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When you open your eyes and look around you I believe that you can find heroes everywhere. Those every day champions whom decide to take the road less traveled, those that put others before themselves, and understand that service to others is the most rewarding path to happiness. I am always stuck by the stories that have driven these ordinary people to do extraordinary things. Champions of the underdog, fearless activists, animal lovers, stay at home moms…. I have met so many heroes over these past 3.5 years.
Most recently, I met Sergeant Rolando Diaz Brenes, a gentle spirited police officer with a contagious smile, here in Bocas del Toro. We had started to do first-response training at the local fire department and naturally it had transitioned to an interest to lend a hand to the police as well. One of my volunteers had met a Sergeant and had scheduled a meeting for us to meet and talk about what services we could offer. We met in the lobby at the station and he politely listened as I botched my Spanish explanation of our work here and was excited at the possibility of working together. Near the end of our conversation he slipped in a question about us getting involved with his new youth boxing club… wanting nothing more than for us to check his boys and make sure they were fit to fight. Being a group that has befriended youth on the fringe in every country that we have visited we were immediately taken with the prospect. He invited us to come back that afternoon to meet the trainer and see what the program consisted of.
We arrived back at the police station a little after 5pm and walked into the large room that serves as the stations storage area—it was filled with sweaty kids from 8-23 years old. They were stretching, doing sit-ups, push ups, jumping rope, and sparing with each other and their trainer—5pm and off the streets, doing something productive, something that will make their bodies strong and minds tired. I think we were all so in awe that we barely spoke a word to one another. We just sat against the wall and watched Diaz work the room. Rolando Diaz, an ordinary man taking the time to transform the lives of these forgotten kids.
Those are the faces of happy kids!
Recently we sat with Sergeant Diaz to ask him the simple questions: Why? What is it that makes you do this? And what does boxing mean to you?
Again, this unassuming man humbled all of us with his answers.
I would explain it to you myself but my words would pail in comparison to his.
Floating Doctors: Why do you do this?
Diaz: I don’t believe that bad boys exist, just poorly trained or poorly taught. It could be by their parents, or because their dad doesn’t live with their mom, or he only lives with his mom, or his grandmother. In general what happens here, kids live alone with their mothers; their fathers are not present. So they receive a lot of influence from the outside. They search in the street, in drugs, in alcohol, for that important part of their lives- a father who helps them, teaches them. A father figure is very important in the home so they look in their friendships for what they don’t find at home: affection, education, respect, you know, these are important things for them. And like I said, I don’t believe that there are bad boys, just poorly trained, poorly assessed, poorly taught But programs like this boxing program are good; they provide us a way to help them and they help themselves… they learn that they can change, that they can stop doing drugs, that they need to practice, that they need to respect their mothers, their fathers, their elders, and they start to change. Because here we teach them discipline and we talk about different issues, you, the doctors, have come to talk to them about different issues. And they see, in the coaches, not exactly a father figure, but something similar to a father, someone who helps them, and someone who talks to them. There are times when we have to speak very seriously with them, and sometimes we have to
laugh with them. And that’s why I think these programs are good. The more that comes, the better. Sometimes people think that it is not worth it, but no, if a hundred show up and even just one is able to change, it is big. It is beneficial – for society, for the police, for the youth themselves. Floating Doctors: What does boxing mean to you?
Diaz: Boxing for me, for me in particular, boxing is happiness. It is my happiness, my motivation. Every time I see these boys training, every time I’m in a boxing ring, every time I’m talking with them, practicing, my heart is full of pleasure, it feels happy, it feels big, like it wants to explode out of my chest because it is so happy. It is beautiful. Every time I see a boy boxing it makes me happy because I know it will be good for him, for his future. And a lot of them have told me they would like to be police in the future, when they are of age. This is very good for them.
For me boxing is something that it changed my life. Up to this point in my life, it has helped me so much. I still remember the first time I went to practice. I was really shy, because there were other boys there, you know, but little by little I started boxing, sparring, fighting, and it has helped me so much – so much. I feel so happy. It really helps you, because it keeps you from being out late at night, you change your friendships. The ones who invite you out to go steal, to drink, to smoke drugs, peer pressure you.You have a lot of free time when you’re a child, and if you don’t know how to spend it, or no one tells you, or no one helps you find a good way to use your time, you go places you shouldn’t, with friends who aren’t really your friends. But this gets you out, and it keeps you out of that environment, it helps you a lot. I’m speaking from personal experience – it helped me a lot. That is also how I came to join the police force when I was 18. 16 years later and I haven’t stopped boxing. Last year was my last fight, and I don’t think I’ll fight more this year. My fingers are injured, my nose, on the inside, it has already been operated on once, so for me, now that I’m 35, that’s enough. So it is time for the youth to train. And we have good kids here, all of them are good.
