by long-time volunteer Dr. Anna Bazinet
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 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.
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!
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!
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.
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
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.
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.
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.
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.
By Gloria Obialisi, USC Medical Student
I don’t know how to swim. Well, if I had to freestyle across a pool, I can maybe do it for 25-50m, but honestly, I’m not even sure if I can do that anymore. I’ve taken three swimming classes and have never been able to let go of the wall in the deep end. It’s just too scary. Of course, I’ve known for months that I would have to commute via boat to not only get to the Floating Doctors’ base, but also between islands for clinic. However, I just didn’t pay it much attention. Prior to leaving, I did not give myself a pep talk, because I had confidence in the captains hired by FD and certainly didn’t want to entertain the thought of anything going wrong while I was on a boat. I was either in denial of my fears, not in tune with them because of all the hype and energy from the other members of my group, or I simply was unaware that the fear no longer existed.
It wasn’t until the middle our first boat ride from Bocas del Toro to Isla San Cristobal, that as I looked from left to right and saw nothing but miles of seawater that I thought, “Oh crap, what am I doing here?” Had I let my mind run wild, I probably would have started hyperventilating, but I tapped into my deeper feelings and realized that I actually loved it. I loved the cool gentle splashes of water hitting my sweaty face, I loved knowing that we were free from 405 traffic, and I loved sitting atop that beautiful water with not a care in the world. After several boat rides -some a little bumpier than I would have liked, I started to envision myself surfing the waves. This newfound love grew day by day and to this moment I am still eager to become a better swimmer, so I can finally explore the world of surfing.
When I signed up to volunteer, I thought at most I would be able to further delineate my niche under the umbrella of public health, but thanks to Floating Doctors, I’ve now discovered a love for the seas and a hungry desire to learn how to surf. Sure, it’s great having become aware of this, but it was but a single jewel compared to the heaps of treasures unearthed during the entirety of this trip.
The Asilo is a government-funded nursing home for individuals who are without family or friends to offer care for them in somewhat their later stages of life. Several students and I had the opportunity to visit this place while other members were at the first multi-day clinic for the week. We split into pairs to check the resident’s blood pressures, play games, color pictures, chat about life before the Asilo, and so forth. While all residents were quite impactful, two stood out to me the most, a woman and a man who I’ll refer to as Emilia and Arturo.
Arturo was the first male patient I interacted with there. He was sitting in the corner of the male quarters in worn-out clothing facing a wall, and fidgeting. I walked to him with a fellow Global Medicine student and asked if I could sit on the bed across from him. As my partner turned the pages of her book to locate his file to record his BP, I commenced to make small talk, asking him what he did today. He made eye contact very rarely and spoke slightly incoherently. Perhaps I would have caught more had I practiced Spanish more frequently. In the middle of his ramble, he turned 90 degrees to me, looked square into my eyes and said, “I am very sad. Do you know what it means to be sad?” As I tried to comfort him and ensure him that I understood, he simply turned his head back to the original position, facing the wall, and continued mumbling.
As bleak as this experience was, I found gratitude in the Asilo. People here have no one to look after them. I spoke with colleagues later, and they shared that he cheered up after receiving some cookies. I cannot imagine what his life would consist of would it not be for the Asilo. There he had caregivers, other men to keep him company, regular meals, and visitors like us who understand the importance of caring for these populations.
Emilia was the opposite of Arturo, but again, gave me an overwhelming sense of gratitude for the Asilo. It was almost as if she was running to meet us when we arrived. Her joy and eagerness to mingle with each of us enveloped the whole room. She was extremely excited and bubbled all about the room. Emilia like her sister has a cognitive disability and if I am remembering correctly, was brought to the Asilo because her mother could no longer care for them. Well into her 30’s, Emilia was the only future I could think of when I later met a boy on a different Island, who was12 years old and also with a cognitive impairment. Was this the life he would end up living? He too was characteristically full of life and quite bubbly, but his community lacked the resources to give him the attention and specialized care he needed. Even if he didn’t end up in the Asilo, I am incredibly grateful that it exist for people like Emilia and Arturo. There they have a new family and support during their vulnerable years of life.
