“ It fascinates me that in Panama workers can have a month off from work each year, that Social Security in a third world country can cover medical care and medicines. Agreed the system is flawed, it is imperfect, but I have friends working solely so they can get medical insurance in the US.”

This section prompted some comments about Social Security in Panama. In my statement I did say “the system is flawed” it is but it is better than the working poor have had in much of the US in the past, it is possibly better for many in the US now with new Affordable Healthcare changes.

I want further explore the good and the bad about Panamanian Medical Care, public and private. All that I will write about the Public system is anecdotal, I have personal experience only with the private system.

In Panama workers pay about 10% of gross earnings into Social Security,  more than the 6.2% employee contribution in the US. Employers in both countries also pay about the same amount as employees. In the US Social Security only covers retirement, Medicare is separate and partially covers healthcare for those over 65, who often need to purchase supplemental insurance to fill the holes in Medicare. In Panama Social Security covered both medical care for them and their families, as well as retirement. Employees can, if they wish, also purchase private health insurance.

Panama has three parallel systems, often with the the same doctors crossing between public and private. Anyone can pay for healthcare in either the private or public system. The public system includes a network of clinics and hospitals operated by both the Ministry of Health (MINSA) and the Caja de Seguro Social (CSS). Anyone can use either system and if they are covered by Social Security, care is free. Care is not always available, medicines are not always available, many procedures require long waits. The last part sounds a lot like what I hear from Canadians about their system.

CSS Regional David

My experience with the public system is listening to friends, both expat and native who have used it and some first hand observations. I have been in the CSS Regional Hospital in David as a visitor, not a patient. In two circumstances where people were in immediate need of attention, one a serious motorcycle accident, the other a stroke, the CSS system worked as designed. They were triaged and admitted quickly and received in their words, very good care. In another that spanned both the public and private system, Papa Ricco and his hernia.  Ricco had surgery in Hospital Chiriqui, private, and after having complications and infection he went to the CSS Regional in David. Rico, shortly before his death in a traffic accident, told me he thought the care he received in CSS Regional was good and they did not ask for payment, which was minimal, until he left.

I have interviewed doctors and nurses who work for both MINSA and CSS, they all say the same thing. They do their best with inadequate facilities and too many patients. I have been in consultations with doctors in their private offices and when an expensive test of procedure is discussed they ask if I am eligible for Social Security in Panama. They try to move some of the major costs into the public system. I again know from anecdotal experience that in a non life threatening procedure or test, the wait can be brutal, that makes sense with limited resources and priorities of triage.

My employee has Social Security, I pay it. I have driven his mother to the clinic in Boquete and to the CSS regional hospital in David. She would have no healthcare without his Social Security; something is certainly better than nothing. The system on paper is excellent, the system in practice is inadequate for the population and needs of the country.

Waiting room at CSS David

In my time in the US, I needed emergency room care for myself and others at times. I preferred University Hospital at the University of Arizona. They had some of the best doctors in the city and in some specialties some of the best in the country. Waiting in the emergency room was often a long tedious event unless you could convince a nurse that life was in immediate danger, waiting for a doctor in a clinic either public or private here in Panama is no worse. I have spend hours waiting for routine appointments in Hospital Chiriqui, a private hospital. I have also been treated in minutes in the same facility in an emergency.

If you put my observations into a summary, they system here is perfect, on paper, imperfect in execution. On paper, workers and their families have healthcare and retirement covered by payments made by themselves and their employers into Social Security. Everyone who qualifies for underwriting has an option to buy either national or international private health insurance, if they can afford it. If people are not able to qualify for Social Security and cannot afford or qualify for health insurance they can use the public system at a low cost.

If you need to use the public system you need to have an angel (please read this post by Don Ray), a Spanish Speaking advocate to push your priority or you might indeed die in the waiting room because of the lack of staff, facilities and inability to communicate. But I am not so sure this is different in a public hospital in other countries including the US.

Since my knowledge is limited to my experience, I welcome more comments from others who read this and have had experience in the Public healthcare system. I know there will be both positive and negative experiences, that is inevitable. Medicine is imperfect and although we all hope for a positive outcome,  ultimately we all meet our maker, just best when it is not premature.