written by: sky labrot
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Today’s blog was written by one of our recent volunteers, Dr. Ravi Chokshi, just beginning a residency in Obstetrics and Gynecology. These are his thoughts and impressions of our 4-day mobile clinic up in the mountains to a remote village called La Sabana, or ‘The Grasslands.” Over 200 patients were seen, including pediatric and trauma emergencies. Thanks Ravi! best of luck in your residency, and I look forward to working with you again.
Field Amputation of Small Toe With Digital Nerve Block
He was different at first glance. Quieter. Saw more, spoke little and took his time to smile.
“It hurts here” he exclaimed pointing at his 12 year old heart.
I had examined 20 chests that day, listened to 20 hearts. But only his jumped at me as I lifted his shirt.
A heart that had decided the only way to get noticed was to become outgoing. I place my stethoscope and still the squall fighting within. My ears record and my fingers feel for the familiar radial pulse. There is a flaw here. A Woosh-woosh where a lub-dub should be. I bring over some counsel and we use the portable ultrasound to perform a tropical echocardiogram. What I had heard, we now see. A hole connecting the two atrial chambers of his heart, and a chance to be normal forever taken away.
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By the second morning, we had hit our stride. Awake at 7am with the hum of the village around us. I wish that I could say that I
Morning...Now Get Up And Convert The 'Bedroom' Into A Clinic! Patients Are Here!
slept wonderfully on the hammock. Tied across the wooden beams of the village Rancho, covered in a mosquito net donated by the Lake County Sheriff Cliff Matthews.
I almost did, but the cold from the two rivers that flow around La Sabana got to me.
To build your own bed where the clinic just was. Settle into it with the laughter of new friends around and your mind alive with the memories of the day before you. Of the cold stream water you had bathed in, or the hojaldras and coffee that had started your day. Sleep comes easy and you drift imperceptibly towards it as the days’ labor catches up to you and the hungry river swims around you.
The cold shudders in, and you wake up surrounded by the chatter of excited Ngobe children. A quick breakfast and swim later you are ready for work. Walking back from the river you can already see a mass of patients organizing themselves around the rancho. In 10 minutes a fully functional clinic sits where we had just dismantled our bedroom. A pharmacy lies ready and capable. Our amazing interpreters have already lined up patients, sequestered the roving bands of excited children and started patient intake. I sit with my stethoscope around my neck, a clipboard on my school desk of a chair and try to look ready.
Filling Up Fast As Word Gets Around...
This is impossible.
And we begin! In groups of 4 to 6 the mothers and fathers patiently answer my questions posed in broken Spanish while the kids run around, openly gawking at me and my strange tools. As I address them, smiles break out. They are terribly shy and hide their little faces in their mother’s dresses. But I bring them out and I let them listen to their heart beat through my stethoscope and I see their eyes widen and them calling out their amigos to do the same. ‘Ahh this crazy gringo is funny’.
I hear about coughs and colds, about chronic pain, about diarrhea that just won’t go away. I examine distended bellies and the scars from years of no-see-um bites and battery acid burns from cured cutaneous leishmaniasis. Most of all I see the relief as I dispense Albendazole like candy telling them, “Este Medicamento va a quitar las lombrices de su estomago y su piel”. And I urge them to eat it in front of me. I work in a chain with 4 other doctors, most with many more years of experience than me and I confer with them constantly. I learn to recognize scabies and lice and infected wounds and what treatments we can offer for such. I get called occasionally for my input on obstetric patients, being that it is my area of interest.
Using the Sonosite I am able to show a woman 7 months pregnant her unborn child’s face and lips and nose. The kick she feels – she now sees and she can’t stop smiling. In a place where most of the people have never seen an outsider, a white person, or even a TV an ultrasound is magic and we are a mystery they are too polite to solve.
We are observed constantly. And for good reason. In a place as isolated as this from the rest of the world, we are as alien to them as
Most People Living Here Have Never Been More Than 10 Miles From Home
imaginable. Taking a picture of the children and showing it fascinates them. Then I realize why. There are no mirrors here, no still water. Their first good look at themselves is thru the lens of my camera.