On Day 2 of the multi-day clinic at Playa Verde, I was invited to go on a house call with Dr. Ben, a fellow USC student, and several medical students from Dublin. As we walked from our clinic area into the community, we briefed ourselves on the case and reviewed the patient’s file which was only gathered from her visits to previous FD clinics (talk about building your own health system, huh). We were prepared for what we would potentially face once at her home, but we did not anticipate such a long, steep trek there. At the top of a hill, we gazed out from behind the luscious trees at the beautiful beach. It was a metaphor to me of the incredible outcomes of doing such mission work. We push ourselves and give our best to serve these people, and in the end, with sweat pouring down our faces and oozing from all crevices, we reap beautiful results.
Something particularly funny to me after having seen the patient with Dr. Ben and later discussing a possible case of metastatic uterine or abdominal cancer, was my encounter with some of the local children. I climbed over the ledge of her house and jumped down only to meet a little girl that was utterly fascinated by my skin complexion.
“Where are you from?” she asked
“The United States, but before that, Nigeria in Africa.”
“Yes” (She looked at me with both confusion and skepticism.)
“Where is that?”
“Far, far away from here.”
“How many countries do you have to pass to get there?”
“A lot, maybe 10” (of course I didn’t know)
“Are the people good or bad there”
I tried to hold in my laughter as I replied, “Both. Same as you have here and everywhere else in the world.”
After we talked a bit more, I learned that I was the first black person she had ever met. How interesting that she was first curious about the character of our people. I’m grateful to be the first “Chomba” she met, thanks to FD, and hope I left a good impression for others. How I’d love to re- visit and teach her a lot more.
Aside from gaining exposure to many health issues and recognizing common chief complaints, one of the benefits of being assigned to the intake station during clinic is that you have a chance to meet many families and entertain their children while other team members try to take mom, dad, or grandma’s pulse. As a pre-school Sunday school teacher, I appreciated this opportunity to express my heart for children. Sometimes I had to play games to try to vitals from toddlers, and once I had to carry a very heavy, sleeping 1-year old while quietly altering my voice to feign excitement at nail clipping supplies to console his hysterically crying cousin.
These kinds of situations though somewhat difficult, are valuable because they highlight some of the difficulties in these communities like the lack of enough children supervision. The child’s mother would not have been free to provide a urine sample if I were not watching after her kids, and my partners could not perform the test if they were also holding a baby or trying to quiet another. I believe this patient had the confidence to travel to clinic with her children because Floating Doctors had already established a reputation that we will do all in our power to advance the delivery of care.
“Why do these people even matter? Why did Dr. Ben start this and why has Floating Doctors grown to the extent that it has? What do the few staff and revolving volunteers see in continually coming and putting themselves through this?” These are the questions that surfaced one morning as we traversed soaked and huddled, head down, through the pounding, blinding rain. It literally felt like it was blinding because our eyes were burning. One girl was moved to the point of tears, others found it exhilarating, some felt numb, but all I could do was try to find the answer to those questions. We weren’t traveling with a camera crew, there was no Noble Prize waiting for us at home, we weren’t getting paid exorbitant salaries, and we certainly weren’t getting guaranteed acceptance letters to the doctoral programs of our choice.
So, why then? It was a rough start to the trip and probably one of the most difficult second to having to use the possibly toxic latrines outside of clinic. I am grateful for that incredibly uncomfortable and trying time on that boat because it was at that moment that everything became real to me.
Certainly, as an aspiring physician and one who is especially interested in helping under- served communities, I knew this type of work was important to the development of my career and these were at minimum, valuable steps we could make to aid the physicians and bring healthcare to neglected communities. Here we were literally sailing to a remote island with people who would probably find a way to keep happily surviving even without our service, and all I could think of for that brief moment in time was that jarring question “Why do they matter?”
