For every hospital, there’s specialty expertise

Damas Hospital revamped delivery rooms and an intensive care neonatal center.

By Peter Martin
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Spread out against the verdant highlands in Cidra, Hospital Panamericano feels more like a resort than a healthcare facility with its plush amenities and lush grounds. However, for those who need mental health or addiction assistance treatment, a visit to this piece of paradise will be a lifesaving experience.

This institution consistently outscores its peers in the U.S., delivering quality mental health treatment in the Caribbean and the effective treatment by expert staff at a cost one-third the price of the U.S. average in a beautiful setting full of life.


“Our niche is mental health, which is different than what the other institutions on the island are doing,” said Executive Director Astro Muñoz, noting the institution specializes in treating addictions and addressing behavioral problems of adolescents.

“We are an alternative outside of the mainland in a paradisiacal place with unsurpassed facilities when compared to the U.S. or Puerto Rico. Our hospital is the most similar to a resort in all of the Caribbean for mental health patients,” he added.  

Hospital Panamericano blends into its setting, where the pastoral vistas are seen from every room. It also has resort amenities like a gorgeous pool area, top notch gym, elegant dining room and hotel-like rooms for patients.

Medical tourists are catered to with a VIP section, with 20 high end, private rooms with a specialized menu and other amenities including room service. The VIP staff is completely bilingual and English speaking patients will get all treatment in that language, as well as all documents and reports. Transportation is also taken care of and staff can help families plan stays at nearby hotels and to undertake tours and other diversions. Many families combine a vacation with the treatment required for a family member.

The simple fact of being removed from their daily environment and placed in a new controlled environment is itself beneficial for patients seeking mental health treatment.  Hospital Panamericano prides itself on its discretion, and its isolated location also helps protect the identity of patients. The institution is without peers in the Caribbean in terms of natural beauty, privacy and quality of care, according to Muñoz.  

Hospital Panamericano has been recognized by the U.S. Joint Commission for consistently surpassing U.S. healthcare quality standards. It is part of Universal Health Services, a Forbes 500 company with more than 247 healthcare facilities across the United States. This enables Panamericano patients from the states to receive follow-up treatment once back home, with both Spanish-speaking and English-speaking medical staff in the continental United States available. Hospital personnel can coordinate follow up treatment and continuing service for the patient after their stay on island.

The hospital treats mental health issues and substance abuse problems, as well as the many patients suffering from both issues. The substance abuse program can last from seven to 10 days, with a battery of follow up treatment afterwards, which experts underline is an essential part of the cure.

Hospital Panamericano also prides itself on its holistic treatment approach, and offers patients different activities aimed at bringing them back to wellness, including with yoga, Ta-chi, aromatherapy, massage and other physical activity.

Muñoz said that Panamericano’s beautiful tourism infrastructure and VIP services, combined with its outstanding care, and makes it the No. 1 medical tourism destination for mental health and substance issues in the Caribbean.

The facility’s seven units include two dedicated to dual patient problems, which are those that suffer from substance abuse and mental health problems, and another two are dedicated to adolescent services, for teenagers suffering from a variety of problems.

The primary treatment for adolescents could last six months or more, but the facility has a full-time school on the grounds to ensure that youthful patients’ studies are not interrupted during treatment.  The institution prides itself on its program for youths with behavioral problems, which is an alternative for students across the U.S. and the region.

Ashford Presbyterian’s advanced colorectal services
Tucked discreetly on the ground floor of a building near one of the busiest corners in San Juan’s Condado tourist district, the Colorectal Clinic (CRC) of Ashford Presbyterian Community Hospital has been serving the public since 2011.

These days it is as busy as ever. Which is not surprising since it is the only center in Puerto Rico dedicated to the diagnosis and treatment of the colon, the rectum and the anus, parts of the body most people would rather avoid talking about but which, like the rest of the human body, can fall prey to disease.

The clinic brings under one roof services that the hospital has been offering for years into a 2,000-square-foot space in the Ada Ligia condominium, right across from the hospital.

The conditions handled at the clinic span a wide array of medical issues such as cancer, diverticulitis, ulcerative colitis, Crohn’s disease, hemorrhoids, anal incontinence, fistula, anal fissures, constipation, and rectal prolapse.

The center’s medical staff brings together some of the top colorectal specialists on the island. They include Marla Torres, Jose Reyes, Luis Tous and Nicolas Lopez, all of whom are certified by the American Board of Surgery. Lopez, who came onboard in 2015, is the most recent addition to the team.

“They perform magic,” said Dr. Francisco de Torres, medical director of the hospital, which is familiarly known as El Presby.

