For me the sea has always been where I turn for inspiration, solace, and wonder. The night I was born I breathed thick salt air and first heard the sound of long Pacific swells rolling onto whispering sand, and from that day my life was held forever in the sea’s net of wonders. My mom and dad were living in a beach motel in Southern California while my dad did his medical residency, and my first steps were on the sand and behind my dad as he made hospital rounds and home visits to patients. I can never remember any time in my life when I wanted to be anything except a doctor and a marine naturalist, and thanks to my parents, extraordinary mentors and opportunities I became a marine biologist and a doctor and have had experiences in both fields that make me grateful to be alive just for one of those moments.
My favorite thing about the sea is that it is not lonely; in the sea I feel connected by the water to millions of people around the world. I imagine millions of people of a thousand colors and languages and religions and nations all floating together in the sea’s embrace and connected across thousands of miles by one continuous, unbroken sea. When we float in the vast sea, only a little of it is holding us up, but that small part is connected to an unimaginably vast and powerful body of water. In the same way, this is how a people are strong. When we say ‘a sea of humanity’ we acknowledge that humanity–all of us together–are as powerful as the sea, which is always waiting to show what it can do.
Like every wave, every life is unique and beautiful, something I have experienced time and again through this voyage. In 2011 we saw our
10,000th patient, and although I am very proud of how many people have received care through Floating Doctors, what I am most proud of in 2011 was that as we expanded our project, we always stayed committed to the individual patient. Time and again, this has ultimately led to our being able to do more for more people than we originally anticipated and I have faith that we will remain committed to the single, individual patient as continue our voyage.
Long before I was old enough to venture over the horizon the last lands and seas had long since been charted, but fortunately the frontiers of health and the sea of humanity offer an endless horizon. Looking out over the Pacific horizon so many years ago I never envisioned that my greatest loves would one day combine in a mobile medical relief team exploring frontiers of health across the living ocean that washes all shores equally. I had no idea HOW I would pursue these two passions, I only knew with certainty that if I did not have them both in my life, I would never be happy, and so I would look out over the water or read Jacques Cousteau or trail after my dad on rounds, and dream of adventures on distant seas and future patients I would see and help.
But all the time a voice was urging me to move forward, always there was another voice…darker, more ancient; a more primitive vocabulary but it didn’t need sophisticated words…it has raw fear, self-loathing, shame, narcissism, and petty angst and selfishness. This voice, all my life, has whispered under my dreams, telling me I will never become a doctor, and never see the seas I spent my childhood dreaming of. Sometimes it spoke with other people’s voices, like during the year we struggled to rebuild Southern Wind after she had been donated to us and some people scoffed and said we would never make it, and it would never work, and we would all be killed and waste all the support we gathered…but here we are. Sky and I lived with fear as a constant companion for the whole tenuous first year of our project, when so often it hung by a thread, but (especially with my sister beside me and many hands outstretched to help us keep going) we were able to move forward, one foot in front of the other, and now here we are…going on a mobile clinic in the morning, more than 600 mobile clinics into our voyage.
I know now that this pessimistic voice I’ve always had spoke from feeling not good enough somehow to deserve attaining my dreams, and although as I got older (and continue to get older) the voice got fainter and fainter (I pretty much ignore it on autopilot now…most of the time), it took many years before I could–as my wise sister says–”Allow myself to succeed” without it being a struggle. We are always our own harshest critics and unforgiving judges, but as they saying goes: ‘You never know if you can climb the mountain until you try (REALLY try).’ And as a wise man said, is it really that frightening to succeed, and is it really, in the grand scheme of things, so terrible to fail? And there is always the third option (my favorite): sometimes when you fall, you find out you can fly (or learn how really, really quickly)–especially if hands are outstretched to help you stay in the air, and your ego (and the dark voice inside us) allows you accept the help that is offered.
The kindness and generosity I have seen people show towards us and to others fills me with hope that the daunting
challenges of our time can be survived. I am immensely proud of what my crew, friends and family, and all our volunteers and supporters have made possible, and incredibly grateful to be able to be a part of this voyage and to have shared it with such extraordinary people.
Even with all its faults, earth is a beautiful planet, and humanity, despite its many, many faults, is heroic. There are heroes all around us; it has been a great honor to work alongside so many of them.
“The world is a fine place, and worth fighting for.”
Check out these pictures; some of my favorite moments captured in 2011.
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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.
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,
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.
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
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.
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
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.
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
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.
