Playa Verde opening pics

Day 1 of Playa Verde - we run clinic in the Ranchero, whist the other volunteers paint and finish the clinic! 

Clinic is a never ending opportunity to teach hand hygiene.. here, a collection of friends gathered around whilst I was writing my notes up, so we started chatting and an impromptu lesson about worms and bacteria took place! 

Never before have I seen palm trees growing out of a patients thigh:

More clinic delights. This is 5cm across..

More fun with the kids! The better my spanish becomes, the more fun it is for all of us.  Here, clinic is ending, we're all winding down for the afternoon, so we get to play "what do you want to be when you grow up?" Guess who said Doctor?!

Our brand new clinic! Lit by the setting sun and by our solar powered lights. 

The core group! The tall gringo in the background is Eta, the amazing Peace Corps worker who lives in the village. Ben and Karine are beside him, but the really important people are the locals in front - they are the people who have accepted us into their lives and made this happen.  Can you see the clinic in the background - on the right, white with a green stripe? 

Opening of the Playa Verde clinic!

In a small jungle clearing on the Caribbean coast of north eastern Panama, a group of indigenous Ngäbe indians in their finest traditional dress and an equally proud group of foreigners, with stethoscopes dangling around their necks, gathered to celebrate a landmark event: the opening of Floating Doctors first remote outpost clinic. It began as a dream, as an inspired idea, and following months of discussion, planning, co-ordination and man-power, it has emerged as a physical manifestation of the commitment to healthcare and strengthening relationships between Floating Doctors and the community members of Playa Verde.

Floating Doctors has been providing free, high quality, remote healthcare to Playa Verde and other communities throughout the Bocas del Toro archipelago and Chiriqi Province for several years now. Every 3-4 months we would arrive at each community laden with bags of equipment, paperwork, medications and volunteers, eager to see old friends and sad to hear of others departed. Each time we left we would go with heavy hearts, knowing that there would be no medical care available except for that which we organize, or until we returned. This time however we arrived knowing that we were here to celebrate the opening of a clinic. A place that will be a cornerstone of healthcare, health education, cultural exchange and a base for reaching even more remote communities around the coast.

The day started with a flock of volunteers sand-papering and painting the building, finishing off wooden examination tables and mounting cupboard hinges. At around 11am Ito, the village mayor, blew his conch shell to summon the village to the inauguration ceremony. Local men, women and children gathered alongside the Floating Doctors team and there was a flutter of excited anticipation rippling through the group. The ceremony opened with a short blessing from the community religious leader, and was followed by a heartfelt and highly emotive speech by Ito, welcoming Floating Doctors as part of the community, sharing his aspirations for healthcare and cultural growth, looking forward to a long and healthy relationship with Dr Ben and all the team. Eta, the much loved Peace Corps worker, who was instrumental in co-ordinating this project from the Playa Verde end, said a few words in both Ngäbere and Spanish and handed the baton over to Ben where huge thanks and important acknowledgements were given, wrapped within an eloquent expression of gratitude, hope and future ambition. Following a series of photos to mark the occasion, a huge feast ensued. Piles of yuca, rice, beans and beef emerged and were shared out amongst all, and the afternoon clinic took place amongst a sea of smiles and well sated bellies.

Five of us stayed that night in the new clinic, in preparation for a full day of work there the following day. After sundown, just as we were settling in for the night, a young boy came to the door and asked if we could help him – his grandmother had just been bitten by a scorpion. The clinic was proving it's worth on it's very first day! We picked up our emergency kit and our head torches and followed the boy home to find his grandmother on the floor in serious pain. We sat down with her and inspected the culprit: a small brown scorpion, now chopped in two by machete. No mistaking what had bitten her then! Whilst monitering her we took the opportunity to learn a little more about common biting creatures and the local remedies they use. Fortunately, for an adult, this was not a particularly perilous scorpian and following an hour of observation, administration of medications and educating the family regarding signs of worsening, we retired home. An early morning visit the following day reassured us, and revealed to us just how appreciative the family had been for the care and reassurance they had recevied.

