The Floating Doctors: Mobile medicine comes to Panama’s jungles

When Omayra Abrego was 19 years old, her feet started to swell. Soon afterwards, her knees became inflamed, followed by her hands and elbows. Within months, the once healthy young woman with thick black hair and wide brown eyes had become immobile, unable to bend, stand or lie down.

Omayra’s parents didn’t know what to do or where to turn. They are Ngabe-Bugle, Panama’s most impoverished and populous Indigenous group, and the family of eight lives in a wooden hut with a thatched roof made of palm leaves in an isolated village known as Wari, located high in the mountainous rainforest.

The nearest hospital is three hours away and, to get there, Omayra must be carried in a hammock down slippery, steaming jungle hills, crisscrossing rivers along the way. After multiple visits to a hospital on Panama’s Caribbean coast, the Abregos say they reached a point where they didn’t have any answers or a diagnosis for Omayra’s deteriorating condition.

It was then they contacted the Floating Doctors.

The Abregos knew of the Floating Doctors – a group of mobile volunteer doctors, medical professionals and students offering healthcare services to rural areas – from residents of La Sabana, a nearby Ngabe-Bugle village that is one of 24 communities the organisation serves.

“When the Floating Doctors started coming to our home, I started to feel some hope,” says Omayra, now 25, her frame feeble but her voice robust.

After a few visits, the organisation concluded Omayra likely has juvenile idiopathic arthritis, a rare condition among children that causes inflammation, swelling, pain and stiffness in joints.

On the days the Floating Doctors come, the young woman’s parents, siblings and cousins gather in the family's dimly-lit wood-planked home and observe as the volunteers speak with Omayra about how she’s feeling and run a series of tests. During their quarterly visits, the Floating Doctors check Omayra’s vitals, such as blood pressure, oxygen saturation levels and pulse, listen to her heart and lungs with a stethoscope and test the flexibility of her joints to monitor if they’ve improved or tightened since her last checkup.

During a visit to her home on a hot, muggy day in June, Omayra complained of gastric pain, rashes on her skin and an itchy scalp. The Floating Doctors volunteers asked her to give detailed descriptions of her symptoms, tested her for lice and cleaned her infected, swollen knees.

At the conclusion of the hour-long consultation, the Floating Doctors gave Omayra paracetamol for joint pain, omeprazole for stomach discomfort, clotrimazole antifungal cream to treat her irritated skin, soap and a large box of rice, as there are limited options for food in the village.

“I do feel sad on most days,” says Omayra, who wears cotton dresses to ventilate her swollen knees. “But when the Floating Doctors come to visit I feel cared for. I feel attended to. I feel happy.”

Healthcare by boat

The Floating Doctors began operations in Panama in 2011.

The nongovernmental organisation, which is made up largely of volunteers, was founded by Dr Benjamin LaBrot, a United States-born physician. He developed the idea for a mobile medical team while on vacation in Tanzania, soon after graduating from medical school. On the way to the Serengeti, the driver asked if he wanted to visit a Maasai village. The community, LaBrot says, was "in the middle of nowhere”, had no water, no electricity and a population of around 200 people. After learning he was a doctor, villagers surrounded him for “sidewalk consultations”, he recounted.

“I looked at a first patient and then a second, and suddenly I look up and there’s this line of people,” he says. “This quick visit as a tourist turned into seven hours of me staying in the community and seeing patients while sitting under a tree.”

LaBrot says he then decided to commit his life’s work to providing healthcare services to develop and assist rural, isolated communities that lack hospitals and clinics. Back in the US, he "knocked on a million doors" and an elderly couple in Florida donated a dilapidated 23-metre (76-foot)  ship, which he and a group of about 14 people worked on for a year, while raising funds to launch the organisation. The 2010 Haiti earthquake was their "put up or shut up” moment to provide mobile healthcare, LaBrot says. They sailed to Haiti with a boat full of cargo and medical equipment and spent weeks there providing medical services.

The original plan for the Floating Doctors was to provide short brigade missions to countries accessible by boat. However, the group saw the advantages of a permanent presence, where they could provide consistent long-term care. While on a mission to Honduras, the group was contacted on Facebook by people in Bocas del Toro, Panama, who told them of a pressing need for rural healthcare in the region. They then travelled to Panama to meet with a local mayor, who helped them to establish operations with the local marina and federal government.

