Tuesday, July 9, 2019

Dr. Flais joins the PHA legacy of medical missions

Clinic began at 8 daily, however a line usually
 started to form about 7 am.
In the midst of a bustling remote mobile medical clinic on the western edge of Panama, Sam, our Floating Doctors clinic manager, approached me with his characteristic wide smile and easy manner. “We have a big family for you to see, with lots of kids!” he informed me in his soothing Kenyan accent. A queue of patients lined up outside well before our 8 am start time, and the clinic was now buzzing with midday activity in the warm, tropical air. The sounds of Spanish and a variety of English accents peppered the room. Outside the clinic, an open field served as home to a near-continuous game of fútbol, children shouting boasts and jeers to one another, a scene that could take place anywhere on the globe. A week serving the Ensenada community in the Bocas Del Toro province of Panama rejuvenated not only my love for medicine, but also my faith in humanity.

Within our makeshift clinic, a transformed open-air schoolroom, patients are cared for with a family-centered approach. The particular family Sam told me about had 6 members: a grandmother and 5 kids ages 2, 6, 8, 9, and 16 years. While my expertise is in pediatrics, our medical team cared for whole families including adults, so I welcomed the idea of a crowd of kids, since it’s my comfort zone. As I laid my stethoscope on the chest of the toddler to listen to his heart, I activated the flashing disco lights I’ve kept connected to my stethoscope for years to help distract and entertain my younger patients. Despite being miles from home, well off the grid with neither electricity nor plumbing, and immersed in Spanish, kids’ reactions to my silly stethoscope light were universal: smiles, curiosity, connection. Sharing a light-hearted moment transcends language, geography, age, and financial status.

Setting up our clinic space in the community’s schoolroom.
Floating Doctors is an international nonprofit organization providing mobile medical care to communities in the Bocas Del Toro province, located on the Caribbean side of Panama bordering on Costa Rica. Last winter I learned of this unique organization and was eager to participate; I got my chance in early June of 2019. The topography features an archipelago; the remote nature of the mainland towns and the grouping of islands make it difficult to travel from place to place, complicating community members’ access to basic health care services. The closest dentist to the Ensenada community is a 2 hour walk away. Many of my patients had tooth pain from longstanding cavities, simply because they do not have access to the regular preventative dental care that we typically enjoy in the States.

Boarding the regional flight from Panama City 
to the Bocas Del Toro airport.
My mission with the Floating Doctors was particularly special as I was able to share it with Matthew, the oldest of my 4 kids, a rising high school senior. I couldn’t think of a better way to send him off into adulthood than a mom and son trip helping others, giving our Spanish skills a workout, with some significant one-on-one travel time and life experience. As a daughter of an immigrant, I grew up with a perspective and an appreciation for how fortunate we are to live in America, and it’s important to me as a parent that I pass that appreciation on to my own children. Matthew proved to be an outstanding travel companion as he is open-minded, willing to try new things, and a quick learner. Bonus: our Spanish abilities dovetailed seamlessly together while transferring between multiple airplanes, cities, and boats.

Dr. Flais and her high school senior son 
ready for adventure, leaving O’Hare’s 
International Terminal. 
The weekend we left Chicago’s O’Hare airport we traveled to the Panama City main airport, then transferred to a different airport to take a regional flight to the small Bocas airport. From there, we took a boat to the Floating Doctors headquarters. The FD base is an off-the-grid remote facility nestled among mangroves – cozy yet utilitarian. All electricity was solar powered, and our water supply was filtered rainwater. While somewhat rustic, I marveled at base’s design at every level, from the claimed water supply system to the way our mosquito nets were hung over the dormitory beds with great care and precision. From the base, boats deploy daily or weekly to deliver health care to remote jungle communities. Our particular week was assigned a multiday clinic serving the Ensenada community, a 2-hour boat ride away. 

The Floating Doctors base was the Ritz Carlton compared to multiday clinic - during our time in Ensenada, we had access to neither electricity nor modern plumbing, and hung hammocks to sleep overnight in the schoolroom-turned-clinic. That said, those very conditions I found so challenging were the daily norm for the Ensenada families we served. I was humbled to meet and work with these caring, family focused, hard-working individuals.

