“It is not the strongest of the species that survives, nor the most intelligent that survives. It is the one that is the most adaptable to change.” –Charles Darwin
This year marks 10 years of Floating Doctors operations. In 2010 after the earthquake in Haiti, a rag-tag band of us (aboard a boat we had rebuilt ourselves) sailed to Petit-Goave for our first mission. Weeks turned into months turned into years and we grew from just a few intrepid volunteers and crew members (whose exploits have since passed into legend) into an organization that hosts almost 1,000 volunteers annually from all over the world and operates a rural health care system providing services over more than 10,000 square kilometers of jungle-covered mountains, mangrove mazes, and open sea conditions in Panama.
Everywhere we went, the weather was always changing…the wind and the sea have their own agenda and all we could do to reach that horizon is to trim the sails, batten the hatches, put the wheel over and press on. Living and working on the water means adapting yourself constantly to ever-changing conditions. The sea may be calm one minute, and a white squall may roll you over the next. Adapt or perish.
The health landscape is also always, always changing. Needs change, capabilities change. resources change. Governments change. Diseases rise and fall like empires. To survive and flourish, Floating Doctors has always adapted to meet change, but after ten years of flexibility and change I can still clearly see our original core ideals present in every aspect of what we do and who we are:
- Patients still count. One patient is still worth as much to us as a thousand patients.
- We align ourselves first and foremost with the groups for whom we advocate and serve.
- Volunteers matter and we create learning and growth opportunities to make the world they return to a better place.
- We believe there isn’t anything we’re ever doing so well we couldn’t be doing it better.
- We believe that compassion is the most important first element of any health care.
- We believe that when a goal for humanity is supposed to be impossible, we should try all the harder to achieve it.
- We believe that to be of service to others is a vital part of our own liberation.
- We believe that it is all a leap of faith: for a volunteer to step into the boat, for a patient to place their trust in one of our doctors, for a supporter to believe in us.
- And we still believe that to reach an impossibly far shore, you can’t save anything for the swim back.
In ten years, it seemed like many lifetimes passed. I’m STILL processing what we saw and experienced, especially in those early days. But I’m proud that in all that time we have remained completely true to who we wanted to be, and who we have always been, and who I know we will always be. It sure hasn’t always been easy…in fact it’s easily the hardest thing I’ve ever done, in every way. And it has certainly rarely been comfortable-after all, you can be comfortable or you can be growing, but usually not both at once…and we’ve been growing continuously for ten years.
But although looking at what we have now may seem extraordinary from our humble beginnings, don’t get too comfortable–everything you can see in Floating Doctors now may indeed be a monument to the efforts of those whose acts will write the history of their generation. But we’re just getting warmed up…wait till you see what comes next.
So gear up, batten the hatches, grab the wheel and prepare to trim the sails. There be storms and squalls ahead, but treasures far beyond gold and silver as well. The direction is easy–second star to the right, and straight on till morning. It only seems impossible until one day you look up to find yourself standing on a new world, and already looking ahead to the next one.
Earlier this month, you were teased with a picture of Jonathan, a very sweet boy who we had the pleasure of interviewing. Let me tell you about him and his family.
We first met Jonathan in 2011. He was bright-eyed and incredibly extroverted. Like many his age, he demanded we give him our attention, play with him, and hold him, which we were more than happy to do.
In many ways, making sure Jonathan has the support he needs to grow up healthy is the same as it is for all of our patients. He needs regular well-checks, dental care, access to education, and support for his parents to help him develop. Because he has Down syndrome, however, he and his parents need some additional resources to make sure he can reach his dreams. These resources exist, but they are difficult to access and the system is hard to navigate.
Floating Doctors has been working with Jonathan’s mother, Selina, since we first met them to ensure Jonathan has all the support he needs to grow healthy, strong, and fulfilled.
Now a 9 year-old second grader, Jonathan has grown so much. Like other kids his age, he’s developed strong likes- soccer- and dislikes- loud noises, and he likes art. He’s got big dreams, and we will do everything we can to help him achieve them.
Floating Doctors makes sure families like Jonathan’s have a chaperone to help them go through the systems necessary to obtain the support they need. We assist with access to occupational and physical therapy, provide regular eye and heart checks, and educational assistance.
We work alongside Selina to make sure Jonathan- and his 9 brothers and sisters- have access to the care they need. We make sure to see Jonathan every time we visit his community, to check on his development, assist with the paperwork Selina needs for specialist care, make sure he can get to his specialists for therapy, and spend time with this wonderful, playful boy. Down the line, we are looking at ways to help ensure some independence, such as adding a bathroom to the house (they currently don’t have one.)
We could not provide high-quality, ongoing, and complete care without your support. You are such an important part of the Floating Doctors community. With your support, we look forward to being there for every step of Jonathan’s development!
Our Final Clinic of 2019…
by Gaurav Sikka, Floating Doctors Lead Medical Provider
Floating Doctors’ final clinic of 2019 was a multi-day at Ensenada, a community on the shores of the eastern side of Bahia Azul. Access to healthcare for this population is particularly difficult because, although located on the mainland, it is only really accessible by boat and the closest hospitals are expensive trips for our patients.
The clinic was run over two days. Our crew saw patients well into the evening hours and by the time we had the clinic equipment packed on Wednesday night, ready to leave the next morning, everyone was exhausted but in good spirits.
