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This week we have a blog post from UCI med student Lauren Sims. A group of UCI students came to us to work with the parteras (midwives) in some of our communities. In today’s post she talks about some of the patients she saw and what she learned in her time with us.
-Kim Olpin Operational Manager
Lauren and fellow UCI Med student Kate Horn working hard during a clinic.
At Floating Doctors clinics you are not presented with your typical American patient in a shiny white hospital room or doctors office. You typically find yourself with an indigenous Panamanian Ngobe under a “rancho” (a typical outdoor patio covered meeting place in these communities) sitting in old wooden school desk chairs. This might be their first encounter with a medical professional.. they might have walked a day or more to be at the clinic… some only speak the traditional “dialecto” of the Ngobe and need a Spanish translator. No matter their circumstance or reason for presenting to the clinic they are all extremely grateful for our presence in their community and in search of an answer to what is ailing them.
UCI students with Dr. Ben in Quebrada Sal.
I encountered some interesting cases. I saw a young child with Leishmeniasis in a remote Panamanian community in the mountains. I performed an ultrasound on an infant who was failing to gain weight in the first few weeks of life for an unknown reason. I saw an older woman with a sixteen year history of hyperthyroidism and severe exopthalmos. I measured a blood pressure of 238/192 in an older gentleman who most likely had an adrenal tumor. I visited a pregnant woman with a history of preeclampsia in her home to do an ultrasound. I saw a child with impetigo and another with Herpes virus that covered the entire right side of his face. I listened to breath sounds of a seven year old with TB. I examined a three year old who most likely had a stroke as an infant and could not use his left foot or left hand or talk.
Lauren with some young Nogbe kids.
I learned first hand about the barriers of access to health care for these patients. Some were not able to get medications or make it to the hospital because they lacked the funds. Others would have to walk a day, take a boat for a few hours and then a bus to reach a hospital that might not even be able to treat them. Some distrust the health care system because of a previous bad experience or a story about the hospital that quickly spread through their small community. My time with Floating Doctors showed me how the health status of the community members in these remote areas directly reflects the prosperity of the community. They deserve access to health care and I am very grateful for the opportunity to be a part of a medical team that reaches out to these isolated Ngobe communities. The patients I have visited with in Panama as a medical student will forever hold a special place in my heart as I continuing my training and career.
Lauren and fellow UCI med student Christy Tabit showing off their newly decorated scrubs.
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At the end of August we held our first multi-day clinic in the community of Rio Cana. It is one of the most remote communities we have ever been to. While we were there a new mother became gravely ill and had to be evacuated. This is the story as told by Dr. Kim Wilson.
-Kim Olpin Operational ManagerI’m telling this story as a reminder to every one of the amazing and selfless work that floating doctors does every day!
We went to Rio Cana recently. For those of you who haven’t heard of it, it’s a community on a peninsula about 3 hours from Bocas. We had not made it that far before because of the distance and also because it’s situated just up the mouth of a river so accessing it can be difficult depending on the weather and tides. We were all very excited at the prospect of going there and it was incredible. It’s such a beautiful place and the people were amazing. We arrived at river mouth and a boat came to guide us in and we were met by lots of the local people who were as intrigued by us as we were them. We started clinic early the next morning – we weren’t really sure what to expect as it was our first clinic there but it was so busy…we saw 124 people on that first day and 140 the next day! A lot of people had problems with colds and coughs, worms and scabies and then there were the more unusual cases such as ichthyosis, machete wounds, insects lodged in ears and a multitude of other issues. It’s hard to explain how amazing it is to see an entire family, from infants to grandparents to dogs and even a sloth at one stage, but working with the locals is an eye opening and heartwarming experience.
Just after lunch, Ben asked me to see a lady who had given birth 40 minutes previously who was unwell so Dan, Philippe, and myself headed down to her house to assess the situation. The baby was well but mum was dehydrated and fatigued. We put her on a drip and gave her pain medications and sat with her for a couple of hours and by the time we were leaving, she was drinking tea and had perked up a lot. We went back to clinic where we were run off our feet well into the dark hours. It must have been 8.30pm by the time a man came to say that the lady who had given birth had taken a turn for the worse. Ben and I went to her house to assess the situation and it was honestly a shock to see her this time. She was pale, sweating, staring into space and had a heart rate of 126 and a blood pressure of 80/56. For those of you who are not medically trained, this is not a good sign, she was having a massive post-partum hemorrhage.
