Larry's Central American Travels

What Is A Good Healthcare System?

 

What Is A Good Healthcare System?

For openers let me assure you this is not a rant or critique about Obama Care, although parts of this discussion may raise some questions to the reader about certain provisions of that legislation. Instead it is my intention that my observations in this discussion will allow readers to evaluate their existing systems and also review their existing healthcare in terms of its adequacy for their healthcare requirements in the future.

I have analyzed my recent experiences and hope that reviewing them here will cause the reader to evaluate their healthcare situation, both present and future. The healthcare I received in Panama was good, it was what I did not receive that was the problem – the coverage was not wide enough. I did not know that, did not have the knowledge required to pursue treatments, or even be aware of them. It was only after I made a return trip to the U.S. specifically to investigate what I might be missing in my treatment plan, that the medical world opened up. I discovered that the ex-pat living overseas is often making assumptions about the adequacy of the healthcare because they do not have the knowledge and expertise to evaluate adequately. And as changes take place in an individual's health, they are often subtle, though cumulative, and do not trigger a re-evaluation of the adequacy of the care being received until the condition has become a crises.

The answer to the question, "What is a good healthcare system?", is not as simple as it sounds.  And, in fact, the answer may not even be an evaluation that can be applied to everyone served by any given system. There are also factors that revolve around breadth, depth and volume of a system that are applicable. But these are all macro types of factors. The real question of importance to most of us is the adequacy of a healthcare system for me and my problems in particular.

I am going to itemize some of my recent experiences with healthcare systems as I continue to fight the battle with Chronic Obstructive Pulmonary Disease, more commonly referred to in its acronym form, COPD. Though I do not feel comfortable with discussing my personal problem with 'the world', I do feel that I can pass on some important lessons-learned to readers. It is my hope that some of these 'discoveries' on my part may save some of you from the same agonies and frustrations. But this discussion is not meant to target only the ex-pats living in Panama or ex-pats living overseas anywhere. I think my experiences will raise questions for those of you considering extensive overseas travel and those considering living overseas in particular. But I feel that some of my 'lessons learned' can be a tool for all people approaching senior status, particularly with the unknowns surrounding the new U.S. healthcare system.

I want to assure my ex-pat friends and acquaintances in Panama (where I spent the last six years) that this article is not intended in any way to be an indictment of the healthcare system in Panama or my experiences with it. In fact, just the opposite is my point. However, as you will see, the healthcare I received there was excellent, while also being inadequate. How is that possible you say?  Read on.

As I noted in a previous posting, I began to suspect (finally) that there was something I was missing about both my medical condition and/or the treatment I was receiving from my Panamanian medical professionals. With mans' long history with COPD and the large numbers of people who suffer from it, I became convinced that there had to be something available medically to break the cycle of contract pneumonia, spend 3-5 days in the hospital being treated with strong antibiotics, and then  return home to recover for a few days – recover to a lower level of lung health than before I might add. After being hospitalized in Hospital Chiriqui six times for the condition between late December 2012 and the end of June 2013, the suspicion became so strong that I finally made the decision to return to the U.S. and take the fight to COPD.

That decision highlights my first piece of advice - or warning, if you prefer. I stepped off the airplane in Charlotte, N.C., on a Monday evening and was in an ambulance on the way to the hospital at 2pm the next afternoon. I assure you that that is a traumatic way to 'start over'.  It also complicates the medical treatment primarily because the medical professionals are in effect gathering information and treating you simultaneously. Needless to say it simplifies the situation if those 'medical history pictures' are already posted.

In my first three days in the hospital I was literally flooded with information about COPD in general and my condition in particular. The information was oriented both towards treating the disease and coping more effectively with its effects on my day-to-day living. We covered best diet and eating rules of thumb, breathing and respiration tricks, new medicines, proper sequencing of taking meds, daily activity sequencing, weather and environment exposure do-es/don’t s, respiratory exercises, and many more to numerous to itemize here – plus I am sure you get the idea. Keep in mind NONE of these kinds of things were ever included in responses from the three pulmonologists I was treated by in Panama – though all three spoke excellent English, and all had received at least a portion of their specialty training in the U.S.

I will give you a specific example of a problem I was not advised on properly, while simultaneously shouldering a good portion of the blame for failing to research on my own. I am old enough to remember when they finally discovered the cure for TB. I remember as a kid people who contracted TB being shipped off to Arizona to allow that climate to make breathing easier. So hot weather helps breathing, particularly for folks with lung diseases – right? And since I like warm weather (and turn blue in air-conditioned spaces), I was happy to leave my windows open 24/7 in my apartment in David. But to be safe I asked two of my pulmonologists in Chiriqui Hospital if improving on the climate would help my condition – thinking maybe to filter the air better by closing the windows and turning on the air. The answer in both cases was 'No', complete with a detailed explanation of the rationale for the response.