This being the last day of the final clinic for the year, however, there was sure to be some deviation from the normal end-of-clinic experience. Thursday morning started with a sudden awakening for Angeli, our Executive Director. The woman who had been catering for us during our stay was alerting her to a new arrival at Ensenada.
With a look of excitement and anxiety, she explained to Angeli that her daughter was in labour. Angeli came to wake up two Lead Medical Providers- Nisha and me, Gaurav- and Jess, a volunteer registered nurse. We all rushed to the scene and another volunteer, Joe, joined us a few moments later with the all-important emergency bag.
The walk to the new mother’s house was short but treacherous, stepping on half-floating logs and washed up debris from the sea, but we quickly made it up to the raised floor of the hand-constructed wooden house that stood on stilts.
There, in the corner of an empty room was an exhausted looking woman, with her legs open wide to accommodate her baby girl that she had just given birth to. Births are beautiful moments to witness, yet can occasionally be rather gruesome, even when there are no complications.
Upon entering the house we heard a loud, high-pitched, shrill cry. This was music to our ears- hearing the baby crying is the best indicator that it is breathing and expelling the fluid that fills their lungs while in utero. The baby’s colour was still blue initially, the umbilical cord was still attached, and the delivery of the placenta (also known as the third stage of labour) had not been completed yet either.
This moment in childbirth is critical and as we rummaged through the emergency bag to find the obstetrics kit I was reminded of how the simplest of pieces of equipment can prevent common medical complications. Two sterile cord clamps and a scalpel, for example, allowed us to safely cut the umbilical cord without introducing tetanus or other pathogens to the baby.
Then, with the placenta not yet fully delivered we encouraged the mother to breastfeed and offer skin-to-skin contact with the baby because this is known to speed the third stage up. We also coached the mother to push a final few times to complete the delivery.
The first priority after delivery of a newborn, even before attempting respiratory resuscitation if required, is to dry the baby with a towel and wrap it in another dry towel, then put a hat on its head. This is to avoid the inevitable increased rate of heat loss, even in the tropics, that a wet baby will experience due to an increased surface area to volume ratio.
Though certainly exhausted, with the labour over the mother seemed relieved and other than applying pressure for a short amount of time to restrict a small amount of bleeding we had little to do but offer moral support.
The surrounding female relatives rejoiced in the birth of a new member of their family and in the kitchen next door we could hear a chicken being slaughtered in preparation for the copious amounts of chicken soup the mother was to be served in the coming hours and days to help her recover after such a herculean effort.
Joe then kindly grabbed some more equipment for us from where we had been holding clinic- weighing scales, measuring tape etc. so that we could examine the newborn, just as we would in a high-resource setting. Thankfully, the baby girl was healthy and intact in every way; she even breastfed within moments of being born.
We, the Floating Doctors crew, felt privileged to have been at the birth of a healthy child in this community. We offered our assistance but thankfully not much intervention was required. In the process of the elder ladies in the family deciding a name for the new baby girl, Jessica was ruled out due to it being a common name there already, Nisha was considered but was just pipped to the post when one of the elder female family members found out Angeli’s name and decided it was the one that suited the newborn baby girl best.
by Jill Patel
Jill Patel joined us as initially as a global health student in the summer of 2018, and has been working on a research project focused on mental health within the Ngäbe-Buglé population. She will continue to work on Phase I of the project both in Panama and in the US through the Fall. Keep reading to know more about her initial time spent in Bocas, and be sure to check back in a few months with an update on her research!
Note: Written in summer 2018- future dates noted reference 2019
Words cannot begin to justify my experience in Bocas del Toro this summer with Floating Doctors. What I thought would be a simple medical mission trip turned into a life changing opportunity that has inspired my new path to global medicine. From the outside, I saw a beautiful landscape filled with lush green trees, tall mountains, and colorful houses. However, hidden behind this was a community that has daily contact with the jungle, high worm loads, untreated water, latrine sanitation, and wooden huts. Despite this, the Ngäbe-Buglé people welcomed me with open arms—they laughed, cried, and went on an emotional journey with me, never making me feel more or less than they were. I thought I would be helping them improve their health, but they gave me a whole new perspective on life that enriched my physical, mental, and emotional well-being. All of this may seem so abstract and good-to-be-true, and I would have agreed before coming here.
My most memorable and favorite moment was doing a community health project on mental health with children in Cayo de Agua. Nicole and I had brought coloring books and crayons, as well as prepared activities, from breathing exercise to hand-shakes, to teach children how to relieve stress We also created a simple questionnaire to better understand their emotions. Our activity started with five students. I used my broken Spanish, which was surprisingly better than I expected, to introduce myself. As more children joined our activity, our coloring circle grew from 5 to 30 students scattered, around us. Here I quizzed students on what they were coloring to practice my Spanish. The funny part was that I did not know if they were right—I was just asking to expand my Spanish vocabulary. However, I think they soon realized that and possibly taught me some inappropriate words because they kept laughing every time I repeated it—I wish I remembered the word so I could look it up.
