The balcony of the warehouse where I reside faces a swamp. As I drink my coffee in the morning, the roar of incoming airplanes at the airport on my left funnels hundreds of tourists to Bocas del Toro. On the right lies a mangrove swamp where the indigenous community of La Solucion teeters atop houses and shops built on stilts over a few feet of brackish seawater, precariously clinging to access to clean water, if not electricity.
Tourist maps of Bocas del Toro leave this area unlabeled as a swampy region; yet 250 families of the island’s local population reside within this community. The paved main road that leads to the airport narrows into rocks and gravel as it turnsinto the main road of La Solucion, which branches into rickety wooden walkways and eventually dead-ends into the swamp.
Over the past week, I had the pleasure of meeting Carla1, a type II diabetic who lives in La Solucion and taught me how to fry and eat green bananas, consequently improving my culinary capabilities during residence on the Southern Wind. After visiting her house twice daily with insulin and wound care for her diabetic ulcers (as a result of poorly managed diabetes and lack of resources, Carla is missing five toes and half of two fingers) and watching our doctors instruct her daughter in managing Carla’s diabetes, I became confident in her ability to change her lifestyle. Perhaps earlier healthcare intervention could have saved a few of her toes, or lowered her high blood sugars, but Carla’s lack of seguro, or health insurance, along with the expensive price of the insulin she needs, mean that health has been denied to her based on her inability to pay.
Carla cannot even store the insulin with which Floating Doctors regularly provide her because she has no electricity or refrigerator, nor can she afford to replace her leaky roof because she is too sick to work. She lives with her husband, children, and grandchildren, in a shack around the same size, or smaller, than an average hotel room in Bocas del Toro. I will dare argue that most visitors to Bocas del Toro do not even know that places like La Solucion exist, much less that the province of Bocas is the poorest in the region with the largest indigenous population of all Panama, nor that the majority of the local population lives in communities like La Solucion. The region’s prosperity remains within a two-mile strip surrounding the beach, excluding much of the local population, which has been forced into the swamp by the construction of the airport.
Few, if any, visitors choose to see this side of Bocas del Toro. It is all too easy to ignore uncomfortable realities. After all, wherein lies the difference between Carla and my aunt, who is exactly the same age, also has Type II diabetes, and was also born and raised in a developing country, yet she has never lost toes or fingers to diabetes and has always been able to control her blood sugar. The two were born into different income levels with different levels of access to opportunity. How does one bridge this gap between Carla and my aunt, between La Solucion and Bocas del Toro, or in the United States, between the inner-city and the upper-class suburbs? Lines of division run along race, class, and religion, determining opportunities and consequently health, education, and quality of life.
Personal relationships with others allow us to break the boundaries of our world and step into the world of another, experiencing life from their point of view and accompanying them in their struggles and joys. It is too easy to create barriers—based on race, religion, country of origin, or income level—which cut us off from relationships, causing one to forget that there really is little difference between Carla and myself, or between the family vacationing on Bocas, and the family living in La Solucion. Here at Floating Doctors, we form relationships with communities based upon a sincere nearness to each other that breaks down these so-called boundaries and teaches one to share themselves. These relationships tell me that there is absolutely no reason why Carla should not have the same access to medical care and consequently the same freedom to choose her way of life as does my aunt. Our work here enables the voices of those who are often forgotten, overlooked, or trampled by those in power by ensuring their access to appropriate and effective healthcare.
1 Name and identifying details changed to protect privacy.
“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.
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.
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.
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.
Blog by Volunteer Doctor Jesus Niebla, MD (United Kingdom)
I am a man who before this trip was scared (well I’d say apprehensive) of heights, mountain paths with sheer drops and free running river crossings.
I was not too fond of thunderstorms either.
In the early hours of the 16th of July I set off with the Floating Doctors on a surgical follow-up appointment. In the UK its normal for the patient to come to the hospital, wait an hour or so and get seen by the surgeon who operated on them, then go home. This appointment was different, we went to them, that’s the fundamental difference in our mission.
But when I say ‘We went to them,” what exactly do those few words mean? We took a high-speed water taxi from 25 miles from Bocas to Almirante on the mainland–it takes about 35 minutes bouncing and thudding through the sea. From Almirante we bundle our way into a taxi, pick up some supplies (water, tuna, rice, condensed milk, Gatorade and the important Panamanian Hot sauce). It takes about an hour to sliver up the shoulder of this mountain motor-way to our first base camp. The scenery is lush, I’m pretty tired from the early rise, but I stil take some time to enjoy it while my team-mates sleep (a wise choice with what was ahead of us).
Eventually we get to our base camp, Pueblo Nuevo. It’s the rendez-vous with our guides and pack horses. We charge up on some rice, chicken and the tastiest avocado I’ve set my hands on. We meet our guides and horses to help take the heavier loads; they ride ahead. The horses effortlessly cut through the path ahead–they go first as they scare any snakes or nasty surprises away. They pick their way up the steep climbs with practiced ease; its what they do almost every day and they know the way better than we do. We find ourselves walking on a parallel and tricky path, crossing an Indiana Jones style bridge (except we’re not surrounded by bad guys and its in fairly good shape, although the odd broken panel wasn’t too reassuring).
We make our ascent, climbing up and walking down the steep- clay-brown-well beaten tracks, but this didn’t make them easier. Our guides soared up the tracks with embarrassing casualness.
