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It had been roughly 48 months since I first began working with Floating Doctors and 30 months since my last day on the Southern Wind. Strangely enough, after spending a semester and half helping to transform a dilapidated boat into a beaming vessel of hope, the feeling of wanting persisted. You see, amid all the hammering, sanding, fiber-glassing, painting, shellacking, presentations, donation collection, and cold-calling, I had not been able to realize my ultimate dream; that is, I hadn’t helped a single patient directly. Landing in Panama, however, punctuated the final sentence of one chapter and penned that iconic first calligraphic letter in the next!
One of few characteristics I share with Ben our fearless “captain” – a sobriquet stolen from the cinematic classic Dead Poets Society – is that I love people. And arriving in a foreign country, for me, is akin to a kid in a candy store. As I jumped from traveler to traveler, I stumbled into a conversation with an off-duty flight attendant who was hitching a ride on my flight. Ironically, her free trip transitioned into funding my transit from Tocúmen International Airport to the hostel where I was spending the night. My mother was a flight attendant with TWA for over 30 years and Elizabeth (the American Airlines flight attendant), like any good flight attendant, took me under her wing and drove me to Luna’s Castle in Casco Viejo. After sleeping for a whopping 4 hours, I packed up and caught a cab for Albrook Airport. To my dismay, I had not accounted for the 1 hour time change and was relegated to posting up on the steps for an hour until the doors opened. Despite the lack of cushioning provided by the pavement, I was enjoying the comfort of cloud nine. In only a few short hours I would rendezvous with my long lost compadres and be reunited with a project that has never been far from heart.
As I stepped onto Bocas soil, I spotted a familiar face. In his usual b-boy stance – only this time he was leant on a weathered bmx-style bicycle – Noah greeted me with a smile and a heartfelt hug (a rare and cherished gesture from a hardened, NJ tough guy). I introduced him to Nereida, a young Colombian woman I met at the Albrook airport, because she was excited to volunteer her time as a translator at our next clinic. As soon as I stepped into the main house, I proudly published my philanthropic smuggling by spilling all 80 lbs of medical equipment and medicine onto the sofa. Their eyes lit up with excitement at the mound of glucometers, vitamins, analgesics, antifungals, scalpels, hemostats, nitrile cloves, bandages, etc that were graciously donated to me by professors, students, and friends at Touro University Nevada (the osteopathic medical school where I am a first year student). What made me happiest was when Ben looked at me with his characteristic calm and poignantly professed, “we are gonna’ help a lot of people with this.” And if you don’t know Ben, you should understand that he is one of those people, in that weirdly inexplicable way, you want to make proud.
After reconnecting with Ben (The Doc), Noah (Mr. Fix-it), and Sky (Operations Extraordinaire) at the main house, I was escorted to my new home for the next 12 days. The “Warehouse,” as they called it, was a non-descript white, rectangular structure that housed the essentials: volunteers & supplies. I met my new roommates and resident techies, Chris and Ishan. Only moments after setting my luggage on the bed, was Noah jingling the keys to the skiff. As we bounced on the mild coastal water chop, I caught sight of a beautiful bow of accomplishment. The winsome ruggedness of the Southern Wind instantly brought me back in time to Palm Coast, Florida. As the memories bum rushed my brain I took note of the exhilaration yet to come. A Dream Realized.
A day or so after my arrival, a sizeable group of nurses and nursing students from UCLA and SFSU joined the team for a 10-day medical mission. The original crew gathered everyone around for introductions over Sky’s famously amazing cooking. Ben and Sky welcomed everyone with a big thank you for donating their time to the Floating Doctors family. Even before the food could settle in the stomachs of our excited bodies, we were packing medical supplies for the upcoming mobile clinic. Vitaminas, analgésicos, y otra medicinas were neatly packed into small baggies with dosage and instructions. As we eagerly inventoried what we needed to bring with us, we shared our stories: how did we hear about Floating Doctors, our motivation to be in medicine, and why we wanted to help provide care to the people of Bocas. We all agreed, “this is going to be an awesome experience!” After talking, inventorying, overdosing on children’s gummy vitamins (they were decidedly useless due to the unforgiving Panamanian heat) and getting one of the few full night’s sleep we were privy to while in Bocas, we found ourselves on our first mission. Asilo, the local nursing home of sorts, is a regular visit for the Floating Doctors and we were all excited for the privilege of spending time with a bunch of interesting old souls. Every person in there, regardless of lost limbs, elevated blood glucose levels, and wandering lucidity, had a heart of gold. They all had stories to share and were so happy to just have someone new to interact with. Aside from doing standard health screenings, I found myself most enjoying the intensely competitive dominos games. Victor, and 80+ year old Bocas native, did NOT like to lose. However, after a few wins he honored me with a non-verbal gesture indicating that I was a worthy opponent. I’ll always treasure our games; slamming the porcelain pieces on the thick wooden table, boisterously declaring our victories and laughing over our strategic blunders.
