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I believe everything that we do in this life has a cost and a benefit associated with it—at times the cost that you pay for the decision you have made far out weighs any benefit you may gain while the profit that you get from another
totally justifies the negatives. A cynic would say I view everything through a ‘cost analysis’ in my life and in many ways I believe that is a true statement. On this stormy day in Panama with inches of drenching rain replenishing the jungle around me I find myself thinking of what prices I have paid, both good and bad, for the decisions that I must call my own. April 27, 2012 marked my 1095th day out of Los Angeles and away from ‘my’ life, or rather, the life that was once mine. Anniversaries to me are not a time to celebrate but rather a time to reflect upon what has transpired, the roads you have traveled and where they have taken you, how you have acted, and if those actions sit well with you after time and perspective.Last week’s multi-day mobile clinic led us once again to the shores of a rushing jungle river to bathe and wash away the stress, sweat, and sadness of the clinic. There is nothing like plunging into the cold hastening current of a
river that has cut itself through miles of remote mountains before touching your skin. Its pace caresses the beautiful pain of the day out of your body in ways that are indescribable and leave me refreshed like no other body of water does. I have done this countless times before, but this time, as I sat with my volunteers between the smooth river rocks and watched the Ngobe Indians of the village make their chest deep evening river crossing home with kids and animals in tow I was struck at how far, in every sense of the word, my life has come in these last three years.In the past I have done my best and most profound thinking in the shower. With hands propped high on the wall in front of me, head slung, eyes closed, and hot water pouring down my back I come to my greatest conclusions, my most honest thoughts, and in all truth, it’s the time that I also allow myself to feel the emotions of my life. As a result the shower has been a deeply personal place for me—private, unavailable, closed, and bare. My perfect place for reflection, tears, laughter, and thought. I have not had many of these moments since I left the United States—conservation of water on the boat, public showers, no showers at all, no hot water, bucket showers, etc have all been barriers between me and my time in the comforting steam and solitude of my once were showers. I have often missed them – one of those daily luxuries that I never even contemplated as a luxury before I left home. The ability to walk barefooted out of my bedroom into a clean (well most of the time) bug free space, turn a faucet, slip my towel off, and bury my head under the seemingly never ending warm clean water is something that now seems so foreign and long ago to me. A price that I have paid for leaving home- it doesn’t seem like much, but on those cold and windy nights on Haiti’s northern coast when showering with a cold 5 gallon bucket of water that we lugged from 2 miles away, it really did.
It’s funny, to me, the things that I have ended up longing for… none of them are what I would have guessed. My mom’s hands, driving on cold nights with the heat on and the windows down, my best-friends green place holders- all small and ordinary but when I conjure them up in my mind I never fail to get a lump in my throat. The life that I have chosen is full of people but can be desperately lonely at times and I crave the company and comfort of those that I left behind. I have wished that I could have carried so many of them with me over these years and shared with them the beauty that I have witnessed and humanity that I have gained. The person that I was when the plane lifted me away from Los Angeles in April of 2009 is not the same woman that sits in front of this computer today and I have come to realize that the biggest price I have paid for my experiences here has been the loss of my old ‘me’. But, as fire is to forest, this death has brought forth a budding growth of spirit, heart, and perspective that makes the pain of this change worth it.
The three years after leaving has blessed me with bonds of love like no other- ones that can only be forged, both metaphorically and physically, through black stormed filled nights far from land with only each other to look to. The love of stranger children across 5 different countries whose affection comes with no strings attached and no expectations to fulfill- simply love for love and affection for the simplest of gestures. In Haiti when you would give a child a juice or a soda they never fail to share it with the kids around them… sometimes 10 of them passing around a bottle of juice, each of them taking a small sip and then passing it on, even though you never tell them to share, they do. And they do it out of goodness of heart and the common understanding that this gain should be shared with those around them. To me that is witnessing the goodness of humanity at its most basic element and I am grateful beyond all measure to have been that witness.As I sink my head below the river of my experiences now I have come to deeply realize that life truly is change and the flow forward never allows for anything to stay the same. The life that I left behind was changing while I was there even if I couldn’t or wouldn’t at the time see it. Often people that knew me back at home say that I gave up my Manolo’s and Jimmy Choos’ for Wellingtons and flip flops- this always makes me smile. For me, what I gave up, was my quiet warm lonely showers surrounded by beige tiles for smooth rocks cut out of mountains, rushing jungle currents, and the sounds of life penetrating every pour that I have.
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Bring me that horizon...
For me the sea has always been where I turn for inspiration, solace, and wonder. The night I was born I breathed thick salt air and first heard the sound of long Pacific swells rolling onto whispering sand, and from that day my life was held forever in the sea’s net of wonders. My mom and dad were living in a beach motel in Southern California while my dad did his medical residency, and my first steps were on the sand and behind my dad as he made hospital rounds and home visits to patients. I can never remember any time in my life when I wanted to be anything except a doctor and a marine naturalist, and thanks to my parents, extraordinary mentors and opportunities I became a marine biologist and a doctor and have had experiences in both fields that make me grateful to be alive just for one of those moments.
My favorite thing about the sea is that it is not lonely; in the sea I feel connected by the water to millions of people around the world. I imagine millions of people of a thousand colors and languages and religions and nations all floating together in the sea’s embrace and connected across thousands of miles by one continuous, unbroken sea. When we float in the vast sea, only a little of it is holding us up, but that small part is connected to an unimaginably vast and powerful body of water. In the same way, this is how a people are strong. When we say ‘a sea of humanity’ we acknowledge that humanity–all of us together–are as powerful as the sea, which is always waiting to show what it can do.
Like every wave, every life is unique and beautiful, something I have experienced time and again through this voyage. In 2011 we saw our
Fighting bedsores on a dying patient we inherited at the Asilo
10,000th patient, and although I am very proud of how many people have received care through Floating Doctors, what I am most proud of in 2011 was that as we expanded our project, we always stayed committed to the individual patient. Time and again, this has ultimately led to our being able to do more for more people than we originally anticipated and I have faith that we will remain committed to the single, individual patient as continue our voyage.