Bench warmers is not a single play, it is a series of eight short one act plays, packed between two bookends. The plays were  selected from seventy six submissions. There are fifteen actors, five directors, nine writers and nineteen people on the crew. Like any good box of chocolates there are some some nuts, some sweets, some cherries and some oranges, but no lemons here. Depending upon your taste you will enjoy some flavors and textures more than others. That is the fun part, you will not  know what the next will be.

I embraced the comedy, two playlets directed by Dee Harris and one by Lane Saurez. I also enjoyed the human interactions in Canyon’s Edge and Independence Day, they had savory flavors not often found in a box of chocolates, but providing rich contrast to the humor.

It was fun to see both new and experienced faces on the stage,  Julian Bonifiglio with an Australian accent.  Perron-Jones doing something like a tongue twisted Germanic, Argentine Spanish version of English, what was that supposed to be? How computer dating can cause pregnancy in front of your very eyes and how a dense self absorbed tourist can miss the obvious. You will see that love can survive fifty years and how shaking in the bushes can lead to erotic behavior. Beware of the X rated Buzz Lightyear and Barbie sex scene, it might make you roll on the floor. This box of sweets is a pleasing mixture well worth sharing.

Benchwarmers is a group of your neighbors learning, experimenting and providing us the opportunity to enjoy their evolution. It is an entertaining two hours.  I recommend going to see Bench Warmers, sample all the flavors and decide what you savor most. There are tastes to delight everyone. I suspect the participants would enjoy hearing what you like best.

Here is a list of the playlets and the talent in them.

Bench Warmers is playing this week at the BCP Theater, with five performances including two matinees you have no excuse to miss the sweet and the savory in this box of chocolates.

Today, Wednesday May 22, 2013 from 2pm to 4pm

Thursday May 23, 2013 from 8pm to 10pm

Friday May 24, 2013 from 8pm to 10pm

Saturday May 25, 2013 from 8pm to 10pm

Sunday  May 26, 2013 from 2pm to 4pm

These are some images from each play.

From the moment I encountered the TSA full body scanner in Houston on my flight to Tucson I realized I was not in a place I wanted to be. Everyone was courteous, polite and business like, as I had to empty my pockets and remove my shoes..  All things on the rest of the trip were efficient and almost antiseptically clean, compared to my life in Panama.

My  friends were cordial and fascinated with my seven year adventure in Panama. Many of my friends are caught in the work to survive mode, some could retire, if they could afford to retire. Others can afford to retire but have not found the switch on the treadmill; it does have an off switch. I fear many will keep walking or running until they fall and inertia tosses them into their grave. I chose a different end, an adventure, not a contest of earning and spending until death do us part.

While I was gone someone posted this comment to something I wrote and re-write annually, it is called, Don’t move to Panama, certainly not Boquete..

My son Sebastian and his sanity, wife, Carol.

I was in Tucson in Jan 2010 and witnessed what appeared to be a dying city. Credit what ever you wish, government or sun spots, the city is recovering. There is a lot of new infrastructure built with Federal pump the economy funding, a turn around in the housing market and apparently fewer empty commercial properties. It seems that Tucson is bouncing back.

I have had one day with boots on the ground, or I should say a with a 2013 Mustang on the ground. I rented a Ford Focus, AVIS gave me a Bright Blue Mustang, something so totally out of character for me that I am enjoying the surprised faces of friends an family when I arrive.

The trip was uneventful except for one question at immigration in Houston. The immigration officer started with welcome home, then looked at my form which said I was a resident of Panama. After asking the apparently obligatory, why are you here, he asked about the cost of living in Panama. It was fast and I answered that it was lower than in Houston unless you picked Panama City.

I was wrong, what a change, the government seems to think there has been no inflation for years, my guess is the statisticians have a disconnect between their numbers and their reality. Some thing are less expensive here than in Panama, housing being the biggest bargain. Diesel is about the same price, gasoline lower, cars are less expensive and depending on your choice of restaurants either lower or higher.

It is said that confession is good for the soul, so I confess to eating a Sausage McMuffin with egg, my favorite on the run breakfast. I cannot remember the cost in David, but here it was $3.70 when they gave it to me it lacked the potatoes and coffee, they said that was extra, it did however include 620 calories, no extra charge.