In-between the sweat, heat, humidity, knee-deep mud baths, sheer drops and snake shaped branches there was a different assault of the senses, a real appreciation of the beauty of this place. Our path dissected fields through flowing rivers, to the butterflies that garnished the clear, blue-sapphire sky above us. It felt like scenery that was the mostly an inspiration of the Steven Spielberg classic Jurassic Park. At every bend in the trail I expected to see a Tyrannosaurus.
Four hours later, sore legs and sweat soaked we make our 2nd base camp of the trip. La Savana, “The Grasslands” and such an aptly named place. We try and rehydrate and rest, an hour or so passes, and too soon it’s time to find and see our patient. We head off again, although this time only for an hour; I’m relieved at this small amount of time, but the path is much different. It was such a steep incline compared to the other paths. Perhaps it was the cumulative effect of the trip, the dehydration, missing the most important meal of the day (breakfast; I know, schoolboy error), but I think I must have hit the wall as soon as I reached the house where our patient lived. Luckily Ben had a Gatorade, it made such a difference.
This didn’t matter, the fact our patient was pretty much running down the hillside to meet us. His actions and motion answered so many of our questions effortlessly. He was fine, he pulled off his wellington, the amputated toe we came to see had healed nicely. There were no signs of infections and the skin flaps were opposed nicely. There were no problems with his balance or ability to continue with his daily routine, although I expect he is a bit more cautious with his machete.
So we made our way back down to Las Savana, make a few house calls on the way (including ANOTHER machete wound), see some patients with pulmonary TB (surprisingly a clear chest on auscultation). We bump into some National Health workers and have positive interactions regarding sharing the responsibility for the medical treatment of the patients with TB.
Eventually we settle back to our camp, have an impromptu clinic under the village’s rancho and soon meet a 6 year old boy with a tricky problem. His father mentions he has a piece of maize in his ear. Ben attempts to extract it, but we just didn’t have small enough tools (my first Job is ENT; I’ll see if I can borrow a set next time). One part of Floating Doctors’ mission is to bring healthcare to patients, if this can’t be done we bring the patient to healthcare. That is exactly what we decided to do–help with the transfer of this young patient and his father to the local hospital. This would normally mean a good 4 hour walk, a few bus trips and perhaps a taxi, so we would accompany them and cover the cost of travel and any medical fees.
The next morning we set off down the mountain with the corn-in-the-ear boy and his father, thinking that descending it would be a little easier. The horses have the heavy loads and we are pretty much on a continuous descent. We still cross the same rivers, and there a few steep sections, but the sun is a lot kinder than on the way up.
A few hours into our walk back it starts to rain, at first a welcome change. We progress, but the rain doesn’t stop–instead it intensifies; the heavens have opened above us. It doesn’t take long for the well-trodden path to become a quagmire. Now it’s a like playing hotch-scotch, planting one’s feet on anything that isn’t the centre of the path otherwise you’re the stick in the mud–a knee-deep mud bath. The downpour also makes the river crossings a tad trickier, as the water level rose significantly in less than 20 minutes.
I am all up for a bit of a challenge, the mud isn’t too bad, we all get used to it, but it saps one’s energy. There is the odd fall, but nothing too serious to anything other than pride. The quagmire now turns into small rivers of chocolate-milk-mud, and then the heavens open a little bit more and decided to spice things up. A thunderstorm starts, we are about 1-2 miles from Pueblo Nuevo, and the more we walk through the jungle trenches the smaller the gap between seeing the lightning above and around us in the canopy and the sound of thunder. We are walking into the eye of the storm. The pace and urgency naturally pick ups, each snap of thunder signals a small sprint for me, then a lull, a sense of dread and then back to a fast march.
An opening is ahead of us, not only are we void of the “protective” jungle canopy but we have to ascendand cross a high, open hill. I recall saying to Ben and Steve we have to clear this ASAP. All the pain, muscle ache and fatigue from the last and current day of trekking for miles of tricky terrain and river crossing all disappeared, the adrenaline was released with a mighty crash of thunder directly above us and and fight-or-flight chemicals coursed through my arteries and veins…. I sprinted up the hill, I slipped on the muddy slope, I got up. I am on my hands and knees trying to get up this hillside as quickly as possible. The desire to get over this death-trap is like nothing I have experienced before. I crest the hill and slide down on my backside, it looked inviting but a few stones and rocks proved otherwise on the way down.
Only a small stretch of jungle is left, and at last we step onto a concrete path that signals our re-entry into Pueblo Nuevo. Stumbling our way through the village back to the shop where we had eaten before making our ascent on the mountain path. To my amazement the town is bustling with Ngabe who have come down from the mountains to place their vote in the general elections, tightly packed under the tin roofs of the local school to shelter from the storm. It gets more ridiculous–there is a local football match ( Soccer) in the football pitch, at the centre of the school. I make a comment to Steve ‘How could the officials allow this match to be played, the pitch is waterlogged”, the players showed no concern of playing in the middle of a lightning storm…until a lightning bolt hits the ground 30 yards from them…then they scarper like they should have 90 minutes before.
We take a short break from the downpour, under the overhanging roof of a house, and the pain starts to re-defuse through my feet and is interrupted only by the thunder and crash of another lightening strike; this one shrieks and booms onto someone’s roof near by. Unfortunately this is followed by cries and panic. The message got passed through the crowed…shouting that someone had been struck by the lightning.