Long before I was old enough to venture over the horizon the last lands and seas had long since been charted, but fortunately the frontiers of health and the sea of humanity offer an endless horizon. Looking out over the Pacific horizon so many years ago I never envisioned that my greatest loves would one day combine in a mobile medical relief team exploring frontiers of health across the living ocean that washes all shores equally. I had no idea HOW I would pursue these two passions, I only knew with certainty that if I did not have them both in my life, I would never be happy, and so I would look out over the water or read Jacques Cousteau or trail after my dad on rounds, and dream of adventures on distant seas and future patients I would see and help.
First clinic in the new Panga (before we built a canopy)
Repairing torn stitches in Labadie
But all the time a voice was urging me to move forward, always there was another voice…darker, more ancient; a more primitive vocabulary but it didn’t need sophisticated words…it has raw fear, self-loathing, shame, narcissism, and petty angst and selfishness. This voice, all my life, has whispered under my dreams, telling me I will never become a doctor, and never see the seas I spent my childhood dreaming of. Sometimes it spoke with other people’s voices, like during the year we struggled to rebuild Southern Wind after she had been donated to us and some people scoffed and said we would never make it, and it would never work, and we would all be killed and waste all the support we gathered…but here we are. Sky and I lived with fear as a constant companion for the whole tenuous first year of our project, when so often it hung by a thread, but (especially with my sister beside me and many hands outstretched to help us keep going) we were able to move forward, one foot in front of the other, and now here we are…going on a mobile clinic in the morning, more than 600 mobile clinics into our voyage.
La Sabana in the mountains
I know now that this pessimistic voice I’ve always had spoke from feeling not good enough somehow to deserve attaining my dreams, and although as I got older (and continue to get older) the voice got fainter and fainter (I pretty much ignore it on autopilot now…most of the time), it took many years before I could–as my wise sister says–”Allow myself to succeed” without it being a struggle. We are always our own harshest critics and unforgiving judges, but as they saying goes: ‘You never know if you can climb the mountain until you try (REALLY try).’ And as a wise man said, is it really that frightening to succeed, and is it really, in the grand scheme of things, so terrible to fail? And there is always the third option (my favorite): sometimes when you fall, you find out you can fly (or learn how really, really quickly)–especially if hands are outstretched to help you stay in the air, and your ego (and the dark voice inside us) allows you accept the help that is offered.
The kindness and generosity I have seen people show towards us and to others fills me with hope that the daunting
La Sabana in the mountains
challenges of our time can be survived. I am immensely proud of what my crew, friends and family, and all our volunteers and supporters have made possible, and incredibly grateful to be able to be a part of this voyage and to have shared it with such extraordinary people.
Even with all its faults, earth is a beautiful planet, and humanity, despite its many, many faults, is heroic. There are heroes all around us; it has been a great honor to work alongside so many of them.
“The world is a fine place, and worth fighting for.”
Check out these pictures; some of my favorite moments captured in 2011.
Please click on any of the photos to activate the slide viewer.
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For the Floating Doctors, 2011 was a year that was marked by thousands of patients seen, turbulent ocean crossings, and hundreds of boxes of medication and medical supplies distributed. It was our most successful year to date in terms of patients treated, countries visited, and partnerships formed. The 12 months cemented our belief that the next and most important phase of our project will be the procurement of funding, support, and supplies for Floating Doctors’ permanent clinics in the countries that we have visited thus far. We clearly defined our role as the primary care givers to the remote communities that we serve and the importance of the follow up care we provide to them. We worked hard to secure lasting partnerships in Haiti, Honduras, and Panama which have enabled us entrance into and support from communities that otherwise would have been nearly impossible to gain.
As an organization, I am proud of what we have accomplished in the past twelve months but, for me personally, it goes much farther than miles traveled, pounds of supplies delivered, and numbers of patients seen. It is about the individual. It is about who patient #127 was and what it meant to her for us to be there, or how we were able to give patient #3679 relief from the pain he had been suffering from for years. It is the joy on a woman’s face somewhere in a forgotten jungle when she sees her baby’s heart beat on an ultrasound that fuels my pride in Floating Doctors. Rather than numbers on a spread sheet, for us, our patients are people with lives, children, and family who cherish them.As the Director of Operations, I am both honored and humbled that I get to witness these individuals first-hand and to be a part of the care that they receive from us. Daily, I am able to work closely
with our doctors and patients while running clinics, breathe in the culture of distance lands, and know what it is like to be one with a vast ocean. I get to live our work and see the results of it on levels that are deeply personal and important to me. I believe that my hands-on involvement makes me a better leader for the Floating Doctors and our crew.
One person can be just a number, but to those that love them, they are the entire universe, and we feel they should always be treated as such. Our belief that, “nothing is more important than the individual” has become a core ideology for the Floating Doctors, and it has woven itself in the fabric of our every action. I am endlessly blessed and inspired by our work, and I am honored to be there and be available as a resource to people who have no other option. I feel an immense sense of gratitude to those who have contributed to our work and who make it possible for us to be of service to so many. When a lot of people do just a little, it is amazing what can be accomplished. An innumerable amount of people have helped us in many ways, big and small, and the ripple effect of that collective work has reached thousands of patients across five countries and hundreds of isolated communities.On the precipice of 2012, I am excited for what the year will bring through our clinic doors and under
the keel of Southern Wind. The past three years have been a wonderful learning and growing experience for us – on both professional and personal levels, and we are eager to continue that growth in the coming years. With thousands of miles of coastline and countless communities in need, the future holds no bounds for us as an organization.Fair Winds and Calm Seas,
Sky Labrot
Director of Operations, Floating Doctors -
The Floating Doctors have been in Panama now for nearly nine months and during that time period we have been asked to help in a lot of different situations: sick babies, communities in need of medical attention, patient transports, even the removal of bot flies on a remote finca or two but last week left us in the middle of a situation that none of us ever anticipated or imagined.
