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While in the past we based our entire operation from a sailing vessel; at present, our model is to deploy our teams in small open boats called ‘pangas’ or in traditional Ngabe-Bugle indigenous dugout canoes called ‘cayucos’ to reach the target communities scattered across 10,000+ miles of archipelago and coastal mountains we serve. These smaller craft can navigate much shallower waters and up rivers, allowing us to reach isolated rural jungle villages much more easily.
Doctor Panga #2
2016 Fiberglass Panga 29’ long. 115hp Yamaha Outboard Motor
Capacity: 20 crew
Active Service: 2017 – Present
This is our ‘people mover’ panga. With a light but sturdy fiberglass deep-V hull, this panga we built and launched in 2017 can move fast and get our team to our target communities (and back safely) ahead of incoming weather or in heavy swells. She is also ideal for conducting an emergency transport, with enough room for a patient and transport team.
Photo: Matta Dyka/Vitamin Angels The Original “Doctor Panga”
2011 Fiberglass Panga 24’ long. 60hp Yamaha Enduro Outboard Motor
Capacity: 12 crew
Active Service: 2012 – Present
The first small craft we built in Panama. The Doctor Panga has carried our teams safely more than 20,000 miles around the archipelago since we built her from a wrecked hull we obtained. Light but strong, nimble enough to navigate tight mangrove rivers and shallow approaches. The ideal type of craft for reaching communities with the most difficult access to care.
The Floating Doctors Cayuco
2007 Traditional Dugout Canoe, 47’ long, hand-carved from a single bateo tree, 75hp Yamaha Enduro Outboard Motor
Capacity: 25 Crew or 4,000lbs of cargo
Active Service: 2016-Present
“When all else fails, try doing what the locals have done for centuries.” The traditional cayuco used by the Ngabe-Bugle people comes in all sizes, from tiny mini-cayucos suitable for a 6 year-old to go to school, all the way up to 70’ monsters carved from gigantic jungle trees. These hardwood craft are very heavy and can land on beaches, carry a lot of passengers and cargo and navigate heavy swells safely. Although their weight makes it impossible to reach the high speed that pangas can attain, their long, arrow-like bodies allow a relatively tiny motor to push them up to 10-14 knots and deliver large passenger loads at low cost.
S.V. Southern Wind (now retired from service)
1981 Custom Motorsailor. 76’ long, 115 tons.
Capacity: 20,000 lbs of material & up to 20 crew
Restored by Floating Doctors 2009-2010
Active service: 2010-2013 (Haiti Earthquake, Honduras, Haiti Cholera Epidemic, Panama)
We obtained Southern Wind from Dennis and Jeanette Dean in Palm Coast, Florida. She had been neglected for ten years and was in a state of severe disrepair. Our initial founding crew totally rebuilt her over 13 months before we set sail for Haiti for our first mission after the 2010 Earthquake. She was retired from service in 2013.
With thanks for carrying us for over 6,000 miles, weathering hurricanes and lightning and poorly charted waters. She kept us safe and made everything we are doing now possible. We have grown beyond her capacity for the amount of primary care we provide and in Panama we are able to deploy from a central base on land, and transport our teams throughout the region in smaller craft that can land on beaches and travel up shallow rivers.
We learned a lot about the specific needs of an ideal sailing ship that could deliver specialist services like ophthalmologic or abdominal surgery, or cardiac procedures to underserved regions without requiring a massive hospital ship, and we look forward in the future to exploring this concept again. At present we will focus on creating highly mobile, permanent services that cover large areas in smaller boats from a central base, as with our current model in Panama.
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“Always strive for the far shore. Don’t save anything for the swim back.”
by Dr. Ben
One of the most common questions I am asked (aside from “where are we?” and “can you come look at this weird rash?”) is how this all started. I’m never quite sure how to answer that—the true origin of anything always seems to be just one more link further back in a very long chain of causality.
But moving the clock hand back about a dozen years finds me traveling as a new doctor in Tanzania, and for me this is where Floating Doctors truly begins. I travelled to Tanzania as a tourist, to climb Mt. Kilimanjaro and to see the wildlife of the Serengeti. Kilimanjaro was amazing, but on the drive out to Serengeti the guide asked if I wanted to visit a nearby Maasai village. It sounded interesting. Of course I said yes.
I had no idea that I was about to come face-to-face with my destiny
We turned down a dusty road and soon came to a small Maasai village of about 140 people. The village was truly located in the middle of nowhere, in the middle of a dry, dusty plain with no water, at least 30 miles from the nearest ANYTHING, and a lot further from even the nearest small town. I liked the Maasai immediately. They were very poor, and very proud, and very confident in their strength and their identity. And very tall.
Pretty soon, it came out in conversation that I was a doctor, and what happens everywhere to all doctors happened to me: “Oh, you’re a doctor—hey, do you mind having a look at this thing on my [insert any body part name]?” So I attended one person. Then another. Then another. Then I was sitting on a small stool under an acacia tree and seeing people as fast as I could. Lots of little problems, some big problems. Musculoskeletal issues, pregnant women, respiratory issues, old poorly healed injuries (lion wounds). The oversized personal first-aid kit I had with me was quickly emptied and I went “Oh….resource-limited health care. So this is what that is. What do I do now?” There was still a big group of people that wanted to be seen.
I started get creative. If someone had back pain, I showed them straight-leg stretches and safe lifting techniques and explained why they could help. Everyone was chronically dehydrated and I talked about the importance of drinking enough water but acknowledged that since the village had to buy all its water, that would be difficult but maybe the pregnant women could be prioritized. I did some wound care. I wasn’t able to do everything I wanted to do for everyone, and often there was devastatingly little at all that I could offer. But I tried very hard to find something.
Hours later, it was time to go. I stood up and the chief’s son and several other village leaders thanked me and gave me Maasai jewelry as gifts. I promised that if I could ever come back, I would. Then I got back in the Land Rover and was pretty emotional. Something had happened to me. I knew that this was what I wanted to do. This was the medicine I was looking for. As we drove away from the village I swore to myself that I would return there one day, or anywhere people were poor and far from care…and I would bring a much bigger backpack.