It was as if the sun emerged from the behind clouds and the rain vanished when I finally began to answer those questions. Health is a human right. So long as you are living and a human being, you deserve medical attention. In a world where technology abounds and people have been flying to the moon, surgeons are transplant faces, and we’re able to eradicate monsters like small pox, these people deserve to receive even the most basic form of healthcare. Whole communities shouldn’t be afraid to name their children until age 3 due to the unacceptably high infant mortality rates. Loving fathers and husbands deserve get treated for chronic pain or injuries sustained by the difficult lifestyles they live in order to provide for their families. Health is a human right.
This is why that short moment of salt water burning my eyes and having my wet scrubs clinging to my entire back was so important. Because health is a human right, and they matter. Neglected communities are also our responsibility. We seek not fame or recognition, just satisfaction in knowing we helped another person and we are strengthened by the beautiful, grateful smiles.
By Katherine LeTendresse, Student at Global Medicine Program, USC
Floating Doctors Volunteer
From the first hours encountering the health professionals who volunteer with or work full time at Floating Doctors, I had the feeling that the week ahead of me would be filled with interesting cases to learn from. What I realize now is that the cases, no matter if they were routine or unique, have filled me with a renewed sense of compassion and helped me apply the concepts that I have learned this year as a student in the Global Medicine Program at USC.
The country of Panama is a culturally vibrant place in Latin America and like many of its neighbors faces challenges with healthcare infrastructure. Though it is considered an upper-middle income country by the WHO, many of its citizens struggle with healthcare access, often due to poverty. The areas in which indigenous peoples live are often isolated rural villages, further complicating the process of accessing health services, many of which they struggle to afford. One large challenge regarding healthcare in Panama is that it must address the double burden of infectious diseases, such as Malaria, Leishmaniasis, and the Zika virus, as well as non-communicable diseases such as Obesity and Cardiovascular Disease. In addition to these challenges there are a lack of services and education in my area of interest, oral health.
Like many other countries in the region, the children I saw in Panama had access to food and drink high in sugar, such as soda and candy.
Rural populations in Latin American countries are typically thought to adhere to traditional diets high in fruit, grains, and vegetables, whereas the diets of urban populations have shifted toward Western staples. This can contribute to an array of health issues including obesity and oral health problems. The imbalance between energy expended and caloric intake is a challenge that is expanding into rural areas, which I observed in Bocas del Toro. At the end of one clinic day in an area called Quesbada Sal, I walked passed cases of soda being unloaded from small wooden boats onto the dock. This island is an hour away from the main town, and is an example of how diets high in sugar are penetrating rural environments.
The level of sugar intake, along with the use of water untreated with fluoride, was reflected in the oral health issues patients presented with at the clinic. Only a handful of children were living completely free of dental caries, and many more were living with rampant tooth decay. I had never observed such a high number of extractions of the deciduous teeth, prompted by severe tooth decay, reducing a once healthy tooth to one causing constant pain. Other children with less decay received fillings, which were performed using only basic instruments, no drill or suction. The atmosphere of the dental side of clinic was one where we did the best we could with what we had. One extraction was even done without a dental chair, on the steps of the clinic. What I admired most about the dentists as well as my peers was their willingness to improvise and to provide the best care given the circumstances. The overall community response to our presence was largely positive, with many patients waiting hours in the queue to be seen by the dentists.
One thing that struck me immediately at these rural clinics was the number of locals who had never been seen by a dentist before. Many of these people were of the indigenous Ngobe population, and though I expected them to be hesitant of us they surprised me with their welcoming attitude. Some of the patients we saw were children at their first dental visit, but others were adults who were having their first experience as well. The reputation of Floating Doctors within these communities was a great asset, and without the trust of the community these patients may never have come out to be seen.
What was most challenging was the management of patient anxiety, especially in our pediatric patients. While I assisted the two dentists, Sarah and Philippe, I observed them using an interesting technique to calm a patient, a scared three-year-old girl. The conventional method of managing anxiety in pediatric dental patients, called “Tell-Show-Do”, was not successful with this child, so they decided to try a different method. The mother sat on the chair and held her daughter on her lap, and this calmed the girl enough so that Sarah could perform the dental exam. Over the course of this encounter the patient began to relax, and she received a filling for a cavity on one of her maxillary teeth. It was interesting to see an alternative to the usual methods of managing patient anxiety, and to gain perspective on situations where a practitioner must adjust their plans in order to be effective. Though it was challenging to calm this young patient, it is my hope that this introduction to dentistry was positive overall, and that she will be responsive to oral health education in the future.