With rain pouring down in thick sheets, the clinic got off to a slow start that morning, but as the sun peeked out from behind the clouds, so too did faces peek around the doors of the clinic and soon enough we were in full swing. Big family groups attended together, some with serious illnesses, others just for a health check. It made such a difference to provide care in a custom made facility, with space and privacy that is so often lacking in the makeshift clinic environments. Ultrasounds could be performed on specially made beds in private rooms, medications displayed on shelves in an ordered manner, diagnostic equipment layed out in a spacious, easily accessible way. It was bliss!

Needless to say, here at Floating Doctors we are both excited and proud to have reached this milestone. None of it would have been possible without our volunteers and the many, many people who have shown their support through donations of money, time, advice, equipment and an endless stream of encouragement. So, I'll take a few moments to add my thanks to the huge list of thanks already given; to everyone involved, past and present. Together we are making a real difference. 

La Sabaña pictures

What looks like a river, but is in fact just a water logged path..

Ziggy taking time for a little refreshment after one of the river crossings:

 Katy testing out her flashy water filter pipe in one of the many streams - the water tastes amazing!

Mud, glorious mud!

Oh and so much water..

More mud, but fortunately a few boardwalks too:

Lining up for the river crossings, it looks deceptively easy in the picture:

The second, and far calmer, crossing:

Beautiful riverside pastureland:

The village! The building in the centre was our home for the duration of our stay, the thatched roof in the distance was the shelter where food was cooked and the metal roofed building to the left of our house, behind the tree is the school where we held clinic:

Philipp testing out his hammock tying skills:

Part way through construction.. more hammocks and mosquito nets to go up.  We use the nets here not for mosquitos, of which there are very few, but to keep off the many spiders, scorpions and possible reduvid bugs (carriers of Chagas disease) that live in the thatched roof and have a habit of dropping in at night to come and say hello:

Game of village volleyball in progress (using a football we brought):

The beautiful river that runs beside the village. Crystal clear, cool but not too cold to put you off and in the most incredible jungle setting.  Suffice to say that bathing is the highlight of the day!

Our supper being prepared:

Luke entertaining the masses whilst we ran clinic inside:

Katy with one of our trusty horses, loaded up with medical gear ready for the long walk home at the end of clinic:

La Sabaña

Sitting here in rural rainswept Devon beside a roaring fire, with a soppy Rottweiler draped over me on the sofa, I am reminded of the ridiculous sight of watching a local (and equally soppy) Rottie fishing in the shallow warm Caribbean waters off Bocas one weekend afternoon in November following our return from La Sabaña.  A strange sight, you might agree.  The dog, however, seemed not only quite content but also remarkably successful.  These memories in turn reminded me that I have promised you all a window into the extraordinary world of La Sabaña; the rural mountain village that we visited as our last multi-day clinic of the year.

Knowing that the Ngöbe indian settlements span a large mountainous region of northern Panama as well as the coastal areas, it has been an important process for Floating Doctors to forge strong relationships within key villages in the mountains. In addition to running clinics there it allows our reputation to spread and opens up the path to go deeper in to the mountains and access the truly isolated communities.  La Sabaña is one of these key villages and lies a four hour hike up into the hills.  As a charity we have visited with multi-day clinics eight times and it is by no means a walk in the park!  The preparation process starts in the kit room back in Bocas where the challenge is to reduce our usual eleven bags of medical equipment into six.  You see usually we just have to hike the kit a few hundred metres in the coastal villages so having eleven bags is not an issue, but for La Sabaña we hire horses to hike it in for us and horses = expense so the more compact we can be with packing our kit, the happier our finance team are and the more money we have available for expenses like patient transport and medications.  So, after a couple of hours testing our spatial awareness with a Tetras-style puzzle of surgical and gynaecological equipment, we miraculously succeed in this impossible sounding task without seemingly compromising the quality of the content.  This, of course, beggars the question as to why we needed eleven bags in the first place.  Step two is packing our personal bags lightly and efficiently so that we can happily hike with them over tricky terrain.  Personally, and I imagine for most of you, this is not much of a challenge but I have to admit to falling about with laughter upon walking into another room and seeing a fellow volunteer filling up a beautiful shoulder holdall bag with her kit. You can take the person out of the city.. 