These are the Ngöbe-Buglé Indians, Panama’s largest indigenous group. After years of historical fighting they were allowed to retain their ancestral lands largely confined to the western rainforests of Panama. Here in their Comarca, they implement their own system of governance and economy. In terms of healthcare they have a raw deal. A long history of poor interactions with outside groups (pretty much everyone since the first explorers) has left the Ngöbe understandably skeptical of ‘Meriginees’ (non-Ngabe people). As the mother of a very sick Ngöbe child put it to us, “the hospital is where we go to die.” Language is another barrier. While the Ngöbe men have reason to conduct business with communities in close contact with the mainland and thus have some Spanish speaking skills, the women and children are different matters. Not being able to speak Spanish in Panama is as isolating as it gets.
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Day 1
La Sabaña, the remote Ngobe village that we have made our way too, is one of the more isolated communities dotting the Chiriqui
Don't Let It Get Above Your Boot Tops! Too Late!!
province of Panama.
Our journey there begins at 5am from Bocas marina, where the Southern Wind currently rests.
A group of 9 odd, we sleepily catch a water taxi to our first destination – the port town of Almirante. Blazing through the Caribbean on a 200 horsepower boat is enough to get everyone up and awake.
?Costa Rica!, usted? is the banner cry as we disembark.
Ahh Almirante. A hastily thatched together port town created entirely by the Chiquita Banana Company, it is best described as a jump off point to better places.
Brushing off the taxi drivers, we find ourselves in a car on a 90-minute ride to the sleepy little village of Pueblo-Nuevo. A tasty Panamian breakfast of fried bread and coffee awaits us and now we are ready for our hike. Ben has hired horses to carry the supplies up the slope, while we carry only water and essentials on ourselves. A 3-hour hike when dry, 5 plus when wet and we approach La Sabaña by late afternoon.
La Sabaña – literally translating to ‘The Grasslands’ is a mesmerizing place. Found at the crossing of two rivers, its thatched huts and raised wooden floors are as living artifacts to the age before Panama won the geographical lottery and started collecting revenue from the canal. The Ngobe here live simple lives, the men work in agriculture and raise animals. The women take care of the children and keep the house, all while dressed in the colorful patterns unique to their culture.
It is here we are most in need.
Day 2:
Along with the storm, comes the call from up the mountain. A child has been hurt severely, on his foot by a self-inflicted machete cut. Ben quickly
The Second Toe Can Be Saved; The Small Toe Has To Come Off...
dispenses half our group with the general surgeon on a race up the slope. I am part of the group that stays behind, together seeing the last few families waiting to be seen. The number of patients has been growing larger every day. Word has gotten around about us and families have traveled on foot for many hours to see a doctor, possibly for the first time in their lives. I have to remind myself of this, as I quietly ache to learn what is transpiring with our other half.
Hours we wait, the rain pouring down, the darkness absolute. The conversation feels forced, every one’s mind on our missing party and what has transpired with them.
Moments before a search party must be raised, their lights are spotted, little moonbeams making their way down the muddy path. They have returned, soaked to the bone but with stories to tell.
It had been necessary to amputate the 10 year old child’s little toe. Amputate it. In the darkness, working on a wooden floor guided by headlamps.
They had quelled the bleeding, stitched it together and addressed his pain as best as they could. We would return the next day with antibiotics and supplies to redress the wound. To leave supplies and to teach the family to keep the site clean. And a phone number to call, just in case.
Day 4:
He Deserves Access To A Doctor If He Gets Sick!
By our last night the hammocks come up like clockwork. Clinic today had been a sold out success. Patients came from all around the mountain, with many families walking a day’s journey to reach us. We had worked like a well-oiled machine.
As we pack our boxes for the long journey back, the stories come through.
And its not the number of patients seen that we count, but the tooth brushes we had run out of. The soap we had no more off. The medicine for scabies we had to deny.
If there were patients to count, they were the ones we now had the responsibility of following up on. The 12 year old that needed to see a pediatric cardiologist. The women with suspicious breast lumps that needed mammograms, and the ones we couldn’t quite put a diagnosis on out in the field.
Ben and his crew will arrange transport, appointments with the necessary consultants and provide a voice of advocacy to accompany these patients.
What I have seen here erased all presumptions I had before the trip. We were there to see patients and dispense medicine yes, but much more importantly we were there to build trust. To raise the community up bit by bit. To give out toothbrushes and teach kids how to clean their teeth. To teach mothers to recognize dehydration in their children and how to make ORS. Most of all, to provide the village with an avenue of communication they could rely on when posed with a serious problem.
