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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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No one advocates for them
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.
The water under La Solucion filled with trash and human waste
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.
She lives in abject poverty but knows how to smile!
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.
Homes on stilts among the mangroves
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.
A typical ‘sidewalk’ in La Soucion
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.
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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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Blog by Volunteer Doctor Jesus Niebla, MD (United Kingdom)
Amputation in the field, at the top of a mountain…
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.
What a beautiful walk in good weather…
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.
6 Nationalities Represented in the La Sabana team…
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.
Toe Amputation 1 Day Post-Op
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.
Incredible patient bravery
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.
We start work pretty much on awakening…patients waiting…
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.
Amputation in the field, at the top of a mountain…
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.
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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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Building a wheelchair bridge for a girl with CP
When I last posted in June, a couple of months in, we had just started to really connect with the various subcultures in the Bocas Province, and some situations we quickly identified for interventional projects were as yet beyond our reach. Now we have many more friends and contacts in the community, and we can tackle much more ambitious projects for far less cost.
We have:
• Partnered with local group Operation Safe Water to help transport and install raincatcher systems at local schools when we run clinics
• Arranged CPR certification for the fire department
• Worked with the Ministry of Education to train local high school students as trainers for health education in the community and give them medical work experience by participating in our mobile clinics
• Created pictorial and written information sheets on health issues we have identified and that we make available at our clinics
• Gathered and data-entered over 600 patient health data sets and begun doing surveillance of our own interventions and identifying health issues from the data to help guide our mission activities
• Microfinanced patient transports to care on the mainland and chaperoned them in the hospital system (many Ngobe don’t speak Spanish, and are VERY shy, so they easily fall through cracks in systems)
• Connected with an indigenous Curandero to identify and investigate the plants he uses medicinally and are helping him develop his small botanical laboratory always keeping a lookout for.
• Arranged and executed a CPR and First Aid Seminar for the cruising community in Bocas
• Partnered with the Mayor’s Office to run mobile clinics in conjunction with the government visits to the community
• Partnered with the local Lion’s Club to work in a community they support and help supply the neonatal support unit they built with Direct Relief International suppliesAnd, as always, sometimes we find situations that are just not right. Por ejemplo…
Unacceptable for a 14 year old in a wheelchair
While I was in California, Dr. Barney found out about a 14-year-old girl with what turned out to be undiagnosed cerebral palsy in a small squatter’s community called La Solucion. I have been told it used to be where the airport is now (right next to a mangrove swamp), and when they built the airport the community moved out onto shacks built on stilts over the mangrove mud.
She comes to land at most twice a year…land is about 100 feet away over the sewage-contaminated swamp (all the homes
She has rarely, in many years, been to shore
have outhouses and sink drains that drain directly into the water below). She has never gone to school…she has a wheelchair, but rarely uses it because she has nowhere to go; she has to be carried over the dangerous footbridge by her grandfather, and she is too big now for him to carry (Noah noticed he has drop-foot also…potentially a serious falling hazard, especially if you are carrying your 14-y.o granddaughter over a wet slippery footbridge). She is COVERED in bug bites…she can’t really swat bugs away or keep moving to keep them off her, and she lives in an open unscreened house on stilts over mangroves.
Her grandparents have always thought they were at fault for her CP because she fell out of bed at 6 months (though she had never crawled, which makes me think it probably was CP at birth)…they have carried that burden and they always worried they would get in trouble if the hospital found out, so they have indicated that she has never seen a doctor.
If I were a Hollywood writer writing for some medical drama, my editor would probably throw me out of the building for it being so unbelievably challenging emotionally and physically…but this is real life…this is somebody’s actual life. Sometimes people ask if I miss ‘the real world’…let me tell you, it looks pretty real from where I’m standing.
Driving pilings into the sewage muck of La Solucion
We said we would build her a walkway, and now—6 months into our time in the community—we called on the community to help and EVERY level of Bocas society came together to make it happen. Mangrove posts from an indigenous community, lumber and funds and food from local Panamanians and expats, help from boat owners, crew on other boats, locals from La Solucion, local taxi drivers, local restaraunts…at the last minute we even had no trouble rounding up 2 sledgehammers (one from the fire department and one from the fish market, which I sometimes haunt in the afternoons when the fishing canoes come in).
