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MARCH 10TH: TRAVEL AND FIRST DAY IN BOCAS DEL TORO
The adventure began with a small group of eager travelers. We waited during these beginnings: waited for the train to take us into New York, waited to get out of the frigid cold airport, and waited to arrive at Panama. And after hours of travel, we arrived in paradise where we settled into our hotel and cooled off in the pool with some Latin tunes in the background. After an early start (3 am!), our group hopped on a plane to Bocas del Toro, where we were greeted by our sunny volunteer coordinator, Skye; the blue Caribbean sea; and the rooster outside our rooms.
After a much-needed nap, Dr. Ben, the founder of Floating Doctors, shared his vision with us on projects to better the community: like building walkways in La Solución, working with elderly people in El Asilo, and many more. We then met the team of devoted individuals who each shared Dr Ben’s commitment to better public health and access to medical care. And after our team meeting, we celebrated our beginning with hopes of making a positive contribution in the next few weeks.
Post by Carolyn
MONDAY, MARCH 11TH: FIRST WORKING DAY!
Bringing wood to the new walkway
Trash. A morning in the village of La Solucion definitely taught us to appreciate many of the basic services we take for granted in our everyday lives. Waking up mid-morning and heading out into the beaming sunlight, we “dove” into the waters below this makeshift community to clean up the trash that had been building up for months; we found the work to be both humbling and rewarding.
The casualties of Lucy, Caroline, Carolyn, and almost Patty by falling in the wastewater epitomized the fruitful sacrifices we made to help this struggling community. After a quick lunch of empanadas, served by the nicest and most caring Panamanian boy, we headed back out into La Solucion to tackle a bridge-building project and
continue with the garbage clean-up. This time however, our efforts were aided by children of the community (who by the way, were the most adorable and sweet kids ever). The smiles and cuteness of these children definitely alleviated our tired bodies and was definitely one of the major highlights of the day.BEACH. There is not a better way to rest from a day of hard labor than by heading to a nearby beach in the afternoon. Sweet waves and salty waters felt absolutely amazing. And after a picturesque dinner, where did we go? Back to the beach of course. A warm, loving night with the mellow sound of ocean waves crashing around us was the perfect way to end the night. La solucion? THE BEACH? Panama Spring Break 2013 couldn’t have started off on a better note!
Post by Jiou
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Tessa making friends with a young Playa Verde boy
Early September mornings found us running through the streets of Bocas, trying to get a workout in before the heat of the day was upon us. Volunteering with Floating Doctors for a month, we got to see a different side of Bocas in those early mornings. We watched the firemen cleaning off their truck and preparing for the day ahead, fishermen setting off in hopes of the day’s big catch, fruit vendors arranging and rearranging their displays, and children walking and chatting on their way to school. We caught a glimpse of real life in Bocas as we ran through the town and we fell in love with this place and the people of Panama.
We had some extraordinary experiences throughout our time with Floating Doctors. We travelled to several different communities providing medical care in the most basic of settings. The fancy equipment and comfortable environment we were used to at home were absent, but what may
Dennis on the job
have been lacking was filled with people like the young man who brought us fruit he picked to thank us or the elderly gentleman who spent his afternoon showing us his garden and cocoa plants. A highlight was a jungle expedition to find a remote community in need of medical care. We packed backpacks full of medications and set up a two day clinic where many had not seen a doctor in years.
As people and experiences carved out places in our hearts, we couldn’t help but think about their health and care in the future. We were familiar with organizations who would blast through towns with mass clinics, identifying illnesses, but with no intention of returning. We were delighted to find out that Floating Doctors is committed to the communities they serve and would return to bring a wheelchair to the housebound man with Polio, to check up on the young child with pneumonia, and to monitor the progress of pregnancy of a first time mother. We left knowing that those we saw from our early morning runs in Bocas to those we treated in the jungle villages would continue to be cared for in the long run.
4 of the reasons why we do this!
