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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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Bring me that horizon...
For me the sea has always been where I turn for inspiration, solace, and wonder. The night I was born I breathed thick salt air and first heard the sound of long Pacific swells rolling onto whispering sand, and from that day my life was held forever in the sea’s net of wonders. My mom and dad were living in a beach motel in Southern California while my dad did his medical residency, and my first steps were on the sand and behind my dad as he made hospital rounds and home visits to patients. I can never remember any time in my life when I wanted to be anything except a doctor and a marine naturalist, and thanks to my parents, extraordinary mentors and opportunities I became a marine biologist and a doctor and have had experiences in both fields that make me grateful to be alive just for one of those moments.
My favorite thing about the sea is that it is not lonely; in the sea I feel connected by the water to millions of people around the world. I imagine millions of people of a thousand colors and languages and religions and nations all floating together in the sea’s embrace and connected across thousands of miles by one continuous, unbroken sea. When we float in the vast sea, only a little of it is holding us up, but that small part is connected to an unimaginably vast and powerful body of water. In the same way, this is how a people are strong. When we say ‘a sea of humanity’ we acknowledge that humanity–all of us together–are as powerful as the sea, which is always waiting to show what it can do.
Like every wave, every life is unique and beautiful, something I have experienced time and again through this voyage. In 2011 we saw our
Fighting bedsores on a dying patient we inherited at the Asilo
10,000th patient, and although I am very proud of how many people have received care through Floating Doctors, what I am most proud of in 2011 was that as we expanded our project, we always stayed committed to the individual patient. Time and again, this has ultimately led to our being able to do more for more people than we originally anticipated and I have faith that we will remain committed to the single, individual patient as continue our voyage.
Long before I was old enough to venture over the horizon the last lands and seas had long since been charted, but fortunately the frontiers of health and the sea of humanity offer an endless horizon. Looking out over the Pacific horizon so many years ago I never envisioned that my greatest loves would one day combine in a mobile medical relief team exploring frontiers of health across the living ocean that washes all shores equally. I had no idea HOW I would pursue these two passions, I only knew with certainty that if I did not have them both in my life, I would never be happy, and so I would look out over the water or read Jacques Cousteau or trail after my dad on rounds, and dream of adventures on distant seas and future patients I would see and help.
First clinic in the new Panga (before we built a canopy)
Repairing torn stitches in Labadie
But all the time a voice was urging me to move forward, always there was another voice…darker, more ancient; a more primitive vocabulary but it didn’t need sophisticated words…it has raw fear, self-loathing, shame, narcissism, and petty angst and selfishness. This voice, all my life, has whispered under my dreams, telling me I will never become a doctor, and never see the seas I spent my childhood dreaming of. Sometimes it spoke with other people’s voices, like during the year we struggled to rebuild Southern Wind after she had been donated to us and some people scoffed and said we would never make it, and it would never work, and we would all be killed and waste all the support we gathered…but here we are. Sky and I lived with fear as a constant companion for the whole tenuous first year of our project, when so often it hung by a thread, but (especially with my sister beside me and many hands outstretched to help us keep going) we were able to move forward, one foot in front of the other, and now here we are…going on a mobile clinic in the morning, more than 600 mobile clinics into our voyage.
La Sabana in the mountains
I know now that this pessimistic voice I’ve always had spoke from feeling not good enough somehow to deserve attaining my dreams, and although as I got older (and continue to get older) the voice got fainter and fainter (I pretty much ignore it on autopilot now…most of the time), it took many years before I could–as my wise sister says–”Allow myself to succeed” without it being a struggle. We are always our own harshest critics and unforgiving judges, but as they saying goes: ‘You never know if you can climb the mountain until you try (REALLY try).’ And as a wise man said, is it really that frightening to succeed, and is it really, in the grand scheme of things, so terrible to fail? And there is always the third option (my favorite): sometimes when you fall, you find out you can fly (or learn how really, really quickly)–especially if hands are outstretched to help you stay in the air, and your ego (and the dark voice inside us) allows you accept the help that is offered.
The kindness and generosity I have seen people show towards us and to others fills me with hope that the daunting
La Sabana in the mountains
challenges of our time can be survived. I am immensely proud of what my crew, friends and family, and all our volunteers and supporters have made possible, and incredibly grateful to be able to be a part of this voyage and to have shared it with such extraordinary people.
Even with all its faults, earth is a beautiful planet, and humanity, despite its many, many faults, is heroic. There are heroes all around us; it has been a great honor to work alongside so many of them.
“The world is a fine place, and worth fighting for.”
Check out these pictures; some of my favorite moments captured in 2011.
Please click on any of the photos to activate the slide viewer.
