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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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Petit-Goave, Haiti–Almost a Year To The Day We First Arrived Here In 2010
This is the overdue final chapter of our voyage from Honduras to Haiti, bringing supplies for the cholera relief and personnel for a string of clinics and villages along the north coast.
Sky clerking in our first patients
After our repairs in Kingston were complete, all that remained was to chomp on the bit while only 40 miles away on the north side of Jamaica’s Blue Mountains a series of storms swept down the Windward Passage and collided with a SE swell across our path. At the first day when the swells and wind subsided, we left Kingston at first light and made all speed for the Windward Passage. Once we got out of the shadow of Jamaica, we encountered the most disorganized sea I’ve ever seen—in the space of five minutes we would encounter NE, SE, W, and N swell…thank god the wind had died or it would have been a horrible bathtub; as it was it was merely uncomfortable until we ghosted into the protection of the Bay of Haiti and at last dropped anchor in Petit-Goave, the first place we ever went for a mission…almost a year to the day that we first arrived in Haiti.
An hour after we dropped anchor, in the dead of night, our first friend from Petit-Goave,
Carrying our clinic bags back to the shore from our Fort Liberte clinic
Aniel, came out in a canoe…the next day, we saw dozens of people we knew; we went back to the DesGranges clinic and saw Meomene and ‘Cheeks’ and the kids who were there when we left. The two schools we built are now surrounded by larger concrete structures in mid construction; a larger future school sponsored by Korea, I think…but when we walked up to our little schools, each one was packed with kids and classes were in session as they have been since we built them. That was a great feeling…the pharmacy we cleaned and reorganized, and the day patient treatment room and the minor ops room were all organized and cleaned as when we left, and more rebuilding and expansion was still going on. We left a box of supplies for Dr. Cutler, an MD from L.A. who we arranged to go out ahead of us last year and who is returning to Petit-Goave to volunteer again this year—I think he actually arrived yesterday, as a matter of fact.
A scene from the past...on our way to our first shore clinic 18 hours after arriving in Petit-Goave
It was so different arriving here this time…amazingly, most of the rubble had been cleared, and most of the tents crowding every street were nowhere in sight. Some houses had been rebuilt (in concrete block without much rebar and suspect cement), but we saw hundreds of wood frame and tin roof one-room structures, on new poured concrete foundations from (apparently) a Swiss-led European consortium. More commerce was happening, some small businesses had reopened, and the central park was clear of tents and refugees.
I admit, when we left Petit-Goave after witnessing both the massive problems the
The only catch we made trolling in Haitian waters...a bag of used maxi pads
Haitians wake up to every morning and the effects of much of the relief efforts after the earthquake, I was not expecting the level of improvement that we saw. My journey to Port-Au-Prince to drop a volunteer off at the airport, however, was much more depressing…a city imploding on itself, with little visible progress over the past year of funds and relief being poured into it. Petit-Goave’s determination to pull itself out of its downward spiral it gave me a renewed hope for Haiti, a hope that I could see in the faces of all of our friends and the new people we saw.
Ultrasound revealed cholecystitis (gall bladder); antibiotics and analgesia given
The best moments for me came during the mobile clinics we ran, on the beach at Fort Liberte and in the ruins of an old French fort back from the coast a mile or so. I saw babies that I had ultrasounded 8 months ago and were born while we were away, patients showed me their thin scars where large machete wounds used to be…when I pulled onto the beach in the first load (two trips in the skiff from the boat to our clinic), the kids in the village saw us coming and ran down the beach yelling ‘Sky?! Rachel?!’ and we were surrounded by everyone we knew and treated in the mobile clinics last year. We wormed everyone again, handed out thousands of vitamins, and saw the usual litany of problems great and small—but we saw one patient in our first mobile clinic–less than 18 hors after we arrived–that made the whole 38 days of struggle and travel to get to Haiti worthwhile.
