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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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The Floating Doctors have been in Panama now for nearly nine months and during that time period we have been asked to help in a lot of different situations: sick babies, communities in need of medical attention, patient transports, even the removal of bot flies on a remote finca or two but last week left us in the middle of a situation that none of us ever anticipated or imagined.
It was late in the afternoon and I was wrapping my day up with a cold soda in the Cantina at the Bocas Marina when several water taxis pulled up. I paid little attention as the taxis come and go from the marina at all hours of the day and I assumed that this was nothing different—but I did watch as one of the drivers made their way towards the cantina while the other two waited in the Panga. Odd but nothing very note worthy. The driver made his way into the Cantina and started speaking to several of the cruisers that had taken up their usual spots around the communal table but was having trouble breaking the English/Spanish barrier with them. Being that, at the time, I was the best Spanish speaker in the group I was asked to come in and help interpret for the driver but quickly found myself confused at what he was saying.He looked at me square in the eyes and said “my friend has precious tigers for sale in my boat”. Excuse me? I asked him to repeat himself several times as, although I was interpreting what he was saying in my head, it made no sense to me. I asked if we could walk over to the panga so I could see what he was selling—I honestly thought that he was going to show me a launcha filled with Lion Fish and that I was just not getting the local slang for the fish—but as I neared the boat I could hear a very strange but oddly familiar kitten like cry. To my utter horror and shock as we got to the end of the dock, there they were, two less than one month old Mountain Lion kittens shoved into a small card board box covered in their own filth and obviously scared.
Now I recognize that these animals are very cute when young and obviously bring with them a large pay day for those that get their hands on them but at that moment I was sickened. Here below me were two wild animals- young, scared, and fighting for their lives. I asked first where they had gotten them and why they had them and was told that they were “found” in the mountains outside of Changuinola. Right….
I started to explain to the 3 men that not only was it very bad that they had taken them but that if they were sold to someone for the house that they will die as they need a very different kind of care than a normal house cat. They then told me that for $500 a piece I could have them. We started a back and forth – them speaking only of the cash they wanted and me making a futile attempt to explain to them the ramifications of what they had done- that wild animals should never be taken and caged. Finally I looked at the water taxi drivers, both of whom I recognized, and said—“Hey, you know this is wrong and I know you, and I see you and I would proceed with caution if I were you”. They all immediately became nervous and started their engines. Off they went with the crying kittens.
We jumped into our own Panga and followed them into town and as the man with the cats exited the boat and the taxi took off I followed suit. I ran after him and after a few seconds was face to face with him again explaining that he wasn’t going to go anywhere with those cats. He called for a few of the taxi to help him with this crazy woman, but thank god, the months of work that we have been doing here in Bocas came to my aid when the men gave a simple reply, “ nope, she’s good”. He again began to walk away with me not leaving his side and again he tried to get assistance from some locals on the street and once again got the same reply from them… “she’s good man”. He finally stopped and faced me. At that point I told him that this could be a problem for him or it couldn’t- all he had to do was hand over the cats and come with me to the Smithsonian or he could make it a problem. He simply handed the box over turned around and was gone.I have seen a lot of sick babies in my last three years working throughout Central America and although not a doctor could tell that these two cats were not in good shape. We rushed them to the Smithsonian Institute in Bocas who gave us pointers on how to care for them—we were hoping that we would have been able to hand them over at that point but the group needed time to assemble their resources and identify the best place for these wild animals to go. They told us how to bottle feed them with goats milk and that them staying warm was very important and set us on our way.
The next three days were spent feeding them every two hours, day and night, helping them go to the bathroom, and making sure that they were never cold. They cried incessantly when not sleeping and we tried to offer them whatever comfort that we could but there was nothing that we could do to stop the pain that happens when a baby losses its mother. To stop the fear of a surrounding that is not and should not be theirs.