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Prepare to deploy…
There comes a time in any journey, when initial prejudices have been shed and before nostalgia settles, when one can see things as they are. I spent the month of October working with Floating Doctors, and for me that moment came while traveling from Bocas town to Kusapin on the panga, the group’s small run-about boat. Ben was at the helm. Tall Greg was at the bow intently listening to a book on tape. Little Greg had claimed the good seat, a plastic chair. I was lying on my back, mid-boat, reading about three men adrift in a tiny raft after their plane crashed in the Pacific ocean. It had been a still and shining morning, but when the sky turned dark I sat up to watch the sea, slightly concerned we might become like the characters in my book. I was more afraid that the increasing wave size would mean we’d have to turn around and I wouldn’t get to visit the fabled Kusapin.
I had extended my time in Panama in order to do one more mobile clinic: five days in Kusapin, a large Ngabe-Bugle community situated at the end of a peninsula jutting out from the mainland and accessible only by boat, a 3-hour ride from our Bocas base. Due to inevitable developing world delays the clinic had been postponed, and because it is not possible just to send a memo, we had to go in person to relay the news. Which is what we were doing when, watching the coast slip by, I had my moment. Being rather simpleminded, my epiphany was not exactly fireworks. It went like this: This is good.
In the preceding weeks I’d fretted over how I was practicing medicine in the clinics we held. I am accustomed to fully
When all you have is your hands…
equipped emergency rooms, the latest technology and medications at my fingertips. At home I check diagrams, doses and drug interactions on my phone, then I recheck them on the computer. I call the neurologist, the urologist, the hematologist. I go the radiologist reading room for further explanation, repeat labs, and have my patients come back for 24-hour follow-up visits. I was not always so neurotic. Prior to studying medicine I had dropped out of university, a few times. I’d worked on dive boats, monitored chimpanzees on an island in Lake Victoria, studied Indonesian in Oregon, called a horse-trailer home. I’d worked for a newspaper in Austria until I quit in order to climb. Then I traipsed around central Africa and worked for magazines. My shining minute was performing at the New York Metropolitan Opera. I rode a horse across the stage, which, although less than 30 seconds in the spotlight, would have been brilliant had I not been forbidden to open my mouth. Despite being tone deaf, I really wanted to sing.
Returning from the mountains; almost home!
The more we engage with the world the more it makes us want to sing, and the more it breaks our heart. At some point I realized it wasn’t enough to dance around stealing stories. I decided I must do more, it was time to become… something. Medicine seemed a good something, so despite the fact that I didn’t know the difference between an organ and a hormone, I applied to Cornell Medical School’s PA Program in New York City. My application was about how I would return with a skill to the places I’d been where there was a lack of even the most basic health care. I wanted to be able to offer something solid to the people who had so graciously welcomed me into their homes and lives. I wrote my essays about malnourishment, malaria, child mortality.
The next couple of years were spent stressing about microbes and molecules and mundane things like exams. Then came the humiliating experience of clinical rotations. There was the New York-Presbyterian cardiologist who interrupted me as I waffled through an EKG interpretation: “I’m a bullshitter too, Antoszewski! But this is someone’s heart you are assessing so I advise you get it right.” To this day, despite having now practiced medicine for six years, I’m haunted and inspired by those great doctors and nurses who taught me accountability. What test have you forgotten Claire? What question are you not asking? I learned responsibility. I also learned fear. It is one thing to play with our own lives, but someone else’s life… First do no harm.
Yet here I was, in remote Panama, seeing patients, not in a white coat but surf shorts, relying often only on hands
Thank goodness it’s strawberry flavored…
and stethoscope. I was handing out puppies instead of pain killers, prescribing antibiotics without the benefit of cultures, assessing limbs and lungs without imaging. There were parrots on the examining tables for crying out loud. I was very happy. I was also rather uneasy. Is it better to do something, even if that something is imperfect, rather than do nothing? I banged my head against this question, turned it over and over in my mind and in conversations. But what if we do harm by not believing in our dreams, by not putting them into action?