It was late in the afternoon and I was wrapping my day up with a cold soda in the Cantina at the Bocas Marina when several water taxis pulled up. I paid little attention as the taxis come and go from the marina at all hours of the day and I assumed that this was nothing different—but I did watch as one of the drivers made their way towards the cantina while the other two waited in the Panga. Odd but nothing very note worthy. The driver made his way into the Cantina and started speaking to several of the cruisers that had taken up their usual spots around the communal table but was having trouble breaking the English/Spanish barrier with them. Being that, at the time, I was the best Spanish speaker in the group I was asked to come in and help interpret for the driver but quickly found myself confused at what he was saying.He looked at me square in the eyes and said “my friend has precious tigers for sale in my boat”. Excuse me? I asked him to repeat himself several times as, although I was interpreting what he was saying in my head, it made no sense to me. I asked if we could walk over to the panga so I could see what he was selling—I honestly thought that he was going to show me a launcha filled with Lion Fish and that I was just not getting the local slang for the fish—but as I neared the boat I could hear a very strange but oddly familiar kitten like cry. To my utter horror and shock as we got to the end of the dock, there they were, two less than one month old Mountain Lion kittens shoved into a small card board box covered in their own filth and obviously scared.
Now I recognize that these animals are very cute when young and obviously bring with them a large pay day for those that get their hands on them but at that moment I was sickened. Here below me were two wild animals- young, scared, and fighting for their lives. I asked first where they had gotten them and why they had them and was told that they were “found” in the mountains outside of Changuinola. Right….
I started to explain to the 3 men that not only was it very bad that they had taken them but that if they were sold to someone for the house that they will die as they need a very different kind of care than a normal house cat. They then told me that for $500 a piece I could have them. We started a back and forth – them speaking only of the cash they wanted and me making a futile attempt to explain to them the ramifications of what they had done- that wild animals should never be taken and caged. Finally I looked at the water taxi drivers, both of whom I recognized, and said—“Hey, you know this is wrong and I know you, and I see you and I would proceed with caution if I were you”. They all immediately became nervous and started their engines. Off they went with the crying kittens.
We jumped into our own Panga and followed them into town and as the man with the cats exited the boat and the taxi took off I followed suit. I ran after him and after a few seconds was face to face with him again explaining that he wasn’t going to go anywhere with those cats. He called for a few of the taxi to help him with this crazy woman, but thank god, the months of work that we have been doing here in Bocas came to my aid when the men gave a simple reply, “ nope, she’s good”. He again began to walk away with me not leaving his side and again he tried to get assistance from some locals on the street and once again got the same reply from them… “she’s good man”. He finally stopped and faced me. At that point I told him that this could be a problem for him or it couldn’t- all he had to do was hand over the cats and come with me to the Smithsonian or he could make it a problem. He simply handed the box over turned around and was gone.I have seen a lot of sick babies in my last three years working throughout Central America and although not a doctor could tell that these two cats were not in good shape. We rushed them to the Smithsonian Institute in Bocas who gave us pointers on how to care for them—we were hoping that we would have been able to hand them over at that point but the group needed time to assemble their resources and identify the best place for these wild animals to go. They told us how to bottle feed them with goats milk and that them staying warm was very important and set us on our way.
The next three days were spent feeding them every two hours, day and night, helping them go to the bathroom, and making sure that they were never cold. They cried incessantly when not sleeping and we tried to offer them whatever comfort that we could but there was nothing that we could do to stop the pain that happens when a baby losses its mother. To stop the fear of a surrounding that is not and should not be theirs.
We nurtured them back to health over the days and finally got connected with Elena Castejon from APPC who immediately sprung into action to get these two innocent little souls to her in Panama City. We packed up their bottles and goats milk, put them on a flight to Panama City to be met by Elena and the crew from ANAM, and they were gone. Out of our lives as quickly as they came but leaving an impression bigger than they will grow when they are large.For me personally, although it was an amazing experience to be able to care for such animals, it was agonizing. These were not two kitties bred for human affection and love but rather two wild animals who will now be relinquished to a cage, ripped from their natural habitat, and made to become something that they are not—cared for by humans. These two will never know the joy of running unimpeded through the wild, to feel a jungle bark beneath their paws, or what flowers bloom deep in the forest after a drenching rain. They will never know what sounds howler monkeys make at night and what should alarm them in the wild. Instead they will be caged in a sanctuary that is a poor surrogate for their land.
I believe that all of us here in Bocas are in our hearts wild things that have refused to be caged by the normalcy of life. We have sacrificed the comfort of stability for the beauty of freedom. We have chosen winding jungle trails over the constrained isles of Walmart and the untamable ocean over freeways. I saw the same hopeless sense of amazement in each one of the Bocateranians that came to see these little wonders that I felt so deeply- as if seeing these caged and scared cubs was like witnessing the part of our lives that we have all railed against so vehemently.
Once again I am honored to have been a part of something that helped to stopped pain and suffering but in this instance I did not walk away feeling a complete sense of calm. D. H. Lawrence said, “ I never saw a wild thing sorry for itself.” But for me, here, I felt sorry. These two will never feel sorry for themselves- they are young and they will grow up believing their caged existence is how life should have been. Three years, 6000 nautical miles, and countless wonders ago I may have said the same about my own life. It was how I thought it should be- the job, car, credit card- all a part of the foolish game I believed was so necessary for happiness. Unlike those caged cats I think we all now see otherwise….“Life is not about seeing what you want and how to get it but rather is about seeing what you have and how to give it.” Frank Baxter
Written by: Sky LaBrot
For more information and to get involved please visit:
APPC http://www.panamericancon.org/ -
maggots in a tunneling ulcer
Ah, the Asilo…one of the places we heard about here in Panama when we were still in Honduras. We found a unit seldom visited by a doctor (in a year), but with a wonderful staff of no more than a cook, cleaner and nurse on each of the two 8 hour day shifts and 2 on the night shift. There are 27 patients there, all elderly, ranging from totally mobile to totally bedridden, some without sight, some without limbs, many with varying degrees of dementia—they all have to be fed, bathed, many changed, floors cleaned, meals prepared and cleaned up after…the fact that the floors are clean and the patients are clean and fed is an extraordinairy achievement, but the patients need more attention.
When we got there I thought they were totally medicated…so many of them looked so catatonic…it turned out almost none of them were medicated,
They seemed so catatonic when we first were working there
or where very occaisionally medicated. They were just bored and unstimulated, almost into catatonia. It was months before some of them spoke; I came back from 5 weeks in California to find patients that I thought had no power of speech actually talking with me. It was like awakenings, and it isn’t because of medication, it is because of all the time our volunteers and people in the community have spent with the patients there. Many had not been out of the grounds for years, and now walk in town weekly—our friend Javier, a Colombian physiotherapist in town who also works at the Asilo, brought his four horses and our elderly patients dressed up and rode like kings and queens through the streets, looking down around them as if to say ‘So…this is Bocas, you say.’
one of 3 trucks of trash we removed
The mayor sent three trucks and we removed several tons of rusted metal and trash from the grounds and landscaped a little (more to go), repaired two broken washing machines and plumbed 3 in total (the only working one had been filled by bucket), installed handrails in the common area for walking and physio, changed the showerheads to removable handle versions, put a commode chair in the bathroom, created and update charts for the patients, provide medications, and have done our best to provide the additional more advanced care that the staff are sometimes not able to provide.
