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3. Panama: hurdles for healthcare and education
18 August 2010

Panamanian child of refugee applicants from Colombia; he was forced to fly to a hospital on his own from Jaque, Panama. (photo by Shaina Aber/JRS)
"Little by little, they've been taking away our help, first the food, then the hospital …"
– PTH, Jaqué

In the remote and rural towns of Jaqué and Piña obtaining adequate medical treatment is a challenge for everyone, but particularly those whose mobility is limited. There is no hospital in Jaqué, only a small health center. In the event of a medical emergency, Migration allows individuals with Temporary Humanitarian Protection to leave the community to go to hospital immediately upon the advice of a doctor. However, for non-emergency medical visits, such as health conditions that require the attention of a specialist, the process is more complicated. Refugees must present their doctor's note to the local functionary of ONPAR who sends the requests to the Panama City office by air on a weekly basis. The Panama City office of ONPAR then communicates with Hospital Santo Tomas to arrange an appointment and calls back to Jaqué when a date is set. The functionary of ONPAR in Jaqué must then communicate the date of the appointment to the patient,1 something that can be difficult as not all Jaqué residents have telephones. According to community members, it can take from two weeks to up to two months to secure an appointment.  As one woman puts it "It's kind of complicated, because you have to visit [ONPAR] many times in order to get the permit."

Naturally, this delay can be frustrating, particularly when the situation involves a serious illness that does not qualify for as an emergency, which would allow for an immediate exit. One family was particularly upset when their baby was sick and they had to wait two weeks to get an appointment at the Children's Hospital in Panama City. Although it turned out to be a minor illness, the experience was upsetting to the family because, "We imagined it was something really serious."

Aside from the delay, a major hurdle to receiving health care for residents in Darién is the cost. Roundtrip tickets from Darién to Panama City are about $150, and if the individual does not have family members in Panama City they will need to stay in a pension for around $12 a night. Previously, the vicariate of Darién covered the lodging, food, and travel expenses of refugees traveling to Panama City for medical reasons. However, beginning approximately a year ago the vicariate has only been able to cover the costs of the most economically needy within the displaced population, generally single mothers or those without any form of employment. According to Avid Alvarado, ONPAR previously paid a portion of medical expenses, however, this assistance was also discontinued around two years ago.

Unfortunately, many individuals with temporary protected status are not able to afford the costs of medical visits without this assistance. According to one mother of four whose partner supports the family by fishing: "I had a medical date last month – they were supposed to do an exam – but I have to pay for housing, the flight, and right now the fishing isn't bringing in much money and I missed my appointment." According to ONPAR's functionary in Jaqué, since the vicariate ceased their funding for most medical visits, the number of people travelling to Panama City each month has declined dramatically, from approximately 25 people per month to only three or four.2 However, the vicariate still pays full costs in the event of a medical emergency to any family that is unable to pay at the time. With the end of assistance for medical visits, many people feel that the international community has abandoned them. As one elderly man stated, "Little by little, they've been taking away our help, first the food, then the hospital…"

The health situation of undocumented refugees in Piña is even more worrying. There is no doctor in Piña, only a small health outpost with one nurse and one medical assistant. The doctors from the clinic in Jaqué visit Piña for one week a month, but if someone becomes seriously ill during the rest of the month, their only option is to travel to Jaqué. According to Dr. Menezes, the director of the Health Center in Jaqué, a proposal is being considered for a project to expand the health post in Piña.

Many undocumented refugees expressed a fear of travelling to Jaqué to visit the health center, or affirmed that the health center would not treat them due to their undocumented status. One man used the identification card his Panamanian brother in law when he visited the health center for fear of being denied care or reported to Migration, while another stated that when he is sick "I just deal with it here" – due to his fear of traveling to Jaqué. Although the health center is committed to serving the displaced population as well as the Panamanian community, individuals who arrive at the center without documentation will be referred to the office of the National Migration Service in Jaqué.3

According to the functionary of ONPAR in Jaqué, until an individual is granted refugee status, they must ask permission from Migration to leave for medical reasons. In practice, this means that those individuals without documentation may only leave for extreme medical emergencies. As one undocumented refugee describes "Last month one of my sons was sick, I had to leave urgently. I had to go to Migration and consult the representative of Jesuit Refugee Service, because I didn't have any documents. I had to wait a long time, like six or seven hours. Because my son is Panamanian, they let me go. I think that if he had been foreign, it would have been more complicated, because the first thing they asked me was if the child was Panamanian and if I was Panamanian."

"An education is every person's right – I'm thinking of my older sons – what is the Ministry of Education going to do with them if they are graduating and can't get a diploma?" – Undocumented refugee, Puerto Piña

Young people with Temporary Protected Status are frequently granted permits to leave Jaqué or Piña for educational reasons. High school in Panama is in two cycles, and up until recently these two towns only offered education through the first cycle, or up to approximately age 15. Once again, however, financial constraints can be prohibitive. Currently, the Darién vicariate provides scholarships for promising students to study in Yaviza, another town in Darién, where they live in a boarding house run by nuns.

However, due to limited resources, the vicariate is considering withdrawing funding available to students who want to study outside of Jaqué, as since 2005, the town has a school that provides education through the second cycle of high school, the Technical Institute of Agro-Forestry of Jaqué.4 The school, however, is generally thought not to afford its students the same types of possibilities as other schools, limiting their chances to attend university. Even more worryingly, although students with temporary protected status have a right to an education, without a work permit that will allow them to gain formal employment it is unclear how they can take advantage of the education they do receive.

For those who are undocumented, obtaining an education is even more difficult. If a student has Colombian documents, such as a birth certificate, his or her parents can petition the Panamanian Ministry of Education for a document that will allow the child to continue in his or her education. However, many refugees fled their communities leaving documentation behind. Moreover, if the student does not have any migratory status in Panama at the time of his or her graduation, the student will not receive a diploma and no record

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