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For the Floating Doctors, 2011 was a year that was marked by thousands of patients seen, turbulent ocean crossings, and hundreds of boxes of medication and medical supplies distributed. It was our most successful year to date in terms of patients treated, countries visited, and partnerships formed. The 12 months cemented our belief that the next and most important phase of our project will be the procurement of funding, support, and supplies for Floating Doctors’ permanent clinics in the countries that we have visited thus far. We clearly defined our role as the primary care givers to the remote communities that we serve and the importance of the follow up care we provide to them. We worked hard to secure lasting partnerships in Haiti, Honduras, and Panama which have enabled us entrance into and support from communities that otherwise would have been nearly impossible to gain.As an organization, I am proud of what we have accomplished in the past twelve months but, for me personally, it goes much farther than miles traveled, pounds of supplies delivered, and numbers of patients seen. It is about the individual. It is about who patient #127 was and what it meant to her for us to be there, or how we were able to give patient #3679 relief from the pain he had been suffering from for years. It is the joy on a woman’s face somewhere in a forgotten jungle when she sees her baby’s heart beat on an ultrasound that fuels my pride in Floating Doctors. Rather than numbers on a spread sheet, for us, our patients are people with lives, children, and family who cherish them.
As the Director of Operations, I am both honored and humbled that I get to witness these individuals first-hand and to be a part of the care that they receive from us. Daily, I am able to work closely
with our doctors and patients while running clinics, breathe in the culture of distance lands, and know what it is like to be one with a vast ocean. I get to live our work and see the results of it on levels that are deeply personal and important to me. I believe that my hands-on involvement makes me a better leader for the Floating Doctors and our crew.One person can be just a number, but to those that love them, they are the entire universe, and we feel they should always be treated as such. Our belief that, “nothing is more important than the individual” has become a core ideology for the Floating Doctors, and it has woven itself in the fabric of our every action. I am endlessly blessed and inspired by our work, and I am honored to be there and be available as a resource to people who have no other option. I feel an immense sense of gratitude to those who have contributed to our work and who make it possible for us to be of service to so many. When a lot of people do just a little, it is amazing what can be accomplished. An innumerable amount of people have helped us in many ways, big and small, and the ripple effect of that collective work has reached thousands of patients across five countries and hundreds of isolated communities.On the precipice of 2012, I am excited for what the year will bring through our clinic doors and under
the keel of Southern Wind. The past three years have been a wonderful learning and growing experience for us – on both professional and personal levels, and we are eager to continue that growth in the coming years. With thousands of miles of coastline and countless communities in need, the future holds no bounds for us as an organization.Fair Winds and Calm Seas,
Sky Labrot
Director of Operations, Floating Doctors -
Building a wheelchair bridge for a girl with CP
When I last posted in June, a couple of months in, we had just started to really connect with the various subcultures in the Bocas Province, and some situations we quickly identified for interventional projects were as yet beyond our reach. Now we have many more friends and contacts in the community, and we can tackle much more ambitious projects for far less cost.
We have:
• Partnered with local group Operation Safe Water to help transport and install raincatcher systems at local schools when we run clinics
• Arranged CPR certification for the fire department
• Worked with the Ministry of Education to train local high school students as trainers for health education in the community and give them medical work experience by participating in our mobile clinics
• Created pictorial and written information sheets on health issues we have identified and that we make available at our clinics
• Gathered and data-entered over 600 patient health data sets and begun doing surveillance of our own interventions and identifying health issues from the data to help guide our mission activities
• Microfinanced patient transports to care on the mainland and chaperoned them in the hospital system (many Ngobe don’t speak Spanish, and are VERY shy, so they easily fall through cracks in systems)
• Connected with an indigenous Curandero to identify and investigate the plants he uses medicinally and are helping him develop his small botanical laboratory always keeping a lookout for.
• Arranged and executed a CPR and First Aid Seminar for the cruising community in Bocas
• Partnered with the Mayor’s Office to run mobile clinics in conjunction with the government visits to the community
• Partnered with the local Lion’s Club to work in a community they support and help supply the neonatal support unit they built with Direct Relief International suppliesAnd, as always, sometimes we find situations that are just not right. Por ejemplo…
Unacceptable for a 14 year old in a wheelchair
While I was in California, Dr. Barney found out about a 14-year-old girl with what turned out to be undiagnosed cerebral palsy in a small squatter’s community called La Solucion. I have been told it used to be where the airport is now (right next to a mangrove swamp), and when they built the airport the community moved out onto shacks built on stilts over the mangrove mud.
She comes to land at most twice a year…land is about 100 feet away over the sewage-contaminated swamp (all the homes
She has rarely, in many years, been to shore
have outhouses and sink drains that drain directly into the water below). She has never gone to school…she has a wheelchair, but rarely uses it because she has nowhere to go; she has to be carried over the dangerous footbridge by her grandfather, and she is too big now for him to carry (Noah noticed he has drop-foot also…potentially a serious falling hazard, especially if you are carrying your 14-y.o granddaughter over a wet slippery footbridge). She is COVERED in bug bites…she can’t really swat bugs away or keep moving to keep them off her, and she lives in an open unscreened house on stilts over mangroves.
Her grandparents have always thought they were at fault for her CP because she fell out of bed at 6 months (though she had never crawled, which makes me think it probably was CP at birth)…they have carried that burden and they always worried they would get in trouble if the hospital found out, so they have indicated that she has never seen a doctor.
If I were a Hollywood writer writing for some medical drama, my editor would probably throw me out of the building for it being so unbelievably challenging emotionally and physically…but this is real life…this is somebody’s actual life. Sometimes people ask if I miss ‘the real world’…let me tell you, it looks pretty real from where I’m standing.
