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Rafael De Gracia is a medical specialist of obstetrics and gynecology, with a master's degree in Hospital Management. Currently, he serves as the Director of San Miguel Arcángel Hospital. He’s a 5th generation CAHI Fellow.


Dr. De Gracia is the Director of the San Miguel Arcángel Hospital, the only hospital of the Ministry of Health (MINSA) in Panama for the San Miguelito area, a community that is currently characterized by the highest population density in the country.

The San Miguel Arcángel Hospital was established 20 years ago and serves the local population of more than 640,000 people, comprising San Miguelito and four neighboring districts. As a secondary level hospital, services include basic care in medicine, surgery, psychiatry, pediatrics and emergency services. These services are coordinated with the surrounding primary healthcare centers and clinics.

Dr. De Gracia says, “It is a very complex task due to the number of people that require attention and the diversity of situations that arise. My responsibility is to ensure that all the services provided are functioning properly, as well as generating alternatives when we are not yet offering solutions. Perhaps it is this desire that led me to the idea of ​​the Day Hospital, an unconventional solution for the medical care of uncomplicated patients who require, for example, an intravenous infusion, or a timely treatment that does not require hospitalization, but requires a certain level of medical attention.”

Hospital de Día, the project developed by Dr. De Gracia during the CAHI Fellows Program, allows patients to receive ambulatory health services they need without having to go to an emergency room or pay for the procedure in a private clinic.

"For example, if someone needs an intravenous infusion that takes several hours to administer, or the treatment of a complicated wound that does not require hospitalization, these are the kinds of situations that are treated in a day hospital."



“I learned about the program from the participants of the 3rd generation. I had the opportunity to interact with them while I was doing a senior management program of health institutions at INCAE Business School. It was an interesting moment for me, because from the beginning I knew was interested in applying to become a part of the CAHI Fellows community. ”

Dr. De Gracia shares that he viewed the CAHI Fellows Program as the next step in his training and as the perfect complement to put his knowledge and experience into practice. This allowed him to develop a project to benefit the community and drive improvements in medical care in Panama.

When Dr. De Gracia was accepted into the program, he quickly made friends in the network. He described the bonds that were generated and the strong sense of ethics that characterize the CAHI Fellows Network as the basis for future possibilities of shared learning and collaboration among Fellows and their projects.

“I think the experience in the CAHI Fellows Program is tremendously enriching. Not only because of the staff and academic team, but also because the group of colleagues with whom I have shared the program are amazing people and very diverse in their cultures and in their professions: there are lawyers, engineers, administrators. Really a very interesting group with great projects.”

His participation in this learning process has also allowed him to have a broader and clearer vision of the reality of the Central American region, the challenges faced by other countries and different approaches to address problems in each particular context and reality.

The CAHI Fellows Program is a proactive investment in the future of health in Central America. CAHI’s theory of change rests on the belief that forming a network of leaders with a shared vision for health equity in the region, and fostering concrete projects designed to positively influence the health sector, the quality, affordability and accessibility of medical care will improve.

For Dr. De Gracia, the management tools learned during the CAHI Fellows Program and the structured process of organizing the development and implementation of his project were fundamental. His leadership ability is further enriched by the constant exchange and communication with Fellows in other countries, with whom there is the opportunity to discuss and compare perspectives in an environment of mutual respect and regard, so that ideas multiply and evolve.

“The CAHI Fellows Program is a good opportunity for all Central Americans to get involved clearly and decisively in the state of health in our countries. CAHI offers us the tools to organize ourselves, to connect and move forward as a network, to really do something. It is not easy, but it guarantees an impact. This program has shown me that we can all do something, no matter if you are a doctor, administrator, lawyer, nurse: anyone who has the interest can make a contribution. That is very valuable.”

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