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Playa Verde Remote Outpost at night
Playa Verde clinic opening
In a small jungle clearing on the Caribbean coast of north western Panama, a group of indigenous Ngäbe Indians in their finest traditional dress and an equally proud group of foreigners, with stethoscopes dangling around their necks, gathered to celebrate a landmark event: the opening of Floating Doctors first remote outpost clinic. It began as a dream, as an inspired idea, and following months of discussion, planning, coordination and manpower, it has emerged as a physical manifestation of the commitment to healthcare and strengthening relationships between Floating Doctors and the community members of Playa Verde.
Playa Verde construction crew
Floating Doctors has been providing free, high quality, remote healthcare to Playa Verde and other communities throughout the Bocas del Toro archipelago and Chiriqi Province for several years now. Every 3 to 4 months we would arrive at each community laden with bags of equipment, paperwork, medications and volunteers, eager to see old friends and sad to hear of others departed. Each time we left we would go with heavy hearts, knowing that there would be no medical care available except for that which we organize, or until we returned. This time however we arrived knowing that we were here to celebrate the opening of a clinic. A place that will be a cornerstone of healthcare, health education, cultural exchange and a base for reaching even more remote communities around the coast.
Volunteers Rachel Blackwell and Scott O’Rourke sand the new clinic
The day started with a flock of volunteers sandpapering and painting the building, finishing off wooden examination tables and mounting cupboard hinges. At around 11am Ito, the village mayor, blew his conch shell to summon the village to the inauguration ceremony. Local men, women and children gathered alongside the Floating Doctors team and there was a flutter of excited anticipation rippling through the group. The ceremony opened with a short blessing from the community religious leader, and was followed by a heartfelt and highly emotive speech by Ito, welcoming Floating Doctors as part of the community, sharing his aspirations for healthcare and cultural growth, looking forward to a long and healthy relationship with Dr Ben and all the team. Eta, the much loved Peace Corps worker, who was instrumental in coordinating this project from the Playa Verde end, said a few words in both Ngäbere and Spanish and handed the baton over to Ben where huge thanks and important acknowledgements were given, wrapped within an eloquent expression of gratitude, hope and future ambition. Following a series of photos to mark the occasion, a huge feast ensued. Piles of yuca, rice, beans and beef emerged and were shared out amongst all, and the afternoon clinic took place amongst a sea of smiles and well sated bellies.
Ito calls the community
Five of us stayed that night in the new clinic, in preparation for a full day of work there the following day. After sundown, just as we were settling in for the night, a young boy came to the door and asked if we could help him – his grandmother had just been bitten by a scorpion. The clinic was proving it’s worth on it’s very first day! We picked up our emergency kit and our head torches and followed the boy home to find his grandmother on the floor in serious pain. We sat down with her and inspected the culprit: a small brown scorpion, now chopped in two by machete. No mistaking what had bitten her then! Whilst monitoring her we took the opportunity to learn a little more about common biting creatures and the local remedies they use. Fortunately, for an adult, this was not a particularly perilous scorpion and following an hour of observation, administration of medications and educating the family regarding signs of worsening, we retired home. An early morning visit the following day reassured us, and revealed to us just how appreciative the family had been for the care and reassurance they had received.
Private Examination Room in PV clinic
With rain pouring down in thick sheets, the clinic got off to a slow start that morning, but as the sun peeked out from behind the clouds, so too did faces peek around the doors of the clinic and soon enough we were in full swing. Big family groups attended together, some with serious illnesses, others just for a health check. It made such a difference to provide care in a custom made facility, with space and privacy that is so often lacking in the makeshift clinic environments. Ultrasounds could be performed on specially made beds in private rooms, medications displayed on shelves in an ordered manner, diagnostic equipment laid out in a spacious, easily accessible way. It was bliss!
Needless to say, here at Floating Doctors we are both excited and proud to have reached this milestone. None of it would have been possible without our volunteers and the many, many people who have shown their support through donations of money, time, advice, equipment and an endless stream of encouragement. So, I’ll take a few moments to add my thanks to the huge list of thanks already given; to everyone involved, past and present. Together we are making a real difference.
– Dr. Lizzie Parker Floating Doctors Medical Director
Dr. Lizzie Parker showing the kids of Playa Verde how to wash their hands.