In the little enclave of cactus on the shore west of Petit-Goave, sitting in the same spot
There are worse waiting rooms
that we did our very first ever mobile clinic as Floating Doctors, we saw a 6-day old baby with an eye infection from Chlamydia or gonorrhea (or both) acquired during birth. This is a very serious, time sensitive problem–a few more days untreated and scarring develops, blinding the child forever (and cross infection and blinding in the originally uninfected eye are very common). We treated the mom and dad and used several days of rigorous cleaning and washing, and antibiotic eye ointment, and the greatest moment of our return for me was watching the pus-filled swollen eye lose its swelling and turn clear—just a few more days and the baby would probably have been blind forever.
Crew shot at the dock in Kingston 3/17/11
It’s not about saving the day, or being a hero…it’s about timing. It’s about being there, and being available as a resource to people who have no other options. A single patient treated at just the right place and just the right time to prevent a lifetime’s worth of suffering for a baby already born into a hard existence. If we had not been delayed by bad weather and bad fuel on the way from Honduras to Haiti, we would have arrived and departed Petit-Goave for Cap Haitian weeks before the baby was born…and when we finished working around Cap Haitian and returned to Petit-Goave, we would have found a blind 1 month old baby.
Life tends to unfold on schedule…not always the schedule I want, and most of the time I never get to know why things happen just the way they do. But sometimes we get a glimpse of a purpose…sometimes what we endure in life makes sense after the fact, and every moment of struggle and frustration and discomfort and fear during the voyage here suddenly became a price I would pay a hundred times over if it meant being able to be there at that exact moment with everything necessary so that baby will get the chance to grow up with both its eyes working.
Dr. Holly saw the baby and when I wandered over to investigate and the problem became
We strip excess packaging from what we bring aboard; this is the total trash generated from a clinic with 80 patients (including ultrasound and two small surgeries)
clear, I though “Ahhhhh….so THAT was why we had to go through that crossing.” If we saw not a single other patient there are people who would say the journey was wasted…the old numbers game; people always want to know how many patients seen (over 5,000 so far), how many vitamins (over a million given away so far), etc…and those numbers are important in making sure the investment of resources is not ‘wasted’…but when I get a patient like that baby, the numbers become meaningless and that one patient becomes, for a moment, your whole reason for existing at all.
To that baby and her parents and to me, it seemed pretty worthwhile that we were there and equipped to help…and we see hundreds of people like this, whose paths cross ours at crucial moments when only a small intervention is necessary to change a life forever.
And with each such patient, our lives are also changed forever and a memory is created that I know I will playback to myself many years from now when my adventuring days have ended and smile and wonder how that little intervention in time played out on the world’s stage ove the years. I’ll likely never know–the years-later effects of what we do aren’t ultimately up to me, but I’ll always remember that we were able to help give people a chance at better lives and futures, and no one will ever be able to take that away from us.
Sunset behind us as we ghost east in the bay of Haiti on our final leg to Petit-Goave
All patient photos used with patients’ consent. Please click on any image below to activate the slide show viewer.
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Holly and I finally face the task of completely clearing out, organizing, and restocking our medical go-bags
This week saw the first heavy, 3 day long pouring rain for several weeks (of course, while we are trying to load the boat and finish our preparations for departure) and the tying off of many threads we have been following for months…we closed up our clinic in Oakridge, packing everything up and saying hasta luego a mi pacientes. Un momento muy difficile. Thank goodness we plan to return to open the clinic permanently as a satellite clinic, open every day with a doctor and staff on site even when Southern Wind is working elsewhere. Knowing we are coming back after this voyage, and knowing that with what we learned and the relationships we forged on Roatan, we can and will open that clinic, makes it much easier to say farewell. Instead, we say (we are going to Haiti, after all) aur revoir.
We finished off a lot of rainy day projects inside the boat (there are always, always more
Capt. Ed cutting a new gasket for our 671 GM engine pan...doin' it old school
projects), and got down to the business of prepping to load—that means taking every item out of its storage onboard, condensing everything, repacking all our medical go-bags (thank you Dr. Holly!), and most important: we took delivery of our 5 pallets of material left over in Miami from our last mission to Haiti (thank you Gary, Donna, and everyone at Roatan Rotary!), and our 40-foot container from Direct Relief International, packed with medicine and equipment for the clinics in the island and distributed the material to 5 clinics and the public hospital on the island.