I turn to Ben; “Let’s go check it out”. We now make our way to two houses about 50 yards apart. These houses are elevated about 2 meters off the ground on wooden stilts. Underneath we meet a ring of 200+ people crowding around an 18 year-old Ngabe woman, crying and in obvious distress. Ben checks her out and she seems ok, just in shock (literally) and hyperventilating with some muscle spasms and pain. As we calm her we here cries of two more lightning-struck victims.
I sprint over to the other house (trying to avoid being hit by the continuous lightning attacks), but she is in another house–apparently they were inside when they got struck through the thatched roof. The crowd surround my patient; they eclipse my light; I can’t see. A few choice words and they let the light in.
I notice that her abdomen is distended. This lady is pregnant, 8 months pregnant. My adrenal glands squeeze their last drop of adrenaline. The baby!
She isn’t saying much; visibly shocked, dazed. So I’m thinking to myself, what do I do, its time to get this woman assessed as best we can and transport to hospital. ABCDE, it all comes back. Her airway is good, she is breathing, her lungs are clear, equal air entry. She is pulse is slightly elevated, with a normal character and volume. Heart sounds are normal. She seems a bit dazed, but is responsive. Phew! I notice she has a zig-zag burn starting on her right scapular, working it way down her back to about L5. Presumably the energy dissipated through her feet as she was complaining of severe tenderness in her ankles.
The third patient was a man who had been struck and hurled ten feet across the grass, and wasn’t able to move his arm. I was worried about compartment syndrome, another condition requiring a speedy intervention.
We needed to get the patients transported to hospital as soon as possible for a full review and appropriate investigations, in particular an ultrasound of the 8-month pregnancy. Practically this would mean hailing down a taxi on the jungle highway, or maybe a bus. Fortunately for everyone, this challenge was made much easier as we met some police officers who were able to drive us in a safe and speedy manner to the nearest Hospital in Rambala, a town some miles down the road from Pueblo Nuevo.
How the story ended…
The little boy with a piece of corn in his ear was admitted and had it removed under a general anaesthetic.
The two sisters who had been struck by lightning were both ok and thankfully so was the baby (although perhaps it will be born with super powers).
The man did not have compartment syndrome and eventually regained arm function.
Soaking wet, tired, feet-blistered, hungry and drained we sat outside the hospital and I realized this is what it takes to provide healthcare to these remote communities. On the long taxi ride back (in clear weather at last), and on the water-taxi back to Bocas in the deepening evening, the fear is now replaced with the drive to help these communities further. After a couple of hours of travelling we arrive back in Bocas del Toro absolutely devastated with exhaustion and satisfaction…and I realize this is just another day for the Floating Doctors.
I’m coming back.
Today’s blog was written by one of our recent volunteers, Dr. Ravi Chokshi, just beginning a residency in Obstetrics and Gynecology. These are his thoughts and impressions of our 4-day mobile clinic up in the mountains to a remote village called La Sabana, or ‘The Grasslands.” Over 200 patients were seen, including pediatric and trauma emergencies. Thanks Ravi! best of luck in your residency, and I look forward to working with you again.
He was different at first glance. Quieter. Saw more, spoke little and took his time to smile.
“It hurts here” he exclaimed pointing at his 12 year old heart.
I had examined 20 chests that day, listened to 20 hearts. But only his jumped at me as I lifted his shirt.
A heart that had decided the only way to get noticed was to become outgoing. I place my stethoscope and still the squall fighting within. My ears record and my fingers feel for the familiar radial pulse. There is a flaw here. A Woosh-woosh where a lub-dub should be. I bring over some counsel and we use the portable ultrasound to perform a tropical echocardiogram. What I had heard, we now see. A hole connecting the two atrial chambers of his heart, and a chance to be normal forever taken away.
By the second morning, we had hit our stride. Awake at 7am with the hum of the village around us. I wish that I could say that I
slept wonderfully on the hammock. Tied across the wooden beams of the village Rancho, covered in a mosquito net donated by the Lake County Sheriff Cliff Matthews.
I almost did, but the cold from the two rivers that flow around La Sabana got to me.
To build your own bed where the clinic just was. Settle into it with the laughter of new friends around and your mind alive with the memories of the day before you. Of the cold stream water you had bathed in, or the hojaldras and coffee that had started your day. Sleep comes easy and you drift imperceptibly towards it as the days’ labor catches up to you and the hungry river swims around you.
The cold shudders in, and you wake up surrounded by the chatter of excited Ngobe children. A quick breakfast and swim later you are ready for work. Walking back from the river you can already see a mass of patients organizing themselves around the rancho. In 10 minutes a fully functional clinic sits where we had just dismantled our bedroom. A pharmacy lies ready and capable. Our amazing interpreters have already lined up patients, sequestered the roving bands of excited children and started patient intake. I sit with my stethoscope around my neck, a clipboard on my school desk of a chair and try to look ready.
This is impossible.
And we begin! In groups of 4 to 6 the mothers and fathers patiently answer my questions posed in broken Spanish while the kids run around, openly gawking at me and my strange tools. As I address them, smiles break out. They are terribly shy and hide their little faces in their mother’s dresses. But I bring them out and I let them listen to their heart beat through my stethoscope and I see their eyes widen and them calling out their amigos to do the same. ‘Ahh this crazy gringo is funny’.