Though we were busy with the high volume of patients, we still took the time to hand out toothbrushes, toothpaste, and speak with the children about oral hygiene. My group created a poster that taught the techniques of brushing and flossing, which was both informative and colorful. This was one of my favorite activities while working in these communities because education is essential to changing behavior and effecting long-term health. The people in these communities were receptive to new information, the children most of all. After being taught about brushing their teeth they seemed to share what they had learned with their family and friends. The children would line up and ask for “cepillos” and “colgata”, which I quickly learned are their words for toothbrushes and toothpaste. The children seemed genuinely curious about the dental station, and on several occasions I saw their intent faces peering in at us, and I felt as fascinated by them as they were about our work.
In the short-term it is a small victory to teach a child to brush their teeth and give them the means to do so, but the real challenge ahead is to address how they will maintain these health behaviors. Will they have access to basic supplies like toothbrushes, toothpaste, and floss? If not, how can this be addressed? This is something that has been in my thoughts since returning from Panama, and I realize that solutions will ultimately have to be a result of prioritization within the communities. There must also be a strong presence of healthcare providers to stress the importance of maintaining these behaviors. This is one of the many reasons that Floating Doctors is important for the area, and why the Global Medicine Program should continue sending students to participate in this valuable experience.
Another portion of the trip that will likely have a lasting impact on my perspective of the world was visiting the local nursing home on the main island. From the moment I walked into the facility I had to challenge my expectations and reevaluate my assumptions about the culture. I met several residents who had been abandoned by their families, and others who lived there with family members. One example of this is a woman I met who lives in this facility with her mother as well as her sister. They are only in their 40s, which by US standards is a young age to be admitted to a facility for long term care, with 88% of residents being age 65 or older. However, both appeared to have mental health issues, and with nowhere else to go they were admitted to the nursing facility.
Spending time with these women made me reflect upon the idea of treating every person kindly and helping them live with dignity. As I stood in that room where upwards of fifteen women slept, my only desire was to give them attention, show compassion, and let them know that someone cares. I could sense this motivation in all of the volunteers there, saw it in their body language, and heard it in the kind words they spoke. This experience was one of the most humbling I have had in my life because these residents value the things we often take for granted, like a conversation or a hand to hold.
After spending time with the residents of the nursing home I have reflected on my career and am drawn to the idea of practicing as a general dentist where I can see children, the elderly, and everyone in-between. Moreover, it renews my sense of purpose for seeking out education as dentist, and where I may practice in the future.
Though we were only in Panama for a short time, the long-term impact of our visit can come in the form of support for Floating Doctors and other groups like it. Beyond giving care that is needed, Floating Doctors educates their patients at every opportunity. What has stuck with me from this experience is that while we address issues such as access to healthcare and overall health we should also empower these populations with knowledge. Perhaps one of the children I spoke to about oral hygiene will someday become a dentist, a physician, or an advocate in their community healthy living. Educating is the key to empowering all people, and it is my hope that the people of the Ngobe communities will be positively affected in their health today and in the future by continued efforts from Floating Doctors.
- WHO Panama Profile Socioeconomic. World Health Organization. 2011 Report.
- Panama – Health in the Americas 2007 – Volume II. Pan American Health
- Kain, Juliana et al. “Obesity Trends and Determinant Factors in Latin America”. Cad. Saude Publica, Rio de Janeior, 19 (Sup. 1): S77-S86, 2003.
- Farhat-McHayleh N. Harfouche A. Souaid P. “Techniques for Managing Behavior in Pediatric Dentistry: Comparative Study of Live Modeling And Tell-Show-Do based on Children’s Heart Rates During Treatment”. Journal of Canadian Dental Association. May 2009.
- Nursing Homes Fact Sheet. AARP Public Policy Institute. Oct. 2007.