From that day I thought of almost nothing else but how I would do this…with my background on the water and the mobility and self-sufficiency of a ship, I imagined bringing help by sea, and began the “what if we…?” mental game that occupied me when walking though the hospital on rounds, when driving home late at night, when sitting at home, when walking through the grocery store. Eventually I had a plan to get a ship, get a crew, get supplies, and visit many locations and conduct mobile clinical services. I found an old, beat up-ship in Florida and with my sister Sky, my friend Ryan and a small team of dedicated volunteers managed to rebuild her. It took a couple of dozen people over a full year, with about 10 of us stuffed into one house, sleeping on the floor and working every day to rebuild the 100-ton ship we had obtained. It was touching because in one of the most economically hard-hit regions in the country, a LOT of people extended themselves to us and shared their time and knowledge and resources. And after 12 brutal months, we were as ready as we were going to be….
…and then the 2010 Haiti earthquake happened, we set sail for Haiti and haven’t quit since. The rest is history. After Haiti, then Honduras, then Haiti again during the cholera epidemic, then to Panama where we determined to build our first permanent rural health care and community development service.
Crossing the mountains in Honduras in a rescue helicopter transporting a family burned in a house fire 
Landing through the surf to conduct a clinic on the north coast of Haiti 
On the bridge of Southern Wind mid-ocean 
Ship’s officers’ pre-sailing meeting before departing Haiti 
Machete-Chopped toe paddled out to us for help 
Our first mobile clinic deployment in Petit Goave 
Our first Sonosite ultrasound in Haiti 
Wound cleaning in Haiti 
Years have passed since we first set sail for Haiti (it feels like a thousand years of incident packed into that time). Many mistakes, many hard lessons, many lucky escapes and many skills learned. My own destiny (and many others) altered forever in ways I never expected. I never dreamed that by now Floating Doctors would have grown so far and so fast. Who knows what the future will hold? One day I dream of seeing the Floating Doctors flag flying over similar permanent services rendered on many different shores, and perhaps a fleet of ships offering different specialist services traveling between land-based services, offering specialist care at each location annually. Or maybe something I can’t even imagine.
It all sounds so remote and impossible, but who can tell what may happen? After all, the unlikely epilogue to our origin story is that many years after my first visit to the Maasai village in Tanzania, I DID keep my promise to return…on my honeymoon with my wife Karine. We brought a much bigger backpack, packed the way I WISH I had known to pack all those years ago. My wife and I attended nearly everyone including people from neighboring villages, and when they learned we had just been married they slaughtered a goat and we shared a feast with them. Then they dressed us and married us as Maasai. And the moment when one of the senior women in the village took the copper rings from her fingers and placed them on ours was a moment I will never, ever forget. It feels good to have kept that promise to return, and to continue to keep that promise to others.
Beyond a lot of human kindness, a lot of hard work, and more than a fair amount of luck, I’ve learned that one of the secrets of this success story is that the world does not usually favor half-measures. I—and many others—risked everything to make this dream a reality, and there were many moments where we hung by a single thread…but here we are today. We arrived in Haiti a few weeks after the earthquake with literally NO money–no Floating Doctors money, no personal money… just a medical expedition ship full of supplies, fuel, food and a dedicated crew. And we worked without money for weeks until we began to receive other donations and began our long climb to the large-scale rural health service we now operate. When I look back on that first journey to Haiti, I think we must have been insane…and yet here we are.
There’s never a guarantee that we’ll successfully make every crossing we attempt in this life…but that first voyage to Haiti, and my visit visit back to that small Maasai village where it all began remind me to always dream big, strike out for the far shore with all your strength and endurance and to never to save anything for swim back, until your long swim ends with your feet touching down on a new world.
Fair Winds,
Ben
Click Here for Information About Volunteering With Us In The Field
Photo Credit: Matt Dayka/Vitamin Angels -
3 week untreated leishmaniasis lesion on lower leg
Leishmaniasis (often called “leish” or ‘peeko de vay-hoo-co’ by the Ngabe) is a tropical skin infection found in Panama. In Panama, Leshmaniasis exists in a natural reservoir of sloths and anteaters and is then passed to humans by female sandflies (chitras). Once infected, a small red bump will appear on the skin, turn into a blister, and later break open to form a slowly spreading skin ulcer. The sore is usually painless and not very itchy, and slowly enlarges over weeks. A key feature to look for when diagnosing suspected leishmaniasis lesions is that it is a slowly enlarging skin ulcer that does not respond to antibiotic cream or wound care.
The Nbobe sometimes fight the infection with topical treatments, covering it in battery acid to burn it out, which seems to be effective if somewhat scarring—patients trade a very large, shallow scar of untreated leishmaniasis for a smaller, deeper scar from battery acid treatment. There are some botanic remedies used by the curanderos that bear further investigation, such as applying the hot amber liquid expressed by heating the meat of a raw cashew nut, which we have seen used in some of the communities with promising results.
3 Leishmaniasis ulcers on young Ngabe girl in the Bahia Azul region
As far as western medicine is concerned, there is currently NO effective topical treatment for leishmaniasis, although antibiotic cream can be helpful to prevent a secondary infection of the lesion by other bacteria. The two existing treatments, which are 98% effective, are daily intramuscular injections with antimony (a heavy metal) for up to 21 days, or an intravenous medication called amphotericin B, which is very expensive. Leishmaniasis responds rapidly and well to these treatments.
Because the injections need to be taken every day, early identification is vital—the smaller the lesion, the fewer days of injections will be needed and the smaller the scar will be. If left untreated the initial skin infection can spread, spawning lesions elsewhere on the skin, and involving the mucous membranes (eyes, mouth, nose) with devastating consequences. If you are worried you or someone you know has leishmanisis, it is very important to get checked out as soon as possible.
There is no vaccine or preventative medicine that can be taken for leish, but there is one really good defense that is 100% effective if achieved—don’t get bitten! Easier said than done when it comes to sandflies, but the best way to minimize you risk of infection is to protect yourself: use bug spray, cover exposed skin, and use fans with airspeeds of 5+ MPH to keep insects away. Mosquito nets don’t usually work against sandflies because of their small size unless the net is regularly treated. Place the net in a plastic bag and spray/pour a lot of mosquito repellent (ideally with permethrin, but at least with DEET) into the bag. This will deter anything from even landing on the net and trying to get through. After all, there are way worse things than leishmaniasis that are carried on tiny wings…
Until next time, fair winds and safe travels!
Leishmaniasis scar on recovered Ngabe boy
Resolving leishmaniasis lesion week 6 (week 7 treatment)
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One of Dr. Dan’s canine patients
At last, a veterinarian has come to stay! Dr. Dan is a wonderful addition to the Floating Doctors team here in Panama–it is very hard to work in remote rural communities and see animals riddled with parasites or with horrible injuries that go untreated.