I hear about coughs and colds, about chronic pain, about diarrhea that just won’t go away. I examine distended bellies and the scars from years of no-see-um bites and battery acid burns from cured cutaneous leishmaniasis. Most of all I see the relief as I dispense Albendazole like candy telling them, “Este Medicamento va a quitar las lombrices de su estomago y su piel”. And I urge them to eat it in front of me. I work in a chain with 4 other doctors, most with many more years of experience than me and I confer with them constantly. I learn to recognize scabies and lice and infected wounds and what treatments we can offer for such. I get called occasionally for my input on obstetric patients, being that it is my area of interest.
Using the Sonosite I am able to show a woman 7 months pregnant her unborn child’s face and lips and nose. The kick she feels – she now sees and she can’t stop smiling. In a place where most of the people have never seen an outsider, a white person, or even a TV an ultrasound is magic and we are a mystery they are too polite to solve.
We are observed constantly. And for good reason. In a place as isolated as this from the rest of the world, we are as alien to them as
imaginable. Taking a picture of the children and showing it fascinates them. Then I realize why. There are no mirrors here, no still water. Their first good look at themselves is thru the lens of my camera.
These are the Ngöbe-Buglé Indians, Panama’s largest indigenous group. After years of historical fighting they were allowed to retain their ancestral lands largely confined to the western rainforests of Panama. Here in their Comarca, they implement their own system of governance and economy. In terms of healthcare they have a raw deal. A long history of poor interactions with outside groups (pretty much everyone since the first explorers) has left the Ngöbe understandably skeptical of ‘Meriginees’ (non-Ngabe people). As the mother of a very sick Ngöbe child put it to us, “the hospital is where we go to die.” Language is another barrier. While the Ngöbe men have reason to conduct business with communities in close contact with the mainland and thus have some Spanish speaking skills, the women and children are different matters. Not being able to speak Spanish in Panama is as isolating as it gets.
La Sabaña, the remote Ngobe village that we have made our way too, is one of the more isolated communities dotting the Chiriqui
province of Panama.
Our journey there begins at 5am from Bocas marina, where the Southern Wind currently rests.
A group of 9 odd, we sleepily catch a water taxi to our first destination – the port town of Almirante. Blazing through the Caribbean on a 200 horsepower boat is enough to get everyone up and awake.
?Costa Rica!, usted? is the banner cry as we disembark.
Ahh Almirante. A hastily thatched together port town created entirely by the Chiquita Banana Company, it is best described as a jump off point to better places.
Brushing off the taxi drivers, we find ourselves in a car on a 90-minute ride to the sleepy little village of Pueblo-Nuevo. A tasty Panamian breakfast of fried bread and coffee awaits us and now we are ready for our hike. Ben has hired horses to carry the supplies up the slope, while we carry only water and essentials on ourselves. A 3-hour hike when dry, 5 plus when wet and we approach La Sabaña by late afternoon.
La Sabaña – literally translating to ‘The Grasslands’ is a mesmerizing place. Found at the crossing of two rivers, its thatched huts and raised wooden floors are as living artifacts to the age before Panama won the geographical lottery and started collecting revenue from the canal. The Ngobe here live simple lives, the men work in agriculture and raise animals. The women take care of the children and keep the house, all while dressed in the colorful patterns unique to their culture.
It is here we are most in need.
Along with the storm, comes the call from up the mountain. A child has been hurt severely, on his foot by a self-inflicted machete cut. Ben quickly
dispenses half our group with the general surgeon on a race up the slope. I am part of the group that stays behind, together seeing the last few families waiting to be seen. The number of patients has been growing larger every day. Word has gotten around about us and families have traveled on foot for many hours to see a doctor, possibly for the first time in their lives. I have to remind myself of this, as I quietly ache to learn what is transpiring with our other half.
Hours we wait, the rain pouring down, the darkness absolute. The conversation feels forced, every one’s mind on our missing party and what has transpired with them.
Moments before a search party must be raised, their lights are spotted, little moonbeams making their way down the muddy path. They have returned, soaked to the bone but with stories to tell.
It had been necessary to amputate the 10 year old child’s little toe. Amputate it. In the darkness, working on a wooden floor guided by headlamps.
They had quelled the bleeding, stitched it together and addressed his pain as best as they could. We would return the next day with antibiotics and supplies to redress the wound. To leave supplies and to teach the family to keep the site clean. And a phone number to call, just in case.
By our last night the hammocks come up like clockwork. Clinic today had been a sold out success. Patients came from all around the mountain, with many families walking a day’s journey to reach us. We had worked like a well-oiled machine.
As we pack our boxes for the long journey back, the stories come through.
And its not the number of patients seen that we count, but the tooth brushes we had run out of. The soap we had no more off. The medicine for scabies we had to deny.
If there were patients to count, they were the ones we now had the responsibility of following up on. The 12 year old that needed to see a pediatric cardiologist. The women with suspicious breast lumps that needed mammograms, and the ones we couldn’t quite put a diagnosis on out in the field.
Ben and his crew will arrange transport, appointments with the necessary consultants and provide a voice of advocacy to accompany these patients.
What I have seen here erased all presumptions I had before the trip. We were there to see patients and dispense medicine yes, but much more importantly we were there to build trust. To raise the community up bit by bit. To give out toothbrushes and teach kids how to clean their teeth. To teach mothers to recognize dehydration in their children and how to make ORS. Most of all, to provide the village with an avenue of communication they could rely on when posed with a serious problem.