I had been promised an experience of a lifetime when I signed up to volunteer. I say they undersold it.
Our Patients And Friends From La Sabana
Four days I lived alongside the Ngöbe Indians. Absolute cutout from the world I knew and an absolute outsider to this hidden world that time had forgotten. I almost died. I very nearly lived. I fell in love again. I yearned to go on, to live this fantasy of waking up in a hammock with lines of patients to see and a fast flowing river to bathe in. Four days is much too short but somehow felt like a lifetime in terms of lessons learned.
In a few short weeks I will return to the US to train in one of the most developed and technologically advanced healthcare systems in the world. I will learns volumes everyday and gain skill sets I ache to possess. But it will always be in a remote Ngöbe village in the protected area of western Panama where I first really learned the gravity of the promise we make everyday on saying these words, “Me llamo Ravi. Soy su Doctor”.
Added by Ben La Brot:
“It is from the numberless diverse acts of courage and belief that human history is shaped. Each time a man stands up for an ideal or acts to improve the lot of others or strikes out against injustice, he sends forth a tiny ripple of hope, and crossing each other from a million different centers of energy and daring, those ripples build a current that can sweep down the mightiest walls of oppression and resistance.”
–Robert F. Kennedy speech in South Africa, carved in stone on his grave.
"Me llamo Ravi. Soy su doctor."
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I believe everything that we do in this life has a cost and a benefit associated with it—at times the cost that you pay for the decision you have made far out weighs any benefit you may gain while the profit that you get from another
totally justifies the negatives. A cynic would say I view everything through a ‘cost analysis’ in my life and in many ways I believe that is a true statement. On this stormy day in Panama with inches of drenching rain replenishing the jungle around me I find myself thinking of what prices I have paid, both good and bad, for the decisions that I must call my own. April 27, 2012 marked my 1095th day out of Los Angeles and away from ‘my’ life, or rather, the life that was once mine. Anniversaries to me are not a time to celebrate but rather a time to reflect upon what has transpired, the roads you have traveled and where they have taken you, how you have acted, and if those actions sit well with you after time and perspective.Last week’s multi-day mobile clinic led us once again to the shores of a rushing jungle river to bathe and wash away the stress, sweat, and sadness of the clinic. There is nothing like plunging into the cold hastening current of a
river that has cut itself through miles of remote mountains before touching your skin. Its pace caresses the beautiful pain of the day out of your body in ways that are indescribable and leave me refreshed like no other body of water does. I have done this countless times before, but this time, as I sat with my volunteers between the smooth river rocks and watched the Ngobe Indians of the village make their chest deep evening river crossing home with kids and animals in tow I was struck at how far, in every sense of the word, my life has come in these last three years.In the past I have done my best and most profound thinking in the shower. With hands propped high on the wall in front of me, head slung, eyes closed, and hot water pouring down my back I come to my greatest conclusions, my most honest thoughts, and in all truth, it’s the time that I also allow myself to feel the emotions of my life. As a result the shower has been a deeply personal place for me—private, unavailable, closed, and bare. My perfect place for reflection, tears, laughter, and thought. I have not had many of these moments since I left the United States—conservation of water on the boat, public showers, no showers at all, no hot water, bucket showers, etc have all been barriers between me and my time in the comforting steam and solitude of my once were showers. I have often missed them – one of those daily luxuries that I never even contemplated as a luxury before I left home. The ability to walk barefooted out of my bedroom into a clean (well most of the time) bug free space, turn a faucet, slip my towel off, and bury my head under the seemingly never ending warm clean water is something that now seems so foreign and long ago to me. A price that I have paid for leaving home- it doesn’t seem like much, but on those cold and windy nights on Haiti’s northern coast when showering with a cold 5 gallon bucket of water that we lugged from 2 miles away, it really did.
It’s funny, to me, the things that I have ended up longing for… none of them are what I would have guessed. My mom’s hands, driving on cold nights with the heat on and the windows down, my best-friends green place holders- all small and ordinary but when I conjure them up in my mind I never fail to get a lump in my throat. The life that I have chosen is full of people but can be desperately lonely at times and I crave the company and comfort of those that I left behind. I have wished that I could have carried so many of them with me over these years and shared with them the beauty that I have witnessed and humanity that I have gained. The person that I was when the plane lifted me away from Los Angeles in April of 2009 is not the same woman that sits in front of this computer today and I have come to realize that the biggest price I have paid for my experiences here has been the loss of my old ‘me’. But, as fire is to forest, this death has brought forth a budding growth of spirit, heart, and perspective that makes the pain of this change worth it.
