My Battle with the Health Center

Someone more knowedgable on the nuances of politics could tell you if Panama's health system would be considered "socialist". What I do know is that the government provides health care for free or nearly free to anyone who needs it. Of course, you do pay for it in inconvienience, long waits, and less than respectful treatment, at times.

Still for me, it's worth it. Care for all children under 5 is free, so that means all check-ups and immunizations are free for the girls. Not a bad deal. It requires getting there at 6:00 AM, and sometimes not getting out of there until noon, but we made it work.

My problems began when Princess went in for her 1 1/2 check-up. She been weaned and started walking since her last appointment, and had dipped below the acceptable weight on their charts. She was declared "in danger of malnutrition" and I was sent to see their nutritionist. The nutritionist asked about her eating habits. She filled out her little chart and suggested that I not give Princess water with meals, "every drink of water is one less bite of food she is going to eat." I was not overly impressed with her advice. She handed me a bag full of fortified hot cereal, known here as "crema". It's great for kids that really ARE malnourished, somehow I can't see any peditritian in the USA recommending it.

After Princess totally rejected the "crema", we stopped taking her to the nutritionist, and I didn't worry much about her weight. She was reaching all her milestones on time, healthy, alert, and growing.

Then came the fateful day when both girls had appointments the same day: 3 years and 15 months. This time they were BOTH under weight, and the doctor was not happy. She told me in a voice that I can only decribe as offended, that Rose had "the weight of an 8-month-old baby". Didn't matter than in every other way she was totally normal. Off again we went to the nutritionist. Another armload of "crema", and advice on how to get them to eat more. Princess still hates it, but Rose likes it and when I offer, yells for her "c'ema!".

I should also mention that all this was happening while we were heading out on a two month outreach into remote villages. Not the best envirnment for keeping kids healthy and gaining weight.

However, after we returned from the outreach things did eventually calm down a little. Maybe it was the stress of outreach. Maybe they were hitting a growth spurt. But they began to noticably plump up, especially obvious on Rose.

I didn't think about it much the day we headed off to Princess' 3 1/2 year appointment, except to hope that they wouldn't scold me for not bringing her to see the nutritionist. We had a happy surprise. She has edged up into the "normal" weight range. Yeah! No more lectures for me, defective Mommy who obviously doesn't feed her children.

This whole experience is even more interesting to me, seeing as how all the advice coming out of the USA in relation to kids and nutrition, is focused on helping kids NOT gain too much weight. And here I am being encouraged to make sure the girls are gaining plenty of weight. The mindset here totally makes sense. Lots of kids in Panama truly are underweight. I have seen it with my own eyes, and it's terribly sad.

It makes me feel like I am living in two worlds at the same time. One a world of plenty, where food is always available, and one a world where every child who is a little too small is seen as in danger.