Two Years!

OK, questions and comments . . .

Plan my cruise . . .

Hello sir, After reading your interesting blogs in cruise critics, I would like to ask you for some suggestions/tours to take. We are planning to take a Panama Canal Cruise on early Dec/January/Feb, we are on our early 40’s, in a tight budget but would like to have some unforgettable time on the following ports.
ARUBA
FUERTE AMADOR, PANAMA
PUERTO CALDERA, COSTA RICA
PUERTO QUETZAL, GUATEMALA
PUERTO CHIAPAS
HUATULCO
ACAPULCO
This will be our first Panama Canal Cruise. Thank you. Julius Cristobal

Hey Julius, like your last name, Cristobal . . . as in Christopher . . . as in Cristobal, the section of Colon where there is a pier that many of the Canal ships use. Check my page Panama Cruise for more . . . depending on how long you have in Fuerte Amador, which is really the Amador Peninsula area of Panama City, I have some suggestions for you on the Panama Cruise page. Aruba . . . go enjoy the beach! Take a $2.50 city bus from the station across from where the ships dock and have fun! Acapulco . . . the best view is from the ship IMHO. Cliff divers are highly overrated, again IMHO. Huatulco, not much to see where the ship docks. I usually just spend some time on the tiny beach. Puerto Caldera . . . beach in town, but other than that there’s nothing there unless you take a tour. Guatemala . . . definitely get up to Antiqua! If you don’t want a ship tour, get a few other couples together and rent a van. It’s worth the trip. Enjoy!

Get off the ship!

Hi…i really love your blog. Could you please tell me if you would recommend that I stay on the Mercury to cruise through the Panama canal…or should I take a shore excursion? any help would be great! thanks, Irene

Irene, I don’t know what itinerary every ship is doing . . . depends on MERCURY itinerary, and what your options and choices are. My Panama Cruise page gives a lot of information that will help. Generally I think you should be on for at least one lock experience, and then, when possible, take advantage of the opportunity to see some of Panama . . . you’ve come all this way! Suggestions for Panama tours depend on your areas of interest . . . again, that’s why I wrote the Panama Cruise page! You’ll love MERCURY!

Popular retirement destinations . . .

Didn’t know if you’ve seen this. Re: recent retirement rating destinations.
http://articles.moneycentral.msn.com/RetirementandWills/RetireInStyle/the-worlds-best-places-to-retire.aspx

Iaorana! Bob P.S. Can you tell we’re getting ready to go on a 33 day HAL Rotterdam/French Polynesia cruise in January?

You’ll love the ROTTERDAM Bob! Susan Wood, one of my favorite cruise directors, is often on the ROTTERDAM, although I heard she may have left Holland America, and I understand that Joseph Pokorski may be heading to ROTTERDAM. I’ve worked with Joseph as cruise director and also as one of the stars of the new entertainment approach Holland is rolling out on the smaller ships. Joseph is a fantastic tenor with experience in opera and Broadway. You may be in luck!

That’s an interesting article . . . and you note that Ecuador is just a few points higher than Panama on International Living’s rankings. I know several folks who’ve moved on from Boquete to Ecuador. One is back in the States . . . the other hasn’t been there that long. 8,000 feet elevation rules a lot of retired folks out . . . I understand the cost of living right now is cheaper. The fact that Panama uses the US dollar was an advantage . . . I thought. Time will tell. You gotta find a place where you feel comfortable.

Elizabeth Taylor (really!) asks . . .

Hi I am going on a cruise around the Caribbean to Aruba,Colombia, Cristobal pier, Costa Rica and Gran Cayman I am coming from England and leaving from Miami.Could you please tell me if I need any Visa please Elizabeth Taylor

Elizabeth, I’m not the person to ask about this . . . for US citizens I know that no visas are required. I would doubt that it’s any different for UK/EU folks, but to be sure you need to check with your travel agent and/or the cruise line. I know cruise lines are increasingly ducking these kind of questions, telling you to check. The fine print in most cruise contracts tells you that the cruise line isn’t responsible for anything, and I suppose their lawyers have told them to shift the burden back on the passenger. I’ve found some of the bigger visa service sites are a quick and easy way to find out and generally very accurate and up-to-the-minute. Enjoy your cruise!

Responding to my post about hospital costs in Panama, David says . . .

Do not forget about Jubilado Descounto. If you are over 55 for women or 60 for men you can ask for a discount at pharmacies, hospitals and hotels which can range from 10 to 50% off. David Maples

Technically, you are correct . . . BUT . . . in my opinion the “Jubilado Discount” . . . offered to Panamanians who are over a certain age and to expats who have been granted a “Pensionado” visa, is the most overhyped thing in Panama. Folks selling Panama love to opine about the “Pensionado” benefits . . . There are sometimes you would have to be totally insensitive to ask for the discount, other times . . . like with medical stuff . . . you have know way of knowing what the regular fee is. Maybe they’ve just inflated the regular fee since you are a gringo and “all gringos are fabulously wealthy” and they figure you’ll ask for the discount anyway, so you still end up paying more than a normal, working Panamanian who walks through the door. I know that’s not the law, but unless you’re ex-Canal, know these people, and speak Spanish fluently . . . how are you going to complain, much less discuss it. Most restaurants in Boquete automatically up the price to adjust for the discount, especially if they have a big “gringo “clientele. I look at the prices and can tell pretty quickly if they are “gringo” or “Panamanian” prices, and we have both . . . although not legally . . . on everything. Send your maid to the farmer’s market, and if they don’t know she’s working for a gringo, you’ll be stunned at the prices she’s paying for produce, compared to what you pay. Unfortunately there are some Panamanians who aren’t sure how long all this is going to last, so they want to get theirs while the getting is good. I have a neighbor who was going to lay cement blocks for me and agreed to work for $15 a day. A fair rate. The next day when he was supposed to start work he didn’t show. I’m sure he went home and his wife said, “For a gringo! They have all kinds of money! You should have asked for $30!” And I just might have paid it then . . . not now. I’m scouting around for shipping containers and the going rate is about $2500-3000. I was talking with the wife of a local guy who brings these up from Colon when he’s making a trucking run empty. She had quoted me $3000 for a 40-foot container, delivered to my farm. I went back to see her and a so-called “friend” of this family was there, and the wife wasn’t. And he, knowing I was there to see the wife said, “Oh, I can get you a container!” trying to beat out his friend for the business. I asked, “How much?” And I could see the wheels turning as he paused to consider just how much he could get from this stupid gringo while at the same time beating out his friend. “$10,000.” I could go on and on, but won’t.

2 years and 200,000 visitors!

Who knew? Certainly not me when I started this October 16, 2007, not sure anybody would read it! 200,000 visitors later, and folks from all over the world, all I can say is “Thank you!” It’s been fun, a lot of work, but still fun. And what I enjoy most is meeting folks on cruises and around Boquete who first met me online and when we talk about something, or I say, “Nice to meet you”, respond with something like, “Oh, I know all about you!” scary, huh? And I enjoy your comments and questions, so keep reading, and keep the comments coming!