And step three, of course, is getting first to the trailhead and then up the mountain.  Waking up at dawn there was an excited buzz in the air; hiking socks were being worn for the first time in months, feet were protesting at being suddenly squashed back into boots where previously they had been allowed to pad about barefoot and in sandals.  Something new was going on! With several kilograms of fresh water packed into each of our daypacks to combat the inevitable pouring of sweat we gathered at the dock and took a boat taxi across to the mainland to meet up with a fantastic local guy whose taxi services we can rely upon. After securing our gear down under a tarpaulin we bundled into a minibus and a pickup truck, plugged into our respective iPhones/tablets, and settled into a two hour drive inland to a village whereupon we would pick up the horses and start walking.  Much to our delight our boss Ben had organised for us to have breakfast at a café in the village; we were greeted with huge kind smiles, pots of steaming coffee, light fresh fried bread and stewed chicken.   Not what you might imagine would be a first choice for breakfast but it went down a treat and was to fuel us well for the hike ahead.  With the horses saddled up we left the village on a single track mud path through the jungle and encountered what would be the first of many huge thick greasy deep mud pockets that sucked at boots and threatened to throw unsuspecting walkers onto their bottoms.  Fortunately I was not one of them, but the mud did not take much time to claim it's first victim!  Along with this mud came steep climbs and descents as the path undulated ever upwards.  The first few people did not have many troubles tackling these hills but as more and more feet travelled the path it became glossy and slippery, the subtle tree roots and pebbles providing secure foot placements were long squashed and buried,  so those less fortunate at the back had a lesson or two in mud skating and four-limbed clambering.  

But there is no antidote for muddy hands, legs and boots so great as a series of river crossings! And that is what we had in store next; huge, smooth boulders stood scattered across the river with the fast flowing water frothing and rolling at their bases.  Their spacing just close enough to form a bridge and afford us safe passage to the other side.  In reality being swept off the rock would have resulted only in a burst of giggles and a head-to-toe refreshment in the crisp clear water.  A further two crossings signalled the end of our journey as we climbed up the far bank and saw the smiling faces of our horsemen, a handful of villagers and our kit at the entrance to La Sabaña. 

We set about with our usual buzz greeting the locals, finding our lodgings, setting up our hammocks and generally organising ourselves for the days ahead.  There is a familiar feel about these villages, possibly it is the kind and open way in which we are received by the locals, it is a real joy to chat and play with the children as they venture down from their houses through the afternoon.  I've mentioned food many times in blogs before; the never ending mounds of rice and beans and pots of hot sweet coffee.  However La Sabaña is a little different - here, we buy a pig.  It has become somewhat of a tradition and the local men 'deal' with it and hand it on to the local women whom we employ to cook for us.  The result is four days of delicious piggy delights and a very happy medical crew.

The village sits in a relatively level clearing in the jungle, flanked by two rivers with huge steep sided jungly mountains behind. Unlike most of the coastal villages we support, La Sabaña is has very little 'western' influence and it reflects in the health of the population. There are no fizzy sodas or penny sweets, no processed biscuits or crisps, the knock on effect being that dental decay and diabetes are remarkably infrequent.  Not to say that disease is not present here - we saw a huge number of patients and I can say hand on heart that we most definitely saved several peoples lives and delivered health education and primary health care to dozens more.  A boy that we were all very pleased to hear about was Gustivino; he is a delightful young boy whose illness and management demonstrates exactly why it is so important that we do the job we do.  He is a young teenager, has a severe heart condition and advanced tuberculosis (TB) and lives in La Sabaña.  He had been ill for a long time but his family did not have the funds to take him to a doctor in the town four hours away.  When our team visited earlier in 2013 they organised for him to get to a specialist hospital for investigation and it was then that he was formally diagnosed. We worked with the Panamanian Red Cross to co-ordinate his care with the 'local' tuberculosis centre and for six months he walked up and down that same greasy mud path weekly to to receive his treatment.  That's twenty four round trips.  It was a triumph to be able to celebrate with him the end of his treatment for TB and to observe the ongoing specialist cardiac care for his heart.   