I had been promised an experience of a lifetime when I signed up to volunteer. I say they undersold it.
Four days I lived alongside the Ngöbe Indians. Absolute cutout from the world I knew and an absolute outsider to this hidden world that time had forgotten. I almost died. I very nearly lived. I fell in love again. I yearned to go on, to live this fantasy of waking up in a hammock with lines of patients to see and a fast flowing river to bathe in. Four days is much too short but somehow felt like a lifetime in terms of lessons learned.
In a few short weeks I will return to the US to train in one of the most developed and technologically advanced healthcare systems in the world. I will learns volumes everyday and gain skill sets I ache to possess. But it will always be in a remote Ngöbe village in the protected area of western Panama where I first really learned the gravity of the promise we make everyday on saying these words, “Me llamo Ravi. Soy su Doctor”.
Added by Ben La Brot:
“It is from the numberless diverse acts of courage and belief that human history is shaped. Each time a man stands up for an ideal or acts to improve the lot of others or strikes out against injustice, he sends forth a tiny ripple of hope, and crossing each other from a million different centers of energy and daring, those ripples build a current that can sweep down the mightiest walls of oppression and resistance.”
–Robert F. Kennedy speech in South Africa, carved in stone on his grave.
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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
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.
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.
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
challenges of our time can be survived. I am immensely proud of what my crew, friends and family, and all our volunteers and supporters have made possible, and incredibly grateful to be able to be a part of this voyage and to have shared it with such extraordinary people.
Even with all its faults, earth is a beautiful planet, and humanity, despite its many, many faults, is heroic. There are heroes all around us; it has been a great honor to work alongside so many of them.
“The world is a fine place, and worth fighting for.”
Check out these pictures; some of my favorite moments captured in 2011.
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Cap Haitian, Labadee, Shadda, Milot, Coco (east of Bayeux)
Today is the 1 year anniversary of when we first set sail from Florida to Petit-Goave. Returning to Petit-Goave after a year and seeing our old friends and patients (and meeting new ones) was an incredible experience, but after a week working in Petit-Goave we weighed anchor and headed north to Cap Haitian. After the Windward Passage, it was great to ride across the smooth glass of the Bay of Haiti, but as we approached Cap-du-Mol on the western tip of Haiti’s northern peninsula we entered the edge of the Windward Passage and had a few rough miles before turning east along Haiti’s north coast, arriving shortly after daylight and pulling onto the commercial docks in the port of Cap Haitian.
We were met by Hannah from the Cap Haitian Health Network, and after several days of
paperwork and meetings we unloaded our medical cargo onto the docks, onto a truck and got it into the CHHN warehouse, where it will be available for distribution to the clinics that are members of the network. While we were waiting to unload at the dock so we could move to our mobile locations, we took the opportunity to visit a couple of other health centers, meet the minister of health for the north, do a mobile clinic in Shadda—Cap Haitian’s worst slum—and see a steady stream of patients at the dock the entire time we were there.
It took us almost 4 days to get our material cleared in, which gave us time to visit Milot hospital, the primary center for major or specialist surgery (staffed year round by local and visiting teams) and get a schedule for the next few months of that doctors and specialist teams will be visiting there; that way when I am further afield I can write referral letters and give the dates and doctor’s names to patients I encounter who need specialist care. Above Milot is the Citadel…the largest and most impressive castle I have ever seen, perched on a mountaintop above Cap Haitian. Built after independence, it was made to hold 12,000 troops and be able to fight a devastating guerrilla war from the mountains should Cap Haitian have been re-taken by the French. I liked the raincatchers built into all the roofs, but mostly I was shocked by the size and scale of it. “My name is Ozymandias, King of Kings…Look On My Works, Ye Mighty, And Despair…” The castle was never really used or completed but it has been well preserved as a UNESCO site and SHOULD be a huge tourist draw for anyone visiting Haiti…just plan to bring $10 for a horse if you don’t want to walk all the way up (3,000 feet in 3 miles…I made it but I wanted to have a coronary at the top).
Cap Haitian was not too badly damaged in the earthquake and is quite prosperous in
comparison to other places I’ve been in Haiti, but Shadda, its central slum, was awful. We saw a ton of scabies, which always tells me an area is really poor, and some half-done operations (like a colostomy that has not been reversed though it was supposed to be). A toxic river draining sewage, agricultural and industrial runoff and storm drains from all of Cap Haitian flows between two dykes made of garbage, medical waste and sewage…Donna was saddened to see three children: one standing in a huge pile of garbage, another simultaneously defecating on the pile, and another simultaneously picking a can out of the pile and checking it for scraps of food. The general health of the population in Shadda reflects the surroundings.
By contrast Labaddee, where we moved and dropped anchor to work from this protected fjord, is one of the more prosperous-looking little villes I’ve seen in Haiti—pretty much 100% because of the jobs and income that come with Royal Carribbean Cruise Line’s destination here. RCCL run a school, help support the small clinic in Labaddee, and have extended themselves to us by providing fuel at cost and allowing us to get water from their dock (thank you Peter and Dave!! Lifesavers!!) and do laundry (16 continuous hours of laundry when we first went over there). I
It is important to remember that Labaddee’s prosperity is relative to places likes Shadda,
so we still saw loads of bad injuries, poorly healed wounds, a LOT of major operations with little or no follow up (we asked Hannah from CHHN to come do a day of physiotherapy and she is planning to try and come regularly), and some unusual cases also—I treated a little boy with a knee wound all septic with ripped apart stitches (almost all healed now), we ultrasounded nearly every pregnant woman in the village of 6,000, and after only two days people started coming out to the boat, night or day, for emergency care.