This fun quickly turned upside down when I interviewed a five-year old boy. I still quiver every time I think about him. He was very reserved and would not look up at us when we spoke to him. At first, I thought his actions may be driven by socio-cultural factors and thus was common in this community. However, I soon realized that this was not the case. When we asked him what makes him happy, he said nothing, and he does not do anything to make himself feel better. He also told us that “ellos”—everyone—scares him; instinctively, I leaned in to give him a hug. He disclosed that a girl, who was present in the circle, was bullying him at school. My eyes watered up because I was no stranger to bullying myself. I was bullied up until high school for having thick facial hair, not shaving my legs often, and wearing long, oily braids- I know what it feels like to be different and to want to be a normal teenager. Before he left, I told him, “Tú eres muy fuerte y yo soy tu amiga.”
Mental health remains unknown and under-served in the Ngäbe-Buglé community, but the need is very large. From bullying at school to young mothers, children and teenagers are vulnerable to various mental health conditions as they are pushed into adult roles from a very young age. We all have been fearful, anxious, nervous, scared, and traumatized. Unfortunately, these communities lack the resources and support we receive here, and Floating Doctors has taken the initiative to address this issue. In January, a Family Therapist and a PhD candidate will come for a year to examine the mental health statues and needs of the community. I will join this team to further my community-based project in hopes of delivering better tailored care, and I encourage others to join the cause so no child ever has to cope with sadness and fear alone. Whether one is a volunteer, student, or professional, we can all make a difference in our unique ways as long as we have hands to serve, ears to listen, and a passion to help.
From clinic and beyond, I made many new friends and strengthened bonds with others. To continue Floating Doctors’ mission to improve the health of all, my group and I volunteered at Asilo, a nursing home in Bocas town, to address patient’s non-clinical needs—painting their nails, massaging their hands and legs, bringing water. When I entered the nursing home, I was surprised by the conditions of these elders- they were so frail and weak. My eyes watered up as I realized that many of them were either the same age or even older than my grandparents, who I am tremendously attached to. When I asked an elderly woman if she wanted to color or get her nails painted, she reached her hand out. As I held her hand in mine for a couple of minutes, her face relaxed and she closed her eyes. She reminded me of my grandmother, who would hold my hand as she watched TV or laid down because she loved having someone physically close to her. I sat with this woman for a while, just holding her hand without saying a word. This is the true power of a simple touch, something that many people may disregard but is immensely valuable.
Here I also met my new friend, Richard Garret from Queens, New York. I introduced myself and asked how his day was going in Spanish. To my surprise, he responded back in English—another lesson: never assume what one can and cannot do. From Turtle Beach to Summer, he gave me an oral tour of the entire town and listed all the places I should visit. When I asked if he goes to Summer, a dance bar, often, he enthusiastically said yes. Just like me, he loves to dance. We spent the next thirty minutes talking about our passion for dance. I shared with him pictures and stories from my previous dance competitions. Before I left, we took a picture together. He told me to show this photo to my family and tell them that I made a new friend at Bocas. He gave me a hug and told me to come visit him when I come back to town.
The Asilo opened my eyes to the struggles of the elderly in Panama and more significantly, the importance of addressing a patient’s non-clinical needs to provide holistic care. Sometimes medical mission trips get caught up in providing preventive and surgical care but forget that health encompasses much more than the physiological. Floating Doctors is unique and successful because it improves health at the clinical, social, and personal level. And this is what has, is, and will always pull me to Floating Doctors
As my story comes to an end, I want to leave with a final lesson: Dr. La Brot always says that in order to serve, we must learn from those that we serve. No matter how superior my knowledge or skill may be, I can never provide the best service or obtain the best outcome if I do not listen to my patients. While living in an open church and eating with locals in wooden huts at Cayo de Agua, I witnessed the lack of infrastructure and services. But through these activities, I also learned about the community’s lifestyle, needs, and wants. This helped me understand why certain medications and preventions were utilized in situations that we normally wouldn’t in the US. Learning and applying these social, cultural, and economic determinants of health in practice has been a humbling experience. I remain driven by the knowledge that easing the service gap can mean drastic change for neglected populations, which motivates me to continue my path in global and community medicine. I cannot wait to return back in January to help further the Floating Doctors mission! Thank you to Dr. LaBrot and his Floating Doctors’ team, the Ngäbe-Buglé and Asilo communities, and my wonderful colleagues for making this a memorable experience.
By Dr. Kevin Lan, Dental Director
“You can never cross the ocean unless you lose sight of the shore.”
Now more than ever, we face a rising epidemic of dental caries in the teeth of children from the indigenous Ngäbe communities we serve. The combination of their inability to afford basic oral health products such as toothbrushes and toothpaste, poor education, lack of access to healthcare, compounded by a sharp increase in consumption of refined, sugary hot and cold drinks, has resulted in many children with decayed and broken down teeth, especially in their newly developed adult teeth, ones that will not be replaced.
2018 saw the Floating Doctors dental program explore new horizons and greatly increase our services provided to the communities of the Bocas del Toro Archipelago. We established our first mobile dental team, held independent dental clinics, provided continuous oral health education and prevention, recorded dental health in the communities for research and we have hosted dental groups from the University of California Santa Barbara and the Dental Humanitarian Outreach Program (DHOP) of the University of Southern California.
14 undergraduate students from UCSB and 3 dentists visited and stayed in the communities of Nance de Risco and Cerro Brujo, where 156 patients were seen and treated. The challenges faced by this team were numerous; it was our first dental only deployment away from the medical team, the first time we had stayed in two communities and worked 4 days consecutively, whilst setting up and packing away our equipment in between both communities and working the same day. The success of this group can only be measured by the amount of hard work put in by our FD staff and the UCSB group where despite being constantly pushed outside of their comfort zones, numerous students embraced the opportunity to learn and be part of a positive life changing experience where they sought to give to those who had less, rather than how their time with us could benefit them.