The three years after leaving has blessed me with bonds of love like no other- ones that can only be forged, both metaphorically and physically, through black stormed filled nights far from land with only each other to look to. The love of stranger children across 5 different countries whose affection comes with no strings attached and no expectations to fulfill- simply love for love and affection for the simplest of gestures. In Haiti when you would give a child a juice or a soda they never fail to share it with the kids around them… sometimes 10 of them passing around a bottle of juice, each of them taking a small sip and then passing it on, even though you never tell them to share, they do. And they do it out of goodness of heart and the common understanding that this gain should be shared with those around them. To me that is witnessing the goodness of humanity at its most basic element and I am grateful beyond all measure to have been that witness.As I sink my head below the river of my experiences now I have come to deeply realize that life truly is change and the flow forward never allows for anything to stay the same. The life that I left behind was changing while I was there even if I couldn’t or wouldn’t at the time see it. Often people that knew me back at home say that I gave up my Manolo’s and Jimmy Choos’ for Wellingtons and flip flops- this always makes me smile. For me, what I gave up, was my quiet warm lonely showers surrounded by beige tiles for smooth rocks cut out of mountains, rushing jungle currents, and the sounds of life penetrating every pour that I have.
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Bring me that horizon...
For me the sea has always been where I turn for inspiration, solace, and wonder. The night I was born I breathed thick salt air and first heard the sound of long Pacific swells rolling onto whispering sand, and from that day my life was held forever in the sea’s net of wonders. My mom and dad were living in a beach motel in Southern California while my dad did his medical residency, and my first steps were on the sand and behind my dad as he made hospital rounds and home visits to patients. I can never remember any time in my life when I wanted to be anything except a doctor and a marine naturalist, and thanks to my parents, extraordinary mentors and opportunities I became a marine biologist and a doctor and have had experiences in both fields that make me grateful to be alive just for one of those moments.
My favorite thing about the sea is that it is not lonely; in the sea I feel connected by the water to millions of people around the world. I imagine millions of people of a thousand colors and languages and religions and nations all floating together in the sea’s embrace and connected across thousands of miles by one continuous, unbroken sea. When we float in the vast sea, only a little of it is holding us up, but that small part is connected to an unimaginably vast and powerful body of water. In the same way, this is how a people are strong. When we say ‘a sea of humanity’ we acknowledge that humanity–all of us together–are as powerful as the sea, which is always waiting to show what it can do.
Like every wave, every life is unique and beautiful, something I have experienced time and again through this voyage. In 2011 we saw our
Fighting bedsores on a dying patient we inherited at the Asilo
10,000th patient, and although I am very proud of how many people have received care through Floating Doctors, what I am most proud of in 2011 was that as we expanded our project, we always stayed committed to the individual patient. Time and again, this has ultimately led to our being able to do more for more people than we originally anticipated and I have faith that we will remain committed to the single, individual patient as continue our voyage.
Long before I was old enough to venture over the horizon the last lands and seas had long since been charted, but fortunately the frontiers of health and the sea of humanity offer an endless horizon. Looking out over the Pacific horizon so many years ago I never envisioned that my greatest loves would one day combine in a mobile medical relief team exploring frontiers of health across the living ocean that washes all shores equally. I had no idea HOW I would pursue these two passions, I only knew with certainty that if I did not have them both in my life, I would never be happy, and so I would look out over the water or read Jacques Cousteau or trail after my dad on rounds, and dream of adventures on distant seas and future patients I would see and help.
First clinic in the new Panga (before we built a canopy)
Repairing torn stitches in Labadie
But all the time a voice was urging me to move forward, always there was another voice…darker, more ancient; a more primitive vocabulary but it didn’t need sophisticated words…it has raw fear, self-loathing, shame, narcissism, and petty angst and selfishness. This voice, all my life, has whispered under my dreams, telling me I will never become a doctor, and never see the seas I spent my childhood dreaming of. Sometimes it spoke with other people’s voices, like during the year we struggled to rebuild Southern Wind after she had been donated to us and some people scoffed and said we would never make it, and it would never work, and we would all be killed and waste all the support we gathered…but here we are. Sky and I lived with fear as a constant companion for the whole tenuous first year of our project, when so often it hung by a thread, but (especially with my sister beside me and many hands outstretched to help us keep going) we were able to move forward, one foot in front of the other, and now here we are…going on a mobile clinic in the morning, more than 600 mobile clinics into our voyage.