Dan and his wife Cindy moved in right next door to us, and have been incredibly supportive since they heard about our program. We invited Dan to join us on one of our mobile clinic visits to the community of Cerro Brujo about 45 minutes away by boat, and it was like the first time we visit a community–all the chronically suffering patients are brought. Dan had his hands full–a cow had been bitten by a snake, so you can imagine how happy I was to have a great vet!
Worms and other parasites that plague the communities often live in the animals, especially worms, so part of creating healthy communities is ridding the animals of their parasites. Dr. Dan has accompanied us to other communities, including making the trek to La Sabana deep in the mountains, and we are thrilled to have him as part of our permanent team here.
Dan shared an email with us that he wrote to his family back in the US after his first mobile clinic with us, and we would like to share it with everyone to introduce you to a wonderful vet and wonderful human being. Looking VERY forward to working with you and being neighbors! –Dr. Ben
Dr. Dan Ever’s letter:
Dear family and friends,
Dr. Dan’s office in tight quarters!
Thought I would update everyone after one of the greatest days I have had in Bocas del Toro Panama. There is a wonderful organization here called the “Floating Doctors.” They treat the indigenous tribes on the islands of Panama through purely a volunteer basis from people and doctors and allsorts of people from around the world, but mostly the United States.
Dr. Ben started this enormous project, which is his dream in life. The FD work through donations to continue their monumental task as the indigenous tribes have no medical care, scant transportation, and no money. They live off the land and sea. Well, today the FD invited me to go with them to a village on an island about one hour away and thank God I didn’t get seasick of which I am quite famous. A scrawny dog that jumped into the boat greeted us and I immediately said, “My first patient!” Everyone laughed.
Another canine patient riddled with parasites
As we cautiously treaded up the very slippery, muddy, watery paths high up the steep hill slipping and sliding and even getting on all fours, we eventually arrived at the village. Five or six dogs were there to greet us…”more patients,” I exclaim excitedly. While Dr. Ben and his assistants went into various huts to treat people, I was asked to take a look at a cow that had been bitten by a snake in her rear leg. “Sure, no problem! Lead me to her” I said to Juan through an interpreter.
But I hadn’t worked on a cow in about 27 years so…I know nothing about cows! Juan and the interpreter and I went down a steep, muddy path, crossed over a single, narrow log bridge, crawled in the mud under barb wire, then climbed up another steep hill on all fours, more barbed wire, and finally arrived at the family’s home who owned the cow. The cow was laying on her chest when we skidded down another hill to get to her. She promptly jumped up but could not walk well due to a possible hairline fracture in her left ulna/radius area. Although she could still kick the daylights out of a mere human, and of course “gore” a mere human with her horns, Juan grabbed her by the nose and I proceeded to give her an antibiotic injection in her neck with lightening speed due to fear.
Dr. Ben consulting with a peace corps volunteer about issues in the community
Dr. Ben went into their home of which I have included a picture, and he treated a young woman who had scabies. The trip back to the main village was more difficult because of a light rain. I was also called on to look at a pig that was not eating and depressed. Juan grabbed that pig and body slammed him to the muddy ground. Although that pig was sick, he certainly put up a valiant fight and ear piercing “squealing” while I stuck my finger up his butt to retrieve a fecal sample for analysis. Gave him an antibiotic also and it was then another hike to see another pig that had some paralysis in his rear end but could still walk some. Didn’t know what the heck to do to him…yup, another antibiotic injection while the pig was squealing and Juan had him in a headlock.
Lastly, Dr. Ben has arranged a project to lay a water line downhill to a new birthing house for the people. Apparently a large group of students from Yale University are arriving next week and that is one of the things they will be doing…. ha-ha, would love to see the look on their faces when they see the mud, the slipperiness, and the steep, straight-up hills! Get on all fours lest you ski down the Black Diamond of mud! Juan then chopped down some coconuts, sliced them open with his machete and gave them to us to drink to thank us for coming to his village. That was the best drink I have EVER had in my whole life! We were all sweating, exhausted, and sooooo grateful to him for that nectar from heaven.
Another reluctant patient getting dewormed
Before I got into our boat, I told Juan that he was my number one assistant and asked him if he would always help me because I think he is “Superman” (all through the interpreter of course). We loaded our boats again and off we headed to an island even farther away, but the rains poured down and we turned around and headed for home. Dr. Ben asked if I would be willing to accompany him every week to the out islands to help break the parasitic life cycle of which his patients are susceptible. I told him I would be honored just to accompany him and that I have never been “paid” so much in my life. Well, I really can’t believe that I have written such a long email and even send pictures! Hope you are fine and we love you and we will see you next week!
Dad/Dan
P.S. Anyone have some books on pigs and cows?
My first cow patient in about 25 years. Snake bite in rear leg and lame left front leg.
Boat dock entrance to the village and muddy pathway
The family who owns the snakebitten cow
Path through the village. My poor sketchers!
My humble little office
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MARCH 10TH: TRAVEL AND FIRST DAY IN BOCAS DEL TORO
The adventure began with a small group of eager travelers. We waited during these beginnings: waited for the train to take us into New York, waited to get out of the frigid cold airport, and waited to arrive at Panama. And after hours of travel, we arrived in paradise where we settled into our hotel and cooled off in the pool with some Latin tunes in the background. After an early start (3 am!), our group hopped on a plane to Bocas del Toro, where we were greeted by our sunny volunteer coordinator, Skye; the blue Caribbean sea; and the rooster outside our rooms.
After a much-needed nap, Dr. Ben, the founder of Floating Doctors, shared his vision with us on projects to better the community: like building walkways in La Solución, working with elderly people in El Asilo, and many more. We then met the team of devoted individuals who each shared Dr Ben’s commitment to better public health and access to medical care. And after our team meeting, we celebrated our beginning with hopes of making a positive contribution in the next few weeks.
Post by Carolyn
MONDAY, MARCH 11TH: FIRST WORKING DAY!
Bringing wood to the new walkway
Trash. A morning in the village of La Solucion definitely taught us to appreciate many of the basic services we take for granted in our everyday lives. Waking up mid-morning and heading out into the beaming sunlight, we “dove” into the waters below this makeshift community to clean up the trash that had been building up for months; we found the work to be both humbling and rewarding.