Over the course of my time in Panama we helped many in the immediate area, in addition to those more than a few hours into the Bocas Del Toro Province. Small towns like Almirente, Las Tables, Changuinola, Popa, and others spread out on the mainland and among the neighboring islands of the archipelago, were all places that were in dire need of help. The one day clinics were amazing because they finally gave me that patient interaction I craved and still crave. It was the multiday clinic, however, that really opened my eyes to the barrier-breaking work that the Floating Doctors pride themselves in. Just before my we embarked on the multiday clinic, I was able to accompany Ben on a small expedition of sorts. Unlike the medical care in the United States, where bureaucracy, fear of liability, and the incessant fixation on time spent per patient are barriers in and of themselves, the care the Floating Doctors provide in Panama is subject only to one unforgiving notion: every patient is a person, and every person deserves to be sincerely heard. Ben, and all those who personally grow from being part of the Floating Doctors, embrace this notion and understand that doing what it takes to improve someone’s life is more than simply writing a script or audibly enduring a few complaints. Delivering care, regardless of location, is about truly hearing the needs and wants of a person and their situation and then making a concerted effort to provide for them. I knew this to be true when Ben took me on a 4.5 hour trek into the jungle to make a house call to an elderly woman who had severe complications from her untreated diabetes, e.g. neuropathy and ulcerations on her feet, bowel obstruction, colic, headaches, and generalized sluggishness. I was able to take her blood glucose and assist Ben in logging her information. We were invited into their home and we did the consult in her bedroom (where she was most comfortable). Unhindered by time restrictions, unremitting insurance regulation, and exorbitant costs, we were able to truly hear her needs and respond accordingly. We were able to make a follow-up visit to check how she was handling the appropriate medication, and to secure an open line of communication with her eldest daughter for routine care.
Once on the multiday clinic in Las Tables, I finally experienced what all of us in the original crew dreamed up so many months earlier. Attempting to sleep to the dissonant, yet seemingly operatic, tunes of feral farm animals while on the floor of a small two room house that had no glass windows, no air conditioning or fans, no hot water, no refrigeration, and limited lighting, was a clear indication that this was the REAL deal! In the morning I shrugged off a stiff neck and traded my bagged eyes for a warm smile because I was about to do what I came to do; I was going to make a difference! We were greeted by a line of about 60 people, ranging from infants to great grandparents, and the line continued to grow as the day went on. No matter how many people we saw, the crowd never seemed to clear. Although I wasn’t a bona fide provider, I was able to take records, vitals, and some diagnostic blood tests. I learned a great deal about the art of the patient in-take, diagnosing, and treating. I learned more in 3 days than I had ever learned in a classroom and I yearned for more. The BNF (British National Formulary) became my bible and I was constantly, and many times frantically, looking up conditions, drugs and their side effects, while trying not to miss the next case. At night I would try and review my notes and make sense of each case – the feeling I got from learning was unfamiliar. I was no longer simply reading a medical textbook, I was investigating a case! However, nothing compared to spending time with the village children. It was a steadfast reminder of why I am certain that pediatrics is the specialty for me.
Even if I was simply giving them a sticker, playing a game, or giving them a reassuring smile, the children always reciprocated with genuine enthusiasm. One young boy, Luís was quick to befriend me and we spent a good amount of time taking pictures, playing soccer (albeit with a flattened ball), breakdancing, and catching countless cases of the giggles. The Road From Dream to Reality Begets Another Beginning. Leaving Bocas was difficult, but I had medical school waiting for me. If I wanted to make a difference in the lives of others and feel the fulfillment of being a physician, I would have to go through the training and earn the degree. My time in Panama with Floating Doctors armed me with an invigorated sense of purpose that I hope to maintain throughout my medical training. Even now, as I study for my first big exam next Monday, I am reminded why I am doing all this. Finally experiencing a medical mission trip with Floating Doctors not only brought things full circle, but has inspired myriad goals for the future. I am working on improving the mobile technology, in terms of hardware, for their patient records. I am working with Touro University Nevada to get them portable computing devices for both patient records and diagnostic purposes, as Ishan and Chris are working hard to create a new online patient database/tracking system (probably not using the correct jargon, but I’m no “techy”). I also plan on bringing a bunch of first year medical students down next summer to experience what I have – there is nothing more motivating! I am so impressed with how much the organization has grown and how it continues to grow. I am very proud to be part of the Floating Doctors and I can’t wait to return! I am already wondering how this project will grow and what my role will be. Floating Doctor’s was born with Ben’s vision and has grown by providing a platform for others to live their dreams. In the end, it seems, every milestone humbly begins as a dream – I cannot be happier because, just like Ben, I love to dream!
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Prepare to deploy…
There comes a time in any journey, when initial prejudices have been shed and before nostalgia settles, when one can see things as they are. I spent the month of October working with Floating Doctors, and for me that moment came while traveling from Bocas town to Kusapin on the panga, the group’s small run-about boat. Ben was at the helm. Tall Greg was at the bow intently listening to a book on tape. Little Greg had claimed the good seat, a plastic chair. I was lying on my back, mid-boat, reading about three men adrift in a tiny raft after their plane crashed in the Pacific ocean. It had been a still and shining morning, but when the sky turned dark I sat up to watch the sea, slightly concerned we might become like the characters in my book. I was more afraid that the increasing wave size would mean we’d have to turn around and I wouldn’t get to visit the fabled Kusapin.