And the unloading begins...
This is a crowning moment for Sky. To get this container in, it required over 1,000 emails between Sky, the shipping company, Direct Relief International, Joseph Natale from Fundacion Heart Ventures, the customs office, the customs broker, Roatan Rotary, a cross-country trucking company and a local trucking company in Miami and another in Roatan, the warehouse in Miami with our 5 leftover pallets, the Ministry of Health in Honduras, 6 different clinics on Roatan, and Cepudo (a Honduran NGO on the mainland).
Roatan Public Hospital emergency room with the floor up to fix the backed up sewer
The difficulty is not in sending down material—anyone can order a container and have it
Gary and Sky picking up the pallets Rotary helped us bring in
shipped down here…but not without enormous import fees. It is sending down material and getting it cleared through customs as donated material without $30,000 worth of customs duties applied that is difficult, not to mention that we wanted to create a conduit so that we could send containers on a regular basis. One time is easy…to set it up to be sustainable is way, way more difficult. It took more than anyone else will ever know to get it set up by Sky, but I will always know and always be impressed how much the people you already love and admire can still amaze you.
Holly checking the pile earmarked for the Pandytown Centro de Salud
In a few months I will begin contacting the clinics again, finding out their needs and getting another request for DRI and container number 2…
Our staging area for the distribution to the clinics--thank you Gary and Donna for letting us use the tents!!!! Lifesavers!
Our aid station at the triathlon finish line
In the midst of all this, we still see patients, provided the medical service for the Bay Islands Triathalon (including the kayaks monitoring the swimmers during the first leg), and Dr. Holly—whose training
heading out...some swimmers were really struggling, and a few got lost and started to swim to Guatemala, but thankfully no one went under and didn't come back up
includes major scene accident management—provided 2 days of training for the Fire Department, following up the training provided by our volunteer Sirin last year.
Maintaining head control as Johel comes out
Dr. Holly showed the firemen a particular extrication trick—when you have a patient with suspected spinal injury from a car accident, you can extract the patient through the back window by lowering the front seat, sliding the board in through the back window and taking the patient straight out. Since we have the use of Gary and Donna’s open jeep, we could simulate the extraction without having to smash a car’s back window. We are nothing if not adaptable.
The weather is looking good for this weekend (pouring rain now)…high pressure pushing down, maybe keeping the low centers at bay over our projected route. Loading the IV fluids tomorrow and the next day…Finish securing the boat for sea…provisioning….and a last good night’s sleep.
Then give me that horizon.
Photos of patients used with patients’ express permission.
Photos of unloading and interior boat construction (pretty much most of the nice-looking photos) courtesy of Dan Chomistek
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His right hand took the most injury because he was using it to defend himself
As we were closing up shop after a busy clinic day in Oakridge, we got a call from the Roatan Zoo—one of the new keepers had been badly mauled by one of the monkeys while cleaning the enclosure. Oh man…after a late night working on the computer and a CRAZY day in clinic I was looking forward to lying down for a while, but when the call comes for help, you have to help–so we grabbed our minor surgery bag and some antibiotics and headed over.
Apparently, the victim had been employed there about two months, and was working (as usual) with the main keeper, who had been with the zoo
On arrival we found he had been bitten about 40 times on the legs, hands and arms
for 5 years. They had been in the cages together many times before, and had no problems, but this time the head keeper stepped out to grab some additional cleaning supplies and one of the monkeys decided to challenge the new guy.
While with the head keeper, he had been safe—the head keeper’s place in the monkey society was well established (as boss), so the new keeper got a free pass. But when he was left on his own, one of the males just went for him. He was knocked to the ground and savaged, bitten and clawed all over his legs and his arms and hands; the monkey actually went for his face—all the wounds on his arms and hands are classic defensive wounds. Fortunately the head keeper heard the commotion, ran back and pulled the monkey off (the monkey immediately submitted to the head keeper).
The male in question had been horribly abused in its previous home; it had come to the zoo nearly dead…now it is in fine form; I guess it feels strong enough to challenge newcomers in its little kingdom. Everyone always looks at monkeys and goes ‘Awwww….how cute.” And it is true, with their little human faces and adorable antics, they are pretty fun—but they are also wild animals with motivations all their own, and with lots of strength, agility, speed and teeth and claws!
