Wednesday, October 17, 2012

THE LAND OF BAD SKIN

The retirement websites tell you that medical care in Panama is as good as you can get in the United States at a much cheaper price.  It is cheaper, but good is a question mark.  Two hospitals in Panama are supposedly linked with US research hospitals like Johns Hopkins.  That means some of the doctors may be bilingual and US trained, but not necessarily the one you get in ER. 

In the US I worked as a quality control nurse.  Doctors got dinged if they didn't see the patients within 20 minutes of their appointment times.  In Panama, appointments are given as a range of time, like 2p.m to 6 p.m.  While I was in Panama I had three appointments with two different doctors.  The first one, a dermatologist, never had me waiting less than three hours.  The second one was not even available for the appointment, but had taken the week off.  I was rescheduled for the next Monday, and ended up waiting another three hours.  Lesson learned: take a good book and some water with you.

The doctors I saw spoke fair, not good, English, but we were able to make ourselves understood.   I can see this as an issue if there is something out of the ordinary going on that is hard to explain.

My skin developed a nasty rash on the left side of my face almost as soon as I got to Panama.  The dermatologist diagnosed it as allergic dermatitis and gave me steroid shots locally, antihistamine pills and two different creams ($75 senior price plus $35 for the appointment).  After a month and not much improvement in the rash, I saw him again.  He said to keep taking one of the creams till the tube was gone.  I questioned him about the insert that said (in Spanish) not to use the cream for more than ten days.  He said he had used it on a baby's bottom for six months with no problem.  With no alternative, I continued using the cream for the next two months.  The red rings went away, but the bumps continued.  The rash never really cleared up till I saw a dermatologist in Santa Monica the day after I flew in from the US.  One week on her creams (free samples, even) and my skin was fine.

I saw an internal medicine doctor at Chiriqui Hospital for a physical exam prior to taking a ship around the world (semesteratsea.org).  I had him fill out the examination form required by the University ("what do you want me to write?") and asked for routine meds for malaria, a typhoid booster shot, and medication for seasickness. 

He said they only prescribed doxycycline for malaria, which is what made me sick when I took it in Africa last year.  He called the infectious disease doctor at the county hospital and said he could give me daraprim if I went there the next day.  I remember taking daraprim when I went to Africa in the mid 1970's, but it is not even recommended by the CDC anymore due to widespread resistance to the drug.  In other words, it doesn't work. 

Typhoid shot?  No, they apparently don't give them in Panama.  They use doxycycline.  I repeat, this made me sick in Africa.

For seasickness he prescribed Vontrol.  I had never heard of this, so I looked it up on the internet.  It is for nausea and vertigo, but should only be used in a hospital situation under close supervision because it can cause hallucinations.  I can see myself acting crazy on the ship and nobody would have the slightest idea if something was wrong or that was my normal behavior.

In summary, three requests and the doctor struck out on all of them.  I did get my physical form signed, but ended up filling out most of it myself.  The only clinical thing he did was take my blood pressure.

I was able to send the form in by the deadline, but will have to see a travel doctor in the US.  Of course, this is not covered by my $636 a month insurance policy.