Floating Doctors dispenses soap, toothbrushes and vitamins at every clinic. This is a good thing. In the communities we visit worms are rampant leading to dehydration, malnutrition and other complications. The worms can be eradicated with one dose of the medication albendazole. Also very good! The Ngabe think the free eyeglasses are great. Education about water purification, nutrition, and sexually transmitted diseases is desperately needed as the modern world encroaches on even the most isolated peoples. And whether or not there is a hospital, there are always sick people. Should a tumor be ignored because there is not an operating room one floor above us? May be in the over developed word we rely too much on technology. Certainly I have often balked at scanning the head of a child who took a small tumble. A CT scan of the head is equivalent in radiation to roughly 100 chest x-rays, and studies show an increase in the risk of cancers secondary to medical radiation. When I quote this as reason for observing instead of scanning I am asked to imagine what the prosecuting attorney will say in court if the child has an intracranial bleed. There is a trend in the United States to practice medicine defensively. This is not necessarily good. I suppose wherever we work there is room for improvement, and we are constantly weighing the good against the bad.
Painting children purple with scabicide
Like many of those who practice medicine in the world’s neglected places, the Floating Doctors do not have the luxury of MRIs, there is no lab, no specialists waiting at the end of a pager. Where we practice we go on small boats, skinny ponies, our own feet. The donated medicines are carried in plastic bins. But the patients are the same whether seen in a city hospital, a private doctor’s office or during a home visit to a thatched-roof hut in the forest. They have a pain, a concern, or a question they need someone to address. They are pregnant and worried about the baby. They have headaches, constipation, wounds that wont heal. They have a child who is not eating. They have a child who faints. The child who faints has a hole in his heart. Whether or not we listen to the heart doesn’t change the hole. But because he listens Ben can put in motion the steps it will take to get the boy the surgery he needs, and that changes everything.
All of this I thought about, or rather I felt, as we bounced along in the panga that day. The dark had become a storm and the storm drove us to seek shelter on an uninhabited island. Ben drew a diagram in the sand with a stick, made squiggles to show the currents, more lines to denote wind, and an indentation to represent where the ocean floor sloped. Basically, given the conditions it was not safe to make the ocean crossing to Kusapin in our small open boat with its one outboard engine. We had to turn around. I was more subdued on the ride home, but the panga’s loud engine precludes conversation and the sea and salt are conducive to contemplation. I felt a quietening of the questions. My pendulum has had a wide arc, but with Floating Doctors I seemed to be finding a balance. I was remembering why I wanted to study medicine in the first place. It is important to doubt. But we do ourselves and the world a disservice if we forget that shining, elusive something called faith, or hope, or may be just a better tomorrow. After we tied up the panga that evening, Ben said, “Well, we’ll try again tomorrow.” I took a hot shower, and curled up in a hammock to finish my book. Against all odds, having lost everything including the clothes on their backs because the raft capsized again and again and again… the three men were rescued after 34 days at sea.
Learning to dance Ngabe-style
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“If we listened to our intellect we’d never have a love affair. We’d never have a friendship. We’d never go in business because we’d be cynical: “It’s gonna go wrong.” Or “She’s going to hurt me.” Or,” I’ve had a couple of bad love affairs, so therefore . . .”
Well, that’s nonsense. You’re going to miss life. You’ve got to jump off the cliff all the time and build your wings on the way down.”
–with thanks to Ray Bradbury for the words I wish I had written (everything in italics)
Fighting entropy
As a critical care doctor for over 30 years, my dad has seen many thousands of people die.
For the health worker this can be a vulnerable moment when the result was not what you wanted; you face your own mortality and your own ultimate powerlessness. I remember clearly the first patient of mine who passed away despite doing everything that could possibly be done. I remember feeling helpless and angry, at myself and at the world. And then I
The result isn’t always what you want
remembered something my dad said about patients and their lives and deaths.
My dad always says, when people die–sometimes it is a peaceful anticipated passing at the end of a long rich life, sometimes it is the unexpected nightmare of a child broken beyond repair by a chance fall–that no matter what we do as doctors, ultimately everyone gets the same: one lifetime; no more, no less.
