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..

A few more pics..

Packing for a multi-day:

Setting off on our trusty boat:

A new village, a new ranchero to set up home in:

With kids always ready to play in our hammocks as soon as we disappear:

Beautiful little washing creeks:

And laundry drying on trees:

Plenty of patients:

With wierd and wonderful problems:

And the most amazing fresh agua de pipa (coconut water) in the world!!

And a guaranteed swim at the end of each day!

Multi-day clinic in Norteño, with an unexpected patient

I'm living a very satisfying moment right now. Sitting in my hammock, which is one of eleven spread out in a star shape connected to a central pole underneath the Peace Core workers house, I'm listening to music and relaxing with my FD friends having just bathed in a crisp, fresh, crystal clear river in Norteño, the jungle village we are staying in for three days to deliver a multi-day clinic. 

Today produced some unexpected events, although it started normally enough; cockerels crowing at dawn, dogs causing merry hell and fighting underneath our hammocks; school aged children being bundled out of their houses, hair scraped back in perfect plats and bodies neatly covered in pristine white shirts and blue skirts; bleary eyed volunteers hopping out of hammocks and contemplating the day ahead over a cup of coffee and some fried bread. And the day continued as usual with bundles of children and clusters of teenage sisters presenting themselves and their various relatives for assessment. After what we thought was a very successful first day we were all relaxing in the clinic as the night set in when a commotion outside caught our attention. A woman was being rushed in towards us on a stretcher with blood all around. She had fallen whilst exiting her house (which is about 1.5m up from the ground) and landed on rocks on her head, knocking herself unconscious.  Time for some gloves, a trauma assessment and some problem solving. Fortunately for her there didn't seem to be any immediate life threatening danger but her injuries were such that we had to immobilise her spine and get her to hospital to have X-rays to look for neck fractures. 

Oh but hang on a minute, we're in the middle of the jungle in the dark and there's a river to cross to get to the road. Now you know why I mentioned problem solving..

Fortunately for us, we are a resourceful bunch with a broad set of skills. Our firefighter (a female, just in case you had pictured a man!) proved to be invaluable as did our four ambulance technicians. They co-ordinate the foot transport and worked together with great teamwork to deliver the patient to the waiting ambulance that we had ordered. Except that "ambulance" was pushing the definition just a little.. It did have impressive flashing blue lights which gave us all great feelings of reassurance as it arrived, but after a cursory inspection there was no escaping the fact that it was just an old flat bed pick up truck. No paramedic, no drugs, no nothing really. But it was wheels and it was the only option that could get our lady where she needed to go. So we strapped her on (if you can imagine this she is lying on a makeshift stretcher which has just been tied down to the truck, the end of the truck is open so her feet are poking out into nothing and at this point she's not actually secured to the stretcher by anything except for her head tape..). The ambulance driver seemed quite happy to head off like this but with scenes from a horror movie unfolding on our minds we persuaded him to wait whilst we secured the patient on to the stretcher so she wouldn't slide off the end of the truck as they started the bumpy ascent up the track to the road.  It certainly gave me a new gratitude for our poor battered old NHS. 

I am actually writing this end bit in retrospect two days later and we are still waiting for news of her condition. In all likelihood she will fine but she's not returned home yet so there's no way to know. We have only the pay phone in the village and it hasn't yet rung.

A few Baya Azul multi-day pics

Early morning coffee with a Cayuco silently being paddled in the background:

The organised chaos of clinic:

Everyone is really keen to have their pictures taken! Especially as they can see the results:

Explaining treatment of a sick child to his sixteen year old mother. In Spanish. In fourty degree heat. I would be sitting down but we don't have enough chairs:

The result of us having previously visited this community? Being able to review X-rays that we had previously organised to look for TB when they have chronic lung complaints. It's a four hour round trip in a motorboat to get to the hospital, and costs far too much for these people to imagine paying for themselves. Fortunately for this guy his xray looks pretty good:

We are our own pharmacists, creating robust treatment regimens from what we have in the bags. We often run short of drugs and have to be creative (yet safe and effective) to be able to adequately treat te diseases we find:

Lunchtime! (note the rice and beans.. I wasn't kidding about the sweetcorn being my saviour)

Diedre having a well deserved shower at the end of a hard day:

The sight of our hammocks looking more and more inviting as the sun goes down:

The view from sitting in my hammock:

And the reward for hiking at dawn to watch the sunrise over the village:

Bocas and beyond

First of all, apologies for having not posted for a while; since joining Floating Doctors I feel like I have been swept up into a whirlwind of adventure and am in a permanent state of ecstatic exhaustion.  It's currently six thirty am and the coffee is hubble-bubbling away in the background, filling the room with that familiar aroma of morning as the world awakens around me.  Every day is different here and today we are up early to pack for a multi-day clinic at Norteño, a large village on the mainland (one of the few non-island communities we serve). Having been on a multi-day clinic in my first week I have a few extra experience-based additions to my rucsac, loo paper being the most valuable! It is amazing what people (and in this context I mean volunteers) will trade for a few sheets of cotton soft luxury upon the realisation that the community has no plan to provide for our creature comforts.  Tinned sweetcorn comes a close second and is an immense morale booster when, tired and powerless over the food being served, we are faced with the third bowl of rice and beans for the day. But do not mistake my list for complaints.. far from it.  It is actually a complete joy to derive such immense pleasure from these simple things. It brings life into sharper focus, highlighting the immense privilege we experience day to day without even giving it a second thought.

Another treat on multi-day trips is that of living in a Ngobe village for four days. We arrive, set up our clinic in some form of structure: a school house, an open sided barn or a library, and set about making our homes. This, for the uninitiated, is quite an entertaining spectator sport for hammocks and mosquito nets are not the easiest in the world to set up and invariably at least one or two people end up on the floor part way through night one. Fortunately I lived in the Belize rainforest in a hammock for six months as a teenager so, after hearing the familiar squak and thud of a midnight hammock catastrophe, can pretty quickly and easily sort it out even blindfolded by the rainforest's velvety darkness. 

Following a restful, rocking sleep we rise early and are in full swing seeing patients by eight thirty and do not stop until nightfall save for a quick bite here and there to keep energy levels up. The Ngobe people are absolutely wonderful; open hearted, playful, inquisitive, earnest and exceptionally hard working. There is very little alcohol or drugs in the culture and even smoking is a rarity. 

 Baya Azul was the village we visited for one such multi-day a couple of weeks ago and, it being my first week with FD, was a baptism by fire into the whole process and I am still grinning like a goofy school child at the memories. Packing gargantuan amounts of medical supplies, food and coffee into Elvis' boat (yup, that really is his name!!) a group of twenty of us - some medical and some with absolutely no medical experience at all - climbed aboard and out across the archipelago of mangove Islands to receive patients from across the region. It would take a very long blog to detail the experience so I will tell it through photos in my next entry. (To follow imminently!) 

As for this last week, we have been living and working from 'home' in Bocas, going out on day clinics and doing ward rounds at the local old peoples home. This elderly care facility by all accounts was a pretty dismal place to be up until FD partnered up with the locals.  It still has a long way to go but the residents now at least are clean, fed, have regular medical attention and probably most importantly they have people that come over and spend time with them, shower them with affection and take them on outings.  After all everybody needs love.

So here I stand, on the brink of another multi-day adventure, my complete heart and soul open and engaged. But let's not romanticise here, I'm absolutely pouring sweat as I sit here in the early morning sun, my balcony overlooking a grim shanty town that was created when the govennment displaced an entire village to make way for a runway. It is a relentless, tough environment here with challenges coming no only from disease but from the diseases of power, greed and neglect. We are making a hugely important difference but it is a grain of sand in a desert of need.