Driving pilings into the sewage muck of La Solucion
We said we would build her a walkway, and now—6 months into our time in the community—we called on the community to help and EVERY level of Bocas society came together to make it happen. Mangrove posts from an indigenous community, lumber and funds and food from local Panamanians and expats, help from boat owners, crew on other boats, locals from La Solucion, local taxi drivers, local restaraunts…at the last minute we even had no trouble rounding up 2 sledgehammers (one from the fire department and one from the fish market, which I sometimes haunt in the afternoons when the fishing canoes come in).
Everyone gave a little (some more than a little), and in 5 hours we sank thirty 10-foot mangrove tree trunks 7 feet into the mud, from the shore all the way to her grandparents’ house. The walkway went on in the next few days, and then this little girl went to shore (we still have some work to do to finish the walkway and make it safer for a wheelchair). I asked if there was anything in particular she wanted to do on shore (which she can see, 100 feet away) and she said ‘Quiero pasier’—‘I just want to go.’
planking the wheelchair walkway
This is my favorite, favorite kind of project…one where the whole community comes together when it learns about a situation like this. When the walkway is done, it will have been done right, with the right material (always seek expert advice) to make it last for many years. No matter what, this girl’s life is going to be changed forever—and here’s the best part: total cost for all the lumber, food for the volunteers actually building the walkway, gas to go pick up the posts from another island, hardware, etc: less than $1000.
There’s opportunities for helping, constantly around us…when we are alone we can help in small ways…but mira aqui, look what we can do when we all come together! Poco a poco para cambiar el mundo.
Please click on any of the images to activate the slide show viewer.
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I need an opthamologist
The last time I wrote a blog, an unconscionable number of months ago, we had recently arrived here to Bocas del Toro and I ended the blog excited by what might be possible over the coming months…now those coming months have passed, and it is time to catch everyone up and take stock of what we have accomplished here in.
6 months ago feels like a million years ago…with more long-term volunteers, we’ve been able
I love my sister
to really expand some parts of our project, including self-surveillance. I looked at what we had done—how many mobile clinics, how many volunteers, how many projects, how many patients…it is overwhelming to try and describe. I should either write bullet points, or a 3-volume novel to describe everything since my last update.
Canadian medical student doing kids health checks
Over most of our time here, for example, for every 3 days we were here, we ran one day of mobile clinic work—even counting rained-out days (and it rains 150 inches a year here) and days we were involved in any other kind of activity, whether it was working on boat projects, escorting patients to the mainland to get treatment, holding office hours in our consultorio, working in the asilo, eating, sleeping, or doing anything else. We’ve seen over 3,000 patients in more than 17 communities that we visit on a roughly 2-month rotation across the entire province of Bocas (an area of over 4,500 square kilometers), in addition to all our other activities.
No matter what other projects we get involved in, the core of Floating Doctors is our mobility—even the permanent clinics we are now working to establish are to serve as bases from which to continually run mobile clinics by panga, as we have done everywhere we go. I’m incredibly proud of all my volunteers and my crew for maintaining that level of dedication to work one day of mobile clinic for every 3 days we were here.
We’ve seen a lot of different communities, and noticed that there are enormous clusterings of health issues in different small communities that at a glance may seem similar. Why does one community have an incredibly high rate of obesity and diabetes, while the neighboring community has no obesity or diabetes but has lots of parasites? We have gathered detailed demographic and health data on over 550 patients so far, community assessments on a dozen different communities, and are beginning focused projects based on issues we have prioritized based on the data so far. Results of our first survey project coming in the new year…
ultrasounding in a chair in the jungle
We’ve started doing overnight and multi-day mobile clinics—getting two or more clinic days for the price of one day’s travel, since our accommodations have almost always been in the homes of local members of the community, or expats who notify the community that we are coming, house and feed our team, and often allow us to use their facilities to hold our clinic and arrange our transport to work in communities near their homes. I have been overwhelmed by the generosity of the expat and local community here…I have never worked anywhere—in the developing or the developed world—where the community at every level will actually deliver on its promises of support like here. From the Mayor sending trucks to help us cart garbage out of the nursing home, and letting us use his old consulting room to open for patient consults two days a week to the local marina workers who are giving their Sunday to help drive 36 10-foot posts into stinking mud to build a wheel-chair walkway, this is a wonderful community, with many eccentric people (after all, we are here too) and many people with good hearts who have shown us enormous kindness and support for our work here. Thank you to everyone—this is what makes Floating Doctors possible. A thousand hands holding us afloat…
We’ve also joined forces with the Peace Corps volunteers scattered throughout the province;
Harold, Peace Corps worker in Shark Hole; we did a clinic there on his very last day on site...a giant amongst his Ngobe friends; thank you Harold for your fantastic work
