Overall, another good trip.  We lost a day in the lab with a water main bursting in the street by the hospital.  But we had some “firsts” on the trip in terms of devices used in a couple of situations, and lots of patient evaluations otherwise.  I am > 700 caths now over the past 17 years (>40/year) with just shy of 400 of those in Panama—Thanks!  The team is basically self-sufficient now and a new member will be coming in Feb 2017, and at that point, they will probably be about “full speed” with hospital support for their material for basic caths.  The emphasis will expand to pre-operative cases, new types of interventions, and work with other cardiologists including adult cardiologists in Panama, and pediatric colleagues from Costa Rica, Nicaragua and perhaps El Salvador, which we have been doing whenever possible the past several years—getting “regional” in the project.