better or you die.”
The reason I say “half flippantly” is because isn’t that really what life is like? When you get sick you either get better or you die. We, in the United States especially, have been brainwashed to believe that medical care in the States is unequaled anywhere in the world. ‘Taint so. Most expensive is NOT a synonym for BEST. And consider this: it has only been in MY lifetime that the world has had anti-biotic drugs that were life savers. Sadly there are now more and more nasty things that are becoming completely resistant to these drugs.
These days coronary bypasses are so common it’s likely that everyone knows someone who has had the procedure if not having had it done themselves. It wasn’t always so, of course. One of my classmate’s sisters, who graduated a couple of years ahead of us, was part of the team that invented the heart-lung machine without which open-heart surgery would be impossible. (BTW-my public high school class consisted of all of 60 students and the girl who pioneered the heart-lung machine and traveled all over the world teaching others how to use it graduated in a class with considerably fewer students.)
I have to admit that I was extremely lucky when I had my heart attack a couple of years ago to be living, literally, within eye sight of one of the best cardiac care facilities in southeast Florida. When I realized what was happening to me I had my roommate drive me the six blocks to the hospital. No sense waiting around for an ambulance. When my two and a half day stay was over I was presented with a bill for nearly $70,000.00!
But what if you don’t live six blocks away from a good hospital? What if you live out in the middle of the farm belt? Even back where I grew up on Cape Cod you’re still a half hour’s drive from the nearest hospital. There’s a good chance you’re not going to make it. So even in the country with the “best” health care in the world, as some would like you to believe, in a lot of cases you either get better or you die.
I certainly don’t profess to be an expert but my impression is that Panamanians have access to some of the best health care south of the Rio Grande. Certainly, I’d bet, head and shoulders over Guatemala, El Salvador or Nicaragua. There are hospitals in Panama City that would stack up favorably with any found in major metropolitan areas in the States. There are 12 hospitals in Panama City, many staffed by doctors that have studied in the United States. Hospital Punta Pacifica, in fact, is managed by world-famous Johns Hopkins of Baltimore, Maryland. Medical tourism here in Panama is a growing segment of the economy.
Outside of the capital things get a little sketchier. I noticed that there were a couple of modern-looking hospitals in Chitré when I was initially roaming the country looking for a place to settle. I know if one chose to settle down in the Bocas del Toro area and had serious health concerns they might be living on the edge. But I’d say it’s not too much different than someone choosing to live in most rural parts of the United States, either.
Here, near David, the country’s third largest city there are several hospitals, two of which, Mae Lewis and Hospital Chiriqui (this is Chiriqui Province) are privately run. Hospital Chiriqui, shown below,
has a program called Medical Services Chiriqui which is sort of an in-house HMO. Here is what it covers:
http://www.mschiriqui.com/coberturas_en.html
This week I signed up for it. On Monday I had to get blood work done. I HATE being stuck with needles. Absolutely DETEST it. However, the girl at the lab was a true artist with the needle and I can honestly say I didn’t even feel the needle going in. All my test results show me to be in pretty good shape. Yesterday with the test results in hand I met with Dr. Julio Osorio who will be my primary physician. Nice guy. Speaks good English and gave me a thorough exam. The only thing wrong is my cholesterol is just a hair over the limit, but I’m not upset by that. After all, we’re all going to die of something eventually and if eating twigs and bark is what it takes to extend one’s life, what’s the point?
The lab tests were a FRACTION of what they would have cost in the States. Of course I had to pay full price out-of-pocket for them but with my “Jubilado” discount I got ten bucks whacked off the top, never the less. If I do it again next year and being in the program the tests will cost me less than $20.00. In general what you spend on health care here is unheard of back home. Here’s a sign I saw on a clinic when I was wandering around Chitré:
That’s right! Feeling achy and out of sorts? It’ll set you back three bucks to talk to a doctor in Chitré,
As always, there’s a bit of a hitch in all medical programs and the Chiriqui program won’t cover pre-existing conditions for the first two years. That means my heart condition is up for grabs, but while Medicare doesn’t cover anything once you leave the U.S. I’ll continue to pay for Part B which covers doctors. Should things get really bad and to the point where I can’t pay for it here I can go back to the States and be a leech on the country’s taxpayers.
The cost of the program, at my age and next year when I’m 70, is $62.00/month. There’s an 8% discount if you pay the whole year at one whack and 6% off if you pay six months at a time.
All things considered, I think the health care system here in Chiriqui Province is a pretty good deal but I do hope I don’t have to use it.