My dad says that nowhere does it say for how long a life, only that you get ONE, and one only. In this job, you see how quickly it can be taken away; how sudden and how senseless. Arriving in a community in Petit-Goave, Haiti JUST in time to administer simple antibiotic eye drops to prevent permanent blindness in a baby with gonnorheal conjunctivitis…but also arriving in a community 2 days after a 22-year old Ngabe girl died of diarrhea that we could have prevented had we been there.
We are an impossibility in an impossible universe.”
One life…length indeterminate.
Struggling at the edge of the abyss
Why is it so hard to remember this every second of every day? Every breath is one less we will ever take; every step we take is one more both to our destiny and to the grave. So many external pressures can be brought to bear on us…money, peer pressure, social expectation; and so many internal pressures…fear, guilt, resentments. It seems like such a recipe for despair until we remember that ALL of us are Captains. Everything can be taken from us and a gun held to our heads, and even then we have the ultimate power not to give in, to retain that last bit of free will that is us, that chooses not to go quietly into the night but to rage against the dying of the light.
“So few want to be rebels anymore. And out of those few, most, like myself, scare easily.”
Returning from clinic, home in sight
We have that power; all of us know of ordinary men and women who were beaten and degraded into hell, and who somehow found that power within themselves to defy tyranny and refuse to be coerced. The martyr who suffers torture and death rather than renounce their beliefs…the concentration camp victims who chose a bullet and a communal grave rather than inform on their fellow prisoners…the young student in Tienanmen Square who stood firm before the tanks…the passengers on the hijacked plane who decided to go down standing up.
“Don’t ask for guarantees. And don’t look to be saved in any one thing, person, machine, or library.
Do your own bit of saving, and if you drown, at least die knowing you were heading for shore.”
You’re alive with the wind and the spray in your face
These ordinary people just like us became legend, but ALL of us have that power within us. Although very few of us have ever been put to the extremes above (and I hope I am never put to such an extreme test), all of us have faced moments in our lives when we had to draw on strength we didn’t know we had in order to survive–how to get past the loss of a child…the betrayal of your husband or wife of 40 years…all the way down to one day long ago when I was swimming far out at sea over deep water and got caught in a current. No matter how hard I swam, I was getting swept further out to sea and was getting more and more tired as the wind got stronger, pushing me away from the island. I actually don’t remember how I made it back to shore…I just remember making the decision right then and there that I was NOT going to die that day…and I swam. I remember breathing fire, choking on sea water, and not being able to feel my body anymore; diving down and swimming below the wind current, surfacing and being swept back, and diving again and again and again. My eyes were closed most of the time. To this day I have no idea how long that swim took…it felt like my entire life; my whole existence had been reduced to one great driving impulse…swim. And then I opened my eyes and saw the bottom sloping up below me and the breakers only a few hundred yards away…and then I was in the breakers, and as my body was hurled forward I went limp and the sea took pity on me and cast me up onto the beach, with nothing left. I lay there on the wet sand for a long time until I crawled above the tideline and lay down again. And that day I did NOT die. And I learned greater respect for the sea’s power and saw that for a moment I had touched within myself that spark of endurance that all of us have within us.
When those moments of extremity come we don’t always manage to access that power–what is is that stops us?? When the extreme tests come, however, there are always ordinary people just like you and me who time and again suddenly become strong like a wave harnessing the power of the whole sea and rise up to smash themselves against the rocks rather than retreat, “making nations quake, and monarchs tremble in their capital.” How amazing if we could unlock it at will to seize control of our destinies…to turn the power to defy a nation into the power to follow our dreams?
A momentary connection, once made, never unmade
How beautiful and how sad that a life with infinite potential richness should be such an eyeblink in the universe…each life unique and beautiful like a single wave among the billions of others rolling across the seas and onto the beach, only once, and then gone forever except in the echoes of what we have touched during our lives.
“Everyone must leave something behind when he dies, my grandfather said. A child or a book or a painting or a house or a wall built or a pair of shoes made. Or a garden planted. Something your hand touched some way so your soul has somewhere to go when you die, and when people look at that tree or that flower you planted, you’re there.