Peace corps Volunteers have thus far been 100% reliable—individual peace corps volunteers live (very often alone) in a community and work on a project. We got in contact with one, on the mainland, and ran a mobile clinic at his village…it is so awesome to arrive with everyone notified, a place to work, directions, someone to help interpret and to give us the inside scoop on patients we are meeting for the first time, someone to pre-arrange accommodation in the community, and best of all, the Peace Corps volunteers can and do follow up with patients that we have identified as needing more advanced care. This has been our experience with the Peace Corps every time we have worked with them, and we look forward to our upcoming multiday clinics to some new communities we are visiting through Peace Corps, including a Ngobe community way up in the mountains that I have heard a Peace Corps volunteer visited but that he thinks has NEVER been visited by a medical team. Looking forward to that later this week…
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It has been two months since I have been able to put words to page although this is not for lack of content or consideration but rather the inability to put thoughts into meaning. In that time period we have left Haiti, seen old friends in Jamaica, and crossed the remainder of the Caribbean Sea to Panama. All amazing accomplishments that should be noted, written about, and reflected upon- yet every time I open the computer to a blank white WORD page I sit paralyzed. It’s as if all of the experiences and work bottle neck themselves in my head and leave a connection with my hands useless.I thought this time that leaving Haiti would be easy, knowing that we would return again, to have seen the faces that I love and know that they are well, and yet in reality it was much harder than the last. To see a little boy that I love with all of my heart playing by the tree where I last left him was a joy but leaving him once again at the same tree eats at me… having him not there the next time we return will break me, and yet when I sit back and think about, having him still there may be just as bad. The never ending tail chasing ‘whats worse’ game that plays in my mind. It seems at times to me that my heart will never win when it comes to my time in Haiti—I will always be pulled back and tormented away. The sights, sounds, and deaths get no easier the second time around- they still work their way in, nuzzle themselves into my soul, and trouble my moonlit nights on the water. As we left Haiti I sat on our back deck for as long as the light would allow my eyes sight with my heart being crushed and simultaneously elated that we were pulling away from the shores not knowing if the tears I was shedding were for her, for me, or for those I was once again leaving behind.
The transit that lay ahead of me turned into 5 of the most memorable days of my life- flat calm and beautiful the seas opened themselves and the life that dwells deep within its blue waters to us. We spent the days spotting whales, dolphins, endless fish, whale sharks, and sharks with an elation that only wildlife can bring. I felt my heart being drawn into the
dark blue that lay beneath our keel, the salt water starting to become part of my blood, her vastness a part of my soul, and perhaps on this transit I truly became a sailor. As I walk down the docks now I feel her calling to me- beckoning me into her wildness and away from the safety of solid land. To trade stability for freedom and schedule for adventure- to stand on our bow with salt laced air in my face and dolphins underneath my feet. To undo our lines and sail into the never ending splendor that is the open ocean.I had dreamed of Panama from the start of my involvement in this project – it always seemed so wild and distant to me. It has not failed to disappoint either- the people, the
jungles, and the islands have opened themselves and embraced our project like no place we have been before. The unending kindness of the people here leaves me speechless as it seems that there is nothing that they won’t do to make ‘us’ happen. Free Dockage from the Bocas Marina and Yacht Club, amazing Fashion Show/Fundraisers from the Calypso Cantina, Wednesday night girls night with some amazing women. The community has thrown its heart open to us and is literally making our project here possible. So much of what I have constantly had to worry about has been lifted from my shoulders allowing me to immerse myself in our clinics. I am humbled, once again, by the generosity of others.I find myself loving my life – on the precipice of my 30th year I am thankful beyond all reason for the life I get to lead. I wake up every morning, usually no one is up yet, and I drink my coffee overlooking one of the most stunning bays in the Caribbean. I awake my crew and head off to a distant shore, often feeling like I have stepped back hundreds of
years in time, and spend my days making peoples’ lives better, making their pain stop, quieting the worried minds of mothers and the crying of babies. And all too often people tell me that it’s so amazing what we do—my only reply is, nope, it’s amazing what I get to do. I am surrounded by suffering and pain and beauty and wonder. My heart is broken and lifted twisted and torn and I would change none of it. My cup runeth over. I am haunted and changed and the luckiest girl I know. -
My little sister Sky...at the helm...she is so awesome
Bocas del Toro, Panama
As always, leaving Haiti was difficult. There is always a sense of leaving things unfinished, no matter how many patients you see or projects you complete. I always tell people, we are not going to go help Haiti. That is beyond our power…but we went to help HAITIANS, and helped many. Leaving is hard…but I comfort myself when I remember that our anchor will drop in Haiti again.
Moonrise 200 miles off Nicaragua
We had an amazingly calm and uneventful passage from Haiti to Jamaica (our 4th time crossing the Windward Passage…it was tolerable this time, I’ll give it that). We ghosted through mirror glass seas 200 miles off the coast on our way south to Panama, a full moon reflected among the stars on a sea so smooth that the horizon was not visible. We caught some fish, slept well, had a whale shark partially breach in our wake, saw pilot whales and dolphins…Jamaica to Bocas del Toro has been by far our easiest and most pleasant transit.
this looks like a scene from an italian opera
Our arrival in Bocas was marked by the immediate generosity of the expat and local community here. Dylan and Darien on S/V Jackaroo, the owners of the Calypso Cantina at Bocas Marina, helped arrange Bocas Marina hosting us while we are here, welcomed us with a fire dance at the cantina, and have just organized a big fashion show fundraiser to support our time here (blog with THAT story coming soon!). Chuck, Courtney and Rosemary and Dana from Bocas Marina have gone way out of their way to support our mission here, and everyone in the local community has reached out to help us here.