All patient photos used with patients’ consent. Please click on any image below to activate the slide show viewer.
Part 3 of Our Transit: Cayman to Jamaica
We departed Grand Cayman on a beautiful sunny morning, anxiously clearing past
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
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.
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.
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
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.
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
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.
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: This is Part 2 of the story of our voyage from Honduras to Haiti
First, I will say that the first 48 hours of this crossing from Guanaja to Jamaica will remain with me forever as two of the greatest days I have ever spent on the water…so good that even at the end of the second day, we said to each other that we would surely pay dearly for the day we had. And pay we did…I wish we had pictures of the madness that ensued when things turned from paradise to misery, but by then we were working too hard to remedy our situation, and too sick, to pick up a camera.
Those first 2 days, however, we cruised at 7 knots over a glassy Caribbean sea, with clouds reflected in it, catching fish after fish—dorado, tuna, wahoo, longbill spearfish, blue marlin at sunset, barracuda, grouper (when we passed over the reefs of Swan Island on the morning of the second day) and Jacks. One of the most epic and beautiful days on the water ever—but it meant that when I was off-watch (I had the con from 12-4 AM/PM), dawn was just coming so two full days of catching fish almost hourly kept me awake all day, catching only an hour or two in the evening after dinner.
On the morning of the 3rd day, I went to bed around 4:30 AM after my watch, but since my bunk is in the forepeak I feel the seas pretty badly when we are pitching, and I woke to hell…a wild sea, and a cross sea with the wind out of the northeast and the swell from the southeast. We strapped everything down and bore down dead ahead, climbing up the faces of the swells and coming down hard; Southern Wind handles seas on the bow pretty well, but this Caribbean sea is like a bathtub! Every sailor I’ve talked to says it is choppy, unpredictable, subject to sudden changes in weather, and watching the 3rd day of this supposed 7-day weather window dawn to whitecaps and a short cross-swell makes me long for the long rolling groundswell of the Pacific.
Our journey probably would have been merely miserable but uneventful, but 60 miles south of Grand Cayman
and only a day and a half from Jamaica, bad fuel we took on in Honduras (the worst I have ever seen…might as well have put gutter water in our tanks) started sloshing in our tanks and our fuel filters soon became clogged…Ed and Larson spent hour after hour in the engine room shutting down one engine at a time, changing filter cartridges (good thing we stocked up in Roatan with enough to last—we thought—6 months), until one of the canister cartridges grew so hot the metal fatigued and broke, disabling the starboard engine (to run it unfiltered, as we then rigged it in case of emergency, would have seized all our injectors and the engine would have been much more damaged).
When the port engine fuel filter clogged again, as we struggled to change it in the heaving engine room and reprime the fuel system, we turned beam onto the seas and started to roll. I threw lawn chairs tied to heavy lines off our bow to act as a sea anchor and hold our bow to the weather, and Noah, Dr. Holly and Randy worked to bring the sails up as we turned north to try and make it to Cayman. Sky raised a nearby freighter on the VHF, whose radio operator relayed our position and situation to Cayman port authorities and USCG Miami, and the Jamaican Coast Guard. The freighter stood ready to divert and take us off if necessary, and Sky contacted USCG directly on Satphone to update them with our position and situation in case a major rescue should become necessary. It meant a great deal to us that the freighter was willing to divert and rescue us if our ship had been lost; when we were in Roatan we saw a captain on another ship be told by the owner NOT to divert to help a sailboat that had gone up on the rocks on a channel entrance; the captain was very shaken up by this as he felt it was very, very bad karma. The law of the sea is the ethos of Floating Doctors…always stop and help, since you never know when it might be you on the receiving end of assistance
However, because I have a ship that refuses to give up fighting and a crew that can tackle any challenge and
function even under horrible conditions (even if afterwards we all have a series of quiet heart attacks and have lost weight from vomiting), we refused to give up the battle and with the wind sustained at 25 knots on the beam, the sails stabilized us (I immediately felt it in the engine room) and for a while we made 4.5 knots under sail alone (so much for the skeptics! We may not have all the sail Southern Wind had before her mast was shortened, and she’ll never be a racer, but she was a champion that day).
