A Journey Towards Fairer Winds: A Reflection of Panama

Medical Volunteer Opportunities Abroad

by volunteer Trisha In

“Be sympathetic to the weakest, because the odds of silver and gold are what determines our lives. Some do not have the same fate as us, so if one day we have the ability to help others, do not overlook that.”

I took this quote from a reflection that my mom wrote in Khmer, the official language of Cambodia, which makes up half of who I am. The similarities between Cambodia and Panama in terms of healthcare was also a large reason why I wanted to go on this particular trip to begin with, but beyond that, something about this Panama trip instilled a strong inclination within me to get a passport and apply. I just felt like this particular one was meant for me. And it was, truly. There are a couple of things in my life that I feel like were absolutely bound to happen and this trip was one of them. It’s a bit funny though, because even a few days after coming home, I still find it hard to describe to others what my experience was like when asked. So much had happened, and it feels like an injustice to just pick one or two things to tell them about.

Dr. Philippe Martin from Floating Doctors and his assistant, Trisha In, work on extracting a tooth from a young male patient. In this resource- limited setting, extractions and restorations encompass the entire scope of dental care.

However, with that being said, there are a few instances that really stood out to me, ones that I hope to never forget as I continue on my pathway to become a dentist one day.

My most difficult moment occurred immediately after doing my oral health and education charla with my partner, Jamie, as well as doing a solo one for the adults as part of my DK Fellowship. It was not doing the “charlas”, per se, but I remember debriefing with Mary about everything afterwards and I couldn’t help but tear up. I think in my mind, I had always thought that education would be the solution to everything (to a certain extent, I will always believe that). After all, that is why I spent so much time in the states trying to focus on making educational materials both in and out of dentistry. However, I don’t think I realized that education can only take you so far when you are in a really resource-limited setting such as this one. I could preach all that I want about flossing, mouthwash, toothpaste, etc., but it doesn’t do the community any good if they cannot access these materials. Mary seemed to understand what I was saying despite my ramblings, and she also mentioned that it’s similar for nutrition—a lot of these families don’t work. They might harvest foods for their families, wait for rainwater, and fish for their survival. So for an outsider to come in and say to do X, Y, and Z can be insensitive to their culture, resources, and way of life. I related this to how ridiculous I find it in the states that we often preach to eat healthy, but if one goes to McDonald’s, a salad costs $7 and a hamburger costs $1.50. Mary and I concluded our discussion with her telling me that despite all challenges, we must remember that we are helping the community as best as we can, given the resources that both we have, and that is something to be proud of.

Children from the schoolhouse in Quebrada Sal learn how to properly brush their teeth after a disclosing tablet demonstration and charla given by USC students. Since it was pouring rain, the children gathered in a row under shelter!

That moment was also special to me, because a few of the children from the schoolhouse followed me after the charla. I couldn’t recognize them at first, because they had changed out of their uniforms, but they told me in Spanish that they were our students from earlier. They kept following me around and it was one of the cutest things that ever happened to me. I was a little confused as to what they wanted, though. When I saw them a bit later in the day, I realized that they had seen the plastic bag of sunglasses in the pharmacy, and that was why they followed me. Unfortunately, I wasn’t as popular as I thought I was! I was, however, popular the following day in clinic when I was shadowing some of the other charlas. Since I was the one handing out water for a demonstration, I had about a dozen children follow me telling me to refill their cups so they could drink. Those cute faces made it so hard to say no, that I ended up giving them all of my water and eventually had to run away…but then they found me near the jerry can and I had to explain, “No tengo más aqua, lo siento.” On the surface level, it makes for a cute and funny story, but I could not help but remember the fact that this community does rely on rainwater as their main water source, do not have typical toilets or constant electricity.

Juxtaposition is one of my favorite words in the English language—my friends always make fun of me for using it, but it’s the perfect word to explain another aspect of my time in Quebrada Sal. A hilarious and unbelievable experience on our first day there: we walked to the beach in order to shower but were kicked off due to the filming of an upcoming reality TV show. Even more hilarious was when I learned that they wanted it to seem remote, which is why nobody could be on the beach. I couldn’t help but think: that seems so contrived, especially when we literally just walked through mud from an actually isolated community, on this same exact island, but instead here we are on this beautiful, white-sandy beach, that has a sign “Welcome to Paradise” right when you set foot. I had wondered if all of the cameramen and actors knew the life that existed right outside of this beauty.

Within Quebrada Sal, a white sandy beach with the clearest of waters, which was where the Floating Doctors crew was not able to shower because of the filming of a reality TV show.
A Ngabe mother and child walk hand-in-hand in traditional clothing, waiting in line to be seen at the Floating Doctors clinic.