By Dr. Kevin Lan
Lead Dental Provider
A new year upon us, and what a year 2015 was for the Floating Doctors. I would like to update everyone with the progress our dental program has made and share a few stories of the past year. Our work and development would not have been possible without your support and kind donations, I would personally like to especially thank Don Scott and Ted Hannig for their tireless efforts in raising over $10,000 to help with the advancement of our program in acquiring essential equipment and materials.
At the close of 2015, we have extracted over 300 teeth, placed more than 100 fillings and incised and drained multiple abscesses. We are now able to provide a wider range of treatments with our newly acquired portable dental chair and equipment from Dentaid and Aseptico, as well as receiving several thousand toothbrushes from Global Grins and supplies and tools from Henry Schein.
It was fitting that our last dental clinic of 2015 would finish in the community of Norteño, where our program first started. 70 patients were seen over two days working from the early hours of sunrise until the company of the moonlight and stars. Rice and beans after the last patient, have never tasted so delicious with a splash of chicken. Working in this environment is very tiring and back breaking, the list of patients is always growing and there is always the fear of not being able to see everyone. Our last family of 2015 had waited for 5 hours to be seen and faced an hour walk back home. Reading their notes from our first dental clinic, the two young boys (Raul and Daniel) had been very anxious and were uncooperative during treatment, but our team had successfully extracted some of their teeth. Having had such a long wait, I was expecting to use my last reserves of persuasion, but much to my surprise the chicos were fighting to be first in the chair. From an anxious patient to becoming a dental assistant was a big step for Raul; armed with head torch and gauze, he diligently cleaned his mum’s teeth as we restored two cavities.
As we were planning to bid farewell to the community of Rio Cana, a 5 year old girl called Natalia presented with a large left sided facial swelling extending up to her eye. She had been unwell for the past two days with a fever and was unable to eat due to the swelling and pain. The team unpacked our equipment and after much reassurance we were able to extract the problematic tooth and drain the dental abscess. This took some of our volunteers by surprise at how much infection could result from one decayed tooth. Moments like these, when we are able to provide care where there are no alternatives and change the outcome of an unwell patient, or witness a positive change in the attitudes of the communities we visit, makes every second spent in our work worthwhile. It has been a pleasure to see the communities embrace our programme and it is very disheartening when no dentists are available to provide dental care.
Our dreams are big for 2016 and in the new year, we will strive to continue and improve our provision of oral healthcare. Plans are in place for a mobile floating clinic where radiographs can be taken and surgical operations can be performed. Agreements have been made to start water testing and implementing water fluoridation in the communities’ water supplies.
Many of the Ngäbe people have been forgotten or must suffer in pain; it is a privilege and honor being welcomed into their communities, to give them the opportunity and education to leading a healthier life. Together with your support we can overcome these challenges and ensure that every child has a toothbrush and toothpaste, no one has to suffer with toothache for over a month, and we are able to provide dental care in a clean and comfortable environment for our patients.
by Dr. Ben LaBrot
I love when our reports are written by our volunteers–their perspective is often unique and I love to have their voices added to support our project, but today I want to personally share an experience with you all.
We visit about 25 communities spread over 7,000+ square miles of jungle-covered mountain and mangrove island mazes. Some of the communities are a shorter boat ride from our base, but some are VERY far away–and the Ngabe community of Rio Caña, where we went last month, is the furthest community we currently visit, on the exposed, open-ocean side of the Bahia Azul peninsula.
Rio Caña is about 70 miles by boat from the nearest small community hospital, and VERY hard to get to–it requires a lot of planning and the willingness to endure pretty bad weather and rough seas to get there. It is about 6 hours in a huge dugout canoe, at the end of which there is a treacherous river entrance blocked by a sandbar with big surf. I know longboard surfing is widely popular, but until you have surfed a 50′ hollowed out log down the face of turbulent waves to enter the Rio Caña, you have not truly longboarded.
In this community, small emergencies are almost always big emergencies–because the chance that the patient may be able to travel to help is VERY low–at best, the trip would cost more than most families live on for 2 months; at worst, bad weather and 15-foot seas make the trip a complete impossibility even if you were a millionaire. These are the communities we specialize in serving–the ones where a lot of people see a doctor for the first time in their lives when they come to our clinic.