DHOP held 6 clinic days from the 9th -14th December in Bocas del Toro. A total of 90 dentists, dental students and FD staff, worked tirelessly each day from 7am – 7pm in temperatures above 85°F, providing dental care to over 700 patients from 20 communities in the Bocas del Toro Archipelago, where some were transported 3 hours by our boats. The DHOP clinic was a very emotional experience to work alongside such a dedicated, skilled and high spirited group where it was heartwarming to see people from communities that we know, receive high quality advanced dental treatment, like Root Canal Treatment which we could not normally provide when in their community. This is the difference between saving or losing a tooth. I will never forget the family of 4 who had traveled the whole day to attend our clinic, where a 10 year old girl had fallen and broken her upper front teeth 3 weeks ago and required Root Canal Treatment. Due to the required treatment time and inability for this family to return home that day, they were given accommodation as they were unable to afford this themselves. The next day, her father could not express to me without tears in his eyes, how grateful he was for the care and compassion we had shown to his family.
For me, it is not the numbers of patients that we can see that drives our ambition to care for the Ngäbe people, but it is to be present for those who have been forgotten or unable to access healthcare and being able to make one little girl smile again without losing her front teeth. Floating Doctors is proud to host groups like UCSB and DHOP so that we can try and inspire the next generation of healthcare providers to educate and improve the lives of others, so that we can leave our communities and world better than we found it.
Walt Disney once said “All our dreams can come true, if we have the courage to pursue them.” 2018 saw Floating Doctors take big steps towards continuous and sustainable dental care to the communities we serve. 2019 will see huge development and partnerships being established as our family grows with increasing support from Europe and America. 2020 is still unknown for what the future holds, but I can predict that we will continue to work hard in providing dental care and education for the people in the communities who need our time, compassion and support against the challenges we will face together.
Through the courage of our team and those supporting us, our dreams are not far away from reality.
As the last days of the year draw to an end, I’ve been handed an impossible task.
It is traditional for NGO founders to write a post at the end of the year to summarize the work of the past year and to share with everyone the vision for the year ahead. When I sat down to do so, I momentarily panicked….how can I, in a few words, convey even a small sense of what hard-won achievements by our staff and volunteers this year? We grew from a single team to two medical teams and a dental and veterinary team deploying nearly every week. We launched a surgical program and our veterinary program blossomed. We made many new partnerships and grew our infrastructure, including building a laboratory. We published research. Patients received impossible treatments such as a new heart valve. I could go on and on well into the new year and never do justice to the victories for humanity won by women and men whose names will likely never be known to the world but whose kindness and courage will never, ever be forgotten by the people whose lives they impacted.
People like to lament how there is so much ugliness in the world, and my dad is fond of saying, “Of course there are ugly things in the world. For example, there are people dying of cancer in a hammock hanging under a shack in the jungle, and that is a horrible injustice. But there are also people–total strangers–who will pull that person out from under their house, clean them up and do their best to help them not die in pain and alone. And this is a beautiful thing in the world; an astonishing miracle.”
And it was this taking such personal responsibility for strangers that I watched my team do all year long that really struck me. People talk a lot these days about ‘Global Citizenship’ and ‘Global Leadership’ but I think both of those terms lack something. ‘Global Citizenship’ seems to indicate merely living in the world, passive, and ‘Global Leadership’ smacks of the hubris of knowing better than everyone else what is needed to lead the world to righteousness.
And finally this fall I realized what it was that Floating Doctors inspires in our volunteers, our supporters, our communities, and ourselves–Global STEWARDSHIP: the commitment to stand up and make a better world our own personal responsibility, in whatever ways we can every day. And that may seem like a semantic difference, but I think it is a critical one.
Every evening that I can, I take my daughter (who just turned 1 year old) outside when the sun is setting and hold her to the west and I whisper in her ear. I say to her, ‘Look Aya, the sun is setting. This day is done, and will never come again. There will never be another day like it as long as we live; we can never return and change it. Were we kind and loving today? Were we honest and truthful, with others and with ourselves? Did we work hard? Did we find time for play? Did we find an opportunity to show compassion, forgiveness, courage? Is there something we put our hands on today that was more like us when we took our hands away?” I have no idea how much of what I say she can understand…all I know is that she definitely understands more than I think she does. So this is what I tell her…and, truth be told, I need to tell to myself every day also.
She’s too young to to know that of course, it’s impossible for us to do all of these things every day. We are not saints. But it’s important to always aim high. After all, when you study for an exam, would you aim to get a C? If that’s as high as you raise your sights, that’s all you’ll ever achieve. Living things aren’t made to aim at mediocrity. All things strive–every living thing strives in an unforgiving universe, and to be human is to often stand with our feet in the mud, but reach always upwards towards the stars.
The best part is that we don’t have to achieve all those great things every day in order to change the world. We don’t have to free a nation or launch a movement or solve world hunger. As Bobby Kennedy said, “Few will have the greatness to bend history itself, but…it is from 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 which can sweep down the mightiest walls of oppression and resistance.” That still chokes me up very time I read it.