The magic he referred to is transanal endoscopic microsurgery (TEM) which is the clinic’s crowning glory. In fact, this is the only place in Puerto Rico with the specialized equipment and the trained doctors to carry out this procedure. Doctors at the center also perform traditional kinds of surgeries and medical procedures like endoscopy and laparoscopy which are minimally invasive.

TEM is a type of surgery that has practically redefined treatment of the colon. Pioneered in 1983 by a German surgeon, it revolutionized the surgical removal of rectal lesions.

More importantly, it is an alternative to more radical surgery in which, as de Torres explained, the doctor makes a long incision that usually goes from chest to stomach. With this minimally invasive surgery the surgeon “can take out the entire intestine through small incisions,” de Torres explained.

Also, in cases where a cancer is too low down the intestine doctors might opt to close the anus and carry out a colostomy, which forces patients to wear a pouch to collect intestinal waste. TEM minimizes the need to resort to this drastic measure, according to de Torres.

El Presby’s Executive Director Pedro Gonzalez said that the clinic “confirmed the absolute commitment we have in bringing the best to our patients.”

Cardiovascular Center cures broken hearts
The Cardiovascular Center of Puerto Rico and the Caribbean in San Juan is well familiar with matters of the heart.

Backed by advanced technology and top heart specialists, this 154-bed public hospital specializes in treating cardiac conditions in patients from Puerto Rico and from outside the island. Its record is impressive.

Between 1992, when the center opened as a 98-bed facility, and 2014, when it celebrated its 22nd anniversary, the hospital has admitted more than 86,000 patients, carried out some 200,000 noninvasive procedures and performed more than 60,000 cardiovascular surgeries.

In 1999 the Cardiovascular Center took a gigantic step and launched the first and sole heart transplant program in the Caribbean. It has been highly successful, according to Executive Director Carlos A. Cabrera Bonet and Medical Director Dr. Juan Carlos Sotomonte.

In fact, Puerto Rico is among the top three programs with the shortest waiting time for a heart transplant: about three months. In the states, the average wait is between six months to three years because of a shortage of donor organs. In the 16 years the program has been running, a total of 151 patients have received donor hearts.

On average, Cardiovascular does between four and six transplants each year. Currently there is one person waiting for a heart and another 25 people are under evaluation as potential candidates.

To be considered for a transplant a patient must have end-stage heart failure which means the heart is failing and does not respond to any treatment. The average age of patients receiving transplants in Puerto Rico is 48 years; the oldest patient was 68.

Cardiovascular’s transplant program is open to patients from the U.S. and the Caribbean. Patients will have to spend some time on the island but after the transplant, can return to their former place of residence, if they so wish. However, periodic medical checkups will require return trips to Puerto Rico.

To date, three off island patients have received hearts in Puerto Rico: a Venezuelan, a Dominican, and a Cuban, all three residing in the U.S. The Cuban patient, a resident of Miami, had been waiting for a heart for more than a year when he decided to get on the waiting list in Puerto Rico. Within three months, he got the good news he had been waiting for. Since the operation, the patient has made a full recovery, moved back to Miami and returns to the island for his checkups.

The transplant program is under the direction of heart and transplant surgeon Ivan F. Gonzalez Cancel. The transplant team encompasses a multidisciplinary group of people integrating a lot of different physicians and professionals, including a cardiologist, a psychologist, a social worker, even a financial adviser. The cost of getting a transplant in Puerto Rico is about $350,000, less than half what it would cost if carried out in the U.S., said Cardiovascular spokeswoman Lillian Camacho.

The Cardiovascular Center is Joint Commission accredited while its transplant program is certified by the United Network for Organ Sharing (UNOS), the nonprofit organization that coordinates U.S. organ transplants.

HIMA brings cutting-edge techniques to healing 
The HIMA Group runs four hospitals in Puerto Rico and two –  HIMA San Pablo in Caguas and HIMA San Pablo in Bayamon  – are dedicated to attending medical tourists from the U.S. and the Caribbean region.

Staffed with experienced physicians and equipped with the latest cutting-edge technology, these two hospitals have been serving the needs of medical tourists for years through such services as cardiovascular surgery, orthopedic surgery, spine surgery and oncology.

It is a pioneer at new, non-invasive procedures in a number of different specialties, which also bolsters its attraction for medical tourists.

Another area of service that HIMA excels in is neurology. Its strengths in this area were considerably bolstered a few years ago when it opened the first Primary Stroke Center in Puerto Rico, a project that took four years to realize and involved an investment of around $7 million.

The center, which has Joint Commission accreditation, counts with a medical team that includes certified vascular neurologists, neuro-radiologists, neurosurgeons and neuro-ICU specialists.

