I would like to share with you a presentation I made several years ago, when I was part of the medical staff of specialists at St. Thomas Hospital, which was my home for more than 10 years.<\/p>\n
First of all, it is important to point out that there is no data on the care of the mentally ill in our country before the 20th century.<\/p>\n
In 1883 the French inaugurated the Ancon Hospital. The construction of the Panama Canal had begun, by La Compagnie Universelle du Canal Interoc\u00e9anique de Panama, however, a terrible enemy would put an end to this stage of the project, the yellow fever. During the following two years, 1,200 people died of this disease in that hospital.<\/p>\n
After the failure of the French Canal, the United States of America bought the assets of the French Canal Company and thus began this new stage in the construction of the project.<\/p>\n
It should be remembered that in November 1903, prior to the beginning of the construction of the Panama Canal by the United States, the Hay-Buneau Varilla Treaties were signed, granting the northern country the concession in perpetuity of the use of the Canal. As part of the treaty, the United States was granted the right to carry out environmental cleanup work in the canal area and in the cities of Panama and Colon.<\/p>\n
To this end, the U.S. Army should have the authority to establish sanitation measures in the Canal Zone. To this end, the Taff Agreement in June 1904, granted the United States the responsibility to “construct, maintain and manage a hospital or hospitals in the Panama Canal Zone for mentally ill persons, lepers and charitable persons”.<\/p>\n
William Gorgas was the first person to occupy the position of Chief Health Officer in the territory occupied by the Americans. The Miraflores Hospital, located in Colozal, was built. Its facilities provided care to almost 125 patients with mental illness.<\/p>\n
In 1905, honoring the stipulations of the Hay Buneau-Varilla treaties and the Taff Agreement, 18 Panamanian patients were hospitalized at the Miraflores Hospital. By 1907, people with psychiatric disorders were cared for at the Ancon Hospital, in a complex of 12 buildings. In addition to administrative buildings, men’s wards and women’s wards, there were “cells” for violent patients, equipped with windows with security bars.<\/p>\n
In 1928, the care of mentally ill patients at Ancon Hospital was terminated by order of the President of the United States, Calvin Coolidge. As a result of this decision, all patients were transferred to the new Colozal Hospital, specialized in mental illnesses, thus recognizing the importance of treating these patients.<\/p>\n
What began as a way to cope with the avalanche of cases of psychiatric disorders that arose from the various tropical diseases and the strenuous working hours caused by the construction of the canal, became the development of new modalities for the treatment of mental illnesses in our country.<\/p>\n
At the time of the construction of the Canal by the French, it has been noted, perhaps exaggeratedly, that of the first 500 young engineers who arrived in Panama from France and some other European countries, none lived long enough to collect their first salary. It has also been estimated that about twenty thousand people, one third of the European labor force that came to the isthmus to work on the canal, died victims of tropical diseases. Since colonial times, the Isthmus of Panama had a reputation as one of the most unhealthy places in the world. Malaria, yellow fever, typhoid, dysentery and other tropical diseases were endemic in the region.<\/p>\n
Due to the high cost to the national government of the care of the Panamanian mentally ill by the United States, the first law was passed in 1924, which allocated a budget item for the construction of a psychiatric care institution, which would be the future Matias Hernandez Retreat.<\/p>\n
This prestigious institution was born on June 26, 1933. Faced with the pressing need to respond to Panamanian patients with mental illnesses who had to be urgently transferred from the Colozal Hospital in the canal zone, the Panamanian government decided to improvise and adapt the structures that were originally intended to serve as the headquarters of the agronomy school, converting them as soon as possible into a place suitable for treating the mentally ill.<\/p>\n
Six hundred Panamanians and some foreigners were hospitalized by order of the Panamanian authorities in this unique center for the care and treatment of patients with mental disorders in the country. The patients now had to be transferred from any geographical point of the country to Panama City.<\/p>\n
I now invite you to take a journey through the history of those illustrious characters who played a leading role in the emergence of psychiatry as a medical science in our country.<\/em><\/strong><\/p>\n In the early fifties, Dr. Octavio M\u00e9ndez Pereira created the Faculty of Medicine of the University of Panama, and Dr. Mariano Gorriz, a Spanish psychiatrist, was part of the team. As a professor and collaborator of the Ministry of Labor and Social Security, he contributed to reduce the stigma surrounding mental illness.<\/p>\n During this period, the first National Mental Health Plan was drawn up. This document follows the trend of the time by prioritizing the humanization of care for people with mental illness.<\/p>\n An achievement of the First National Mental Health Plan was the establishment, in 1962, of psychiatric outpatient clinics in the provinces of Colon, Cocle, Chiriqui, Herrera, Los Santos and Veraguas.