Nestor Sosa, MD, FACP
General Director of Gorgas Memorial Institute of Health Studies
— MEDICAL SCHOOL —
University of Panama Faculty of Medicine Panama
— RESIDENCY —
University of Miami Jackson Memorial Hospital
The ACP Central America chapter was established in 1928, making it one of our earliest international chapters, and Dr. Nestor Sosa has been the Governor of the chapter since 2016. The Central America chapter includes Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, and Panama. As of this writing, the chapter supports 556 members of the college.
What inspired you to become a physician?
In my country, you had to go directly from high school to medical school. I loved biology classes above all other courses, but it was difficult to make a living as a biologist, so I decided to go into medicine. Out of all the available careers at the university, medicine was the closest thing to biology. Later, I went into internal medicine and infectious diseases. In the end I became more or less what I had dreamed: a biologist specialized in humans and microbes.
What do you enjoy about being an internist?
Internal medicine is a never-ending love affair with knowledge, intellectual growth, and the science and art of our profession.
I enjoy having the knowledge to understand in depth the complexities of the disease process, and I enjoy being able to diagnose and treat very difficult clinical conditions in my patients. The satisfaction of applying what I have learned, the privilege of being able to help others in need, and the interaction and scientific exchange with my peers and students are three things that rapidly come to mind when I think of my internal medicine practice.
What advice would you give to someone who is thinking about going into internal medicine?
First, they have to love reading and studying medicine. Internal medicine is a never-ending love affair with knowledge, intellectual growth, and the science and art of our profession. They need to develop the capacity to listen, observe and to learn from patients and colleagues. Empathy, compassion and humility should also be an integral part of the toolkit of every internist. I would also tell them to be ready to work hard, study hard and enjoy what you will do.
What is the role of the internist in your country?
Internists in Panama are very important. They have to take care of patients in the hospital and at the same time function as primary care physicians in the ambulatory setting. We do not have hospitalists, nurse practitioners or physician assistants, so most of the care is the direct responsibility of the internal medicine service.
As the Governor of the Central America chapter, what types of activities do you organize for physicians in your country?
The main event we organize is the annual chapter meeting. During this conference we have outstanding speakers that update our knowledge in internal medicine and related specialties. We have a scientific poster presentation for medical students and internal medicine residents and we organize a Doctor’ Dilemma competition every year. We have done several internal medicine update courses for internists and general practitioners in the different Central American countries. We have activities tailored for medical students, such as lectures and question competitions. Our chapter also organizes its participation at the internal medicine meetings in the U.S. A significant contingent of internists, residents and medical students attend these meetings and when we return, in collaboration with the internal medicine society, we share what we have learned with the rest of the members at a local meeting.
How did you become involved with ACP?
I have represented my country in two chess Olympiads and I have been national champion on three occasions.
When I was doing my internal medicine residency at the University of Miami Hospitals, our program director promoted our affiliation to the ACP. I participated in the team that competed in the Doctor’ Dilemma competition and attended local chapter meetings. When I returned to Panama, I realized that the ACP already had a chapter in my country so I joined it and continued to participate in our local chapter activities.
Do you have any interests or hobbies outside of your work?
Oh yes! I am a chess player and I love to play sports. As a chess player I have participated in many national and international competitions. I have represented my country in two chess Olympiads and I have been national champion on three occasions. During my life I have played baseball, softball, tennis and I have run several marathons and triathlons. Currently I play softball and run an occasional 5km race, but just for fun and fitness.
Why is it important for international physicians to belong to professional organizations like ACP?
First, it keeps you in contact with the latest trends in the specialty and it gives you the opportunity to interact with the leaders in the field in the local, regional and national meetings. It gives you inspiration and a sense of belonging to something greater than your day-to-day clinical practice. Being able to see and hear what other internists are doing in research, medical care, ethics and professionalism energizes me and allows me to be more creative, enthusiastic and caring when I practice medicine in my country.
What are some of the biggest health care concerns in Central America?
Central America is a heterogeneous region. There are still a lot of inequalities in the provision of healthcare between and within the different countries. There are countries and regions with serious problems of basic sanitation (clean water, sewage systems, extreme poverty). In those areas, health care delivery systems are precarious and social determinants of health are not conducive to a healthy life.
In other more developed regions, access to health care and quality of health care are important concerns. Public Health systems are overburdened with difficulties like long waiting lists, not enough physicians and nurses and medication stock-outs. Excessive bureaucracy and corruption plague the systems.
A more subtle deficiency is the lack of up to date knowledge and proficiency among health care personnel. There is a need for continuing medical education and evaluation of competencies. Many health care professionals stop learning once they leave their academic centers. A certification or recertification process is not in place in most (but not all) countries in Central America.
Back to the October 2018 issue of ACP IMpact
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