As the last days of the year draw to an end, I’ve been handed an impossible task.

It is traditional for NGO founders to write a post at the end of the year to summarize the work of the past year and to share with everyone the vision for the year ahead. When I sat down to do so, I momentarily panicked….how can I, in a few words, convey even a small sense of what hard-won achievements by our staff and volunteers this year? We grew from a single team to two medical teams and a dental and veterinary team deploying nearly every week. We launched a surgical program and our veterinary program blossomed. We made many new partnerships and grew our infrastructure, including building a laboratory. We published research. Patients received impossible treatments such as a new heart valve.  I could go on and on well into the new year and never do justice to the victories for humanity won by women and men whose names will likely never be known to the world but whose kindness and courage will never, ever be forgotten by the people whose lives they impacted.

People like to lament how there is so much ugliness in the world, and my dad is fond of saying, “Of course there are ugly things in the world. For example, there are people dying of cancer in a hammock hanging under a shack in the jungle, and that is a horrible injustice.  But there are also people–total strangers–who will pull that person out from under their house, clean them up and do their best to help them not die in pain and alone. And this is a beautiful thing in the world; an astonishing miracle.”

And it was this taking such personal responsibility for strangers that I watched my team do all year long that really struck me. People talk a lot these days about ‘Global Citizenship’ and ‘Global Leadership’ but I think both of those terms lack something.  ‘Global Citizenship’ seems to indicate merely living in the world, passive, and ‘Global Leadership’ smacks of the hubris of knowing better than everyone else what is needed to lead the world to righteousness.

And finally this fall I realized what it was that Floating Doctors inspires in our volunteers, our supporters, our communities, and ourselves–Global STEWARDSHIP:  the commitment to stand up and make a better world our own personal responsibility, in whatever ways we can every day. And that may seem like a semantic difference, but I think it is a critical one.

Every evening that I can, I take my daughter (who just turned 1 year old) outside when the sun is setting and hold her to the west and I whisper in her ear. I say to her, ‘Look Aya, the sun is setting. This day is done, and will never come again.  There will never be another day like it as long as we live; we can never return and change it. Were we kind and loving today? Were we honest and truthful, with others and with ourselves? Did we work hard? Did we find time for play? Did we find an opportunity to show compassion, forgiveness, courage? Is there something we put our hands on today that was more like us when we took our hands away?”  I have no idea how much of what I say she can understand…all I know is that she definitely understands more than I think she does. So this is what I tell her…and, truth be told, I need to tell to myself every day also.

She’s too young to to know that of course, it’s impossible for us to do all of these things every day.  We are not saints. But it’s important to always aim high. After all, when you study for an exam, would you aim to get a C? If that’s as high as you raise your sights, that’s all you’ll ever achieve. Living things aren’t made to aim at mediocrity. All things strive–every living thing strives in an unforgiving universe, and to be human is to often stand with our feet in the mud, but reach always upwards towards the stars.

The best part is that we don’t have to achieve all those great things every day in order to change the world.  We don’t have to free a nation or launch a movement or solve world hunger. As Bobby Kennedy said, “Few will have the greatness to bend history itself, but…it is from 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 which can sweep down the mightiest walls of oppression and resistance.”  That still chokes me up very time I read it.

As you watch the sunset tonight wherever you may be, decide how you want to mark the end of the end of this year, for it will never come again.  There will never be another like it as long as we live; we can never return and change it. But it is not too late–there is still time to show compassion, to be kind and loving, and to choose to be a steward of this world and send forth a tiny ripple of hope.  2018 was a year of staggering accomplishments by our staff and volunteers…but we are just getting started. A million different centers of energy and daring are building; the current against oppression and suffering will continue to grow but only with your help.  A very funny and very wise lady, Lily Tomlin, said “I always thought ‘Somebody should do something about that.’  Then I realized I was somebody.”

Be somebody today, so that when the sun sets tonight, you can look to the west and hold your head high because in the twilight of the 2018 you put your hands on the world and made it a little more like you–a little more compassionate and caring–when you took your hands away.

Thanks for an amazing year, everyone.  If you thought what we all accomplished together this year was something, just wait.  We’re only getting warmed up.  Happy New Year Everyone!  Próspero Año Nuevo!

Fair Winds

Dr. Ben LaBrot

by long-time volunteer Dr. Anna Bazinet

Dr. Anna

At 9 years old, Mariana was confident, outgoing and so excited to see all the equipment we were unpacking that morning for the day’s medical clinic. She eagerly watched us set up the small pharmacy with medications, a scale, and a few blood pressure cuffs. She was wearing a bright green nagua, a traditional dress of the Ngäbe-Bugle people, but this was not the most striking thing about her. On her left cheek, she had a 3×3 centimeter ulcer that fortunately she seemed relatively unfazed by. As we continued to set up for clinic, I leaned over to Dr. Ben LaBrot to ask him about this lesion. Without skipping a beat he said, “leshmaniasis, a skin parasite that is carried by the sandflies.” I have since learned more about leshmaniasis and other fascinating parasites, but see this moment as the beginning of my interest in tropical medicine.