The Floating Doctors team working together to evacuate the mother.
It was clear at that point that this lady needed to get to a hospital but the logistics of this were slightly more complicated. We were 3 hours by boat from the nearest hospital and we would have to use our boat to transport her. Aside from the fact that fuel would cost a few hundred dollars, it would also mean that the team that transported her would miss the morning clinic the following day. I looked at Ben and said ‘she has 8 children and a new born baby’ and he replied ‘we can’t put a price on a life!’ We immediately jumped into action and it was amazing to see how the whole Floating Doctors team pulled together to get that woman to safety. Ben ran to sort the boat, I set up drips and started resuscitating the lady and everyone automatically assumed a role from compiling emergency bags and equipment for the boat to figuring out the logistics of getting this lady out of her small cramped house up the windy, hilly roads to the boat. One thing that struck me during all this was when we were all so focused on the task ahead and I walked into the room where she was and Philippe was sitting on the floor beside her just holding her hand and talking to her. Sometimes in the chaos, we can forget how scared and vulnerable the patient is and just to sit with her and hold her hand and explain exactly what’s happening must have meant the world to her!
From left to right, Philippe, Bethany and Dan.
We got the boat as close as we could to her house and carried her on a hammock from her house to the boat. We were travelling on a small wooden ponga which, for those who don’t know, is an open top boat. We constructed a bed from life jackets and a thin foam mattress and set her down on this on the floor of the boat. The other factor which I haven’t mentioned, was her 8 hour old baby boy. He was wrapped in a thin white shirt and had barely fed since he was born as mum wasn’t well enough. We had to bring him too so we found a small blanket and wrapped him in this and I put him up my top in an effort to give him as much body heat as possible. Many of the locals came to see the boat off and to wish this lady and her baby well. It was pitch dark when we left and we were not allowed any lights as Elvis (our amazing boat driver) couldn’t see if we turned on lights. There was one man at the top of the boat with a torch and he shined it into the air and gave instructions to Elvis on the route to take. We got to the river mouth and Elvis stopped the boat while we waited for a break in the waves. All of a sudden, the man at the top of the boat shouted go and Elvis accelerated. There were massive breaking waves and each time the boat went over one, we were flung 1-2 feet from our seats back onto the hard wood. There were 4 of us on the rescue team, myself holding the baby like my life depended on it, Philippe who literally lay across the woman to try and keep her still and prevent her from being thrown around the boat and Dan and Bethany who took her vitals and held the drip in place to give her the fluids that she vitally needed! I honestly can’t put into words how everyone worked as a team, assumed a role and excelled at it but sitting on that boat getting thrown around the place, I remember thinking that I would trust my life to these people.
Those first 10 minutes in the boat were scary. We couldn’t hold on as we were either holding a baby or drips and at one stage my stethoscope fell overboard. Dan grabbed me for fear I would fall over board with the baby. Finally the waves settled a bit but it was still like we were working on a wooden trampoline! We couldn’t hear the lady’s heart due to the noise, the blood pressure monitor got smashed by the waves and we used only her pulse rate and radial pulse and her degree of interaction with us as markers of how well she was doing. As for the baby, that little boy did not cry or move for the first hour. I was absolutely terrified that he had been hurt by the momentum of the boat or that I had inadvertently smothered him whilst trying to protect him. I couldn’t check because it was too bumpy until we stopped the boat to refuel and the relief to see that little fellah move was incredible.
Dr. Kim checking on the newborn during the boat ride.
During our trip, it also stuck me how amazing the night was. There were so many stars in the sky and the moon was full and bright, there was lightening flashing in the distance and the sea lit up from algae as we sped through it
The trip took approximately 3 hours and we pulled into the dock behind the hospital at 1.30am. The gate was locked and 2 of the guys had to scale a barbed wire fence and run to find help. We got the woman out of the boat and an ambulance brought her straight to the emergency room. We sat outside the hospital for an hour to make sure mum and baby were ok and then headed back to Bocas for the night. Elvis drove us back to Rio Cana at 8am the next morning for the second day of our clinic.