Reluctantly I have concluded that at this point, and with my commitments to cruise lines, I just can’t post a new blog every day . . . so, starting today I will be blogging on even-numbered days only . . . whenever that is possible. There are times onboard ship when we’re not getting the satellite signal, or there is some interference, and the Internet is down, but as much as I possibly can, I’ll be here on even-numbered days.

I thought you might get a kick out of seeing how all this has played out!

Your Comments & Questions

Have a heart . . .

Richard, Are you able to able to share the name of the cardiologists both in Chiriqui and P-city that were recommended to your wife Thanks, Mountainman

Sure . . . the Cardiologist, whose office is at Mae Lewis Hospital in David, is Dr. Franklin Anguixola Santos [507-774-2453] and the surgeon, Dr. Norberto Javier Calzada, [507-204-8300 Ex 811] Cardiologos Associados de Panama, in Panama City at Hospital Paitilla.

New home construction . . .

I am a student researching the homes of the Indigenous people of Panama and I will like to get more information on how they are built. I have seen pictures, however I need more detailed information on how they are constructed (materials, structure).Can someone point me in the right direction?Celia Evangelista

 Celia, Come on down and see for yourself! For Kuna, Embera and Wounan, almost all of their houses are primarily palm. Different types of palm are used for the sides, thatched roof, and flexible flooring. Bamboo is also a popular building material. Over around Bocas del Torro wood is the primary material. My Embera friend tells me it takes about a week to build a house, and it is a project in which the entire village helps out. The Embera houses are generally open on the sides, except during the windy season, when they put up palm siding. Tradition is very important, so the Embera used a notched log as a front stairway. Usually the “kitchen” is made by putting down layers of banana leaves, then dirt, then more banana leaves until you have a non-flamable base sitting on top of the flooring, You add three big logs, to support the pot, and voila! – a stove. Our local Gnobe Bugle prefer a “fagon”, the outside raised cooking platform, to the little gas stoves we supply because they are able to better control the heat and flame with the open fire. My Embera friend’s house is a lot cheaper to build, goes up quicker, and has a whole lot less problems than mine!

Veragua Rainforest . . .

Is there any way to arrange in advance a taxi to bring (pick up later) my husband and me from the cruise ship port to Veragua Rainforest? Or is it easy to arrange that at the port after we arrive there? Kyung Mueller

There are lots of cabs right at the end of the pier. The red cabs are the licensed ones, and the ones you should use. There are also several local tour operators who will take you out to Veragua with others in a mini-bus. Take a raincoat or poncho along since it rains in the rainforest!

Private tours in Panama . . .

Found your address at a cruisecritic blog. I’m from Tampa Florida and taking a cruise to the Canal with Island Princess. We will be there Friday October 16. I was originally told that I could only do the Cruiseship tours, but then I found a posting on a Friends of Mario that does tours. Seem you live there and have experience cruising. Can I tour with private tours when ariving on a ship? Anyone you recommend? Thanks, hope I’m not overstepping by asking for your assistance. Madeline Tejera

There are lots of questions about this on Cruise Link. First, check out my Panama Cruise  page . . . A lot depends on which ship you are taking and the itinerary. Princess has a variety of options and without spending a lot of time on their Website, off the top, I don’t know what ISLAND PRINCESS is doing on October 16th. If the ship is calling on the Pacific side at Amador (part of Panama City) you can do whatever you want, same thing if it is stopping at Colon (Colon 2000, RCL pier, or Cristobal) . . . If you have enough time. Remember, Panama looks small on the map but traffic is horrendous especially in the afternoon just before a lot of ships are sailing. If the ship is dropping anchor in Gatun Lake to let off guests there for shore excursions, in Gatun Lake you cannot get off the ship unless you are taking a shore excursion booked on board. You tender off to a place called “Gatun Lake Yacht Club” . . . where there is not a yacht or any other kind of boat in sight! There is nothing at Gatun Lake Yacht Club but a parking lot where the tour buses are waiting. It is the Panama Canal Authority, not the cruise line, that only allows guests to disembark who have purchased shore excursions. (Man, I know that line backwards and forwards!) Reason: it is a secure area of the Canal with no public access: no cabs, no vendors, nada.

I don’t know anything about Mario. He either has a big following, or a lot of family members who post on Cruise Critic. I do know Anne Gordon who offers independent tours of the Embera Indian Village. She is a gringa from California, married to an Embera man from the village, so she knows a lot about Embera life and has many unique insights.

My advice is generally to take a ship tour. You spend all this money on a cruise, why go through the hassle and risk of doing your own thing? A ship’s tour is generally the easiest, safest, and most efficient way to get the most out of a relatively brief time in a port. The cruise line vets operators to make sure they have insurance, monitors their performance, and will never leave if a tour bus is late. If you go on your own you take your chances. The further the attraction is from the pier, the more important it is, IMHO, to take a ship tour.

I know folks don’t want to feel they are in a “herd with Red number Eight” stickers. Well, folks, I have news for you. Take your independent tour to Ephesus . . .and there will be 4 Holland America groups behind you, 6 Royal Caribbean groups ahead of you, 3 Princess groups to your left, and a bunch of crazy Germans from AIDA eves-dropping on your “private” English guide. Go to the Colosseum and you’ll stand in a line of thousands waiting to get in along with all the ship tour groups. I don’t get it!

Start with the blog . . .

Hi Richard, I got your e-mail off your posts on Cruise Critic (OhioLair on CC). I have been doing research on what to do, where to do it and so on by scouring the boards. Everytime I found something informative and interesting, it was one of your posts! Thanks for all the info, and if you have any other suggestions I would appreciate a reply. We are sailing on the Statendam Oct 30th from San Diego… with stops in Puerto Vallarta, Huatulco (I liked your Carona suggestion), Puerto Quetzal, Puerto Chiapas, Fuerte Amador (The causeway sounds like an interesting area) and Cartagena! Always on a budget, any inside suggestions, hints or tips will be greatly appreciated. I am also going to check out your blog when I have a few minutes.  Thanks, Larry Potts

Hey Larry! I’ve tried to put a lot of effort, and certainly a lot of time into this blog to answer most of these questions. Start with my Panama Cruise  page, then go to the right hand column and click on the “Cruising and Travel” category and it will open a whole list of blogs on cruising and travel.   I realize the cost of tours booked through the ship is more than the cost if you book independently, just like the cost of a Coke or a beer is more onboard.  That’s how the cruise line makes its money, especially if you look at the prices of cruises right now.  Believe me, I understand “saving a buck”, but when you go on vacation you need to loosen up the sphincter a bit and enjoy life!    There are ports where I’d say, “Do your own thing!”  If you are going to Portofino, just go ashore independently, find a nice cafe, pay $50 for a cup of coffee and sit there and soak up the ambiance.  But there are many ports where the attractions and the things you came to see aren’t right next to the ship, and those are the ports where it is easiest, most efficient, and often cost-effective to take the ship’s tour, even if it is more expensive up front.

* * * * *

Well this morning is a spectacular Sunday morning in Boquete!  Absolutely stunning!  This past week has been “the week that was”, which I’ll tell you about later.  The guy who usually works on Sundays for me doing concrete and block work fell last week on his regular job, and can’t work this morning . . . A day with no workers!! No questions!! No struggling with Spanish!! Also no progress, but . . . hey!