I had extended my time in Panama in order to do one more mobile clinic: five days in Kusapin, a large Ngabe-Bugle community situated at the end of a peninsula jutting out from the mainland and accessible only by boat, a 3-hour ride from our Bocas base. Due to inevitable developing world delays the clinic had been postponed, and because it is not possible just to send a memo, we had to go in person to relay the news. Which is what we were doing when, watching the coast slip by, I had my moment. Being rather simpleminded, my epiphany was not exactly fireworks. It went like this: This is good.
In the preceding weeks I’d fretted over how I was practicing medicine in the clinics we held. I am accustomed to fully
When all you have is your hands…
equipped emergency rooms, the latest technology and medications at my fingertips. At home I check diagrams, doses and drug interactions on my phone, then I recheck them on the computer. I call the neurologist, the urologist, the hematologist. I go the radiologist reading room for further explanation, repeat labs, and have my patients come back for 24-hour follow-up visits. I was not always so neurotic. Prior to studying medicine I had dropped out of university, a few times. I’d worked on dive boats, monitored chimpanzees on an island in Lake Victoria, studied Indonesian in Oregon, called a horse-trailer home. I’d worked for a newspaper in Austria until I quit in order to climb. Then I traipsed around central Africa and worked for magazines. My shining minute was performing at the New York Metropolitan Opera. I rode a horse across the stage, which, although less than 30 seconds in the spotlight, would have been brilliant had I not been forbidden to open my mouth. Despite being tone deaf, I really wanted to sing.
Returning from the mountains; almost home!
The more we engage with the world the more it makes us want to sing, and the more it breaks our heart. At some point I realized it wasn’t enough to dance around stealing stories. I decided I must do more, it was time to become… something. Medicine seemed a good something, so despite the fact that I didn’t know the difference between an organ and a hormone, I applied to Cornell Medical School’s PA Program in New York City. My application was about how I would return with a skill to the places I’d been where there was a lack of even the most basic health care. I wanted to be able to offer something solid to the people who had so graciously welcomed me into their homes and lives. I wrote my essays about malnourishment, malaria, child mortality.
The next couple of years were spent stressing about microbes and molecules and mundane things like exams. Then came the humiliating experience of clinical rotations. There was the New York-Presbyterian cardiologist who interrupted me as I waffled through an EKG interpretation: “I’m a bullshitter too, Antoszewski! But this is someone’s heart you are assessing so I advise you get it right.” To this day, despite having now practiced medicine for six years, I’m haunted and inspired by those great doctors and nurses who taught me accountability. What test have you forgotten Claire? What question are you not asking? I learned responsibility. I also learned fear. It is one thing to play with our own lives, but someone else’s life… First do no harm.
Yet here I was, in remote Panama, seeing patients, not in a white coat but surf shorts, relying often only on hands
Thank goodness it’s strawberry flavored…
and stethoscope. I was handing out puppies instead of pain killers, prescribing antibiotics without the benefit of cultures, assessing limbs and lungs without imaging. There were parrots on the examining tables for crying out loud. I was very happy. I was also rather uneasy. Is it better to do something, even if that something is imperfect, rather than do nothing? I banged my head against this question, turned it over and over in my mind and in conversations. But what if we do harm by not believing in our dreams, by not putting them into action?
Floating Doctors dispenses soap, toothbrushes and vitamins at every clinic. This is a good thing. In the communities we visit worms are rampant leading to dehydration, malnutrition and other complications. The worms can be eradicated with one dose of the medication albendazole. Also very good! The Ngabe think the free eyeglasses are great. Education about water purification, nutrition, and sexually transmitted diseases is desperately needed as the modern world encroaches on even the most isolated peoples. And whether or not there is a hospital, there are always sick people. Should a tumor be ignored because there is not an operating room one floor above us? May be in the over developed word we rely too much on technology. Certainly I have often balked at scanning the head of a child who took a small tumble. A CT scan of the head is equivalent in radiation to roughly 100 chest x-rays, and studies show an increase in the risk of cancers secondary to medical radiation. When I quote this as reason for observing instead of scanning I am asked to imagine what the prosecuting attorney will say in court if the child has an intracranial bleed. There is a trend in the United States to practice medicine defensively. This is not necessarily good. I suppose wherever we work there is room for improvement, and we are constantly weighing the good against the bad.
Painting children purple with scabicide
Like many of those who practice medicine in the world’s neglected places, the Floating Doctors do not have the luxury of MRIs, there is no lab, no specialists waiting at the end of a pager. Where we practice we go on small boats, skinny ponies, our own feet. The donated medicines are carried in plastic bins. But the patients are the same whether seen in a city hospital, a private doctor’s office or during a home visit to a thatched-roof hut in the forest. They have a pain, a concern, or a question they need someone to address. They are pregnant and worried about the baby. They have headaches, constipation, wounds that wont heal. They have a child who is not eating. They have a child who faints. The child who faints has a hole in his heart. Whether or not we listen to the heart doesn’t change the hole. But because he listens Ben can put in motion the steps it will take to get the boy the surgery he needs, and that changes everything.
