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.

Fair Winds,

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

When I left Los Angeles for Floating Doctors I was 27 years old.  It was a rainy LA early morning.  The streets were dark, empty, and glistening as my dad drove me to LAX.  We spoke in short spurts…most of that ride was filled with a silent apprehension, both of us knowing deep down that what and who I was leaving behind would be impossible to return to.

My Dad, having done medical missions all over the globe, knew what was in store for me. I had no idea of the incomprehensible changes ahead.  My journey with Floating Doctors has taken me a long way from the girl of six years ago…changed, re-shaped, and molded me into the woman that I am today.

As a soon-to-be mother, my mind is often pulled back to the countries my baby’s father, Noah Haas, and I have visited with Floating Doctors. I play back moments I shared with other mothers, children, and infants.  One moment above all has played in my mind’s eye over and over again during the 8 months of my own pregnancy.

It was 2010.  We were in the middle of our first deployment in Haiti.  We had been there for about a month, working hard, long days in the clinic. We were, also, ­­deep in the middle of construction of new schoolhouse on the clinic grounds to replace the one devastated by the earthquake.  Daily, we walked the ¾ of a mile from the beach where our small skiff came ashore to drop us off to make our way to the clinic, winding through the narrow passages of the make-shift tent communities that were set up in the surrounding fields.

I saw her one late afternoon, after a long day in clinic, the sunlight was fading, making dappled streams of gold pour through the gaps between the tents.   She was a beautiful, young Haitian woman, standing beneath a barren tree, holding a young baby boy swaddled in a worn out tee-shirt. He could have been no older than a week or two.  She stepped out into the path in front of us. She smiled shyly as she held her baby towards me.  He was beautiful.  I did my best to explain in broken Creole that I thought her baby was gorgeous.  I started to try to walk past her when she grabbed my arm and again held her baby out.  She said something that I didn’t understand.   “Tanpri, pran l ‘nan kannòt la.” She said it again, this time with a bit of force, trying to mask the sadness behind her voice.  I explained that I didn’t understand.  The young mother shoved her baby into my arms and again repeated her sentence, this time pointing towards the shoreline.   It was then that, without an exact translation, I understood what she was saying… we all did.  She was asking me to take this beautiful baby boy to the boat…to take him away from the rubble and destruction that he was born into… to give him a chance at a better life.  I stood there frozen with this baby boy in my arms. I could feel his little heart beating swiftly against my chest as my own heart broke.  In total silence, his mom and I locked eyes, hers pleading and mine fighting back tears for what seemed like forever.  I gave a slight shake of my head, unable to speak, and placed her son back into her arms and continued on, unable to look back.

This past October, 4 years and 5 months after that encounter, I sat surrounded by beautiful baby gifts… Graco Pack and Plays, swaddling clothes, Citi-Mini Stroller accessories, baby monitors…everything you can imagine.  35 wonderful, supportive, generous women attended my baby shower. While I sat unwrapping those beautiful packages full of pink lace and pristine baby gear, those pleading eyes washed over me in waves.  I kept seeing that young mother with her t-shirt swaddled son .

As I drove home after the party, my SUV packed to the brim with my growing family’s new gear, I wept.  I wept for the want that all children could be brought into the world with such love, support, and comfort, free of disease, with access to care, and the chance at a life free from the pains of poverty.

I will bear witness to that sad mother in Haiti to my daughter someday.  I will pass the experiences that molded my life to my child. I will tell her of my adventures…the beauty, the ugliness…the sadness, the joy…the despair and the courage that her Daddy and I have shared with the people we serve.  I want to share with her the true nature of giving and service expressed through action.  I want to help her understand that the difference between her and the one she is helping is a lot of luck, that we are all connected, some born to plenty, some not, but all deeply human. I want her to learn that to those to whom much is given, much is expected.

I am forever grateful to those that have supported me on my own journey into the magical, uncharted waters of my motherhood.  And I am grateful for all of you, our supporters, who have gifted us with the ability to be there for the mothers we are lucky enough to serve.  You make it possible for us to be available to care for mothers in distress during delivery, to be available in the middle of the night when a child is hot with fever, to save a child from the lifetime of consequences from a cleft palate or a heart defect., to provide prenatal care.  You make it possible to ease the fears of a new mom and see her face light up when we show her the heart beat of her unborn child on ultrasound.

None of this would be possible without you. I am grateful to be bringing my daughter into a world with people like you in it.  Thank You for what you make possible.

From all of us at Floating Doctors, Happy Thanksgiving.

Sky LaBrot

Chief Executive Officer, Floating Doctors

2/22/14

Mending Kids International (MKI) was starting our second day of medical clinics with Floating Doctors (FD) in Salt Creek Panama, a remote island in the Bora Del Toro archipelago.  The first arrival was seen at intake by Dr. Kate Porter a phenomenal volunteer tropical medicine doctor working with the Floating Doctors this year.

