by Jill Patel

Jill Patel joined us as initially as a global health student in the summer of 2018, and has been working on a research project focused on mental health within the Ngäbe-Buglé population. She will continue to work on Phase I of the project both in Panama and in the US through the Fall. Keep reading to know more about her initial time spent in Bocas, and be sure to check back in a few months with an update on her research!

Note: Written in summer 2018- future dates noted reference 2019

Words cannot begin to justify my experience in Bocas del Toro this summer with Floating Doctors. What I thought would be a simple medical mission trip turned into a life changing opportunity that has inspired my new path to global medicine. From the outside, I saw a beautiful landscape filled with lush green trees, tall mountains, and colorful houses. However, hidden behind this was a community that has daily contact with the jungle, high worm loads, untreated water, latrine sanitation, and wooden huts. Despite this, the Ngäbe-Buglé people welcomed me with open arms—they laughed, cried, and went on an emotional journey with me, never making me feel more or less than they were. I thought I would be helping them improve their health, but they gave me a whole new perspective on life that enriched my physical, mental, and emotional well-being. All of this may seem so abstract and good-to-be-true, and I would have agreed before coming here.

My most memorable and favorite moment was doing a community health project on mental health with children in Cayo de Agua. Nicole and I had brought coloring books and crayons, as well as prepared activities, from breathing exercise to hand-shakes, to teach children how to relieve stress We also created a simple questionnaire to better understand their emotions. Our activity started with five students. I used my broken Spanish, which was surprisingly better than I expected, to introduce myself. As more children joined our activity, our coloring circle grew from 5 to 30 students scattered, around us. Here I quizzed students on what they were coloring to practice my Spanish. The funny part was that I did not know if they were right—I was just asking to expand my Spanish vocabulary. However, I think they soon realized that and possibly taught me some inappropriate words because they kept laughing every time I repeated it—I wish I remembered the word so I could look it up.

This fun quickly turned upside down when I interviewed a five-year old boy. I still quiver every time I think about him. He was very reserved and would not look up at us when we spoke to him. At first, I thought his actions may be driven by socio-cultural factors and thus was common in this community. However, I soon realized that this was not the case. When we asked him what makes him happy, he said nothing, and he does not do anything to make himself feel better. He also told us that “ellos”—everyone—scares him; instinctively, I leaned in to give him a hug. He disclosed that a girl, who was present in the circle, was bullying him at school. My eyes watered up because I was no stranger to bullying myself. I was bullied up until high school for having thick facial hair, not shaving my legs often, and wearing long, oily braids- I know what it feels like to be different and to want to be a normal teenager. Before he left, I told him, “Tú eres muy fuerte y yo soy tu amiga.”

Mental health remains unknown and under-served in the Ngäbe-Buglé community, but the need is very large. From bullying at school to young mothers, children and teenagers are vulnerable to various mental health conditions as they are pushed into adult roles from a very young age. We all have been fearful, anxious, nervous, scared, and traumatized. Unfortunately, these communities lack the resources and support we receive here, and Floating Doctors has taken the initiative to address this issue. In January, a Family Therapist and a PhD candidate will come for a year to examine the mental health statues and needs of the community. I will join this team to further my community-based project in hopes of delivering better tailored care, and I encourage others to join the cause so no child ever has to cope with sadness and fear alone. Whether one is a volunteer, student, or professional, we can all make a difference in our unique ways as long as we have hands to serve, ears to listen, and a passion to help.

From clinic and beyond, I made many new friends and strengthened bonds with others. To continue Floating Doctors’ mission to improve the health of all, my group and I volunteered at Asilo, a nursing home in Bocas town, to address patient’s non-clinical needs—painting their nails, massaging their hands and legs, bringing water. When I entered the nursing home, I was surprised by the conditions of these elders- they were so frail and weak. My eyes watered up as I realized that many of them were either the same age or even older than my grandparents, who I am tremendously attached to. When I asked an elderly woman if she wanted to color or get her nails painted, she reached her hand out. As I held her hand in mine for a couple of minutes, her face relaxed and she closed her eyes. She reminded me of my grandmother, who would hold my hand as she watched TV or laid down because she loved having someone physically close to her. I sat with this woman for a while, just holding her hand without saying a word. This is the true power of a simple touch, something that many people may disregard but is immensely valuable.

Here I also met my new friend, Richard Garret from Queens, New York. I introduced myself and asked how his day was going in Spanish. To my surprise, he responded back in English—another lesson: never assume what one can and cannot do. From Turtle Beach to Summer, he gave me an oral tour of the entire town and listed all the places I should visit. When I asked if he goes to Summer, a dance bar, often, he enthusiastically said yes. Just like me, he loves to dance. We spent the next thirty minutes talking about our passion for dance. I shared with him pictures and stories from my previous dance competitions. Before I left, we took a picture together. He told me to show this photo to my family and tell them that I made a new friend at Bocas. He gave me a hug and told me to come visit him when I come back to town.