As you watch the sunset tonight wherever you may be, decide how you want to mark the end of the end of this year, for it will never come again. There will never be another like it as long as we live; we can never return and change it. But it is not too late–there is still time to show compassion, to be kind and loving, and to choose to be a steward of this world and send forth a tiny ripple of hope. 2018 was a year of staggering accomplishments by our staff and volunteers…but we are just getting started. A million different centers of energy and daring are building; the current against oppression and suffering will continue to grow but only with your help. A very funny and very wise lady, Lily Tomlin, said “I always thought ‘Somebody should do something about that.’ Then I realized I was somebody.”
Be somebody today, so that when the sun sets tonight, you can look to the west and hold your head high because in the twilight of the 2018 you put your hands on the world and made it a little more like you–a little more compassionate and caring–when you took your hands away.
Thanks for an amazing year, everyone. If you thought what we all accomplished together this year was something, just wait. We’re only getting warmed up. Happy New Year Everyone! Próspero Año Nuevo!
Dr. Ben LaBrot
by volunteer Trisha In
“Be sympathetic to the weakest, because the odds of silver and gold are what determines our lives. Some do not have the same fate as us, so if one day we have the ability to help others, do not overlook that.”
I took this quote from a reflection that my mom wrote in Khmer, the official language of Cambodia, which makes up half of who I am. The similarities between Cambodia and Panama in terms of healthcare was also a large reason why I wanted to go on this particular trip to begin with, but beyond that, something about this Panama trip instilled a strong inclination within me to get a passport and apply. I just felt like this particular one was meant for me. And it was, truly. There are a couple of things in my life that I feel like were absolutely bound to happen and this trip was one of them. It’s a bit funny though, because even a few days after coming home, I still find it hard to describe to others what my experience was like when asked. So much had happened, and it feels like an injustice to just pick one or two things to tell them about.
However, with that being said, there are a few instances that really stood out to me, ones that I hope to never forget as I continue on my pathway to become a dentist one day.
My most difficult moment occurred immediately after doing my oral health and education charla with my partner, Jamie, as well as doing a solo one for the adults as part of my DK Fellowship. It was not doing the “charlas”, per se, but I remember debriefing with Mary about everything afterwards and I couldn’t help but tear up. I think in my mind, I had always thought that education would be the solution to everything (to a certain extent, I will always believe that). After all, that is why I spent so much time in the states trying to focus on making educational materials both in and out of dentistry. However, I don’t think I realized that education can only take you so far when you are in a really resource-limited setting such as this one. I could preach all that I want about flossing, mouthwash, toothpaste, etc., but it doesn’t do the community any good if they cannot access these materials. Mary seemed to understand what I was saying despite my ramblings, and she also mentioned that it’s similar for nutrition—a lot of these families don’t work. They might harvest foods for their families, wait for rainwater, and fish for their survival. So for an outsider to come in and say to do X, Y, and Z can be insensitive to their culture, resources, and way of life. I related this to how ridiculous I find it in the states that we often preach to eat healthy, but if one goes to McDonald’s, a salad costs $7 and a hamburger costs $1.50. Mary and I concluded our discussion with her telling me that despite all challenges, we must remember that we are helping the community as best as we can, given the resources that both we have, and that is something to be proud of.
That moment was also special to me, because a few of the children from the schoolhouse followed me after the charla. I couldn’t recognize them at first, because they had changed out of their uniforms, but they told me in Spanish that they were our students from earlier. They kept following me around and it was one of the cutest things that ever happened to me. I was a little confused as to what they wanted, though. When I saw them a bit later in the day, I realized that they had seen the plastic bag of sunglasses in the pharmacy, and that was why they followed me. Unfortunately, I wasn’t as popular as I thought I was! I was, however, popular the following day in clinic when I was shadowing some of the other charlas. Since I was the one handing out water for a demonstration, I had about a dozen children follow me telling me to refill their cups so they could drink. Those cute faces made it so hard to say no, that I ended up giving them all of my water and eventually had to run away…but then they found me near the jerry can and I had to explain, “No tengo más aqua, lo siento.” On the surface level, it makes for a cute and funny story, but I could not help but remember the fact that this community does rely on rainwater as their main water source, do not have typical toilets or constant electricity.
Juxtaposition is one of my favorite words in the English language—my friends always make fun of me for using it, but it’s the perfect word to explain another aspect of my time in Quebrada Sal. A hilarious and unbelievable experience on our first day there: we walked to the beach in order to shower but were kicked off due to the filming of an upcoming reality TV show. Even more hilarious was when I learned that they wanted it to seem remote, which is why nobody could be on the beach. I couldn’t help but think: that seems so contrived, especially when we literally just walked through mud from an actually isolated community, on this same exact island, but instead here we are on this beautiful, white-sandy beach, that has a sign “Welcome to Paradise” right when you set foot. I had wondered if all of the cameramen and actors knew the life that existed right outside of this beauty.
Speaking of the community, there is something to be said about it here. Within the first 15 minutes of setting foot in it, while trying to find the Floating Doctors lodging area, a woman came running out of her house and asked us if there would be a dentist at the clinic the following day. When we told her that there would be, she told us “Mañana, yo voy.” I was surprised, honestly, because even in the states, I feel like going to the dentist is something that is severely under prioritized. I believed that most did not understand that oral health is an important part of overall health. It truly touched my heart that my first encounter in this community was dental-related. I also had learned how much the community respects Floating Doctors. Of course, I knew about this already from talking to Dr. Ben and learning about the organization online, but I didn’t really get it until I experienced it myself. Even in Bocas del Toro, I would use my broken Spanish to explain that I was a part of Floating Doctors and two people gave me their phone numbers to contact them if I ever needed help. One of those people was Toby, who apparently is a boat driver for Floating Doctors?! Dr. Ben also explained a while back in one of our pre-departure meetings that families will come from far away and dress up in order to visit the clinic. I witnessed this, as a line started to form before we even finished setting up the clinic, and despite rain.
