Shooting the breeze with Dr. Francisco Sanchez, cardiothoracic surgeon


As I mentioned in one of my previous posts, meeting and talking to surgeons in different countries can be anxiety-producing at times.. Other times, just plain interesting and enjoyable.

It was the latter during my conversations with Dr. Francisco Sanchez Garido  and his colleague, Dr. Geraldo Victoria.  (We talked about Dr. Victoria in a previous post.)

At 71, Dr. Sanchez has seen and experienced volumes; in medicine, surgery and in life.  We talked about all three of these during my visit – including some of his ‘war stories’ of yesteryear.

These included actual stories of war – such as trying to take care of the gravely wounded American GIs during the  December 1989 military invasion of Panama (Operation: Just Cause), when he was working at the Gorgas Army Hospital at the Howard Military Base.

 Dr. Sanchez talked about the difficulties of trying to save the GIs who parachuted in (and immediately became fodder for Noriega’s troops).

He also reflected on the fifteen years he spent training in the United States.  He attended medical school at the University of Oklahoma, and completed both his residencies in the US at George Washington University prior to returning to Panama in 1972.  He studied with a famous surgeon from the Cleveland Clinic  as well as hosting multiple visits by American cardiac surgeons,  Dr. Denton Cooley and Dr. Michael DeBakey (among others).  These included one ignoble attempt to convert a Panamanian hospital into the private operating room suite for the ailing Shah of Iran.  He laughed a bit when he explained how the illustrious Dr. DeBakey attempted to bluster his way into taking over the hospital but were foiled by Dr. Sanchez and his team, resulting in the Shah traveling to Cairo for his ill-fated surgery for lymphoma. (See the linked articles for more information about the fateful travels of an ailing ruler).

As he explained, “They just wanted to use our hospital [to perform a spleenectomy on the Shah] – and leave.  They didn’t want our help or involvement.  But you can’t just operate on someone and then go home.”  As it turns out – his concerns were warranted, as the Shah experienced surgical complications after surgery in Egypt, and his surgeons were long gone, leaving his care to people previously un-involved in his care. (Ultimately, the Shah died four months after surgery – closing a chapter in Iranian history and ending the controversies regarding his treatment).

These stories are, of course, just minor tales in the long career of one of Panama’s first heart surgeons.

Dr. Francisco Sanchez Garido, cardiothoracic surgeon

Dr. Francisco Sanchez Garido, cardiothoracic surgeon

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Ceviche with Anthony Bourdain in Panama City


Okay, okay.. so maybe it wasn’t actually WITH Anthony Bourdain, but based on Anthony Bourdain and his episode on Panama.. (Season Six, episode 1 of “No Reservations“).

As everyone who is a fan of any of his shows already knows, Anthony Bourdain loves ceviche.. Me, personally, not so much..  I mean – it is raw fish – in juice.. Or at least that’s what I thought it was after a particularly nasty encounter in Buenos Aires..

But one of the members of my “Away Team” convinced me to give it another shot..  Since, rumor had it – “Anthony Bourdain recommends the ceviche at stall #2 in the fish market.” Logically it seemed like sound advice – where better to re-attempt ceviche than a place named “Abundance of Fish”..

type different varieties of ceviche from the famed stall #2.

type different varieties of ceviche from the famed stall #2.

Anthony’s right – it was delicious..

Dr. Geraldo Victoria and Dr. Francisco Sanchez, cardiothoracic surgeons


I am currently writing another article about Dr. Geraldo Victoria for Examiner.com but I wanted to tell readers a bit about these two very nice, and charming surgeons. (I will also be re-posting this article at a sister site). Dr. Victoria graciously invited me to spend even more time with them, but I had a minor injury yesterday and had to defer.

Dr. Geraldo Victoria and Dr. Francisco Sanchez, cardiothoracic surgeons

Dr. Geraldo Victoria and Dr. Francisco Sanchez, cardiothoracic surgeons

It’s always a bit nerve-wracking to meet and talk to surgeons but Dr. Victoria was very welcoming, and friendly.  He readily answered my questions and told me about his practice.

Dr. Victoria is primarily Spanish-speaking but does speak some English.

He showed me around his offices at both Hospital San Tomas and Punto Pacifico while talking about his work.  He is a Professor of Surgery at Hospital Santo Tomas – which is the primary teaching facility in Panama City.  He also operates as a general surgeon there.