The Asilo opened my eyes to the struggles of the elderly in Panama and more significantly, the importance of addressing a patient’s non-clinical needs to provide holistic care. Sometimes medical mission trips get caught up in providing preventive and surgical care but forget that health encompasses much more than the physiological. Floating Doctors is unique and successful because it improves health at the clinical, social, and personal level. And this is what has, is, and will always pull me to Floating Doctors

As my story comes to an end, I want to leave with a final lesson: Dr. La Brot always says that in order to serve, we must learn from those that we serve. No matter how superior my knowledge or skill may be, I can never provide the best service or obtain the best outcome if I do not listen to my patients. While living in an open church and eating with locals in wooden huts at Cayo de Agua, I witnessed the lack of infrastructure and services. But through these activities, I also learned about the community’s lifestyle, needs, and wants. This helped me understand why certain medications and preventions were utilized in situations that we normally wouldn’t in the US. Learning and applying these social, cultural, and economic determinants of health in practice has been a humbling experience. I remain driven by the knowledge that easing the service gap can mean drastic change for neglected populations, which motivates me to continue my path in global and community medicine. I cannot wait to return back in January to help further the Floating Doctors mission! Thank you to Dr. LaBrot and his Floating Doctors’ team, the Ngäbe-Buglé and Asilo communities, and my wonderful colleagues for making this a memorable experience.

By Dr. Kevin Lan, Dental Director

“You can never cross the ocean unless you lose sight of the shore.”

Now more than ever, we face a rising epidemic of dental caries in the teeth of children from the indigenous Ngäbe communities we serve.  The combination of their inability to afford basic oral health products such as toothbrushes and toothpaste, poor education, lack of access to healthcare, compounded by a sharp increase in consumption of refined, sugary hot and cold drinks, has resulted in many children with decayed and broken down teeth, especially in their newly developed adult teeth, ones that will not be replaced.

2018 saw the Floating Doctors dental program explore new horizons and greatly increase our services provided to the communities of the Bocas del Toro Archipelago. We established our first mobile dental team, held independent dental clinics, provided continuous oral health education and prevention, recorded dental health in the communities for research and we have hosted dental groups from the University of California Santa Barbara and the Dental Humanitarian Outreach Program (DHOP) of the University of Southern California.

14 undergraduate students from UCSB and 3 dentists visited and stayed in the communities of Nance de Risco and Cerro Brujo, where 156 patients were seen and treated. The challenges faced by this team were numerous; it was our first dental only deployment away from the medical team, the first time we had stayed in two communities and worked 4 days consecutively, whilst setting up and packing away our equipment in between both communities and working the same day. The success of this group can only be measured by the amount of hard work put in by our FD staff and the UCSB group where despite being constantly pushed outside of their comfort zones, numerous students embraced the opportunity to learn and be part of a positive life changing experience where they sought to give to those who had less, rather than how their time with us could benefit them.

DHOP held 6 clinic days from the 9th -14th December in Bocas del Toro. A total of 90 dentists,  dental students and FD staff, worked tirelessly each day from 7am – 7pm in temperatures above 85°F, providing dental care to over 700 patients from 20 communities in the Bocas del Toro Archipelago, where some were transported 3 hours by our boats.  The DHOP clinic was a very emotional experience to work alongside such a dedicated, skilled and high spirited group where it was heartwarming to see people from communities that we know, receive high quality advanced dental treatment, like Root Canal Treatment which we could not normally provide when in their community. This is the difference between saving or losing a tooth. I will never forget the family of 4 who had traveled the whole day to attend our clinic,  where a 10 year old girl had fallen and broken her upper front teeth 3 weeks ago and required Root Canal Treatment. Due to the required treatment time and inability for this family to return home that day, they were given accommodation as they were unable to afford this themselves. The next day, her father could not express to me without tears in his eyes, how grateful he was for the care and compassion we had shown to his family.

For me, it is not the numbers of patients that we can see that drives our ambition to care for the Ngäbe people, but it is to be present for those who have been forgotten or unable to access healthcare and being able to make one little girl smile again without losing her front teeth. Floating Doctors is proud to host groups like UCSB and DHOP so that we can try and inspire the next generation of healthcare providers to educate and improve the lives of others, so that we can leave our communities and world better than we found it.

Walt Disney once said “All our dreams can come true, if we have the courage to pursue them.” 2018 saw Floating Doctors take big steps towards continuous and sustainable dental care to the communities we serve. 2019 will see huge development and partnerships being established as our family grows with increasing support from Europe and America. 2020 is still unknown for what the future holds, but I can predict that we will continue to work hard in providing dental care and education for the people in the communities who need our time, compassion and support against the challenges we will face together.

Through the courage of our team and those supporting us, our dreams are not far away from reality.

Cheers,

Kevin

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