I’ve got a dozen “Sailaway” and “Sailin” presentations to work on . . . so I’m off to sit on the front porch, relax, and sip our own coffee.  We just had the first batch of last year’s harvest roasted and it is wonderful!  This year’s coffee is looking great and our harvest should begin next week.

Have a great day!

Healthy Living

Who comes up with this stuff?  I don’t know!  This one was sent by Dinah Sutton to my wife who forwarded it to me, who is forwarding it to . . . you!

Here’s stuff the folks I worked with at 24 Hour Fitness and Apex Fitness never knew!!

Q: Doctor, I’ve heard that cardiovascular exercise can prolong life. Is this true?

A: Heart only good for so many beats, and that it… Don’t waste on exercise. Everything wear out eventually. Speed up heart not make live longer; that like say you can extend life of car by driving faster. Want live longer? Take nap.

Q: Should I cut down on meat and eat more fruits and vegetables?

A: You must grasp logistical efficiencies. What does cow eat? Hay and corn. What are these? Vegetables. So, steak nothing more than efficient mechanism of delivering vegetables to system. Need grain? Eat chicken. Beef also good source of field grass (green leafy vegetable). And pork chop can give 100% recommended daily allowance of vegetable products.

Q: Should I reduce my alcohol intake?

A: No, not at all. Wine made from fruit. Brandy is distilled wine. That means they take water out of fruity bit; get even more of goodness that way. Beer also made out of grain. Bottoms up!

Q: How can I calculate my body/fat ratio?

A: If you have body and you have fat, ratio is one to one. If you have two bodies, ratio is two to one, etc.

Q: What are some of the advantages of participating in a regular exercise program?

A: Cannot think of single one, sorry. My philosophy: No Pain…Good!

Q: Aren’t fried foods bad for you?

A: YOU NOT LISTENING!!! …. Foods fried in vegetable oil. How getting more vegetables be bad for you?

Q: Will sit-ups help prevent me from getting a little soft around the middle?

A: Definitely not! When you exercise muscle, it get bigger. You should only do sit-ups if want bigger stomach.

Q: Is chocolate bad for me?

A: You crazy? HELLO … Cocoa beans! Vegetable!!! Cocoa beans best feel-good food around!

Q: Is swimming good for your figure?

A: If swimming good for figure, explain whales to me.

Q: Is getting in-shape important for my lifestyle?

A: Hey! ‘Round’ is shape!

So, laughter is the best medicine . . . and if that’s not enough . . .

For those of you who watch what you eat, here’s the final word on nutrition and health. It’s a relief to know the truth after all those conflicting nutritional studies:

1. The Japanese eat very little fat
And suffer fewer heart attacks than Americans.

2. The Mexicans eat a lot of fat
And suffer fewer heart attacks than Americans.

3. The Chinese drink very little red wine
And suffer fewer heart attacks than Americans.

4 The Italians drink a lot of red wine
And suffer fewer heart attacks than Americans.

5. The Germans drink a lot of beers and eat lots of sausages and fats
And suffer fewer heart attacks than Americans.

CONCLUSION….. Eat and drink what you like. Speaking English is apparently what kills you.

Or could it be . . .

a) Our lifestyle is wacked . . .

or

b) Our health care system sucks . . .

Just a thought.

* * * * *

I used the above picture because it’s what was with the forward from Dinah.  I have no idea if this guy is the one who proffered these tips for healthy living, or not.   For all I know maybe the real guy in the picture runs a photo lab or is a nuclear scientist . . . or is a proctologist or pathologist . . . or just plays one on Asian TV.  And I don’t want to be accused of racial stereotyping . . . The guy who offered these suggestions could just as easily be this anglo guy . . .

Over the years I’ve learned to choose my doctors carefully . . . the same way folks tend to choose their pastors . . . find someone whose lifestyle and practice agrees with you! A doctor who works out 5 times a week at the gym and runs triathalons certainly can’t understand the challenge of eating as appropriately as one who is 40 pounds overweight . . . and looks like me! After all the purpose of seeing a doctor is to feel good! (Just ask Michael Jackson . . . well, not now, but you should have while he was still dancin’.)

Celebrating 95 Years . . . in The Dentist’s Chair

Happy 95th!

Yesterday was the 95th Anniversary of the first transit of the Panama Canal by the SS ANCON in 1914.

Although the building of the Canal had been a worldwide dream, and although the whole world watched the failed efforts of the French, and the successful US effort to ,in effect , “sponsor” a revolution to acquire rights to build a Canal, and then bring off one of the greatest engineering feats in history, even to this day. . .  the actual opening of the Canal was eclipsed as a news story by news of a world on the brink of war.

Although I won’t be on a ship doing the Panama Canal this season, I decided to use some of my time off to reread the three primary books about the Canal including Matthew Parker’s PANAMA FEVER which I had not read before.   

If you are only going to read one book before taking a Panama Canal cruise the one I would recommend is PANAMA FEVER instead of the oft-recommended, including by me, tome by David Mc Cullough, THE PATH BETWEEN THE SEAS.  Parker gives equal time to the awesome effort and tragedy of the French attempt and is a much more readable and engaging work than THE PATH BETWEEN THE SEAS.

So if you’re planning a Canal cruise, here’s the reading list . . .

David McCullough, THE PATH BETWEEN THE SEAS – “The” definitive history of the construction of the Panama Canal. A little tedious at points. As the Captain of the ZUIDERDAM once told me, while he was reading McCullough, “It puts me to sleep.” If you get through the first 200 pages, you will be hooked.

Douglas Galbraith, THE RISING SUN – No, it’s not about Japan. “The Rising Sun” was the name of a Scottish ship that established the first settlement in Panama with high hopes of digging a canal by hand! Based on actual notes of the expedition’s clerk who was one of the few to survive, this is a fantastic historical novel and amazingly is a “first book.”

Matthew Parker, PANAMA FEVER – Another version of “The epic story of one of the greatest human achievements of all time – the building of the Panama Canal.” Of the three books – McCullough, Green, and this one, this, in my humble opinion, is the most interesting read. If you are only going to read one, this would be my recommendation.

Julie Green, THE CANAL BUILDERS – The newest “groundbreaking history of the Panama Canal offers a revelatory workers’-eye view of the momentous undertaking and shows how it launched America’s Twentieth-Century empire.” Heavy on the sociology of the social stratification during the building of the Canal. Helped me understand the genesis of some of the issues we still face in Panama.

Almost a million passages have been made between the oceans using the Canal since it opened, and sometime next year . . . probably the ZUIDERDAM and I won’t be there!! . . . the millionth ship will make the passage. And what will happen? Free passage? Probably not. Probably just balloons and free key chains. The big celebration will be in on the 100th anniversary and when the new Canal expansion project is completed.

So how did I celebrate?

In the dentist’s chair in David having implants put in. Yuk! My dentist is great, but his assistants . . . I think graduated from the Dick Cheney International Correspondence School of Waterboarding. I grimace at the cost . . . $1500 per implant. However a dentist from St. Louis who was on the ZUIDERDAM last year told me how much he charges . . . and told me my dentistry in Panama was a bargain. This could be the reason why medical tourism for elective proceedures and dentistry is becoming a big business in Panama.

Ok, I’m off for another pain pill, and to smell and drool over my wife’s left over supper while I feast on yogurt and soup.