It doesn’t matter what you do, he said, so long as you change something from the way it was before you touched it into something that’s like you after you take your hands away. The difference between the man who just cuts lawns and a real gardener is in the touching, he said. The lawn-cutter might just as well not have been there at all; the gardener will be there a lifetime.”
One life…length indeterminate.
Make it count!
“Where would you like to go, what would you really like to do with your life?
See Istanbul, Port Said, Nairobi, Budapest. Write a book. Smoke too many cigarettes. Fall off a cliff but get caught in a tree halfway down. Get shot at a few times in a dark alley on a Morrocan midnight. Love a beautiful woman.”
Bring me that horizon…
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“Lifeboat Chronicles”
July 29, 2012
Blog by Las Tablas Peace Corps Volunteer Doug Martin
Sandwiched between the banana plantations and the mountains
Sometimes, early in the morning, the mist from overnight rain storms envelopes the town and hides her from outsiders. Sometimes the murky brown waters of the Sixaola River creep higher and higher until they stumble up and over the only road into and out of town. Its a place to get lost, a place to start over.
La empresa showed up one day, years back. They brought complex irrigation systems, John Deere tractors, and an airplane. The menacing drone of diesel fuel combusting hundreds of feet high shakes the town from her slumber. The cool evening breeze carried the seductive whisper of modernity; the people from the mountain came down.
For three days in July, sister Sky and brother Dr. Ben LaBrot and the volunteer group they head
A rare x-ray available…
offered free medical care to the communities of Las Tablas and Barranco Adentro. One can see in the hour long queues that the service their group Floating Doctors provides is desperately needed.
Their volunteer medical professionals work hard. Long days start when the rooster crows and often don’t end until after the sun has long settled behind the mountains. They sleep in hammocks strung up over cement walls, on sleeping pads strewn out over the floor, under mosquito nets. On Saturday the baseball game doesn’t end until two in the morning. Neither does the blaring reggaeton coming from the trunks of several baseball fanatics cars. But they never complain.
Hammocks hung in a half-built house…
Many people here do not have access to medical care. There exist several barriers – cost, culture, language – that have kept the people from the mountain out of a doctors office. The Floating Doctors work to remove these barriers, and not just by providing medical care free of cost. Dr. Ben is a leader by example, and his volunteers all show a genuine sensitivity and interest in the diverse culture of the indigenous groups that they attend. He also converses in Spanish after spending time in Honduras and Panama, and might accidentally greet you in the Creole French that he picked up in Haiti.
Dental Health is Important–send toothbrushes!
The end to each of their three multi day mobile health clinics has been bittersweet. Imagine being the captain of a sinking cruise ship with only one life boat. Mothers weeping to include their sons and daughters. Adult children pleading for their elderly parents. An uncomfortable undertone, asking “what more could we have done?” often lingers after the last patient has gone.
Somewhere beyond the mountains to the north there are children grown fat from too much and too many. Here the children’s bulging bellies speak not to a fast food diet and cable television but to malnutrition and constant parasites. What response quells the crying eyes of a six month old child, forgotten by the world and unable to access the most basic and fundamental care that he so desperately needs?
Fortunately, the Floating Doctors are continuing to grow. The most recent clinic expanded its offerings to both the thirty five hundred people living in Las Tablas and for the first time to another one thousand living in Barranco Adentro. The life raft is getting bigger, better stocked, and more efficient.
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Sometimes Conditions Are Against You
“Turning a ‘No’ Into a ‘Yes’–How To Adapt Your Mission For Success When Conditions Change”
Blog by Volunteer Doctor Jordan Amor-Robertson, MD (Pediatrics; Australia)
On my last weekend with the Floating Doctors a multiday clinic was scheduled in Bahia Azul (Bluefields), a Ngobe village which is on the mainland, however is only accessible by sea. We were fortunate enough to have some rather impressive friends (JP, a doctor, and Marie, a dietician) with a rather impressive boat called ‘Domino’ who invited us aboard for the journey. We even managed to fit in a spot of fishing along the way, reeling a couple of decent sized tuna, with the first fish-catcher (luckily not me) being required to eat the tuna’s still beating heart!
