I distinctly remember the morning of my first mobile clinic with the Floating Doctors. Only knowing the small group of UCLA nursing and nurse practitioner students in my group, we were anxious and excited to get started on our first full day of volunteering. We quickly began shaking hands and making introductions unaware of the incredible experiences we would all share together over the following ten days.
Within minutes I had met an orthopedic surgeon from Germany, a medical student from England, a nurse practitioner from Boston, and an emergency medicine physician from Australia (among many others). While from all over the world with widely different levels of experience and training, here we found ourselves together on an island in
Panama sharing the same goal to provide healthcare to those who would otherwise be without it.
We all got to know each other quite quickly to say the least. Within minutes of meeting my fellow volunteers, we were pushing off, sitting shoulder to shoulder in a hollowed out tree trunk (literally) destined for Bocatorito, a small island about an hour away from FD’s headquarters. En route we shared stories of our past medical volunteering experiences and all agreed that even already we had never been a part of something like this.
Within a half hour of reaching our destination, I was immediately put into situations even five years of working in a busy trauma ICU in Los Angeles couldn’t have prepared me for. For example, after learning one of the women on a nearby island had just given birth, I experienced firsthand just how challenging it can be to count the pulse of a newborn infant with a wild parrot squawking away on your shoulder. Later on that same day we performed another house call, this time to a frail diabetic woman. We were able to deliver her much-needed medications, provide her with important education, and also leave her ten other family members with soap, toothbrushes, vitamins, and some toys for the kids. The smiles and waves we received from the children as we motored away from their dock is a mental image that I hope to never lose.
Over the next ten days, each experience proved to be something more unique than the day before. All throughout the trip our team of doctors, nurses, translators, and administrators worked, sometimes into the night, allowing us to see up to 140 children and adults in one day. Thanks to the diversity of the group of medical volunteers we were able to see patients of all ages and requiring all levels of care. The presence of our ultrasound technologist allowed us to perform pivotal pregnancy check ups, while our surgeon performed much needed wound closures. I was even able to use my intensive care background to assist when a decompensating patient arrived at our clinic hypotensive, tachycardic and in respiratory distress. After stabilizing her with IV fluids and performing a diagnostic ultrasound our team was able to safely transport her to the nearest hospital and receive further treatment.
After days of traveling up and down the Panamanian coast, our trip began to come to a close. On one of our final nights in Panama the volunteers threw a “family dinner” at the Floating Doctor’s headquarters. After enjoying the food and conversation, I took a step back and looked over all of us who were complete strangers a week ago, now sharing laughs and stories like old friends. Looking back now, it’s easy to see how a group of dedicated volunteers, sharing a common goal to help others, could result in such a meaningful experience as the one I shared working with the Floating Doctors.
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.
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.
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
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.
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
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.
La Sabaña, the remote Ngobe village that we have made our way too, is one of the more isolated communities dotting the Chiriqui
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.
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
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.
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.
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.
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I believe everything that we do in this life has a cost and a benefit associated with it—at times the cost that you pay for the decision you have made far out weighs any benefit you may gain while the profit that you get from another totally justifies the negatives. A cynic would say I view everything through a ‘cost analysis’ in my life and in many ways I believe that is a true statement. On this stormy day in Panama with inches of drenching rain replenishing the jungle around me I find myself thinking of what prices I have paid, both good and bad, for the decisions that I must call my own. April 27, 2012 marked my 1095th day out of Los Angeles and away from ‘my’ life, or rather, the life that was once mine. Anniversaries to me are not a time to celebrate but rather a time to reflect upon what has transpired, the roads you have traveled and where they have taken you, how you have acted, and if those actions sit well with you after time and perspective.
Last week’s multi-day mobile clinic led us once again to the shores of a rushing jungle river to bathe and wash away the stress, sweat, and sadness of the clinic. There is nothing like plunging into the cold hastening current of a
river that has cut itself through miles of remote mountains before touching your skin. Its pace caresses the beautiful pain of the day out of your body in ways that are indescribable and leave me refreshed like no other body of water does. I have done this countless times before, but this time, as I sat with my volunteers between the smooth river rocks and watched the Ngobe Indians of the village make their chest deep evening river crossing home with kids and animals in tow I was struck at how far, in every sense of the word, my life has come in these last three years.
In the past I have done my best and most profound thinking in the shower. With hands propped high on the wall in front of me, head slung, eyes closed, and hot water pouring down my back I come to my greatest conclusions, my most honest thoughts, and in all truth, it’s the time that I also allow myself to feel the emotions of my life. As a result the shower has been a deeply personal place for me—private, unavailable, closed, and bare. My perfect place for reflection, tears, laughter, and thought. I have not had many of these moments since I left the United States—conservation of water on the boat, public showers, no showers at all, no hot water, bucket showers, etc have all been barriers between me and my time in the comforting steam and solitude of my once were showers. I have often missed them – one of those daily luxuries that I never even contemplated as a luxury before I left home. The ability to walk barefooted out of my bedroom into a clean (well most of the time) bug free space, turn a faucet, slip my towel off, and bury my head under the seemingly never ending warm clean water is something that now seems so foreign and long ago to me. A price that I have paid for leaving home- it doesn’t seem like much, but on those cold and windy nights on Haiti’s northern coast when showering with a cold 5 gallon bucket of water that we lugged from 2 miles away, it really did.
It’s funny, to me, the things that I have ended up longing for… none of them are what I would have guessed. My mom’s hands, driving on cold nights with the heat on and the windows down, my best-friends green place holders- all small and ordinary but when I conjure them up in my mind I never fail to get a lump in my throat. The life that I have chosen is full of people but can be desperately lonely at times and I crave the company and comfort of those that I left behind. I have wished that I could have carried so many of them with me over these years and shared with them the beauty that I have witnessed and humanity that I have gained. The person that I was when the plane lifted me away from Los Angeles in April of 2009 is not the same woman that sits in front of this computer today and I have come to realize that the biggest price I have paid for my experiences here has been the loss of my old ‘me’. But, as fire is to forest, this death has brought forth a budding growth of spirit, heart, and perspective that makes the pain of this change worth it.
The three years after leaving has blessed me with bonds of love like no other- ones that can only be forged, both metaphorically and physically, through black stormed filled nights far from land with only each other to look to. The love of stranger children across 5 different countries whose affection comes with no strings attached and no expectations to fulfill- simply love for love and affection for the simplest of gestures. In Haiti when you would give a child a juice or a soda they never fail to share it with the kids around them… sometimes 10 of them passing around a bottle of juice, each of them taking a small sip and then passing it on, even though you never tell them to share, they do. And they do it out of goodness of heart and the common understanding that this gain should be shared with those around them. To me that is witnessing the goodness of humanity at its most basic element and I am grateful beyond all measure to have been that witness.
As I sink my head below the river of my experiences now I have come to deeply realize that life truly is change and the flow forward never allows for anything to stay the same. The life that I left behind was changing while I was there even if I couldn’t or wouldn’t at the time see it. Often people that knew me back at home say that I gave up my Manolo’s and Jimmy Choos’ for Wellingtons and flip flops- this always makes me smile. For me, what I gave up, was my quiet warm lonely showers surrounded by beige tiles for smooth rocks cut out of mountains, rushing jungle currents, and the sounds of life penetrating every pour that I have.
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,
Director of Operations, Floating Doctors