This place is almost purpose-designed for a team like ours: a large population spread out over a large area, mostly accessible only by boat, with little or no access to health care…nearest surgery is an hour and half by fast boat ride…a mammogram is 2 hours away…a very, very, very underserved population (lots of indigenous people who have had a long history of poor interactions with foreigners).
We immediately became involved in several initial activities:
Mobile Clinics:
Shark Hole community (mobile clinic with the Mayor)
By car (thank you Rosemary!) and by panga (thank you Alcaldia!) we have so far been running mobile clinics for the communities in San Cristobal, Drago, and Shark Hole and have returns for follow up and visits to other communities on the calendar for the next few weeks, with help from expats in the area, peace corps volunteers in the communities, and with the help of the local mayor (the Alcaldia).
- Sarah doing health checks in Drago (about 1 in 6 had something needing attention)
Dr. Joe, previously the town’s only doctor before entering politics, visits the outlying communities once a week with a government team (health inspector, education directors, building inspector, etc) and we go with to do a mobile clinic. We have some bigger multi-day mobile clinics coming up; on one we will be carrying five 750 gallon water tanks to a remote series of coastal communities for Operation Safe Water.
Nursing Home (The Asilo):
Felicity and I doing ulcer care in Asilo
3 staff (cook, cleaner, nurse) on each day shift to cook for, feed, clean, wash, change, dress, and otherwise care for 25 long-term care residents who are wards of the state, most with few (usually none) family members and no means of support. The fact that the floors are clean and the patients are fed is a huge achievement, but otherwise it is heart-wrenching. There is a 3-inch concrete sill in each door…to go outside, I watched an old man with no legs roll himself up to the sill, climb down out of his wheelchair, lift the chair over the sill, lift himself over the sill, and then climb back into his chair.
The first truckload of garbage taken from the Asilo
Piles of rusting metal and trash and junk fill the backyard, and vultures walk amongst the patients in the fall-hazard garden. There are no handrails anywhere, including the bathrooms. A doctor has not come from the hospital to look at the patients for months, and they have no meds at all. And the patients have no charts at all. SO…we created charts, did full histories and physicals on everyone. Now we can write and document progress notes and exams and studies.
Please come to the Asilo and help us take the residents for walks!
The mayor sent a municipal truck and we filled it three times with garbage and junk, CJ has gathered many cuttings and plants given by other members of the community and begun systematically landscaping the demilitarized zone that was the backyard, we’ve been doing wound care, skin care, walking and exercising the patients, repairing leaking water pipes, changing inappropriate shower heads, providing eyeglasses, and generally trying to improve conditions everywhere we turn. If you are in Bocas and reading this, come by and give us a hand!
Bocas Emergency Network:
Grit from a sanding disc injury lodged deep in abcess...
We arrived here to find that the BEN (Bocas Emergency Network) was already in existence here—a network of about 50 expats scattered across the area who remain in radio contact to alert and assist each other in emergencies. The name seemed a fit made by fate, so our call sign in the BEN is ‘BEN911’. We have taken a couple of calls through the network, but fortunately none which were serious enough to necessitate an emergency callout. We are working on getting our own panga and programming known safe routes through this maze of mangroves to all the different BEN member homes (which are all located near local villages) into our GPS so with a searchlight we can make high-speed response to emergencies or do fast transit to Changinola (closest place with surgical facilities)
One of the cruisers here helping us landscape at Asilo
So far here we have had medical students from Israel and Saskatchewan, Canada, an RN and her cameraman fiancé from Australia, pre-medical and nursing students from Duke and Berkeley, an Optometrist living locally who is going to come do monthly prescription clinics (we have glasses), a nurse from Florida who just moved here with her husband, and we have a tropical medicine specialist coming from the UK, a nurse from California, and other volunteers coming throughout the summer, and some of our old volunteers returning too (awesome). It is amazing watching them go through the experience. It changes us daily, and it is fascinating and rewarding to watch people rise to challenges, encounter people and situations which push them past their boundaries, and seek out and develop opportunities to help.
Felicity helping Asilo residents pick out new glasses
I read about a playwright/director, terrified after an awful dress rehearsal before the debut of his one chance at success, who fell asleep and dreamed that he was scaling a immense mountain peak…vertical walls…no ropes…he, who had always been scared of heights, in the dream is climbing like a man born to the rock and the sky, and as he nears the summit, he loses his grip and slips, hanging just below the summit by his fingertips.
- Eve and Sarah changing decubitous ulcer dressings in Asilo
A man on the summit looks down and asks him if he is afraid of failing…and says ‘it is sometimes a mistake to climb; it is always a mistake never even to make the attempt. Sometimes, when you climb, you succeed, and sometimes, yes, you fall…but there is a third option…’ And then the playwright falls. And as he is falling, he realizes what the third option is: sometimes, when you fall, you find out you can fly.
This I believe.