After that, we had no phone reception for 4 days so we hadn’t heard how she was doing. I can’t explain the relief and happiness to hear she was doing well when we got back. I went to Almirante to see her yesterday and walked into the hospital room to see mum and baby alive and well. Mum didn’t speak much but when we went into the room, she looked at me and Sam and gave us the most amazing smile…In that moment, I would have done the trip a hundred more times just to see her smile! Words would not have expressed thanks like her smile did that day – honestly, it reduced me to tears and it’s pretty difficult to look professional when you are crying like a blubbering idiot!!!
Dr. Kim holding the newborn while in looking after the mother in the ambulance.
For me, the whole experience was mind blowing…the way that everyone came together and worked as such a team, no one needed to be told what to do, they just did it. Everyone was selfless and hard working with a common goal- all we wanted was for this woman and her baby to be safe. She’s going back home today and even as I write this, I have tears in my eyes and all I can see is her dazzling smile!
Floating doctors is an extraordinary charity and this is just one small example of the impact that Ben and his team are making on the people of Panama!!
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This week I’d like to share with you our second guest blogger from the Master of Science in Global Medicine program at USC, Lily Sheshebor.
-Kim Olpin Operational Manager
Lily on the dock ready to get picked up for clinic.
The Power of Passion
I have always thought that I wanted to be a doctor. I volunteered at clinics, studied rigorously for my MCATS, and dedicated hours to memorizing facts for my pre-med courses. My passion for medicine was evident, yet my drive to continue pushing through the numerous obstacles before medical school was beginning to mitigate. I was tired, stressed, and scared that I would not become accepted. Attending USC for my Master’s of Science in Global Medicine, I was given the opportunity to study abroad in Panama for the summer. Those couple weeks, while working closely with the volunteers of the Floating Doctors, gave me back the energy for my passion. I quickly remembered why I am committed to the world of medicine.
The first “clinic day” that we had was the most memorable experience of my life. I was very anxious the days leading up to our clinics as I had never worked in rural settings nor an international nation. Stories of past clinics included many infectious and contagious diseases that were somewhat concerning and I was nervous that I would let the group down in terms of executing various clinic tasks. Early morning, we were picked up with a small boat and sailed through the beautiful archipelago of islands to reach the community of Cerro Brujo. Wearing our scrubs and carrying bags of equipment up the hill, I immediately felt a sensation of motivation. I realized we had arrived and we would soon be apart of medical access that the individuals of this island greatly lacked.
Getting your nails painted is a popular activity anywhere in the world.
We were asked by the head doctor, Dr. Ben, to split into groups and inform the community that our clinic has arrived. I wanted to tell everyone and split from our group with another student to cover more ground. Since the people of Cerro Brujo only speak Spanish, my years of high school Spanish were paying off as I told the families and children to spread the news. Once the clinic began to commence, the motivation that started earlier grew into dedication. I did not stop working and loved every minute from checking patients into the clinic, beginning a new chart, taking a medical history and vitals, shadowing the doctors, to the overall interactions with the patients. After our clinic was coming to an end, we were able to distribute stickers, paint the kids’ nails, hand out coloring books, and take millions of pictures. The children were one of the most beautiful children I have ever met. Their eyes were so shiny with excitement that they had new friends and memories aside from their everyday lives. I wanted to give everything I owned to these children from every crayon in my bag to the peanut-butter sandwich and chips from my lunch.
Leaving the island that day, I was not only exhausted from the day’s work but I was in love with the power of helping those in need. I knew that my small part with the Floating Doctor collaboration was important but it was not enough. This organization that has dedicated its life to improving and helping the poor communities of rural Panama is savior of these people. These islands lack money, transportation, clean water, adequate housing and sewage, protection, and care. The country does not care to reach out to these communities but Floating Doctors does. The power of passion is why our world has not yet been defeated. The volunteers of Floating Doctors have that passion and have re-inspired my passion for medicine.
Lily and two other USC students making new friends.
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This past summer we had a number of amazing student groups join us in Panama. One of those was from the Master of Science in Global Medicine program at USC. A couple of the students from that group were willing to share their experience with us. Today I have the pleasure of introducing you to Natalie Reyes.