Everyone gave a little (some more than a little), and in 5 hours we sank thirty 10-foot mangrove tree trunks 7 feet into the mud, from the shore all the way to her grandparents’ house. The walkway went on in the next few days, and then this little girl went to shore (we still have some work to do to finish the walkway and make it safer for a wheelchair). I asked if there was anything in particular she wanted to do on shore (which she can see, 100 feet away) and she said ‘Quiero pasier’—‘I just want to go.’
planking the wheelchair walkway
This is my favorite, favorite kind of project…one where the whole community comes together when it learns about a situation like this. When the walkway is done, it will have been done right, with the right material (always seek expert advice) to make it last for many years. No matter what, this girl’s life is going to be changed forever—and here’s the best part: total cost for all the lumber, food for the volunteers actually building the walkway, gas to go pick up the posts from another island, hardware, etc: less than $1000.
There’s opportunities for helping, constantly around us…when we are alone we can help in small ways…but mira aqui, look what we can do when we all come together! Poco a poco para cambiar el mundo.
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I need an opthamologist
The last time I wrote a blog, an unconscionable number of months ago, we had recently arrived here to Bocas del Toro and I ended the blog excited by what might be possible over the coming months…now those coming months have passed, and it is time to catch everyone up and take stock of what we have accomplished here in.
6 months ago feels like a million years ago…with more long-term volunteers, we’ve been able
I love my sister
to really expand some parts of our project, including self-surveillance. I looked at what we had done—how many mobile clinics, how many volunteers, how many projects, how many patients…it is overwhelming to try and describe. I should either write bullet points, or a 3-volume novel to describe everything since my last update.
Canadian medical student doing kids health checks
Over most of our time here, for example, for every 3 days we were here, we ran one day of mobile clinic work—even counting rained-out days (and it rains 150 inches a year here) and days we were involved in any other kind of activity, whether it was working on boat projects, escorting patients to the mainland to get treatment, holding office hours in our consultorio, working in the asilo, eating, sleeping, or doing anything else. We’ve seen over 3,000 patients in more than 17 communities that we visit on a roughly 2-month rotation across the entire province of Bocas (an area of over 4,500 square kilometers), in addition to all our other activities.
No matter what other projects we get involved in, the core of Floating Doctors is our mobility—even the permanent clinics we are now working to establish are to serve as bases from which to continually run mobile clinics by panga, as we have done everywhere we go. I’m incredibly proud of all my volunteers and my crew for maintaining that level of dedication to work one day of mobile clinic for every 3 days we were here.
We’ve seen a lot of different communities, and noticed that there are enormous clusterings of health issues in different small communities that at a glance may seem similar. Why does one community have an incredibly high rate of obesity and diabetes, while the neighboring community has no obesity or diabetes but has lots of parasites? We have gathered detailed demographic and health data on over 550 patients so far, community assessments on a dozen different communities, and are beginning focused projects based on issues we have prioritized based on the data so far. Results of our first survey project coming in the new year…
ultrasounding in a chair in the jungle
We’ve started doing overnight and multi-day mobile clinics—getting two or more clinic days for the price of one day’s travel, since our accommodations have almost always been in the homes of local members of the community, or expats who notify the community that we are coming, house and feed our team, and often allow us to use their facilities to hold our clinic and arrange our transport to work in communities near their homes. I have been overwhelmed by the generosity of the expat and local community here…I have never worked anywhere—in the developing or the developed world—where the community at every level will actually deliver on its promises of support like here. From the Mayor sending trucks to help us cart garbage out of the nursing home, and letting us use his old consulting room to open for patient consults two days a week to the local marina workers who are giving their Sunday to help drive 36 10-foot posts into stinking mud to build a wheel-chair walkway, this is a wonderful community, with many eccentric people (after all, we are here too) and many people with good hearts who have shown us enormous kindness and support for our work here. Thank you to everyone—this is what makes Floating Doctors possible. A thousand hands holding us afloat…