His practice is a mix of cardiac, thoracic, vascular, endovascular and general surgery.  He attended medical school and completed the majority of his training in Caracas, Venezuela at the Luis Razetti School of Medicine  – University of Central Venezuela.  He completed his general surgery and specialty fellowship training at the University Hospital of Caracas (Hospital Universidad de Caracas) before completing additional training sessions in cardiac (Texas Heart) and endovascular surgery in New Orléans, La.

He reports that prior to 1992, the majority of patients in Panama travelled to the United States and other countries for cardiac surgery.  Since then cardiac surgery volumes have increased.  Since rheumatic fever remains problematic in Panama, he has a large volume of patients with rheumatic heart disease.

His thoracic practice largely consists of trauma surgery – from penetrating trauma (guns, knives) and hemothoraces as is typical of many surgical practices in large urban areas.   He also sees cases of empyema (infected pleural space around the lung) with several cases involving multi-drug resistant strains of Klebsiella.

Contrary to many vascular surgery practices I have encountered in Latin America, Dr. Victoria has a thriving peripheral arterial disease (PAD) practice. In fact, I was able to see him in action in the cath lab as he performed arteriography on a patient with persistent intermitten claudication (despite medical management).

cathlabVictoria

Since this post is becoming quite lengthy – I will talk about Dr. Sanchez in the next post.

Punta Pacifica, Hospital San Tomas and Centro Medico Paitilla


**Due to some unforeseen changes in my itinerary, I can only provide just a brief overview of some of the facilities in Panama City, which falls far short of my usual.**

Centro Medico Paitillo (CMP)

Balboa Ave. and 53rd Street

Website: http://centromedicopaitilla.com/

Founded in 1975, CMP has grown to become the largest private facility, though  Punta Pacifica appears to rapidly approaching on their heels.  They have several well-established international health insurance programs and the hallways were well populated with English-speaking visitors and patients.  The hospital has community outreach and health promotion classes as well as a 64 slice CT scanner, MRI and other diagnostic capabilities.

Website is attractive, and well-designed with English and Spanish versions.

Clinica Hospital San Fernando

Via Espana Las Sabanas

Website: http://www.hospitalsanfernando.com

There are two facilities for Hospital San Fernando; a Panama City facility and another facility in Coronado. The Panama city facility is one of two Panamanian facilities accredited by Joint Commission International.  This is a private facility designed to entice foreign visitors and upwardly mobile Panamanians.

Website with English language version that includes price quotes for International travelers. Website is well-designed and easy to navigate.

I have not visited or viewed this facility

Hospital Punta Pacifica

Boulevard Pacífica y Vía Punta Darién
Ciudad de Panamá

Website: http://www.hospitalpuntapacifica.com/

Webpage with English and Spanish versions, and has been designed for international travellers. However, the overall quality of the website is poor. Information has been poorly laid out and is often mischaracterized. For example, visitors to the site who are seeking information about individual physicians are transferred to a poorly typed resume-style pdf. Physician specialties are mislabeled; with cardiologists listed as surgeons, which may cause confusion for potential patients.

Hospital Punta Pacifica was accredited by Joint Commission International in September of 2011. Hospital Punta Pacifica’s main claim to fame, as it were, is that it is John Hopkins International branded facility.  As such, it is aggressively marketed as a medical tourism destination.

It is located in downtown Panama City, just a kilometer from the CMP (Centro Medico Paitilla).

Victoria 001

Hospital Santo Tomas

Calle 34 Este y Avenida Balboa

Website: http://hospitalsantotomas.gob.pa/

Hospital San Tomas is the oldest public hospital in Panama. Originally started as a small facility for impoverished women in September of 1702, the hospital has grown over the last 300 years to become the largest hospital in the country. The hospital now offers multiple service lines including surgical specialties such as thoracic surgery, plastic surgery and general surgery, among others.  The campus includes separate facilities (Maternity hospital, children’s hospital), a blood bank and Cancer center.

Blue Cross Blue Shield of Panama – one of the international arms of the Blue Cross Blue Shield insurance company, and just one of the many insurances accepted at most Panamanian facilities.

What’s this about free insurance for tourists to Panama?