La Sabana in the mountains
I know now that this pessimistic voice I’ve always had spoke from feeling not good enough somehow to deserve attaining my dreams, and although as I got older (and continue to get older) the voice got fainter and fainter (I pretty much ignore it on autopilot now…most of the time), it took many years before I could–as my wise sister says–”Allow myself to succeed” without it being a struggle. We are always our own harshest critics and unforgiving judges, but as they saying goes: ‘You never know if you can climb the mountain until you try (REALLY try).’ And as a wise man said, is it really that frightening to succeed, and is it really, in the grand scheme of things, so terrible to fail? And there is always the third option (my favorite): sometimes when you fall, you find out you can fly (or learn how really, really quickly)–especially if hands are outstretched to help you stay in the air, and your ego (and the dark voice inside us) allows you accept the help that is offered.
The kindness and generosity I have seen people show towards us and to others fills me with hope that the daunting
La Sabana in the mountains
challenges of our time can be survived. I am immensely proud of what my crew, friends and family, and all our volunteers and supporters have made possible, and incredibly grateful to be able to be a part of this voyage and to have shared it with such extraordinary people.
Even with all its faults, earth is a beautiful planet, and humanity, despite its many, many faults, is heroic. There are heroes all around us; it has been a great honor to work alongside so many of them.
“The world is a fine place, and worth fighting for.”
Check out these pictures; some of my favorite moments captured in 2011.
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For the Floating Doctors, 2011 was a year that was marked by thousands of patients seen, turbulent ocean crossings, and hundreds of boxes of medication and medical supplies distributed. It was our most successful year to date in terms of patients treated, countries visited, and partnerships formed. The 12 months cemented our belief that the next and most important phase of our project will be the procurement of funding, support, and supplies for Floating Doctors’ permanent clinics in the countries that we have visited thus far. We clearly defined our role as the primary care givers to the remote communities that we serve and the importance of the follow up care we provide to them. We worked hard to secure lasting partnerships in Haiti, Honduras, and Panama which have enabled us entrance into and support from communities that otherwise would have been nearly impossible to gain.
As an organization, I am proud of what we have accomplished in the past twelve months but, for me personally, it goes much farther than miles traveled, pounds of supplies delivered, and numbers of patients seen. It is about the individual. It is about who patient #127 was and what it meant to her for us to be there, or how we were able to give patient #3679 relief from the pain he had been suffering from for years. It is the joy on a woman’s face somewhere in a forgotten jungle when she sees her baby’s heart beat on an ultrasound that fuels my pride in Floating Doctors. Rather than numbers on a spread sheet, for us, our patients are people with lives, children, and family who cherish them.As the Director of Operations, I am both honored and humbled that I get to witness these individuals first-hand and to be a part of the care that they receive from us. Daily, I am able to work closely
with our doctors and patients while running clinics, breathe in the culture of distance lands, and know what it is like to be one with a vast ocean. I get to live our work and see the results of it on levels that are deeply personal and important to me. I believe that my hands-on involvement makes me a better leader for the Floating Doctors and our crew.
One person can be just a number, but to those that love them, they are the entire universe, and we feel they should always be treated as such. Our belief that, “nothing is more important than the individual” has become a core ideology for the Floating Doctors, and it has woven itself in the fabric of our every action. I am endlessly blessed and inspired by our work, and I am honored to be there and be available as a resource to people who have no other option. I feel an immense sense of gratitude to those who have contributed to our work and who make it possible for us to be of service to so many. When a lot of people do just a little, it is amazing what can be accomplished. An innumerable amount of people have helped us in many ways, big and small, and the ripple effect of that collective work has reached thousands of patients across five countries and hundreds of isolated communities.On the precipice of 2012, I am excited for what the year will bring through our clinic doors and under
the keel of Southern Wind. The past three years have been a wonderful learning and growing experience for us – on both professional and personal levels, and we are eager to continue that growth in the coming years. With thousands of miles of coastline and countless communities in need, the future holds no bounds for us as an organization.Fair Winds and Calm Seas,
Sky Labrot
Director of Operations, Floating Doctors -
The Floating Doctors have been in Panama now for nearly nine months and during that time period we have been asked to help in a lot of different situations: sick babies, communities in need of medical attention, patient transports, even the removal of bot flies on a remote finca or two but last week left us in the middle of a situation that none of us ever anticipated or imagined.