We’ve also joined forces with the Peace Corps volunteers scattered throughout the province;
Harold, Peace Corps worker in Shark Hole; we did a clinic there on his very last day on site...a giant amongst his Ngobe friends; thank you Harold for your fantastic work
Peace corps Volunteers have thus far been 100% reliable—individual peace corps volunteers live (very often alone) in a community and work on a project. We got in contact with one, on the mainland, and ran a mobile clinic at his village…it is so awesome to arrive with everyone notified, a place to work, directions, someone to help interpret and to give us the inside scoop on patients we are meeting for the first time, someone to pre-arrange accommodation in the community, and best of all, the Peace Corps volunteers can and do follow up with patients that we have identified as needing more advanced care. This has been our experience with the Peace Corps every time we have worked with them, and we look forward to our upcoming multiday clinics to some new communities we are visiting through Peace Corps, including a Ngobe community way up in the mountains that I have heard a Peace Corps volunteer visited but that he thinks has NEVER been visited by a medical team. Looking forward to that later this week…
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My little sister Sky...at the helm...she is so awesome
Bocas del Toro, Panama
As always, leaving Haiti was difficult. There is always a sense of leaving things unfinished, no matter how many patients you see or projects you complete. I always tell people, we are not going to go help Haiti. That is beyond our power…but we went to help HAITIANS, and helped many. Leaving is hard…but I comfort myself when I remember that our anchor will drop in Haiti again.
Moonrise 200 miles off Nicaragua
We had an amazingly calm and uneventful passage from Haiti to Jamaica (our 4th time crossing the Windward Passage…it was tolerable this time, I’ll give it that). We ghosted through mirror glass seas 200 miles off the coast on our way south to Panama, a full moon reflected among the stars on a sea so smooth that the horizon was not visible. We caught some fish, slept well, had a whale shark partially breach in our wake, saw pilot whales and dolphins…Jamaica to Bocas del Toro has been by far our easiest and most pleasant transit.
this looks like a scene from an italian opera
Our arrival in Bocas was marked by the immediate generosity of the expat and local community here. Dylan and Darien on S/V Jackaroo, the owners of the Calypso Cantina at Bocas Marina, helped arrange Bocas Marina hosting us while we are here, welcomed us with a fire dance at the cantina, and have just organized a big fashion show fundraiser to support our time here (blog with THAT story coming soon!). Chuck, Courtney and Rosemary and Dana from Bocas Marina have gone way out of their way to support our mission here, and everyone in the local community has reached out to help us here.
This place is almost purpose-designed for a team like ours: a large population spread out over a large area, mostly accessible only by boat, with little or no access to health care…nearest surgery is an hour and half by fast boat ride…a mammogram is 2 hours away…a very, very, very underserved population (lots of indigenous people who have had a long history of poor interactions with foreigners).
We immediately became involved in several initial activities:
Mobile Clinics:
Shark Hole community (mobile clinic with the Mayor)
By car (thank you Rosemary!) and by panga (thank you Alcaldia!) we have so far been running mobile clinics for the communities in San Cristobal, Drago, and Shark Hole and have returns for follow up and visits to other communities on the calendar for the next few weeks, with help from expats in the area, peace corps volunteers in the communities, and with the help of the local mayor (the Alcaldia).
- Sarah doing health checks in Drago (about 1 in 6 had something needing attention)
Dr. Joe, previously the town’s only doctor before entering politics, visits the outlying communities once a week with a government team (health inspector, education directors, building inspector, etc) and we go with to do a mobile clinic. We have some bigger multi-day mobile clinics coming up; on one we will be carrying five 750 gallon water tanks to a remote series of coastal communities for Operation Safe Water.
Nursing Home (The Asilo):
Felicity and I doing ulcer care in Asilo
3 staff (cook, cleaner, nurse) on each day shift to cook for, feed, clean, wash, change, dress, and otherwise care for 25 long-term care residents who are wards of the state, most with few (usually none) family members and no means of support. The fact that the floors are clean and the patients are fed is a huge achievement, but otherwise it is heart-wrenching. There is a 3-inch concrete sill in each door…to go outside, I watched an old man with no legs roll himself up to the sill, climb down out of his wheelchair, lift the chair over the sill, lift himself over the sill, and then climb back into his chair.