On this visit, there were several ‘small’ emergencies–a horribly infected ax wound on a young man’s foot, a young girl with acute appendicitis, a young boy whose entire scalp was an infected mass of pus and fungus…the list goes on. All of these things are dealt with in more developed regions by a trip to the family doctor or to the emergency room; here, they are treated mostly with hope, which unfortunately is not always enough to prevent a terrible outcome.
We saw 250 patients, pulled about 60 abscessed teeth, performed ultrasounds on about 25 pregnant moms, and made sure the ‘small’ emergencies STAYED small and were dealt with promptly.
No one who has not shared a journey to distant communities like Rio Caña can truly understand what it takes to make it out there and to provide good health care so far from the comforting presence of a nearby hospital with specialists and advanced services, but if we don’t go out there…the young man loses his foot (and perhaps his life); the young girl’s appendix ruptures and she dies, the young boys’ scalp infection poisons his blood.
This is why our volunteers endure such hardships to get there, and why we go to such great lengths to reach these communities. I wanted to write the report myself today because I wanted to bear witness both to the courage of our patients, and to the dedication and endurance of our medical teams. Am I a hero? Absolutely not–but I am privileged to work with heroes every day. Hope in Rio Caña and other communities is no longer the only care available.
The health care our volunteers provide is some of the most loving, caring medicine I have seen anywhere in the world. In 2016, the infrastructure we have worked so hard to build this year will more than double our capacity. It has been a tough journey to get this far; traveling to Rio Caña is like a microcosm of the journey of our organization. When I look back at how far we have come in such a short time, the daunting challenges in the future suddenly don’t seem quite so insurmountable.
When someone tells you something is impossible, always remember what Tom Hanks’ astronaut character in ‘Apollo 13’ tells visiting congressmen while giving them a tour of the space center: “You know, there’s nothing remarkable about us going to the moon. We just decided to go.”
What will you decide today?
In the early months of 2015, Floating Doctors added another paddle to its ever-expanding Cayuco (wooden canoe) by launching its dental programme in tandem with the flourishing mobile medical clinics. It has always been the dream of Ben LaBrot, the founder of Floating Doctors, to have a long-term dentist join the crew. The need for dental treatment is in high demand but unfortunately very rarely accessible to the Ngäbe communities.
In its inception, the team’s first clinic was set in the mountainous village of Norteno. From dawn till dusk, spanning over two days, 80 patients were seen by our tireless dentists who maintained high spirits despite the failing light and increasingly limited resources. It is this drive and motivation to deliver healthcare in such challenging conditions that epitomises the spirit of our leadership team and volunteers representing our organisation.
Since then, we have visited multiple communities where we are continuously amazed by the extent of dental caries prevalence, especially in young children. On each clinic, we will see an average of thirty patients, many of whom have suffered in pain with toothache or infections for several months or even years! Imagine, or can you remember, the debilitating sensation of dental pain and being without access to dental treatment for that length of time? Our clinic is currently restricted to extractions and minor oral surgery, but with time and correspondence to those with invaluable resources or expertise, we will strive to make Ben’s dream come true.
The development of the Floating Doctors dental programme would not be possible without the support and kind donations from our benefactors and organisations. For this we cannot extend our gratitude enough. We have set a target of $10,000 which, once achieved, would provide all the equipment necessary for a fully functional dental clinic to serve the Ngäbe communities. We have a fantastic opportunity to implement positive changes to the oral health of the communities in Bocas del Toro.
It is a privilege to share this journey with you. Our working environment is such a challenging, exciting, very tiring, but thoroughly rewarding experience. Improving a patient’s quality of life is not based on what procedure or medication I give them, but my ability to show compassion and care to a person where they are expected to expose their problems and fears to a stranger whilst overcoming language, cultural, and social barriers.
Written by: Kevin Lan, Floating Doctors Lead Dental Provider
Coming home from the jungle and the mangroves at the end of the year is a lot like coming back to the dock after a long voyage. We see our family and friends (and a hot shower is available everywhere…what luxury), and it is time to take stock of the trip and look ahead to the future.