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2/22/14
Mending Kids International (MKI) was starting our second day of medical clinics with Floating Doctors (FD) in Salt Creek Panama, a remote island in the Bora Del Toro archipelago. The first arrival was seen at intake by Dr. Kate Porter a phenomenal volunteer tropical medicine doctor working with the Floating Doctors this year.The first arrival, a young Ngäbe-Bugle man explains that he is here for a problem in both his eyes – or so Dr. Kate hears it, but shortly after commencing his history, he says “Tengo un tiernito en casa.” Having limited Spanish, Dr. Kate asks a fluent Spanish speaking Mending Kids volunteer, Juan Ramirez, to interpret ‘Tiernito.’ Juan interprets – the Ngäbe man has a newborn, a ‘tender child’ at his home. Its eyes are white and it is blind. The mother pushed him away and won’t feed him.
Dr. Kate marks the intake form with a big star and bold letters, “House call, new born – Chi chi – 5 days old, mother refuses to feed, possible blindness.” The Tiernito is growing perilously weak, would the doctor be able to come see it in his home? Juan says ‘this is quickly becoming high drama’ ….a slight understatement!
Due to high infant mortality, Ngäbe babies are all named chi-chi (baby) until their second birthday. Quickly a medical team coalesces to make the emergency house call. Running to the home, our MKI volunteer leader, Isabel Fox, stumbles and falls deep into mud, then shortly thereafter spots her patient, lying moribund in the hot sun and mud.
Chi-chi, – as Dr. Kate, Allie, and Isabel are about to find out – is a 5 day old calf. So, regroup – there was a slight error in translation as the ‘father’ whose native language is Ngäbe spoke his second language, Spanish, to the English speaking Dr. Kate, also using Spanish as her second language.
By sheer coincidence, Drs. Dan Evers – veterinarian ex-patriot, and I – Renee Kaswan, retired veterinary ophthalmology professor – are tangentially participating in this mission and evaluating a baby Howler monkey affected with bot fly granulomas. The baby monkey – Jasmine – was acquired by a family from Memphis, who were relieved Jasmine was not very ill, and most surprised to learn that Jasmine would need a new name, she was a he…. Dr. Dan and I finish that delightful adventure and move onward to the neonatal calf.
Having not eaten for 5 days Chi-chi was severely dehydrated.
In the most primitive possible conditions, Dr. Dan and I assessed a dire situation while a family of 8, a sizable film crew from MKI, 3 impressionable 15 year old MKI student volunteers all waited to see if this first born calf – hopefully the Ngäbe family’s second cow – would live. Although the farmer assumed Chi-chi was rejected due to blindness, Chi-chi was actually only blind in his left eye, further evaluations were needed.
The diagnosis: Chi-chi had a relatively common bovine congenital ocular defect – persistent pupillary membranes (PPMs). In all species, the embryological pupil first forms like a spider web of blood vessels from the iris that bridge the future pupillary hole; these prenatal vessels should atrophy and desist prior to and or shortly after birth. However, sometimes these vessels inadvertently touch the lens and/or inside of the cornea – as they did in Chi-chi, and they persist. Persistent pupillary membranes can adhere to the lens, disrupt its growth causing cataracts and also adhere to the innermost layer (endothelium) of the cornea. These capillary attachments lead fibroblasts to follow the vascular path, the fibroblasts proliferate leading to a deep white fibrous corneal scar – which is what the Ngäbe farmer observed.What were the chances that a calf – born in a primitive village in Panama – no electricity or running water – would be attended by a retired veterinary ophthalmologist seeking meaning and purpose on an MKI/Floating Doctors mission?
For further irony, in August 1985, I was sweating in similar subtropical conditions in Evanston, GA, 8 months pregnant. The University of GA Veterinary Hospital where I was on faculty as an ophthalmologist, was called to attend a herd of cattle with ocular problems in Deep South GA. We diagnosed that the herd had multiple congenital defects, the most common being PPMs. Based on those observations – made at great effort by myself and 2 female colleagues – who would catch over 20 free roaming beef cattle (the farmer chided he couldn’t believe UGA didn’t send even one man), sweat ridden in the GA heat, I wrote the first case study of purportedly heritable PPMs in cattle. Our female senior student and large animal intern who did the hard work of catching and restraining the cows did not get authorship on the case report – physical labor being poorly remunerated as usual. As my academic curiosity has diminished over the years, I did not seek to examine other cattle in Salt Lake Island to determine if Chi-chi represented an isolated or herd problem.
