Family medicine resident Meghan Richli (with glasses) teaches Emily, a nurse practitioner who works on staff at Floating Doctors, how to do a steroid knee injection in an elderly woman with presumed arthritis. Emily lives in Bocas del Toro with her husband and two children.
Family medicine resident Meghan Richli (in scrubs) shows a patient how to use an inhaler with a plastic cup attached as a spacer, which helps the patient get more of the medication into her lungs.
Medical student Aman Cheema applies coconut oil to the legs of a resident of the Asilo nursing home in Bocas del Toro.
Family medicine resident Brianne MacKenzie enjoys a chat with a woman at the Asilo nursing home in Bocas del Toro.
Members of the UB team carry supplies across a footbridge on their way back to Floating Doctors after spending three days at the clinic in Pueblo Nuevo.
Members of the UB team tour the Panama Canal after arriving in Panama City at the start of their trip.
Editor's note: David Holmes, clinical associate professor of family medicine and director of global health education, recently led a group of UB medical students and residents on a medical mission to Panama. The team worked with Floating Doctors, an organization that travels by boat to remote villages to provide medical care.
This account of the trip, which took place April 8-16, was culled from emails sent by Holmes and other members of the team to family, friends and other supporters.
Published April 21, 2017
The UB-Panama global health team arrived in Panama City safe and sound. We went out to dinner together and stayed the night at a hotel. After a busy week of exam studying — for the med students — and trip preparations, everyone appreciated the chance to sleep in the next morning. After that, some of us relaxed around the hotel pool and others went to see the Panama Canal and its museum. It was quite impressive, especially as it was built in the early 1900s. It looked a lot like the Erie Canal, but on a much larger scale. Panama City is a much bigger and more modern city than we had imagined. There were many skyscrapers with unique architecture.
It took four different modes of transportation, but we did eventually reach Floating Doctors.
We started our journey by taking a taxi to the domestic airport and then a plane to the town of Bocas del Toro. As soon as we exited the small airport there were dirt roads. With our bags we walked almost a mile into the town and then to a dock, where we loaded onto two water taxis — motor boats that fit about 10 people in each. They took us to the island where Floating Doctors is based. We were happy to be there at last and enjoyed dinner, followed by an orientation session.
Besides the UB team, Floating Doctors had a few other volunteers this week, including a couple of medical students from the Netherlands, a nursing student from Colorado, an OB-GYN physician from California and an oncologist from Lake Placid.
There are three main buildings on the island. One is the community hall where we eat. The other is the bunk house, which has several rooms with two bunk beds in each. The place definitely has a rustic, summer camp feel, which is a lot of fun. The third building contains the bathrooms.
They use sea water to flush the toilets and collect rain water for everything else. The drinking water is rain water that has been filtered twice, which is reassuring. They use solar power for all their electricity. We’re impressed with how well-organized everything is here.
From Floating Doctors we went to Pueblo Nuevo, the remote village where we worked for three days. To get there, we took a warm 45-minute boat ride and a two-hour bus ride through the Panamanian jungle until the road ended. At that point, we unloaded the vans and carried all our personal gear, medical supplies and medications, as there were no roads that went to this village. Our hike lasted about 15-20 minutes and took us over three cable footbridges, one of which was suspended over a beautiful river.
As guests of Pueblo Nuevo, our team set up camp in a community center structure that had a roof, but no walls — similar to a picnic shelter in the U.S. We hung our hammocks across whatever roof support or post we could find and that was our home for three days. Supper was rice and beans, as was every meal except breakfast. Sometimes we also had chicken. Afterward, some went to the river for a refreshing swim. The first night, sleeping under a bug net in a hammock was certainly a learning experience and many did not sleep very well, either due to the hammock, cool nighttime temperatures that we didn’t prepare for, or the noise. Chickens, dogs, frogs and hogs accompanied us throughout the night and day. By the second and third nights, we were more used to things and slept better.
We woke up each morning to a simple, but satisfying breakfast of fried dough with peanut butter, passion fruit jam and coffee. Around 8 a.m., the team made its way to the “rancho” — a very large picnic shelter-type building in the center of the village — and set up the clinic. Everyone was assigned to either the administration, intake, provider or pharmacy stations and then rotated. The first day we saw 115 patients and the second day 141 patients. The third day was reserved for follow-up visits only. There were only a handful of them and then we packed up and traveled back to the Floating Doctors’ base in the same way that we came.
During the medical clinics, we saw some interesting cases: parasitic worms, fungal infections, diabetes, dehydration, rickets in a 3-year-old, a patient with developmental abnormalities following a meningeal infection at 10 months, HPV and even a teenager with possible gallstones. Even though there were no roads to this village, they still had at least four tiny stores that sold candy and Coke. Diabetes used to be unheard of in this region; now it’s fairly common. This may be an over-generalization, but it seems that wherever in the world Coke goes, diabetes soon follows.