2014 saw the foundations laid for a huge expansion in 2015—remote outposts were built, new partnerships formed, construction begun on a base of operations, new equipment obtained, and resources developed to allow Floating Doctors to handle an expected 300% more volunteers next year. We saw some wonderful victories, such as obtaining specialized heart surgeries, rescuing difficult births or getting large tumors removed, but we also saw some terrible tragedies that remind us how lucky we are and how precarious and fragile life can be for so many people in the world.
At this time of year, while we visit our families and enjoy the incredible bounty around us, I am grateful for my family’s health, and I remember all the families waiting back in the jungle who face the rainy season without running water, electricity, sanitation or access to basic health care. It is not the wins that drive us to build more, do more, and help more people—it is the losses. The reward we are blessed to receive in this work is the opportunity to help prevent these tragedies, and for this we need your help.
The most frustrating thing is when we hear about one of these tragedies that occurred—all too often—because the patient lacked access to something simple: a child who died because they had no access to a basic antibiotic; a mother who dies of bleeding in childbirth. Conversely, my favorite wins are when a simple intervention changes a life forever. It always makes me think of the old rhyme:
“For want of a nail, the shoe was lost,
For want of a shoe, the horse was lost,
For want of a horse, the knight was lost,
For want of a knight, the battle was lost,
For want of a battle, the kingdom was lost.
So a kingdom was lost—all for want of a nail.”
Most of the time we don’t need a CT scanner or an advanced laboratory or a major trauma unit to save the kingdom—most of the time, we just need a basic antibiotic, or a bag of IV fluids, or 5 gallons of gas. We just need a nail.
Something that costs less than $5 is often the key to saving a life. This year, sign up to help us with just a nail or two each month—with enough nails, we will build and staff more outposts, obtain more medicine and equipment, reach more communities, and help more families end the year by remembering their good fortune instead of their losses.
From all of us at Floating Doctors—thank you for your support, and may this holiday season find you and your friends and loved ones in good health and ready for an exciting 2015.
Dr. Ben La Brot
It is difficult to explain the transformation that happens while you volunteer with the Floating Doctors. For the group of us nine medical students there were six months of planning, coordinating, and fundraising topped off with much anticipation and excitement.
Our goal was to teach local providers working with the Floating Doctors how to screen for high-risk pregnancies and heart defects in children using portable ultrasound machines. We planned to study the feasibility of the training as well as help screen as many patients as we could. Our hope was that by empowering local providers with the knowledge and tools to perform these potentially life saving exams, we could leave lasting impact beyond our eight week summer.
Soon enough we were in Panama, working along side Dr. Ben and Floating Doctors doing just that- educating and empowering the locals, and giving them the tools to sustain the improved health of their communities. As UC Irvine medical students, ultrasound is a part of our curriculum. Working with Floating Doctors validated just how useful portable ultrasound technology is in resource-limited settings. We were able to inform a pregnant woman that she had placenta previa, an extremely dangerous condition that can be fatal during childbirth. Floating Doctors provided transportation to the woman from her residence on a remote island to a nearby hospital, where she safely had a cesarean section. She and her baby are alive, and that would most likely not be the case without the ultrasound screening, and without the assistance provided by Floating Doctors. Throughout our cumulative eight weeks with Floating Doctors, we were able to forewarn many women with high-risk pregnancies, and children with congenital heart defects that they should seek attention from a hospital to receive life-saving treatment.