In one of their more effective (and dramatic) public relations gestures, the Panamanian government widely advertises “Free  medical insurance for the visitors”.  This catastrophic policy covers all visitors during the first thirty days of their stay for accidents and injuries (up to $7000.00) that may occur during a stay in Panama.  Visitors just need to show their passports on arrival to one of the participating medical facilities.

The policy also covers up to $500.00 of dental expenses, and economy class air tickets for return home for family members (in case of a death of a tourist) and repatriation of the deceased.  (This may sound like a grisly benefit but from previous discussions with tourists in various locations – this can be quite costly.)

*Just so you know – it doesn’t cover chronic conditions or pregnancy, so visitors can’t come here and expect to have free care for non-emergent problems (ie, elective hip replacement and the like.)

Introduction to Panama City and Panama


Had some internet difficulties the last few days, so I will be posting several posts to ‘catch-up’ as it were.

downtown Panama City

downtown Panama City

Panama

The nation of Panama is a nation of contrasts; at once old and young, rich in wealth with grinding poverty, Americanized yet foreign. Rainforests, and lush jungles teem with steamy heat, in comparison with the cooler mountainous regions.  These contrasts extend to the general attitudes of local residents as well, similar to that of “big city versus friendly hometown” with Panama city residents often exemplifying the attitudes of their northern neighbors (New York City).

Daily rainstorms pound the capital city during the rainy season (May – December) but offer little respite from the heat, which can be oppressive. However, despite urbanization along with an impressive array of skyscrapers, the city remains just steps from the rainforest, and a bountiful variety of birds, plants and other animals.

American-ish?

Reluctant or nervous travelers will appreciate Panama’s shared history with the United States. As the USA encouraged the Central American nation towards independence (as part of American efforts to control the canal zone and thwart the Colombian government), these close ties have resulted in a degree of Americanization that is surprising to some first time travelers.

While Panama boasts of a national currency featuring ‘Balboas’ or ‘Martinellis’ by the nations’ satirists, only coins exist as evidence of this. The remainder of trade and economic barter is done using American currency. English is commonly spoken by Panamanians, and the North American presence has grown exponentially in the last decade. Several exclusive communities of United States and Canadian residents dot the Panamanian landscape, particularly in more desirable areas such as the more temperate areas surrounding David.

the 'Balboa', the official currency of Panama

the ‘Balboa’, the official currency of Panama

The shared history of Panama and ‘the gringo’ has existed for well over a century – since the Americans financed and engineered their way in – to complete that Canal project after a spectacular French failure twenty-five years earlier*.

Of course, this influx of gringos, and influence/ interference in Panamanian life comes with mixed feelings.  Some of the local publications are quite critical of  the American economy, and current government policies as being responsible for increased inflation in Panama due to their reliance on American currency due to American currency devaluation.

The large number of US ex-pats and other North Americans has a more appreciable downside to today’s tourists – in that Gringos are a frequent target for scams and rip-offs but that’s no different from several other tourist destinations, (and is more noticeable in the city itself.)

Victoria 009

International flavor

However, the local mix is much more than Panamanians and Gringos, which gives the capital city a more interesting cultural mix..  There are groups of Venezuelan immigrants both quite recent and more remote, Chinese neighborhoods as well as barrios of Colombians, Salvadorans, and other Latin American neighbors..  Germans and Russians also have a presence in the city – making it quite cosmopolitan despite the relatively small population in Panama overall with a total population of just under four million.

* Canal history is pretty interesting, so I have included some links for readers interesting in additional information.

History of the Panama Canal – wikipedia standard

Panama canal

Canal museum 

Smithsonian Collection blogs

New name, same site & Hello, Panama!


Panama City, Panama

firstday 002

Long time readers may notice some changes to the site, mainly that we have expanded to include information on areas outside of Bogotá, Colombia.

Since the original Bogotá book, we’ve been back to Bogotá several times (of course!) to update the book and keep readers abreast of any changes.  But we have also travelled to several other Latin American countries including Bolivia, Chile, Mexico and (now) Panama.  During these journeys, we’ve continued to research, writing, and interview surgeons along with trips to the operating room.

We’ve also published several books and articles since ‘Bogotá surgery’ days, so as we embark on our newest project here in Panama – it only seemed fitting to update the blog to include our newer geographic locations.

It may take a bit of time to get the blog sorted out – and the look may change, but the high quality content, and active discussions will be the same.