When we arrived, there was an elderly stroke victim, immobile and unable to communicate, and terribly emaciated and contracted with bedsores
emaciated, rigid, and covered in bedsores
all over. We worked for weeks, doing wound care and working with the staff to use advanced wound dressings we provided and creating turning regimens—our goal not to extend his life, but to allow him to die with more dignity and in greater comfort. At one point he got a chest infection and we stood by to administer oxygen and midazolam and buscopan to make him comfortable as he passed, but he rallied…and subsequently gained 12 pounds and the ability to focus and speak a little (very, very little) before he died quietly one night in his sleep a few months later.
ulcers spreading in a deteriorating body
And he died with not a single bedsore on him…that was a victory to me, at a personal level. I hate it when people die with their bodies disintegrating externally around them as well as internally. It is unnecessary, but totally natural for birth and death to be so awkward and difficult…the first time doing ANYTHING is usually awkward and difficult: the first day of school, first kiss, first great loss, first great love, first great adventure, the first and final sunset cruise, and finally, the end of the voyage.
Any ship, no matter what storms it has weathered and what damage it has sustained in a long life of navigating unknown waters, wants to look its best when it pulls into harbor for the last time. There should be dignity at the end, as much as can be wrenched from an unfeeling universe. Not always possible…but always a betrayal not to even try.
My cousin, a physical trainer, just arrived here for a few months…I have another patient in the Asilo who has not walked for 9 years after his stroke. He stood up the other day after exercising on his own, ferociously, with some basic exercises we showed him after we applied a difene patch to his paralyzed knee for knee pain, and he and we found out the immobility was more pain-related and he could move it a little. He freaked out an dhas been exercising like a fiend.
Our friend Bolivar snapped some pics in the asilo while we were working there one day
I came back from California and he collared me from his wheelchair and looked me in the eye and said ‘Yo Puede CAMINAR!’ And stood up, giggling like schoolgirl. Sometimes things are too much for me to process when they happen…later at night, especially when I’m writing a blog or making a facebook album of the day, I start to process…thinking about that patient a lot. I want to go for a walk with him before he dies—and he might live for many more years, so if he does, I’d like him to be able to walk, and he REALLY wants it, more than almost any patient I’ve ever seen. I feel tiny beside the strength of his determination.
Matt and I changing a suprapubic catheter blocked after 11 months of neglect
I tell all my incoming student volunteers (I have my little speech about this prepared): “You are so lucky we have the Asilo for you to volunteer in. Not only does every second you spend there interacting with some of the loneliest people I have ever seen benefit them beyond what you can know, but care of the elderly—and especially in this setting—is where you find out if health care is for you.
Eve and Sarah doing wound care on tunneling ulcers
“Yes, it’s challenging, the medical issues are very complicated, the patients may have dementia and can be challenging, and you have few resources to deploy except what you can somehow manifest…but beyond that, its where you learn things like ‘are you the type of person who is thoughtful enough to throw a corner of a sheet at least over the exposed genitalia of some bedridden shell of a human during some procedure that leaves them all exposed?’ Or ‘When you lift a frail contracted foot off the bed, do you automatically support the knee out of awareness (to avoid torqueing the knee)?’
walking the patients
“It’s a good place to learn PATIENT CARE…not something everyone can learn, because some aspects of it I just don’t think you can teach. I feel like I have to practice at it constantly…people are afraid of old people…can you learn to look past the rotting shell of their failing minds and bodies to ressurect in your mind’s eye when you look at them the glory of their individual histories? It is like looking at old ships tied up in the scrapyard and neglected, never to leave again…remember that those ships voyaged 70 or 80 years across 2 or 3 of your lifetimes…can you see who they were and what oceans and storms they have passed, somewhere inside the wrinkled, frail bodies awaiting their final voyage?”
I love the Asilo…my volunteers go more frequently than I (I only have 2 hands) these days, but I love going in and seeing my friends there. We need people in the community to each give 30 minutes once or twice a month…come on…an hour a month, that’s pretty good…want to walk patients with us? It is awesome—email us or (better) contact us on facebook if you want to go for a walk with us and be checked out to walk patients on your own. One hour per month…you saw the walkway we all built in La Solucion; a miracle happened because everyone showed up and made it with their hands and time.
giving time
Make a miracle happen at the Asilo…everybody give an hour a month, and every patient will be walked several times a week instead of never. They’ll get stronger and be more fit (less pain), and be more mobile (and they HAVE to be, the ones that are bedridden have the worst time of it). Let’s make it happen Bocas!
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Building a wheelchair bridge for a girl with CP
When I last posted in June, a couple of months in, we had just started to really connect with the various subcultures in the Bocas Province, and some situations we quickly identified for interventional projects were as yet beyond our reach. Now we have many more friends and contacts in the community, and we can tackle much more ambitious projects for far less cost.
We have:
• Partnered with local group Operation Safe Water to help transport and install raincatcher systems at local schools when we run clinics
• Arranged CPR certification for the fire department
• Worked with the Ministry of Education to train local high school students as trainers for health education in the community and give them medical work experience by participating in our mobile clinics
• Created pictorial and written information sheets on health issues we have identified and that we make available at our clinics
• Gathered and data-entered over 600 patient health data sets and begun doing surveillance of our own interventions and identifying health issues from the data to help guide our mission activities
• Microfinanced patient transports to care on the mainland and chaperoned them in the hospital system (many Ngobe don’t speak Spanish, and are VERY shy, so they easily fall through cracks in systems)
• Connected with an indigenous Curandero to identify and investigate the plants he uses medicinally and are helping him develop his small botanical laboratory always keeping a lookout for.
