Starting an Epilepsy Surgery Program in Panama
By Ruben Kuzniecky, MD
Interviewed by Linda Azarian
Our own Dr. Ruben Kuzniecky recently took a special trip and helped make remarkable things happen in the country of Panama. With the sponsorship of the office of Panama’s First Lady, he worked with the Children’s Hospital and Ministry of Health to develop a program that focused on bringing together local neurologists and neurosurgeons with a number of specialists from abroad to organize the first epilepsy surgery program in Panama, at the Children’s Hospital of Panama City.
Dr. Kuzniecky has been traveling to Panama for many years where, informally, he has helped set up a basic epilepsy clinic and EEG laboratory. Last year, with the help of two physicians from Argentina who came to Panama, they performed the first epilepsy surgery ever conducted in the country. With the many trips made there, he has seen Panama’s infrastructure up close and worked within the system enough to know exactly what they need to succeed in this venture. The Children’s Hospital in Panama City is the only tertiary children’s hospital in the country and receives all of the most complicated cases throughout the region. The number of patients with seizures is particularly high in the indigenous population. Their need for epilepsy care is tremendous.
In the hospital, he met with all members of the administration, medical directors and physicians who would be involved with the program: this included the Chief of Neurosurgery as well as the Chief of Pediatric Neurology. But, as Dr. Kuzniecky writes: “the most interesting and important part of my visit was to meet the families. Most of them are of humble origins. The families however do take care of their relatives in an incredible way. They all tend to stay in the hospital throughout the hospitalization and bring food and items necessary for their care. In some situations, the villagers have to travel one to two days by bus from remote areas where there is no electricity, water or telephones. This was a most vivid and sensitive experience.”
In Panama, the equipment and hospitals are modern, particularly in the private sector. The government hospitals are relatively good but as expected in third world countries, the hospitals are not well maintained and the equipment often brakes down and there are no repairs. The epilepsy clinic in Panama is a basic clinic in which physicians have access to an EEG machine. The hospital doesn’t have MRI equipment but an MRI can sometimes be obtained and done somewhere else. Most of the basic drugs are available such as Phenobarbital, Tegretol, Depakote, and Dilantin but second generation drugs are more difficult to find.
Dr. Kuzniecky continues: “The biggest surprise was the commitment and enthusiasm that everyone showed towards putting together a program for epilepsy surgery in Panama. Panama is a small country of approximately 3.3 million people with at least 2 to 3 thousand patients with intractable epilepsy who may benefit from surgery. Therefore the needs are astronomical. “
“There are some differences between US attitudes and Panama’s particularly in respect to the social views on epilepsy. Here in the United States we have advanced care and issues of quality of life are handled very proactively in terms of a person’s rights, work and disability issues. Panama is a developing country where these things can often be implemented copying from the United States model but it takes time and effort. The social stigma of epilepsy in Panama still reminds me of what this country looked like 25-30 years ago. However, I am confident that with education and this program, we will be able to improve the situation very shortly.”
A question posed to Dr. Kuzniecky was if his experience in Panama influenced the way he worked at the NYU Comprehensive Epilepsy Center? In reply: “it always does and it always will in the future. Every time I go to a poor country, you realize how fortunate we are in this country to have what we have. It also changes your attitude on the practical aspects of medicine. When I say that, I mean that many times we make decisions based, for example, on legal and potential liabilities. This concern is much less important in countries such as Panama as medical issues take precedent.”
“I would like to concentrate on fully developing this program in Panama. We have requested a small grant from the government and the First Lady’s office to jumpstart the program. I think with very little we can start a basic epilepsy surgery program in Panama with the help and advice from outside experts.”