In fact, this is the Floating Doctors video that follows his initial diagnosis process:

http://www.youtube.com/watch?v=hq9B6Gsve8c

And just in case you've not visited it yet, here's the Floating Doctors website:

www.floatingdoctors.com 

and their Facebook page: 

https://www.facebook.com/floating.doctors

It has been an incredible few months and I am over the moon to be returning this year as a member of staff.  We have huge projects in the pipeline and a stellar team to make it all happen.  2014 is going to be a pivotal year for Floating Doctors and I can not wait! 

Merry Christmas and Happy New Year to you all.

A fishing rottweiler:

Jatuita kanoi! ..

...Ngobere for 'see you again soon!' were the final words I called out to my smiling friends as I raised my hand, waved and ducked into a local minibus to start my long journey back to the UK from the jungles of northern Panama.  

It's been a long journey home; Miami airport is not a kind place, and my body threw me a hefty dose of tonsillitis just to make the travelling that much more pleasant. But I made it in one piece and into the giggling, smiling arms of my 2 year old niece at London's Heathrow.  After a warm reception and the usual faff of car park tickets, figuring out where to deposit your now-empty luggage trolley and navigating the airport exit signs, we made it back to the tranquil countryside village of my family home. Only then did it began to sink in that I really had left Panama.  Well, it's now fully sunk in and It's blowing a hoolie outside my Oxfordshire window (and for those of you with no Scottish blood that means there's a huge great gale trying to force it's way into the house); so as I pull on my thermals, wiggle into my fleecy slippers and cup my hands around a warm hot chocolate it is time to look back, reflect upon the last twelve weeks and share with you some of the finer details that have escaped me whilst writing excitedly from my Panamanian jungle hideaways. 

The first thing that is dying to spring from my fingertips is a description of our most recent multi-day clinic to La Sabana, but that deserves a whole blog to itself, so I shall refrain and instead embark upon a virtual 'day in the life of a Floating Doctor volunteer' (not least because I have been gently nudged into doing so by a very wise lady who brought to my attention that she really had absolutely no idea of how life unfolded when we were not out on multi-day clinics!).  So this one is for you Chris.

Well, Xylophone girl really deserves a mention here. She is the first thing any of us hear in the morning time and has become somewhat of a legend/mascot for us long-termers. Xylophone girl is thus named because none of us have ever seen her (I must point out here we do, admittedly, assume that the player is a girl for no particular reason other than the phrase 'xylophone girl' stuck..) and she crashes around on a very durable xylophone for, mas o menos, three to four hours a day. To her credit she has improved dramatically in three months; every so often someone will shout out a song name that seems to roughly fit the spluttering of notes wafting in through our windows and everyone else cries out in celebration that she has finally learnt a new tune.  Good on her.  If only she wouldn't start at six thirty in the morning.  

But to rewind for just a moment, I need to explain our set-up entirely. We live in the upper floor of what is charmingly nicknamed the Warehouse.  Not an imaginative nickname; the lower part of the building houses a series of cavernous storage facilities, one of which is our much loved local Veterinarian Dr Dan and the other is the quad bike garage for a local company. The upper floor where we live though is well appointed and on first inspection surprisingly upmarket for a charity.  It is only when you realise that there are three other people sharing your open plan studio room that expectations return to those befitting a money-conscious organisation. Entering the room is pleasant enough, with large built in wardrobes designed to absorb the majority of our kit and clothing, the fridge-freezer hums quietly - not a patch on the squeaky drone of the four large standing fans whirring on full speed as they attempt to circulate the damp, hot air around the room.  Somehow, despite having glassless windows along one side of the building, there is an extraordinary ability for the rooms to heat up to oven-like temperatures.  The resulting (and quite amusing) effect is that most volunteers spend their first week acclimatising by lying/standing in-front of the fans in disbelief at the amount of sweat their bodies can produce. Resignation is the name of the game. 

So you have arrived, safely and triumphantly, deposited your belongings at your bedside and met your new roomies. It's now time to gather essentials and get a feel for the town.  Bocas is a very small, almost entirely friendly island town that is used to having many 'gringos' pass through on the hedonistic backpacker tourist route as they drop in from Costa Rica on their way to Columbia.  It can be frustrating to be lumped in with this stereotype but the longer you stay the more faces recognise you and slowly the vibe changes and genuine calls of 'Que sopa Tia!' (What's up my friend!) follow you down the street.  

