Day 15/April 11: Today was my last official day with Floating Doctors, and it was a wonderful day to end on. We were meant to start our day off around 9am, but the usual tropical rains prevented us from getting on the panga boat until around 11. As soon as the downpours were over we jumped on the boat to begin the hour long ride out to a village called Loma Partida. It literally means "split hill," because apparently there is a very low area between it and the mainland, although the two are connected. The ride was beautiful with mangrove islands, mountains and a pod of 5 dolphins swimming and playing along side our panga!
Today's clinic was different and wonderful because instead of trekking up into a village through muddy paths, tall grass and endless bugs, our clinic was held on the dock of a woman's restaurant/bar. This woman named Michelle is a native South Carolinian who bought land here in 2006 and has turned it into a very nature-esque resort. She lives alone surrounded by many Ngöbe Indians who have almost zero access to medical care. Michelle hosts the floating doctors on her dock-bar whenever we are able to come out. Instead of the usual tree stumps as chairs and dirt floor, we had an amazing setup for a clinic with cushioned bamboo chairs, real tables, running water and electricity! (oh, the things I used to take for granted...)
When we got to the dock at Loma Partida there were many patients waiting for us. We started right away, and I saw about 20 patients total throughout the afternoon. The Ngöbe people in Loma Partida are very secluded from the modern world and it is noticeable. They are quiet people in general; the kids do not cry, play loudly or scream. The women talk very quietly, speak very little Spanish, and do not make eye contact when speaking. It makes physical exam difficult because to me all the children seemed ill! They sit and stare at you but will not smile back or laugh when you tickle them. My very first patient of the day was a 67 year old woman who complained of back pain. She described it briefly, but would not answer any of my questions or look at me. I soon realized that she spoke Ngöbe, not Spanish and her body language was just part of the culture. Once I got the hang of the "cultural vibe" and realized they didn't all just hate me, the day ran more smoothly! ;)
The patients were interesting, one 31 year-old married woman who we diagnosed and treated for chlamydia, a 38 year-old woman with a goiter who had an appointment with an endocrinologist many years ago, but missed the appointment due to transportation difficulties, and many men with knee and back pain. Dr. Ben and I did an ultrasound on a 15 year old girl who was 16 weeks pregnant, and an 18 year old girl brought her two year old baby in with a cold. After I took care of her and her baby, she asked me "do you have babies?"
"no... I am still in school!"
"are you married?"
"no... but I have a boyfriend and we are both in school,"
"how old are you?"
"26.."
"oh, I'm 18. I already have a baby..." Thanks a lot Ngöbe girl!! Haha!
After seeing all the patients, Michelle gave us a tour of her grounds. She has an amazing place out in the middle of nowhere complete with chocolate, avocado, papaya and banana trees, pineapple bushes, chickens, her own distillery and a "pet" monkey! Not to mention an incredible view of the water and mountains. Pretty amazing.
After Loma Partida we were back on the panga and headed back to Isla Popa Dos for follow-ups from earlier in the week. The main patient of interest to me was a 38 year old woman who has 11 children who Jordan and Hanily suspected last visit to have a rectovaginal fistula. They wanted me to do the pelvic exam since they consider me the ob/gyn of the group. When we got to the dock I went up the hill with Hanily to look for our patient. We found her at her house with tons of small children in underwear, chickens and dogs running around in the dirt (not unusual). I introduced myself and explained to her once more what we were thinking and what the next necessary step was. She took us up into her stilted house to do the exam. Before we started it dawned on Hanily that even though she's given birth at least 11 times, she has probably never been to a gynecologist before so she would need a little extra explaining than my usual patient. After making sure she was comfortable I performed the exam and was done in no time without complications. Although I am certain she does not have a fistula, I am worried about other pathology and am sending her to a gynecologist in Changuinola who can take biopsies and consider surgical treatment for prolapse. She does not have health insurance, so Dr. Ben asked me to write a full history and physical on the patient so that he can go to Changuinola first and try to make an appointment on her behalf. I hope that she is able to go. Sometimes I wonder how people out here make it to old age with the hurdles they face to getting the care we so take for granted in the US.
After everyone was finished at Isla Popa we headed back to the ship. I am officially done with my international elective here in Panama, and I have mixed feelings about it being over. It was an incredible experience, and I learned more than I ever anticipated. I feel I have helped many Panamanians who without our group would not have access to medical care. I learned a lot about myself, my interests and what motivates me to be the best physician I can be. At the same time, this rotation was at times mentally exhausting! It is difficult to see patients and know that you are limited in the services you can provide them. Sure, I can tell a man I think he has TB, but I can't test him for it with out an X-ray machine and a microbiology lab. We can't make the hospital do more for the patients and we can't work inside their hospital. The most we can do here is provide care to the best of our ability and advocate for them to get the rest. I met countless patients on this trip who I wanted so badly to just put on a plane and send to the United States for medical care. Sadly that is not an option and we have to work with what we have here in Panama. In the end our best shot is better than what these people have without us here.
Thanks to everyone who has been reading my "journal" along the way and experiencing this trip with me! This is an assignment to get FSU credit for the international elective, but it sure was fun to add pictures and share with my family and friends. I appreciate your support and can't wait to see everyone back in the states. (after a few days of exploring and fun in the sun with my boo Ryan Kissane!)
Con amor,
Lindsay
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