-Kim Olpin Operational Manager
Adorable Ngobe girl from the village of Cerro Brujo
Traveling to Bocas del Toro, Panama to work with the Floating Doctors team has been one of the most humbling and eye-opening adventures of my life. I have always had a passion for working with under-served populations that have limited healthcare access, however, actually being there on these islands with the indigenous populations was a much more gratifying and awakening experience than I could ever have imagined. The amazing personalities of the doctors, volunteers, and villagers that I got the opportunity to work with truly remind me of the reason I have such a strong passion for medicine and reflect the environment I hope to be surrounded by.
Clinic Day
The experience that Floating Doctors exposed me to on my first day of clinic on the islands taught me so much medically and culturally and allowed everyone within our group to find our own niche within the different roles necessary for a successful clinic. After traveling on a boat bringing all of our medical supplies, we arrived at the community of Cerro Brujo and I was pleasantly enlightened to be greeted by many of the village’s children who could not be more eager and excited to follow us around and talk to us. While many stayed to set up the clinic outdoors, I followed two of the young boys who took me around the entire villaeg, finding houses to let the mothers know we were having a free medical clinic in “el ranchito,” in the central part of the village. I was in complete awe at how rural and isolated these people were from the society I am used to in the United States. Seeing how eager and sweet the children are is an experience worth more than words or photos can reflect. Despite hearing stories of past experiences and being aware of what to expect on the islands, I was surprised by the culture shock I experienced. The villager’s barefoot, simplistic lifestyle was such a difficult,
USC Professor Dr. Meindl-Holman treating a Ngobe mother and her young son.
yet inspiring concept for me to understand. I enjoying being able to get to know entire families during intake and I learned so much from being able to shadow the variety of doctors and medical students throughout the clinic day. It was unreal being able to bring an ultrasound machine into the village and show expectant mothers their child. In one particular instance, we were able to show a mother the heartbeat of her child on the ultrasound screen in the middle of an outdoor, crowded, rural “ranchito” and that is a memory that I will keep with me throughout my medical career.
The ability to practice medicine and help people in the absence of modern day access to technology and hospitals is completely remarkable. Regardless how much time and passion I put into volunteering and immersing myself in the culture of these people, what they taught me and the experience they gave me is worth more than anything I can ever give back to them. I truly thank Floating Doctors for giving me such an opportunity and look forward to returning in the future!
-Natalie Reyes
USC Global Medicine student Natalie Reyes (back row, second from the left) poses with other students, USC Professor Dr. Meindl-Holman, and some local children showing off their new toothbrushes.
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Today’s blog was written by one of our recent volunteers, Dr. Ravi Chokshi, just beginning a residency in Obstetrics and Gynecology. These are his thoughts and impressions of our 4-day mobile clinic up in the mountains to a remote village called La Sabana, or ‘The Grasslands.” Over 200 patients were seen, including pediatric and trauma emergencies. Thanks Ravi! best of luck in your residency, and I look forward to working with you again.
Field Amputation of Small Toe With Digital Nerve Block
He was different at first glance. Quieter. Saw more, spoke little and took his time to smile.
“It hurts here” he exclaimed pointing at his 12 year old heart.
I had examined 20 chests that day, listened to 20 hearts. But only his jumped at me as I lifted his shirt.
A heart that had decided the only way to get noticed was to become outgoing. I place my stethoscope and still the squall fighting within. My ears record and my fingers feel for the familiar radial pulse. There is a flaw here. A Woosh-woosh where a lub-dub should be. I bring over some counsel and we use the portable ultrasound to perform a tropical echocardiogram. What I had heard, we now see. A hole connecting the two atrial chambers of his heart, and a chance to be normal forever taken away.
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By the second morning, we had hit our stride. Awake at 7am with the hum of the village around us. I wish that I could say that I
Morning...Now Get Up And Convert The 'Bedroom' Into A Clinic! Patients Are Here!
slept wonderfully on the hammock. Tied across the wooden beams of the village Rancho, covered in a mosquito net donated by the Lake County Sheriff Cliff Matthews.
I almost did, but the cold from the two rivers that flow around La Sabana got to me.