One tough hombre...he was smiling when we arrived, but I gave him a shot for pain before we started
When we got there, the poor guy was a little shocky, covered in blood, dried monkey saliva, and dirt and debris from the bottom of the monkey enclosure. He was so filthy and crusted that we couldn’t even see where the wounds were. Pretty bad scenario from an infection point of view; monkeys have fangs that can bite pretty deep and inoculate your tissues with their raw sewage-like saliva (pretty similar to human saliva, probably).
I immediately gave him an injection of ceftriaxone and an injection for pain. We used a garden hose (the water at this resort/zoo is filtered and potable) to soak off the filth and dried blood as it would have taken more gauze than we had with us, and been more painful. The hose helped gently soak open the dirty scabs over the wounds, and let them bleed out a little to help clean them. Finally we could see the wounds—lots of them, probably around 40 bites and claw marks. If he hadn’t been wearing jeans, I think he would have lost half the skin on his legs, and if he hadn’t had his arms up in front of his face things would have been a whole lot worse.
After disinfecting and irrigating all the wounds, we salved them with antibiotic ointment, dressed them, and gave him oral antibiotics and painkillers, and fresh bandages for his family to change for him if he got wet. We also started him on acyclovir, an antiviral given as prophylaxis for monkey bites. The next day, all his wounds were clean and dry except for his right hand and left forearm, which were very swollen (and pus was expressed from the hand). We added a second, stronger antibiotic and got him to start bathing his wounds in hot soapy water a few times a day.
Gave an injection of ceftriaxone (antibiotic) as well as tramadol for pain
It worked—his swelling went down and his wounds are healing nicely. Never a dull moment practicing medicine in the tropics, but most of all I liked that we were able to bring care to his home. The house call is still my favorite consult.
When I was a kid I watched my dad do house calls in Los Angeles…practicing Alaskan small-town doctor medicine in a big city. In my folks’ house, as long as I can remember, there is an old print of a painting of a doctor, circa 1830ish, on horseback with a lantern and black medical bag in the dead of night, riding slowly through a driving rainstorm. There’s no adrenaline rush about the figure; the doctor is not flying down the road, coat trailing behind and sparks flashing from the horse’s shoes on the cobbles.
Rolled Gauze to hold the 4x4s on and to cover all the small scratches
Instead, the doctor looks cold and wet—can barely see his face behind his upturned collar, peering head through the dimly lit night. He has the air of one doing a job that he is doing because he has no choice, because it is who he is. It would never occur to him that someone else should be the one to go out in the night and go help a sick patient. He goes, and gets cold and wet and more tired (he must be a critical care doctor), because to him, that is what a doctor does. It isn’t even a sacrifice, just a part of his core being. I always felt like that picture captured some of the essence of what being a doctor means to me.
All photos of patients are depicted with consent of the patients.
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A Typical Catch Of Reef Fish; The Larger Groupers Are The Most Risky
In the wake of Hurricane Richard (which we rode out safely on board), we saw a lot of problems from the rain and flooding like gastrointestinal disease and fevers, but we also saw cases of Ciguatera toxin poisoning.
Ciguetara poisoning is caused by eating large predatory reef fish that have accumulated high amounts of cigautera toxin. Odorless and tasteless, the toxin causes Gastrointesinal and Neurological symptoms:
- Nausea, vomiting, diarrhea
A Typical Dinoflagellate
- Headache, muscle aches, tingling, loss of balance, hallucinations
- Cold allodynia (burning sensation on cold contact)
- Poor circulation and shooting pains in the chest due to vasospasm
It appears that the toxin can even be sexually transmitted, and babies breastfeeding from poisoned moms develop facial rashes and diarrhea so it probably is transmitted in breast milk as well.
Ciguatera’s bizarre repertoire of symptoms, especially because the symptoms can last intermittently for up to 20 years (although most people recover within a few weeks), sometimes leads to a diagnosis of multiple sclerosis by physicians unfamiliar with this condition. A history of travel in the tropics, or the consumption of imported tropical reef fish in restaurants outside the belt of ciguatera distribution, is therefore an important part of the clinical history for patients with atypical MS symptoms or long-term GI issues.