        The 2 hour boat ride from Floating Doctors
 base to the Ensenada community where 
we worked for 4 days.

Unloading 1 of our 2 boats at Ensenada.

I was surprised at the medical complexity of many of the patients we saw. By the time we treated a 6-month-old with an ear infection, something I deal with as an American pediatrician on a daily basis, I was frankly surprised to finally see something that is considered so routine in the US. FD team members explained to me since this particular location is so remote, medical conditions were more likely to progress, hence the complexity. Our team treated a 13 year old pregnant girl with a shockingly loud heart murmur – when asked if she’s always had a murmur, the family shared that no one had ever listened to her heart with a stethoscope before, so they had no idea if this was a new issue or not. The closest heart specialists were in David, Panama, over 100 miles away. We treated endemic worms, something I learned over 20 years ago as a medical student and have never needed to use in clinical practice until this experience. We saw child with lamellar ichthyosis since birth, another condition I’ve only studied and seen in textbooks, never in person.

Children in the community were quite curious about our
 team and were typically peeking in to see the action.
After our experience with Floating Doctors, I’ve witnessed how vital access to a safe water supply and modern plumbing is to maintain public health and prevent the spread of disease. As Americans, we can go to a grocery store and choose from a wide variety of foods. We have multiple dentists, healthcare providers, and hospitals within our communities, as well as access to education and career options beyond farming (for men) and homemaking (for women). I’m indescribably grateful to have a career in which I can go to a different part of the world and utilize my skills and training to help people.

Clinic team meeting before the first day.

Floating Doctors’ diversity of teammates and volunteers, both in terms of background and in experience, was incredibly humbling. Our teammates hailed from Australia, Italy, the UK, Kenya, Ireland, California, Sweden, Costa Rica, Holland, New Jersey, Minnesota, and more, and I marveled that our team was so quickly harmonious and effective. Our pharmacy manager had previously spent months working with the US Antarctic Program. A college student volunteer we worked with plays Division III basketball and is pursuing medicine. My provider partner, a UK medical student, smiled when I called an aubergine an eggplant. All welcomed my American high schooler son as an equal, and he learned some new card games during downtime in the evenings. Never underestimate what a diverse group of people with a similar mindset and goal can accomplish.

Dr. Flais before clinic got busy. 
That’s our pharmacy in the background.
The Floating Doctors, much like our practice at Pediatric Health Associates, strives to care for families in a holistic manner. Cultural competency and understanding the communities we serve is a cornerstone to both organizations. Caring for people means more than caring medically for our physical bodies and organs. Our physical and emotional health are deeply interconnected, and there is a balanced web between mind, body, family, and community. PHA founder Timothy Wall, MD as well as Doctors Jihad Shoshara and Sofia Shakir have established a culture of service and a legacy of global health volunteerism within PHA, spending years working with international medical missions serving Honduras and Syrian refugee relief efforts. My PHA colleagues served as inspiration to pursue a global mission experience and were eagerly supportive of my FD trip. Such experiences as global volunteers caring for all children enhance PHA’s ability to care of our patients back home.

Journeying to Central America to work with the Floating Doctors has rejuvenated my energy for my career, inspires and enhances my care for PHA patients here in the US, and served as a great reminder that we live in a very large world, of which we occupy only a tiny part. When I look back on my Floating Doctors experience, the first images that come to mind are of the kids; playing soccer in an open field, investigating my stethoscope’s disco lights, peering into the clinic space from between slats on the open-air walls to check out the action. I’m incredibly grateful to have had the opportunity to work with this Panamanian community, and I plan to return to Panama with each of my other children to work with the Floating Doctors. Yes, we helped others, but I personally gained much more than I gave.

The field outside our clinic space served as the location for 
a near-constant game of fútbol.

1 comment:

Laura said...

Dr. Flais you have treated my children with outstanding care for 7 years at PHA, thank you for sharing your trip and thank you for all you do!