The casualties of Lucy, Caroline, Carolyn, and almost Patty by falling in the wastewater epitomized the fruitful sacrifices we made to help this struggling community. After a quick lunch of empanadas, served by the nicest and most caring Panamanian boy, we headed back out into La Solucion to tackle a bridge-building project and
continue with the garbage clean-up. This time however, our efforts were aided by children of the community (who by the way, were the most adorable and sweet kids ever). The smiles and cuteness of these children definitely alleviated our tired bodies and was definitely one of the major highlights of the day.BEACH. There is not a better way to rest from a day of hard labor than by heading to a nearby beach in the afternoon. Sweet waves and salty waters felt absolutely amazing. And after a picturesque dinner, where did we go? Back to the beach of course. A warm, loving night with the mellow sound of ocean waves crashing around us was the perfect way to end the night. La solucion? THE BEACH? Panama Spring Break 2013 couldn’t have started off on a better note!
Post by Jiou
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It had been roughly 48 months since I first began working with Floating Doctors and 30 months since my last day on the Southern Wind. Strangely enough, after spending a semester and half helping to transform a dilapidated boat into a beaming vessel of hope, the feeling of wanting persisted. You see, amid all the hammering, sanding, fiber-glassing, painting, shellacking, presentations, donation collection, and cold-calling, I had not been able to realize my ultimate dream; that is, I hadn’t helped a single patient directly. Landing in Panama, however, punctuated the final sentence of one chapter and penned that iconic first calligraphic letter in the next!
One of few characteristics I share with Ben our fearless “captain” – a sobriquet stolen from the cinematic classic Dead Poets Society – is that I love people. And arriving in a foreign country, for me, is akin to a kid in a candy store. As I jumped from traveler to traveler, I stumbled into a conversation with an off-duty flight attendant who was hitching a ride on my flight. Ironically, her free trip transitioned into funding my transit from Tocúmen International Airport to the hostel where I was spending the night. My mother was a flight attendant with TWA for over 30 years and Elizabeth (the American Airlines flight attendant), like any good flight attendant, took me under her wing and drove me to Luna’s Castle in Casco Viejo. After sleeping for a whopping 4 hours, I packed up and caught a cab for Albrook Airport. To my dismay, I had not accounted for the 1 hour time change and was relegated to posting up on the steps for an hour until the doors opened. Despite the lack of cushioning provided by the pavement, I was enjoying the comfort of cloud nine. In only a few short hours I would rendezvous with my long lost compadres and be reunited with a project that has never been far from heart.
As I stepped onto Bocas soil, I spotted a familiar face. In his usual b-boy stance – only this time he was leant on a weathered bmx-style bicycle – Noah greeted me with a smile and a heartfelt hug (a rare and cherished gesture from a hardened, NJ tough guy). I introduced him to Nereida, a young Colombian woman I met at the Albrook airport, because she was excited to volunteer her time as a translator at our next clinic. As soon as I stepped into the main house, I proudly published my philanthropic smuggling by spilling all 80 lbs of medical equipment and medicine onto the sofa. Their eyes lit up with excitement at the mound of glucometers, vitamins, analgesics, antifungals, scalpels, hemostats, nitrile cloves, bandages, etc that were graciously donated to me by professors, students, and friends at Touro University Nevada (the osteopathic medical school where I am a first year student). What made me happiest was when Ben looked at me with his characteristic calm and poignantly professed, “we are gonna’ help a lot of people with this.” And if you don’t know Ben, you should understand that he is one of those people, in that weirdly inexplicable way, you want to make proud.
After reconnecting with Ben (The Doc), Noah (Mr. Fix-it), and Sky (Operations Extraordinaire) at the main house, I was escorted to my new home for the next 12 days. The “Warehouse,” as they called it, was a non-descript white, rectangular structure that housed the essentials: volunteers & supplies. I met my new roommates and resident techies, Chris and Ishan. Only moments after setting my luggage on the bed, was Noah jingling the keys to the skiff. As we bounced on the mild coastal water chop, I caught sight of a beautiful bow of accomplishment. The winsome ruggedness of the Southern Wind instantly brought me back in time to Palm Coast, Florida. As the memories bum rushed my brain I took note of the exhilaration yet to come. A Dream Realized.
A day or so after my arrival, a sizeable group of nurses and nursing students from UCLA and SFSU joined the team for a 10-day medical mission. The original crew gathered everyone around for introductions over Sky’s famously amazing cooking. Ben and Sky welcomed everyone with a big thank you for donating their time to the Floating Doctors family. Even before the food could settle in the stomachs of our excited bodies, we were packing medical supplies for the upcoming mobile clinic. Vitaminas, analgésicos, y otra medicinas were neatly packed into small baggies with dosage and instructions. As we eagerly inventoried what we needed to bring with us, we shared our stories: how did we hear about Floating Doctors, our motivation to be in medicine, and why we wanted to help provide care to the people of Bocas. We all agreed, “this is going to be an awesome experience!” After talking, inventorying, overdosing on children’s gummy vitamins (they were decidedly useless due to the unforgiving Panamanian heat) and getting one of the few full night’s sleep we were privy to while in Bocas, we found ourselves on our first mission. Asilo, the local nursing home of sorts, is a regular visit for the Floating Doctors and we were all excited for the privilege of spending time with a bunch of interesting old souls. Every person in there, regardless of lost limbs, elevated blood glucose levels, and wandering lucidity, had a heart of gold. They all had stories to share and were so happy to just have someone new to interact with. Aside from doing standard health screenings, I found myself most enjoying the intensely competitive dominos games. Victor, and 80+ year old Bocas native, did NOT like to lose. However, after a few wins he honored me with a non-verbal gesture indicating that I was a worthy opponent. I’ll always treasure our games; slamming the porcelain pieces on the thick wooden table, boisterously declaring our victories and laughing over our strategic blunders.