Speaking of the community, there is something to be said about it here. Within the first 15 minutes of setting foot in it, while trying to find the Floating Doctors lodging area, a woman came running out of her house and asked us if there would be a dentist at the clinic the following day. When we told her that there would be, she told us “Mañana, yo voy.” I was surprised, honestly, because even in the states, I feel like going to the dentist is something that is severely under prioritized. I believed that most did not understand that oral health is an important part of overall health. It truly touched my heart that my first encounter in this community was dental-related. I also had learned how much the community respects Floating Doctors. Of course, I knew about this already from talking to Dr. Ben and learning about the organization online, but I didn’t really get it until I experienced it myself. Even in Bocas del Toro, I would use my broken Spanish to explain that I was a part of Floating Doctors and two people gave me their phone numbers to contact them if I ever needed help. One of those people was Toby, who apparently is a boat driver for Floating Doctors?! Dr. Ben also explained a while back in one of our pre-departure meetings that families will come from far away and dress up in order to visit the clinic. I witnessed this, as a line started to form before we even finished setting up the clinic, and despite rain.

Another thing that I noticed particularly in the dental clinic during the two days that I got to assist was how respectful all of the patients were to us. They were willing to hold the tray of materials if I needed to go get up and reload a syringe. They would wait patiently for their turn. But something truly incredible was something that I bridged what I learned in my Palliative Care class and this Panama trip: that different cultures express pain differently. In the states, I have watched everyone, from young kids to grown men, throw tantrums from receiving one anesthetic. I’ve seen patients push the dentist’s hands away, creating an unsafe environment for everyone there, especially with all of the sharp materials.

A 14-year old female patient presents with an abscess on top of a tooth, and local anesthetic is failing. Despite that, she shows unusual bravery and calmness.

That brings me to my favorite patient: my first one. I was really lucky to swap places with the other assistant at this particular time, because I ended up with the coolest case that we had seen in the two days as my first one. We saw a young teenage girl present with an abscess on top of a tooth, and this this made me realize just how different dental care is here versus a resource-rich area. Elsewhere, this would be an easy-fix with a root canal, but here, we had no choice but to just extract her tooth. Despite being in pain because all of the anesthetic that we gave didn’t seem to work after a certain point, I saw tears in her eyes, but she still sat calmly and let us finish. My time in the dental clinic was one of the most meaningful: I was able to meet Dr. Philippe, who is one of the most humble and inspiring dentists that I’ve ever shadowed, I realized the disparities that exist, and got to assist for the first time in my life. I have always said that if I cannot become a dentist, then I don’t want to do anything else in the healthcare field because that’s just how much I feel like dentistry is for me, and that thought was solidified when I stepped into the dental clinic after being around intake and realizing how uncomfortable and foreign that space made me feel. My friends noticed this too, that even though I was nervous to be assisting, I also was elated to be there in that moment.

I feel as though a shout-out needs to be given to Dr. Philippe, who I learned has been with Floating Doctors for four years now. I do not think my experience would have been the same without him: in clinic, I told him it was my first time doing any sort of restoration mixture so I was very nervous. He told me that it was okay, and that after a few times, I would be better than him. Of course, that isn’t true, but the fact that he was so humble was very inspiring. Even outside of the clinic, he went with me to refill the can of water to clean our dirty feet and even held it for me when I tried to get all of the mud off my sandals. But the most heartwarming moment was when we were on the boat leaving Quebrada Sal, he was holding some of my DK Fellowship papers that I asked for feedback from, and despite us all getting completely drenched, he made sure to keep my papers dry despite me telling him that I had more copies. Sometimes in this field, especially in the states, I become disillusioned by all of the dentists that have admitted to me that they simply pursued a career in this path because it was lucrative or because the hours were good. It was refreshing to see someone who genuinely just wanted to help others.

One does not fully appreciate the functionality of a walkway until a downpour leaves mud all around

My mom said something funny—that every time I called home, I was in tears. I’ll ignore the fact that she put me on blast like that, but there is some truth to that statement. I couldn’t help but think of a meme that I had seen (as ridiculous as that sounds), talking about how us first-generations are so lucky to be struggling with the highest tiers of esteem and self-actualization, when our parents were dealing with the lowest physiological and safety needs. I realized that the Ngäbe community is dealing with the same needs that my mom went through, yet somehow I managed to remove myself from that in my life of privilege. So in that sense, it’s hard for me to pick a favorite experience because I think I needed all of the aforementioned aspects to come together as a whole to make my time in Panama as meaningful as it was. I had thought that I lived a hard life, given that I’ve experienced what it was like to not access dental care because of my low socioeconomic status and didn’t know where my next meal or shelter would come from. But now I can say that I don’t understand, at least not in a global context.

People have always asked me what I imagine my end-all- be-all is, and I’ve always thought that it was to simply be a dentist. I had thought that if I made it that far, despite all obstacles that I thought I had faced, I would be eternally happy. I realize now that perhaps my purpose is greater, that I should do something more for the communities around me, both domestically and abroad. I hope that one day, I will be able to come back to Floating Doctors as a provider and do more for these communities. Thank you so much to Floating Doctors for making my first experience abroad an unforgettable one. I’ll always remember it as I continue my pathway in dentistry!