All of this I thought about, or rather I felt, as we bounced along in the panga that day. The dark had become a storm and the storm drove us to seek shelter on an uninhabited island. Ben drew a diagram in the sand with a stick, made squiggles to show the currents, more lines to denote wind, and an indentation to represent where the ocean floor sloped. Basically, given the conditions it was not safe to make the ocean crossing to Kusapin in our small open boat with its one outboard engine. We had to turn around. I was more subdued on the ride home, but the panga’s loud engine precludes conversation and the sea and salt are conducive to contemplation. I felt a quietening of the questions. My pendulum has had a wide arc, but with Floating Doctors I seemed to be finding a balance. I was remembering why I wanted to study medicine in the first place. It is important to doubt. But we do ourselves and the world a disservice if we forget that shining, elusive something called faith, or hope, or may be just a better tomorrow. After we tied up the panga that evening, Ben said, “Well, we’ll try again tomorrow.” I took a hot shower, and curled up in a hammock to finish my book. Against all odds, having lost everything including the clothes on their backs because the raft capsized again and again and again… the three men were rescued after 34 days at sea.
Learning to dance Ngabe-style
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“Lifeboat Chronicles”
July 29, 2012
Blog by Las Tablas Peace Corps Volunteer Doug Martin
Sandwiched between the banana plantations and the mountains
Sometimes, early in the morning, the mist from overnight rain storms envelopes the town and hides her from outsiders. Sometimes the murky brown waters of the Sixaola River creep higher and higher until they stumble up and over the only road into and out of town. Its a place to get lost, a place to start over.
La empresa showed up one day, years back. They brought complex irrigation systems, John Deere tractors, and an airplane. The menacing drone of diesel fuel combusting hundreds of feet high shakes the town from her slumber. The cool evening breeze carried the seductive whisper of modernity; the people from the mountain came down.
For three days in July, sister Sky and brother Dr. Ben LaBrot and the volunteer group they head
A rare x-ray available…
offered free medical care to the communities of Las Tablas and Barranco Adentro. One can see in the hour long queues that the service their group Floating Doctors provides is desperately needed.
Their volunteer medical professionals work hard. Long days start when the rooster crows and often don’t end until after the sun has long settled behind the mountains. They sleep in hammocks strung up over cement walls, on sleeping pads strewn out over the floor, under mosquito nets. On Saturday the baseball game doesn’t end until two in the morning. Neither does the blaring reggaeton coming from the trunks of several baseball fanatics cars. But they never complain.
Hammocks hung in a half-built house…
Many people here do not have access to medical care. There exist several barriers – cost, culture, language – that have kept the people from the mountain out of a doctors office. The Floating Doctors work to remove these barriers, and not just by providing medical care free of cost. Dr. Ben is a leader by example, and his volunteers all show a genuine sensitivity and interest in the diverse culture of the indigenous groups that they attend. He also converses in Spanish after spending time in Honduras and Panama, and might accidentally greet you in the Creole French that he picked up in Haiti.
Dental Health is Important–send toothbrushes!
The end to each of their three multi day mobile health clinics has been bittersweet. Imagine being the captain of a sinking cruise ship with only one life boat. Mothers weeping to include their sons and daughters. Adult children pleading for their elderly parents. An uncomfortable undertone, asking “what more could we have done?” often lingers after the last patient has gone.
Somewhere beyond the mountains to the north there are children grown fat from too much and too many. Here the children’s bulging bellies speak not to a fast food diet and cable television but to malnutrition and constant parasites. What response quells the crying eyes of a six month old child, forgotten by the world and unable to access the most basic and fundamental care that he so desperately needs?
Fortunately, the Floating Doctors are continuing to grow. The most recent clinic expanded its offerings to both the thirty five hundred people living in Las Tablas and for the first time to another one thousand living in Barranco Adentro. The life raft is getting bigger, better stocked, and more efficient.
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Sometimes Conditions Are Against You
“Turning a ‘No’ Into a ‘Yes’–How To Adapt Your Mission For Success When Conditions Change”
Blog by Volunteer Doctor Jordan Amor-Robertson, MD (Pediatrics; Australia)
On my last weekend with the Floating Doctors a multiday clinic was scheduled in Bahia Azul (Bluefields), a Ngobe village which is on the mainland, however is only accessible by sea. We were fortunate enough to have some rather impressive friends (JP, a doctor, and Marie, a dietician) with a rather impressive boat called ‘Domino’ who invited us aboard for the journey. We even managed to fit in a spot of fishing along the way, reeling a couple of decent sized tuna, with the first fish-catcher (luckily not me) being required to eat the tuna’s still beating heart!
We had initially planned to run the weekend as a standard primary health clinic, as well as going house-to-house conducting a survey at the request of the community leaders to establish the degree of health knowledge with regards to HIV/AIDS, risk factors of the individuals and to perform clinical screening examinations for any features suspicious for AIDs. Unfortunately, shortly after our arrival, we received word that our application to practice medicine in Bocas had finally reached the national Ministry for Health and, whilst we had been granted approval to run clinics by both the local and state health ministries over a year earlier, we were advised that we were to suspend all clinical operations until such time as we managed to clear the required bureaucratic hurdles.