Barracuda Accumulate Ciguatera Very Rapidly
Found in all tropical waters, ciguatera toxin is produced by dinoflagellate plankton (tiny photosynthesizing organisms) that bloom in huge numbers near river mouths, or after heavy rains and seas that wash lots of sewage and topsoil into the water and stir everything up. All these nutrients cause blooms of the dinoflagellates, and in the weeks after big storms it is especially dangerous to eat grouper, snapper, and other large predatory reef fish that quickly acculumate dangerous levels.
There is no known treatment for ciguatera, except for supportive care. Most care is focused on treatment of symptoms (pain, fever, etc), and by trying to flush the toxins with various herbal remedies or IV mannitol (differing opinions on the efficacy of mannitol). There is also no practical checmical assay to test fish either.
Avoiding ciguatera means not eating large reef fish, BUT there are some local methods used both in Haiti and here in Honduras for trying to detect ciguatera. The most common we have seen is that pieces of the fish are placed on an anthill, and if the ants reject it, so should you! Also, it is widely believed that cats will show symptoms after ingesting poisoned fish, and that flies will not land on contaminated fish.
Other traditional remedies include bedrest after a guanabana enema, bleeding and porting directly from the GI tract, cleansing with a dove (Santeria ritual), and tea made from mangrove buttons (high in vitamin B, which may help induce diuresis and more rapid excretion of the toxins).
Fish That Are High Risk
A busy week at our clinic in Oakridge…ciguatera on top of everything else! And now another hurricane is on its way–this one might be a big one if it hits here..could be a lot more ciguatera cases on the way if this keeps up. So far, in Oakridge alone, where the primary protein intake is fish and Ciguatera is a higher risk, we have distributed over 12,000 vitamins. If vitamin-induced diuresis helps, hopefully this will reduce the symptoms of some of the sufferers there.
- Nausea, vomiting, diarrhea
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Awesome O.T. Ashleigh Using Finger Paints With One of the Kids From the R.B.C.
On Wings Of Angels
A few days ago we did a house call from the RBC Center to a lady who was 6 weeks post stroke. The family’s house was at the top of a 35-foot steep slope, and she had pretty complete right sided paralysis. Her speech and cognition were affected badly; she seemed unable to understand questions and had no speech. She had a permanent indwelling catheter, and could eat and drink when fed but her swallow was affected and she seemed to be aspirating a little bit (saliva or fluid entering the lungs). Like most elderly or infirm family members in the developing world, she was being cared for at home.
There was not much I could do to help her improve, although her stroke was so recent that it was impossible to say how much spontaneous improvement she might experience over the coming weeks. We told the family to interact with her as much as possible and Annee demonstrated passive motion exercises the family could do with her to help prevent contractures and blood pooling, and discussed turning and bedsores. We talked about signs of urinary tract infection (always a danger with permanent indwelling catheters). And the folks from the RBC center are going to try and help out. Overall, the prognosis was not good, but there is one thing this lady had going for her that many elderly patients in the US and Europe never enjoy.
In the US and Europe, the general tendency is to stick elderly family members in nursing homes and visit them occasionally, usually out of some kind of guilt or obligation. I worked in Care of the Elderly in Ireland and I saw it everyday. The first time I did a house call on an elderly woman in Africa, who coincidentally had also had a stroke, I was ashamed of how we treat our elders in the developed world. Here in Honduras, as in Africa and Haiti and everywhere I have been, older people live with and are cared for by family members in their homes. They do this for two reasons—first, because they have no choice; there are few nursing homes to deposit and forget elderly family members. The second reason is because the culture in most developing countries has much more respect for the older generation, and elderly people get home care and attention from their families simply because that’s the way it is.