Sarah’s World and More!!

Welcome to Sarah’s world!

Dianne Heidke, our rebelious, creative, Aussie-in-residence, posted this map on Facebook . . . I thought at first it was Sarah Palin’s familiarization map of the world!

It shows Australia, Dianne, what more do you want??

Jeff Simon on Social Security . . .

Jeff sent me this and although I usually don’t read or forward or post stuff unless it is really good . . . this is good.

“SOCIAL SECURITY:

Perhaps we are asking the wrong questions . . .

Our Senators and Congresswomen do not pay into Social Security and, of course, they do not collect from it.

You see, Social Security benefits were not suitable for persons of their rare elevation in society. They felt they should have a special plan for themselves So, many years ago they voted in their own benefit plan.

In more recent years, no congressperson has felt the need to change it. After all, it is a great plan.

For all practical purposes their plan works like this:

When they retire, they continue to draw the same pay until they die.

Except it may increase from time to time for cost of living adjustments.

For example, Senator Byrd and Congressman White and their wives may expect to draw $7, 800,000.00 (that’s Seven Million, Eight-Hundred Thousand Dollars), with their wives drawing $275, 000..00 during the last years of their lives. This is calculated on an average life span for each of those two Dignitaries.

Younger Dignitaries who retire at an early age, will receive much more during the rest of their lives.

Their cost for this excellent plan is $0.00. NADA!!! ZILCH!!!

This little perk they voted for themselves is free to them. You and I pick up the tab for this plan. The funds for this fine retirement plan come directly from the General Funds;

“OUR TAX DOLLARS AT WORK”!

From our own Social Security Plan, which you and I pay (or have paid) into, every payday until we retire (which amount is matched by our employer), We can expect to get an average of

$1,000 per month after retirement.

Or, in other words, we would have to collect our average of $1,000 monthly benefits for 68 years and one (1) month to equal Senator Bill Bradley’s benefits!

Social Security could be very good if only one small change were made.

That change would be to

Jerk the Golden Fleece Retirement Plan from under the Senators and Congressmen. . Put them into the Social Security plan with the rest of us

Then sit back…..

And see how fast they would fix it!

If enough people receive this, maybe a seed of awareness will be planted and maybe good changes will evolve.”

No-fly zone . . .

Both Bonnie Williams and Don Ray Williams of Chiriqui Chatter called me to task for mentioning briefly LifeFlight Panama . . . which, like many restaurants in Boquete, has opened and closed it’s doors while I was gone.  According to Don Winter, writing in Panama Guide . . .

To put a long story in a nutshell, basically powerful Panamanian and foreign businessmen who are already operating in the aviation business recognized the validity of Lifeflight’s business model, that the service was needed in Panama, and that eventually Lifeflight would probably succeed resoundingly. Therefore, those same people intervened with the Panamanian government, specifically the Civil Aeronautics Administration, to block Lifeflight’s requests for permits to operate, in effect cutting the legs out from under their operation. The AAC refused to issue Lifeflight the permits required to fly, transport patients, and charge for the service. They could fly, but not charge. And although the people who did this had done absolutely nothing to start a competing medical evacuation business, they simply wanted to keep the field clean should they decide launch a similar service in the future. Basically, Lifeflight was sabotaged.” 

Looks like another good idea crushed by the powers that be.

Building like there is no tomorrow . . .

Or certainly like there is no financial crisis in the world! According to THE PANAMA STAR . . .

“There are currently 191 skyscrapers under construction in the capital city with an average height of 30 stories each. This suggests that although the property boom has slowed down it has not died out completely. The majority of the projects are being constructed in the neighborhoods of San Francisco, Parque Lefevre and Bella Vista.

The General Comptroller said that 128 projects are in the advanced stage, which is the phase that employs the highest amount of people. Of these, 32 companies have also started new construction in different parts of the capital.

In general terms, the construction sector showed clear signs of recovery during the first semester of this year during which the total revenue from construction permits granted was approximately $1.1 billion. For the same period in 2008, construction permits brought in a maximum of $835 million.

According to the Ministry of Economy and Finance this growth was due to diverse internal factors, including trust in the Panamanian economic system, the liquidity of the banking sector and tax incentives that promote private investment.

The development of these building projects will keep the construction sector in the capital city stable and it is expected that these positive expansion signs will continue during the rest of the year, probably until 2010, if the demand for apartments and condominiums increases.”

Hospitals, Emergency Care and Insurance

On of the questions I’m asked most frequently about living in Panama is, “What is the medical care like?” Two days ago I wrote about “Expat Medical Care In Panama”, and yesterday I wrote about “Our Experience With Medical Care In Panama”, so today I’d like to discuss “Hospitals, Emergency Care and Insurance.”

Hospitals . . .

In David, the third largest city in Panama, 45 minute drive from Boquete, there are four large hospitals.  The Maternal & Child Hospital is a National Hospital focusing primarily on material and pediatric care.  It is only two years old and was a gift from the people of Taiwan, with whom Panama has diplomatic relations.  Almost next door is the Social Security Hospital which serves people who are working in Panama and paying into the Social Security system.    Just down the Pan American Highway is Hospital Mae Lewis, a private hospital that is used by locals and gringos.  And a few blocks off the Pan American Highway is Hospital Chiriqui, a private hospital that is generally preferred by expats because of their “insurance” program (more on that later).  Hospital Chiriqui.  Additionally, scattered around David, there are almost a half dozen tiny private hospitals owned and run by a consortium of doctors.  In some ways it isn’t very efficient, yet the hospital costs are low.  A private room runs about $60 a day!   Of the private hospitals, Hospital Chiriqui has the most “bells and whistles” including a state-of-the-art MRI machine, one of two in Panama.

Unlike in the US, in Chiriqui any doctor can practice in any hospital and you are not limited to only certain hospitals where your doctor happens to be on staff.

Emergency Care . . .

Here is where things can get a little dicey. 

If you happen to be one of the very few people to get bitten by one of our famously poison snakes, like the fer de lance which is fairly common in Chiriqui . . . and let me quickly add that your chances of getting bitten by a poisonous snake are about the same as your chances of getting struck by lightening or winning the lottery!  . . . if you are bitten by a snake anywhere in Panama you are generally about 45 minutes from a Social Security hospital which is where the anti-venom is kept.  So you have plenty of time to get to the hospital where you will find that rather than immediately giving you anti-venom there is a long waiting/observation period while they test your blood and wait to figure out what kind of snake bit you and what type of anti-venom you need.   Almost everyone, except for Indians living in very remote areas, recovers.  So although the fer de lance and bushmaster can be “deadly”, your chances of dying if you get assistance are very slim. 

OK, we got that out of the way!

When we first came to Panama my wife asked our Boquete doctor, ”So if I’m having a heart attack, what do I do?”

His response: “First you call me.  I’ll come to your house and call an ambulance.  We’ll stabilize you in David, and if necessary, once you are stabilized, we will fly you to the Panama City where the hospitals and doctors who specialize in invasive procedures are located.”