Another thing that I noticed particularly in the dental clinic during the two days that I got to assist was how respectful all of the patients were to us. They were willing to hold the tray of materials if I needed to go get up and reload a syringe. They would wait patiently for their turn. But something truly incredible was something that I bridged what I learned in my Palliative Care class and this Panama trip: that different cultures express pain differently. In the states, I have watched everyone, from young kids to grown men, throw tantrums from receiving one anesthetic. I’ve seen patients push the dentist’s hands away, creating an unsafe environment for everyone there, especially with all of the sharp materials.
That brings me to my favorite patient: my first one. I was really lucky to swap places with the other assistant at this particular time, because I ended up with the coolest case that we had seen in the two days as my first one. We saw a young teenage girl present with an abscess on top of a tooth, and this this made me realize just how different dental care is here versus a resource-rich area. Elsewhere, this would be an easy-fix with a root canal, but here, we had no choice but to just extract her tooth. Despite being in pain because all of the anesthetic that we gave didn’t seem to work after a certain point, I saw tears in her eyes, but she still sat calmly and let us finish. My time in the dental clinic was one of the most meaningful: I was able to meet Dr. Philippe, who is one of the most humble and inspiring dentists that I’ve ever shadowed, I realized the disparities that exist, and got to assist for the first time in my life. I have always said that if I cannot become a dentist, then I don’t want to do anything else in the healthcare field because that’s just how much I feel like dentistry is for me, and that thought was solidified when I stepped into the dental clinic after being around intake and realizing how uncomfortable and foreign that space made me feel. My friends noticed this too, that even though I was nervous to be assisting, I also was elated to be there in that moment.
I feel as though a shout-out needs to be given to Dr. Philippe, who I learned has been with Floating Doctors for four years now. I do not think my experience would have been the same without him: in clinic, I told him it was my first time doing any sort of restoration mixture so I was very nervous. He told me that it was okay, and that after a few times, I would be better than him. Of course, that isn’t true, but the fact that he was so humble was very inspiring. Even outside of the clinic, he went with me to refill the can of water to clean our dirty feet and even held it for me when I tried to get all of the mud off my sandals. But the most heartwarming moment was when we were on the boat leaving Quebrada Sal, he was holding some of my DK Fellowship papers that I asked for feedback from, and despite us all getting completely drenched, he made sure to keep my papers dry despite me telling him that I had more copies. Sometimes in this field, especially in the states, I become disillusioned by all of the dentists that have admitted to me that they simply pursued a career in this path because it was lucrative or because the hours were good. It was refreshing to see someone who genuinely just wanted to help others.
My mom said something funny—that every time I called home, I was in tears. I’ll ignore the fact that she put me on blast like that, but there is some truth to that statement. I couldn’t help but think of a meme that I had seen (as ridiculous as that sounds), talking about how us first-generations are so lucky to be struggling with the highest tiers of esteem and self-actualization, when our parents were dealing with the lowest physiological and safety needs. I realized that the Ngäbe community is dealing with the same needs that my mom went through, yet somehow I managed to remove myself from that in my life of privilege. So in that sense, it’s hard for me to pick a favorite experience because I think I needed all of the aforementioned aspects to come together as a whole to make my time in Panama as meaningful as it was. I had thought that I lived a hard life, given that I’ve experienced what it was like to not access dental care because of my low socioeconomic status and didn’t know where my next meal or shelter would come from. But now I can say that I don’t understand, at least not in a global context.
People have always asked me what I imagine my end-all- be-all is, and I’ve always thought that it was to simply be a dentist. I had thought that if I made it that far, despite all obstacles that I thought I had faced, I would be eternally happy. I realize now that perhaps my purpose is greater, that I should do something more for the communities around me, both domestically and abroad. I hope that one day, I will be able to come back to Floating Doctors as a provider and do more for these communities. Thank you so much to Floating Doctors for making my first experience abroad an unforgettable one. I’ll always remember it as I continue my pathway in dentistry!
by long-time volunteer Dr. Anna Bazinet
At 9 years old, Mariana was confident, outgoing and so excited to see all the equipment we were unpacking that morning for the day’s medical clinic. She eagerly watched us set up the small pharmacy with medications, a scale, and a few blood pressure cuffs. She was wearing a bright green nagua, a traditional dress of the Ngäbe-Bugle people, but this was not the most striking thing about her. On her left cheek, she had a 3×3 centimeter ulcer that fortunately she seemed relatively unfazed by. As we continued to set up for clinic, I leaned over to Dr. Ben LaBrot to ask him about this lesion. Without skipping a beat he said, “leshmaniasis, a skin parasite that is carried by the sandflies.” I have since learned more about leshmaniasis and other fascinating parasites, but see this moment as the beginning of my interest in tropical medicine.