This island has grown up fast; ten years ago there were virtually no tourists and the rapid growth has been fantastic for tourism but sadly is not without its deleterious environmental and social effects. Rubbish disposal is a major issue on a small island and, although there is an organised system, there are times when it is desperately depressing to walk around town.  Water is another huge issue - tap water here is unsafe to drink and as a consequence the hundreds of tourists that pass through buy small, medium, large water bottles and discard the empty vessels in the bins in favour of refilling. There are water purification and refill stations that we all use as much as possible but I am as guilty as the rest when I forget my five litre jerry can.   I could go on; an oil generator is responsible for supplying the islands electricity; I spoke with an American couple who own a large solar energy company who had submitted plans for installation and maintenance of solar grids for the whole island but had been turned down in favour of a (much more expensive) new oil generator.  Clearly politics and power are no different here than anywhere else.  

Apologies for straying into dangerous territory, may I bring our attention back to the Floating Doctors.  It is now six thirty am and as promised Xylophone girl is practising furiously.  I am awake and am slowly waking my body up with some yoga as the coffee drip drips through into the bowl, spreading it's heavenly aroma out of our room and down the corridor to the other five Floating Doctors rooms.  The sun is rising in the East, showering golden rays through the windows and signalling a brand new day to the birds whose songs warble alongside the metallic twanging from next door.  Slowly but surely over the next hour and a half sleepy people wander up to our room, mug in hand, to pour a cuppa and come for a morning chat. Where are we off to today? Do we have a day clinic or are we heading to the residential home (Asilo)? Um, it's so hard to keep track of actual days, let me see, it's Tuesday. We're off to the Asilo. Oh gawd, better get a second cup of coffee..

Enough for now I think or you will be reading all morning long! I promise to continue the virtual tour very soon. To placate you, please find a few more gorgeous pics, taken by several of our crew over their stays:

A baby boy born the day before we arrived for a follow up clinic; I had ultrasounded the pregnancy the day before his birth to make sure he was in a good position and low and behold, here he was upon our return! 

Simply stunning views. Not a bad commute to work.

Some of the residents of the Asilo, the residental home we look after in Bocas. We take them for a walk to the park, a banana and a soda twice a week. It's simple but actually wonderful to do; these lovely folk have no-one and without our input would stay in the same compound 24/7.

There is no doubt that there is huge need for the medical work we do, and the room to grow, the capacity to expand, integrate and work towards a sustainable locally driven healthcare system is enormous. I have never felt more alive.

Playa Verde

Lining up to be weighed and measured:

The crowds of interested onlookers everywhere you go: 

A patient patient:

You wouldn't believe how good a warm coke tastes when you're almost in the floor with fatigue...

More patients arriving:

Our fantastic team:

End of the day! Time to..play Jumping Frogs:

..go for an explore:

..watch supper being made:

..take in the sunset:

..and fall asleep under the stars:

Chino Rojo and making chocolate

Throughout the world in the minds of young children lay visions of sea monsters covered in barnacles emerging from rolling, frothing surf ready to gobble them up and toss their dainty bones aside to be used as toothpicks.  And it's heartening to know that Playa Verde (our latest mulit-day clinic) is no exception! The village is possibly the most beautiful I have visited yet; sculpted sandstone cliffs sagging and crumbling under their densely vegetated tops, home to toucans, sloths and a myriad of other tropical creatures.  The quiet coves below are used to shelter the cayucos whilst the fishermen come home to rest and are the scene of these fantastical childhood nightmares.  The Chino Rojo are a mythical group of underwater pirates that live in submarines and come ashore at night to steal the children, but unlike myths of the west where it is usually the naughty children that get spirited away, here it can be anyone at anytime.  And God forbid that you swim at night, that's a sure fire one-way ticket to the dark seaweedy underworld.  Sadly though, my jaded grown-up mind wonders whether this myth is just an easy way of keeping the harsh reality of childhood mortality away from young eyes; after all, here, pneumonia and diarrhoea are still the biggest killers of the under 5's and the infant mortality rate has a long way to go.