We nurtured them back to health over the days and finally got connected with Elena Castejon from APPC who immediately sprung into action to get these two innocent little souls to her in Panama City. We packed up their bottles and goats milk, put them on a flight to Panama City to be met by Elena and the crew from ANAM, and they were gone. Out of our lives as quickly as they came but leaving an impression bigger than they will grow when they are large.For me personally, although it was an amazing experience to be able to care for such animals, it was agonizing. These were not two kitties bred for human affection and love but rather two wild animals who will now be relinquished to a cage, ripped from their natural habitat, and made to become something that they are not—cared for by humans. These two will never know the joy of running unimpeded through the wild, to feel a jungle bark beneath their paws, or what flowers bloom deep in the forest after a drenching rain. They will never know what sounds howler monkeys make at night and what should alarm them in the wild. Instead they will be caged in a sanctuary that is a poor surrogate for their land.
I believe that all of us here in Bocas are in our hearts wild things that have refused to be caged by the normalcy of life. We have sacrificed the comfort of stability for the beauty of freedom. We have chosen winding jungle trails over the constrained isles of Walmart and the untamable ocean over freeways. I saw the same hopeless sense of amazement in each one of the Bocateranians that came to see these little wonders that I felt so deeply- as if seeing these caged and scared cubs was like witnessing the part of our lives that we have all railed against so vehemently.
Once again I am honored to have been a part of something that helped to stopped pain and suffering but in this instance I did not walk away feeling a complete sense of calm. D. H. Lawrence said, “ I never saw a wild thing sorry for itself.” But for me, here, I felt sorry. These two will never feel sorry for themselves- they are young and they will grow up believing their caged existence is how life should have been. Three years, 6000 nautical miles, and countless wonders ago I may have said the same about my own life. It was how I thought it should be- the job, car, credit card- all a part of the foolish game I believed was so necessary for happiness. Unlike those caged cats I think we all now see otherwise….“Life is not about seeing what you want and how to get it but rather is about seeing what you have and how to give it.” Frank Baxter
Written by: Sky LaBrot
For more information and to get involved please visit:
APPC http://www.panamericancon.org/ -
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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It has been two months since I have been able to put words to page although this is not for lack of content or consideration but rather the inability to put thoughts into meaning. In that time period we have left Haiti, seen old friends in Jamaica, and crossed the remainder of the Caribbean Sea to Panama. All amazing accomplishments that should be noted, written about, and reflected upon- yet every time I open the computer to a blank white WORD page I sit paralyzed. It’s as if all of the experiences and work bottle neck themselves in my head and leave a connection with my hands useless.
I thought this time that leaving Haiti would be easy, knowing that we would return again, to have seen the faces that I love and know that they are well, and yet in reality it was much harder than the last. To see a little boy that I love with all of my heart playing by the tree where I last left him was a joy but leaving him once again at the same tree eats at me… having him not there the next time we return will break me, and yet when I sit back and think about, having him still there may be just as bad. The never ending tail chasing ‘whats worse’ game that plays in my mind. It seems at times to me that my heart will never win when it comes to my time in Haiti—I will always be pulled back and tormented away. The sights, sounds, and deaths get no easier the second time around- they still work their way in, nuzzle themselves into my soul, and trouble my moonlit nights on the water. As we left Haiti I sat on our back deck for as long as the light would allow my eyes sight with my heart being crushed and simultaneously elated that we were pulling away from the shores not knowing if the tears I was shedding were for her, for me, or for those I was once again leaving behind.The transit that lay ahead of me turned into 5 of the most memorable days of my life- flat calm and beautiful the seas opened themselves and the life that dwells deep within its blue waters to us. We spent the days spotting whales, dolphins, endless fish, whale sharks, and sharks with an elation that only wildlife can bring. I felt my heart being drawn into the