Many of the patients were from indigenous communities in the mountains and had walked for more than two hours to get to the clinic. Overall, there were many similarities to our clinic and ones in the states, but what stood out most was the appreciation the patients had for the care we were providing. Not only were the people excited for our clinic, but also to host us as guests. It seemed as if, regardless of whether we were running the clinic or not, we were interacting with community members via short conversations, playing soccer, touring the village, playing with the kids and much more. The clinic ran to about 6 p.m. when every patient was seen.
Following our clinic duties, the team enjoyed a soap scrub in scrubs in the river. There was a beautiful river flowing on the edge of the community and one of our favorite things to do was go swimming in it with the local kids and playing with them. We also used it as our chance to wash ourselves and try to get clean. The challenging part was that it is offensive in this culture to show your shoulders or knees. Therefore, swim suits were not allowed unless they covered shoulders and knees; hence, the reason for swimming and trying to wash ourselves in scrubs.
In the evenings after dinner, we discussed positive things that happened during the day and some of the challenges, such as hammock sleeping. We also discussed some of the interesting patient cases we saw during the day.
An interesting aspect to our experience was having an OB-GYN physician to work with our team. Dr. David was a fountain of knowledge and helped us gain exposure to a field of medicine most of us had no previous experience in. Using a portable ultrasound machine, we showed many expectant mothers their child for the first time and most likely gave them their only prenatal clinical consult.
This was beautiful in the sense that even though we didn’t speak their language and were not a part of their culture, their emotion was the same as any mother in the United States — full of joy at seeing their baby on the screen. Unfortunately, we did have to tell one mother that her baby had been lost. A sad and somber mood fell over the team, but it was an experience that will definitely better us as future physicians.
The level of compassion, empathy and wisdom Dr. David and the rest of the physicians instilled in our team was second to none. Regardless of where we are, who our patient is, or the situation at hand, one piece of wisdom stays true: treat our patients as people, to the best of our abilities and how we would want our family members to be treated.
One of the greatest parts of the trip was not only being able to treat patients in the clinic, but to be welcomed into homes to treat patients who were too ill to travel to the clinic. These home visits gave students and physicians more insight into the day-to-day life of local people. One family came to the clinic to tell us about a son who was severely ill at home and needed immediate medical attention. A few team members traveled to their home and found a very dehydrated young man who was suffering from extreme diarrhea. The patient’s mouth was swollen from an allergic reaction, which had prevented him from eating for the past two weeks. It was determined the patient’s condition was so severe that the best we could do was supply IV fluids and arrange transportation to the closest hospital.
Without our help, the patient would have been at serious risk of dying in his home. Reflecting on this situation made us all realize how impactful our skills and efforts can be for people all over the world.
After getting back to the Floating Doctors’ base, the UB team spent the afternoon in the pharmacy storage room in Bocas packing medications for a multi-day clinic to a different village that was scheduled for the next week with a new group of volunteers. The team also worked on various tasks at the base, including filing paperwork and building a beach volleyball court. At first it seemed mundane, but we understood how crucial it was in allowing Floating Doctors to function.
The next day, we visited the Asilo, a nursing home in Bocas, to interact with and provide care to elderly residents.
Asilo translates into “asylum” in Spanish and represents a place of safety. In this case, the Asilo was a home for elderly individuals, most of whom have been somewhat abandoned by their families.
At the Asilo, students provided a variety of care to the residents — checking blood pressure, changing wound dressings, administering injections, and giving pedicures and foot/leg massages with coconut oil.
But the most rewarding part was the conversations we had with the residents. Despite the language barrier, the impact we had on them was very evident. The conditions at the Asilo were shocking. The Panamanian government offers little to no support, and in the short time we were there we saw broken fences leaving open access to the ocean. The caretakers shared with us that on two occasions, residents have wandered and fallen into the ocean. With our presence, the residents were able to exercise and move about the property without the risk of injury.
After the Asilo, we said our goodbyes to Floating Doctors and returned to Buffalo.
During this trip, we shared countless laughs, became closer as friends and genuinely felt as if we made an impact on many lives. This trip wouldn’t have been as big of a success without the guidance or teaching of our physicians, residents and the community leaders we interacted with.
Our experience in Panama — using the power of medicine to improve the lives of others — is an experience we will never forget. It has motivated us to not only be better doctors, but to be better people serving others wherever life takes us.
Fair Winds (a common Floating Doctors saying),
David Holmes and UB Team Panama: Medical students Paul Blasio, Laura Reed, Kyle Zittel, Christian Curatolo, Katie Mazurek, Chelsea Marin, Victoria Cranwell, Amandip Cheema, Mark Asirwatham and Jacob Milling; family medicine residents Brianne MacKenzie and Meghan Richli; Lucy Holmes, a pediatrician and wife of David Holmes; and the Holmes' daughters Naomi and Esther.
Congratulations to your team. Beautifully written piece on your experiences. I loved this. Thank you!