Chi-chi – should he live, will have non-painful, unilateral blindness. The other eye was simply so deeply sunk in the socket from dehydration that it was covered by the third eyelid…until rehydrated. The assumption that the baby didn’t nurse due to blindness was erroneous, more likely just a naive mother cow, a newborn, a naive farmer, all fumbling with a new situation for everyone.
With a large audience watching and assisting, we used the limited supplies we had, 2 liters of lactated ringers solution, a couple of 50 ml syringes with 18 gauge needles to blow tennis ball sized bubbles of fluids under Chi chi’s skin all over both sides of his body (photo) while the MKI boys – sheepishly looking like they might be participating in torture – held the calf down. Chi-chi absorbed the fluids like a sponge within 20 minutes, and we were all amazed as Chi-chi stood up and began stumbling around! So we asked the farmer to fetch mom, tied her to the house, tied her rear feet so she wouldn’t kick, and low and behold we taught Chi-chi to nurse.Fate, MKI, Floating Doctors came together, intervened and the Ngäbe family wouldn’t eat veal tonight…..Such a gratifying crazy adventure.
Written by Renee Kaswan
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2014 is off to a running start as Floating Doctors and Mending Kids International (MKI) partner to bring Orthopedic Surgery to patients from across rural Panama! MKI is an American based charity that works to provide life changing surgeries for children around the world. From February 24th to the 28th MKI will be conducting an Orthopedic Surgery clinic in David, Panama at the Hospital Obaldia. Floating Doctors is helping connect the communities we serve with surgery.It is difficult to deliver surgical care to kids in the Ngobe-Bugle Comarca. Families speak either Ngäbere or Buglére, do not speak English, and generally speak Spanish as a second language. Making doctor-patient communication understandably hard. Communities are isolated from one another by jungles, rivers and the sea; and a huge cultural gap separates potential patients from Panamanian surgeons and definitely from surgeons from the US or other more developed nations. When medical problems arise it is difficult to find definitive medical care. Most hospitals and clinics in the region are not equipped for orthopedic surgery and rural populations do not know what resources are available to them. Even when kids who need Orthopedic Surgery can finally have it done, the lack of local physical therapy and follow-up leaves many patients worse-off after the surgery.
Over the last few weeks, an amazing team of Floating Doctors volunteers has been working hard to overcome endless challenges to connect isolated children in need of advanced care with Mending Kids International. Since arriving nearly three
years ago, we have treated thousands of patients in the Comarca and Western Panama, made friends and contacts across dozens of communities and kept a list of patients needing Orthopedic Surgery. This includes, but is not limited to, coordinating with: the local Peace Corps volunteers, the Panamanian Ministry of Health, Hospital Obaldia and all of their physicians, plus the tireless efforts of Mending Kids International.
For weeks we have been working our contacts hard as our volunteers search the region for children requiring Orthopedic Surgery. For many, this could be the chance of a lifetime to finally fix the problem, and we don’t want to miss a single child. We have called over one hundred community contacts and leaders, searched through medical files, and even gone to visit communities in search of candidates for surgery.Our volunteers are a special group that can speak Spanish (and some Ngäbere and Buglére) with families and community leaders, spend hours in the blazing sun searching for patients, navigate uncharted reefs to reach isolated communities and every day return home with new friends and contacts across the area. Last week when we realized we did not have reliable phone contacts for all of the communities we visit, teams went to scout villages in search of patients. In Shark Hole, we arrived in time to address a crowd of 200 gathered to meet government representatives while in other communities volunteers made new friends who helped them go door-to-door talking to families and finding potential patients.
As the effort to find patients grew, we created a hotline families could call to find out more information and identify new patients. Even local radio stations have joined in the effort, donating advertisement time for public service announcements about the clinic and distributing our hotline number.
