Crossing Languages and Cultures in Panama

For many of these people, a supply of ibuprofen is a real boon, and even modest doses of ibuprofen give them noticeable relief. This medication we give them is worth the 4- to 5-hour walk. When we first started this program, we were advised to give a 30-day supply of medications for chronic conditions, but we have been able to expand our formulary and give people 6 months’ worth. We currently make trips to Panama every 6 months, and people know that they can return at 6-month intervals for more medication.

What are some logistical challenges of treating patients who have to travel such a distance?

We use a lot of plastic bags and sealed bottles for medications, and we learned the hard way to show people how to take care of themselves at home. We had one patient who had a splint put on, and they came back the next day because the splint washed away when they were crossing a river to get home.

There are no roads in the reservation, and the Ngöbe people have no access to wheeled vehicles. It is not uncommon for people to walk 4-5 hours each way to see us for medical care, so if people lose the ability to walk, that is a severe handicap for them, and they effectively become homebound.

What are some common conditions that you treat?

We see a lot of cases of iron-deficiency anemia because the Ngöbe people can’t afford to eat meat. On one trip, we took a hemoglobin meter, and when we saw how low the levels were, we were able to change our formulary to include more iron supplements.

We see many cases of dengue fever, and the treatment for that is supportive therapy. We also see many burns – the Ngöbe cook over open fires at home, and people are often burned by hot coals or flames. But because of the time and distance needed to receive care, it is weeks or months before we treat burn patients. I have seen more cases of superficial gangrene in Panama than in my entire career in the United States.

How are the people becoming more receptive to your regular visits?

One real transition we have seen in the last few trips is that more and more men are coming in for medical treatment. At first we saw mostly women and children, but now we have been around long enough, and we are earning the trust of the Ngöbe people. They are starting to recognize us as people who can help.

Could you describe the setup of your clinic?

We have a concrete building, but the only time medical care is given there is when one of our teams is there. There is no air conditioning or running water, and we learned right away that the concept of a sterile field is impossible – we think in terms of “less filthy field,” rather than “sterile field.”

One of the most important things we have to be aware of for ourselves is to stay hydrated. The clinic can be extremely hot, and we do 8- to 10-hour shifts. You can get busy and forget to hydrate, so we have a lay volunteer on the team whose main job is to make sure that everyone in the clinic stays hydrated.

There are starving dogs that live with the Ngöbe that are periodically running through the treatment area, and we have even had vampire bats in the clinic. Once I was in the middle of procedure, and a bat flew in. I took a clipboard and chased it into a fan, which stunned it. When I took a closer look, I thought it looked like a vampire bat, and I was told that they are indigenous to that region.

What do you do for individuals with serious illnesses or injuries?

We try to get the seriously ill and injured to a hospital, but the closest is several hours away by bus, and the increasingly socialized medicine system in Panama has made referrals more and more difficult. That has been frustrating, and we don’t have a good solution at this point.

What are some of the key factors in making a difference overseas in a short time?

I must say that going back to the same place repeatedly makes the most of every trip, the most of every minute. From clinic setup to formulary selection, each trip we get better and deliver better care. That said, I make it a point to travel with other teams to other locations, and I have taken something great from each of those adventures.