Over the course of my time in Panama we helped many in the immediate area, in addition to those more than a few hours into the Bocas Del Toro Province. Small towns like Almirente, Las Tables, Changuinola, Popa, and others spread out on the mainland and among the neighboring islands of the archipelago, were all places that were in dire need of help. The one day clinics were amazing because they finally gave me that patient interaction I craved and still crave. It was the multiday clinic, however, that really opened my eyes to the barrier-breaking work that the Floating Doctors pride themselves in. Just before my we embarked on the multiday clinic, I was able to accompany Ben on a small expedition of sorts. Unlike the medical care in the United States, where bureaucracy, fear of liability, and the incessant fixation on time spent per patient are barriers in and of themselves, the care the Floating Doctors provide in Panama is subject only to one unforgiving notion: every patient is a person, and every person deserves to be sincerely heard. Ben, and all those who personally grow from being part of the Floating Doctors, embrace this notion and understand that doing what it takes to improve someone’s life is more than simply writing a script or audibly enduring a few complaints. Delivering care, regardless of location, is about truly hearing the needs and wants of a person and their situation and then making a concerted effort to provide for them. I knew this to be true when Ben took me on a 4.5 hour trek into the jungle to make a house call to an elderly woman who had severe complications from her untreated diabetes, e.g. neuropathy and ulcerations on her feet, bowel obstruction, colic, headaches, and generalized sluggishness. I was able to take her blood glucose and assist Ben in logging her information. We were invited into their home and we did the consult in her bedroom (where she was most comfortable). Unhindered by time restrictions, unremitting insurance regulation, and exorbitant costs, we were able to truly hear her needs and respond accordingly. We were able to make a follow-up visit to check how she was handling the appropriate medication, and to secure an open line of communication with her eldest daughter for routine care.
Once on the multiday clinic in Las Tables, I finally experienced what all of us in the original crew dreamed up so many months earlier. Attempting to sleep to the dissonant, yet seemingly operatic, tunes of feral farm animals while on the floor of a small two room house that had no glass windows, no air conditioning or fans, no hot water, no refrigeration, and limited lighting, was a clear indication that this was the REAL deal! In the morning I shrugged off a stiff neck and traded my bagged eyes for a warm smile because I was about to do what I came to do; I was going to make a difference! We were greeted by a line of about 60 people, ranging from infants to great grandparents, and the line continued to grow as the day went on. No matter how many people we saw, the crowd never seemed to clear. Although I wasn’t a bona fide provider, I was able to take records, vitals, and some diagnostic blood tests. I learned a great deal about the art of the patient in-take, diagnosing, and treating. I learned more in 3 days than I had ever learned in a classroom and I yearned for more. The BNF (British National Formulary) became my bible and I was constantly, and many times frantically, looking up conditions, drugs and their side effects, while trying not to miss the next case. At night I would try and review my notes and make sense of each case – the feeling I got from learning was unfamiliar. I was no longer simply reading a medical textbook, I was investigating a case! However, nothing compared to spending time with the village children. It was a steadfast reminder of why I am certain that pediatrics is the specialty for me.
Even if I was simply giving them a sticker, playing a game, or giving them a reassuring smile, the children always reciprocated with genuine enthusiasm. One young boy, Luís was quick to befriend me and we spent a good amount of time taking pictures, playing soccer (albeit with a flattened ball), breakdancing, and catching countless cases of the giggles. The Road From Dream to Reality Begets Another Beginning. Leaving Bocas was difficult, but I had medical school waiting for me. If I wanted to make a difference in the lives of others and feel the fulfillment of being a physician, I would have to go through the training and earn the degree. My time in Panama with Floating Doctors armed me with an invigorated sense of purpose that I hope to maintain throughout my medical training. Even now, as I study for my first big exam next Monday, I am reminded why I am doing all this. Finally experiencing a medical mission trip with Floating Doctors not only brought things full circle, but has inspired myriad goals for the future. I am working on improving the mobile technology, in terms of hardware, for their patient records. I am working with Touro University Nevada to get them portable computing devices for both patient records and diagnostic purposes, as Ishan and Chris are working hard to create a new online patient database/tracking system (probably not using the correct jargon, but I’m no “techy”). I also plan on bringing a bunch of first year medical students down next summer to experience what I have – there is nothing more motivating! I am so impressed with how much the organization has grown and how it continues to grow. I am very proud to be part of the Floating Doctors and I can’t wait to return! I am already wondering how this project will grow and what my role will be. Floating Doctor’s was born with Ben’s vision and has grown by providing a platform for others to live their dreams. In the end, it seems, every milestone humbly begins as a dream – I cannot be happier because, just like Ben, I love to dream!
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Prepare to deploy…
There comes a time in any journey, when initial prejudices have been shed and before nostalgia settles, when one can see things as they are. I spent the month of October working with Floating Doctors, and for me that moment came while traveling from Bocas town to Kusapin on the panga, the group’s small run-about boat. Ben was at the helm. Tall Greg was at the bow intently listening to a book on tape. Little Greg had claimed the good seat, a plastic chair. I was lying on my back, mid-boat, reading about three men adrift in a tiny raft after their plane crashed in the Pacific ocean. It had been a still and shining morning, but when the sky turned dark I sat up to watch the sea, slightly concerned we might become like the characters in my book. I was more afraid that the increasing wave size would mean we’d have to turn around and I wouldn’t get to visit the fabled Kusapin.
I had extended my time in Panama in order to do one more mobile clinic: five days in Kusapin, a large Ngabe-Bugle community situated at the end of a peninsula jutting out from the mainland and accessible only by boat, a 3-hour ride from our Bocas base. Due to inevitable developing world delays the clinic had been postponed, and because it is not possible just to send a memo, we had to go in person to relay the news. Which is what we were doing when, watching the coast slip by, I had my moment. Being rather simpleminded, my epiphany was not exactly fireworks. It went like this: This is good.
In the preceding weeks I’d fretted over how I was practicing medicine in the clinics we held. I am accustomed to fully
When all you have is your hands…
equipped emergency rooms, the latest technology and medications at my fingertips. At home I check diagrams, doses and drug interactions on my phone, then I recheck them on the computer. I call the neurologist, the urologist, the hematologist. I go the radiologist reading room for further explanation, repeat labs, and have my patients come back for 24-hour follow-up visits. I was not always so neurotic. Prior to studying medicine I had dropped out of university, a few times. I’d worked on dive boats, monitored chimpanzees on an island in Lake Victoria, studied Indonesian in Oregon, called a horse-trailer home. I’d worked for a newspaper in Austria until I quit in order to climb. Then I traipsed around central Africa and worked for magazines. My shining minute was performing at the New York Metropolitan Opera. I rode a horse across the stage, which, although less than 30 seconds in the spotlight, would have been brilliant had I not been forbidden to open my mouth. Despite being tone deaf, I really wanted to sing.
Returning from the mountains; almost home!