You never know what will arrive paddling up in a canoe at 10:00 at night—a guy came by
the other night and I saw the blood-soaked rag wrapped around his left hand. We pulled him aboard and unwrapped the hand to find he had been bitten by an 8 foot hammerhead shark (HE says 8 feet…but I’m a fisherman too, so I say read ‘5-6 foot;’plus 5-6 feet is about right for the bite radius). We patched it up and he has come every day for dressing changes. I understand he was offshore, tried to pull the hammerhead into his small boat, and it got the best of him before it escaped. Two worlds collide…Shark one, fisherman zero (for a change).
Speaking of worlds colliding, I am fortunate here to have met one of my childhood heroes, Jean-Claude (one of Jacques Cousteau’s original divers), who has built and run the Cormier Plage hotel near Labadie for the last 23 years. He is 79 years old, dives every single day, swims a couple of miles in the ocean every couple of days, and showed me the artifacts he has collected off wrecks he has discovered over 23 years of diving this dangerous lee shore (I nearly keeled over in shock at the collection of priceless artifacts he has recovered for a museum display when it is complete).
I think that so far one of my favorite days here in the North so far has been setting off
from our ship on an 11 mile trip in a leaky handmade wooden boat with no floor or seats, run by one of our new friends here, through a treacherous series of shallow reefs (on a lee shore, too…bet there’s lots of ships’ bones down there), landing not far from columbus’s landing in the new world. I’ll always have a memory of Sky sitting on the bow trying to keep her back from being destroyed, scanning the mile-long, desolate beach for our contact and a safe passage through the surf. We located our contact and another boat rowed out through the surf, we transferred our gear and under oars we backed through the surf.
Donna’s shorts were soaked in the landing and she abandoned them, so partially clothed
we put our gear on our backs and heads and followed our guide off the beach into the trees, stopping at a small school in a village supported by Dr. Anne, an HIV specialist who helped make this mission possible. We did health checks on all the kids in the school, treating a LOT of scabies and skin fungus, respiratory tract infections, some severe malnutrition from parasite infestation, anemia, and a pre-teen patient who told us they ‘had dirty blood’ from birth. This patient travels 2 days once a month to visit a doctor providing their meds. And, as per our SOP, we gave vitamins and albendazole (for worms) to every kid (and quite a few adults, too).
I love the mobile clinics…each one is its own adventure, at the end of it I have a wealth of valuable firsthand information about the location, and I’ve never done one that did not have at least one patient that I was very, very glad to have come to see.
And to be honest, it also felt good to ply the same waters as Columbus for a short time. I
hope the legacy we leave behind has a kinder footprint than his, but I loved rowing through the surf to land in a new place, with mystery and unknown patients waiting somewhere beyond the tree line in the Haiti’s own heart of darkness. Humans aren’t meant to look at cubicle walls…we are hardwired with the desire to stand on new worlds and look to the next. All of us have the explorer soul written into our DNA, and the expression of this most uniquely human characteristic is always a beautiful thing—I think it is when we are being the most true to who we are as human beings.
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Here in Honduras, as it was in Haiti, on any given day my crew are usually spread out at several locations, and when I find out later the details of what they have been doing, I am always astonished. Today we recognize the awesomeness of the work done by nurse and instructor Sirin Petch. By the time we had been here about a week, we learned that the single fire station on Roatan had not been given much formal training, and Sirin agreed to work with Maddie to provide training in emergency response. Nearly every day for almost two months, Sirin worked with the firecrews to provide training in airway management, scene assessment, lifting and immobilization, choking, and other techniques necessary for EMS response. Some of them had joined the department when they were 14, but few had been able to get formal training. The firemen are paid very little (they have to buy oxygen for the ambulance out of their own money), and they work hard.
Sirin first asked the Firemen what they would be most interested in learning, and looked at the resources that were available and would be the most useful instruction for work here in Roatan, and then provided training. Maddie was instrumental in helping communication, plus she is a naturally gifted teacher, and later they were joined by Zach, one of the pilots on the emergency helicopter, and Yolanda, a paramedic from Montana volunteering for a couple of months on the helicopter.
Sirin and her team trained the fire crews, went on night calls with them, and even after Yolanda and Maddie had gone home, Sirin continued with the firemen. Near the end of Sirin’s time with us (for now?), an incident occurred that says a lot about the relationship Sirin created with the Bomberos. I got a phone call to transport a patient on the helicopter to the mainland, so I made my way to the landing field, prepped the gear in the helicopter and waited for the Fire Department ambulance to bring a patient with suspected barbituate overdose. The ambulance arrived, the doors were kicked open, and out jumps Sirin and the firemen, who hand off the patient to me on the helicopter.
On the way back to the station, Sirin and the firemen got a call for a woman in full arrest. Sirens blazing, they arrived at a house surrounded by wailing family members. A larger woman in her 40s had a full arrest, in a house at the top of a 30-foot embankment. Using the techniques Sirin had taught, they put her on an immobilization board, inserted an airway, maneuvered her down the hill to the ambulance and raced to the hospital. They worked hard to resuscitate the woman, both in the ambulance and the hospital, but eventually had to call time of death. Sirin helped arrange the body and deal with the distraught family thronging the hospital corridor, then she and the Bomberos headed back to the Fire Station, only to be diverted to a brush fire. They gave Sirin a brush jacket and sped off to a banana plantation, arriving as it burned itself out. Scrambling up the smoking, scorched earth, they made sure the fire was completely extinguished, then returned to base.
