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by Tionna Szymanski

During spring break of my first year in medical school, I had the opportunity to learn the difference in practicing medicine in another country: Panama. It was truly a transformative time and an experience I will forever be thankful for. I had the pleasure of meeting such incredible people and being trained in a different culture. Through my experiences with the physicians and people of Panama, I feel more capable in understanding and addressing health disparities. I believe all medical students would benefit from experiencing medicine in a different society. I want to explain my experiences in Panama and how they have impacted me and the way I want to practice medicine. My discussion is purely based on my experience and opinion.

It was always interesting when I'd take a full history and complete a physical exam to come up with a differential, and then the Panamanian physician would simply say, “No.” Common illnesses in the United States differ from the common illnesses we were seeing in the people of Panama. As a medical student team, we were thinking a patient was presenting with the flu, but the physician in Panama was more concerned about malaria. It was pivotal for me to learn the precautions of some of these infectious diseases firsthand, not just from a book. The physicians of Panama know their people, the areas they serve, common ailments of the region, and the medications patients can or cannot afford. It was a reminder to me of the importance of community and being an integral part of that community as a physician.

I studied Spanish for 4 years starting in middle school and continuing into high school. I thought I was proficient, or at least proficient enough to carry on casual conversation, but I quickly learned I was not. We had translators aid us in communication, but we would receive only a brief summary of what was stated and I believe that was unfair to the patient. Sometimes, the smaller details end up being what's most important. A patient came in reporting chest pain for 2 months; after a full interview, we decided to do some osteopathic manipulation therapy as DO students. As she lay down on the OMT table, she completely broke down into tears. She was an immigrant working multiple jobs barely able to afford food for her children. Her chest pain was attributed to the all-consuming stress she felt just trying to attain basic needs for herself and her family. We completely missed this through the medical interview with the interpreter. The whole experience made me want to learn other languages so I can continue global health trips and not miss any important pieces of information from patients. I will say, at the end of the visit, this patient did leave with a big smile on her face regardless of the language barrier.

Being in Panama also made me realize the sheer advantages I have in life. My physicians are within 30 minutes of my home, know my name and history, speak my language, and are able to tend to any one of my needs. As a chronic migraine sufferer, my 30-day supply of medication that costs roughly $1050 in the United States is free to me thanks to my health insurance. One patient drove 4 hours to make it to our clinic in Panama. She was struggling with the effects of untreated hypertension for the last 10 years because she could not afford medication. As a team, we thought of prescribing lisinopril, which is an antihypertensive drug readily available in the United States; a 30-day supply is about $10. The physician in Panama explained to us that lisinopril was too expensive because the majority of patients were making roughly $7 per day. Money must go to basic needs first; therefore, for many, health insurance and medications are not financially possible to obtain. The Panamanian physicians adapt to each unique patient circumstance, offering different measures depending on what the patient can afford. I thought about how debilitating my migraines are without medication, yet this is their life. I was completely humbled by the flexibility of the physicians and the strength of the people of Panama.

Our patients would wait in the heat for hours and hours to talk with us and we didn't have any one of the tools a physician's office in the United States would have. We couldn't perform radiographs or EKGs, but I felt like we were performing miracles each day. The gratitude and smiles of the Panamanian people are something I will never forget. This experience impacted how I want to practice medicine. As a physician, I will strive to improve the lives of those less fortunate and work to achieve health equity for all.

Back to the August 2023 issue of ACP IMpact