One the sails were up and I saw that we were making headway safely (if slowly) toward Cayman, I don’t remember much more for the next few hours as I think someone made me go lie down. One of the last things I remember is that the port engine had just been restarted (had to be re-primed with fuel every time the filter clogged) I think, and I put my head down on it in the engine room to fall asleep. It was awesome to make the transit with other captains onboard…otherwise I would have had no choice but to remain awake and functional (the most dangerous scenario faced by solo long-distance sailors). I was pretty dehydrated (had had no water for almost 24 hours, had been vomiting, had not eaten for 2 days, and had been awake for almost 4 days…Ed and Larson (and all of us, really) had a similar experience, and we were crazed when we finally pulled in sight of Cayman.
Holly and I brought the boat the last leg to Cayman and Holly (what a trooper) took the helm and let me sleep a little as we stood offshore, waiting for daylight to make our final approach to dock and clear in at Grand Cayman. We knew a mooring was available free, but first we had to visit the customs dock to clear in before we could move to the mooring and finally relax and sleep. I must have looked wild-eyed in the Port Captain’s office but they must be used to it as we cleared in with no difficulty and got onto the mooring asap.
We spent two days in Cayman waiting for the weather to open (or so we and various government and commercial weather prediction services believed it was going to), made a few repairs and tried to recover from the mess and shock of our previous crossing. We didn’t see much of Cayman (saw a lot of the inside of our engine room!) but the water there was beautiful, and it was a shock to be somewhere with good services available. Our next departure, we thought, would see us arriving in Port Antonio, Jamaica to take on some fuel and fix our broken fuel filter and tie up to a dock one last time for a night before crossing the Windward Passage and beginning our mission in Haiti (where we will likely be anchored in poor holding ground of uncertain depth, and it is impossible to completely relax).
The starboard engine could be used in an emergency (though it would surely soon seize if it had to be run), and
the port engine was functioning adequately to make it to Jamaica in good weather. Repairs were more practical in Jamaica, so at the next weather window we sailed for Jamaica on a calm, flat day…that was not destined to remain so for long.
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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
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
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.
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
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!
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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Being in charge of all of the cooking on board can sometimes be a daunting task. It is important to me that the food I serve is both nutritious as well as tasty and being far from home with ingredients that are foreign to me and the crew can be a work in progress. Over my months at sea I have learned a lot from the locals that I have become close to and I have ended up adopting a lot of their recipes into my every day culinary repertoire.
Below is a recipe for a dish called Pickeleze that I learned while I was in Haiti. It is a delicious side salad, sandwich topper, meat garnish, and goes with just about everything! My favorite is to put it onto top of bbq fish tacos! This is a great way to add crunch, spice, and flavor to a dish without adding almost any fat. Cabbage is a great source for fiber, mangnesium, iron, and omega-3’s as well as sodium, zinc and copper. Carrots are not only sweet and delicious in this dish but they add a good dose of Vitamin C, Vitamin B6, and folate. Being that this dish is only “cooked” in the acids of the salad a lot of the nutritional content stays with the veggies. I hope that you enjoy this as much as I do!
1 Head Cabbage
2 Scotch Bonnet Peppers (Closest to Habanero)
1 Large Carrot
2 Tbsp White Vinegar
1 Cube Boullion (Optional)
1 tsp Salt
In a salad bowl mix the Vinegar, Juice of 3 limes, Salt, and Boullion together.
(Boullion is packed full of sodium and can easily be omitted. It adds a depth of flavor to the salad but can be replaced with ½ teaspoon of Poultry Seasoning)
Shave peppers into thin slices and drop into the marinade mixture.
(This dish can vary from very hot to mild depending on the type and quantities of peppers you use. Jalapeño peppers can be used as a substitute. The spice of the dish is really mellowed out by the vinegar so don’t be afraid to try to use the peppers!)
Using a Cheese Grater shred the carrot and mix into marinade.
Quarter the cabbage head, remove the heart, and shave into thin slices.
(The thinner the slice the easier the cabbage will “cook” in the acid marinade. This can be time consuming and the cabbage can always be grated on the cheese grater for the same effect!)
Mix the cabbage into the marinade and carrot mixture and let stand for 20 minutes. Stir every 5 minutes getting the liquid mixed in with the cabbage, serve, and ENJOY!)
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
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.
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).
The difficulty is not in sending down material—anyone can order a container and have it
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.
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…
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
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.
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
BE WARNED: THIS BLOG CONTAINS A REAL PATIENT HISTORY OFFERED FOR ADVICE AND SUGGESTIONS, WITH THE EXPRESS CONSENT OF THE PATIENT. THE DETAILS AND PICTURES OF THIS CASE, A PARASITE CASE, MAY BE GRUESOME.
