What Went Wrong

By John McCormick  |  Posted 2004-03-08 Print this article Print

Overlooking the skyscrapers of downtown Panama City, amid towering palm trees and gracious homes in the old Canal Zone, sits Gorgas Hospital, an imposing concrete structure which now houses Panamas National Cancer Institute. This is a public hospital. No Panamanian is turned away.

On a Monday morning in January, at least 50 patients and their family members, including Victor Garcia and his wife, are visiting the institute. The patients walk slowly up the driveway; sit quietly on the patio under the lush vegetation that surrounds the building; stand in the lobby. They are all waiting for treatment.

This is not even the hospitals busiest day of the week. That is Tuesday, when the clinic offers every citizen, even those without a doctors referral, free diagnoses of the skin cancer that tends to flourish under the equatorial sun.

Cancer is a leading cause of death in Panama: prostate cancer for men, endometrial and cervical cancer for women. And those are unlikely to be just the suns fault. Many Panamanians blame the United States testing of the chemical defoliant Agent Orange in the Canal Zone during the Vietnam War. Since 1997 the number of new cancer patients in Panama has more than quadrupled, according to the cancer institute. The hospital now sees 10 to 15 new patients per day and performs 300 cancer surgeries per month.

The victims of the faulty radiation treatments in 2000 and 2001 span the breadth of Panamanian society. Among the dead are Margarita Sevillano, a folksinger; Walter Chandler, a professor at the University of Panama; and Rosa Vergara, a nun. Many of the dead lived in the barrios in the hills above downtown, where chickens peck along the roads, laundry flaps from porches and brightly painted stucco houses are interspersed with small shops and Internet cafés.

The hospitals radiotherapy unit is critical to Panama. When the IAEAs investigation, in May 2001, slowed the hospitals routine, patients lined up waiting to be treated. That led the Panamanian ambassador in Austria, Jorge Perez, to urge the Vienna-based agency to hurry up. "Those who could afford to went to the private clinics," Perez says. "Those who could not, waited."

The difference in cost to the Panamanian government is stark. Garcias treatment, for example, which cost him virtually nothing at the National Cancer Institute, would cost $4,000 at a private hospital, using a Cobalt-60 machine. Using a higher-powered, more-precise linear accelerator, the bill would escalate to $10,000.

The current chief of the cancer institutes radiotherapy unit, Dr. España de la Rosa, asserts that some patients died in 2001 waiting for treatment, while the overdoses were being investigated. She says she does not know how many.


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But the survivors of the overdoses didnt fare well, either. The governments of France and Argentina each offered to take two of the over-radiated patients and treat them for a year at no charge. Panama sent no one. "We are a small country, and everybody knows everybody," Ambassador Perez says. "How do you decide who to send?"

The overdoses occurred not in the newly renovated Gorgas Hospital on the hill, but in the cramped Justo Arosemena Avenue facility downtown, which the hospital was in the process of vacating. The Multidata software and the Cobalt-60 teletherapy machine manufactured by Theratronics had been installed there in 1993. According to a letter written to Multidata by ProMed, the Panamanian distributor that sold the hardware and software, the hospital was looking for cheaper software because it couldnt afford the software that Theratronics typically supplied with its radiation machine.

ProMed services manager Camilo Jorge says he doesnt remember the price difference, but he knows the hospital never purchased a maintenance contract for the software-only for the radiation machine. By 1997, hospital staff was so concerned about the possibility of unintended excess exposure that they warned in a report requested by the Ministry of Health of "overexposure of radiation-therapy patients due to human error" unless conditions at the hospital improved.


Next Page: The machine was being used nearly twice what the maintenance program recommended.


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