dark blue that lay beneath our keel, the salt water starting to become part of my blood, her vastness a part of my soul, and perhaps on this transit I truly became a sailor. As I walk down the docks now I feel her calling to me- beckoning me into her wildness and away from the safety of solid land. To trade stability for freedom and schedule for adventure- to stand on our bow with salt laced air in my face and dolphins underneath my feet. To undo our lines and sail into the never ending splendor that is the open ocean.I had dreamed of Panama from the start of my involvement in this project – it always seemed so wild and distant to me. It has not failed to disappoint either- the people, the
jungles, and the islands have opened themselves and embraced our project like no place we have been before. The unending kindness of the people here leaves me speechless as it seems that there is nothing that they won’t do to make ‘us’ happen. Free Dockage from the Bocas Marina and Yacht Club, amazing Fashion Show/Fundraisers from the Calypso Cantina, Wednesday night girls night with some amazing women. The community has thrown its heart open to us and is literally making our project here possible. So much of what I have constantly had to worry about has been lifted from my shoulders allowing me to immerse myself in our clinics. I am humbled, once again, by the generosity of others.I find myself loving my life – on the precipice of my 30th year I am thankful beyond all reason for the life I get to lead. I wake up every morning, usually no one is up yet, and I drink my coffee overlooking one of the most stunning bays in the Caribbean. I awake my crew and head off to a distant shore, often feeling like I have stepped back hundreds of
years in time, and spend my days making peoples’ lives better, making their pain stop, quieting the worried minds of mothers and the crying of babies. And all too often people tell me that it’s so amazing what we do—my only reply is, nope, it’s amazing what I get to do. I am surrounded by suffering and pain and beauty and wonder. My heart is broken and lifted twisted and torn and I would change none of it. My cup runeth over. I am haunted and changed and the luckiest girl I know. -
Petit-Goave, Haiti–Almost a Year To The Day We First Arrived Here In 2010
This is the overdue final chapter of our voyage from Honduras to Haiti, bringing supplies for the cholera relief and personnel for a string of clinics and villages along the north coast.
Sky clerking in our first patients
After our repairs in Kingston were complete, all that remained was to chomp on the bit while only 40 miles away on the north side of Jamaica’s Blue Mountains a series of storms swept down the Windward Passage and collided with a SE swell across our path. At the first day when the swells and wind subsided, we left Kingston at first light and made all speed for the Windward Passage. Once we got out of the shadow of Jamaica, we encountered the most disorganized sea I’ve ever seen—in the space of five minutes we would encounter NE, SE, W, and N swell…thank god the wind had died or it would have been a horrible bathtub; as it was it was merely uncomfortable until we ghosted into the protection of the Bay of Haiti and at last dropped anchor in Petit-Goave, the first place we ever went for a mission…almost a year to the day that we first arrived in Haiti.
An hour after we dropped anchor, in the dead of night, our first friend from Petit-Goave,
Carrying our clinic bags back to the shore from our Fort Liberte clinic
Aniel, came out in a canoe…the next day, we saw dozens of people we knew; we went back to the DesGranges clinic and saw Meomene and ‘Cheeks’ and the kids who were there when we left. The two schools we built are now surrounded by larger concrete structures in mid construction; a larger future school sponsored by Korea, I think…but when we walked up to our little schools, each one was packed with kids and classes were in session as they have been since we built them. That was a great feeling…the pharmacy we cleaned and reorganized, and the day patient treatment room and the minor ops room were all organized and cleaned as when we left, and more rebuilding and expansion was still going on. We left a box of supplies for Dr. Cutler, an MD from L.A. who we arranged to go out ahead of us last year and who is returning to Petit-Goave to volunteer again this year—I think he actually arrived yesterday, as a matter of fact.
A scene from the past...on our way to our first shore clinic 18 hours after arriving in Petit-Goave
It was so different arriving here this time…amazingly, most of the rubble had been cleared, and most of the tents crowding every street were nowhere in sight. Some houses had been rebuilt (in concrete block without much rebar and suspect cement), but we saw hundreds of wood frame and tin roof one-room structures, on new poured concrete foundations from (apparently) a Swiss-led European consortium. More commerce was happening, some small businesses had reopened, and the central park was clear of tents and refugees.
