Palliative care in Panama City: Visit with Monsignor Mirosław Adamczyk, Papal Nuncio, Feb. 13 2019

When the Representative of the Holy See in Panama City, Monsignor Mirosław Adamczyk, exclaims, “The price of medicines here in Panama is scandalously high! Higher than any the countries I have ever been assigned to,” he is echoing his boss, Pope Francis, who has often expressed his concern for the health of his flock, including most recently on World Day of the Sick. As a pastor who respects the universal right to health, the Monsignor was upset by the fact that the high prices mean medicines are unavailable to the poorest of the poor — those not covered by social security.

This Holy See attitude is aligned with the World Health Organisation, which takes a rights based approach to the price of essential medicines and seeks to balance the profit seeking role of the pharmaceutical companies against peoples’ need for basic healthcare. Luckily our visit came at a relatively quiet time, after the papal visit for World Youth Day. I was in the country for the Ministry of Health sponsored Central American Launch of the Lancet Report on Pain and Palliative Care, and to accompany teams on home visits in rural areas. (See my previous blog on Aguadulce).

The Pontifical Academy for Life (APV) in Rome had notified Monsignor Adamczyk that I was coming to Panama for the Lancet event and would like to brief him at his convenience on the Pal-Life program. Our delegation to the Nunciate, showed in the photo below, comprised (left to right) Dr. Tania Pastrana, President of the Latin American Association of Palliative Care (ACLP), Dr. Irena Etcheverry, director of Hospice Madre Teresa, in Luján, Argentina, Professor Myrna McLaughlin-Anderson, Senior Advisor, Ministry of Health, myself, and Dr. Nisa Camaño, Coordinator of PC for the Caja de Seguridad Social in Panama, and President of the Panamanian Society for Hospice and Palliative Care.

It turns out that Mons. Adamczyk, unlike many of the Nuncios I have called on in my travels, knows quite a bit about palliative care, coming as he does originally from Gdansk, home to several hospices. He cited the obligation to care for the sick as though they were the body of Christ, quoting Matthew 25: “when I was sick you visited me.” Another big one for me is, “when I was imprisoned you visited me.” Father Piotr Krakowiak founded a pioneering prison hospice program in Gdansk, teaching inmates to care for one another during their last days.

Monsignor insisted during our conversation, on the importance of the presence of a compassionate pastor throughout the illness and bereavement processes. He was sensitive to the pain of family members who felt guilty and abandoned when the person they had been caring for died, especially when the death had been distressing.

The Nuncio had witnessed this grief first hand in Venezuela, where few priests could be found to comfort the bereaved in public hospitals. Our discussion on the vacuum of compassion in certain healthcare systems also touched on euthanasia and the untimely death of a friend of his in Belgium who requested and received euthanasia after a cancer diagnosis. Apparently it costs EUR48 to fill a euthanasia prescription at the pharmacy.

Sheila Lichacz

We agreed that the fight for a right to palliative care is taking place in the shadow of growing public support for euthanasia and medically assisted dying. The Nuncio expressed support for the idea of a hospice in Panama City, and agreed to remain in contact with Professor Myrna McLaughlin-Anderson, palliative care chargé in the Ministry of Health.

After our lengthy conversation, the Monsignor took us on a tour of the public rooms, showcasing works of art selected to reflect the talent of this tiny, but mighty country.

Sheila Lichacz

The altar in the Chapel (“after all it’s His house!” declared Monsignor before showing us around) is simple and elegant, the door to the ciborium being designed to unroll like the stone from the tomb.