We later saw Mariana and her entire family in clinic and after learning more about her and performing an exam, we helped with the things we could but ultimately had to make the recommendation that her parents take her to the district hospital for treatment. The medication used to treat these lesions, a long course of pentavalent antimony, was beyond the scope of a one-day clinic. The family thanked us, and Mariana gave me a hug at the end of the day. I think she enjoyed watching us work and seeing patients.
This encounter happened during one of my first clinic days 7 years ago when I was first a Floating Doctor volunteer. From then on, I was hooked. I loved learning whatever I could about tropical medicine. Who would have guessed at my fascination with intestinal parasites and leshmaniasis? But, beyond the medicine, I loved the communities we were serving. I loved learning about the culture and language all while traveling by boat and regularly seeing porpoises on our commute to work. During this first trip, I had the opportunity to be in Panama for about 7 months before needing to return to Seattle to start medical school. I remember feeling very torn, both excited for the next step in my training, but sad to have to leave a part of the world I had grown to love and a set of incredible people.
Looking back, my current career path was heavily influence by this time in Panama. The mentorship and leadership that I received by Dr. Ben LaBrot and some of the other providers is one of the reasons I am currently training in family medicine. I love family medicine as it allows me to develop long-lasting patient relationships, connect with the broader community, and tackle some of the challenging issues facing patients today including healthcare disparities. This work is not unlike that of the Floating Doctors.
This September, after 7 years, I finally had the opportunity to make it back to Panama. I honestly didn’t know what to expect, I had heard rumors of new volunteer bunkhouse and base, 20 staff members, and a formal pharmacy, all of which were just dreams 7 years ago. And indeed, I was astounded by the amount of progress Floating Doctors made!
I will admit I was a bit nervous getting into the boat on the morning of the first clinic. Would I know enough? Would I live up to the providers that encouraged me along the path I am on? My nerves quickly faded as I picked up the first set of patient charts and sat down with a mother and her 4 children. My Spanish slowly came back and I started taking a history like I have done hundreds of times in many different situations. Despite the surroundings, seeing patients in Panama feels similar to the US. The chief complaints are for the most part similar; headache, rash, knee pain, back pain and insomnia. One thing I must admit is that for abdominal pain, I was not as accustomed to asking patients if they have seen worms in their stool!
Although so much has progressed with the Floating Doctors since I had been away, I was also amazed at how similar it felt. Even though they have been able to see more patients, do more clinics and keep better records, the sense of mission and commitment to the Ngäbe communities was completely intact. The feel of the clinics, the patients, and the empathetic care they receive was all just as I remember it. And finally, the organization still depends on everyone bringing new ideas, energy to problem solving and the occasional stroke of brilliance to push things forward.
There’s a lot of need for good problem solving when it comes to community healthcare in Panama. Even with all of the progress, I worry about the Ngäbe communities and the individuals I met. I worry about their increasing access to processed foods, snacks, sodas which is leading to increasing obesity rates, hypertension, and diabetes. These can be challenging issues to treat in remote communities where medication adherence and the need for at least occasional monitoring is important. This is coupled with a national health care system that makes it challenging for Ngäbe patients to get the care they need when they go to the larger hospitals.
During this most recent trip, I couldn’t help but think back to Mariana and wonder how she was doing. I could imagine her as a great doctor herself someday, with her inquisitive mind and openness with me 7 years ago. Unfortunately, I know that is a long shot for her as she is likely still living in a community where ~60 percent of people over 10 are illiterate and ~91 percent of people make less than $2 a day. For me, this is the challenge of working in Global Health and what keeps me engaged and passionate. The inequalities seem vast and sometimes insurmountable. I am constantly reminded of the work that needs to be done. I am so thankful for organizations like Floating Doctors who are able to slowly work towards change. After my time in Panama, there are a lot of projects I would love to work on, but alas, this only ensures that I will be back, hopefully sooner than 7 years…and when I come back, I can’t wait to see what Floating Doctor’s dreams have become reality.
by Veterinary Lead Dr. Thomas Easley
Veterinary Public Health (VPH) is an essential component of public health and incorporates various types of cooperation between the many relevant disciplines involved in the interaction between people, animals and the environment they share. VPH programs should not be viewed as operating in isolation, but as making an important contribution, as part of an inter-sectoral collaborative approach, to the improvement of a country’s infrastructure, economy and rural development.
Since the profitability and therefore the supply of private veterinary services is governed by several factors arising from economies of scale, such as the size of the livestock enterprises in the locality, the nature of potential or actual diseases, and the types of animals raised in the production systems, in areas where private veterinary work is unprofitable or where other types of market failure occur, economic or social concern usually makes some type of public intervention necessary. Providing this intervention to the marginalized indigenous communities of the Bocas del Toro archipelago is where Floating Doctors shines like a beacon in the night.
Floating Doctors has integrated a VPH program into their daily operation for two important reasons. The first being focused on human health in that domestic animals (including cattle, goats, sheep, pigs, poultry, and dogs) of poor people can be important reservoirs of zoonotic diseases that impact on their health, either through direct or vector-borne transmission routes. In addition, history has shown us that zoonoses falls disproportionately on poor people with poverty, and unsanitary living conditions associated with poverty, being considered potential risk factors for zoonotic and food- and water-borne diseases in many areas of the developing world. The low standards of education and veterinary public health services commonly associated with poverty and marginalized communities increases the risk of transmission of zoonoses and food-borne diseases.