Beyond the skills and training that she made available to the firemen, I believe that Sirin gave them something much more valuable. They looked at what Sirin knew, and her professionalism, and saw its value. She earned their respect (not always easy for female professionals in Latin America) and their friendship, and helped inspire them and motivate them to want more training and to seek it out. They have asked Sirin to send EMS instruction books and have increased their physical training (Noah has worked with them in the gym and done lifting and transferring instruction with them, and a few days ago I boxed with another).
I am very, very proud of the work at the Fire station, and very proud to have seen Sirin rise to such a challenge. Long after we are gone, I hope the knowledge and professional pride she left behind will continue to grow and help people.
The Million-Year Day
I love the end of the day—not because our work is done, but because that’s when I finally catch up with most of my crew, who are often scattered in several locations across the island for most of the day. We return to our home on Southern Wind with stories, smiles and sometimes tears from what we have seen and accomplished during the day, and every night when I learn what everyone did that day I am astonished at the sheer number of things that happen. Each evening, the morning feels like a million years ago.
A couple of days ago is a good example. I started my day at 6:00 AM when I got up to say farewell to Ashleigh, Nick, Rachel, and Annee. Our friend Sherman, who runs the Iguana Sanctuary on Roatan, arrived at Barefoot Cay to bring everyone to the airport. These moments–when people that I have closely bonded with, lived and worked with for many weeks, shared so many experiences with and laughed with, have to leave and go home–are always tough for me. That morning was especially hard when I said goodbye to Rachel and Nick; Nick has been with us since St. Augustine when we were frantically rebuilding the boat in the marine yard, and Rachel has been with Floating Doctors since the days in Palm Coast with 13 people crammed into a house stuffed with medical supplies, working on the boat parked in the canal behind the house through record heat and record cold. It was hard to watch everyone drive away, getting a last glimpse of their faces and thinking of all we shared together, and wondering when our paths will cross again as we trudge the road of happy destiny into our futures.
At 6:45 AM, the helicopter called—two victims of a house fire in Coxen Hole (a 24 year-old woman and her 7 year-old sister) with 2nd and 3rd degree burns over their extremities, faces and torsos, probably right on the edge of what a person could potentially survive. Sirin, Zach (the helicopter co-pilot who has been staying on the boat and helping us) and I suited up and deployed to the local powerplant, where the helicopter is now parked in a field surrounded by high-tension wires (I’m glad our pilot has over 18,000 hours). Our friends the Bomberos delivered the two patients, we loaded them into the helicopter with two family members and took off with all speed, climbing high over the ocean to weave a path through the weather and over the high mountains of central Honduras.
We flew the patients to Tegulcigalpa, where the only burn unit in Honduras can be found, and coincidentally is one of the most notoriously difficult approaches in the world. Ringed with high steep mountains, at altitude, aircraft have little room to maneuver in Tegus. Also the minimum safe altitude approach is 9,000 feet from every direction—which meant a whole set of problems for me and Sirin manageing our patients in the back of the helicopter. Years ago, before I climbed Mt. Kilimanjaro, I bought a book of high altitude medicine to learn about the particular problems of human physiology at altitude, and that reading came in handy in the helicopter as we climbed quickly from sea level to ten thousand feet. Hypothermia, increasing pulmonary edema and tissue edema, swelling of the 2nd degree burn blisters, and low oxygen in the thin air all come into play when you manage patients at altitude, and burn patients are extremely fragile to begin with.
When you are working with a capable team, your focus can become quite intense—scrutinizing every drop of the fluid falling through the IV, monitoring heart rate and breathing and oxygen, knowing your team has the other patient or other responsibilities under control. Back to back, Sirin and I focused on our patients and willed the helicopter to greater speed as we passed sheer mountain peaks and fought through the cloud layers. The young woman was barely conscious, but the little girl was alternately sleeping and wide awake, and she was the bravest little girl I have ever seen. Third degree burns over her arms and legs, her hair scorched and face blistered, she was aware of us watching her and every few minutes would give us that little smile that means ‘I’m OK’ as she lay in the vibrating helicopter swathed in bandages. I have seen bravery many times, but I don’t know if I have ever seen courage like this little girl had.
We landed and transferred our patients to the airport ambulance, and after a cup of coffee we turned back towards Roatan. I passed out on the stretcher—the fatigue factor flying in the helicopter is very, very high, and after all the endorphins of the patient transport are spent, sometimes the tiredness takes over. Two and a half hours later, we made the approach to our tiny LZ on Roatan, landed safely, and riding high from a tough job well done, we returned to our home on the boat in time to take Giles for a walk before his dinner. It is so surreal, but just another day in the life of the Floating Doctors.
