From Behind The Hospital Walls of Hospital Nacional in Panama City

Like so many of you one of the reasons we chose to retire to Panama was because of the good health care. Although comforting to know it’s available we had no idea one of us would be finding out just how good it really is, sooner than expected. It was that time of year for my annual checkup of the lady parts so I decided to try the new Clinica de la Mujer in Coronado. Once inside I met with Dr. Antonio Altamar Jimenez who spoke very good English. He performed the routine Pap test and said “I’ll call you in a few days with the results.”

The results of the Pap test showed pre-cancerous cells growing inside my uterus along with inflammation of my cervix. Since I had the exact same results pop up about eight years ago, before we even went to talk to the doctor my mind was made up. I had decided that IF one of the choices was a hysterectomy I’d certainly choose that option. After all I was told by my doctor back in Texas after he removed the cells through an outpatient procedure, "these things CAN come back." He instructed me to never skip a Pap just in case, so I've never let a year go by without having one.

My doctor here presented me with two treatment options. One was to treat the pre-cancerous cells with creams and pills for one month and then re-test, and the other option was a hysterectomy. My thought was to eliminate the problem before it further developed into cancer by having the surgery now. Perhaps it was women’s intuition but I had this strong gut feeling that if I didn’t go ahead with the hysterectomy I’d be facing cancer in the future. I felt absolutely no pressure from the doctor to have surgery, as he left the decision up to me.

The surgery was scheduled for the following week at Hospital Nacional in Panama City. My head quickly filled with the obvious fears like: Was this doctor qualified? What would it be like to be hospitalized in a foreign country where I didn’t fully understand the language? What would the hospital be like? I talked to the doctor at length asking tons of silly questions which he gladly answered. He mentioned that he’d performed thousands of hysterectomies throughout his career and assured me that I was going into a very good hospital.

On the morning of the surgery we made our way to the hospital around 9 am just like the doctor ordered. As we walked through the doors it felt as if we were walking into the lobby of a four-star hotel instead of a hospital. A large glass-topped table with a colorful arrangement of flowers sat in the middle of the room. Behind the table stood a life-sized sculpture of Hippocrates on the wall. To the right was a small restaurant called “The Bypass Café,” and to the left was a reception desk. The girl at the front desk checked my orders and sent us around the corner to admissions. Once inside the tiny office the clerk asked me a bunch of questions just like any hospital in the states would, but in Spanish. From there we were sent to what they called the recovery room where my adventure would begin.

The large room was filled with a dozen beds positioned around a nurse’s station, just like a recovery or day surgery unit in the U.S. But unlike the stark white look in the states, these beds were covered in mint green sheets with jade green pads across the middle. A nurse dressed in matching green scrubs instructed me to undress and put on the same backless hospital gown I’d worn so many times before. She handed me blue covers for my feet and head before escorting me into one of the beds. Once I was in the bed she covered me with a green fluffy blanket and soon I was surrounded by staff all wearing the same colors as the bedding. One person checked my vital signs while another started an IV. The nurse asked me some medical questions that I tried to answer in Spanish, stumbling along the way.

It was a welcomed delight to see the familiar face of my doctor enter the room still in street clothes. He chatted a bit in English to calm my fears before leaving the room. A Panamanian woman in a business suit appeared next and introduced herself as the anesthesiologist. She spoke some English which made our interaction a bit easier. She explained that she would be using a general anesthesia and also mentioned what drugs she would order for pain after the surgery.

Soon a crew of people gathered round the bed and wheeled me out of the room and down the hall into the operating room. As I rolled into the room my doctor waved to me and introduced me to another doctor that would assist in the surgery. A tech to my right hooked me up to an EKG machine to monitor my heart. Someone else put a blood pressure cuff on as the anesthesiologist was fiddling with my IV. My doctor walked closer to the table and told me that I’d feel sleepy soon. I joked about the strong margarita they gave me as I began to feel fuzzy and sleepy. The last thing I remember was when the anesthesiologist leaned over my head and whispered “go to sleep.”

Next thing I knew someone was saying "Teresa" in a Spanish and I was back in the recovery room waking up from surgery. Soon after I was wheeled down several long hallways and into a room where the stretcher was positioned next to a bed. There was a male and female nurse nearby and they smoothly slid me over onto the hospital bed using the sheet that I was lying on. My husband Clyde appeared as I took in the sights of the room that would be our home for the next few days.

The private room was painted white and a 19-inch, flat screen TV was perched high in the corner. A large window was dressed in blue and gold curtains which hung under a padded blue, floral cornice high atop the window. In the middle of the cornice was the hospital emblem "HN" in a metallic, gold round piece. To the right of the bed was a blue leather rocker, recliner that sat next to a blue leather couch wide enough for Clyde to sleep on. The room was just as nice, if not nicer, than hospital rooms in the states.

Clyde explained that the doctor came out and spoke to him after the surgery explaining that all went well. Next the doctor pulled out his cell phone and showed him some photos. A picture of a bright red uterus, next to a round, red, ovary and a shriveled up fallopian tube were a surprise to see. The doctor explained that he found a cyst on one of my ovaries and removed it, but left the other one in place so I'd still have some female hormones.

Just like in any U.S. hospital, all through the night staff came in to check vital signs, give me pain meds and bother me every time I managed to fall asleep. In the morning the catheter was removed as my doctor had told me days before that I would be able to get up and use the bathroom. Nothing else was said about whether or not I should or shouldn’t get up and walk around. After other surgeries I was always encouraged to get up and walk as a way to aid in recovery. We waited around until sometime in the afternoon for my doctor to show up. My incision was tender but I really wasn't feeling much pain and later on decided to get up and walk, with Clyde close by of course. After walking around the room a few times later on I wanted to venture out into the hallway. We walked down the hall and passed the nursery and neonate unit full of screaming babies. As we headed back to the room the doctor showed up and his mouth dropped open in shock. Here I was not even 24 hours after major surgery walking the halls, standing upright and feeling little pain. He encouraged me to get back into bed and take it easy for the rest of that day, and said I was free to walk as much as I wanted to next day.

The next morning I looked forward to breakfast since I hadn’t eaten the day before. On the breakfast tray were two thick slices of raisin bread, not toasted along with a soupy, sweetened, cream of corn cereal that seems common here. A thin slice of turkey breast along with a large bowl of prunes accompanied by a choice of coffee or tea completed the meal. Lunch that day was chicken breast and mashed potatoes covered in white gravy. A bowl of carrots alongside some chicken vegetable soup along with a pear in heavy, sweet syrup was included for dessert. For dinner some beef with veggies, white rice and beans, along with chicken soup, veggies and mixed fresh fruit for dessert.

The hospital was clean, modern and just as good as any I’d seen in the U.S. But unlike hospitals in the states that are understaffed, here there were probably 20 to 30 different people each day that came and went from my room. Each had a specific job to perform which they did quickly and efficiently.

The cost of a total abdominal hysterectomy in the U.S. today would be $30,000 or more, with little or no overnight hospital stay. Here in Panama we paid a total of $4,600 which included fees for three doctors and staff, use of the operating room, two days in the hospital, and the pathology report. And the best news came two weeks later when the pathology report showed no cancer. But turns out that my “gut feeling” was right since I had a fast growing cyst on my ovary along with a lesion on my cervix. My doctor said had they not been removed they would have quickly turned into cancer.

So we can rest assured that health care here in Panama really is as good as they say, although I plan to stay far away from hospitals for a long, long time.