We hope she’ll be inspired to pursue medicine

We later saw Mariana and her entire family in clinic and after learning more about her and performing an exam, we helped with the things we could but ultimately had to make the recommendation that her parents take her to the district hospital for treatment. The medication used to treat these lesions, a long course of pentavalent antimony, was beyond the scope of a one-day clinic. The family thanked us, and Mariana gave me a hug at the end of the day. I think she enjoyed watching us work and seeing patients.

This encounter happened during one of my first clinic days 7 years ago when I was first a Floating Doctor volunteer. From then on, I was hooked. I loved learning whatever I could about tropical medicine. Who would have guessed at my fascination with intestinal parasites and leshmaniasis? But, beyond the medicine, I loved the communities we were serving. I loved learning about the culture and language all while traveling by boat and regularly seeing porpoises on our commute to work. During this first trip, I had the opportunity to be in Panama for about 7 months before needing to return to Seattle to start medical school. I remember feeling very torn, both excited for the next step in my training, but sad to have to leave a part of the world I had grown to love and a set of incredible people.

Can’t beat this commute

Looking back, my current career path was heavily influence by this time in Panama. The mentorship and leadership that I received by Dr. Ben LaBrot and some of the other providers is one of the reasons I am currently training in family medicine. I love family medicine as it allows me to develop long-lasting patient relationships, connect with the broader community, and tackle some of the challenging issues facing patients today including healthcare disparities. This work is not unlike that of the Floating Doctors.

This September, after 7 years, I finally had the opportunity to make it back to Panama. I honestly didn’t know what to expect, I had heard rumors of new volunteer bunkhouse and base, 20 staff members, and a formal pharmacy, all of which were just dreams 7 years ago. And indeed, I was astounded by the amount of progress Floating Doctors made!

A view of our base… a far cry from living aboard Southern Wind

I will admit I was a bit nervous getting into the boat on the morning of the first clinic. Would I know enough? Would I live up to the providers that encouraged me along the path I am on? My nerves quickly faded as I picked up the first set of patient charts and sat down with a mother and her 4 children. My Spanish slowly came back and I started taking a history like I have done hundreds of times in many different situations. Despite the surroundings, seeing patients in Panama feels similar to the US. The chief complaints are for the most part similar; headache, rash, knee pain, back pain and insomnia. One thing I must admit is that for abdominal pain, I was not as accustomed to asking patients if they have seen worms in their stool!

Preparing the pharmacy for patient follow-ups

Although so much has progressed with the Floating Doctors since I had been away, I was also amazed at how similar it felt. Even though they have been able to see more patients, do more clinics and keep better records, the sense of mission and commitment to the Ngäbe communities was completely intact. The feel of the clinics, the patients, and the empathetic care they receive was all just as I remember it. And finally, the organization still depends on everyone bringing new ideas, energy to problem solving and the occasional stroke of brilliance to push things forward.

There’s a lot of need for good problem solving when it comes to community healthcare in Panama. Even with all of the progress, I worry about the Ngäbe communities and the individuals I met. I worry about their increasing access to processed foods, snacks, sodas which is leading to increasing obesity rates, hypertension, and diabetes. These can be challenging issues to treat in remote communities where medication adherence and the need for at least occasional monitoring is important. This is coupled with a national health care system that makes it challenging for Ngäbe patients to get the care they need when they go to the larger hospitals.

Remote communities combined with poverty and make regular access to healthcare via the state system difficult

During this most recent trip, I couldn’t help but think back to Mariana and wonder how she was doing. I could imagine her as a great doctor herself someday, with her inquisitive mind and openness with me 7 years ago. Unfortunately, I know that is a long shot for her as she is likely still living in a community where ~60 percent of people over 10 are illiterate and ~91 percent of people make less than $2 a day. For me, this is the challenge of working in Global Health and what keeps me engaged and passionate. The inequalities seem vast and sometimes insurmountable. I am constantly reminded of the work that needs to be done. I am so thankful for organizations like Floating Doctors who are able to slowly work towards change. After my time in Panama, there are a lot of projects I would love to work on, but alas, this only ensures that I will be back, hopefully sooner than 7 years…and when I come back, I can’t wait to see what Floating Doctor’s dreams have become reality.

by Veterinary Lead Dr. Thomas Easley

Dr. Thomas Easley, Veterinary Lead

Veterinary Public Health (VPH) is an essential component of public health and incorporates various types of cooperation between the many relevant disciplines involved in the interaction between people, animals and the environment they share. VPH programs should not be viewed as operating in isolation, but as making an important contribution, as part of an inter-sectoral collaborative approach, to the improvement of a country’s infrastructure, economy and rural development.