• Arranged and executed a CPR and First Aid Seminar for the cruising community in Bocas
• Partnered with the Mayor’s Office to run mobile clinics in conjunction with the government visits to the community
• Partnered with the local Lion’s Club to work in a community they support and help supply the neonatal support unit they built with Direct Relief International suppliesAnd, as always, sometimes we find situations that are just not right. Por ejemplo…
Unacceptable for a 14 year old in a wheelchair
While I was in California, Dr. Barney found out about a 14-year-old girl with what turned out to be undiagnosed cerebral palsy in a small squatter’s community called La Solucion. I have been told it used to be where the airport is now (right next to a mangrove swamp), and when they built the airport the community moved out onto shacks built on stilts over the mangrove mud.
She comes to land at most twice a year…land is about 100 feet away over the sewage-contaminated swamp (all the homes
She has rarely, in many years, been to shore
have outhouses and sink drains that drain directly into the water below). She has never gone to school…she has a wheelchair, but rarely uses it because she has nowhere to go; she has to be carried over the dangerous footbridge by her grandfather, and she is too big now for him to carry (Noah noticed he has drop-foot also…potentially a serious falling hazard, especially if you are carrying your 14-y.o granddaughter over a wet slippery footbridge). She is COVERED in bug bites…she can’t really swat bugs away or keep moving to keep them off her, and she lives in an open unscreened house on stilts over mangroves.
Her grandparents have always thought they were at fault for her CP because she fell out of bed at 6 months (though she had never crawled, which makes me think it probably was CP at birth)…they have carried that burden and they always worried they would get in trouble if the hospital found out, so they have indicated that she has never seen a doctor.
If I were a Hollywood writer writing for some medical drama, my editor would probably throw me out of the building for it being so unbelievably challenging emotionally and physically…but this is real life…this is somebody’s actual life. Sometimes people ask if I miss ‘the real world’…let me tell you, it looks pretty real from where I’m standing.
Driving pilings into the sewage muck of La Solucion
We said we would build her a walkway, and now—6 months into our time in the community—we called on the community to help and EVERY level of Bocas society came together to make it happen. Mangrove posts from an indigenous community, lumber and funds and food from local Panamanians and expats, help from boat owners, crew on other boats, locals from La Solucion, local taxi drivers, local restaraunts…at the last minute we even had no trouble rounding up 2 sledgehammers (one from the fire department and one from the fish market, which I sometimes haunt in the afternoons when the fishing canoes come in).
Everyone gave a little (some more than a little), and in 5 hours we sank thirty 10-foot mangrove tree trunks 7 feet into the mud, from the shore all the way to her grandparents’ house. The walkway went on in the next few days, and then this little girl went to shore (we still have some work to do to finish the walkway and make it safer for a wheelchair). I asked if there was anything in particular she wanted to do on shore (which she can see, 100 feet away) and she said ‘Quiero pasier’—‘I just want to go.’
planking the wheelchair walkway
This is my favorite, favorite kind of project…one where the whole community comes together when it learns about a situation like this. When the walkway is done, it will have been done right, with the right material (always seek expert advice) to make it last for many years. No matter what, this girl’s life is going to be changed forever—and here’s the best part: total cost for all the lumber, food for the volunteers actually building the walkway, gas to go pick up the posts from another island, hardware, etc: less than $1000.
There’s opportunities for helping, constantly around us…when we are alone we can help in small ways…but mira aqui, look what we can do when we all come together! Poco a poco para cambiar el mundo.
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I need an opthamologist
The last time I wrote a blog, an unconscionable number of months ago, we had recently arrived here to Bocas del Toro and I ended the blog excited by what might be possible over the coming months…now those coming months have passed, and it is time to catch everyone up and take stock of what we have accomplished here in.
6 months ago feels like a million years ago…with more long-term volunteers, we’ve been able
I love my sister
to really expand some parts of our project, including self-surveillance. I looked at what we had done—how many mobile clinics, how many volunteers, how many projects, how many patients…it is overwhelming to try and describe. I should either write bullet points, or a 3-volume novel to describe everything since my last update.
Canadian medical student doing kids health checks
Over most of our time here, for example, for every 3 days we were here, we ran one day of mobile clinic work—even counting rained-out days (and it rains 150 inches a year here) and days we were involved in any other kind of activity, whether it was working on boat projects, escorting patients to the mainland to get treatment, holding office hours in our consultorio, working in the asilo, eating, sleeping, or doing anything else. We’ve seen over 3,000 patients in more than 17 communities that we visit on a roughly 2-month rotation across the entire province of Bocas (an area of over 4,500 square kilometers), in addition to all our other activities.
No matter what other projects we get involved in, the core of Floating Doctors is our mobility—even the permanent clinics we are now working to establish are to serve as bases from which to continually run mobile clinics by panga, as we have done everywhere we go. I’m incredibly proud of all my volunteers and my crew for maintaining that level of dedication to work one day of mobile clinic for every 3 days we were here.
We’ve seen a lot of different communities, and noticed that there are enormous clusterings of health issues in different small communities that at a glance may seem similar. Why does one community have an incredibly high rate of obesity and diabetes, while the neighboring community has no obesity or diabetes but has lots of parasites? We have gathered detailed demographic and health data on over 550 patients so far, community assessments on a dozen different communities, and are beginning focused projects based on issues we have prioritized based on the data so far. Results of our first survey project coming in the new year…
ultrasounding in a chair in the jungle
We’ve started doing overnight and multi-day mobile clinics—getting two or more clinic days for the price of one day’s travel, since our accommodations have almost always been in the homes of local members of the community, or expats who notify the community that we are coming, house and feed our team, and often allow us to use their facilities to hold our clinic and arrange our transport to work in communities near their homes. I have been overwhelmed by the generosity of the expat and local community here…I have never worked anywhere—in the developing or the developed world—where the community at every level will actually deliver on its promises of support like here. From the Mayor sending trucks to help us cart garbage out of the nursing home, and letting us use his old consulting room to open for patient consults two days a week to the local marina workers who are giving their Sunday to help drive 36 10-foot posts into stinking mud to build a wheel-chair walkway, this is a wonderful community, with many eccentric people (after all, we are here too) and many people with good hearts who have shown us enormous kindness and support for our work here. Thank you to everyone—this is what makes Floating Doctors possible. A thousand hands holding us afloat…
We’ve also joined forces with the Peace Corps volunteers scattered throughout the province;
Harold, Peace Corps worker in Shark Hole; we did a clinic there on his very last day on site...a giant amongst his Ngobe friends; thank you Harold for your fantastic work
Peace corps Volunteers have thus far been 100% reliable—individual peace corps volunteers live (very often alone) in a community and work on a project. We got in contact with one, on the mainland, and ran a mobile clinic at his village…it is so awesome to arrive with everyone notified, a place to work, directions, someone to help interpret and to give us the inside scoop on patients we are meeting for the first time, someone to pre-arrange accommodation in the community, and best of all, the Peace Corps volunteers can and do follow up with patients that we have identified as needing more advanced care. This has been our experience with the Peace Corps every time we have worked with them, and we look forward to our upcoming multiday clinics to some new communities we are visiting through Peace Corps, including a Ngobe community way up in the mountains that I have heard a Peace Corps volunteer visited but that he thinks has NEVER been visited by a medical team. Looking forward to that later this week…
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It has been two months since I have been able to put words to page although this is not for lack of content or consideration but rather the inability to put thoughts into meaning. In that time period we have left Haiti, seen old friends in Jamaica, and crossed the remainder of the Caribbean Sea to Panama. All amazing accomplishments that should be noted, written about, and reflected upon- yet every time I open the computer to a blank white WORD page I sit paralyzed. It’s as if all of the experiences and work bottle neck themselves in my head and leave a connection with my hands useless.