I admit, when we left Petit-Goave after witnessing both the massive problems the
The only catch we made trolling in Haitian waters...a bag of used maxi pads
Haitians wake up to every morning and the effects of much of the relief efforts after the earthquake, I was not expecting the level of improvement that we saw. My journey to Port-Au-Prince to drop a volunteer off at the airport, however, was much more depressing…a city imploding on itself, with little visible progress over the past year of funds and relief being poured into it. Petit-Goave’s determination to pull itself out of its downward spiral it gave me a renewed hope for Haiti, a hope that I could see in the faces of all of our friends and the new people we saw.
Ultrasound revealed cholecystitis (gall bladder); antibiotics and analgesia given
The best moments for me came during the mobile clinics we ran, on the beach at Fort Liberte and in the ruins of an old French fort back from the coast a mile or so. I saw babies that I had ultrasounded 8 months ago and were born while we were away, patients showed me their thin scars where large machete wounds used to be…when I pulled onto the beach in the first load (two trips in the skiff from the boat to our clinic), the kids in the village saw us coming and ran down the beach yelling ‘Sky?! Rachel?!’ and we were surrounded by everyone we knew and treated in the mobile clinics last year. We wormed everyone again, handed out thousands of vitamins, and saw the usual litany of problems great and small—but we saw one patient in our first mobile clinic–less than 18 hors after we arrived–that made the whole 38 days of struggle and travel to get to Haiti worthwhile.
In the little enclave of cactus on the shore west of Petit-Goave, sitting in the same spot
There are worse waiting rooms
that we did our very first ever mobile clinic as Floating Doctors, we saw a 6-day old baby with an eye infection from Chlamydia or gonorrhea (or both) acquired during birth. This is a very serious, time sensitive problem–a few more days untreated and scarring develops, blinding the child forever (and cross infection and blinding in the originally uninfected eye are very common). We treated the mom and dad and used several days of rigorous cleaning and washing, and antibiotic eye ointment, and the greatest moment of our return for me was watching the pus-filled swollen eye lose its swelling and turn clear—just a few more days and the baby would probably have been blind forever.
Crew shot at the dock in Kingston 3/17/11
It’s not about saving the day, or being a hero…it’s about timing. It’s about being there, and being available as a resource to people who have no other options. A single patient treated at just the right place and just the right time to prevent a lifetime’s worth of suffering for a baby already born into a hard existence. If we had not been delayed by bad weather and bad fuel on the way from Honduras to Haiti, we would have arrived and departed Petit-Goave for Cap Haitian weeks before the baby was born…and when we finished working around Cap Haitian and returned to Petit-Goave, we would have found a blind 1 month old baby.
Life tends to unfold on schedule…not always the schedule I want, and most of the time I never get to know why things happen just the way they do. But sometimes we get a glimpse of a purpose…sometimes what we endure in life makes sense after the fact, and every moment of struggle and frustration and discomfort and fear during the voyage here suddenly became a price I would pay a hundred times over if it meant being able to be there at that exact moment with everything necessary so that baby will get the chance to grow up with both its eyes working.
Dr. Holly saw the baby and when I wandered over to investigate and the problem became
We strip excess packaging from what we bring aboard; this is the total trash generated from a clinic with 80 patients (including ultrasound and two small surgeries)
clear, I though “Ahhhhh….so THAT was why we had to go through that crossing.” If we saw not a single other patient there are people who would say the journey was wasted…the old numbers game; people always want to know how many patients seen (over 5,000 so far), how many vitamins (over a million given away so far), etc…and those numbers are important in making sure the investment of resources is not ‘wasted’…but when I get a patient like that baby, the numbers become meaningless and that one patient becomes, for a moment, your whole reason for existing at all.
To that baby and her parents and to me, it seemed pretty worthwhile that we were there and equipped to help…and we see hundreds of people like this, whose paths cross ours at crucial moments when only a small intervention is necessary to change a life forever.
