A Midwife's Experience in Panama

by Kate Layman, CNM

On the first day of October 2011, I had the great fortune of joining a medical group in Bocas del Toro, Panama.  The Floating Doctors Team is a nonprofit 501 (c)3 with the mission of delivering healthcare to isolated coastal communities throughout the Caribbean. Before arriving in the Archipelago del Bocas, the group had been active in Jamaica, post-earthquake Haiti, and Honduras.   After weeks of reading their Facebook page, combing the website, and brushing up on my Spanish, I embarked on discovering a new country and delivering healthcare out of my usual role at the Birth Center.

I landed in the township of Bocas, a patchwork of colorful buildings and tributes to the “Irie” existence. Dusty streets lined with hammock-strewn patios, fruit stands, and businesses pulsed with life.   I soon realized the stunning landscape truly reveals itself when you get out on the waterways woven among the islands.  Motorized boats and dugout canoes traverse these thoroughfares. Gazing over the side through crystal clear water, glimpses of stingrays, schools of fish, and a white sandy bottom race by.   My hopes were confirmed for an amazing adventure.  

The home base for Floating Doctors was a 76-foot vessel called The Southern Wind.  Her nooks served as pharmacy, occasional exam room, sleeping quarters, and mission control for the group.  The troupe of volunteers was remarkable and diverse.  We were a collection of physicians, nurses, public health researchers, sailors, a pro-surfer and a midwife.   Life on the boat was a buzz of activity and comedy.  I often felt like I was on a floating medical hostel with moments of The Life Aquatic with Steve Zissou.  Unfortunately, we were missing the sauna room, but the soundtrack was just as good.    

The population in this area is incredibly diverse.  The presence of banana plantations and proximity to other Caribbean nations produced a mix of West Indians, Latinos, and more recently ex-pat retirees from all over the world.  Various indigenous populations also inhabit the far reaches of the islands and made up the majority of patients we served.   

The group executes two to three clinics a week in the surrounding archipelago.   The most common ailments I encountered were gastrointestinal parasites, respiratory infections, and fungal skin infections, byproducts of the climate and lack of infrastructure.  Public health disparities abound.  Although fortunes from the Panama Canal provide free healthcare services to all Panamanians, a lack of access to care persists.  Few people can afford the transportation from their isolated village only to encounter extreme bureaucracy and prejudice from the system.  As a result, most of the people we met used a combination of traditional healers and medical professionals.

One of my most gratifying experiences was working with the residents of a local nursing home.  The Floating Doctors attend to the patients twice weekly and take the wheelchair-bound residents out for a walk around the village in the early evening.  Before this project was started, some of them had not been out of the nursing home in four years.  The life that breathed into them from waving to kids in the streets and feeling a part of the community was inspiring to watch.  It is not just the very young that thrive on love and attention.  We all need that human connection for survival.

Some of the other highlights of my trip included meeting and talking with local midwives, those who worked in the hospital and village based birth attendants.  Surprisingly, it was not unusual to hear from a woman that her mother or grandmother was the person that helped birth her children.  I enjoyed a homestay with a village baker where patrons started coming to the living room window at six am to buy their morning pastry.   The group was led on a medicinal plant walk with a traditional healer.   A legacy of medicine men, our guide described how he chooses remedies for a patient based on their constitution, psyche, and how the climate might have affected the plant that year.  He was entirely my impression of a holistic practitioner.  

I think about how my trip connects to what we do at the Birth Center and realize that relationships, community, and a healthy respect for nature enrich the experience.  I may have left with more questions than when I arrived in Panama, as if my inner compass was gently shaken and conventional thoughts recalibrated.  I find myself seeing the world and her difficulties with fresh eyes and I feel renewed.  If you have any interest in joining or contributing to the efforts of Floating Doctors, please contact them at floatingdoctors.com or on Facebook.