I thought this time that leaving Haiti would be easy, knowing that we would return again, to have seen the faces that I love and know that they are well, and yet in reality it was much harder than the last. To see a little boy that I love with all of my heart playing by the tree where I last left him was a joy but leaving him once again at the same tree eats at me… having him not there the next time we return will break me, and yet when I sit back and think about, having him still there may be just as bad. The never ending tail chasing ‘whats worse’ game that plays in my mind. It seems at times to me that my heart will never win when it comes to my time in Haiti—I will always be pulled back and tormented away. The sights, sounds, and deaths get no easier the second time around- they still work their way in, nuzzle themselves into my soul, and trouble my moonlit nights on the water. As we left Haiti I sat on our back deck for as long as the light would allow my eyes sight with my heart being crushed and simultaneously elated that we were pulling away from the shores not knowing if the tears I was shedding were for her, for me, or for those I was once again leaving behind.The transit that lay ahead of me turned into 5 of the most memorable days of my life- flat calm and beautiful the seas opened themselves and the life that dwells deep within its blue waters to us. We spent the days spotting whales, dolphins, endless fish, whale sharks, and sharks with an elation that only wildlife can bring. I felt my heart being drawn into the
dark blue that lay beneath our keel, the salt water starting to become part of my blood, her vastness a part of my soul, and perhaps on this transit I truly became a sailor. As I walk down the docks now I feel her calling to me- beckoning me into her wildness and away from the safety of solid land. To trade stability for freedom and schedule for adventure- to stand on our bow with salt laced air in my face and dolphins underneath my feet. To undo our lines and sail into the never ending splendor that is the open ocean.I had dreamed of Panama from the start of my involvement in this project – it always seemed so wild and distant to me. It has not failed to disappoint either- the people, the
jungles, and the islands have opened themselves and embraced our project like no place we have been before. The unending kindness of the people here leaves me speechless as it seems that there is nothing that they won’t do to make ‘us’ happen. Free Dockage from the Bocas Marina and Yacht Club, amazing Fashion Show/Fundraisers from the Calypso Cantina, Wednesday night girls night with some amazing women. The community has thrown its heart open to us and is literally making our project here possible. So much of what I have constantly had to worry about has been lifted from my shoulders allowing me to immerse myself in our clinics. I am humbled, once again, by the generosity of others.I find myself loving my life – on the precipice of my 30th year I am thankful beyond all reason for the life I get to lead. I wake up every morning, usually no one is up yet, and I drink my coffee overlooking one of the most stunning bays in the Caribbean. I awake my crew and head off to a distant shore, often feeling like I have stepped back hundreds of
years in time, and spend my days making peoples’ lives better, making their pain stop, quieting the worried minds of mothers and the crying of babies. And all too often people tell me that it’s so amazing what we do—my only reply is, nope, it’s amazing what I get to do. I am surrounded by suffering and pain and beauty and wonder. My heart is broken and lifted twisted and torn and I would change none of it. My cup runeth over. I am haunted and changed and the luckiest girl I know. -
My little sister Sky...at the helm...she is so awesome
Bocas del Toro, Panama
As always, leaving Haiti was difficult. There is always a sense of leaving things unfinished, no matter how many patients you see or projects you complete. I always tell people, we are not going to go help Haiti. That is beyond our power…but we went to help HAITIANS, and helped many. Leaving is hard…but I comfort myself when I remember that our anchor will drop in Haiti again.
Moonrise 200 miles off Nicaragua
We had an amazingly calm and uneventful passage from Haiti to Jamaica (our 4th time crossing the Windward Passage…it was tolerable this time, I’ll give it that). We ghosted through mirror glass seas 200 miles off the coast on our way south to Panama, a full moon reflected among the stars on a sea so smooth that the horizon was not visible. We caught some fish, slept well, had a whale shark partially breach in our wake, saw pilot whales and dolphins…Jamaica to Bocas del Toro has been by far our easiest and most pleasant transit.
this looks like a scene from an italian opera
Our arrival in Bocas was marked by the immediate generosity of the expat and local community here. Dylan and Darien on S/V Jackaroo, the owners of the Calypso Cantina at Bocas Marina, helped arrange Bocas Marina hosting us while we are here, welcomed us with a fire dance at the cantina, and have just organized a big fashion show fundraiser to support our time here (blog with THAT story coming soon!). Chuck, Courtney and Rosemary and Dana from Bocas Marina have gone way out of their way to support our mission here, and everyone in the local community has reached out to help us here.
This place is almost purpose-designed for a team like ours: a large population spread out over a large area, mostly accessible only by boat, with little or no access to health care…nearest surgery is an hour and half by fast boat ride…a mammogram is 2 hours away…a very, very, very underserved population (lots of indigenous people who have had a long history of poor interactions with foreigners).