From what I can see overall eating the way I eat, is more expensive here than Panama. Most of my eating habits have evolved in Panama, (hypocrisy of Egg McMuffins noted) to lots of seafood, grass feed beef, free range pork and chicken served with fresh locally grown vegetables and tropical fruits. Even some of the trash food I like is expensive here. When I return I will post a short super market survey for comparison of food costs. I have been working on my list of food related items as I take care of the business that lured me back.

My neighbor and friend Phyllis  has tried to inform me that taking picture of food is related to some mental disorder, perhaps, but if that is my major infirmity I will accept the diagnosis and move on.  I do travel on my stomach and each trip is a struggle with not being able to enjoy all the smells, tastes and textures I want to try. Yesterday it was McDonalds, Rosas on Campbell and Ft Lowell for a Chimichanga and Lil Abners on Silverbell for beef. I realized that I have been eating steak at lil Abners for more than forty years, it used to be miles out of town on a rural road. Now it is the still the same funky building surrounded by “progress” and environmental destruction.

Phyllis these photos are for you!

Little Abners Tucson Arizona

Mexican food on the grill in parking lot

Carne Seca Chimichanga at Rosas in Tucson AZ.

On my way out of David I managed to snap a photo of the Port of Pedregal.

There is lots of water flowing into the sea but it is not in the right place for generating electricity and Panama has a real problem. Notice the brown areas near the top of the photo that once were green, before deforestation. the trees hold the water and removing them does not help a watershed.

These photos posted on Facebook by Dr. Regulo Valdes show Fortuna Reservoir today, 8 May, not looking good.

Tonight I am in hotel in Panama City. I visited the Multicentro Mall and they did indeed shut of their air conditioning, the mall was warming up. I also visited a Casino and their AC was refrigerator cold.

At seven PM I took this photo.

According to the new emergency order all those commercial lights and the casino across from me are supposed shut down at 10pm.

You know the situation is evolving when the government starts with closing their offices early, something few would notice, moves to closing schools that use almost no electricity, Mayra does not even have a light bulb in her class room,  to the now desperate measures of cutting revenues to the Casinos. We now know the cause is just and problem is real.

Panama needs rain, lots of rain, but not all at once or the flooding will be horrific.

They have a new option for Panama only health insurance that includes Hospital Chiriqui and Punta Pacifica in Panama City as the two in network providers. They want to be very clear this has nothing to do with the MS Chiriqui plan many people here use. The only common element is the hospital is a provider to both plans.

This Panama only plan requires you be under 64 years old at the time of enrollment; if enrolled you can continue coverage until age 100 with premium increases as you mature more.

If you are over 64 they have an international plan with three options that allows enrollment up to the day before you turn 75.

Please address any questions to Sr Bellisario, not me.

If you want more information the contact in David is
Belisario Centeno S.
telephone 775-9237
telephone 775-1615
FAX 775-8478
Cell 6672-4479
email minsl@yahoo.com

For more information and some idea of costs www.worldwidegroup.co

I tried to do an online quote, but alas, this is Panama. It did not work for me using Safari or Firefox, maybe IE but I don’t have it. Rates will vary with age, sex, health etc.

My Chili Verde  does not win any prizes but I like it and it can be done with almost entirely local ingredients. This is not exactly the same as what I prepared for the Buenos Vecinos event, nor is it traditional, but it is my preferred method using what we have available here way south of Arizona.

Boquete Chili Verde con Puerco, the recipe, not the picture, I forgot to take a picture.

Scaled for 8 servings mas o menos

1.o kilo of Carne Lisa, boneless pork, usually from the leg, they say. Cubed in 1 cm cubes. I ground it for the cook off, but cubed is much better.

8 poblano chiles, fresh, usually at Super Baru or Romero, San Mateo in David. You can substitute canned green chiles if you can find them. I buy these when they have them, roast, skin and freeze for when I want them. The level of heat varies a great deal with the local Poblanos but they tend toward mild.  You can kick it up with a couple of chopped Jalapeños which you can usually find in the same places.

1 -2 Tbs lard or if you insist vegetable oil

1 large onion chopped

5-6 cloves of garlic, chopped

1tsp of cumin

4 chopped Culantro leaves (Cilantro is good too)

1 can 15oz of cubed tomatoes, drained or better some blanched, skinned roma tomatoes, remove the seeds and cube.

200 grams mas o menos of tomatillos, chopped fine or pureed, hard to find here, in a pinch use a can of green mexican salsa, I do.

