Las Tablas

Day 6/ April 1: We just returned from our three day clinc trip to Las Tablas. I've never experienced anything like it! I also never thought I'd be so happy to be back on our crusty boat :). We left at 7:30am on Friday, taking our bags and medical supplies on our little panga to Boca's town to get on a "water taxi." Because Bocas Del Toro is an archipelago, or giant cluster of islands, they use water taxis which are larger panga boats that take people from island to island for a small fee. After our 45 minute water taxi ride we arrived in Changuinola, where we loaded everything and everyone into a huge van taxi. After an hour and 30 min cab ride we were finally in Las Tablas. When we pulled up to the "rancho" or outdoor pavilion, there were already about 50 people awaiting our arrival. And so it began.
We quickly set up our pharmacy, supplies and work space, which consisted of two small tables preceding three small tables. The intakers sat at the two front tables, taking a general intake history of the patients and then giving them a number. When their number was called they would come sit down at one of the three back tables where the doctors and medical students were sitting. Most of the patients brought their entire families. The largest group of patients we saw at once was a family of 8! We only had 6 chairs total, so we had to use pieces of palm tree stumps and sideways plastic bottle holders as chairs. We saw a LOT of kids with parasitic worms, scabies, rashes and colds. Most of the women had bone pain and headaches (many don't drink any water during the day). There were almost no male patients on Friday because they all have to work long days in the banana fields.

The rock I removed from the little girl's ear!

Although we saw many patients with the same problems, a patient who made it all worth while was a 12 year old girl who came as a part of her entire family. After taking everyone's histories, I asked her "Cual es tu problema?" Her mom told me that she had a rock in her ear that had been there for 6 years. I barely believed her, but I took a look with my otoscope and sure enough, she had a rock in her right ear. We didn't bring the typical tools with us, such as a metal irrigation syringe or an ear curette, but I managed to find a large plastic syringe and some metal tweezers. I filled the syringe with bottled water and took my first try spraying the water into her ear. The rock didn't budge and I got nervous, so I went to ask one of the volunteer doctors who is a pediatrician at home. Carl tried a few times with no results and so I asked if I could try again. I tried two more times, determined to get the darn rock out, and finally on my third squirt the 10mm rock floated out of her ear! I grabbed it and showed her family, and they immediately started screaming and crying, SO happy that the rock was finally out of her ear after 6 years. It was so emotional that I almost started to cry! They wanted to take pictures with me and we celebrated for a few minutes, but soon it was time to get back to my table because waiting patients were increasing by the minute. The day was long and my Spanish skills were absolutely exhausted by the time we were done seeing 48 patients (As a group we saw 134 total).

We went back with the local Peace Corps worker to see where we would be staying for the night. I expected it to be crusty, but this situation never came into my mind! It was a half-finished cement house with open doors and windows, built in the gravely backyard of a woman's house. I cold not believe that this is where poor Doug the Peace Corp worker was living! We hung up 4 hammocks in a cement room and called it a night. It was the first time I've ever slept in a hammock... All I can say is thank goodness I'm short!

The "house" we stayed in :)

The next day we worked very hard again, seeing 142 patients total. The pathology was more of the same, and we ended up running out of Albendazole (worms treatment). When we closed up on Saturday, there was a frenzy because there were still about 50 patients who hadn't seen a doctor. I felt sad as we packed up, leaving these patients without medical assistance. Sky, our director reminded me that we were out of Albendazole along with many other medications and so we would not be able to help many of them even if we did see them. The funny thing about this patient population is that many of them really just need reassurance, counseling on healthy habits (keeping their children clean, drinking enough water, and brushing everyone's teeth) and of course worm tablets. After we packed up we had a few other things to accomplish. Half of the team went to make a house call on a 23 year old woman who was bed bound after a bad labor outcome, and I went to help Jordan our doc from Australia do an ultrasound on a 15 year old girl who was 8 weeks behind on her menstrual period. We took the girl into an apartment where there was electricity and performed the ultrasound. After Jordan realized that the gravid uterus was not actually "the bladder with stuff moving in it :)" we informed the 15 year-old mother of one that she was again pregnant. To our amazement, she was happy. Apparently women in this culture aim to have as many children as possible as a source of social security for when they grow old.
We went back for a dinner that the hosting woman cooked for us, and afterwards jumped into our hammocks, exhausted enough this time to actually sleep in a halfway jackknifed position. The next morning we got up and made a few last minute house calls before packing everything into our pickup truck taxi and squeezing in. Half way back to changuinola, the taxi overheated!!! Of course! It was intereting though because while we were waiting for the taxi driver to come back with coolant (or something) we could really awesome plants! We found a pineapple plant and a chocolate plant. The people who owned the land sold us two chocolate fruits for about a dollar and we ate the delicious seeds. To my disappointment, there was not chocolate inside. You actually have to ferment the seeds, dry them and then roast them.
We are back on the main boat now as the sun is setting. I was so happy to be back near the water and away from the dust and heat. I took a fantastically warm shower and am getting excited for our first day off since I've been here. Tomorrow we don't have to work, so we are going to try to rent paddle boards!
Till Tuesday,
LA