Since the profitability and therefore the supply of private veterinary services is governed by several factors arising from economies of scale, such as the size of the livestock enterprises in the locality, the nature of potential or actual diseases, and the types of animals raised in the production systems, in areas where private veterinary work is unprofitable or where other types of market failure occur, economic or social concern usually makes some type of public intervention necessary.  Providing this intervention to the marginalized indigenous communities of the Bocas del Toro archipelago is where Floating Doctors shines like a beacon in the night.

The health of animals in a community affects everyone in the community

Floating Doctors has integrated a VPH program into their daily operation for two important reasons.  The first being focused on human health in that domestic animals (including cattle, goats, sheep, pigs, poultry, and dogs) of poor people can be important reservoirs of zoonotic diseases that impact on their health, either through direct or vector-borne transmission routes.  In addition, history has shown us that zoonoses falls disproportionately on poor people with poverty, and unsanitary living conditions associated with poverty, being considered potential risk factors for zoonotic and food- and water-borne diseases in many areas of the developing world. The low standards of education and veterinary public health services commonly associated with poverty and marginalized communities increases the risk of transmission of zoonoses and food-borne diseases.

More importantly, and the second reason, Floating Doctors understands One Health and perseveres to integrate its implementation into all of their activities.  While One Health initiatives have traditionally focused on threats to human and animal health, such as zoonoses and a secure food supply, they have not typically promoted an understanding of the many beneficial physical and psychosocial impacts of human-animal relationships and how these can be leveraged to improve both human and animal health around the world.  Additionally, current One Health initiatives are undertaken at international, federal, and provincial levels yet often fail to have an impact at a community and primary care level, especially in poor/marginalized areas.

Treating a pig in Bisira- sometimes, a second set of hands is necessary!

The Centers for Disease Control and Prevention’s definition of health is “a state of complete physical, mental, and social wellbeing.” This definition has included not only physiological, but also emotional and social (behavioral and natural) states as are often described in the definition of good welfare. It is well-recognized that where there are poor states of human welfare there commonly exist poor states of animal welfare. Similarly, animals often act as indicators of human health and welfare, as can be seen in the link between animal abuse and family violence. Considering health and welfare together — because of the interconnections of human-animal-environmental factors — helps to describe context, deepen our understanding of factors involved, and creates a holistic and solutions-oriented approach to health and welfare issues.

The North American Veterinary Medical Education Consortium (NAVMEC) has identified knowledge of One Health concepts and principles as a core competency for veterinarians who will graduate in the 21st century. Despite widespread exposure and support of One Health concepts, a recent survey of veterinary students at Colorado State University demonstrated that few opportunities exist within veterinary curricula for students to get involved and gain practical experience in this area. To fully realize One Health concepts and principles and ensure their promotion by future health professionals, veterinary students require tangible, specific applications.

Veterinary Public Health includes teaching a community’s humans how to treat and care for its animals.

Important goals in teaching are to challenge veterinary student perceptions and facilitate opportunities for not only applying and practicing core learning, but also learning how veterinarians are connected with their communities and with society as a whole. By understanding these concepts, opportunities are provided for long-term personal growth. For many veterinary students, identifying their role in the community as an individual and a professional can be challenging. After all, most of their adult lives have been spent in a focused pursuit of admission into veterinary college. Moving away from this singular goal and exploring their sense of self, their perception of service to others, and recognizing their inner potential to care and empathize with marginalized individuals is desirable both personally and professionally, with significant positive impact for society as a whole.

In a One Health model, factors contributing to each sector — humans, animals, and environment — are studied. Within veterinary medicine and particularly within the veterinary curriculum there is understandably a focus on the animal sector relative to the human and environmental sectors. However, in clinical practice and in community health, equal knowledge of all sectors is required. With Floating Doctors, the outreach experience provides students with the unique opportunity to gain more knowledge, acceptance, and understanding of a marginalized human sector and how the well-being of both animals and owners are intertwined.  Through a One Health lens, the increased empathy, compassion, and stewardship of early career veterinary professionals will undoubtedly lead to improved animal and human welfare, and thus improved community health.

Floating Doctors’ One Health engagement initiatives with the marginalized indigenous communities of the Bocas del Toro archipelago include the integration and community-level collaboration of veterinary teams with human healthcare providers. This team approach serves to cooperatively improve the health and welfare of humans and animals, demonstrating that veterinary care can act as a direct avenue to improve health and social service delivery for underserved populations.

Not only do students gain an appreciation for the power of the human-animal bond, but they also witness how it can be leveraged to motivate changes in behavior that benefit both human and animal welfare. By supporting and maintaining the human-animal bond, students also begin to appreciate that their work extends beyond the health and welfare of animals, but also directly benefits the psychosocial and physical health of their clients.

NOTE: For additional information on the One Health Model, please visit the One Health Initiative website and the American Veterinary Medical Association’s page on One Health