A six pack of Balboa or other lager, don’t waste the dark beer on this, drink it instead.

salt

some flour as needed

some corn meal, I like the Arepas corn meal because I have it in the house.

Ok the fun starts now

You need to fire roast the chilies, here are a few techniques.

1. Using insulated thongs hold them over a gas flame, rotating until charred evenly and then put them into a covered heatproof ceramic or glass container and cover adding them until all are done.

or

2. Put them on a tray under a broiler, turning as needed to char and them,  then put them into a covered heatproof ceramic or glass container and cover adding them until all are done.

Let them sit until cold and the skin will come off easily. Wash and removed stems and seeds.

Chop the chilies and if you have a food processor turn half into a pulp, leave half chopped.

Cookery

Next heat up a heavy dutch oven or a big heavy frying pan with a lid on the stove, add the lard and then the pork chunks. You want to brown the pork so if necessary do it in batches. Remove the pork and add the onions and garlic. Sauté until translucent but not brown. Then add enough flour to absorb the lard and cook a little more to cook the flour.

Return the pork and any juices from the pork. Add the tomatillos, cumin, culantro, the chile both the puree and chopped and one can of beer, less the can of course. Open a second beer for consumption because this is hard work.

Cover and simmer until the pork is falling apart. I like to use a pressure cooker because I hate waiting, usually about 30 minutes of pressure works vs. hours of simmering on a stove and that way I still have some beer left for dinner. Or you can use a crock pot and lament the long term delay in eating.

Add salt to taste and enough corn meal to thicken the sauce. The corn meal adds a pleasing texture. The beer adds flavor and drinking it makes the entire experience worth doing, over and over.

Break out the tortillas or serve over rice and enjoy with any remaining beer.

Cinco de Mayo is a big day for local Mariachis and this event at Amigos had many participants who donated their time and money cooking Mexican food for the many attendees who came.

Buenos Vecinos de Boquete is a small group of volunteers who deliver food supplies to the handicapped and elderly on a monthly basis. If you missed the event you can make donations at the Tuesday meeting they will help feed people who need help.

I was surprised at the absence of another important community group that usually attends and participates in fund raising for good causes, no Dog Breath Chili from Amigos de Animales, a past award winner. I missed their energy and their chili. It is a shame they were not there.

Still the food was good, the Panamanian Gene Autry, below, was fun and the food I managed to taste was all done with love.

Mayra and I dished out some Boquete Green, our local variant of Chili Verde. We did not win any awards, but that was not the reason we went. We were there to support a group that does good things for people who need their assistance.

We the expats in Boquete do some very positive things for our community and those who benefit appreciate the assistance and that was obvious from the increased Panamanian participation in this and other events.

Todays recipe is made from a Dorado I bought whole from the back of a pickup in Bajo Boquete, it was $2 a pound, whole. I asked the vendor to fillet it and he had broke out the knife and board.

If you do not know how to pick a fresh fish from a vendor this old post has some hints. LINK

I took the filets and the skeleton and head too. They made for a great fish soup, but that is another story.

Thai Curried Dorado with Langostinos in a clam and curry sauce

Ingredients

Dorado filetes

Cleaned langosintos

cleaned, rewashed almejas, clams

Red and green bell peppers, Julianne

Thai yellow curry

cooking oil and butter

flour

Coconut milk

cooked rice as a side is perfect

I found the curry in Panama City at Foodie in Bar Harbor center, Patilla

I like to dust the fillet with some flour to give it a crisp exterior

In a heavy frying pan melt some butter and add some olive oil. The butter helps browning, and pan fry the fish until it is done.

At the same time mas o menos, put 1 tbs of cooking oil into a heavy saucepan. Heat at medium and add some of the chili paste. How much is a guess base upon your heat level lust. I like a bit less than one tablespoon. Stir fry the chili until it is aromatic, not too long.

Add about half a cup of the coconut milk and stir until it boils. Add the langostinos and the clams. Then cook about five minutes or until the langostinos are turning pink. Add the vegetables and and the rest of the coconut milk. Bring back to a boil and give them about another five to seven minutes at a simmer. You want them cooked through but not rubber.

Plate the fish and rice, put the langostinos on the fish and pour the clam curry sauce over the fillet. Then savor the aroma. Sake is a great accompaniment and you can now get in at Romero.