"A lot of things fell into place" upon arrival in Panama, LaBrot says. “When we got there, we found that the conditions were exactly what our organisation was designed to overcome. Most of the populations were accessible only via water, so a ship was needed, and they were without access to even basic services.”

In its 13 years in Panama, the Floating Doctors has conducted around 80,000 medical visits, primarily serving Ngabe-Bugle patients. The group currently serves 24 communities on Panama’s Caribbean coast or in the Bocas del Toro archipelago which they visit every three months, meaning they provide medical attention to patients such as Omayra four times per year.

Each week, doctors, nurses and medical students from around the world travel to Panama to volunteer their services as part of the programme and stay anywhere from a few days to several months. The volunteers cover their own travel expenses and pay a contribution fee to the organisation, which is used to fund the operational costs of the healthcare programme, such as medications, equipment and fuel for the boats. In its time in Panama, the organisation has worked with an estimated 4,000 volunteers.

Of all the communities the group currently serves, the most remote village they visit — which requires an eight-hour commute via boat, bus and hike — is nestled high in the Panamanian rainforest.

It is known as La Sabana.

Journey into the clouds

Deep in the jungle of western Panama, La Sabana was founded in 1970 by three Ngabe-Bugle families and is now home to around 200 residents who live in wooden homes with dirt floors and roofs made of tin or thatched dry leaves.

The Floating Doctors have been visiting the village, which is surrounded by verdant mountains and lush green vegetation, for more than a decade. La Sabana is far removed from the modernities of urban life and families in the village sleep in hammocks stretched across rooms of their homes and are largely without basic services such as electricity, working toilets or running water.

Most of the 210,000 members of the Ngabe-Bugle live in small villages in the mountains, in the rainforest or on small islands. They are particularly vulnerable to common illnesses such as fevers and diarrhoea, as well as complications during pregnancy, medical emergencies and accidents.

“When there is an emergency here, it takes us hours to get to the closest hospital, and we usually walk and carry the patient in a hammock,” says Celestino Serrano, a village leader in La Sabana who first sought the assistance of the Floating Doctors years ago.

Serrano, 48, is a thin, strong man of medium height with serious brown eyes, short black hair and a composed demeanour. His first language is the native Ngabere, and when he speaks Spanish, his words are careful and measured.

“The support from the Floating Doctors has helped us understand what to do in those situations, and they’ve trained us on how to treat injuries and emergencies. This is why their visits are so important to us,” he says.

Serrano said that in La Sabana, machete wounds are common. Most villagers carry machetes and use them to hack through thick vegetation when walking. The tools also help them cut grass, open coconuts and fend off venomous snakes.

Before the Floating Doctors started coming to La Sabana, there were few options in the village to treat and manage serious machete wounds. Serrano says that the Floating Doctors have taught villagers how to clean, close and bandage machete wounds and gashes, and have provided medications to ease pain and avoid infections.

“With the hospital so far away, we used to treat deep machete wounds with just warm water,” Serrano said. The Floating Doctors gave them creams, antibiotics and bandages for use in an emergency situation to avoid death or infection, he said.

Samantha Horn, the executive director of the Floating Doctors, explains that the work done in the village “exemplifies the mission” of the organisation.

“The care we provide in La Sabana is basic but vital,” Horn said. “We hire horses to carry all our clinical belongings on the four-hour hike to the community and, despite these logistical challenges, we are still able to provide ethical and essential medical care that improves the wellbeing of the residents.”

A new way to learn medicine

A recent five-day trip to La Sabana begins at sunrise on a Monday in June. I am travelling with them.

The eight-hour journey begins at the Floating Doctors headquarters on Cristobal Island in the Bocas del Toro archipelago. The small island is thick with palm trees and dense mangroves, and hundreds of small brown and orange crabs scurry along the boggy ground.

At the centre of the island is the main base, a large, broad four-storey building with a teal foundation, white protective railings, orange trim and thick red waterproof curtains to keep out tropical rains. Here, volunteers have access to a pharmacy, dining room, classroom and training area, and they sleep in small rooms with bunk beds just beyond the base.

This week, the Floating Doctors group includes six core team members and 13 volunteers.

The six core team members, who spend months working with the Floating Doctors, are in their 20s and 30s and include medical experts who hail from Argentina, Portugal, the Netherlands and Panama. Among them are two young Ngabe-Bugle men who lead the mission and act as translators for patients in La Sabana.