Today during a scorching sunny afternoon, Christmas came the Southern Wind–here’s how:
When we first left Miami for Haiti, we left behind 5 pallets of additional medication and supplies that we could not fit onboard. We planned to return to Miami and pick them up after finishing in Haiti, and then continuing on to Central America.
From Haiti, we connected with Clinica Esperanza and Barefoot Cay Marina in Roatan, so
we came directly here instead of going back to Miami. We saved a lot of fuel and time but it meant we had to ship our pallets here to Roatan. Fortunately, Gary and Donna Evans arranged for Roatan Rotary Club to sponsor the shipping by providing part of Rotary’s yearly donated shipping allotment from Hyde Shipping here on the island. We also had to coordinate someone willing to drive a truck from the warehouse in Miami that was kind enough to hold our supplies to the Hyde Shipping warehouse in Miami…all the while seeing patients, planning our Haiti mission, fueling, securing the boat for sea, coordinating our 40-foot container from Direct Relief International for the island clinics and for Haiti. It has been BUSY.
However, health care is always our primary mandate, and when we are in danger of being overwhelmed by everything we have to do, we ask for help. Especially any clinicians reading this, this patient has suffered significant symptoms for months and has given permission to post his case for review by any of our medical followers.
Please post comments or questions for more details about the case directly on this page where we can all see them and brainstorm together. All posts are visible only after review and approval by Floating Doctors to protect patient dignity and confidentiality.
Patient: 27 year-old Caucasian male; 6’2”, 180lbs
*No prior medical history of note, no medications, no allergies
- Cardio : BP: 125/85, HR 74 (regular)
- Respiratory: Lungs clear, good air entry across both fields, no creps/wheezes
- GIT: Abdo soft and non-tender, non-distended
The patient had spent 7 months in Honduras working as a volunteer co-pilot on a non-profit emergency helicopter service, with frequent trips to the mainland while transporting patients.
3 months ago, a few weeks before his return to the US, he had complained of occasional vague stomach cramps (sometimes acute) and diarrhea. The night before returning to the US, he took a single dose of albendazole and subsequently had what he referred to as an episode of extreme cramping and “explosive worm diarrhea.” The worms he described were 6-8 inches long and very mucous-like. He continued taking a daily dose of 400mg of albendazole for the next few days, but continued to pass similar worms. He went on a strict fruit diet, eliminated fats and although the symptoms seemed to lessen he still passed stringy worm-like strands, some longer than 12” (in the initial days of treatment). After several days, he went to his local doctor and subsequently sent this email:
“I went to the doc yesterday and got a scrip for Flagyl. I never saw the doctor but the nurse
talked to the doc and he prescribed it. I’ve been on it for, now, two days. I’m coughing up some terrible stuff. One time (within the last week), while in the shower I blew my nose in my hands. In the mucus there appeared to be a worm about 1/2 inch long. It was either a worm or the most congealed mucus I’ve ever seen. Figuring I was exhibiting symptoms of hypochondria, I chalked it up as my mind playing tricks on me. Today, about a week later, after taking the Flagyl for two days, I’m coughing up some horrible stuff, which looks similar, but not exactly the same, as the worms in my stool. It’s stringy, if stretched out about 6-8 inches long. From what I’ve ever seen, mucus isn’t generally this stringy with elastic properties. When running the sink full of water, swirling one around rinsing it off, and then picking it out of the water with my finger, it’ll run over my finger like a spaghetti noodle would. It doesn’t look like a spaghetti noodle, (much smaller in diameter) but acts in a similar fashion when running one over your finger.”
He augmented his treatment with Pyrantel Pamoate equine anthelmintic, taking the same dose as for a 250-lb pony (900mg) daily for three days off 4 days, then repeating, and was also prescribed mebendazole 100mg twice daily for three days, then 4 days off, then repeating the regimen for a month along with the flagyl (metronidazole). He also ate enormous amounts of fruit and had a colonic irrigation (though he saw no worms come out during the evacuation, only the next day), and is taking 15,000mg of garlic daily.
He has not had blood work or an ova and parasites study (stool sample). He has been advised to collect one of the worms and bring it to his hospital or GP for parasitology, and to have a full blood count with differential to look for raised eosinophils. Results will be posted as soon as available.
The ‘worms’ pictured do not look at all typical. Could they be some kind of mucous shedding of the intestine post infection or from the treatments he has given himself…even the garlic? If so, what about the episodes of coughing and similar, smaller mucous strings from his nose? He has tried most of the heavy-hitters for parasites…even horse worming medication (not on my advice!).