As new patients are found, we work with the families to prepare them for surgery. Patients must be transported to the hospital for x-rays and the process must be explained to both patients and parents. Our medical team assesses each patient,
takes photos and sends x-rays and briefs to MKI surgeons. Then the logistics of transporting 20+ patients and their parents to David must be organized. Caregivers have to be found for the other children at home and families need to be connected with financial support to allow parents to take time off work.Next week, a fleet of small pangas will collect patients with their parents and bring them to Bocas del Toro. From here we will travel together by bus to David where housing and food will be provided for patients and parents as they wait for and recover from surgery.
Everyone here at Floating Doctors is excited to be working with Mending Kids International to deliver life changing surgeries to our pediatric patients. Also, a special thanks goes out to both of the Pediatric Orthopedic Surgeons whom are volunteering their time: Dr. Robert Bernstein and Dr. Laplaza. Without the help of MKI, our patients could not receive surgery and without Floating Doctors, most patients would not be able to get to the clinic or even know it was occurring. It has been a great partnership allowing both NGO’s to focus on our strengths; MKI will bring world class surgical care to Panama and Floating Doctors will continue to connect with patients and their communities.
We’re excited for next week; many of the patients scheduled for surgery have been in and out of our clinics for years, as volunteers have wished for surgical skills and equipment. We can’t wait to see these kids after surgery and back in their communities!
Until we have more results to share, Fair Winds!
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Gustivino is a 14 year-old Ngäbe indigenous boy for whom every day of life is victory. He lives in a remote mountain community in extreme poverty and in a home accessible only by miles of mud covered jungle trails. On our first visit to his remote community, he presented to us plagued by Tuberculosis and with a heart damaged by the effects of Rheumatic Fever and visibly hammering through his chest as it struggled to provide enough circulation for him to stay alive. Gustivino’s will to survive and his family’s love were the only things keeping him going and as his adolescent body started to grow faster his ailing heart was a ticking time bomb. His life span could be estimated in months, with no hope for more- Until Floating Doctors arrived…..VIDEO!!! Gustivino’s Fight for Life!!!
Gustivino’s fight for life is an unfortunate story that is told and retold in the case histories of our patients who live in La Sabana. This isolated community of roughly
300 indigenous Ngäbe people is a demanding five-hour hike from the nearest road in a high mountain jungle. During the rainy season the trails become rivers of mud that make them impassable without high-tech gear. La Sabana’s isolation and limited access to any public medical services result in a wide variety of advanced diseases and conditions affecting the population.When Floating Doctors first visited La Sabana in November of 2011, many of the villagers had never been seen by a doctor. There was a 5% infant mortality rate. Over two years we have made 13 visits, several emergency interventions, and the infant mortality rate has dropped to ZERO. Additionally, nearly every person in the community has been attended by one of our dedicated volunteer doctors. All pregnant women have been given prenatal care and vitamins, and the population has been regularly treated for parasites.
BUT the need is still great in La Sabana. Trauma, parasites, childhood illnesses, accidents, chronic disease, and no access to pre-natal care put the lives of our friends in La Sabana at real risk.
FLOATING DOCTORS WANTS TO GIVE LA SABANA WEEKLY ACCESS TO CARE!!!
For only $850 per month the community of La Sabana will have weekly access to Floating Doctors medical care providers, maternal services, patient transport services, and emergency extractions.
That is only 85 people giving $10 per month!Please help us to bring a year’s worth of health to this remote community.
Donate monthly today and be one of the hands that help to keep us afloat!
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I distinctly remember the morning of my first mobile clinic with the Floating Doctors. Only knowing the small group of UCLA nursing and nurse practitioner students in my group, we were anxious and excited to get started on our first full day of volunteering. We quickly began shaking hands and making introductions unaware of the incredible experiences we would all share together over the following ten days.Within minutes I had met an orthopedic surgeon from Germany, a medical student from England, a nurse practitioner from Boston, and an emergency medicine physician from Australia (among many others). While from all over the world with widely different levels of experience and training, here we found ourselves together on an island in
Panama sharing the same goal to provide healthcare to those who would otherwise be without it.We all got to know each other quite quickly to say the least. Within minutes of meeting my fellow volunteers, we were pushing off, sitting shoulder to shoulder in a hollowed out tree trunk (literally) destined for Bocatorito, a small island about an hour away from FD’s headquarters. En route we shared stories of our past medical volunteering experiences and all agreed that even already we had never been a part of something like this.