The granddaughter of the elderly stroke victim hovered over her grandmother, stroking her hair and talking to her. The family washed her and cleaned her, emptied her catheter bag, fed her and talked to her and interacted with her. Lying there paralyzed, she received the most tender care and inclusion in the life of the family. There may have been no advanced tech available but this lady was being wonderfully cared for. And a week later, she got some of her comprehension and speech back, and some control over her right side mobility. With love and more care, hopefully she will recover enough to regain some measure of independence, but if not I have confidence in the care I know her family will provide if she remains permanently disabled.
The RBC Center, para los ninos con incapacitados, is staffed and run by people who have extended the kind of care they would provide a family member to the kids and people in the community who have cerebral palsy, have had a stroke. Ashleigh has been there nearly every day she was with us, providing Occupational Therapy and Physical Therapy and helping the clinic workers learn new techniques of therapy.
I am amazed, and very proud of what Ashleigh has accomplished at the RBC Center. She and Annee started a Yoga class for the mothers of the handicapped children, many of whom have bad backs and joint pain from carrying their immobile grown children everywhere. The women who come to the center love the class; one 57 year old woman said it was the first time she had ever exercised, and she was so proud of herself. Peggy from Clinica Esperanza gave us a couple of children’s walkers, and a few days ago a 7-year old boy walked for the first time, and a 9 year-old boy wrote his name for the first time.
Ashleigh does movement therapy, sensory therapy, passive massage; pretty much everything—Supertherapist! Fridays are my favorite day…on Fridays I always go to the RBC Center and see patients, young and old. I treat a lot of gastritis and arthritis there; the moms of these kids have lots of stress and physically challenging lives. But on Fridays, when I am there seeing patients, I get to see what Ashleigh and everyone is doing—giving attention to the children, giving the mothers a desperately needed rest from the constant care they have to provide, helping people get their mobility and independence back. Annee, Sky, Noah, Sirin, Rachel, and Nick have spent many days working with the people at the RBC., and I love when we get to all work in the same place.
It is wonderful what can be achieved when you are helping somewhere long enough to learn the lay of the land and what the real needs are, and make the friends and connections necessary to undertake more ambitious projects. Of course, you also need outstanding individuals like the volunteers that have come out to help us. Ashleigh was amazing in action; when she went home it was a sad day for us and also for the clinic staff and patients and families.
The clinic closes for an hour at lunch, and we usually walk down the road to our friend Sherman Arch’s Iguana Park. Sherman is caracol, meaning of white descent but an islander who speaks the patois of the island. He is second generation here, and on his property iguanas are not allowed to be killed, so over the decades they have congregated. He takes in rescue animals, including monkeys and coatimundis, and does turtle rescue. He often feeds us at lunch and sometimes gives us rides back to the boat in his truck or the 37-foot skiff he made himself. He has been enormously kind to us, esta un bueno hombre, another angel we have met.
High in the air during a night flight across the dark ocean a week or two ago, I suddenly remembered a story I read years ago that seemed appropriate for the moment. It happened on the way back from a patient transport in the helicopter to the mainland, and I was sitting in the back thinking about what Floating Doctors became after starting so long ago as a decision made on the plains of East Africa, when I decided to go back to the developing world with more help. I contemplated the path we followed to make Floating Doctors a reality; I thought of all the heartbreaking setbacks and the glorious triumphs that were achieved by the goodwill of people who seemed to come out of nowhere to help pick us up when we fell, and encourage us to keep going, and who worked side by side with us.
The story I remembered is about a man climbing a tall, steep mountain in his dream. After a desperate struggle, he makes it nearly to the top…then falls. The story says that when it comes to the dreams perched high atop the mountains of your mind, it is sometimes a mistake to climb to reach them—but it is ALWAYS a mistake never even to make the attempt. If you climb, you can either succeed or fall. And sitting there in the helicopter, thousands of feet above the dark, luminous, serpent-haunted sea, I understood in a very literal way the third option mentioned in the story: sometimes, when you fall during the climb to reach your dreams, you find out you can fly.
There have been many angels who caught us when we fell and who helped Floating Doctors continue forward. I know I talk about it a lot, but I don’t care. I wanted to thank you all again very much, and to know how much it means to me that you believed in us and helped us and worked with us to make Floating Doctors fly—both in spirit and, riding the clouds over the gulf of Honduras, in literal fact.