That doesn't stop the kids from whooping and laughing or running off wide-eyed with terror as we finish clinic at sundown and head for a refreshing dip as the sky lights up pink and orange.  In fact, this is without a doubt my favourite part of the day; that first dive into the water after a hot, sweaty, tiring, long day somehow cleanses not only my skin but also my spirit and helps me release the confusions and irritations that inevitably arise in an environment like this.   Washing, however, is something of an art form.  The communities here are very conservative so we swim and therefore wash in scrubs.  I'm not sure if you've even been thrown into a swimming pool in your pyjamas but it's a very similar experience! If you will, imagine distracting the tightly sticking cotton from your skin enough to sneak a bar of soap around your body at the same time as trying to make it froth in sea water, and you will have conjured up the entertaining evening ritual that we perform every night. Despite still feeling sticky from the salt, this is immeasurably better than the slightly sour odour that accompanies everyone at the close of day. 

This multi-day saw a similar spread of illness and public health issues as we usually see, with more scabies, tooth decay and pregnancies than you can shake a stick at. One gentleman in particular touched our hearts; he had some kind of developmental delay and did not speak - he could hear perfectly well, and understand basic conversation but at aged 40 was a comparably 'unaccomplished' man with no wife or family (presumably due to his disability as he seemed like an affable chap).  On attending my consultation, aside from being charmed by his enthusiasm to communicate, I had absolutely no idea what was actually the purpose of his visit.  Was he here with a medical complaint? Did he just want a check up or to say hello and be sociable? Did he want a toothbrush and soap and be on his way? After a good twenty minutes I enlisted the help of the local men in the community who were looking on in kind amusement.  They began talking to him with a combination of sounds and hand gestures: Panamanian sign language!! In fact I think it may have even been Ngobe sign language, even more special.  So with several local men as my translators we managed to deduce that he did indeed have a medical reason for attendance and we were not only able to assess and treat him, but also confidently explain the medications and plan.  Something that I would have been at a complete loss as how to do had I not been so fortunate to have had these friends of his nearby.  It was a wonderful demonstration of the real meaning of community, and one that will stay with me for a long time.

In my writing I do seem to find myself veering away from the medical side of these trips and describing the 'out of work' pieces much more, and I suppose that's a reflection of how many extraordinary experiences it is possible to have (and I am aware that nobody reads this blog to get a discourse on the life cycle of a mosquito).  So humour me as I take us off into the world of chocolate making and bouncing around like a frog with a dozen school children..

The cacao tree, if you have never seen one, is a bit of a bizarre looking beast.  Huge pods sprout off the trunks at random intervals and the process of harvesting, sorting, fermenting, drying and roasting the seeds is complex and intriguing.  Not having anything beyond a rudimentary understanding I will not bore you with my fumbling descriptions but will cut to the kitchen, to the roasting, and to Anna (a fellow volunteer) who is in the middle of grinding roasted seeds.  She stands beside one of the most important women in the village, the Curandero, or botanical medicine woman, who is stooped over an open fire stirring seeds as they roast.  After grinding, the cacao is mixed with milk and a little sugar and patted down into a shallow container.  In a cooler climate I suspect it might set, but here, it is comfortable staying a bit floppy as it rests in thirty degrees heat.  It was an amazing process for Anna to experience and for us to view; we were watching first-hand the traditional method of chocolate making directly from the indigenous healer in the village.  The taste was more earthen than Green & Blacks but all the more extraordinary. 

And what about these frogs? Well one story tells the enormous racket that the real frogs make come sunset.. you would not believe the decibels these guys can achieve. But the other story follows half a dozen local children who took myself and another couple of volunteers on a little explore around the village.  We ended up on the top of a cliff overlooking the bay and after having had our hair plaited by the girls (they go mad for blonde hair) we had a crazy half hour scampering around in the dirt bouncing around like frogs playing 'tag'.  By the time the sun touched the sea a few other children had come down from their homes and had joined in, and the air was filled with the gorgeous sound of innocent, ecstatic giggling as these barefooted potbellied beautiful children roared around like mad.

So with glad hearts we leave Playa Verde behind and look ahead to a busy couple of weeks of day clinics and working in the Asilo.  Time to settle back into Bocas for a while, re-calibrate to 'town' life and re-feed our bodies with leafy vegetables and maybe a beer or two..