Good enough . . . but when we say “ambulance” do NOT think of ambulance service in the US!  There have been times in Boquete when we had four different ambulances . . . and none were working!  And an ambulance here is primarily a means of transportation.  Don’t think a team of trained “EMTs” on call . . . or an ambulance with any sort of equipment on board.  Over the years we’ve been in Boquete the expat community has worked hard and raised money to improve ambulance service, but it still is nothing like what we were used to in the States.

Our experience . . .

One afternoon my wife started having some kind of episode.  She was dizzy, had no feeling in her arms, was weak, and couldn’t stand up.  It looked like some kind of allergic reaction and I feared she was going into anaphylactic shock.  [We have experience with this: I am highly allergic to shellfish of any kind in any amount, and my daughter is highly allergic to chocolate.]  Without 911 or any similar kind of emergency help, I called our friend Brad, and together we carried Nikki to my car, and I went to the doctor’s office (the same guy who treated her when she was thrown off the horse . . . the story I told yesterday).  It turned out the good doctor was on vacation and the gal who was filling in not only didn’t speak any English, but wasn’t that familiar with his office.  Eventually she found the oxygen mask, started an intravenous drip, got Nikki stabilized and agreed we needed to get to the hospital in David.  She called the ambulance . . . and the “fun” began.

The doctor called the ambulance, then said to me, “They don’t have any gas. They want to know if you can pay for the gas?”   Yes!!!

So the ambulance and attendants arrived . . .  

First problem: the doctor’s makeshift treatment room and the gurney that wouldn’t fit in. 

Second problem: the ambulance crew hadn’t the slightest idea how to move a patient from a bed onto a gurney.  Somehow we managed. 

Third problem: Nikki was too big for the ambulance.  Panamanians are shorter.  So they couldn’t close the back doors of the ambulance all the way.  She wouldn’t fit!  So the creative solution was for the ambulance attendant riding in the back to wedge himself between the side of the ambulance and press his feet against the gurney to keep Nikki from sliding out the back doors, which were flapping in the wind.

Fourth problem: Nikki had an IV drip going and there was no place to hang the drip in the ambulance.  The attendant in back was busy trying to keep the gurney from flying out the back, so Nikki had to hold her own IV bag.

OK, we stopped and got $20 worth of gas.  Then we began racing down the mountain to David with lights and sirens going.,

Fifth problem: Nobody in Panama is going to move for an ambulance!    Only the expats will pull over out of force of habit.  So I’m in front, the driver is laying on the horn so people eventually will move out of the way.

Sixth problem: We start to get one of our famous, afternoon “rainy season” cloudbursts when the water is coming down in torrents.  In front the windshield wipers are barely working and in back the doors are flapping in the wind and the water is coming in soaking Nikki and the attendant who is bravely still holding the gurney in place with his feet.

The reality:  Supposedly “laughter is the best medicine” and Nikki, although the center of the drama, couldn’t help but find the humor in the situation.

Fortunately we arrived at Chiriqui Hospital and into the tiny emergency ward.  It took a while, but Nikki was stabilizedand a team of internists eventually discovered that she had developed an allergy to aspirin.    She spent two nights in the hospital, before coming home.  The ambulance ride:(for those of you who remember the original Disneyland . . . definitely an “E-ticket” ride!) $20 for gas, and another $5 (in gratitude) for beer for the guys.  Hospital: emergency room, two nights, and physicians $225.

Yet another story . . . my wife keeps things interesting!

Nikki was experiencing tingling in her arms, chest pain, yada yada . . . with her history . . . “Come on, Nikki, don’t be a hero!  Let’s get it checked now.  If it’s nothing, fine . . . if it’s not, “golden hour” and all that stuff.”  So we go to Boquete to the new clinic for such emergencies that Hospital Mae Lewis has opened.  The only problem is there’s only a receptionist staffing the clinic.  No doctor . . . not even a nurse . . . receptionist and janitor.  The receptionist informed us that the doctor was going to be coming in an hour and that we could sit and wait.    OK, so this is to be an “Emergency Clinic” . . . right.  And if it is a heart attack, we’re going to sit here and twiddle our thumbs for an hour and hope that the doctor actually does show up as scheduled . . . which, in itself, would be somewhat of a miracle anywhere, let alone in Panama.  And I’m about to have a “Richard-goes-ballistic” attack  . . .

I remembered that  a friend I had met because he had read this blog, lived in an apartment upstairs.   He is a retired nurosurgion who still consults via video cam in complicated surgeries around the world.  Although he wasn’t a cardiologist, I knew he had his own personal encounter with a massive heart attack and open heart surgery, so I went upstairs and asked him if he could just come down and take a look at Nikki.  Gracious friend that he was he put on his slippers, found his stethoscope and came down and took a look.  His verdict, “I can’t say what is going on, but I can say with 99.9% certainty that she is not having a heart attack.”  

So . . . forget paramedics and 911. 

As “oldsalt1942″ commented about yesterday’s post, “You get better or you die, and that’s the reality of health care in the vast majority of the world. You get better or you die. Period.  And let’s face it, you can’t take life too seriously because none of us are getting out of here alive.”

Insurance . . .

Folks handle insurance in different ways.  People who worked for the Canal or the US military in Panama have their own insurance.  Some people worked for companies who still provide their retirees with the insurance they were promised when they retired.  Some have their own policies from the States or some international insurance policy.  Like most insurance when you are trying to get insurance after retirement you find that the insurance companies don’t cover preexisting conditions, which is exactly what you are worried about.  And by the time most people reach retirement age they have preexisting conditions.

When you turn 65 of course and are collecting US Social Security you have Medicare.  However, Medicare only covers treatment in the US.  So unless you want to return to the US when you need medical care, which some folks elect to do, you are not covered.  When I looked at the cost of Part B for me, and what all was not covered by Part B, I decided that for me it was cheaper to just pay the full amount for the procedure in Panama.  So we, basically, self-insure . . . with a couple of exceptions.

Since we travel a lot, we purchase annual travel policies from a company in Scandinavia that cover us when we are away from Panama for emergency medical care except in the US.  When you include the US the cost is prohibitive, and at least when I am in the US, I could use Medicare.  My wife is too young for Medicare!   Since we are on ships a lot, it is important for us to have insurance that covers medical evacuation.   I think anyone is crazy who takes a cruise without having travel insurance that includes coverage for evacuation.  The cruise line wants you off the vessel and into a hospital as soon as possible, firstly for your own medical welfare, and secondly to avoid legal responsibility.  A medical evacuation from a ship by helicopter can easily run $10-15,000!  Get insurance!

Hospital Chiriqui does have an insurance scheme called Medical Services Chiriqui, or MSChiriqui which we use.  It is not really “insurance” but more of a discount plan.  A doctor visit that usually would cost $40 with a MSChiriqui coupon costs us $20.  There are discounts on almost all hospital services and treatment, somewhat akin to a major medical plan in the US.  In our case when my wife required an angioplasty and stents, because the procedure is not available at Hospital Chiriqui, we went to Hospital Patilla in Panama City and the MSChiriqui plan covered half of the cost.  After you have belonged to the plan for 2 years it does cover pre-existing conditions.  The plan now costs us about $1200 per year for both of us.

Our Experiences with Medical Care in Panama

It’s the number one question people ask me on ships when they learn I live in Panama: “What is the medical care like?”  Yesterday I wrote about “Expat Medical Care in Panama”,  and today I’d like to share some of our own experiences.