<\/p>\n By this time, health in our country was gaining relevance. An important step forward was the creation of the Ministry of Health, by Cabinet Decree No. 1 of January 15, 1969. This institution was granted actions for the promotion, prevention, repair and rehabilitation of health. Doctor Jose Ramon Esquivel was the first director of this entity.<\/p>\n In the same year, the National Mental Health Program was created, recognizing the need to attend to the growing population of patients with psychiatric disorders.<\/p>\n The Caja de Seguro Social Chapter<\/strong><\/p>\n The CSS establishes polyclinics in various parts of the national territory. In 1955, the provision of psychiatric care began at that time with only one clinic. In 1959, it becomes the Neuropsychiatry Unit, a precursor of the future Psychiatry Service at the General Hospital of the Social Security.<\/p>\n When the General Hospital was inaugurated in May 1962, this service was assigned the west wing of the third floor, where it functioned for only three months, and closed after the suicide of a patient.<\/p>\n It was reopened on September 1, 1969, and it was Dr. Hern\u00e1n Higuero who became Chief of the Service after the retirement of Dr. Mariano Gorriz.<\/p>\n The Psychiatry ward of La Caja de Seguro Social was the first in a general hospital in our country, which also had a liaison psychiatry program, a day hospital and a psychiatry residency program.<\/p>\n The chapter of St. Thomas Hospital<\/strong><\/p>\n The origins of St. Thomas Hospital date back to the beginning of the 18th century. The name was given to it by King Philip V of Bourbon, although a year earlier Fray Juan Arg\u00fcelles had founded this hospice to care for the poor women of the Santa Ana neighborhood. The name of Santo Tomas de Villanueva was due to the fact that it opened its doors on September 22, 1703, the feast day of this saint.<\/p>\n In 1819, the construction of a new building for the Santo Tomas Hospital was begun on Avenue B.<\/p>\n In December 1919, during the presidency of Belisario Porras, the construction of the new Santo Tomas Hospital was ordered and, almost five years later, on September 1, 1924, a new set of buildings, built on five hectares, was inaugurated in its present location, on Balboa Avenue, destined to give attention and relief to the sick of all social classes.<\/p>\n The also called Hospital del Pueblo, did not remain oblivious to the need to attend psychiatric conditions and with a view to offering alternatives to the mentally ill, the first steps were taken for the creation of the future Psychiatry service of the hospital.<\/p>\n Renowned psychiatrists were part of the beginnings of the Psychiatry service of St. Thomas Hospital, among them Dr. Luis Picard Ami, who at the end of the 60’s, initiated psychiatric care in the outpatient clinic. Hospitalization services were not yet offered.<\/p>\n At the end of the 1960’s, changes in society’s values having occurred, young psychiatrists, dissatisfied with the way mental health care was being carried out in our country, initiated important changes that resulted in the development of new models of psychiatric care.<\/p>\n On July 21, 1971, the psychiatric ward of the Santo Tomas Hospital was officially created, since then called Ward 25.<\/p>\n Its building was designed by architect Blanca Escala.<\/p>\n The opening of the psychiatric ward of the Santo Tomas Hospital was opposed by influential medical leaders of this institution, but their objections were dissipated by the Ministry of Health. At that time it was difficult to accept the presence of a psychiatric ward within a general hospital.<\/p>\n This was the first “open door” psychiatric ward within a general hospital in Latin America. Initially it was staffed by personnel working at the National Psychiatric Hospital and, in addition, six patients were transferred from that institution to the new ward.<\/p>\n Among the medical staff were Dr. Jean Delenze, Dr. Juan Kravcio, who had recently completed his training as a psychiatrist at the National Psychiatric Hospital, Lic. Exley Reid as a clinical psychologist, Lic. Nubia de Flores in the area of social work and Nurse Delfina de J\u00e1come, trained as a specialist in psychiatry in the United States, and who previously held the position of Head Nurse at the National Psychiatric Hospital.<\/p>\n Initially, outpatient and inpatient services were offered with 12 beds for women and 12 beds for men, with one bed for isolation. Admission to the ward was voluntary and its style was eclectic and open-door. Several programs were created to address specific patient needs.<\/p>\n Other psychiatrists had an outstanding participation in the evolution of the psychiatry service of the Santo Tomas Hospital, Dr. Ovidio de Leon, who joined the institution in 1974, implementing new concepts for the time, such as the Crisis Intervention Program, Liaison Psychiatry and the Lithium Clinic.<\/p>\n Dr. Jaime Arroyo also made valuable contributions to the psychiatry service. For a long time he provided care to oncology patients at the Santo Tomas Hospital and later organized the Mental Health Service of the National Oncology Institute.<\/p>\n Chapter National Institute of Mental Health<\/strong><\/p>\n There are not many writings referring to the first stages of what is today called the National Institute of Mental Health (INSAM) of the Republic of Panama.<\/p>\n It opened its doors in 1933 as Retiro Matias Hernandez, acting as a solution to the need to receive the mentally ill from the Colozal Hospital, facts that we have already mentioned in previous paragraphs.