We had initially planned to run the weekend as a standard primary health clinic, as well as going house-to-house conducting a survey at the request of the community leaders to establish the degree of health knowledge with regards to HIV/AIDS, risk factors of the individuals and to perform clinical screening examinations for any features suspicious for AIDs. Unfortunately, shortly after our arrival, we received word that our application to practice medicine in Bocas had finally reached the national Ministry for Health and, whilst we had been granted approval to run clinics by both the local and state health ministries over a year earlier, we were advised that we were to suspend all clinical operations until such time as we managed to clear the required bureaucratic hurdles.
Now this posed a problem. The local Peace Corps Worker had invested a lot of time spreading the word to the community that we would be coming to do a clinic and laying the foundations for our HIV surveys. How could we now explain to people that yes, we had arrived in Bahia Azul, but actually no, we would not be doing a clinic. And, even worse, how could we possibly turn away the sick patients that would undoubtedly present for treatment? Do we turn-tail and commence the 4 hour boat ride back home straight away?
As it turned out, this was not the disaster it first appeared to be, but rather an opportunity in disguise. After a hurried brainstorming session, the decision was made to host a ‘charla’ or discussion and to share a lunch with the community. This would give us a rare opportunity to develop the Public Health aspect of our operations, something that is an important long-term focus for the Floating Doctors, however is often put aside somewhat during a multiday, in the face of a hectic clinical work-load.
Beautiful But So Far From Any Services…
We split into groups of 3 or 4, heading off in different directions in an attempt to reach as many families as possible to advise them of this unexpected change of plans (and to invite them to lunch!) A casual stroll through the jungle, thought I, on this glorious tropical day. Appointed our trusty guide, a young Ngobe boy who wants to be a teacher one day, Jenny, Lorie and I set off into the jungle, stopping at each dwelling along the way. We were welcomed into homes where we were given gifts of shells, bananas and guayaba and I even managed to fit in a little shopping along the way – in the form of a colourful traditional handwoven bag.
Unfortunately Lorie had difficulty negotiating the first major hurdle – a dauntingly steep and slippery hill – and parted ways with Jenny and I. I later learned that Lorie, in true Lorie fashion, had befriended the occupants of the house at the bottom of the hill (despite speaking minimal Spanish) and spent the morning engaging them in songs and colouring-in sessions.
Meanwhile, back on the jungle trail, Jenny and I were feeling increasingly like intrepid explorers, ducking under vines, clambering over rocks, leaping over puddles. And then it got real! Our guide ushered us into a kayuke (a traditional dug-out canoe), making sure that the inexperienced gringas were carefully balanced to avoid capsizing, and started paddling up through a mangrove river. We arrived at our…destination? A patch of muddy mangrove ground, indistinguishable from the other patches of muddy mangrove ground we had passed along the way. Apparently this was the only way to access the next lot of houses up on the hill that lead around the bay.
The Panga? Easy To Negotiate. Those Cayucos? Harder Than It Looks…
I stepped out of the kayuke tentatively, immediately realizing that my trusty Aussie thongs (or flip-flops as the rest of the world seems to call them) were grossly inadequate for this kind of terrain, losing both in the mud at the very first step. So shoes off it was, and I set off, barefoot, through the mangrove mud, as the crabs and miscellaneous other creep-crawlies scuttled out of the way. Now this is not the ideal way to greet strangers; barefoot, sweaty, mud up to the knees (and splattered even higher as a result of various misadventures), but still the matriarch of the next house greeted us warmly, offered us water to wash out feet and proudly showed us her garden.
And so this continued, from one house to the next, until it was time to return to the centre of the village for the Charla and the delicious lunch that the village women had prepared from our supplies. And, as exciting and memorable as the morning had been, this is the moment that all our efforts came together. After a brief introduction we opened the floor to the community, encouraging them to identify their key health concerns, common issues in the community and things that they would like to learn more about.