I love the helicopter flights—not only because each one is an adventure, but because there is currently no other medical crew to transport patients, and as far as I know the Aeromed helicopter is the only rescue helicopter in Honduras; certainly the only one that is available to fly impoverished members of the community. The resorts here all have memberships, which helps the helicopter service stay operating, but memberships are also available to the community. 40 families get together and each contribute $10 a month, and are entitled to unlimited emergency medical transport in the helicopter. And when people who are impoverished and are not members of the helicopter service need to be flown? The helicopter usually flies anyway, sometiems with money for fuel from Richard Warren, the manager of RECO (the electric company here). Since there is currently no other medical flight crew (Yolanda, the paramedic has gone home for a few months), we are in the right place and right time to temporarily fill a great need, and we are working to train replacements from among the firemen and local doctors to ensure that the service can continue after we leave. Sometimes people ask me if I miss the ‘Real World’ (not the show, the ACTUAL ‘real world’) and it always makes me a little sad. Every day here feels like a million years because it is packed with reality…look into the brave eyes and smile of a horribly burned 7 year old girl that you are working to keep alive in a situation where there is either you, or no other option for help. This is as real as it gets…real life is all around us, all the time and sometimes in modern developed society it seems like we somehow get blind to the richness and deaf to the heartbeat of the surge of lives and stories happening on all sides.
My dream was to create the means to stop where there was need and help in whatever way we could, and every day I watch my dream unfolding all around me. The people who have made that leap of faith to travel to this far shore and work with us, bringing my dream to life in ways I never imagined, have a spirit of goodness in them that I love to be around, and when they go I miss them very much. I can’t believe how lucky I am to have had the chance to meet and spend time with remarkable men and women who have worked side by side with me to bring help where it is needed. Tweek and Giles miss everyone too, they are moping and needy and looking around for people who aren’t here.
The boat would be very quiet with just Sirin and myself onboard, but thankfully last week we were joined by a new member of our crew, Captain Ed Smith. A McGuyver-level technowizard as well as a Marinero and all around great guy, Ed passed through the boat in one week like a storm, systematically knocking items off our to-do list and getting the boat set for sea when Noah and Sky and Bryan return in three weeks. I’m looking forward to having his skills and his company (he’s got awesome stories and a great laugh) as we navigate further south when we depart Honduras.
And so ends another typical day on Southern Wind, current position, Isla Roatan, Honduras. Every day is an adventure in life. A thought that drifts through my consciousness nearly every night as I fall asleep is always ‘I wonder what will have happened by eveningtime tommorow…a million years from now?’
June 30, 2009. Palm Coast, Florida
A day that began with a storm and ended with a beautiful sunset that turned the evening sky into flames!
Lightning and thunder crashed all around the house at 6 AM, rattling the windows and making the power flicker. Afterward, we managed to continue work as usual on the boat. It is so exciting that we are doing finishing work now—carpeting, paneling, running water lines and plumbing, painting, etc; we can really see the boat coming together!
We finished putting up the carpeting in the Scorpion Cabin—that’s what we call the twin cabin on the port side of the aft cabins; when we were hustling medical supplies onboard during the floods here, we stored many of them temporarily in this cabin, and a day or so later we came upon a scorpion that must have taken refuge from the floods in one of the boxes and got carried aboard. For the next few weeks, that dark, warm cabin piled floor to ceiling with boxes looked like the ultimate scorpion apartment complex and made us a bit cagey about going in there and rummaging around. We never saw another one, but forever after we refer to that cabin as The Scorpion Cabin. Hopefully it will never live up to its name again!
The heat and humidity combine into what is called a ‘Killing Heat.’ A couple of years ago, when I was in Ireland, a rare heat wave drove temperatures in London above 100 degrees, and hundreds of people died—mostly elderly people without air conditioning (not a common household appliance then in England), as they (and infants) are much more vulnerable to overheating. The heat here is even stronger—high humidity, and when we are working on deck, and especially down below decks without the fans turned on, sweat pours from every pore on our bodies. Clothes are soaked in moments, paint trays have a rain of salty water into them…it is BRUTAL. We drink 5-10 liters per day and it flows right out of us.
June 8, 2009. Palm Coast, Florida
Today was a great day…if the Southern Wind had been a human being, today it would have been body-tackled by all of us! SO MUCH got done today! As we have found ourselves saying at the end of every day, ‘Another good day on the boat, a lot got done.’ The day of rest on Sunday made a huge difference; on Saturday everyone strove to work as hard they could and a lot still got done, but I could see that another 6 straight days of hot-weather, heavy work had taken its toll. Although it took us 5 hours to get there yesterday (and 2.5 to get back, we got a little lost on the way out) we managed to (for $5.00 apiece) rent an inner tube and float down a section of the Ichetucknee Springs National Park in central Florida. We rested in the cool clear spring water, drifted by turtles (called ‘Cooters’), looked at mullet and catfish below us, and let the tiredness drain out of us into the water. Plus we snorkeled and splashed around a lot.
Most of us rarely stay up past 11 here; after a full day on the boat and dinner, we are usually DONE. Heatstroke is a chronic, but minor (so far) problem. More Poweraid was picked up tonight to stave off dehydration and tomorrow I’m going to nag everyone all day to drink more water (as everyone should! Practically no one in the developed world is adequately hydrated; now go get a glass of water!).
Seriously, if a patient is not allowed any food or fluids by mouth, I have to give them 2.5 Liters of fluid by IV every day JUST to maintain what they lose lying quietly in bed all day. Imagine how much more you exert yourself every day, or how much we lose when we have to work in hot spaces down below decks…we have our own sauna in the medical supply compartment; seriously it must be about 115 degrees in there because it is not yet insulated (tomorrow for sure we have to get that finished!).