Within a half hour of reaching our destination, I was immediately put into situations even five years of working in a busy trauma ICU in Los Angeles couldn’t have prepared me for. For example, after learning one of the women on a nearby island had just given birth, I experienced firsthand just how challenging it can be to count the pulse of a newborn infant with a wild parrot squawking away on your shoulder. Later on that same day we performed another house call, this time to a frail diabetic woman. We were able to deliver her much-needed medications, provide her with important education, and also leave her ten other family members with soap, toothbrushes, vitamins, and some toys for the kids. The smiles and waves we received from the children as we motored away from their dock is a mental image that I hope to never lose.
Over the next ten days, each experience proved to be something more unique than the day before. All throughout the trip our team of doctors, nurses, translators, and administrators worked, sometimes into the night, allowing us to see up to 140 children and adults in one day. Thanks to the diversity of the group of medical volunteers we were able to see patients of all ages and requiring all levels of care. The presence of our ultrasound technologist allowed us to perform pivotal pregnancy check ups, while our surgeon performed much needed wound closures. I was even able to use my intensive care background to assist when a decompensating patient arrived at our clinic hypotensive, tachycardic and in respiratory distress. After stabilizing her with IV fluids and performing a diagnostic ultrasound our team was able to safely transport her to the nearest hospital and receive further treatment.After days of traveling up and down the Panamanian coast, our trip began to come to a close. On one of our final nights in Panama the volunteers threw a “family dinner” at the Floating Doctor’s headquarters. After enjoying the food and conversation, I took a step back and looked over all of us who were complete strangers a week ago, now sharing laughs and stories like old friends. Looking back now, it’s easy to see how a group of dedicated volunteers, sharing a common goal to help others, could result in such a meaningful experience as the one I shared working with the Floating Doctors.
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This week we have a blog post from UCI med student Lauren Sims. A group of UCI students came to us to work with the parteras (midwives) in some of our communities. In today’s post she talks about some of the patients she saw and what she learned in her time with us.
-Kim Olpin Operational Manager
Lauren and fellow UCI Med student Kate Horn working hard during a clinic.
At Floating Doctors clinics you are not presented with your typical American patient in a shiny white hospital room or doctors office. You typically find yourself with an indigenous Panamanian Ngobe under a “rancho” (a typical outdoor patio covered meeting place in these communities) sitting in old wooden school desk chairs. This might be their first encounter with a medical professional.. they might have walked a day or more to be at the clinic… some only speak the traditional “dialecto” of the Ngobe and need a Spanish translator. No matter their circumstance or reason for presenting to the clinic they are all extremely grateful for our presence in their community and in search of an answer to what is ailing them.
UCI students with Dr. Ben in Quebrada Sal.
I encountered some interesting cases. I saw a young child with Leishmeniasis in a remote Panamanian community in the mountains. I performed an ultrasound on an infant who was failing to gain weight in the first few weeks of life for an unknown reason. I saw an older woman with a sixteen year history of hyperthyroidism and severe exopthalmos. I measured a blood pressure of 238/192 in an older gentleman who most likely had an adrenal tumor. I visited a pregnant woman with a history of preeclampsia in her home to do an ultrasound. I saw a child with impetigo and another with Herpes virus that covered the entire right side of his face. I listened to breath sounds of a seven year old with TB. I examined a three year old who most likely had a stroke as an infant and could not use his left foot or left hand or talk.
Lauren with some young Nogbe kids.
I learned first hand about the barriers of access to health care for these patients. Some were not able to get medications or make it to the hospital because they lacked the funds. Others would have to walk a day, take a boat for a few hours and then a bus to reach a hospital that might not even be able to treat them. Some distrust the health care system because of a previous bad experience or a story about the hospital that quickly spread through their small community. My time with Floating Doctors showed me how the health status of the community members in these remote areas directly reflects the prosperity of the community. They deserve access to health care and I am very grateful for the opportunity to be a part of a medical team that reaches out to these isolated Ngobe communities. The patients I have visited with in Panama as a medical student will forever hold a special place in my heart as I continuing my training and career.
Lauren and fellow UCI med student Christy Tabit showing off their newly decorated scrubs.
