From Bocas Del Toro

Day 1/ March 28: Today we arrived in Bocas del Toro at 8am after traveling all night from Ft Lauderdale. When we arrived we met the director Sky LaBrot, who I felt like I already knew since I have been reading the Floating Doctors blog for the past couple months. Dr. Ben LaBrot is not here currently because he apparently went back to Cali for the week. We will meet him next week when he returns. There are currently 10 people on the boat including us. There are two young physicians, one a first year resident from Australia, and one a first year resident from England. There is one eccentric nurse from New York, one undergraduate student from UC Santa Barbara, and two guys who help build and organize things.  Our first project of the trip, we took the panga boat into town from the marina to visit the Asilo, a home for elderly people and those who cannot care for themselves. It was nicer than I expected, but not as nice as a normal person would expect. We took the residents in their wheelchairs into the center of town to buy them snacks. I pushed Bernardo, an 87 year old man from Panama who has lived in Asilo for a long time. He is very with it, but apparently cannot live on his own. There was a new patient at Asilo who had very bad bed sores. The two physicians cleaned and dressed the areas and provided antibiotics and pain relievers. We will go back to recheck him tomorrow.  In the afternoon we went to the "warehouse" where floating doctors keeps their supplies. Today was the first day that we tried setting up a clinic for the people in town inside the warehouse. We first cleaned and organized the warehouse and then opened the garage-style door for people to come in. About 15 patients came total. I saw about 5 patients on my own. This was the first time I realized how much autonomy I will have on this trip. I was expected to make diagnoses and treat the patients without checking with anyone to make sure I wasn't making a mistake. This was a scary realization! At one point i saw a woman who clearly had allergic rhinitis. When I went to ask the doc from England what kind of nasal sprays we had available, she looked through them and passed right over nasonex to offer me Afrin!  Apparently in England they do not use a lot of the same drugs we use in the US, and so she was not familiar with either. I realized at this point that I, being only a few months away from my MD am going to need to take the responsibility of a physician at certain times while I am here. I provided the patient with nasonex and a generic form of Zyrtec.  At the end of the day I am exhausted! I haven't slept in 48 hours. We ate tacos for dinner on the boat and now I am going to bed.

Day 2/ March 29: today we woke up and headed for another island called Solarte. When we arrived we went to the grade school and performed well checks on the children. They lined up and Natasha and I saw them one by one, checking their skin, heart, lungs, mouths and bellies. Our only tools were a stethoscope and a pen light. We don't have and otoscope, but I am wishing I brought one. Many of the children have scabies. They have an unusual diffuse popular rash with excoriations. The other two doctors here say that is scabies and that all we have for them is soap. So when I see this rash I tell them to wash their bodies very good twice a day. Normally we would give them soap, but we don't have enough soap for all these children. Sky tells me that during the well exam, we are only looking for things we can help with such as rashes, thrush, pneumonia, and major heart murmurs. I saw about 40 children, and most were well besides rotting teeth and "scabies." After the well child visits we went down the hill to a small pavilion where we were setting up clinic for the day. It was very busy with mostly women and children. I saw many women with all over pain and many kids it's cough.  By far the most prevalent ailment was parasitic worms. We had boxes of albendazole and were handing it out like candy! Each time a kid had chronic diarrhea and the mom claimed she saw the worms in the kids stool, we gave out albendazole. I also learned that the weird rash a lot of kids have can also be caused by the worms. The funny thing is, no one knows what kind of parasite these kids have because there is no equipment to perform stool studies. But apparently albendazole works, so I have to have faith.  Today we had 52 patients total and I saw about half of them along side Hanily, the doc from England. It was helpful to have the two of us because trying to speak Spanish gets very frustrating after a while, but we were able to help each other communicate greatly. One thing I found slightly frustrating was that many of the people in these communities are not severely ill, but have very rarely seen a doctor so when they find out we are here, they come to see us with very vague symptoms. It is important to differentiate those in need of medicine from those who do not need intervention. We spend 6 hours working today and now are back at the marina. Tonight we are going to a fundraiser to support a local organization that provides neutering for the stray dogs and cats. "Third world problems!"

Day 3/March 30:  today was a very busy yet exciting day. We started working at 9am and finished at 6:30.  We started out doing follow up on the clinic we brought to Solarte two days ago. There was a girl who was vomiting worms who needed  an ultrasound, two children with asthma who needed albuterol inhalers with spacers (which we hand made out of empty pepsi bottles) and a man who needed eye drops. When we showed up to Solarte, no one was there. We had told the patients that we would be back today and they were to meet us there. After waiting a good 30 minutes, we decided to go looking. We all got back into the panga boat and headed to Solarte Dos, another island where my two year old patient with asthma supposedly lived. We got off the boat and walked up into the village. We luckily had a woman who lives permanently in panama with us and she knew who to ask to find my patient. The mother came out of the woods with her daughter and we showed her how to use the inhaler. One down. Next we went looking for the guy who needed eye drops. No one cold find him, but we found someone who knew him and he agreed to bring him the drops. We went back to Solarte and found our second asthmatic child, then finally found our little two year old with worms, we have a portable ultrasound, but her house doesn't have electricity, so couldn't do the ultrasound there. We ended up taking her and her mom to our clinic in isla colon, and we're finally able to do the ultrasound. It turns out that I, the fourth year medical student, have the most training in ultrasonography since I did a four week rotation in it at Albert Einstein last year. Of course, my training was in ob/gyn ultrasonography and this two year old is nowhere near pregnant, but nevertheless I know how to do an ultrasound. She had echogeinc bowel, but no incredibly unusual findings, so we treated her with four days of albendazole and sent them on their way. They will follow up at our clinic next week.  Next we went to Asilo to follow up with a new patient who has pretty bad bed sores. It turned out again that I have the most training in wound care, so the two doctors from australia and England let me take charge. We simply changed the dressing on all of the wounds except one on his left buttock, which needed debriding. I debrided this wound and we packed it with iodine packing. The situation made me wish that I could remember better all the details of wound care which I learned during my general surgery rotation. I never knew I would be thrown into having this much responsibility! (at least not until July 1st!) I am so used to having my preceptor right behind me to check my work that it is quite scary to be the one in charge when a person's life is in your hands (that sounds like common sense now that i'm typing it). We taught one of the women who works at Asilo how to do the wound dressing changes, because we are leaving tomorrow for a three day clinic in another town.  Next we went to the warehouse clinic in town to open our regular office hours from 3-6. I saw a 6mo pregnant woman who we decided to ultrasound so that I could teach the other doctors. They were all very interested to learn since the portable ultrasound is one of our best tools. We discovered that the woman's baby was vertex, had a good heart beat, and was a girl! Throughout the rest of the day I saw about 4 patients, one with otitis external, one with a urinary tract infection, one with a rash, and one with a cold. At 5 o'clock we held an English class for the people in town. Old and young showed up to learn how to describe a family (mother, brother, father, etc) in English and also the verb "to have." At the end of the day we organized and packed up our supplies for the weekend. We will be traveling to the mainland to hold a three day clinic in a town in the mountains called Las Tablas. We expect to see about 500 patients!