<\/p>\n In the 1950’s it changed its name to National Psychiatric Hospital and in 2004 it underwent a reorganization of its services under the new name of National Institute of Mental Health.<\/p>\n As a specialized Institute, its mission has been to provide hospital care to acute psychiatric cases with difficulties in diagnosis and treatment. At present, it is a Center for Teaching and Research Studies in Mental Health for the benefit of the patient, the family and the community.<\/p>\n The Azuero Regional Hospital Chapter<\/strong><\/p>\n The Anita Moreno Hospital began to function administratively in March 1972. On May 22, 1972, the first 25 psychiatric patients from central provinces were transferred.<\/p>\n Forty years ago, the Anita Moreno Hospital was a concentration hospital for the central provinces, with one ward for women, two for men, and a capacity of 100 beds each. In the 1970s, 1980s and 1990s, a custodial model of care prevailed where overcrowding was endemic.<\/p>\n Treatment was based on the administration of psychotropic drugs, electroconvulsive therapy and occupational therapy. Then came the Caracas Declaration (1990). This instrument of international consensus for action to modernize the mental health sector in the Americas struck a chord in several Latin American and Caribbean countries.<\/p>\n The Caracas Declaration and other subsequent declarations, such as the one signed in Brasilia, were accompanied by international reports denouncing the violation of the human rights of patients with mental illness.<\/p>\n A Civil and Human Rights study of persons with mental illness described the situation at the Anita Moreno in Panama in 1997 as follows: “Deplorable state of infrastructure and poor quality of care for institutionalized patients”.<\/p>\n Psychiatric restructuring in Azuero, at the Anita Moreno Hospital, began in 1995 with the support of PAHO and the Regio Emilia Mental Health Institute of Italy.<\/p>\n Still in 2004, a PAHO evaluation on the quality of care at the Anita Moreno Hospital described the situation as “critical” in terms of infrastructure and living conditions of the inmates, with violation of human rights of hospitalized patients, the existence of cells and an excess of hospital beds.<\/p>\n In 2019, remodeling works of the Hospital, which began several years ago, will be completed, offering new and more modern facilities to continue providing care to all patients in the Azuero region.<\/p>\n Panama Consensus Chapter<\/strong><\/p>\n The Pan American Health Organization\/World Health Organization (PAHO\/WHO), with the co-sponsorship of the Government of Panama, convened the Regional Mental Health Conference in Panama City in October 2010 with the purpose of calling on governments and other national actors to: Promote the implementation of the Strategy and Plan of Action on Mental Health through a process that should be adapted to the particular conditions of each country in order to respond appropriately to current and future mental health needs.<\/p>\n Strengthen the community mental health care model in all countries of the Region, in order to ensure the eradication of the mental health care system in the next decade.<\/p>\n Recognize as an essential objective the protection of the human rights of users of mental health services, particularly their right to live independently and to be included in the community.<\/p>\n Identify in the national scenarios the current and emerging challenges that demand an appropriate response from mental health services, especially the psychosocial problems of children, adolescents, women, as well as population groups in special and vulnerable situations.<\/p>\n To increase the allocation of resources to mental health programs and services and to achieve an equitable and appropriate distribution of these resources, in accordance with the growing burden of mental and substance use disorders, understanding that investment in mental health means a contribution to health and well-being in general, as well as to the social and economic development of countries.<\/p>\n Where are we now?<\/strong><\/em><\/p>\n After all this historical journey through Panamanian psychiatry, it is only fair to talk briefly about the current reality.<\/p>\n Mental health services are nowadays accessible to the entire insured and uninsured population. The Social Security Fund, the Santo Tom\u00e1s Hospital, the National Institute of Mental Health and the San Miguel Arc\u00e1ngel Hospital, in addition to all the health centers and polyclinics in the country, offer outpatient and inpatient care to patients with psychiatric conditions.<\/p>\n We have come a long way in mental health care and although there is still a long way to go in order to raise awareness and educate our population and health authorities, the truth is that we see a promising future on the horizon.<\/p>\n SOURCES:<\/p>\n – Development of Mental Health in Panama<\/p>\n History and Actuality<\/p>\n Mental Health Series No. 1<\/p>\n – Dr. Ovidio De Leon<\/p>\n – Dr. Luis Picard-Ami<\/p>\n","protected":false},"excerpt":{"rendered":" I would like to share with you a presentation I made several years ago, when I was part of the medical staff of specialists at St. Thomas Hospital, which was my home for more than 10 years. First of all, it is important to point out that there is no data on the care of…<\/p>\n","protected":false},"author":1,"featured_media":4872,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[87],"tags":[],"class_list":["post-7170","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-history","single-item"],"yoast_head":"\n