Riding Mr. Ed . . .

When we first came to Panama we used to enjoy riding horses with our friends Brad and Jackie.  We found a local guy who rented out his horses for $5 an hour.  It was great fun!  My kids were visiting so we all went horseback riding, all five of us.  I guess the guy only had four horses of his own, so he borrowed one from a friend, which turned out to be a problem horse not used to amateur riders.  My wife rode horses as a kid on her Grandpa’s ranch in Montana, and although that was a long time ago, she was comfortable on horses, but all this horse wanted to do was run.  The equipment was, well Panamanian, meaning, at times improvised and cobbled together.  As it happened the bit was cobbled together and came apart just as the horse was acting up. The horse took off, the bit was broken so my wife had no way to control the animal . . . she ended up being thrown off and landing on the pavement on her head. 

Fortunately my daughter Rebecca is a “wilderness outdoor first responder” or something like that, somewhat equivalent to an EMT except she can’t deliver babies but can pronounce people dead if they are a certain distance from a hospital.  Rebecca immediately went into EMT-mode.  We were a long way from town, and my older daughter said, “Dad, you have to get a doctor since we don’t know where to go!”

So I rode off for town, not knowing at that point whether my wife was dead or alive. 

I rode quite away until a car came along.  The driver had seen the riderless horse so knew there must be a problem.  We tied up my horse and he took me into town to the doctor’s office.  We got in his brand new Toyota with gray seat covers and rode back to the scene of the accident.  By this time my wife was somewhat responsive.  My daughter gave the doctor a quick summary.  With a head wound there was blood everywhere, but the doctor put my wife into his brand new car and we went back to his office.   It took 3 hours and 70 stitches for him to sew Nikki’s head together, and he saw her three times a week for 10 weeks.  The total cost was $850 . . . probably the cost of an ambulance ride in Southern California.

The really interesting thing was on one of the follow up visits the doctor greeted us with, “Nikki!  I’m so glad to see you!  I had a dream last night that you didn’t come in, and then I couldn’t get back to sleep worrying if something was wrong.”  How many HMO doctors in the States even know your name, if they aren’t looking at your chart, let alone wake up at night worrying about you? 

And this guy made house calls!

I told that story on the ship and a guy sitting in the front row said, “I’m a doctor, and I still make house calls and wake up nights worrying about patients!”  So there are still a few guys and gals out there . . . but, in general, it’s not the face of managed health care in the US.

So what happened?  Nikki is fine!  After spending a lifetime wasting 25 minutes every morning doing her hair, she discovered a new no-fuss, no-muss hair do that better suits our life in Panama.  We ended up buying helmets in the States, which we haven’t gotten around to using.  The guy is still renting horses, and still sometimes using the same horse, and sometimes we see obviously totally inexperienced riders on that same horse . . .  If we found a reliable place to rent horses, we’d probably ride again.  [One of the things about a non-litigious society like Panama is folks don't worry about being sued.]

Every man’s favorite day at the doctor . . .

I went in for my “every five year” physical  . . . new doctor, internist, $20 plus my insurance coupon, and another $40 for tests . . . and of course he told me “it’s time” for that guy-favorite, a day with Mr. Sigmoidoscopy.   So I called to make an appointment, expecting to enjoy weeks of eager anticipation . . . only to discover I had an appointment in three days . . . only three days becasue I needed to “prepare.”  I forget the exact cost, but most was covered by our local insuranced (more on that tomorrow), but it was quick, easy and relatively “painless” . . . unless you enjoy that type of thing. 

Roto Rooter . . .

My wife has heart disease and has had several angioplasties. This time last year she knew it was getting time to return to the hospital for another procedure. Her last angioplasty had been 12 years earlier, but the familiar symptoms were returning. We did not have a cardiologist in Panama so we began asking around and talking with gringo friends to find out who was the best cardiologist in Western Panama. There was universal agreement on one doctor. So we called and asked for an appointment . . . expecting to wait weeks . . . and he gave us an appointment the next evening. We sat down with him and he spent an hour with us, going over Nikki’s records, reviewing her medication, examining her, and explaining the situation. Although his English was somewhat limited, we received the most understandable explanation of Nikki’s condition we have received from any doctor. There was no rush. He took Nikki’s records and said he wanted “to take them home to study” and set up an appointment for stress tests. A week later we returned for a series of stress tests at his office, and began a two-month series of exams, tests, adjusting medication and diet, etc.

At the end of the two months, and shortly before I was scheduled to leave on Holland America for five months, it was decided that yes, indeed, Nikki did need an angioplasty and probably one or two stents. The doctor made an appointment with the best guy in Panama City who works out of Hospital Patilla which is affiliated with Johns Hopkins. We had the appointment right away, but it took about a week to shuffle papers between our insurance provider (more about this tomorrow) and the cardiologist to get approval for the procedure in Panama City.

So my wife flew to Panama for three days and had an angioplasty and two stents implanted, and then flew back to Chiriqui. The total cost for an angioplasty and two stents (including hospital and surgeon) was $14,000.We have a friend who had the same procedure performed in Boston, and his hospital bill alone was $60,000! Because we had a hopsital insurance scheme with Hospital Chiriqui in David, and because they do not do invasive cardio procedures, our local insurance picked up half of the cost, so our out-of-pocket cost was $7,000.

Tomorrow I’ll talk more about hospitals, insurance and emergency care.

Expat Medical Care in Panama

When I am on cruise ships the single question people ask most frequently about living in Pamana is, “What’s the medical care like?”

When we were considering countries we’d like to retire to, the question of medical care was obviously close to the top of our list as well.  [I've posted as series of three blogs based on the "Escape to Paradise" lecture I sometimes do on ships: "What is it that you want?", "What if you can't have everything?", and "How to find your nirvana".]

“Better than anyone else!”

There is amongst US Americans I think a universal assumption, well, at least until the past few years, that everything in the US must be the best in the world: after all, the thinking goes, “We are the brightest, most powerful, most knowledgeable, most generous, most blessed, most prosperous, most wealthy, most envied, most lucky, most free people in the world!”, aren’t we.  To suggest anything else, was to risk being called “Anti-American!”  That in itself reflects the common US assumption that, “Weare the Americans, and everone else [Latin Americans, South Americans, Canadians] are, well . . . chopped liver.”

Lately we’re discovering that we, like everyone else, are a flawed and struggling people.

And certainly that is true when it comes to health care.

So, before we talk about medical care in Panama, we need to think about medical care in the US.

Some quick comparisons, courtesy of the CIA [CIA Worldbook]:

Death Rate: 
USA 8.38 deaths/1,000 population
PANAMA 4.66 deaths/1,000 population

Life Expectancy at Birth:
USA 78.11 years
PANAMA 77.25 years

Life Expectancy at Birth Country Comparison to The World:
USA 50
PANAMA 58

My wife worked for the County of Ventura. Every year the County, looking to save a few taxpayer dollars, would shift to a new HMO. One of their choices actually went under taking with them, and destroying, all of the medical records of the county employees. Before we moved to Panama, my wife paid one last visit to her HMO to collect her records, have a final check up, and get prescriptions renewed. Meeting with the doctor, the doctor asked, “So how are you doing with your diabetes?”