We immediately became involved in several initial activities:
Mobile Clinics:
Shark Hole community (mobile clinic with the Mayor)
By car (thank you Rosemary!) and by panga (thank you Alcaldia!) we have so far been running mobile clinics for the communities in San Cristobal, Drago, and Shark Hole and have returns for follow up and visits to other communities on the calendar for the next few weeks, with help from expats in the area, peace corps volunteers in the communities, and with the help of the local mayor (the Alcaldia).
- Sarah doing health checks in Drago (about 1 in 6 had something needing attention)
Dr. Joe, previously the town’s only doctor before entering politics, visits the outlying communities once a week with a government team (health inspector, education directors, building inspector, etc) and we go with to do a mobile clinic. We have some bigger multi-day mobile clinics coming up; on one we will be carrying five 750 gallon water tanks to a remote series of coastal communities for Operation Safe Water.
Nursing Home (The Asilo):
Felicity and I doing ulcer care in Asilo
3 staff (cook, cleaner, nurse) on each day shift to cook for, feed, clean, wash, change, dress, and otherwise care for 25 long-term care residents who are wards of the state, most with few (usually none) family members and no means of support. The fact that the floors are clean and the patients are fed is a huge achievement, but otherwise it is heart-wrenching. There is a 3-inch concrete sill in each door…to go outside, I watched an old man with no legs roll himself up to the sill, climb down out of his wheelchair, lift the chair over the sill, lift himself over the sill, and then climb back into his chair.
The first truckload of garbage taken from the Asilo
Piles of rusting metal and trash and junk fill the backyard, and vultures walk amongst the patients in the fall-hazard garden. There are no handrails anywhere, including the bathrooms. A doctor has not come from the hospital to look at the patients for months, and they have no meds at all. And the patients have no charts at all. SO…we created charts, did full histories and physicals on everyone. Now we can write and document progress notes and exams and studies.
Please come to the Asilo and help us take the residents for walks!
The mayor sent a municipal truck and we filled it three times with garbage and junk, CJ has gathered many cuttings and plants given by other members of the community and begun systematically landscaping the demilitarized zone that was the backyard, we’ve been doing wound care, skin care, walking and exercising the patients, repairing leaking water pipes, changing inappropriate shower heads, providing eyeglasses, and generally trying to improve conditions everywhere we turn. If you are in Bocas and reading this, come by and give us a hand!
Bocas Emergency Network:
Grit from a sanding disc injury lodged deep in abcess...
We arrived here to find that the BEN (Bocas Emergency Network) was already in existence here—a network of about 50 expats scattered across the area who remain in radio contact to alert and assist each other in emergencies. The name seemed a fit made by fate, so our call sign in the BEN is ‘BEN911’. We have taken a couple of calls through the network, but fortunately none which were serious enough to necessitate an emergency callout. We are working on getting our own panga and programming known safe routes through this maze of mangroves to all the different BEN member homes (which are all located near local villages) into our GPS so with a searchlight we can make high-speed response to emergencies or do fast transit to Changinola (closest place with surgical facilities)
One of the cruisers here helping us landscape at Asilo
So far here we have had medical students from Israel and Saskatchewan, Canada, an RN and her cameraman fiancé from Australia, pre-medical and nursing students from Duke and Berkeley, an Optometrist living locally who is going to come do monthly prescription clinics (we have glasses), a nurse from Florida who just moved here with her husband, and we have a tropical medicine specialist coming from the UK, a nurse from California, and other volunteers coming throughout the summer, and some of our old volunteers returning too (awesome). It is amazing watching them go through the experience. It changes us daily, and it is fascinating and rewarding to watch people rise to challenges, encounter people and situations which push them past their boundaries, and seek out and develop opportunities to help.
Felicity helping Asilo residents pick out new glasses
I read about a playwright/director, terrified after an awful dress rehearsal before the debut of his one chance at success, who fell asleep and dreamed that he was scaling a immense mountain peak…vertical walls…no ropes…he, who had always been scared of heights, in the dream is climbing like a man born to the rock and the sky, and as he nears the summit, he loses his grip and slips, hanging just below the summit by his fingertips.
- Eve and Sarah changing decubitous ulcer dressings in Asilo
A man on the summit looks down and asks him if he is afraid of failing…and says ‘it is sometimes a mistake to climb; it is always a mistake never even to make the attempt. Sometimes, when you climb, you succeed, and sometimes, yes, you fall…but there is a third option…’ And then the playwright falls. And as he is falling, he realizes what the third option is: sometimes, when you fall, you find out you can fly.
This I believe.
Dylan orbited by flames
And in this community there are already many hands under us. What do we have in the works? Of course we want to bring in a container from Direct Relief International with equipment and material for the hospital and dispensarias here; we will soon be doing training with the firemen (who do water rescue here also) in Bocas, working with Operation Safe Water to deliver more tanks and equipment for water projects, doing consults using the mayor’s old consulting room, putting a raised vegetable garden in at the asilo, getting some specialists down here, doing more multiday mobile clinics and continuing to return for follow-up…who knows what else? I feel like this is a community in which we can accomplish a lot…it’s an exciting feeling after 1 month; wondering what we will have done here in another few months…
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Nec Aspera Terrent: “Difficulties be Damned”–the Family Motto of Perry Fawcett, Amazonian Explorer
Labadie, Camp Louise, Caracol; Haiti
Our clinic landed in Camp Louise
It has been a very, very busy few weeks…a lot accomplished; we recently treated our 750th patient for this month. That’s an average of 30 patients a day, including minor surgeries, ultrasounds and acting as 24/7 floating urgent care center. In that time, we have also done mobile clinics in Shadda, Coco, Camp Louise and pre-natal vitamin distribution in Caracol and have visited Milot Hospital, Justinian Hospital, and the HHH physiotherapy center and have helped many patients connect with needed specialist care (I got the schedule of all the visiting American specialist teams for the next few months at Milot so I know when and to whom to refer patients).
Pietre, Dave and everyone at Royal Caribbean have been awesome—we are wrapping up
Striking Day to Watch the Royal Carribbean Ships Come In
our time here and getting ready to make our way to Panama to work south of the hurricane zone as the season advances, but I am very grateful to RCCL for making us welcome in Labadie and we will miss everyone when we go.