More importantly, and the second reason, Floating Doctors understands One Health and perseveres to integrate its implementation into all of their activities. While One Health initiatives have traditionally focused on threats to human and animal health, such as zoonoses and a secure food supply, they have not typically promoted an understanding of the many beneficial physical and psychosocial impacts of human-animal relationships and how these can be leveraged to improve both human and animal health around the world. Additionally, current One Health initiatives are undertaken at international, federal, and provincial levels yet often fail to have an impact at a community and primary care level, especially in poor/marginalized areas.
The Centers for Disease Control and Prevention’s definition of health is “a state of complete physical, mental, and social wellbeing.” This definition has included not only physiological, but also emotional and social (behavioral and natural) states as are often described in the definition of good welfare. It is well-recognized that where there are poor states of human welfare there commonly exist poor states of animal welfare. Similarly, animals often act as indicators of human health and welfare, as can be seen in the link between animal abuse and family violence. Considering health and welfare together — because of the interconnections of human-animal-environmental factors — helps to describe context, deepen our understanding of factors involved, and creates a holistic and solutions-oriented approach to health and welfare issues.
The North American Veterinary Medical Education Consortium (NAVMEC) has identified knowledge of One Health concepts and principles as a core competency for veterinarians who will graduate in the 21st century. Despite widespread exposure and support of One Health concepts, a recent survey of veterinary students at Colorado State University demonstrated that few opportunities exist within veterinary curricula for students to get involved and gain practical experience in this area. To fully realize One Health concepts and principles and ensure their promotion by future health professionals, veterinary students require tangible, specific applications.
Important goals in teaching are to challenge veterinary student perceptions and facilitate opportunities for not only applying and practicing core learning, but also learning how veterinarians are connected with their communities and with society as a whole. By understanding these concepts, opportunities are provided for long-term personal growth. For many veterinary students, identifying their role in the community as an individual and a professional can be challenging. After all, most of their adult lives have been spent in a focused pursuit of admission into veterinary college. Moving away from this singular goal and exploring their sense of self, their perception of service to others, and recognizing their inner potential to care and empathize with marginalized individuals is desirable both personally and professionally, with significant positive impact for society as a whole.
In a One Health model, factors contributing to each sector — humans, animals, and environment — are studied. Within veterinary medicine and particularly within the veterinary curriculum there is understandably a focus on the animal sector relative to the human and environmental sectors. However, in clinical practice and in community health, equal knowledge of all sectors is required. With Floating Doctors, the outreach experience provides students with the unique opportunity to gain more knowledge, acceptance, and understanding of a marginalized human sector and how the well-being of both animals and owners are intertwined. Through a One Health lens, the increased empathy, compassion, and stewardship of early career veterinary professionals will undoubtedly lead to improved animal and human welfare, and thus improved community health.
Floating Doctors’ One Health engagement initiatives with the marginalized indigenous communities of the Bocas del Toro archipelago include the integration and community-level collaboration of veterinary teams with human healthcare providers. This team approach serves to cooperatively improve the health and welfare of humans and animals, demonstrating that veterinary care can act as a direct avenue to improve health and social service delivery for underserved populations.
Not only do students gain an appreciation for the power of the human-animal bond, but they also witness how it can be leveraged to motivate changes in behavior that benefit both human and animal welfare. By supporting and maintaining the human-animal bond, students also begin to appreciate that their work extends beyond the health and welfare of animals, but also directly benefits the psychosocial and physical health of their clients.
In the early months of 2015, Floating Doctors added another paddle to its ever-expanding Cayuco (wooden canoe) by launching its dental programme in tandem with the flourishing mobile medical clinics. It has always been the dream of Ben LaBrot, the founder of Floating Doctors, to have a long-term dentist join the crew. The need for dental treatment is in high demand but unfortunately very rarely accessible to the Ngäbe communities.
In its inception, the team’s first clinic was set in the mountainous village of Norteno. From dawn till dusk, spanning over two days, 80 patients were seen by our tireless dentists who maintained high spirits despite the failing light and increasingly limited resources. It is this drive and motivation to deliver healthcare in such challenging conditions that epitomises the spirit of our leadership team and volunteers representing our organisation.
Since then, we have visited multiple communities where we are continuously amazed by the extent of dental caries prevalence, especially in young children. On each clinic, we will see an average of thirty patients, many of whom have suffered in pain with toothache or infections for several months or even years! Imagine, or can you remember, the debilitating sensation of dental pain and being without access to dental treatment for that length of time? Our clinic is currently restricted to extractions and minor oral surgery, but with time and correspondence to those with invaluable resources or expertise, we will strive to make Ben’s dream come true.
The development of the Floating Doctors dental programme would not be possible without the support and kind donations from our benefactors and organisations. For this we cannot extend our gratitude enough. We have set a target of $10,000 which, once achieved, would provide all the equipment necessary for a fully functional dental clinic to serve the Ngäbe communities. We have a fantastic opportunity to implement positive changes to the oral health of the communities in Bocas del Toro.
It is a privilege to share this journey with you. Our working environment is such a challenging, exciting, very tiring, but thoroughly rewarding experience. Improving a patient’s quality of life is not based on what procedure or medication I give them, but my ability to show compassion and care to a person where they are expected to expose their problems and fears to a stranger whilst overcoming language, cultural, and social barriers.
Written by: Kevin Lan, Floating Doctors Lead Dental Provider
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