And with each such patient, our lives are also changed forever and a memory is created that I know I will playback to myself many years from now when my adventuring days have ended and smile and wonder how that little intervention in time played out on the world’s stage ove the years. I’ll likely never know–the years-later effects of what we do aren’t ultimately up to me, but I’ll always remember that we were able to help give people a chance at better lives and futures, and no one will ever be able to take that away from us.
Sunset behind us as we ghost east in the bay of Haiti on our final leg to Petit-Goave
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Part 3 of Our Transit: Cayman to Jamaica
Trouble ahead...out of nowhere
We departed Grand Cayman on a beautiful sunny morning, anxiously clearing past
Left: Polished Fuel; Right: Same Fuel as It Came Out Of The Hose In Roatan
the eastern end of the island and waiting to see if an unexpected northeast swell would devastate us, but all seemed tranquil with gentle 1-2 foot seas and clear skies. With the calm water, our fuel (having already been filtered through 10 of our filter cartridges) wasn’t sloshing badly, and our port engine was running smoothly. When it did require a filter change it was comfortable to drift forward for ten minutes while we changed filters.
The next day, as we bore further south, we started to take the wind just forward of
Holly Steering In Rough Seas
the beam. We shook out the sails, gaining another 2.5 knots to the port engine, but as we came within sight of the western tip of Jamaica, waves wrapping around the north AND south of Jamaica were building and converging on our position at 45-90 degrees to each other, and building fast. As night fell, we were well east along Jamaica but still 50 miles offshore, having worn south to use the wind longer. We turned east and pulled the sails down, securing the ship in anticipation of yet another nasty sea coming…and we were not disappointed.
Sky trying to keep her back together...
The seas came round close to the starboard beam, and the period shortened as we drove dead into the wind. Fuel started sloshing, and we soon found ourselves dead in the water as the port engine sucked up the sludge that was our fuel. Frantic filter changes continued, with increased urgency each time as we bore closer to the lee shore. We downloaded a weather report through our satphone (tough to hold the antennae southwest in that sea state) and realized that, once again, unexpected bad weather (11-12 foot seas and 35 mph winds) were coming to the windward passage, and we knew that we would be very, very lucky to make it around Jamaica’a eastern tip and pull into Port Antonio on the north side.
As day broke, Sky and I made the decision to divert to Kingston, which we might be able to reach before dark.
Getting stability and 2.5 knots extra from the sails...
As we approached, we were not able to raise any of the Jamaican officials. It was a public holiday. We raised a local boater on VHF who connected us with a retired Evinrude dealer, who lived up the mountains and monitored all marine radio traffic. We rendezvoused with the first boater at a small cay off Kingston. He lent me a chart and pointed out the unmarked location of the
Making An Electrical Repair When He Should Be Asleep...But Has No Choice
customs area, a small unmarked anchorage, and the Royal Jamaican Yacht Club anchorage, also unmarked and uncharted. Then, our new friend Tony Tame up on the mountain contacted the customs, immigration, health, and port officials, and we made our final, hair raising approach past Wreck Reef’s dangerous lee shore into Kingston’s main channel and the protection of its harbor…what a relief.
Talking To Ensley, Carib Maritime's Master Mechanic About Where To Find Parts
Within 2 hours we were cleared in and allowed to proceed to the yacht club, where we dropped anchor and collapsed asleep. We then spent 24 hours on reconnaissance; getting a Jamaican sim card and number for the blackberry, finding and calling stores that might carry the parts we needed, finding and arranging transport into town to search for what we need at stores we had already
Ed, source the fuel filters, assembly and additional parts...
contacted. The kind master mechanic and master engineer from the neighboring Carribbean Maritime Training Institute drove us all over town and helped us figure out where to find what we needed. Within 72 hours, we had obtained and installed all the parts that we needed to repair our engine systems (and incidentally, our alternator) and had polished the 400 gallons of diesel in our tanks…opening each of the three tanks’ access hatches, pumping out and filtering all the fuel, scrubbing and vacuuming the sludge from the bottom and then re-sealing the tanks. We finished at midnight, took on fuel the next day and then were invited by the yacht club to wait for weather at their dock.