Now this posed a problem. The local Peace Corps Worker had invested a lot of time spreading the word to the community that we would be coming to do a clinic and laying the foundations for our HIV surveys. How could we now explain to people that yes, we had arrived in Bahia Azul, but actually no, we would not be doing a clinic. And, even worse, how could we possibly turn away the sick patients that would undoubtedly present for treatment? Do we turn-tail and commence the 4 hour boat ride back home straight away?
As it turned out, this was not the disaster it first appeared to be, but rather an opportunity in disguise. After a hurried brainstorming session, the decision was made to host a ‘charla’ or discussion and to share a lunch with the community. This would give us a rare opportunity to develop the Public Health aspect of our operations, something that is an important long-term focus for the Floating Doctors, however is often put aside somewhat during a multiday, in the face of a hectic clinical work-load.
Beautiful But So Far From Any Services…
We split into groups of 3 or 4, heading off in different directions in an attempt to reach as many families as possible to advise them of this unexpected change of plans (and to invite them to lunch!) A casual stroll through the jungle, thought I, on this glorious tropical day. Appointed our trusty guide, a young Ngobe boy who wants to be a teacher one day, Jenny, Lorie and I set off into the jungle, stopping at each dwelling along the way. We were welcomed into homes where we were given gifts of shells, bananas and guayaba and I even managed to fit in a little shopping along the way – in the form of a colourful traditional handwoven bag.
Unfortunately Lorie had difficulty negotiating the first major hurdle – a dauntingly steep and slippery hill – and parted ways with Jenny and I. I later learned that Lorie, in true Lorie fashion, had befriended the occupants of the house at the bottom of the hill (despite speaking minimal Spanish) and spent the morning engaging them in songs and colouring-in sessions.
Meanwhile, back on the jungle trail, Jenny and I were feeling increasingly like intrepid explorers, ducking under vines, clambering over rocks, leaping over puddles. And then it got real! Our guide ushered us into a kayuke (a traditional dug-out canoe), making sure that the inexperienced gringas were carefully balanced to avoid capsizing, and started paddling up through a mangrove river. We arrived at our…destination? A patch of muddy mangrove ground, indistinguishable from the other patches of muddy mangrove ground we had passed along the way. Apparently this was the only way to access the next lot of houses up on the hill that lead around the bay.
The Panga? Easy To Negotiate. Those Cayucos? Harder Than It Looks…
I stepped out of the kayuke tentatively, immediately realizing that my trusty Aussie thongs (or flip-flops as the rest of the world seems to call them) were grossly inadequate for this kind of terrain, losing both in the mud at the very first step. So shoes off it was, and I set off, barefoot, through the mangrove mud, as the crabs and miscellaneous other creep-crawlies scuttled out of the way. Now this is not the ideal way to greet strangers; barefoot, sweaty, mud up to the knees (and splattered even higher as a result of various misadventures), but still the matriarch of the next house greeted us warmly, offered us water to wash out feet and proudly showed us her garden.
And so this continued, from one house to the next, until it was time to return to the centre of the village for the Charla and the delicious lunch that the village women had prepared from our supplies. And, as exciting and memorable as the morning had been, this is the moment that all our efforts came together. After a brief introduction we opened the floor to the community, encouraging them to identify their key health concerns, common issues in the community and things that they would like to learn more about.
The session ran better than we could possibly have hoped! With a very good showing from the community (we filled a whole classroom and many more peered in through the windows), and an even representation of both men and women, everyone was granted the opportunity to have their say. Quickly the conversation turned to the topic of HIV, something that we knew the community were concerned about, however we were not sure whether they would be keen to talk about such sensitive matters in the public forum.
Much to our delight both men and women stood up and spoke openly and frankly on what they knew about HIV, giving us the opportunity to dispel a few myths and to outline the basic facts about disease transmission, progression, symptoms, treatment and, most importantly, prevention strategies. As one older Ngobe woman pointed out to me – topics of sex and sexual health were traditionally taboo, however now the discussions are too important to be avoided. For the sake of the health of her children she wanted to make sure they were educated on such matters so that they would know how to protect themselves.
Knowledge is the best preventive medicine!
Rather than being upset or annoyed that we were, on this occasion, unable to provide the primary health care services that are so needed, and so inaccessible to the people of Bahia Azul, they were excited to have the opportunity to discuss the key health concerns of the community, knowing that this would help the Floating Doctors and the local community to work together better in the future. That weekend was just the beginning – on subsequent visits to Bahia Azul the Floating Doctors intend to have ongoing conversations with the community about what they want and ongoing Public Health Education sessions. We are also hoping to do some capacity building with the local parteras (midwives) and other interested members of the community, many of whom have already nominated themselves as wanting to up-skill in basic health care so that they can act as Community Health Workers, allowing for a permanent health-care presence in the community.