Does anyone recognize these as worms or other pathology, or have suggestions for further treatment or investigations? The patient has no medical insurance so cost will be a factor in patient ability to comply with investigations. Taking the worm to a doctor so it can be sent to a specialist and analyzed if necessary is definitely the next step, but any advice or ideas would be appreciated.
Our 40-foot container from Direct Relief is supposed to be cleared through customs Thursday!
Then we can distribute everything, load the boat and depart at the first weather window to Jamaica for fuel and back to Haiti!
All Photos (Except The 3 Worm Pics) Courtesy of Dan Chomistek
Last week we had an awesome experience—in the midst of our last weeks of preparation for our mission to Haiti, we are continuing to open our Oakridge clinic. Pretty hectic—clinic by day, boat work by afternoon and evening, and computer work late into the night…but totally worth opening the clinic not only because we had a full patient list right away, but also because we had some very welcome visitors to the Oakridge clinic on Wednesday.
Optometrists from Manteca Rotary Club in California’s Central Valley came to our clinic
and provided prescriptions and eyeglasses to 40 or more people in one morning’s work. They were cool—came in, knew exactly what to do, had obviously done it before and saw as many people as humanly possible in the time allowed. Exactly the kind of group I love to work with; the maximum effect with the minimum fuss.
One thing that made their work really efficient was the little device they had with them—it was a Welch-Allyn device for scanning and identifying patients’ eye prescriptions. When I heard optometrists were coming, we pulled out and dusted off the traditional optometrist machine sitting in the clinic building we use, but the device they had with them made it
look like a piece of obsolete medieval torture equipment. Fred, the optometrist scanned patients, gave them their prescriptions, and Renee (the former club president) gave them their glasses—both reading and distance.
If one of those were on station somewhere for a month, I think it could do about 2,000-3,000 patients. That is an INSTANT, huge increase in someone’s quality of life. Apparently the units are affordable, easy to learn to use, and of course small and portable. We have GOT to try and get one of those.
It was great being back in clinic—plus, we have Dr. Holly with us as well. We picked her
up at the airport in San Pedro Sula on our way back from Copan. She is an Accident and Emergency Room doctor and Tropical Medicine specialist from the UK, and will be working with us for 3 months before joining the Flying Doctors in Africa. It was wonderful to have so much help in clinic; Donna from Roatan Rotary was with us, Sky was running the front desk, Noah was doing his Thursday physio sessions. I love it when the clinic is humming; ultrasounds and minor ops, consults…love it.
Our container from Direct Relief comes soon…can’t wait to distribute it among the clinics (and pack the 350 cases of IV fluids onboard to take to Haiti for the cholera relief). So much to do in these last
weeks…just like the first time, we went, except this time we have already done it and have substantially continued to rebuild our ship ever since we set sail. We are better equipped and more experienced than our first trip, and that was a success.
I am confident, a little scared (if you aren’t scared of the ocean then you have no business going out on it), and excited to return to Haiti. It’ll be an 800-mile, uphill (upwind and up current) trip but with the right weather window we can do it. Still have a lot to do first, but it is getting done every day…and probably will be right up to the day we leave!
Last week we managed to get a weather window permitting us to visit Isla Guanaja, about 30 miles east of Roatan. This island, which was heavily damaged by Hurricane Mitch, has only one small Centro de Salud public clinic, and only one doctor for the 10,000+ people living on the island. We plan to visit again on our way south towards Panama and drop off a shipment of medical supplies, so this was our chance to visit and see what the particular needs of the community are and what the clinic could really use.
We left from Oakridge at dawn, around the corner from our little clinic there. We were fortunate to hitch a ride with Captain Larry from East End Divers; when we come back here in our ship we will have already been over the ground once with Captain Larry. Now we know where the safe approaches are, where the anchorages are, and how the winds and currents normally run. As it happens, Captain Ed talked to the mayor of Bonacca Cay (the largest settlement on Guanaja) while we were there and managed to get us secure dockage when we return, so it was a very helpful trip!
There is no better way to understand the needs and capabilities of a clinic than to roll up your sleeves and get to work in it, and since we had contacted the
Centro de Salud in Guanaja to let them know we were coming, we had a long list of patients waiting when we got there. On islands, sometimes particular genetic conditions become very prevalent in the population, and we saw a lot of diabetes and high blood pressure–perhaps not surprisingly, we also saw way more obesity on Guanaja than on Roatan.