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At the end of August we held our first multi-day clinic in the community of Rio Cana. It is one of the most remote communities we have ever been to. While we were there a new mother became gravely ill and had to be evacuated. This is the story as told by Dr. Kim Wilson.
-Kim Olpin Operational ManagerI’m telling this story as a reminder to every one of the amazing and selfless work that floating doctors does every day!
We went to Rio Cana recently. For those of you who haven’t heard of it, it’s a community on a peninsula about 3 hours from Bocas. We had not made it that far before because of the distance and also because it’s situated just up the mouth of a river so accessing it can be difficult depending on the weather and tides. We were all very excited at the prospect of going there and it was incredible. It’s such a beautiful place and the people were amazing. We arrived at river mouth and a boat came to guide us in and we were met by lots of the local people who were as intrigued by us as we were them. We started clinic early the next morning – we weren’t really sure what to expect as it was our first clinic there but it was so busy…we saw 124 people on that first day and 140 the next day! A lot of people had problems with colds and coughs, worms and scabies and then there were the more unusual cases such as ichthyosis, machete wounds, insects lodged in ears and a multitude of other issues. It’s hard to explain how amazing it is to see an entire family, from infants to grandparents to dogs and even a sloth at one stage, but working with the locals is an eye opening and heartwarming experience.
Just after lunch, Ben asked me to see a lady who had given birth 40 minutes previously who was unwell so Dan, Philippe, and myself headed down to her house to assess the situation. The baby was well but mum was dehydrated and fatigued. We put her on a drip and gave her pain medications and sat with her for a couple of hours and by the time we were leaving, she was drinking tea and had perked up a lot. We went back to clinic where we were run off our feet well into the dark hours. It must have been 8.30pm by the time a man came to say that the lady who had given birth had taken a turn for the worse. Ben and I went to her house to assess the situation and it was honestly a shock to see her this time. She was pale, sweating, staring into space and had a heart rate of 126 and a blood pressure of 80/56. For those of you who are not medically trained, this is not a good sign, she was having a massive post-partum hemorrhage.
The Floating Doctors team working together to evacuate the mother.
It was clear at that point that this lady needed to get to a hospital but the logistics of this were slightly more complicated. We were 3 hours by boat from the nearest hospital and we would have to use our boat to transport her. Aside from the fact that fuel would cost a few hundred dollars, it would also mean that the team that transported her would miss the morning clinic the following day. I looked at Ben and said ‘she has 8 children and a new born baby’ and he replied ‘we can’t put a price on a life!’ We immediately jumped into action and it was amazing to see how the whole Floating Doctors team pulled together to get that woman to safety. Ben ran to sort the boat, I set up drips and started resuscitating the lady and everyone automatically assumed a role from compiling emergency bags and equipment for the boat to figuring out the logistics of getting this lady out of her small cramped house up the windy, hilly roads to the boat. One thing that struck me during all this was when we were all so focused on the task ahead and I walked into the room where she was and Philippe was sitting on the floor beside her just holding her hand and talking to her. Sometimes in the chaos, we can forget how scared and vulnerable the patient is and just to sit with her and hold her hand and explain exactly what’s happening must have meant the world to her!
From left to right, Philippe, Bethany and Dan.
We got the boat as close as we could to her house and carried her on a hammock from her house to the boat. We were travelling on a small wooden ponga which, for those who don’t know, is an open top boat. We constructed a bed from life jackets and a thin foam mattress and set her down on this on the floor of the boat. The other factor which I haven’t mentioned, was her 8 hour old baby boy. He was wrapped in a thin white shirt and had barely fed since he was born as mum wasn’t well enough. We had to bring him too so we found a small blanket and wrapped him in this and I put him up my top in an effort to give him as much body heat as possible. Many of the locals came to see the boat off and to wish this lady and her baby well. It was pitch dark when we left and we were not allowed any lights as Elvis (our amazing boat driver) couldn’t see if we turned on lights. There was one man at the top of the boat with a torch and he shined it into the air and gave instructions to Elvis on the route to take. We got to the river mouth and Elvis stopped the boat while we waited for a break in the waves. All of a sudden, the man at the top of the boat shouted go and Elvis accelerated. There were massive breaking waves and each time the boat went over one, we were flung 1-2 feet from our seats back onto the hard wood. There were 4 of us on the rescue team, myself holding the baby like my life depended on it, Philippe who literally lay across the woman to try and keep her still and prevent her from being thrown around the boat and Dan and Bethany who took her vitals and held the drip in place to give her the fluids that she vitally needed! I honestly can’t put into words how everyone worked as a team, assumed a role and excelled at it but sitting on that boat getting thrown around the place, I remember thinking that I would trust my life to these people.