Scabies scratched and secondarily infected
There’s a saying in medicine: “Common things are common,” and at a certain level of poverty some things become VERY common. Scabies, parasites, respiratory infections and fungal infections are common among my patients, but I hate when several such conditions are found simultaneously in all the members of only one family. A mother, daughter and young son came in with terrible scabies, secondary skin infections from scratching, bad worm infestations, anemia, and chest infections…we medically treated all the ailments, but I spent most of the consult working to make the mom understand the importance of washing, cutting the dirty fingernails of itchy children, washing, not drinking coffee at age 5, washing…and washing. Properly used, a single bar of soap can prevent an awful lot of disease, but poor home conditions and poor health awareness are two regular factors in the illnesses of my patients.
We are barricaded in a single schoolroom to keep from being overrun
We did a mobile clinic by small boat in Camp Louise, a diffuse farming community of a few thousand people living a few miles west of Labadie. We visited the health center there but did our clinic in one of the local schools, treating the school kids and a lot of other children in the neighborhood. We were joined by a nurse from the Camp Louise Clinic, a Doctor, Physio and two teachers and Hannah from the Cap Haitian Health Network. This clinic was a tough one…a crowd of several hundred gathered within minutes; people were trying to literally pull themselves into the room we were working in (we all worked in one room, hot and crowded but impossible to maintain security otherwise). Hannah and the teachers had their hands full trying to keep us from being overrun, but we got through it—as usual in schools, lots and lots of scabies and parasites, and this location had lot of urinary tract infections and bacterial vaginosis in the young kids. Camp Louise is somewhere I would like to spend some time doing health education in the charitable schools there, as the high prevalence and poorer hygiene of the kids with UTIs suggests there might be a special need there.
Aside from the common stuff, the last couple of weeks have also brought us some very
Our Medicine Lifted The Voodoo Arm Pain curse...
unusual cases, and some unfortunate ones. The one that caught me the most off-guard was when I was consulting with a 96-year old woman (she’s in awesome shape, totally ambulatory) presenting with shoulder pain radiating to the arm. As I was writing “?mild strain?arthritis” on her notes, she told me that she had accidentally picked up some cursed money (people don’t like picking up money on the ground in Haiti, because JuJu men will curse the coins and scatter them around) and essentially been voodoo’d, so I gave her an anti-inflammatory and Noah showed her gentle stretches and exercises for improving shoulder stability. A few days later she came in and thanked us because she hadn’t had to go to a voodoo man to pay to remove the curse; our medicine had beaten the voodoo.
Hammerhead Sharkbite
Let’s see…my shark bite victim is all healed up…the kid who came in with his stitched knee all torn open and infected is all healed up, but he’ll have a big scar on that knee for the rest of his life (but gets to keep his leg; it was pretty horrible looking when he came in and we first unwrapped the dirty bandage covering the torn-open, homemade stitches). The other night, just before dinner, we heard a familiar sound…a small wooden boat making its way towards Southern Wind, with a man, a woman, and a young kid with a dark-stained rag wrapped around his leg. He had been cut with broken glass, and a deep, 5-inch laceration on the back of his calf. It was pretty deep, with a lot of fat and connective tissue exposed and swollen with fluid; at first I wasn’t sure if the edges could actually be
Cut With A Broken Bottle ...
closed, but skin is always a lot stretchier than you might think—I washed the wound and sutured it back up, and a few days later the edges had pretty well opposed. Incredibly, the sutures were ready to come out after about 4 days (really—they were already starting to be grown over); I love healthy kids—they heal so fast and bounce back.
This is how I usually spend the journey to a clinic...conserving strength
While walking on the beach, we met a guy whose upper arm bone was completely fractured 2 years ago—I mean completely fractured, and it was never treated at all. It hurt badly for a year…and then the next year, without healing, it somehow stopped hurting and he retained use of the arm. It’s some kind of one in a million medical anomaly; absolutely incredible. His arm essentially has another hinge in it…if you bend the arm, the broken bone tents up under the skin and the arm bends right at the middle of the upper arm—Noah and I were absolutely shocked; this guy needs surgery to screw the 2 broken bones back together, so we are going to see if we can get the surgery arranged with someone before we leave.
got it to hospital that day over mountains...too weak...died 5 days later
And lastly…some bad news…a small baby came in about 5 days ago, age 1 month. It looked premature; it had been born weighing 6 pounds but had lost half its body weight, tipping the scales at a skeletal 3.3 pounds. It had no fever, no diarrhea, no vomiting, no cough, but hadn’t eaten much at all since birth.
The baby was listless and weak; it looked pretty thin at first glance but when Donna unwrapped it, we were shocked and dismayed at its emaciated body. I will always remember the apathy of the mother, the frustration of her sister…but especially the moment when we were examining the baby for its sucking reflex—young babies, if you stroke their cheeks with the tip of your finger, will reflexively turn toward the stimuli (as when the nipple brushes their face when they are being put to breast). This baby repeatedly turned its head away, almost as if it were deliberately giving up…unsettling to watch.
We contacted the Cap Haitian Health Network and got the mom and baby transported over the mountains to a hospital in Cap Haitian where they tried to feed the baby through a nasogastric tube, but last night, after 5 days of deteriorating steadily, the baby died (and it was only fed for 1 or 2 days through the NG because the mom couldn’t afford more…I found out too late or I would have found the funds somewhere!).
Things like this almost always penetrate my Zen, I’m afraid…it takes a lot of determination to let it go when things
1 month old...born 6 pounds...now 3.3 lbs
that shouldn’t happen just keep happening, like that poor guy’s untreated broken arm, or the 10 kids with urinary tract infections I saw in Camp Louise, or that woman’s baby, or the hundreds of other things like that that drop in my lap every month. If you have a 1 month old premature baby that has lost half its body weight you damn well get it care right away, not after it has been deteriorating for a month…but that is easy to say, since to get checked or get prompt neonatal care, care has to actually be available and affordable, and this baby and mother didn’t have that luxury.
So when I sent that baby to the hospital, I knew that it was so fragile it could slip away at any moment, but I knew that its life or death was not mine to decide, only to do everything in my power right then to give it a chance, and the universe would decide. The universe chose to take it back. I’d be lying if I said this time I really, really, really am working hard to not be upset that the result I wanted wasn’t what happened. I wanted the baby to have a future, not just a chance, but I can’t give futures…only chances.
I need more doctors and clinicians out here. Come where your training is REALLY needed!
I love our boat!
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