Dylan orbited by flames
And in this community there are already many hands under us. What do we have in the works? Of course we want to bring in a container from Direct Relief International with equipment and material for the hospital and dispensarias here; we will soon be doing training with the firemen (who do water rescue here also) in Bocas, working with Operation Safe Water to deliver more tanks and equipment for water projects, doing consults using the mayor’s old consulting room, putting a raised vegetable garden in at the asilo, getting some specialists down here, doing more multiday mobile clinics and continuing to return for follow-up…who knows what else? I feel like this is a community in which we can accomplish a lot…it’s an exciting feeling after 1 month; wondering what we will have done here in another few months…
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All pictures of patients used with patient’s or guardians’ consent.
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Cap Haitian, Labadee, Shadda, Milot, Coco (east of Bayeux)
Norwegian Crusted Scabies
Today is the 1 year anniversary of when we first set sail from Florida to Petit-Goave. Returning to Petit-Goave after a year and seeing our old friends and patients (and meeting new ones) was an incredible experience, but after a week working in Petit-Goave we weighed anchor and headed north to Cap Haitian. After the Windward Passage, it was great to ride across the smooth glass of the Bay of Haiti, but as we approached Cap-du-Mol on the western tip of Haiti’s northern peninsula we entered the edge of the Windward Passage and had a few rough miles before turning east along Haiti’s north coast, arriving shortly after daylight and pulling onto the commercial docks in the port of Cap Haitian.
We were met by Hannah from the Cap Haitian Health Network, and after several days of
trash river in cap haitian
paperwork and meetings we unloaded our medical cargo onto the docks, onto a truck and got it into the CHHN warehouse, where it will be available for distribution to the clinics that are members of the network. While we were waiting to unload at the dock so we could move to our mobile locations, we took the opportunity to visit a couple of other health centers, meet the minister of health for the north, do a mobile clinic in Shadda—Cap Haitian’s worst slum—and see a steady stream of patients at the dock the entire time we were there.
holly hefting an instrument of war...
It took us almost 4 days to get our material cleared in, which gave us time to visit Milot hospital, the primary center for major or specialist surgery (staffed year round by local and visiting teams) and get a schedule for the next few months of that doctors and specialist teams will be visiting there; that way when I am further afield I can write referral letters and give the dates and doctor’s names to patients I encounter who need specialist care. Above Milot is the Citadel…the largest and most impressive castle I have ever seen, perched on a mountaintop above Cap Haitian. Built after independence, it was made to hold 12,000 troops and be able to fight a devastating guerrilla war from the mountains should Cap Haitian have been re-taken by the French. I liked the raincatchers built into all the roofs, but mostly I was shocked by the size and scale of it. “My name is Ozymandias, King of Kings…Look On My Works, Ye Mighty, And Despair…” The castle was never really used or completed but it has been well preserved as a UNESCO site and SHOULD be a huge tourist draw for anyone visiting Haiti…just plan to bring $10 for a horse if you don’t want to walk all the way up (3,000 feet in 3 miles…I made it but I wanted to have a coronary at the top).
Cap Haitian was not too badly damaged in the earthquake and is quite prosperous in
infected and necrotic burn from hot oil
comparison to other places I’ve been in Haiti, but Shadda, its central slum, was awful. We saw a ton of scabies, which always tells me an area is really poor, and some half-done operations (like a colostomy that has not been reversed though it was supposed to be). A toxic river draining sewage, agricultural and industrial runoff and storm drains from all of Cap Haitian flows between two dykes made of garbage, medical waste and sewage…Donna was saddened to see three children: one standing in a huge pile of garbage, another simultaneously defecating on the pile, and another simultaneously picking a can out of the pile and checking it for scraps of food. The general health of the population in Shadda reflects the surroundings.
a river of sewage, garbage, agricultural and industrial runoff flowing through shadda in cap haitian
By contrast Labaddee, where we moved and dropped anchor to work from this protected fjord, is one of the more prosperous-looking little villes I’ve seen in Haiti—pretty much 100% because of the jobs and income that come with Royal Carribbean Cruise Line’s destination here. RCCL run a school, help support the small clinic in Labaddee, and have extended themselves to us by providing fuel at cost and allowing us to get water from their dock (thank you Peter and Dave!! Lifesavers!!) and do laundry (16 continuous hours of laundry when we first went over there). I
It is important to remember that Labaddee’s prosperity is relative to places likes Shadda,
meeting his first white person, and unafraid
so we still saw loads of bad injuries, poorly healed wounds, a LOT of major operations with little or no follow up (we asked Hannah from CHHN to come do a day of physiotherapy and she is planning to try and come regularly), and some unusual cases also—I treated a little boy with a knee wound all septic with ripped apart stitches (almost all healed now), we ultrasounded nearly every pregnant woman in the village of 6,000, and after only two days people started coming out to the boat, night or day, for emergency care.
You never know what will arrive paddling up in a canoe at 10:00 at night—a guy came by
wound care for the skarkbite victim
the other night and I saw the blood-soaked rag wrapped around his left hand. We pulled him aboard and unwrapped the hand to find he had been bitten by an 8 foot hammerhead shark (HE says 8 feet…but I’m a fisherman too, so I say read ‘5-6 foot;’plus 5-6 feet is about right for the bite radius). We patched it up and he has come every day for dressing changes. I understand he was offshore, tried to pull the hammerhead into his small boat, and it got the best of him before it escaped. Two worlds collide…Shark one, fisherman zero (for a change).