Borrowing Luther's Fuel Polisher
What a relief! Tied to the dock, everything is easier, and anchor watches don’t need to be set. It will be hard enough in Haiti; it is great that everyone might get a chance to rest now. The weather is driving us crazy…there is a huge high pressure system over the east, sending howling winds down the Windward Passage, and a SE swell meeting it…it is nasty there, and we are heavily loaded with IV fluids.
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Note: A month ago we departed from Roatan for a ten-day transit to Haiti, with a stop in Isla Guanaja to clear out of Honduras and a stop in Port Antonio, Jamaica, for fuel and a night’s sleep before the final 36 hours to Petit-Goave, our first destination In Haiti.
That was the plan, anyway.
The next couple of updates, written here in Kingston, will tell the saga of what happened and catch us up from Roatan to here in Jamaica…I have written them all in one go, and will post one a day till we are caught up.
March 1, 2010–Isla Roatan to Isla Guanaja, Honduras
Ernest Shackleton's Recruiting Ad...
We knew it would be an up-wind, up-current battle the whole way to Haiti, so we made the 40-mile run from Roatan to Isla Guanaja to clear out, and wait for a weather window long enough to reach the protection of Jamaica. When we got to Guanaja through 6 foot, choppy seas coming from the east, there was no room in the only protected anchorage and we anchored outside in the channel, where it
Each Red Line Shows Our New Swing Line As We Dragged And Reset All Night
proceeded to blow hard from the E and SE for 9 days. We dragged anchor several times before finally putting out a second bow anchor, which seemed to hold, but we spent many hours at night watching our chartplotter and peering out at Dunbar Rock to see if it loomed any closer in the darkness than it had 5 minutes before as we bucked and swung on our anchors.
Ed Wiring A Cell Phone Charger To Our Generator To Make It Work
Our generator was not putting out full power; its regulator control board had finally failed (it had done well to survive the lightning strike at all) but Ed managed to coax it to produce some power by using an old cell phone charger, wired directly to the circuit board, plugged into a small dashboard inverter which he wired directly to our battery bank. Thus, we were able to excite the part of the generator circuitry that allowed the generator to produce power, but it would frequently get hot and fail and need to be reset.
It turned out that I had to fly back to Roatan on a puddlejumper with all of our passports to clear out of Honduras, and we also had several cases of vitamins, IV fluids, gauze, syringes, antibiotics, heart monitors, and other supplies to deliver to the health center on Guanaja. I went back to Roatan and got everybody cleared out of Honduras, and when I got back we connected with the director there and we arranged for me and Dr. Holly to help out in the clinic. Holly saw patients for general consults, and I did ultrasounds on some pregnant women and women with abdominal masses.
We also managed to revisit a patient we saw when we were there in October—the patient that we suspected had
A Good Omen For The Crossing??
elephantaiasis. With a tropical medicine specialist onboard, and armed with the opinions and advice of many clinicians (form as far away as Fiji!) who wrote to offer suggestions, we re-examined him and decided on a course of treatment that might at least stop forward progression of the symptoms by killing any active filarial worms, and Noah taught him a series of exercises and techniques to try and increase lymphatic drainage. The next time we visit Guanaja, I hope he will show improvement…at least no progression!