Those first 10 minutes in the boat were scary. We couldn’t hold on as we were either holding a baby or drips and at one stage my stethoscope fell overboard. Dan grabbed me for fear I would fall over board with the baby. Finally the waves settled a bit but it was still like we were working on a wooden trampoline! We couldn’t hear the lady’s heart due to the noise, the blood pressure monitor got smashed by the waves and we used only her pulse rate and radial pulse and her degree of interaction with us as markers of how well she was doing. As for the baby, that little boy did not cry or move for the first hour. I was absolutely terrified that he had been hurt by the momentum of the boat or that I had inadvertently smothered him whilst trying to protect him. I couldn’t check because it was too bumpy until we stopped the boat to refuel and the relief to see that little fellah move was incredible.
Dr. Kim checking on the newborn during the boat ride.
During our trip, it also stuck me how amazing the night was. There were so many stars in the sky and the moon was full and bright, there was lightening flashing in the distance and the sea lit up from algae as we sped through it
The trip took approximately 3 hours and we pulled into the dock behind the hospital at 1.30am. The gate was locked and 2 of the guys had to scale a barbed wire fence and run to find help. We got the woman out of the boat and an ambulance brought her straight to the emergency room. We sat outside the hospital for an hour to make sure mum and baby were ok and then headed back to Bocas for the night. Elvis drove us back to Rio Cana at 8am the next morning for the second day of our clinic.
After that, we had no phone reception for 4 days so we hadn’t heard how she was doing. I can’t explain the relief and happiness to hear she was doing well when we got back. I went to Almirante to see her yesterday and walked into the hospital room to see mum and baby alive and well. Mum didn’t speak much but when we went into the room, she looked at me and Sam and gave us the most amazing smile…In that moment, I would have done the trip a hundred more times just to see her smile! Words would not have expressed thanks like her smile did that day – honestly, it reduced me to tears and it’s pretty difficult to look professional when you are crying like a blubbering idiot!!!
Dr. Kim holding the newborn while in looking after the mother in the ambulance.
For me, the whole experience was mind blowing…the way that everyone came together and worked as such a team, no one needed to be told what to do, they just did it. Everyone was selfless and hard working with a common goal- all we wanted was for this woman and her baby to be safe. She’s going back home today and even as I write this, I have tears in my eyes and all I can see is her dazzling smile!
Floating doctors is an extraordinary charity and this is just one small example of the impact that Ben and his team are making on the people of Panama!!
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This week I’d like to share with you our second guest blogger from the Master of Science in Global Medicine program at USC, Lily Sheshebor.
-Kim Olpin Operational Manager
Lily on the dock ready to get picked up for clinic.
The Power of Passion
I have always thought that I wanted to be a doctor. I volunteered at clinics, studied rigorously for my MCATS, and dedicated hours to memorizing facts for my pre-med courses. My passion for medicine was evident, yet my drive to continue pushing through the numerous obstacles before medical school was beginning to mitigate. I was tired, stressed, and scared that I would not become accepted. Attending USC for my Master’s of Science in Global Medicine, I was given the opportunity to study abroad in Panama for the summer. Those couple weeks, while working closely with the volunteers of the Floating Doctors, gave me back the energy for my passion. I quickly remembered why I am committed to the world of medicine.
The first “clinic day” that we had was the most memorable experience of my life. I was very anxious the days leading up to our clinics as I had never worked in rural settings nor an international nation. Stories of past clinics included many infectious and contagious diseases that were somewhat concerning and I was nervous that I would let the group down in terms of executing various clinic tasks. Early morning, we were picked up with a small boat and sailed through the beautiful archipelago of islands to reach the community of Cerro Brujo. Wearing our scrubs and carrying bags of equipment up the hill, I immediately felt a sensation of motivation. I realized we had arrived and we would soon be apart of medical access that the individuals of this island greatly lacked.
Getting your nails painted is a popular activity anywhere in the world.