My wife said, “You must be looking at the wrong chart. I don’t have diabetes?”

Doctor, “Oh yes you do. We diagnosed you with diabetes a year ago. Didn’t anybody tell you?”

No, in fact they didn’t! How is that for “quality” health care?

According to the Council on Foreign Relations, talking about the impact of the cost of health care on US competitiveness in the world,

“Factoring in costs borne by the government, the private sector, and individuals, the United States spends over $1.9 trillion annually on health care expenses, more than any other industrialized country. Researchers at Johns Hopkins Medical School estimate the United States spends 44 percent more per capita than Switzerland, the country with the second highest expenditures, and 134 percent more than the median for member states of the Organization for Economic Cooperation and Development (OECD).”

Of course the Iraq War will end up costing about $3 trillion (according to the WASHINGTON POST) . . .

We all know the US health care system is broken and may . . . or may not . . . be fixable. So let’s just drop the assumption that we have the “best” . . .

Three Systems

Panama has three health care systems:

• National Heath Care – “Salud” – you see these white, yellow and green buildings in almost every Panamanian community. It is a basically “free” or “low cost” – 50 cents to see a doctor, $1 to see a specialist – system designed mainly to treat the enormous and poor Indigenous population and those without Social Security health care. It is underfunded, understaffed, and plagued by inefficiency and bureaucracy.
• Social Security – Everyone who works in Panama must by law pay into the Panamanian Social Security system. Basically the employer pays half and the employee pays half. For our Indian worker I think we pay about $4 a week. Long lines, understaffed, and plagued by inefficiency and bureaucracy. Often doctors prescribe drugs that are supposed to be “free” but the Social Security system doesn’t have them, so users must buy them at pharmacies. Pharmacies sell drugs here by the pill. So if your doctor prescribes something, you buy only as many as you can afford, when you can afford them!
• Private System – Is the system used by many middle and upper class Panamanians, by expats, and by the increasing number of people who are coming to Panama to have procedures done, a growing industry called “medical tourism.”

Likes and Dislikes

Based on our experience, here’s what we like . . . and dislike . . . about medical care in Panama.

Like . . .

• It is personal – Your doctor has time for you. An appointment takes as long as necessary. The doctor isn’t part of an HMO and required to see 20 patients an hour to keep his or her job.
• Doctors are allowed to practice medicine – Their diagnosis and treatment plan isn’t being second guessed by a 20-year-old kid with a high school diploma sitting at a computer terminal in the HMO office.
• It is affordable – There are several reasons for this. First, Panama is not a litiginous society, so the doctor doesn’t have to order dozens of unnecessary tests to cover his butt. And the doctor isn’t paying out half or more of his or her income for liability insurance. We have the bells and whistles, and the latest equipment, but every hospital isn’t competing on the basis of having the latest equipment, the fastest (and perhaps most dangerous) helicopter evacuation service, and the plushest offices and facilities.
• It is accessible – And in this regard I’m talking mainly about the private health care facilities. At the national health and social security hospitals people endure and endless run around. But for those able to pay, and it is a little by US standards, you can quickly see a doctor and get a needed procedure.

Dislike . . .

• Appointments mean nothing: prepare to wait for 30 minutes to 2 hours. Busy doctors? Not really. Flaky receptionists, yes . . . but what’s different about that? Pretty much it’s just a Panamanian “thing” with everyone, not just doctors. Your time is theirs, their time is theirs . . . it’s the land of “manana”, and it’s just the way things are.
• No, you don’t need the most sleek and modern of everything . . . but often things “feel” grungy, which sometimes translates into feeling, dare I say, “dirty”. I know it’s not necessarily germ dirty, but . . . how much would a coat of paint cost?
• You get nervous when in the middle of a pandemic the hospital bathrooms lack soap and hand towels, especially if you come off a ship with a Purell dispenser every five feet, and Viox wipes to open the bathroom door with . . .
• Did I mention hospitals don’t necessarily have hot water? Now I grant you most Panamanians don’t have hot water: the national old wives tale is that taking a warm shower will make you sick. I know hot water isn’t necessary if you are scrubbing with anti-bacterial soap, but . . . as my wife discovered in Hospital Punta Pacifica, one of the best in Panama and affiliated with John’s Hopkins, when nurses give you a bed bath in cold water . . . well something is missing in the “bedside manner”, of which there was none.

Tomorrow I’ll share a little about our experiences with medical care in Panama.

Playing “Catch Up”

OK, after being gone for an extended period on the ZUIDERDAM I am definitely playing “catch up” around the house and the garden!  We use a kind of grass here that grows by runners.  It grows fast, particularly in the rainy season, making it easy to get a green lawn fast.  You cut it with a weed wacker, which is almost the universal implement, next to a machete, in Panama.  Lawn mowers are as rare as snow blowers.  This grass is nice because it holds up well during the 4 month windy and dry season.  The problem is the runners go everywhere, and since nobody has been controlling them in my absence . . . much “catch up”!

I thought you might enjoy seeing the view this morning that I woke up to . . . taken from my bed . . .

Another Nail in Mexico’s Tourism Coffin

As if it couldn’t get any worse with drug wars, shootouts, piles of decapitated bodies, and the pig flu . . . Now there is a shootout between cops and robbers right in Acapulco that kills 16!

ACAPULCO, Mexico – Soldiers fought for two hours with armed men apparently holding police hostage at a house in Acapulco, leaving one soldier and 15 gunmen dead, a military official said Sunday.

Three soldiers and three Mexican bystanders were wounded. Several Mexican tourists were evacuated from small hotels in the old Acapulco neighborhood, which was once popular with Hollywood stars but has since become run-down.

The gun battle erupted Saturday night when soldiers received a tip about the presence of armed men at a gated house, said an army colonel who led the operation and spoke on condition of anonymity for security reasons.

The gunmen opened fire and hurled some 50 grenades at soldiers who arrived at the house, according to the colonel, who wore a ski mask as he led reporters through the scene.

Several gunmen tried to flee, but crashed their car into a Humvee blocking the gate. At one point during the fighting, armed men with grenades arrived in a car to reinforce the gunmen in the house, but they died in the shooting, the colonel said.

Soldiers found four Guerrero state police officers handcuffed inside the garage of the house, the colonel said. The officers, who were still bound and sitting the floor when reporters arrived, said they were being held captive by the gunmen, the colonel said.

The soldiers did not know the police were inside when the shootout began, and the colonel said their claims would be investigated.

“We found them like this, handcuffed, and they say they were kidnapped. So, if they were kidnapped, as they say, then we rescued them,” the colonel said, pointing to the four men.

Residents cowered inside their homes and several small, low-cost hotels while the fighting lasted.

When the shooting subsided, several people too scared to stay in the area were evacuated in an ambulance.

Am I glad we didn’t retire in Mexico! Actually I love it when cruise ships I’m on stop in Acapulco: the greatest view in Acapulco is from the deck of the ship! It is a beautiful harbor to look at from the deck of the ship, but other than that . . . And if you’re cruising to Acapulco and want to see something, my advice: take a ship’s tour and avoid wandering off on your own.