The more we engage with the world the more it makes us want to sing, and the more it breaks our heart. At some point I realized it wasn’t enough to dance around stealing stories. I decided I must do more, it was time to become… something. Medicine seemed a good something, so despite the fact that I didn’t know the difference between an organ and a hormone, I applied to Cornell Medical School’s PA Program in New York City. My application was about how I would return with a skill to the places I’d been where there was a lack of even the most basic health care. I wanted to be able to offer something solid to the people who had so graciously welcomed me into their homes and lives. I wrote my essays about malnourishment, malaria, child mortality.
The next couple of years were spent stressing about microbes and molecules and mundane things like exams. Then came the humiliating experience of clinical rotations. There was the New York-Presbyterian cardiologist who interrupted me as I waffled through an EKG interpretation: “I’m a bullshitter too, Antoszewski! But this is someone’s heart you are assessing so I advise you get it right.” To this day, despite having now practiced medicine for six years, I’m haunted and inspired by those great doctors and nurses who taught me accountability. What test have you forgotten Claire? What question are you not asking? I learned responsibility. I also learned fear. It is one thing to play with our own lives, but someone else’s life… First do no harm.
Yet here I was, in remote Panama, seeing patients, not in a white coat but surf shorts, relying often only on hands
Thank goodness it’s strawberry flavored…
and stethoscope. I was handing out puppies instead of pain killers, prescribing antibiotics without the benefit of cultures, assessing limbs and lungs without imaging. There were parrots on the examining tables for crying out loud. I was very happy. I was also rather uneasy. Is it better to do something, even if that something is imperfect, rather than do nothing? I banged my head against this question, turned it over and over in my mind and in conversations. But what if we do harm by not believing in our dreams, by not putting them into action?
Floating Doctors dispenses soap, toothbrushes and vitamins at every clinic. This is a good thing. In the communities we visit worms are rampant leading to dehydration, malnutrition and other complications. The worms can be eradicated with one dose of the medication albendazole. Also very good! The Ngabe think the free eyeglasses are great. Education about water purification, nutrition, and sexually transmitted diseases is desperately needed as the modern world encroaches on even the most isolated peoples. And whether or not there is a hospital, there are always sick people. Should a tumor be ignored because there is not an operating room one floor above us? May be in the over developed word we rely too much on technology. Certainly I have often balked at scanning the head of a child who took a small tumble. A CT scan of the head is equivalent in radiation to roughly 100 chest x-rays, and studies show an increase in the risk of cancers secondary to medical radiation. When I quote this as reason for observing instead of scanning I am asked to imagine what the prosecuting attorney will say in court if the child has an intracranial bleed. There is a trend in the United States to practice medicine defensively. This is not necessarily good. I suppose wherever we work there is room for improvement, and we are constantly weighing the good against the bad.
Painting children purple with scabicide
Like many of those who practice medicine in the world’s neglected places, the Floating Doctors do not have the luxury of MRIs, there is no lab, no specialists waiting at the end of a pager. Where we practice we go on small boats, skinny ponies, our own feet. The donated medicines are carried in plastic bins. But the patients are the same whether seen in a city hospital, a private doctor’s office or during a home visit to a thatched-roof hut in the forest. They have a pain, a concern, or a question they need someone to address. They are pregnant and worried about the baby. They have headaches, constipation, wounds that wont heal. They have a child who is not eating. They have a child who faints. The child who faints has a hole in his heart. Whether or not we listen to the heart doesn’t change the hole. But because he listens Ben can put in motion the steps it will take to get the boy the surgery he needs, and that changes everything.
All of this I thought about, or rather I felt, as we bounced along in the panga that day. The dark had become a storm and the storm drove us to seek shelter on an uninhabited island. Ben drew a diagram in the sand with a stick, made squiggles to show the currents, more lines to denote wind, and an indentation to represent where the ocean floor sloped. Basically, given the conditions it was not safe to make the ocean crossing to Kusapin in our small open boat with its one outboard engine. We had to turn around. I was more subdued on the ride home, but the panga’s loud engine precludes conversation and the sea and salt are conducive to contemplation. I felt a quietening of the questions. My pendulum has had a wide arc, but with Floating Doctors I seemed to be finding a balance. I was remembering why I wanted to study medicine in the first place. It is important to doubt. But we do ourselves and the world a disservice if we forget that shining, elusive something called faith, or hope, or may be just a better tomorrow. After we tied up the panga that evening, Ben said, “Well, we’ll try again tomorrow.” I took a hot shower, and curled up in a hammock to finish my book. Against all odds, having lost everything including the clothes on their backs because the raft capsized again and again and again… the three men were rescued after 34 days at sea.
Learning to dance Ngabe-style
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maggots in a tunneling ulcer
Ah, the Asilo…one of the places we heard about here in Panama when we were still in Honduras. We found a unit seldom visited by a doctor (in a year), but with a wonderful staff of no more than a cook, cleaner and nurse on each of the two 8 hour day shifts and 2 on the night shift. There are 27 patients there, all elderly, ranging from totally mobile to totally bedridden, some without sight, some without limbs, many with varying degrees of dementia—they all have to be fed, bathed, many changed, floors cleaned, meals prepared and cleaned up after…the fact that the floors are clean and the patients are clean and fed is an extraordinairy achievement, but the patients need more attention.
When we got there I thought they were totally medicated…so many of them looked so catatonic…it turned out almost none of them were medicated,
They seemed so catatonic when we first were working there
or where very occaisionally medicated. They were just bored and unstimulated, almost into catatonia. It was months before some of them spoke; I came back from 5 weeks in California to find patients that I thought had no power of speech actually talking with me. It was like awakenings, and it isn’t because of medication, it is because of all the time our volunteers and people in the community have spent with the patients there. Many had not been out of the grounds for years, and now walk in town weekly—our friend Javier, a Colombian physiotherapist in town who also works at the Asilo, brought his four horses and our elderly patients dressed up and rode like kings and queens through the streets, looking down around them as if to say ‘So…this is Bocas, you say.’
one of 3 trucks of trash we removed
The mayor sent three trucks and we removed several tons of rusted metal and trash from the grounds and landscaped a little (more to go), repaired two broken washing machines and plumbed 3 in total (the only working one had been filled by bucket), installed handrails in the common area for walking and physio, changed the showerheads to removable handle versions, put a commode chair in the bathroom, created and update charts for the patients, provide medications, and have done our best to provide the additional more advanced care that the staff are sometimes not able to provide.