One More Good Adventure 
This is really interesting – lots to ponder.
Geographical factors are important – especially where some of my friends live in West Texas, it’s not a half hour to a hospital, it’s two hours. It’s just part of life.
On the other hand, I talked in the grocery store today with someone whose spouse developed cancer about two years ago. They’ve been going to MD Anderson at the Texas Medical Center – surgery, chemo, etc. When the usual treatments weren’t effective they started an experimental drug. It helped, and then it didn’t, and they were removed from the research program. Now, it’s just day by day.
But the point is that there really isn’t anywhere in the world better than Anderson, although I’m sure many places offer the same level of care. But sometimes, it doesn’t matter.
As for cost – well. A tiny story. As a self-employed sort I’ve been providing my own insurance for years. When I was told the premium would be going up from just over $400 to nearly $500 per month, I said, “Don’t believe so.” And canceled my policy.
Recently I discovered I have glaucoma, as well as early cataracts. When the eye clinic discovered I had no insurance, the first thing they did was give me a 50% discount. And, with the equivalent of one month’s premium I was able to pay the bill.
The kicker? The insurance policy hadn’t covered eyes, anyway. The whole system is just a mess. It’s going to take more than Obama care to straighten it out. But if you need to, come on back. I for one will be happy to pay my portion of your bill! 😉
And I’m with you on the leaves and twigs routine. I get such a chuckle from people who ask, “What would you do if you knew you were going to die?” Uh…….
Thanks for your generous offer of helping to pay my bills.
People who ask such dumb questions as the one you cite are in complete denial of their own mortality. Death is a subject that has fascinated me since I was a child. I had a brother, Jimmy, who was a year younger than myself who died a bit short of his second birthday. I don’t have the slightest memory of him at all. But I do remember one time (actually one of my earliest memories) of getting up in the middle of the night and wandering down to where my mother was working in the sewing room of her parent’s house where we lived while my dad was fighting in the Pacific. I remember I was in my footie pajamas and holding my teddy bear and asked her “What does it feel like to die?” I don’t remember what her answer was but it must have satisfied me at the moment. And what was a more horrifying thought than that child’s prayer “Now I lay me down to sleep. I pray the Lord my soul to keep. If I should die before I wake I pray the Lord my soul to take.” Now sleep tight…there are no monsters in the closet.
When I was in the third grade another brother, Howard, died just short of his second birthday, too. Both succumbed to viral pneumonia. The way it effected some of the adults around me at the time, not my parents, though, changed how I view religion to this day. A couple we referred to as Robin and Daddy Al who baby sat for us were devout Roman Catholics and completely freaked out because Howard hadn’t been baptized. For them and their beliefs he would be consigned to Limbo until Judgement Day. Of course this made absolutely NO sense to me then, or now for that matter. In fact I think it was John Paul II who, with the stroke of a pen eliminated the concept of Limbo. What then became of all the souls that had been consigned there over the millennia? Where did they go? Then there was the minister at the Congregational Church (direct descendant of the Puritans) where Howard’s funeral was held who started going on about SIN. I sat there, in my third grade ignorance to theological matters and said, “Hey, wait a minute. WHAT SIN could this baby have committed? He could barely walk and couldn’t talk. What you’re talking about is STUPID!” (I know now it was a reference to “original sin” a concept I think is just as stupid. As a child you truly believe adults have all the answers, yet these people’s reactions to the death of an infant was just plain DUMB!
Over the years I have been present a couple of times at the moment of a person’s death. The first time was when I was a hospital corpsman at Bethesda Naval Hospital working on the neurosurgery ward. A retired Filipino Chief Petty Officer had suffered a massive stroke and I had been caring for him for about a week before he finally died. I sat there at his bedside holding his hand as he took his final breaths. It, too, changed me and since that moment I have not been afraid to die myself.
I’m always impressed with the quality of the literary quotes you use in your wonderful blog. I, on the other hand, am drawn to such as: “I want to die peacefully in my sleep and not screaming in terror like the passengers in the car he was driving.” And one of my own: “I know when it’s your time to go, it’s your time to go. I just don’t want to be on a plane when it’s someone else’s time to go and they drag me with them.”
And then there’s always the Woody Allen classic: “I’m not afraid of death. I just don’t want to be there when it happens.”