Whenever I have patients with high blood pressure, I treat with advice on how to lower blood pressure combined with medication to control their blood pressure. Sometimes I see patients on expensive brands of blood pressure pills that they can only get on the mainland (if at all) or can’t afford, so they end up with their blood pressure intermittently controlled and rebounding. The Centros de Salud nearly always have some basic blood pressure medication, so I always try and change people onto medication that they have access to or can afford rather than some of the things private doctors put people on when they can afford to go to one.
Our volunteer acupuncturist Megan did 24 acupuncture treatments, mostly for chronic pain, insomnia, neck pain, and anxiety. The patients really took to it; several came for a second treatment on our second day on Guanaja. Noah saw a lot of adults and kids with poorly healed fractures and soft tissue injuries, and spent time with them teaching exercises to improve their flexibility, support weakened joints and regain strength and flexibility. With our ultrasound, we drew a lot of pregnant women and we ended up distributing over 6,000 vitamins.
As well as diseases, bumps and scrapes that are common to both the developing world and developing nations, we did a house call on a 24 year-old man who weighed 450 lbs and had a huge, painless swelling of his lower right leg developing over the last couple of years. After examining it and talking to him, I am pretty sure he has filarial elephantiasis, sometimes mistakenly called ‘Elephantitis.’
Elephantiasis refers to huge amounts of lymphatic fluid (the clear stuff that makes your organs all wet and shiny looking and that seeps out of your skin
when you get a bad graze) getting trapped in some part of the body, very often the legs or genitalia. If the lymph glands in your body (little balls of immune tissue that your lymphatic fluid seeps through to be filtered) get clogged, the drainage of lymphatic fluid from that part of the body can be blocked and enormous swellings can occur.
Over 120 million people in 80 countries suffer from elephantiasis, primarily in the tropics and with a very high incidence in parts of Africa. There appear to be two kinds of elephantiasis;
one caused by persistent barefoot contact with irritant volcanic soils (particularly in east Africa), and another caused by the parasitic filarial worms like Wucheria bancrofti. Transmitted as larvae in the saliva of mosquitoes, Wucheria nestles in lymphatic glands and blockage of lymphatic flow occurs.
The swelling is painless (though physically and socially debilitating), but crusting and thickening of the skin (probably in part to the victim’s own immune response to the parasite) can result in secondary infections, and the stretching of the skin can cause itching. Rigorous moisturizing, cleaning, washing and drying of affected area is helpful for avoiding secondary infections and other complications, and the worms can be treated with Diethylcarbamazine, Ivermectin, Metrifonate, Suramin, Mebendazole and Levamisole, but most of these are most effective against larval worms and do not get all the adult worms.
Doxycycline over 8 weeks has shown great success at eliminating both larval and adult forms of the worm (possibly by killing the symbiotic bacteria in the worms), but that creates its own special problems. When the worms have been killed, their dead bodies nestled in the lymphatic glands can cause a massive anaphylactic reaction–you could break out in a rash, your blood pressure could collapse, and your throat and airways could swell shut. These symptoms can be treated with antihistamines and steroids, but if the reaction is severe, a patient might have to be intubated.
With the patient we saw on Guanaja, this could be a real problem. Because of his weight, his neck already has a lot of compression on it (and a tracheotomy would sure be hard, as would
IV access) so intubating if his throat started to swell to that level of danger could be a real nightmare. I am going to inquire about whether the initial dose can be done in the hospital on the mainland with an anesthesiologist present–maybe not necessary (prophylactic steroids, antihistamines, and IV access and nebulizer beforehand might be enough) but I don’t think the risk is worth it. I’d rather he was inconvenienced by a long trip to the mainland to have his first doses in hospital only to have nothing bad happen, than to have him risk it at home and be inconvenienced by his own funeral.
If any doctors reading this have more experience treating elephantiasis with doxycycline, please contact me if you have any advice or suggestions. I plan on seeking many expert opinions in my search to find a solution for this young man. Even if the worms are safely eliminated, the swelling may be difficult to get rid of (though massage and compression bandaging can help), but I really want to find a way to get this guy treated.
This is the problem with remote paradises, especially very, very poor ones. The sunrises are beautiful, like this one on our way to Guanaja…but sometimes care for a problem that can be taken care of with some basic treatment is an impossibly long way off. By the time we come back to Guanaja on our way south I want to have a solution for this guy.
Please click on one of the thumbnails below to view a slideshow of pics from our trip to Guanaja
All pictures of patients used with patients’ consent
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