The session ran better than we could possibly have hoped! With a very good showing from the community (we filled a whole classroom and many more peered in through the windows), and an even representation of both men and women, everyone was granted the opportunity to have their say. Quickly the conversation turned to the topic of HIV, something that we knew the community were concerned about, however we were not sure whether they would be keen to talk about such sensitive matters in the public forum.
Much to our delight both men and women stood up and spoke openly and frankly on what they knew about HIV, giving us the opportunity to dispel a few myths and to outline the basic facts about disease transmission, progression, symptoms, treatment and, most importantly, prevention strategies. As one older Ngobe woman pointed out to me – topics of sex and sexual health were traditionally taboo, however now the discussions are too important to be avoided. For the sake of the health of her children she wanted to make sure they were educated on such matters so that they would know how to protect themselves.
Knowledge is the best preventive medicine!
Rather than being upset or annoyed that we were, on this occasion, unable to provide the primary health care services that are so needed, and so inaccessible to the people of Bahia Azul, they were excited to have the opportunity to discuss the key health concerns of the community, knowing that this would help the Floating Doctors and the local community to work together better in the future. That weekend was just the beginning – on subsequent visits to Bahia Azul the Floating Doctors intend to have ongoing conversations with the community about what they want and ongoing Public Health Education sessions. We are also hoping to do some capacity building with the local parteras (midwives) and other interested members of the community, many of whom have already nominated themselves as wanting to up-skill in basic health care so that they can act as Community Health Workers, allowing for a permanent health-care presence in the community.
That particular weekend was special, but it was in no way unique. During my time with the Floating Doctors there were countless occasions where we had the opportunity to engage with the local community, working with them and for them, to enact change and to begin establishing grass-roots health initiatives. I returned to my home in Australia revitalised and inspired, already planning my next stint in Panama with the Floating Doctors and the Ngobe communities of Bocas Del Toro.
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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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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.
Please click on any of the photos to activate the slide viewer.
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maggots in a tunneling ulcer
Ah, the Asilo…one of the places we heard about here in Panama when we were still in Honduras. We found a unit seldom visited by a doctor (in a year), but with a wonderful staff of no more than a cook, cleaner and nurse on each of the two 8 hour day shifts and 2 on the night shift. There are 27 patients there, all elderly, ranging from totally mobile to totally bedridden, some without sight, some without limbs, many with varying degrees of dementia—they all have to be fed, bathed, many changed, floors cleaned, meals prepared and cleaned up after…the fact that the floors are clean and the patients are clean and fed is an extraordinairy achievement, but the patients need more attention.
When we got there I thought they were totally medicated…so many of them looked so catatonic…it turned out almost none of them were medicated,
They seemed so catatonic when we first were working there
or where very occaisionally medicated. They were just bored and unstimulated, almost into catatonia. It was months before some of them spoke; I came back from 5 weeks in California to find patients that I thought had no power of speech actually talking with me. It was like awakenings, and it isn’t because of medication, it is because of all the time our volunteers and people in the community have spent with the patients there. Many had not been out of the grounds for years, and now walk in town weekly—our friend Javier, a Colombian physiotherapist in town who also works at the Asilo, brought his four horses and our elderly patients dressed up and rode like kings and queens through the streets, looking down around them as if to say ‘So…this is Bocas, you say.’
one of 3 trucks of trash we removed
The mayor sent three trucks and we removed several tons of rusted metal and trash from the grounds and landscaped a little (more to go), repaired two broken washing machines and plumbed 3 in total (the only working one had been filled by bucket), installed handrails in the common area for walking and physio, changed the showerheads to removable handle versions, put a commode chair in the bathroom, created and update charts for the patients, provide medications, and have done our best to provide the additional more advanced care that the staff are sometimes not able to provide.