It was late in the afternoon and I was wrapping my day up with a cold soda in the Cantina at the Bocas Marina when several water taxis pulled up. I paid little attention as the taxis come and go from the marina at all hours of the day and I assumed that this was nothing different—but I did watch as one of the drivers made their way towards the cantina while the other two waited in the Panga. Odd but nothing very note worthy. The driver made his way into the Cantina and started speaking to several of the cruisers that had taken up their usual spots around the communal table but was having trouble breaking the English/Spanish barrier with them. Being that, at the time, I was the best Spanish speaker in the group I was asked to come in and help interpret for the driver but quickly found myself confused at what he was saying.He looked at me square in the eyes and said “my friend has precious tigers for sale in my boat”. Excuse me? I asked him to repeat himself several times as, although I was interpreting what he was saying in my head, it made no sense to me. I asked if we could walk over to the panga so I could see what he was selling—I honestly thought that he was going to show me a launcha filled with Lion Fish and that I was just not getting the local slang for the fish—but as I neared the boat I could hear a very strange but oddly familiar kitten like cry. To my utter horror and shock as we got to the end of the dock, there they were, two less than one month old Mountain Lion kittens shoved into a small card board box covered in their own filth and obviously scared.
Now I recognize that these animals are very cute when young and obviously bring with them a large pay day for those that get their hands on them but at that moment I was sickened. Here below me were two wild animals- young, scared, and fighting for their lives. I asked first where they had gotten them and why they had them and was told that they were “found” in the mountains outside of Changuinola. Right….
I started to explain to the 3 men that not only was it very bad that they had taken them but that if they were sold to someone for the house that they will die as they need a very different kind of care than a normal house cat. They then told me that for $500 a piece I could have them. We started a back and forth – them speaking only of the cash they wanted and me making a futile attempt to explain to them the ramifications of what they had done- that wild animals should never be taken and caged. Finally I looked at the water taxi drivers, both of whom I recognized, and said—“Hey, you know this is wrong and I know you, and I see you and I would proceed with caution if I were you”. They all immediately became nervous and started their engines. Off they went with the crying kittens.
We jumped into our own Panga and followed them into town and as the man with the cats exited the boat and the taxi took off I followed suit. I ran after him and after a few seconds was face to face with him again explaining that he wasn’t going to go anywhere with those cats. He called for a few of the taxi to help him with this crazy woman, but thank god, the months of work that we have been doing here in Bocas came to my aid when the men gave a simple reply, “ nope, she’s good”. He again began to walk away with me not leaving his side and again he tried to get assistance from some locals on the street and once again got the same reply from them… “she’s good man”. He finally stopped and faced me. At that point I told him that this could be a problem for him or it couldn’t- all he had to do was hand over the cats and come with me to the Smithsonian or he could make it a problem. He simply handed the box over turned around and was gone.I have seen a lot of sick babies in my last three years working throughout Central America and although not a doctor could tell that these two cats were not in good shape. We rushed them to the Smithsonian Institute in Bocas who gave us pointers on how to care for them—we were hoping that we would have been able to hand them over at that point but the group needed time to assemble their resources and identify the best place for these wild animals to go. They told us how to bottle feed them with goats milk and that them staying warm was very important and set us on our way.
The next three days were spent feeding them every two hours, day and night, helping them go to the bathroom, and making sure that they were never cold. They cried incessantly when not sleeping and we tried to offer them whatever comfort that we could but there was nothing that we could do to stop the pain that happens when a baby losses its mother. To stop the fear of a surrounding that is not and should not be theirs.
We nurtured them back to health over the days and finally got connected with Elena Castejon from APPC who immediately sprung into action to get these two innocent little souls to her in Panama City. We packed up their bottles and goats milk, put them on a flight to Panama City to be met by Elena and the crew from ANAM, and they were gone. Out of our lives as quickly as they came but leaving an impression bigger than they will grow when they are large.For me personally, although it was an amazing experience to be able to care for such animals, it was agonizing. These were not two kitties bred for human affection and love but rather two wild animals who will now be relinquished to a cage, ripped from their natural habitat, and made to become something that they are not—cared for by humans. These two will never know the joy of running unimpeded through the wild, to feel a jungle bark beneath their paws, or what flowers bloom deep in the forest after a drenching rain. They will never know what sounds howler monkeys make at night and what should alarm them in the wild. Instead they will be caged in a sanctuary that is a poor surrogate for their land.