When we arrived, there was an elderly stroke victim, immobile and unable to communicate, and terribly emaciated and contracted with bedsores
emaciated, rigid, and covered in bedsores
all over. We worked for weeks, doing wound care and working with the staff to use advanced wound dressings we provided and creating turning regimens—our goal not to extend his life, but to allow him to die with more dignity and in greater comfort. At one point he got a chest infection and we stood by to administer oxygen and midazolam and buscopan to make him comfortable as he passed, but he rallied…and subsequently gained 12 pounds and the ability to focus and speak a little (very, very little) before he died quietly one night in his sleep a few months later.
ulcers spreading in a deteriorating body
And he died with not a single bedsore on him…that was a victory to me, at a personal level. I hate it when people die with their bodies disintegrating externally around them as well as internally. It is unnecessary, but totally natural for birth and death to be so awkward and difficult…the first time doing ANYTHING is usually awkward and difficult: the first day of school, first kiss, first great loss, first great love, first great adventure, the first and final sunset cruise, and finally, the end of the voyage.
Any ship, no matter what storms it has weathered and what damage it has sustained in a long life of navigating unknown waters, wants to look its best when it pulls into harbor for the last time. There should be dignity at the end, as much as can be wrenched from an unfeeling universe. Not always possible…but always a betrayal not to even try.
My cousin, a physical trainer, just arrived here for a few months…I have another patient in the Asilo who has not walked for 9 years after his stroke. He stood up the other day after exercising on his own, ferociously, with some basic exercises we showed him after we applied a difene patch to his paralyzed knee for knee pain, and he and we found out the immobility was more pain-related and he could move it a little. He freaked out an dhas been exercising like a fiend.
Our friend Bolivar snapped some pics in the asilo while we were working there one day
I came back from California and he collared me from his wheelchair and looked me in the eye and said ‘Yo Puede CAMINAR!’ And stood up, giggling like schoolgirl. Sometimes things are too much for me to process when they happen…later at night, especially when I’m writing a blog or making a facebook album of the day, I start to process…thinking about that patient a lot. I want to go for a walk with him before he dies—and he might live for many more years, so if he does, I’d like him to be able to walk, and he REALLY wants it, more than almost any patient I’ve ever seen. I feel tiny beside the strength of his determination.
Matt and I changing a suprapubic catheter blocked after 11 months of neglect
I tell all my incoming student volunteers (I have my little speech about this prepared): “You are so lucky we have the Asilo for you to volunteer in. Not only does every second you spend there interacting with some of the loneliest people I have ever seen benefit them beyond what you can know, but care of the elderly—and especially in this setting—is where you find out if health care is for you.
Eve and Sarah doing wound care on tunneling ulcers
“Yes, it’s challenging, the medical issues are very complicated, the patients may have dementia and can be challenging, and you have few resources to deploy except what you can somehow manifest…but beyond that, its where you learn things like ‘are you the type of person who is thoughtful enough to throw a corner of a sheet at least over the exposed genitalia of some bedridden shell of a human during some procedure that leaves them all exposed?’ Or ‘When you lift a frail contracted foot off the bed, do you automatically support the knee out of awareness (to avoid torqueing the knee)?’
walking the patients
“It’s a good place to learn PATIENT CARE…not something everyone can learn, because some aspects of it I just don’t think you can teach. I feel like I have to practice at it constantly…people are afraid of old people…can you learn to look past the rotting shell of their failing minds and bodies to ressurect in your mind’s eye when you look at them the glory of their individual histories? It is like looking at old ships tied up in the scrapyard and neglected, never to leave again…remember that those ships voyaged 70 or 80 years across 2 or 3 of your lifetimes…can you see who they were and what oceans and storms they have passed, somewhere inside the wrinkled, frail bodies awaiting their final voyage?”
I love the Asilo…my volunteers go more frequently than I (I only have 2 hands) these days, but I love going in and seeing my friends there. We need people in the community to each give 30 minutes once or twice a month…come on…an hour a month, that’s pretty good…want to walk patients with us? It is awesome—email us or (better) contact us on facebook if you want to go for a walk with us and be checked out to walk patients on your own. One hour per month…you saw the walkway we all built in La Solucion; a miracle happened because everyone showed up and made it with their hands and time.
giving time
Make a miracle happen at the Asilo…everybody give an hour a month, and every patient will be walked several times a week instead of never. They’ll get stronger and be more fit (less pain), and be more mobile (and they HAVE to be, the ones that are bedridden have the worst time of it). Let’s make it happen Bocas!
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Building a wheelchair bridge for a girl with CP
When I last posted in June, a couple of months in, we had just started to really connect with the various subcultures in the Bocas Province, and some situations we quickly identified for interventional projects were as yet beyond our reach. Now we have many more friends and contacts in the community, and we can tackle much more ambitious projects for far less cost.
We have:
• Partnered with local group Operation Safe Water to help transport and install raincatcher systems at local schools when we run clinics
• Arranged CPR certification for the fire department
• Worked with the Ministry of Education to train local high school students as trainers for health education in the community and give them medical work experience by participating in our mobile clinics
• Created pictorial and written information sheets on health issues we have identified and that we make available at our clinics
• Gathered and data-entered over 600 patient health data sets and begun doing surveillance of our own interventions and identifying health issues from the data to help guide our mission activities
• Microfinanced patient transports to care on the mainland and chaperoned them in the hospital system (many Ngobe don’t speak Spanish, and are VERY shy, so they easily fall through cracks in systems)
• Connected with an indigenous Curandero to identify and investigate the plants he uses medicinally and are helping him develop his small botanical laboratory always keeping a lookout for.
• Arranged and executed a CPR and First Aid Seminar for the cruising community in Bocas
• Partnered with the Mayor’s Office to run mobile clinics in conjunction with the government visits to the community
• Partnered with the local Lion’s Club to work in a community they support and help supply the neonatal support unit they built with Direct Relief International suppliesAnd, as always, sometimes we find situations that are just not right. Por ejemplo…
Unacceptable for a 14 year old in a wheelchair
While I was in California, Dr. Barney found out about a 14-year-old girl with what turned out to be undiagnosed cerebral palsy in a small squatter’s community called La Solucion. I have been told it used to be where the airport is now (right next to a mangrove swamp), and when they built the airport the community moved out onto shacks built on stilts over the mangrove mud.