The first truckload of garbage taken from the Asilo
Piles of rusting metal and trash and junk fill the backyard, and vultures walk amongst the patients in the fall-hazard garden. There are no handrails anywhere, including the bathrooms. A doctor has not come from the hospital to look at the patients for months, and they have no meds at all. And the patients have no charts at all. SO…we created charts, did full histories and physicals on everyone. Now we can write and document progress notes and exams and studies.
Please come to the Asilo and help us take the residents for walks!
The mayor sent a municipal truck and we filled it three times with garbage and junk, CJ has gathered many cuttings and plants given by other members of the community and begun systematically landscaping the demilitarized zone that was the backyard, we’ve been doing wound care, skin care, walking and exercising the patients, repairing leaking water pipes, changing inappropriate shower heads, providing eyeglasses, and generally trying to improve conditions everywhere we turn. If you are in Bocas and reading this, come by and give us a hand!
Bocas Emergency Network:
Grit from a sanding disc injury lodged deep in abcess...
We arrived here to find that the BEN (Bocas Emergency Network) was already in existence here—a network of about 50 expats scattered across the area who remain in radio contact to alert and assist each other in emergencies. The name seemed a fit made by fate, so our call sign in the BEN is ‘BEN911’. We have taken a couple of calls through the network, but fortunately none which were serious enough to necessitate an emergency callout. We are working on getting our own panga and programming known safe routes through this maze of mangroves to all the different BEN member homes (which are all located near local villages) into our GPS so with a searchlight we can make high-speed response to emergencies or do fast transit to Changinola (closest place with surgical facilities)
One of the cruisers here helping us landscape at Asilo
So far here we have had medical students from Israel and Saskatchewan, Canada, an RN and her cameraman fiancé from Australia, pre-medical and nursing students from Duke and Berkeley, an Optometrist living locally who is going to come do monthly prescription clinics (we have glasses), a nurse from Florida who just moved here with her husband, and we have a tropical medicine specialist coming from the UK, a nurse from California, and other volunteers coming throughout the summer, and some of our old volunteers returning too (awesome). It is amazing watching them go through the experience. It changes us daily, and it is fascinating and rewarding to watch people rise to challenges, encounter people and situations which push them past their boundaries, and seek out and develop opportunities to help.
Felicity helping Asilo residents pick out new glasses
I read about a playwright/director, terrified after an awful dress rehearsal before the debut of his one chance at success, who fell asleep and dreamed that he was scaling a immense mountain peak…vertical walls…no ropes…he, who had always been scared of heights, in the dream is climbing like a man born to the rock and the sky, and as he nears the summit, he loses his grip and slips, hanging just below the summit by his fingertips.
- Eve and Sarah changing decubitous ulcer dressings in Asilo
A man on the summit looks down and asks him if he is afraid of failing…and says ‘it is sometimes a mistake to climb; it is always a mistake never even to make the attempt. Sometimes, when you climb, you succeed, and sometimes, yes, you fall…but there is a third option…’ And then the playwright falls. And as he is falling, he realizes what the third option is: sometimes, when you fall, you find out you can fly.
This I believe.
Dylan orbited by flames
And in this community there are already many hands under us. What do we have in the works? Of course we want to bring in a container from Direct Relief International with equipment and material for the hospital and dispensarias here; we will soon be doing training with the firemen (who do water rescue here also) in Bocas, working with Operation Safe Water to deliver more tanks and equipment for water projects, doing consults using the mayor’s old consulting room, putting a raised vegetable garden in at the asilo, getting some specialists down here, doing more multiday mobile clinics and continuing to return for follow-up…who knows what else? I feel like this is a community in which we can accomplish a lot…it’s an exciting feeling after 1 month; wondering what we will have done here in another few months…
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All pictures of patients used with patient’s or guardians’ consent.
