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.

A few great picture moments over the last 10 days

I had to start with the most famous..

A great installation that showed a video from inside a ships cab..

One of the monsters passing through with only 24 inches breathing space either side..

The little stream outside my house in Boquete before the rain..

And the same 'stream' six hours later..

My favourite local honey!

And not just any espresso: this is Gesha coffee from The Ruiz coffee growers in Boquete, in 2012 this particular coffee broke world records as the most expensive coffee in the world. Even at source today it is $160/kg.. 

and it tastes amazing! 

Atop Volcán Baru

Dawn..

and sunrise..

from the summit..

having wiggled a lot to get there!..

and walked up some pretty hefty hills..

Was it worth it? 

Every step!

Night-time jungle exploring

Waking up this morning there is very little to bely the heroic efforts of yesterday's climb up Volcán Baru. I feel surprisingly normal which in some ways makes me feel great for having a body that can tough it out, and also slightly un-nerved that perhaps it was actually all a dream. Fortunately for me I have two groaning companions who fared slightly less well and can testify to my presence. 

As Panamá's highest point the dormant volcano, often shrouded in cloud, is an obvious "must do" for anyone stepping off the bus in the Chiquiri province. Most people however do it in a 4x4 rather than wrestle with the challenge of a 14km,1700 vertical metre hike starting at midnight. With a gradient worth respecting, a track swimming in mud and boulders and no sleep I feel quite proud of myself for maintaining a measly 2.5km/hr on the ascent. And even more proud that I was whooping and smiling as dawn came and the sky exploded into colour. 

As you well know by now it absolutely pours with rain in the afternoon but the beneficial result of this is clear skies from around eleven pm until around nine am the next day. This makes a midnight hike not only an adventure (this is tropical rainforest not the South Downs Way, with it's resident jaguars, snakes and other various hungry carnivores on the hunt) but also almost guarantees clear skies for the duration of the climb and most importantly for the summit.  The moon, full and shining brightly, casts silvery light down through the canopy catching tree bark and lichens and outlining the forest to contrast against the inky blue sky. Quite extraordinarily and something that filled me with wonder was that throughout the night at some place in the sky (never directly overhead) there was lightening striking and thunder letting out it's ominous growl. As we climbed we gained an elevation advantage over the clouds and began to see the lightening from above, something I have only previously witnessed from an aeroplane. 

Throughout the night we were accompanied by the various cries and calls of the jungle night. At one point my hyperactive imagination (or maybe not..) thought that we were being stalked but it was just wishful thinking that the monotonous grunt of slipping over greasy boulders might soon come to an end with a spectacular wrestle with the illusive jaguar. 

Suffice to say we made it to the top. Chasing time as we so often seem to do in life I sped up for the last two km to ensure that I didn't miss the sunrise I so desperately wished to see.  And sure enough, as the dawn light began to glow we rounded the final corners, rested weary legs and sat on the rocks to watch a glimmering orange sun rise and fill the skies with pinks and yellows.  Elated and having unceremoniously plonked ourselves on the ground we dug around our bags for the assortment of squashed sandwiches and crumbled biscuits we had brought for a picnic and, hiding from the cold wind at the summit, ate them with smug satisfaction. A satisfaction, however, that was not to last too long: as those of you who walk in the hills will know the descent is more often than not the devil of the hike, especially for the knees. 

Lying here in my hammock the morning after however, the fiery heat in my knees is only a memory and I am left only with fabulous memories and photos to match.  This mini adventure marks the end of my time in Boquete, it's time to pack up my spanish dictionary and head across to my new home for the next few months: Bocas del Toro and the crew of Floating Doctors. 

So my next entry will be from a whole new world. Stethoscope and hammock in hand, the fun is well and truly about to begin.