We went into our Floating Doctors experience with a goal- to make a sustainable impact while improving our clinical skills, but we ended up coming out with so much more than that. The greatest lessons learned weren’t which ultrasound probe worked best to assess fetal head diameter or which view of the heart was easiest to get on a small child. The most profound lesson was discovering what being a healer meant for each of us. Everyone goes to medical school for slightly different reasons, but the underlying theme for all of us is that we want to improve the lives of others. When working and learning in the United States it can be easy to lose sight of the human aspect of medicine. Your time is limited with each patient, you send your patients to get X-rays, CT scans, blood tests. To some, a patient can become a list of lab values and radiology reports who can be treated with a medication. Every hospital needs to have the latest equipment to make that list of lab values and radiology reports that much more accurate. But that is not what medicine is about, and working with Floating Doctors helped us remember what it means to be a healer. We made house calls and lived along side the Ngobe people. We got to know each patient as a whole person and took as much time as we needed with each patient. We didn’t close the clinic at 5:00pm, we closed the clinic when there were no patients left. Many times we saw patients into the night with our headlamps as our only source of light. That’s what the Floating Doctors experience, and medicine, is all about: providing healthcare to people in need.
With Dr. Ben and his fearless team as a model we learned what a privilege it was to be let into the lives of people in their moments of need and how as providers we are in the unique position do something to make it better. We have learned that being a healer means doing the best you can with what you can. It means putting in the extra work to figure out what is going on when things are unclear. It means asking for help when you can’t solve a problem on your own. It means being reliable and keeping your word. It means carrying this sense of awe and responsibility with us for the rest of our careers. Our Floating Doctors experience has undoubtedly influenced each and every one of us, and we will all be better physicians because of our experience.
Written by: Amanda Purdy and Jessica Vaughan
Photos by: Amanda Purdy and Jessica Vaughan
In biological terms, the heart is a muscle, a pump moving the vital materials of our blood throughout the body. It beats about 3 billion times during the average lifetime. The heart, with its constant function and immense bodily responsibility, allows us to live.
The heart is also described in psychological terms, a broken heart, a healing heart, a forgiving heart, a loving heart. Metaphorically, the heart can laugh, it can smile; it acts with and without reason.
So what happens when a person, a child, has a heart condition in a place where no medical care is available? You could ask the mother of Roxanna, a young Nbobe girl from the remote village of Quebrada Sal in the archipelago of Bocas del Toro. Heartbreaking? Absolutely. But for eight year old Roxanna, it was an undeviating matter of life or death.
While seeking a physical at a medical clinic held in her village, a medical student volunteering with the Floating Doctors noticed an abnormal beat in Roxanna’s heart. Her mother explained that she grew tired very quickly while playing with the other children and complained of chest pains often.
The Floating Doctors, a medical non-profit serving the indigenous communities of Bocas, arranged an ultrasound of Roxanna’s heart at the National Children’s Hospital in David. The diagnosis: pulmonary valve stenosis, a narrowing of the valve in the pulmonary artery that carries blood to the lungs. When children are very small this condition affects them less, but as they begin to enter puberty their bodies grow, and they require more blood. If it goes untreated, there is a very high risk of sudden death. This condition also isolates children affected by it as they eventually lack any energy at all for playtime with others.
It was clear that Roxanna would need surgery in order to have an active long life. Over the course of nearly a year donations were raised and the right specialist was found for the procedure. The Floating Doctors developed a partnership with Tom Ford of Fundacion de Obsequio de Vida that proved to be instrumental in Roxanna’s case, as they host interventional cardiologists from many different specialties and countries including Ecuador, Costa Rica, Colombia, and Panama.
Ten months after Roxanna’s diagnosis, the essential components they had all been waiting for finally fell into place and everyone proceeded as planned.The surgeon was able to go through the femoral artery in Roxanna’s leg to correct the problem with her valve. This is an excellent alternative considering open heart surgery is very risky.
The surgery was a great success, and Roxanna left the hospital with her mother just three days later. The last time Dr. Benjamin Labrot, Medical Director of the Floating Doctors, called to ask about Roxanna, her mother replied, “She’s out playing.”
Today, Roxanna is able to live a full life thanks to so many people who heard her story, thought of their loved ones, their own children and did everything they could to help.
***Special thanks to Tom Ford and his hard working team at Fundacion de Obsequio de Vida, David and Suzanne Smith at Casa Cayuco for volunteering their time and resources to transport patients in need of care, The National Children’s Hospital in David, and the Floating Doctors for providing healthcare to those who previously had none.
Written by Casie Dean
Editor in Chief, The Bocas Breeze
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