You can imagine my surprise when experts here informed me that the constant hot and humid days in David where absolutely not the environment I should have been in. It turns out that those TB patients of old were sent to Arizona because most were living in cold/wet climates – the worst case respiratory situation. Almost any environment was an improvement. Arizona also did not have one of the other breathing problem irritants – humidity (like say David?). My N.C. doctor hastens to add as possible explanation that the Panamanian specialist were responding to my question in terms of 'their world' – e.g., here in Panama. In their mind the question was, "Is this David climate bad, should I be looking at Boquete or some other cool climate?"

Note that my N.C. pulmonologists also cautions that one should NOT be critical of the treatment I received in Panama because, in her opinion, the difference procedures and therapeutic approachs may just be a function of the maturation of the specific medical system in general. 

It is a given, is it not, that there are differences even between the system in Panama City and David? The system in David therefore is oriented more towards top-flight treatment of patients admitted to the hospital- at least in certain specialties.  The science and practices required to treat the disease in an effort to keep one out of the hospital has less (if very little) priority.

Now that I understand the generality of the term 'medical system', I also have to hasten to add that the statement  in the previous paragraph, "The system in Panama is oriented more towards top-flight treatment of patients admitted to the hospital", is true only as it applies to COPD and to the treatment regiment I did/didn't receive. And that is precisely why it is so difficult to evaluate medical systems for the layman, and particularly difficult to appraise the impact on you and your specific medical condition (much less those that may develop in the future).

The Key To  The Adequacy of Your Healthcare

The real key to the adequacy of your healthcare system ultimately boils down to YOU – like it are not, you are the key. You must stay informed, ask questions, get smart (AND stay smart) about your health problems and those of your loved ones. We in the U.S. have had this preached to us for years, and modern medicine only continues to get more, not less, complex. I suggest to you that you can make NO assumptions when dealing with a medical system outside the U.S. - Panama or anywhere else.

I will give you the perfect example of what I am talking about and you can them apply the potential for 'surprise' I found to your situation.  When I started having real problems with shortness of breath in mid-2012, my Panamanian pulmonologist chose not to increase the dosage of my long-time medication, but to change my medication. He also suggested that when I began to experience discomfort to sit down, get on oxygen, turn up the flow rate and stay quiet for at least 30 minutes.

Imagine my surprise when the pulmonologist here enlightens me to the fact that COPD is such a generic term that different forms require significantly different treatments. My version of the disease (a result of TB damage) dictates that I become seriously winded because I can't get rid of the carbon dioxide, not from shortage of oxygen. The worse thing I can do is turn up the oxygen. In addition the changed medications I had been prescribed were not formulated to target my form of COPD. In addition, it was also important that I get up and get moving around as soon as possible after an attack.  How many marks did we miss?

Also note that every pulmonologists' office and hospital ward I have seen in the U.S. have relatively simple electronic test machines that can spotlight one's COPD problem and its projected effects in about three minutes.  This affords the medical professionals with the precise information they need to build a treatment plan.  I never saw any such equipment in Panama on any of my numerous appointments.

 

So What Is A Good Healthcare System?

I hope that this information will provoke some of you to take a hard look at your situation and consider as much as possible that into the future. Get smart and stay smart.

I also urge each and every one of you to not put off critical decisions concerning healthcare to 'another day'. I can assure you relocating with a medical problem that has reach a critical stage is not the way to go. Trust me – trying to coordinate settling in your new home from a hospital ward is not the best way to go!

 

Till Next Time!  Pura Vida

 

 

Modern Medicine 101 - Revisited

 

Live And Learn?

I have learned a lot in the last few weeks! I am convinced that some of my discovery will be of benefit to many of you. For some time I have been making some serious errors in not taking full advantage of modern healthcare and in some cases not even paying any attention to things that were available.  And I am now convinced that his problem may be compounded for all my U.S. expats living in Panama.  No, this is not a rant on the healthcare in Panama or anywhere else - read on

I did make my 'Grand Exit' from Panama and made it back to the U.S. in early June, but like everything else in my life in recent month it was not an easy exit nor did it go as scheduled. As I discussed in an earlier posting. (See Adiós a Panamá  for details), medical problems dictated that I take a different road in the future - a road that includes the latest treatments and most scientific approaches for both treating and living with chronic COPD.

Twice I had to delay my departure (and 'donate $200 to U.S. Air for the pleasure) because I found myself at the last minute not healthy enough to travel.  I did finally make it to my son's house on a Monday night, only to go straight into the hospital the following afternoon. Yes, one more bout with pneumonia. Do you get the feeling I may have waited too long making the decision that I needed to migrate back to the U.S.?