Attending to patients who have suffered a stroke is but one of many services HIMA provides out of its Advanced Neuroscience Center (ANC) based at its Caguas hospital. Here, a team of 21 experienced physicians, including surgeons, and other healthcare professionals provide diagnosis, treatment and other services for patients with disorders of the nervous system.

Patients come to ANC to receive care and treatments for neurological conditions that affect the spine and the spinal cord as well as other medical conditions besides stroke, such as multiple sclerosis, epilepsy, cerebrovascular disease, and brain tumors.

The care provided to patients is based on an interdisciplinary treatment approach that incorporates specialists in neurology, interventional neuroradiology, critical and neuro intensive care, physical medicine and rehabilitation, and pain management.

ANC houses the neurology department (adult and pediatric),  a multiple sclerosis center, an epilepsy monitoring unit, a neurosurgery section (adult and pediatric), the neurosurgical intensive care unit, and the already mentioned Primary Stroke Center.

The department of Neurosurgery offers a complete range of services for adult and pediatric patients with diseases of the brain, spine, spinal cord, and peripheral nerves. Distinct subspecialty areas of expertise include complex spine, pediatric neurosurgery, neuro oncology, and cerebrovascular and endovascular stroke (including carotid disease, aneurysms and vascular malformations), peripheral nerve surgery, epilepsy surgery and stereotactic radio surgery.

Among the neurological diagnostic testing used by the neurology department to evaluate patients are electrocardiogram, echocardiogram, cerebral vascular study (CVS), electroencephalography, transcranial doppler (measures the velocity of blood flow in the brain), lumbar puncture or spinal tap (a procedure to collect and look at the fluid surrounding the brain and spinal cord).

The three highly specialized board certified neurosurgeons who make up the neurosurgery section perform complex operations using advanced technologies such as Neuronavigation image guidance, a hybrid biplane angiography suite, Cyber Knife radio surgery, and image-guided intracranial endoscopy as well as magnetic resonance imaging and computed tomography angiography.

The biplane angiography, for example, makes it possible to carry out minimally invasive procedures thus avoiding surgeries such as a craniotomy which involves the surgical removal of part of the bone from the skull so as to expose the brain. It took one year to build and install this highly sophisticated equipment.

Multiple Sclerosis is a degenerative disease that compromises the central nervous system. The Multiple Sclerosis Center at ANC provides comprehensive, multidisciplinary care to patients including services such as neuropsychology, speech therapy, and physiatrists with spasticity management. The center also has an area for drug infusions administered directly into the bloodstream.

The Epilepsy Center, recognized by the National Association of Epilepsy Centers as Level 4, includes an Epilepsy Monitoring Unit with 10 rooms fully equipped with state of the art Video EEG technology to monitor seizures 24-hours with cameras and electrodes. VEEG allows the medical staff to identify the kind of crisis the patient is suffering and determine the necessary medical or neurosurgical management.

For patients with resistance to epilepsy medication, surgery can be an option offering relief. Some of the alternatives include resective surgery (in which brain tissue in the temporal lobe is cut away), Vagus Nerve Stimulator implantation (this is a pacemaker-like device that generates pulses of electricity to stimulate the vagus nerve), callosotomy (a palliative surgical procedure for the treatment of seizures) and hemispherectomy (half of the brain is removed or disabled).

Damas Hospital from servicing the poor to medical tourism
Damas Hospital has come a long way since it was founded in 1863 by a group of ladies to provide health services to Ponce’s poor. Today, this south coast modern healthcare facility’s constituency extends beyond patients from Ponce and surrounding towns to include medical tourists from across the region and the U.S.

The hospital has developed a medical tourism office as well as a global care initiative in partnership with government and private institutions and has wing of private rooms for the exclusive use of medical tourists who usually stay an average of five days.

Services most in demand are minimally invasive surgery, invasive and interventional cardiology, cardiovascular and endovascular surgery, orthopedic surgery and rehabilitation, cosmetic and maxillofacial surgery, obstetrics, gynecology and intensive neonatal.

The hospital’s surgery rooms are now intelligent rooms with the integration of digital technology that is used in minimally invasive surgery procedures. Damas also revamped delivery rooms and an intensive care neonatal center.

Damas has also invested in modern CT scan technology with high image resolution and low radiation for its Imaging Center and its nuclear medicine department is equipped with a SPECT/CT. The single photon emission computed tomography CT combines two different scans into one image and as a result is much better at detecting problems like tumors.
The 10-story, 331-bed facility has a first rate medical staff with 370 doctors.

The hospital started a trailblazing gynecologic oncology program this year, under the tutelage of Dr. Ingrid J. Ramirez Diaz, who was trained at Yale and Columbia universities and trained for her specialty at the South Florida Moffitt Cancer Institute.

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