To build your own bed where the clinic just was. Settle into it with the laughter of new friends around and your mind alive with the memories of the day before you. Of the cold stream water you had bathed in, or the hojaldras and coffee that had started your day. Sleep comes easy and you drift imperceptibly towards it as the days’ labor catches up to you and the hungry river swims around you.
The cold shudders in, and you wake up surrounded by the chatter of excited Ngobe children. A quick breakfast and swim later you are ready for work. Walking back from the river you can already see a mass of patients organizing themselves around the rancho. In 10 minutes a fully functional clinic sits where we had just dismantled our bedroom. A pharmacy lies ready and capable. Our amazing interpreters have already lined up patients, sequestered the roving bands of excited children and started patient intake. I sit with my stethoscope around my neck, a clipboard on my school desk of a chair and try to look ready.
Filling Up Fast As Word Gets Around...
This is impossible.
And we begin! In groups of 4 to 6 the mothers and fathers patiently answer my questions posed in broken Spanish while the kids run around, openly gawking at me and my strange tools. As I address them, smiles break out. They are terribly shy and hide their little faces in their mother’s dresses. But I bring them out and I let them listen to their heart beat through my stethoscope and I see their eyes widen and them calling out their amigos to do the same. ‘Ahh this crazy gringo is funny’.
I hear about coughs and colds, about chronic pain, about diarrhea that just won’t go away. I examine distended bellies and the scars from years of no-see-um bites and battery acid burns from cured cutaneous leishmaniasis. Most of all I see the relief as I dispense Albendazole like candy telling them, “Este Medicamento va a quitar las lombrices de su estomago y su piel”. And I urge them to eat it in front of me. I work in a chain with 4 other doctors, most with many more years of experience than me and I confer with them constantly. I learn to recognize scabies and lice and infected wounds and what treatments we can offer for such. I get called occasionally for my input on obstetric patients, being that it is my area of interest.
Using the Sonosite I am able to show a woman 7 months pregnant her unborn child’s face and lips and nose. The kick she feels – she now sees and she can’t stop smiling. In a place where most of the people have never seen an outsider, a white person, or even a TV an ultrasound is magic and we are a mystery they are too polite to solve.
We are observed constantly. And for good reason. In a place as isolated as this from the rest of the world, we are as alien to them as
Most People Living Here Have Never Been More Than 10 Miles From Home
imaginable. Taking a picture of the children and showing it fascinates them. Then I realize why. There are no mirrors here, no still water. Their first good look at themselves is thru the lens of my camera.
These are the Ngöbe-Buglé Indians, Panama’s largest indigenous group. After years of historical fighting they were allowed to retain their ancestral lands largely confined to the western rainforests of Panama. Here in their Comarca, they implement their own system of governance and economy. In terms of healthcare they have a raw deal. A long history of poor interactions with outside groups (pretty much everyone since the first explorers) has left the Ngöbe understandably skeptical of ‘Meriginees’ (non-Ngabe people). As the mother of a very sick Ngöbe child put it to us, “the hospital is where we go to die.” Language is another barrier. While the Ngöbe men have reason to conduct business with communities in close contact with the mainland and thus have some Spanish speaking skills, the women and children are different matters. Not being able to speak Spanish in Panama is as isolating as it gets.
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Day 1
La Sabaña, the remote Ngobe village that we have made our way too, is one of the more isolated communities dotting the Chiriqui
Don't Let It Get Above Your Boot Tops! Too Late!!
province of Panama.
Our journey there begins at 5am from Bocas marina, where the Southern Wind currently rests.
A group of 9 odd, we sleepily catch a water taxi to our first destination – the port town of Almirante. Blazing through the Caribbean on a 200 horsepower boat is enough to get everyone up and awake.
?Costa Rica!, usted? is the banner cry as we disembark.
Ahh Almirante. A hastily thatched together port town created entirely by the Chiquita Banana Company, it is best described as a jump off point to better places.
Brushing off the taxi drivers, we find ourselves in a car on a 90-minute ride to the sleepy little village of Pueblo-Nuevo. A tasty Panamian breakfast of fried bread and coffee awaits us and now we are ready for our hike. Ben has hired horses to carry the supplies up the slope, while we carry only water and essentials on ourselves. A 3-hour hike when dry, 5 plus when wet and we approach La Sabaña by late afternoon.