That particular weekend was special, but it was in no way unique. During my time with the Floating Doctors there were countless occasions where we had the opportunity to engage with the local community, working with them and for them, to enact change and to begin establishing grass-roots health initiatives. I returned to my home in Australia revitalised and inspired, already planning my next stint in Panama with the Floating Doctors and the Ngobe communities of Bocas Del Toro.
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Blog by Volunteer Doctor Jesus Niebla, MD (United Kingdom)
Amputation in the field, at the top of a mountain…
I am a man who before this trip was scared (well I’d say apprehensive) of heights, mountain paths with sheer drops and free running river crossings.
I was not too fond of thunderstorms either.
In the early hours of the 16th of July I set off with the Floating Doctors on a surgical follow-up appointment. In the UK its normal for the patient to come to the hospital, wait an hour or so and get seen by the surgeon who operated on them, then go home. This appointment was different, we went to them, that’s the fundamental difference in our mission.
What a beautiful walk in good weather…
But when I say ‘We went to them,” what exactly do those few words mean? We took a high-speed water taxi from 25 miles from Bocas to Almirante on the mainland–it takes about 35 minutes bouncing and thudding through the sea. From Almirante we bundle our way into a taxi, pick up some supplies (water, tuna, rice, condensed milk, Gatorade and the important Panamanian Hot sauce). It takes about an hour to sliver up the shoulder of this mountain motor-way to our first base camp. The scenery is lush, I’m pretty tired from the early rise, but I stil take some time to enjoy it while my team-mates sleep (a wise choice with what was ahead of us).
Eventually we get to our base camp, Pueblo Nuevo. It’s the rendez-vous with our guides and pack horses. We charge up on some rice, chicken and the tastiest avocado I’ve set my hands on. We meet our guides and horses to help take the heavier loads; they ride ahead. The horses effortlessly cut through the path ahead–they go first as they scare any snakes or nasty surprises away. They pick their way up the steep climbs with practiced ease; its what they do almost every day and they know the way better than we do. We find ourselves walking on a parallel and tricky path, crossing an Indiana Jones style bridge (except we’re not surrounded by bad guys and its in fairly good shape, although the odd broken panel wasn’t too reassuring).
We make our ascent, climbing up and walking down the steep- clay-brown-well beaten tracks, but this didn’t make them easier. Our guides soared up the tracks with embarrassing casualness.
6 Nationalities Represented in the La Sabana team…
In-between the sweat, heat, humidity, knee-deep mud baths, sheer drops and snake shaped branches there was a different assault of the senses, a real appreciation of the beauty of this place. Our path dissected fields through flowing rivers, to the butterflies that garnished the clear, blue-sapphire sky above us. It felt like scenery that was the mostly an inspiration of the Steven Spielberg classic Jurassic Park. At every bend in the trail I expected to see a Tyrannosaurus.
Four hours later, sore legs and sweat soaked we make our 2nd base camp of the trip. La Savana, “The Grasslands” and such an aptly named place. We try and rehydrate and rest, an hour or so passes, and too soon it’s time to find and see our patient. We head off again, although this time only for an hour; I’m relieved at this small amount of time, but the path is much different. It was such a steep incline compared to the other paths. Perhaps it was the cumulative effect of the trip, the dehydration, missing the most important meal of the day (breakfast; I know, schoolboy error), but I think I must have hit the wall as soon as I reached the house where our patient lived. Luckily Ben had a Gatorade, it made such a difference.
Toe Amputation 1 Day Post-Op
This didn’t matter, the fact our patient was pretty much running down the hillside to meet us. His actions and motion answered so many of our questions effortlessly. He was fine, he pulled off his wellington, the amputated toe we came to see had healed nicely. There were no signs of infections and the skin flaps were opposed nicely. There were no problems with his balance or ability to continue with his daily routine, although I expect he is a bit more cautious with his machete.
So we made our way back down to Las Savana, make a few house calls on the way (including ANOTHER machete wound), see some patients with pulmonary TB (surprisingly a clear chest on auscultation). We bump into some National Health workers and have positive interactions regarding sharing the responsibility for the medical treatment of the patients with TB.
Eventually we settle back to our camp, have an impromptu clinic under the village’s rancho and soon meet a 6 year old boy with a tricky problem. His father mentions he has a piece of maize in his ear. Ben attempts to extract it, but we just didn’t have small enough tools (my first Job is ENT; I’ll see if I can borrow a set next time). One part of Floating Doctors’ mission is to bring healthcare to patients, if this can’t be done we bring the patient to healthcare. That is exactly what we decided to do–help with the transfer of this young patient and his father to the local hospital. This would normally mean a good 4 hour walk, a few bus trips and perhaps a taxi, so we would accompany them and cover the cost of travel and any medical fees.
The next morning we set off down the mountain with the corn-in-the-ear boy and his father, thinking that descending it would be a little easier. The horses have the heavy loads and we are pretty much on a continuous descent. We still cross the same rivers, and there a few steep sections, but the sun is a lot kinder than on the way up.