Today I am not yet 'healthy', but I am on the right track. More importantly, for the first time in years, I am feeling optimistic about the treatment program. I am being prescribed the latest state-of-the-art medications, and have spent a week in a COPD rehab program (I did not even know there was such a thing).

My pulmonologist is a gem.  She does things the old fashion way - she visits all her patients daily when they are in the hospital (for those of you that don't know, that is no longer a common practice). She also holds a COPD Research chair at Duke University Med School and has been named 'North Carolina's Pulmonologist of the Year" twice in the last ten years.  The bottom line is - my treatment no longer is confines primarily of tweaking the same program(s) over and over. Things are happening!

What is the lesson to be learned here? Why am I even bothering to tell this story? And what factor may be of particular importance to the U.S. expat in Panama?

In my initial interview with the new pulmonologist I explained that I had become disillusioned with my medical treatment in Panama. It seemed my health was on a cycle.  A case of sniffles turns to serious cold symptoms, which leads directly to Hospital Chiriqui for a 3-day antibiotic battle with a strain of pneumonia - followed by a 4-5 day recovery back at home. When this happens four times in six months it is time to do something. And each visit to the hospital draws a different hospital staff pulmonologist, none of whom seem to be enamored with medical history. For a disease like COPD, that is so common and been around forever - there has to be some better way(s).

Her answer to my concerns was enlightening. She cautioned me not to be too critical of staff pulmonologists - that there job was to insure I got the correct treatment to insure I got out of the hospital. By contrast, her job is to try to get me healthy and keep me out of the hospital.

And that is the point I offer to all of you. If you have a health problem, which end of that equation are YOU pursuing?  And for you U.S. expats - Does the capability exist with your present medical folks to address the root of serious medical problem you may be encountering (or may in the future)?

 

INTERESTING EXAMPLE OF USE OF TECHNOLOGY IN MEDICAL TREATMENT

Thought you would like this. The nurse had just put a new bag on the IV stand, hooked me up and pushed a bunch on buttons on the dispensing machine to start it. She watched for a couple of minutes to see that the drip went properly. As she turned to leave the room, her phone rang. The pharmacy department was calling to suggest that she might want to change the flow setting to .166. The manufacturer recommended that since they changed the formula slightly. Yes, the pharmacy can monitor every IV drip going in the hospital in minute detail. OMG!

 

Till Next Time. 

"Deciding On The Right Retirement Village"

 

The View As I Approach The U.S.

 

After six years living in Panama, I am returning to the United States with the gnawing feeling that I am entering a New World - and not necessarily a Brave New World.

Let me emphasize for starters that I am not of those ex-pats who 'escaped' to live abroad as some form of protest, political or otherwise. In my case, what started out as a couple of weeks visiting a friend in Costa Rica turned into a six year adventure. I did not leave the U.S. with a chip on my shoulder about any personal or political conditions, nor do I return with any.  But I am concerned and definitely feel that I have some adjusting to do because the country I am returning to is not the one I left.

Let me assure you that we do not live in an isolated shell in Panama. The ex-pat population is aware and knowledgeable about what goes on in the world, at least to the degree that one wants to be. The CNNs and FOX News of the world come through loud and clear and newspapers from  around the world are available for daily download on your Kindle. But in simplest terms, reading about it is not the same as being there.

The disengaged feeling I get is similar to what I experienced during my Air Force days involved with being called back home to a friend or relative's funeral - something I am sure most of you share with me.  The logical part of you knows that the loved one is gone, starting right at the moment of notification.  But regardless of how long your travel to the funeral home takes, the loss does not really sink in before you are there - until you walk in that funeral home. And at this point in my return to the U.S., I have not completed this journey.

I will admit I have never fully understood what goes on with our federal government, and plead guilty to the charge that I was never too interested in following the story too closely. But shenanigans in Washington in recent years are not just outrageous, they border on embarrassing in my opinion. Oh no, Michelle Bachman is retiring? I don't know what the gestation cycle for Looney birds is, but maybe there is time to breed a replacement. And I singled her out, not because she is the only wacko in our Congress, or even the worst - just the most recognized of the breed.

The days of the gentlemen statesmen populating our Congressional halls has given way to behavior patterns that would be right at home at  'last call' on Saturday night in any biker bar. Even long-termed congressmen who have evidenced in the past the intelligence and civility to get things done even under trying circumstances complicated by a variety of conflicting political goals, seem to all be reduced to Sunday News shows' talking heads spouting their latest version of 'Nanny .. Nanny.. poo..poo.'