Mail Bag

From Norway . . .

hei – Here in Norway we watched the episode (Exiled . . . Embera) to day greate episode…I want to by a braiseless that Chere make. were can I do that? mvh anne beth

Cher is an entrepreneur . . . no wonder she lives in a castle! Cher says, “A portion of the proceeds of the “Cher My Love” Bracelet will be donated to the children of Embera, Panama.” Here’s the link for the bracelet.   And thanks for reading my blog in Norway!!

Photos for the Embera

(The visit to the Embera Village) is a must, MUST see! . . .  no matter what the price, you HAVE to go!   . . .  And  Richard, have you recieved the photos that I sent some time ago (for you to pass on to the Embera)? Sherry Forrester

Hi Sherry! Not yet . . . Panamanian mail is nothing like in the US. Generally it takes at least 3 to 4 weeks for a letter from the US to get to Panama. As yet . . . nothing. My address is Richard Detrich, Apt 0413-00004, Boquete 0413, Chiriqui, Republic of Panama.

About my comments on real estate in Panama . . .

True enough Richard and there are not many Real Estate Offices here that practice the way we did when we were Realtors in the US. I was an agent in Florida for 13 years and sure was suprised when we came here. For those reasons I decided to join CENTURY 21 Boquete Gold – a name brand company that does adhere to the standards and practices that we from the US and Canada are familiar with and people you can trust. Lyn McKee

Hi Lyn! Nice way to slip in a little commercial! But I’ll let you since you are a regular reader and neighbor in Palmira. Frankly I think people will judge you by your professionalism and honesty and not by any brand label from the US. Century 21, ReMax, Coldwell Banker and all the rest, I don’t think made much difference in the US, and I don’t think it will make a difference here. People worked with REALTORS they could trust and had good experiences with in the past. If we had a US style real estate structure, with licensing and control, and a local real estate board of REALTORS who subscribed to and enforced a code of ethics, THAT would make a difference. Just a puke-colored gold jacket (Who ever picked that color?) . . . which I know you don’t wear . . . doesn’t make any difference IMHO. Being Century 21 may get you some referrals, and folks may feel more comfortable walking into your office, but in the end it’s all about you.

Finding a surgeon . . .

Could you recommend a doctor for a hernia operation? Any help would be appreciated. Thanks, Valma

Fortunately for me I haven’t needed a hernia operation and I haven’t heard of anyone in particular.  When we needed a cardiologist here’s how we went about it.  First we started asking around, talking with gringo friends who had been here from back in the US Canal days and who had retired in Chiriqui.  There was pretty much unanimity as to who the best cardiologist was in Chiriqui and who the best cardiology man was in Panama, should we need an angioplasty and stents.  Then we talked to the folks at Chiriqui Hospital where we have a kind of insurance/discount policy.   Everyone agreed . . . so we called up the recommended cardiologist and asked for an appointment.  He stunned us with his reply, “How about tomorrowevening at 7PM?” . . .  an unimaginable response in the US!   It turned out my wife needed an angioplasty and two stents.  Once we sorted out the insurance papers and permissions we easily got an appointment at Hospital Punta Pacifica which is affiliated with Johns Hopkins.    Hope that helps!

OK, it’s off to gardening!  How it works during the “wet” or “rainy season” in Chiriqui . . . mornings generally start out beautiful!  So you get up early and start early.  The work day begins at 7AM!  You’ve got to get all your gardening done in the morning, because around 12 noon or 1PM the clouds start building up over the mountain.   By 2PM the humidity is going up and you know it “needs to rain.”  3PM the thunder starts to rumble and the rain follows watering everything you planted in the morning!

Gorgas’ Legacy Lives On

When I lecture on ships I’m frequently asked about yellow fever in Panama. Yellow fever is not a problem thanks to Dr. Willam C. Gorgas who really made the construction of the Canal possible by eliminating yellow fever. LA PRENSA featured this article about the Gorgas Institute.

As the Gorgas Memorial Laboratory turns 80, researchers continue the doctor’s legacy by battling the “ yellow fevers” of modern epidemiology.

The Gorgas Memorial Laboratory, in Calidonia, celebrates its 80th anniversary this month.

“The last death from yellow fever in Panama City was on May 28; in Colón, on May 15. Since then, cases have been kind of mild.” So reported Dr. William C. Gorgas to U.S. General Robert O’Rielly on June 3, 1905, about the progress of infection control efforts in the country’s principal port cities.

In those days, Gorgas, working as Chief Sanitary Officer for the U.S. Army, had but one mission in Panama: to eradicate the disease that had helped put an end to France’s dream of building the Panama Canal and was taking its toll on the American endeavor. By the time Gorgas arrived in Panama, yellow fever had claimed the lives of roughly 25,000 people involved with the project, and American administrators were fighting a war of attrition against a yet unidentified enemy.

Having worked in Cuba with Dr. Carlos Juan Finlay, Gorgas brought with him a crucial piece of information: the disease was spread by the female Stegomyia fasciata mosquito. Armed with this key detail, Gorgas launched a broad-based counterattack against the insect.

First, he ordered the drainage of streets and areas where stagnant water accumulated. Streets were paved and rainwater channeled through aqueducts. And in hospitals, he prohibited nurses from placing buckets of water under bed legs to keep bugs from crawling on to patients, a practice that had unwittingly contributed to the mosquito problem.

Then Panamanian president Manuel Amador Guerrero put him in charge of public health in the major cities and granted him the power to enter homes and check whether citizens were following the anti-mosquito regulations.

Gorgas died in 1920, but his legendary work was memorialized by President Belisario Porras, who inaugurated the Gorgas Memorial Laboratory in 1928. That facility, whose development parallels Panama’s own history, celebrates its 80th anniversary this year.

At first, the laboratory, funded and operated by the United States, continued Gorgas’ work, leading the study of tropical scourges.

“This was one of the first places that investigated the effectiveness of insecticides such as DDT in malaria control,” said Jorge Motta, current director general of the Instituto Conmemorativo Gorgas.

Over the years, however, the research facility changed course, and began investigating diseases that could be considered the modern equivalent of yellow fever, such as diabetes, heart disease, stress-related illness and even sexually transmitted diseases.

“In fact, the center is the currently the chief reference laboratory for AIDS in Central America,” Motta added.

In 1990, when the United States momentarily withdrew its financial support for Gorgas, the center was forced to join the Ministerio de Salud, a move that kept it alive, but just barely.

“It received very little of Minsa’s budget and suffered a lot. The rooms were converted to house institute administrative offices and only had a couple used as laboratories. It was on the verge of disappearing,” explained Motta.

The turning point, however, followed the detection of Hantavirus in 2000, which caused several deaths in Panama and led health authorities to suspend Carnavales in Las Tablas.

“That’s when many realized its importance,” said Motta.

The institute became autonomous in 2005, and since then has seen their annual budget for research projects go from $400,000 to $3.5 million, a sum that has offered researchers a greater flexibility in choosing studies.

Maritza Gruber, a researcher at the laboratory for the last 42 years, still recalls her first days at the center with a mixture of excitement and pride.

“I came here on December 6, 1966. I had the opportunity to work with gentlemen of the stature of Milton Carl Johnson or Pedro Galindo (the first director). Frankly, I can’t imagine working anywhere else,” she said.