Me and Jean Claude, one of Cousteau's original divers and one of my heroes
Speaking of worlds colliding, I am fortunate here to have met one of my childhood heroes, Jean-Claude (one of Jacques Cousteau’s original divers), who has built and run the Cormier Plage hotel near Labadie for the last 23 years. He is 79 years old, dives every single day, swims a couple of miles in the ocean every couple of days, and showed me the artifacts he has collected off wrecks he has discovered over 23 years of diving this dangerous lee shore (I nearly keeled over in shock at the collection of priceless artifacts he has recovered for a museum display when it is complete).
I think that so far one of my favorite days here in the North so far has been setting off
The only way to pass a physically uncomfortable journey
from our ship on an 11 mile trip in a leaky handmade wooden boat with no floor or seats, run by one of our new friends here, through a treacherous series of shallow reefs (on a lee shore, too…bet there’s lots of ships’ bones down there), landing not far from columbus’s landing in the new world. I’ll always have a memory of Sky sitting on the bow trying to keep her back from being destroyed, scanning the mile-long, desolate beach for our contact and a safe passage through the surf. We located our contact and another boat rowed out through the surf, we transferred our gear and under oars we backed through the surf.
Donna’s shorts were soaked in the landing and she abandoned them, so partially clothed
sky clerking in a kid 8 years old going on 47...
we put our gear on our backs and heads and followed our guide off the beach into the trees, stopping at a small school in a village supported by Dr. Anne, an HIV specialist who helped make this mission possible. We did health checks on all the kids in the school, treating a LOT of scabies and skin fungus, respiratory tract infections, some severe malnutrition from parasite infestation, anemia, and a pre-teen patient who told us they ‘had dirty blood’ from birth. This patient travels 2 days once a month to visit a doctor providing their meds. And, as per our SOP, we gave vitamins and albendazole (for worms) to every kid (and quite a few adults, too).
I love the mobile clinics…each one is its own adventure, at the end of it I have a wealth of valuable firsthand information about the location, and I’ve never done one that did not have at least one patient that I was very, very glad to have come to see.
And to be honest, it also felt good to ply the same waters as Columbus for a short time. I
landing our clinic through the surf a short distance from where columbus first made landfall in the new world...
hope the legacy we leave behind has a kinder footprint than his, but I loved rowing through the surf to land in a new place, with mystery and unknown patients waiting somewhere beyond the tree line in the Haiti’s own heart of darkness. Humans aren’t meant to look at cubicle walls…we are hardwired with the desire to stand on new worlds and look to the next. All of us have the explorer soul written into our DNA, and the expression of this most uniquely human characteristic is always a beautiful thing—I think it is when we are being the most true to who we are as human beings.
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Part 3 of Our Transit: Cayman to Jamaica
Trouble ahead...out of nowhere
We departed Grand Cayman on a beautiful sunny morning, anxiously clearing past
Left: Polished Fuel; Right: Same Fuel as It Came Out Of The Hose In Roatan
the eastern end of the island and waiting to see if an unexpected northeast swell would devastate us, but all seemed tranquil with gentle 1-2 foot seas and clear skies. With the calm water, our fuel (having already been filtered through 10 of our filter cartridges) wasn’t sloshing badly, and our port engine was running smoothly. When it did require a filter change it was comfortable to drift forward for ten minutes while we changed filters.
The next day, as we bore further south, we started to take the wind just forward of
Holly Steering In Rough Seas
the beam. We shook out the sails, gaining another 2.5 knots to the port engine, but as we came within sight of the western tip of Jamaica, waves wrapping around the north AND south of Jamaica were building and converging on our position at 45-90 degrees to each other, and building fast. As night fell, we were well east along Jamaica but still 50 miles offshore, having worn south to use the wind longer. We turned east and pulled the sails down, securing the ship in anticipation of yet another nasty sea coming…and we were not disappointed.
Sky trying to keep her back together...
The seas came round close to the starboard beam, and the period shortened as we drove dead into the wind. Fuel started sloshing, and we soon found ourselves dead in the water as the port engine sucked up the sludge that was our fuel. Frantic filter changes continued, with increased urgency each time as we bore closer to the lee shore. We downloaded a weather report through our satphone (tough to hold the antennae southwest in that sea state) and realized that, once again, unexpected bad weather (11-12 foot seas and 35 mph winds) were coming to the windward passage, and we knew that we would be very, very lucky to make it around Jamaica’a eastern tip and pull into Port Antonio on the north side.
As day broke, Sky and I made the decision to divert to Kingston, which we might be able to reach before dark.
Getting stability and 2.5 knots extra from the sails...