The first arrival, a young Ngäbe-Bugle man explains that he is here for a problem in both his eyes – or so Dr. Kate hears it, but shortly after commencing his history, he says “Tengo un tiernito en casa.”   Having limited Spanish, Dr. Kate asks a fluent Spanish speaking Mending Kids volunteer, Juan Ramirez, to interpret ‘Tiernito.’  Juan interprets – the Ngäbe man has a newborn, a ‘tender child’ at his home.  Its eyes are white and it is blind.  The mother pushed him away and won’t feed him.

Dr. Kate marks the intake form with a big star and bold letters, “House call, new born – Chi chi – 5 days old, mother refuses to feed, possible blindness.”  The Tiernito is growing perilously weak, would the doctor be able to come see it in his home?  Juan says ‘this is quickly becoming high drama’ ….a slight understatement!

Due to high infant mortality, Ngäbe babies are all named chi-chi (baby) until their second birthday.  Quickly a medical team coalesces to make the emergency house call.  Running to the home, our MKI volunteer leader, Isabel Fox, stumbles and falls deep into mud, then shortly thereafter spots her patient, lying moribund in the hot sun and mud.

Chi-chi, – as Dr. Kate, Allie, and Isabel are about to find out – is a 5 day old calf.  So, regroup – there was a slight error in translation as the ‘father’ whose native language is Ngäbe spoke his second language, Spanish, to the English speaking Dr. Kate, also using Spanish as her second language.

By sheer coincidence, Drs. Dan Evers – veterinarian ex-patriot, and I – Renee Kaswan, retired veterinary ophthalmology professor – are tangentially participating in this mission and evaluating a baby Howler monkey affected with bot fly granulomas.   The baby monkey – Jasmine – was acquired by a family from Memphis, who were relieved Jasmine was not very ill, and most surprised to learn that Jasmine would need a new name, she was a he…. Dr. Dan and I finish that delightful adventure and move onward to the neonatal calf.

Having not eaten for 5 days Chi-chi was severely dehydrated.

In the most primitive possible conditions, Dr. Dan and I assessed a dire situation while a family of 8, a sizable film crew from MKI, 3 impressionable 15 year old MKI student volunteers all waited to see if this first born calf – hopefully the Ngäbe family’s second cow – would live.  Although the farmer assumed Chi-chi was rejected due to blindness, Chi-chi was actually only blind in his left eye, further evaluations were needed.

 The diagnosis: Chi-chi had a relatively common bovine congenital ocular defect –  persistent pupillary membranes (PPMs).   In all species, the embryological pupil first forms like a spider web of blood vessels from the iris that bridge the future pupillary hole; these prenatal vessels should atrophy and desist prior to and or shortly after birth.  However, sometimes these vessels inadvertently touch the lens and/or inside of the cornea – as they did in Chi-chi, and they persist. Persistent pupillary membranes can adhere to the lens, disrupt its growth causing cataracts and also adhere to the innermost layer (endothelium) of the cornea.  These capillary attachments lead fibroblasts to follow the vascular path, the fibroblasts proliferate leading to a deep white fibrous corneal scar – which is what the Ngäbe farmer observed.

What were the chances that a calf – born in a primitive village in Panama – no electricity or running water – would be attended by a retired veterinary ophthalmologist seeking meaning and purpose on an MKI/Floating Doctors mission?  

For further irony, in August 1985, I was sweating in similar subtropical conditions in Evanston, GA, 8 months pregnant.  The University of GA Veterinary Hospital where I was on faculty as an ophthalmologist, was called to attend a herd of cattle with ocular problems in Deep South GA.  We diagnosed that the herd had multiple congenital defects, the most common being PPMs.  Based on those observations – made at great effort by myself and 2 female colleagues – who would catch over 20 free roaming beef cattle (the farmer chided he couldn’t believe UGA didn’t send even one man), sweat ridden in the GA heat, I wrote the first case study of purportedly heritable PPMs in cattle. Our female senior student and large animal intern who did the hard work of catching and restraining the cows did not get authorship on the case report – physical labor being poorly remunerated as usual.  As my academic curiosity has diminished over the years, I did not seek to examine other cattle in Salt Lake Island to determine if Chi-chi represented an isolated or herd problem.

Chi-chi – should he live, will have non-painful, unilateral blindness.  The other eye was simply so deeply sunk in the socket from dehydration that it was covered by the third eyelid…until rehydrated.  The assumption that the baby didn’t nurse due to blindness was erroneous, more likely just a naive mother cow, a newborn, a naive farmer, all fumbling with a new situation for everyone.

With a large audience watching and assisting, we used the limited supplies we had, 2 liters of lactated ringers solution, a couple of 50 ml syringes with 18 gauge needles to blow tennis ball sized bubbles of fluids under Chi chi’s skin all over both sides of his body (photo) while the MKI boys – sheepishly looking like they might be participating in torture – held the calf down.  Chi-chi absorbed the fluids like a sponge within 20 minutes, and we were all amazed as Chi-chi stood up and began stumbling around!  So we asked the farmer to fetch mom, tied her to the house, tied her rear feet so she wouldn’t kick, and low and behold we taught Chi-chi to nurse.

Fate, MKI, Floating Doctors came together, intervened and the Ngäbe family wouldn’t eat veal tonight…..Such a gratifying crazy adventure.

Written by Renee Kaswan