Our Path Through The Reef...The Asterisks And Pluses Are Exposed/Awash Rocks
We endured the wind and anxiety of anchor dragging for 8 days, finally moving to the backside of the island and negotiating a narrow, twisting reef passage to an anchorage with some protection. We still dragged, but only a little, so we managed to have a semi-restful last night and in the morning the sea and wind died down to nothing and we nosed out through the reef passage and headed NE towards Jamaica. Little did we know that the calm glassy waters of our departure would not last for long…
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Holly and I finally face the task of completely clearing out, organizing, and restocking our medical go-bags
This week saw the first heavy, 3 day long pouring rain for several weeks (of course, while we are trying to load the boat and finish our preparations for departure) and the tying off of many threads we have been following for months…we closed up our clinic in Oakridge, packing everything up and saying hasta luego a mi pacientes. Un momento muy difficile. Thank goodness we plan to return to open the clinic permanently as a satellite clinic, open every day with a doctor and staff on site even when Southern Wind is working elsewhere. Knowing we are coming back after this voyage, and knowing that with what we learned and the relationships we forged on Roatan, we can and will open that clinic, makes it much easier to say farewell. Instead, we say (we are going to Haiti, after all) aur revoir.
We finished off a lot of rainy day projects inside the boat (there are always, always more
Capt. Ed cutting a new gasket for our 671 GM engine pan...doin' it old school
projects), and got down to the business of prepping to load—that means taking every item out of its storage onboard, condensing everything, repacking all our medical go-bags (thank you Dr. Holly!), and most important: we took delivery of our 5 pallets of material left over in Miami from our last mission to Haiti (thank you Gary, Donna, and everyone at Roatan Rotary!), and our 40-foot container from Direct Relief International, packed with medicine and equipment for the clinics in the island and distributed the material to 5 clinics and the public hospital on the island.
And the unloading begins...
This is a crowning moment for Sky. To get this container in, it required over 1,000 emails between Sky, the shipping company, Direct Relief International, Joseph Natale from Fundacion Heart Ventures, the customs office, the customs broker, Roatan Rotary, a cross-country trucking company and a local trucking company in Miami and another in Roatan, the warehouse in Miami with our 5 leftover pallets, the Ministry of Health in Honduras, 6 different clinics on Roatan, and Cepudo (a Honduran NGO on the mainland).
Roatan Public Hospital emergency room with the floor up to fix the backed up sewer
The difficulty is not in sending down material—anyone can order a container and have it
Gary and Sky picking up the pallets Rotary helped us bring in
shipped down here…but not without enormous import fees. It is sending down material and getting it cleared through customs as donated material without $30,000 worth of customs duties applied that is difficult, not to mention that we wanted to create a conduit so that we could send containers on a regular basis. One time is easy…to set it up to be sustainable is way, way more difficult. It took more than anyone else will ever know to get it set up by Sky, but I will always know and always be impressed how much the people you already love and admire can still amaze you.
Holly checking the pile earmarked for the Pandytown Centro de Salud
In a few months I will begin contacting the clinics again, finding out their needs and getting another request for DRI and container number 2…
Our staging area for the distribution to the clinics--thank you Gary and Donna for letting us use the tents!!!! Lifesavers!
Our aid station at the triathlon finish line
In the midst of all this, we still see patients, provided the medical service for the Bay Islands Triathalon (including the kayaks monitoring the swimmers during the first leg), and Dr. Holly—whose training
heading out...some swimmers were really struggling, and a few got lost and started to swim to Guatemala, but thankfully no one went under and didn't come back up
includes major scene accident management—provided 2 days of training for the Fire Department, following up the training provided by our volunteer Sirin last year.
Maintaining head control as Johel comes out
Dr. Holly showed the firemen a particular extrication trick—when you have a patient with suspected spinal injury from a car accident, you can extract the patient through the back window by lowering the front seat, sliding the board in through the back window and taking the patient straight out. Since we have the use of Gary and Donna’s open jeep, we could simulate the extraction without having to smash a car’s back window. We are nothing if not adaptable.
The weather is looking good for this weekend (pouring rain now)…high pressure pushing down, maybe keeping the low centers at bay over our projected route. Loading the IV fluids tomorrow and the next day…Finish securing the boat for sea…provisioning….and a last good night’s sleep.
Then give me that horizon.
Photos of patients used with patients’ express permission.
Photos of unloading and interior boat construction (pretty much most of the nice-looking photos) courtesy of Dan Chomistek