As we approached, we were not able to raise any of the Jamaican officials. It was a public holiday. We raised a local boater on VHF who connected us with a retired Evinrude dealer, who lived up the mountains and monitored all marine radio traffic. We rendezvoused with the first boater at a small cay off Kingston. He lent me a chart and pointed out the unmarked location of the
Making An Electrical Repair When He Should Be Asleep...But Has No Choice
customs area, a small unmarked anchorage, and the Royal Jamaican Yacht Club anchorage, also unmarked and uncharted. Then, our new friend Tony Tame up on the mountain contacted the customs, immigration, health, and port officials, and we made our final, hair raising approach past Wreck Reef’s dangerous lee shore into Kingston’s main channel and the protection of its harbor…what a relief.
Talking To Ensley, Carib Maritime's Master Mechanic About Where To Find Parts
Within 2 hours we were cleared in and allowed to proceed to the yacht club, where we dropped anchor and collapsed asleep. We then spent 24 hours on reconnaissance; getting a Jamaican sim card and number for the blackberry, finding and calling stores that might carry the parts we needed, finding and arranging transport into town to search for what we need at stores we had already
Ed, source the fuel filters, assembly and additional parts...
contacted. The kind master mechanic and master engineer from the neighboring Carribbean Maritime Training Institute drove us all over town and helped us figure out where to find what we needed. Within 72 hours, we had obtained and installed all the parts that we needed to repair our engine systems (and incidentally, our alternator) and had polished the 400 gallons of diesel in our tanks…opening each of the three tanks’ access hatches, pumping out and filtering all the fuel, scrubbing and vacuuming the sludge from the bottom and then re-sealing the tanks. We finished at midnight, took on fuel the next day and then were invited by the yacht club to wait for weather at their dock.
Borrowing Luther's Fuel Polisher
What a relief! Tied to the dock, everything is easier, and anchor watches don’t need to be set. It will be hard enough in Haiti; it is great that everyone might get a chance to rest now. The weather is driving us crazy…there is a huge high pressure system over the east, sending howling winds down the Windward Passage, and a SE swell meeting it…it is nasty there, and we are heavily loaded with IV fluids.
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Note: A month ago we departed from Roatan for a ten-day transit to Haiti, with a stop in Isla Guanaja to clear out of Honduras and a stop in Port Antonio, Jamaica, for fuel and a night’s sleep before the final 36 hours to Petit-Goave, our first destination In Haiti.
That was the plan, anyway.
The next couple of updates, written here in Kingston, will tell the saga of what happened and catch us up from Roatan to here in Jamaica…I have written them all in one go, and will post one a day till we are caught up.
March 1, 2010–Isla Roatan to Isla Guanaja, Honduras
Ernest Shackleton's Recruiting Ad...
We knew it would be an up-wind, up-current battle the whole way to Haiti, so we made the 40-mile run from Roatan to Isla Guanaja to clear out, and wait for a weather window long enough to reach the protection of Jamaica. When we got to Guanaja through 6 foot, choppy seas coming from the east, there was no room in the only protected anchorage and we anchored outside in the channel, where it
Each Red Line Shows Our New Swing Line As We Dragged And Reset All Night
proceeded to blow hard from the E and SE for 9 days. We dragged anchor several times before finally putting out a second bow anchor, which seemed to hold, but we spent many hours at night watching our chartplotter and peering out at Dunbar Rock to see if it loomed any closer in the darkness than it had 5 minutes before as we bucked and swung on our anchors.
Ed Wiring A Cell Phone Charger To Our Generator To Make It Work
Our generator was not putting out full power; its regulator control board had finally failed (it had done well to survive the lightning strike at all) but Ed managed to coax it to produce some power by using an old cell phone charger, wired directly to the circuit board, plugged into a small dashboard inverter which he wired directly to our battery bank. Thus, we were able to excite the part of the generator circuitry that allowed the generator to produce power, but it would frequently get hot and fail and need to be reset.
It turned out that I had to fly back to Roatan on a puddlejumper with all of our passports to clear out of Honduras, and we also had several cases of vitamins, IV fluids, gauze, syringes, antibiotics, heart monitors, and other supplies to deliver to the health center on Guanaja. I went back to Roatan and got everybody cleared out of Honduras, and when I got back we connected with the director there and we arranged for me and Dr. Holly to help out in the clinic. Holly saw patients for general consults, and I did ultrasounds on some pregnant women and women with abdominal masses.
We also managed to revisit a patient we saw when we were there in October—the patient that we suspected had
A Good Omen For The Crossing??
elephantaiasis. With a tropical medicine specialist onboard, and armed with the opinions and advice of many clinicians (form as far away as Fiji!) who wrote to offer suggestions, we re-examined him and decided on a course of treatment that might at least stop forward progression of the symptoms by killing any active filarial worms, and Noah taught him a series of exercises and techniques to try and increase lymphatic drainage. The next time we visit Guanaja, I hope he will show improvement…at least no progression!
Our Path Through The Reef...The Asterisks And Pluses Are Exposed/Awash Rocks
We endured the wind and anxiety of anchor dragging for 8 days, finally moving to the backside of the island and negotiating a narrow, twisting reef passage to an anchorage with some protection. We still dragged, but only a little, so we managed to have a semi-restful last night and in the morning the sea and wind died down to nothing and we nosed out through the reef passage and headed NE towards Jamaica. Little did we know that the calm glassy waters of our departure would not last for long…
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