She comes to land at most twice a year…land is about 100 feet away over the sewage-contaminated swamp (all the homes
She has rarely, in many years, been to shore
have outhouses and sink drains that drain directly into the water below). She has never gone to school…she has a wheelchair, but rarely uses it because she has nowhere to go; she has to be carried over the dangerous footbridge by her grandfather, and she is too big now for him to carry (Noah noticed he has drop-foot also…potentially a serious falling hazard, especially if you are carrying your 14-y.o granddaughter over a wet slippery footbridge). She is COVERED in bug bites…she can’t really swat bugs away or keep moving to keep them off her, and she lives in an open unscreened house on stilts over mangroves.
Her grandparents have always thought they were at fault for her CP because she fell out of bed at 6 months (though she had never crawled, which makes me think it probably was CP at birth)…they have carried that burden and they always worried they would get in trouble if the hospital found out, so they have indicated that she has never seen a doctor.
If I were a Hollywood writer writing for some medical drama, my editor would probably throw me out of the building for it being so unbelievably challenging emotionally and physically…but this is real life…this is somebody’s actual life. Sometimes people ask if I miss ‘the real world’…let me tell you, it looks pretty real from where I’m standing.
Driving pilings into the sewage muck of La Solucion
We said we would build her a walkway, and now—6 months into our time in the community—we called on the community to help and EVERY level of Bocas society came together to make it happen. Mangrove posts from an indigenous community, lumber and funds and food from local Panamanians and expats, help from boat owners, crew on other boats, locals from La Solucion, local taxi drivers, local restaraunts…at the last minute we even had no trouble rounding up 2 sledgehammers (one from the fire department and one from the fish market, which I sometimes haunt in the afternoons when the fishing canoes come in).
Everyone gave a little (some more than a little), and in 5 hours we sank thirty 10-foot mangrove tree trunks 7 feet into the mud, from the shore all the way to her grandparents’ house. The walkway went on in the next few days, and then this little girl went to shore (we still have some work to do to finish the walkway and make it safer for a wheelchair). I asked if there was anything in particular she wanted to do on shore (which she can see, 100 feet away) and she said ‘Quiero pasier’—‘I just want to go.’
planking the wheelchair walkway
This is my favorite, favorite kind of project…one where the whole community comes together when it learns about a situation like this. When the walkway is done, it will have been done right, with the right material (always seek expert advice) to make it last for many years. No matter what, this girl’s life is going to be changed forever—and here’s the best part: total cost for all the lumber, food for the volunteers actually building the walkway, gas to go pick up the posts from another island, hardware, etc: less than $1000.
There’s opportunities for helping, constantly around us…when we are alone we can help in small ways…but mira aqui, look what we can do when we all come together! Poco a poco para cambiar el mundo.
Please click on any of the images to activate the slide show viewer.
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I need an opthamologist
The last time I wrote a blog, an unconscionable number of months ago, we had recently arrived here to Bocas del Toro and I ended the blog excited by what might be possible over the coming months…now those coming months have passed, and it is time to catch everyone up and take stock of what we have accomplished here in.
6 months ago feels like a million years ago…with more long-term volunteers, we’ve been able
I love my sister
to really expand some parts of our project, including self-surveillance. I looked at what we had done—how many mobile clinics, how many volunteers, how many projects, how many patients…it is overwhelming to try and describe. I should either write bullet points, or a 3-volume novel to describe everything since my last update.
Canadian medical student doing kids health checks
Over most of our time here, for example, for every 3 days we were here, we ran one day of mobile clinic work—even counting rained-out days (and it rains 150 inches a year here) and days we were involved in any other kind of activity, whether it was working on boat projects, escorting patients to the mainland to get treatment, holding office hours in our consultorio, working in the asilo, eating, sleeping, or doing anything else. We’ve seen over 3,000 patients in more than 17 communities that we visit on a roughly 2-month rotation across the entire province of Bocas (an area of over 4,500 square kilometers), in addition to all our other activities.
No matter what other projects we get involved in, the core of Floating Doctors is our mobility—even the permanent clinics we are now working to establish are to serve as bases from which to continually run mobile clinics by panga, as we have done everywhere we go. I’m incredibly proud of all my volunteers and my crew for maintaining that level of dedication to work one day of mobile clinic for every 3 days we were here.
We’ve seen a lot of different communities, and noticed that there are enormous clusterings of health issues in different small communities that at a glance may seem similar. Why does one community have an incredibly high rate of obesity and diabetes, while the neighboring community has no obesity or diabetes but has lots of parasites? We have gathered detailed demographic and health data on over 550 patients so far, community assessments on a dozen different communities, and are beginning focused projects based on issues we have prioritized based on the data so far. Results of our first survey project coming in the new year…
ultrasounding in a chair in the jungle
We’ve started doing overnight and multi-day mobile clinics—getting two or more clinic days for the price of one day’s travel, since our accommodations have almost always been in the homes of local members of the community, or expats who notify the community that we are coming, house and feed our team, and often allow us to use their facilities to hold our clinic and arrange our transport to work in communities near their homes. I have been overwhelmed by the generosity of the expat and local community here…I have never worked anywhere—in the developing or the developed world—where the community at every level will actually deliver on its promises of support like here. From the Mayor sending trucks to help us cart garbage out of the nursing home, and letting us use his old consulting room to open for patient consults two days a week to the local marina workers who are giving their Sunday to help drive 36 10-foot posts into stinking mud to build a wheel-chair walkway, this is a wonderful community, with many eccentric people (after all, we are here too) and many people with good hearts who have shown us enormous kindness and support for our work here. Thank you to everyone—this is what makes Floating Doctors possible. A thousand hands holding us afloat…
We’ve also joined forces with the Peace Corps volunteers scattered throughout the province;
Harold, Peace Corps worker in Shark Hole; we did a clinic there on his very last day on site...a giant amongst his Ngobe friends; thank you Harold for your fantastic work
Peace corps Volunteers have thus far been 100% reliable—individual peace corps volunteers live (very often alone) in a community and work on a project. We got in contact with one, on the mainland, and ran a mobile clinic at his village…it is so awesome to arrive with everyone notified, a place to work, directions, someone to help interpret and to give us the inside scoop on patients we are meeting for the first time, someone to pre-arrange accommodation in the community, and best of all, the Peace Corps volunteers can and do follow up with patients that we have identified as needing more advanced care. This has been our experience with the Peace Corps every time we have worked with them, and we look forward to our upcoming multiday clinics to some new communities we are visiting through Peace Corps, including a Ngobe community way up in the mountains that I have heard a Peace Corps volunteer visited but that he thinks has NEVER been visited by a medical team. Looking forward to that later this week…