I believe that all of us here in Bocas are in our hearts wild things that have refused to be caged by the normalcy of life. We have sacrificed the comfort of stability for the beauty of freedom. We have chosen winding jungle trails over the constrained isles of Walmart and the untamable ocean over freeways. I saw the same hopeless sense of amazement in each one of the Bocateranians that came to see these little wonders that I felt so deeply- as if seeing these caged and scared cubs was like witnessing the part of our lives that we have all railed against so vehemently.
Once again I am honored to have been a part of something that helped to stopped pain and suffering but in this instance I did not walk away feeling a complete sense of calm. D. H. Lawrence said, “ I never saw a wild thing sorry for itself.” But for me, here, I felt sorry. These two will never feel sorry for themselves- they are young and they will grow up believing their caged existence is how life should have been. Three years, 6000 nautical miles, and countless wonders ago I may have said the same about my own life. It was how I thought it should be- the job, car, credit card- all a part of the foolish game I believed was so necessary for happiness. Unlike those caged cats I think we all now see otherwise….“Life is not about seeing what you want and how to get it but rather is about seeing what you have and how to give it.” Frank Baxter
Written by: Sky LaBrot
For more information and to get involved please visit:
APPC http://www.panamericancon.org/ -
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…
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It has been two months since I have been able to put words to page although this is not for lack of content or consideration but rather the inability to put thoughts into meaning. In that time period we have left Haiti, seen old friends in Jamaica, and crossed the remainder of the Caribbean Sea to Panama. All amazing accomplishments that should be noted, written about, and reflected upon- yet every time I open the computer to a blank white WORD page I sit paralyzed. It’s as if all of the experiences and work bottle neck themselves in my head and leave a connection with my hands useless.
I thought this time that leaving Haiti would be easy, knowing that we would return again, to have seen the faces that I love and know that they are well, and yet in reality it was much harder than the last. To see a little boy that I love with all of my heart playing by the tree where I last left him was a joy but leaving him once again at the same tree eats at me… having him not there the next time we return will break me, and yet when I sit back and think about, having him still there may be just as bad. The never ending tail chasing ‘whats worse’ game that plays in my mind. It seems at times to me that my heart will never win when it comes to my time in Haiti—I will always be pulled back and tormented away. The sights, sounds, and deaths get no easier the second time around- they still work their way in, nuzzle themselves into my soul, and trouble my moonlit nights on the water. As we left Haiti I sat on our back deck for as long as the light would allow my eyes sight with my heart being crushed and simultaneously elated that we were pulling away from the shores not knowing if the tears I was shedding were for her, for me, or for those I was once again leaving behind.The transit that lay ahead of me turned into 5 of the most memorable days of my life- flat calm and beautiful the seas opened themselves and the life that dwells deep within its blue waters to us. We spent the days spotting whales, dolphins, endless fish, whale sharks, and sharks with an elation that only wildlife can bring. I felt my heart being drawn into the
dark blue that lay beneath our keel, the salt water starting to become part of my blood, her vastness a part of my soul, and perhaps on this transit I truly became a sailor. As I walk down the docks now I feel her calling to me- beckoning me into her wildness and away from the safety of solid land. To trade stability for freedom and schedule for adventure- to stand on our bow with salt laced air in my face and dolphins underneath my feet. To undo our lines and sail into the never ending splendor that is the open ocean.I had dreamed of Panama from the start of my involvement in this project – it always seemed so wild and distant to me. It has not failed to disappoint either- the people, the
jungles, and the islands have opened themselves and embraced our project like no place we have been before. The unending kindness of the people here leaves me speechless as it seems that there is nothing that they won’t do to make ‘us’ happen. Free Dockage from the Bocas Marina and Yacht Club, amazing Fashion Show/Fundraisers from the Calypso Cantina, Wednesday night girls night with some amazing women. The community has thrown its heart open to us and is literally making our project here possible. So much of what I have constantly had to worry about has been lifted from my shoulders allowing me to immerse myself in our clinics. I am humbled, once again, by the generosity of others.I find myself loving my life – on the precipice of my 30th year I am thankful beyond all reason for the life I get to lead. I wake up every morning, usually no one is up yet, and I drink my coffee overlooking one of the most stunning bays in the Caribbean. I awake my crew and head off to a distant shore, often feeling like I have stepped back hundreds of
years in time, and spend my days making peoples’ lives better, making their pain stop, quieting the worried minds of mothers and the crying of babies. And all too often people tell me that it’s so amazing what we do—my only reply is, nope, it’s amazing what I get to do. I am surrounded by suffering and pain and beauty and wonder. My heart is broken and lifted twisted and torn and I would change none of it. My cup runeth over. I am haunted and changed and the luckiest girl I know.