Hi Shoreacres,
We lived in Houston for 25 years, I was diagnosed with a rare form of cancer. No files, history or program of treatment for this type of cancer!! Consequently MD Anderson bombarded me with chemo and radiation for five months (c0vering their rear??), then pronounced I had 18 months max to live. So, here I am 10 years later still enjoying life so I disagree with “the point is that there really isn’t anywhere in the world better than Anderson”. Yes there is, a great environment (Potrerillos) and great healthcare system — Hospital Mae Lewis — and my doctors there specifically. My main health concerns now are the multitude of side-effects from five months of 24 hour a day chemo via a fanny pack and daily radiation — decimated kidneys, liver, intestines, lungs, etc. etc. As one young lady (in the US) put it “my organs are petrified”. But the doctors at Mae Lewis respect my wishes, no more chemo or radiation. And with their help and several medications I continue to live a great life. I often think that in the US they are not as concerned about patient care as amount of money they can make. One of these days, when I can tear myself away from Chiriqui, I will go to the US, present myself to M.D. Anderson and tell them “fooled you all didn’t I”.
Seems an appropriate comment for “Breast Cancer Week” from a Cancer Survivor. I would add that if they told me tomorrow I had six months to live if I stayed here or 12 months if I went back to the US for treatment, I’d take the 6 months — for me, quality of life and care is more important than quantity.
Marion
Hi, Marion,
The first thing to say is good for you – I’m really glad you were able to find a way to live your way past the diagnosis and treatment at Anderson. It sounds like you’re in a good place – in every sense of the phrase – and I’m sure every day is a blessing.
Still, I stand by my opinion of Anderson, with the additional allowance that everyone has their own experience of such a place. Mine was good – and the loved ones who were treated there, both those who lived and those who died, were given what I considered consummate care. They were treated with dignity, were full partners in the decision-making processes associated with their treatments and were supported in all kinds of ways.
Of course it’s a fact that the level of care varies among and within Med Center institutions. I spent some time working at Ben Taub, and if you were in Houston for 25 years you surely know why they call it “The Tub”. I saw things in that hospital that never would have been allowed at the Liberian hospital where I worked, and the patients suffered because of the system.
One thing’s for sure – we need to be active in our own health care and the final decision makers about treatment. It makes it much easier to live with the consequences of decisions – and living is the point, after all.
@Richard – laughing really out loud at your Woody Allen quotation. It’s one of my favs, second only to “The longest journey begins with a single step. The best journeys begin with a moment of temporary insanity.”
My family’s approach to death was to pretend nothing had happened. It’s a little hard to do with someone lying in a casket, but they were pretty intent on trying to pull it off.
One of these days I want to write about my best friend Charlotte, who died of cancer when she was in her 30s. Maybe 40. I’ll just say here that she was the one who finally got me past the fear of death. I’d prefer the process of dying not be gruesome, but I don’t worry a whit about what comes next.
I had to chuckle just a little at your stories – the Catholics on one side and the Puritans on the other. Such foolishness.
I was raised Methodist, and later landed amongst the Lutherans, where at least we have Bach and a really earthy theologian to keep us company. But good gosh – I had friends who were bereft when the Catholic church took St. Christopher away from them. I don’t know what they thought about losing limbo. 🙂
Hi Shoreacres,
Totally agree with your comments — to each his own. The main thing is to fight, fight, fight and not give in. The care and support I perceived I did not receive at Anderson may be a 180 degree reverse opinion from others and their families. The secrets of fighting cancer are: never give up; have a positive attitude — whatever the doctors say; and to hell with insurance companies — after all you will have a lifetime ahead of you to pay back the hospital. Oh and uncontrolled bodily functions and throwing up are natural side effects of chemo and radiation — you’re paying for it so to heck with disapproving glances from the nurses — you could go to a Five Star Hotel in Outer Mongolia (is there such a thing as a Five Star Hotel in Outer Mongolia??) for daily spa treatments and massages for less than you are paying for a US Hospital Room (without medication, doctor visits etc.) — and the views from a window in Outer Mongolia — unbelievable, much better than the views from Anderson. Whereas Anderson was not an embracing cocoon for me, a great friend of mine, who had a double mastectomy five years ago thinks that Anderson is without doubt the best. The main thing is not to give in and to continue fighting, tell that to anybody that you know with cancer. Maybe I am biased, I love Panama, the environment, the people, even the quirky government offices and I have supportive and positive doctors, fresh fruit and veggies at cheap, cheap prices, clean air and amazing views each morning which makes me realize that living life here to attain 120 years of age is not beyond my reach.
As for Ben Taub — we won’t even go there!! The “drop off” area in front where people without insurance or street people are dumped — horrendous.
Marion