We were asked by the head doctor, Dr. Ben, to split into groups and inform the community that our clinic has arrived. I wanted to tell everyone and split from our group with another student to cover more ground. Since the people of Cerro Brujo only speak Spanish, my years of high school Spanish were paying off as I told the families and children to spread the news. Once the clinic began to commence, the motivation that started earlier grew into dedication. I did not stop working and loved every minute from checking patients into the clinic, beginning a new chart, taking a medical history and vitals, shadowing the doctors, to the overall interactions with the patients. After our clinic was coming to an end, we were able to distribute stickers, paint the kids’ nails, hand out coloring books, and take millions of pictures. The children were one of the most beautiful children I have ever met. Their eyes were so shiny with excitement that they had new friends and memories aside from their everyday lives. I wanted to give everything I owned to these children from every crayon in my bag to the peanut-butter sandwich and chips from my lunch.
Leaving the island that day, I was not only exhausted from the day’s work but I was in love with the power of helping those in need. I knew that my small part with the Floating Doctor collaboration was important but it was not enough. This organization that has dedicated its life to improving and helping the poor communities of rural Panama is savior of these people. These islands lack money, transportation, clean water, adequate housing and sewage, protection, and care. The country does not care to reach out to these communities but Floating Doctors does. The power of passion is why our world has not yet been defeated. The volunteers of Floating Doctors have that passion and have re-inspired my passion for medicine.
Lily and two other USC students making new friends.
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This past summer we had a number of amazing student groups join us in Panama. One of those was from the Master of Science in Global Medicine program at USC. A couple of the students from that group were willing to share their experience with us. Today I have the pleasure of introducing you to Natalie Reyes.
-Kim Olpin Operational Manager
Adorable Ngobe girl from the village of Cerro Brujo
Traveling to Bocas del Toro, Panama to work with the Floating Doctors team has been one of the most humbling and eye-opening adventures of my life. I have always had a passion for working with under-served populations that have limited healthcare access, however, actually being there on these islands with the indigenous populations was a much more gratifying and awakening experience than I could ever have imagined. The amazing personalities of the doctors, volunteers, and villagers that I got the opportunity to work with truly remind me of the reason I have such a strong passion for medicine and reflect the environment I hope to be surrounded by.
Clinic Day
The experience that Floating Doctors exposed me to on my first day of clinic on the islands taught me so much medically and culturally and allowed everyone within our group to find our own niche within the different roles necessary for a successful clinic. After traveling on a boat bringing all of our medical supplies, we arrived at the community of Cerro Brujo and I was pleasantly enlightened to be greeted by many of the village’s children who could not be more eager and excited to follow us around and talk to us. While many stayed to set up the clinic outdoors, I followed two of the young boys who took me around the entire villaeg, finding houses to let the mothers know we were having a free medical clinic in “el ranchito,” in the central part of the village. I was in complete awe at how rural and isolated these people were from the society I am used to in the United States. Seeing how eager and sweet the children are is an experience worth more than words or photos can reflect. Despite hearing stories of past experiences and being aware of what to expect on the islands, I was surprised by the culture shock I experienced. The villager’s barefoot, simplistic lifestyle was such a difficult,
USC Professor Dr. Meindl-Holman treating a Ngobe mother and her young son.
yet inspiring concept for me to understand. I enjoying being able to get to know entire families during intake and I learned so much from being able to shadow the variety of doctors and medical students throughout the clinic day. It was unreal being able to bring an ultrasound machine into the village and show expectant mothers their child. In one particular instance, we were able to show a mother the heartbeat of her child on the ultrasound screen in the middle of an outdoor, crowded, rural “ranchito” and that is a memory that I will keep with me throughout my medical career.
The ability to practice medicine and help people in the absence of modern day access to technology and hospitals is completely remarkable. Regardless how much time and passion I put into volunteering and immersing myself in the culture of these people, what they taught me and the experience they gave me is worth more than anything I can ever give back to them. I truly thank Floating Doctors for giving me such an opportunity and look forward to returning in the future!
-Natalie Reyes
USC Global Medicine student Natalie Reyes (back row, second from the left) poses with other students, USC Professor Dr. Meindl-Holman, and some local children showing off their new toothbrushes.
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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)