Meanwhile the nation sits mired in the mud while conflicting points of view invent new ways to say that they will never negotiate their position.  What did we Americans do to deserve this?  To date the efforts to improve things seemed to have backfired.

Now to our shock we have discovered that electing a 'crusader' to congress that has no experience is, in many cases, worse than what we had. At least the old comfortable incumbent did not feel pressured to make a name for himself (herself) by insisting on national news programs that something like changing weather patterns were being influenced by something like the competing party's political action committee teaming up with Martians (illegal immigrants at that!).  And the old pros, efficient or not, knew that certain things HAD to get done!

And have you also noticed that personal freedoms seem to be a concept of the past. The government is indiscriminately screening billions of ordinary citizens' phone calls looking for anti-terrorist leads? You're kidding, right? No I am not. They collect an estimated 1.7 billion (with a 'B') pieces of communication a DAY!  Now this is the same group that had information that could have thwarted the 9-11 attacks, but that information was lost - buried - in the volume of information that they had collected. So they need thousands of times more info, right? Government logic personified!

Obviously the people who run this program, and similar ones, in this 'transparent' government of ours, have never heard of the U.S. Constitution!  A simply-stated concept like 'guilty until proven innocent' evidently has some legal subtleties that escape us common folks.  Instead 'collect private info on everyone and we'll sort it out later as we see fit' seems to rule. This program alone stuns me. Programs approved by a man whose only real work experience (in my opinion) prior to being elected POTUS was as a professor of Constitutional Law.  This collection program is even more invasive and massively broader based then the infamous 'stop and frisk' fiasco. And, I predict will be even less productive than the famously failed 'frisking' joke. I am now also convinced the President would fail a legitimate Constitutional law coursse.

By the way, don't start on me with the infamous "Bush is the one that pushed the Patriots Act into our freedoms ..blah..blah..blah." I am trying not to make this a political argument.  I am talking about government intrusions - not Democratic or Republican. Plus Obama not only extended most of the Patriots Act provisions when they came due for extinction, and in fact, strengthen some making them even more intrusive.

The latest IRS scandal is close to the 'straw that broke the camel's back' for me philosophically. The targeting of groups based on political persuasion is in a word - despicable. And not because of the targeting itself. I will put this in military terms only because that is my experience. All of you have similar experiences and will know what I am talking about - specifically for want of a better term, an organization's personality. 

Think of the good companies or organizations you worked in or with.  They had ground-rules, ways of doing things, priorities. and definitely do's/don’ts. Fighter pilots don't decide they are going to modify the airplanes landing configuration. Salesmen don't change the product prices and terms of the sale. Secretaries don't change the company letterhead. There are rules, procedures AND philosophies, many of which are sacred - they ARE the organization!

In such organizations - REAL organizations with a mission - there are NO rogues.  Rogue behavior survives only until it is discovered - usually with the first complaint. "You required they submit the answers to how many questions?" Even discussing some kind of rogue behavior with a colleague could threaten your job.  It is embarrassing that IRS officials would try to explain away  this travesty as so-called rogue behavior.  Embarrassing because it proves conclusively that those highly-placed (and highly paid) senior government officials know absolutely NOTHING about organizational behavior - or assume that we don't.

America is said to be in decline, although we face no devastating plague, nuclear holocaust, or shortage of oil or food -  and in fact recent projections show the U.S. will become a major oil exporter. But we are in decline primarily due to our out of control national debt.

In recent years Americans have never led such affluent material lives -- from houses and cars, to cell phones and big-screen TVs, to cheap jet travel and fast food. Unlike many countries in the world, obesity rather than malnutrition is the greater threat to national health. Americans spend more money on cosmetic surgeries and Botox than many nations spend fighting polio, small pox and malaria.

But the political dialog is not centered on capitalizing and expanding our natural and inherited wealth. Instead, Americans bicker over entitlement programs as the nation continues to pile up trillion-dollar-plus deficits. And a continuing war roars on concentrating on enforced equality rather than personal liberty. As I saw written elsewhere, "The medicine of cutting back on government goodies seems far worse than the disease of borrowing trillions from the unborn to pay for them." Hmm......

While you are thinking about where America is going, think about where America has been. A good example: In August 1945, Hiroshima was in shambles, while Detroit was among the most innovative and wealthiest cities in the world. Contemporary Hiroshima now resembles a prosperous Detroit of 1945; parts of Detroit look like they were bombed decades ago.

I do not embrace the idea that a government's redistribution of shrinking wealth, in preference to a private sector's creation of new sources of it, is the correct answer. As a result I object to the government honing the tools, while simultaneously taking my personal rights so as to facilitate making that approach possible.

 

Till Next Time. See Ya' Later