La Sabaña – literally translating to ‘The Grasslands’ is a mesmerizing place. Found at the crossing of two rivers, its thatched huts and raised wooden floors are as living artifacts to the age before Panama won the geographical lottery and started collecting revenue from the canal. The Ngobe here live simple lives, the men work in agriculture and raise animals. The women take care of the children and keep the house, all while dressed in the colorful patterns unique to their culture.
It is here we are most in need.
Day 2:
Along with the storm, comes the call from up the mountain. A child has been hurt severely, on his foot by a self-inflicted machete cut. Ben quickly
The Second Toe Can Be Saved; The Small Toe Has To Come Off...
dispenses half our group with the general surgeon on a race up the slope. I am part of the group that stays behind, together seeing the last few families waiting to be seen. The number of patients has been growing larger every day. Word has gotten around about us and families have traveled on foot for many hours to see a doctor, possibly for the first time in their lives. I have to remind myself of this, as I quietly ache to learn what is transpiring with our other half.
Hours we wait, the rain pouring down, the darkness absolute. The conversation feels forced, every one’s mind on our missing party and what has transpired with them.
Moments before a search party must be raised, their lights are spotted, little moonbeams making their way down the muddy path. They have returned, soaked to the bone but with stories to tell.
It had been necessary to amputate the 10 year old child’s little toe. Amputate it. In the darkness, working on a wooden floor guided by headlamps.
They had quelled the bleeding, stitched it together and addressed his pain as best as they could. We would return the next day with antibiotics and supplies to redress the wound. To leave supplies and to teach the family to keep the site clean. And a phone number to call, just in case.
Day 4:
He Deserves Access To A Doctor If He Gets Sick!
By our last night the hammocks come up like clockwork. Clinic today had been a sold out success. Patients came from all around the mountain, with many families walking a day’s journey to reach us. We had worked like a well-oiled machine.
As we pack our boxes for the long journey back, the stories come through.
And its not the number of patients seen that we count, but the tooth brushes we had run out of. The soap we had no more off. The medicine for scabies we had to deny.
If there were patients to count, they were the ones we now had the responsibility of following up on. The 12 year old that needed to see a pediatric cardiologist. The women with suspicious breast lumps that needed mammograms, and the ones we couldn’t quite put a diagnosis on out in the field.
Ben and his crew will arrange transport, appointments with the necessary consultants and provide a voice of advocacy to accompany these patients.
What I have seen here erased all presumptions I had before the trip. We were there to see patients and dispense medicine yes, but much more importantly we were there to build trust. To raise the community up bit by bit. To give out toothbrushes and teach kids how to clean their teeth. To teach mothers to recognize dehydration in their children and how to make ORS. Most of all, to provide the village with an avenue of communication they could rely on when posed with a serious problem.
I had been promised an experience of a lifetime when I signed up to volunteer. I say they undersold it.
Our Patients And Friends From La Sabana
Four days I lived alongside the Ngöbe Indians. Absolute cutout from the world I knew and an absolute outsider to this hidden world that time had forgotten. I almost died. I very nearly lived. I fell in love again. I yearned to go on, to live this fantasy of waking up in a hammock with lines of patients to see and a fast flowing river to bathe in. Four days is much too short but somehow felt like a lifetime in terms of lessons learned.
In a few short weeks I will return to the US to train in one of the most developed and technologically advanced healthcare systems in the world. I will learns volumes everyday and gain skill sets I ache to possess. But it will always be in a remote Ngöbe village in the protected area of western Panama where I first really learned the gravity of the promise we make everyday on saying these words, “Me llamo Ravi. Soy su Doctor”.
Added by Ben La Brot:
“It is from the numberless diverse acts of courage and belief that human history is shaped. Each time a man stands up for an ideal or acts to improve the lot of others or strikes out against injustice, he sends forth a tiny ripple of hope, and crossing each other from a million different centers of energy and daring, those ripples build a current that can sweep down the mightiest walls of oppression and resistance.”
–Robert F. Kennedy speech in South Africa, carved in stone on his grave.
"Me llamo Ravi. Soy su doctor."
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