Incredible patient bravery
A few hours into our walk back it starts to rain, at first a welcome change. We progress, but the rain doesn’t stop–instead it intensifies; the heavens have opened above us. It doesn’t take long for the well-trodden path to become a quagmire. Now it’s a like playing hotch-scotch, planting one’s feet on anything that isn’t the centre of the path otherwise you’re the stick in the mud–a knee-deep mud bath. The downpour also makes the river crossings a tad trickier, as the water level rose significantly in less than 20 minutes.
I am all up for a bit of a challenge, the mud isn’t too bad, we all get used to it, but it saps one’s energy. There is the odd fall, but nothing too serious to anything other than pride. The quagmire now turns into small rivers of chocolate-milk-mud, and then the heavens open a little bit more and decided to spice things up. A thunderstorm starts, we are about 1-2 miles from Pueblo Nuevo, and the more we walk through the jungle trenches the smaller the gap between seeing the lightning above and around us in the canopy and the sound of thunder. We are walking into the eye of the storm. The pace and urgency naturally pick ups, each snap of thunder signals a small sprint for me, then a lull, a sense of dread and then back to a fast march.
An opening is ahead of us, not only are we void of the “protective” jungle canopy but we have to ascendand cross a high, open hill. I recall saying to Ben and Steve we have to clear this ASAP. All the pain, muscle ache and fatigue from the last and current day of trekking for miles of tricky terrain and river crossing all disappeared, the adrenaline was released with a mighty crash of thunder directly above us and and fight-or-flight chemicals coursed through my arteries and veins…. I sprinted up the hill, I slipped on the muddy slope, I got up. I am on my hands and knees trying to get up this hillside as quickly as possible. The desire to get over this death-trap is like nothing I have experienced before. I crest the hill and slide down on my backside, it looked inviting but a few stones and rocks proved otherwise on the way down.
We start work pretty much on awakening…patients waiting…
Only a small stretch of jungle is left, and at last we step onto a concrete path that signals our re-entry into Pueblo Nuevo. Stumbling our way through the village back to the shop where we had eaten before making our ascent on the mountain path. To my amazement the town is bustling with Ngabe who have come down from the mountains to place their vote in the general elections, tightly packed under the tin roofs of the local school to shelter from the storm. It gets more ridiculous–there is a local football match ( Soccer) in the football pitch, at the centre of the school. I make a comment to Steve ‘How could the officials allow this match to be played, the pitch is waterlogged”, the players showed no concern of playing in the middle of a lightning storm…until a lightning bolt hits the ground 30 yards from them…then they scarper like they should have 90 minutes before.
We take a short break from the downpour, under the overhanging roof of a house, and the pain starts to re-defuse through my feet and is interrupted only by the thunder and crash of another lightening strike; this one shrieks and booms onto someone’s roof near by. Unfortunately this is followed by cries and panic. The message got passed through the crowed…shouting that someone had been struck by the lightning.
I turn to Ben; “Let’s go check it out”. We now make our way to two houses about 50 yards apart. These houses are elevated about 2 meters off the ground on wooden stilts. Underneath we meet a ring of 200+ people crowding around an 18 year-old Ngabe woman, crying and in obvious distress. Ben checks her out and she seems ok, just in shock (literally) and hyperventilating with some muscle spasms and pain. As we calm her we here cries of two more lightning-struck victims.
I sprint over to the other house (trying to avoid being hit by the continuous lightning attacks), but she is in another house–apparently they were inside when they got struck through the thatched roof. The crowd surround my patient; they eclipse my light; I can’t see. A few choice words and they let the light in.
I notice that her abdomen is distended. This lady is pregnant, 8 months pregnant. My adrenal glands squeeze their last drop of adrenaline. The baby!
She isn’t saying much; visibly shocked, dazed. So I’m thinking to myself, what do I do, its time to get this woman assessed as best we can and transport to hospital. ABCDE, it all comes back. Her airway is good, she is breathing, her lungs are clear, equal air entry. She is pulse is slightly elevated, with a normal character and volume. Heart sounds are normal. She seems a bit dazed, but is responsive. Phew! I notice she has a zig-zag burn starting on her right scapular, working it way down her back to about L5. Presumably the energy dissipated through her feet as she was complaining of severe tenderness in her ankles.
Amputation in the field, at the top of a mountain…
The third patient was a man who had been struck and hurled ten feet across the grass, and wasn’t able to move his arm. I was worried about compartment syndrome, another condition requiring a speedy intervention.
We needed to get the patients transported to hospital as soon as possible for a full review and appropriate investigations, in particular an ultrasound of the 8-month pregnancy. Practically this would mean hailing down a taxi on the jungle highway, or maybe a bus. Fortunately for everyone, this challenge was made much easier as we met some police officers who were able to drive us in a safe and speedy manner to the nearest Hospital in Rambala, a town some miles down the road from Pueblo Nuevo.
How the story ended…
The little boy with a piece of corn in his ear was admitted and had it removed under a general anaesthetic.
The two sisters who had been struck by lightning were both ok and thankfully so was the baby (although perhaps it will be born with super powers).
The man did not have compartment syndrome and eventually regained arm function.