When we arrived, there was an elderly stroke victim, immobile and unable to communicate, and terribly emaciated and contracted with bedsores
emaciated, rigid, and covered in bedsores
all over. We worked for weeks, doing wound care and working with the staff to use advanced wound dressings we provided and creating turning regimens—our goal not to extend his life, but to allow him to die with more dignity and in greater comfort. At one point he got a chest infection and we stood by to administer oxygen and midazolam and buscopan to make him comfortable as he passed, but he rallied…and subsequently gained 12 pounds and the ability to focus and speak a little (very, very little) before he died quietly one night in his sleep a few months later.
ulcers spreading in a deteriorating body
And he died with not a single bedsore on him…that was a victory to me, at a personal level. I hate it when people die with their bodies disintegrating externally around them as well as internally. It is unnecessary, but totally natural for birth and death to be so awkward and difficult…the first time doing ANYTHING is usually awkward and difficult: the first day of school, first kiss, first great loss, first great love, first great adventure, the first and final sunset cruise, and finally, the end of the voyage.
Any ship, no matter what storms it has weathered and what damage it has sustained in a long life of navigating unknown waters, wants to look its best when it pulls into harbor for the last time. There should be dignity at the end, as much as can be wrenched from an unfeeling universe. Not always possible…but always a betrayal not to even try.
My cousin, a physical trainer, just arrived here for a few months…I have another patient in the Asilo who has not walked for 9 years after his stroke. He stood up the other day after exercising on his own, ferociously, with some basic exercises we showed him after we applied a difene patch to his paralyzed knee for knee pain, and he and we found out the immobility was more pain-related and he could move it a little. He freaked out an dhas been exercising like a fiend.
Our friend Bolivar snapped some pics in the asilo while we were working there one day
I came back from California and he collared me from his wheelchair and looked me in the eye and said ‘Yo Puede CAMINAR!’ And stood up, giggling like schoolgirl. Sometimes things are too much for me to process when they happen…later at night, especially when I’m writing a blog or making a facebook album of the day, I start to process…thinking about that patient a lot. I want to go for a walk with him before he dies—and he might live for many more years, so if he does, I’d like him to be able to walk, and he REALLY wants it, more than almost any patient I’ve ever seen. I feel tiny beside the strength of his determination.
Matt and I changing a suprapubic catheter blocked after 11 months of neglect
I tell all my incoming student volunteers (I have my little speech about this prepared): “You are so lucky we have the Asilo for you to volunteer in. Not only does every second you spend there interacting with some of the loneliest people I have ever seen benefit them beyond what you can know, but care of the elderly—and especially in this setting—is where you find out if health care is for you.
Eve and Sarah doing wound care on tunneling ulcers
“Yes, it’s challenging, the medical issues are very complicated, the patients may have dementia and can be challenging, and you have few resources to deploy except what you can somehow manifest…but beyond that, its where you learn things like ‘are you the type of person who is thoughtful enough to throw a corner of a sheet at least over the exposed genitalia of some bedridden shell of a human during some procedure that leaves them all exposed?’ Or ‘When you lift a frail contracted foot off the bed, do you automatically support the knee out of awareness (to avoid torqueing the knee)?’
walking the patients
“It’s a good place to learn PATIENT CARE…not something everyone can learn, because some aspects of it I just don’t think you can teach. I feel like I have to practice at it constantly…people are afraid of old people…can you learn to look past the rotting shell of their failing minds and bodies to ressurect in your mind’s eye when you look at them the glory of their individual histories? It is like looking at old ships tied up in the scrapyard and neglected, never to leave again…remember that those ships voyaged 70 or 80 years across 2 or 3 of your lifetimes…can you see who they were and what oceans and storms they have passed, somewhere inside the wrinkled, frail bodies awaiting their final voyage?”
I love the Asilo…my volunteers go more frequently than I (I only have 2 hands) these days, but I love going in and seeing my friends there. We need people in the community to each give 30 minutes once or twice a month…come on…an hour a month, that’s pretty good…want to walk patients with us? It is awesome—email us or (better) contact us on facebook if you want to go for a walk with us and be checked out to walk patients on your own. One hour per month…you saw the walkway we all built in La Solucion; a miracle happened because everyone showed up and made it with their hands and time.
giving time
Make a miracle happen at the Asilo…everybody give an hour a month, and every patient will be walked several times a week instead of never. They’ll get stronger and be more fit (less pain), and be more mobile (and they HAVE to be, the ones that are bedridden have the worst time of it). Let’s make it happen Bocas!
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