Soaking wet, tired, feet-blistered, hungry and drained we sat outside the hospital and I realized this is what it takes to provide healthcare to these remote communities. On the long taxi ride back (in clear weather at last), and on the water-taxi back to Bocas in the deepening evening, the fear is now replaced with the drive to help these communities further. After a couple of hours of travelling we arrive back in Bocas del Toro absolutely devastated with exhaustion and satisfaction…and I realize this is just another day for the Floating Doctors.
I’m coming back.
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Bring me that horizon...
For me the sea has always been where I turn for inspiration, solace, and wonder. The night I was born I breathed thick salt air and first heard the sound of long Pacific swells rolling onto whispering sand, and from that day my life was held forever in the sea’s net of wonders. My mom and dad were living in a beach motel in Southern California while my dad did his medical residency, and my first steps were on the sand and behind my dad as he made hospital rounds and home visits to patients. I can never remember any time in my life when I wanted to be anything except a doctor and a marine naturalist, and thanks to my parents, extraordinary mentors and opportunities I became a marine biologist and a doctor and have had experiences in both fields that make me grateful to be alive just for one of those moments.
My favorite thing about the sea is that it is not lonely; in the sea I feel connected by the water to millions of people around the world. I imagine millions of people of a thousand colors and languages and religions and nations all floating together in the sea’s embrace and connected across thousands of miles by one continuous, unbroken sea. When we float in the vast sea, only a little of it is holding us up, but that small part is connected to an unimaginably vast and powerful body of water. In the same way, this is how a people are strong. When we say ‘a sea of humanity’ we acknowledge that humanity–all of us together–are as powerful as the sea, which is always waiting to show what it can do.
Like every wave, every life is unique and beautiful, something I have experienced time and again through this voyage. In 2011 we saw our
Fighting bedsores on a dying patient we inherited at the Asilo
10,000th patient, and although I am very proud of how many people have received care through Floating Doctors, what I am most proud of in 2011 was that as we expanded our project, we always stayed committed to the individual patient. Time and again, this has ultimately led to our being able to do more for more people than we originally anticipated and I have faith that we will remain committed to the single, individual patient as continue our voyage.
Long before I was old enough to venture over the horizon the last lands and seas had long since been charted, but fortunately the frontiers of health and the sea of humanity offer an endless horizon. Looking out over the Pacific horizon so many years ago I never envisioned that my greatest loves would one day combine in a mobile medical relief team exploring frontiers of health across the living ocean that washes all shores equally. I had no idea HOW I would pursue these two passions, I only knew with certainty that if I did not have them both in my life, I would never be happy, and so I would look out over the water or read Jacques Cousteau or trail after my dad on rounds, and dream of adventures on distant seas and future patients I would see and help.
First clinic in the new Panga (before we built a canopy)
Repairing torn stitches in Labadie
But all the time a voice was urging me to move forward, always there was another voice…darker, more ancient; a more primitive vocabulary but it didn’t need sophisticated words…it has raw fear, self-loathing, shame, narcissism, and petty angst and selfishness. This voice, all my life, has whispered under my dreams, telling me I will never become a doctor, and never see the seas I spent my childhood dreaming of. Sometimes it spoke with other people’s voices, like during the year we struggled to rebuild Southern Wind after she had been donated to us and some people scoffed and said we would never make it, and it would never work, and we would all be killed and waste all the support we gathered…but here we are. Sky and I lived with fear as a constant companion for the whole tenuous first year of our project, when so often it hung by a thread, but (especially with my sister beside me and many hands outstretched to help us keep going) we were able to move forward, one foot in front of the other, and now here we are…going on a mobile clinic in the morning, more than 600 mobile clinics into our voyage.
La Sabana in the mountains
I know now that this pessimistic voice I’ve always had spoke from feeling not good enough somehow to deserve attaining my dreams, and although as I got older (and continue to get older) the voice got fainter and fainter (I pretty much ignore it on autopilot now…most of the time), it took many years before I could–as my wise sister says–”Allow myself to succeed” without it being a struggle. We are always our own harshest critics and unforgiving judges, but as they saying goes: ‘You never know if you can climb the mountain until you try (REALLY try).’ And as a wise man said, is it really that frightening to succeed, and is it really, in the grand scheme of things, so terrible to fail? And there is always the third option (my favorite): sometimes when you fall, you find out you can fly (or learn how really, really quickly)–especially if hands are outstretched to help you stay in the air, and your ego (and the dark voice inside us) allows you accept the help that is offered.
The kindness and generosity I have seen people show towards us and to others fills me with hope that the daunting
La Sabana in the mountains
challenges of our time can be survived. I am immensely proud of what my crew, friends and family, and all our volunteers and supporters have made possible, and incredibly grateful to be able to be a part of this voyage and to have shared it with such extraordinary people.
Even with all its faults, earth is a beautiful planet, and humanity, despite its many, many faults, is heroic. There are heroes all around us; it has been a great honor to work alongside so many of them.
“The world is a fine place, and worth fighting for.”
Check out these pictures; some of my favorite moments captured in 2011.
Please click on any of the photos to activate the slide viewer.