The volunteers for the week include 10 women and one man in their early to mid-20s — most of whom are medical students at the University of New England College of Osteopathic Medicine in Maine in the United States — as well as two professors. On the morning of the voyage, there is a nervous excitement among the young volunteers, most of whom have never been to Panama, speak little Spanish and have never previously conducted medical consultations with patients.

“The Floating Doctors have multiple impacts on the communities we visit, and one of those is social impact,” explains Lenin Baker, who has been with the organisation since 2019.

Baker, who is Ngabe-Bugle and grew up in a small town in Bocas del Toro province, laughs often and has a wide smile. “There are communities that have never received people from other countries, haven’t shared experiences with people from other countries, and haven’t ever seen an organisation that is dedicated to this type of mission,” he says.

When Baker and the Floating Doctors arrive in remote Ngabe-Bugle villages, the communities stir with excitement and curiosity. The Ngabe-Bugle are known for being reserved and resistant to outsiders, though when they welcome the Floating Doctors to town, village adults are welcoming, generous and patient, while children swarm and warm to the volunteers immediately, looking to play with their medical equipment, hear them speak a foreign language, taste their unfamiliar snacks or scroll through pictures on their phones.

“This creates a connection with people that are from different backgrounds and can inspire people and awaken their curiosities, maybe to consider studying medicine, or to study at a university or to learn English,” Baker explains.

Trepidation, anticipation and inspiration

After a 7am breakfast as the heat begins to rise, members of the group — some dressed in light blue scrubs — carry heavy duffel bags to the island’s main dock to load long, narrow red boats with equipment needed for the week: ultrasounds, stethoscopes, thermometers, scales, medications and dry food. In total, the Floating Doctors bring around 185 kilogrammes (408 pounds) of medical equipment, food and supplies up a mountain in the jungle for the three-night stay in La Sabana.

Following a 30-minute boat trip across the calm Caribbean waters, the group boards a small bus, which takes them along a bumpy coastal highway to a town known as Pueblo Nuevo, just over an hour away. From there, the four-hour hike into the rainforest begins.

Making good time is important, particularly during the June rainy season, when almost every day includes a tropical downpour bringing its own complications.

And the 200 or so residents of La Sabana are anxiously awaiting the group's arrival.

“I did have a little bit of trepidation coming here knowing that La Sabana was one of the most remote communities that the Floating Doctors service,” said Dr Rita Kamra, a physician who is an assistant professor in family medicine in the department of primary care at the University of New England College of Osteopathic Medicine. Of all the communities the Floating Doctors visit, La Sabana is the one to which the trek is the most physically strenuous.

Kamra, a 56-year-old Canadian-born doctor with shoulder-length black hair and thin-frame eyeglasses, also volunteered – along with her daughter – with the Floating Doctors the previous summer. She encouraged her students to join the June trip, both for the medical practice and for the unique cultural opportunity.

“You see so many interesting things, not all of which are medical, as a lot of this is the social aspect of seeing how people live and the conditions of these communities,” Kamra says. “It’s a fantastic experience for the students and they see things here, medically and socially, that they’ll never see at home.”

In Pueblo Nuevo, the heavy duffel bags are transferred from the bus to the backs of pack horses manned by residents of La Sabana, who carry the cargo up to the village, traversing multiple rivers on the ascent into the hilly rainforest. The group follows behind, plodding along a muddy, rocky trail through dense vegetation and beneath a jungle canopy. Tropical birds sing and insects hum as the group scales steep hills, crosses streams and rivers, eats lunch atop wet rocks in a creek and trudges forward through the heat en route to La Sabana.

For the next three nights, the team will stay at base camp, an open-air meeting area at the centre of the village. There are a concrete floor and a tin roof, supported by wooden beams. At night, they will sleep side by side in hammocks covered in mosquito nets, sometimes in the cold and rain, with skinny village dogs passing beneath them in search of food.

Each morning, the space is transformed into a busy makeshift clinic where the Floating Doctors get to work.

Treating the people of La Sabana

By 7:30am, a substantial queue has already formed for the clinic, which opens at 8am.

As the clouds dissipate overhead, Ngabe-Bugle men in baseball caps and boots and women wearing naguas – long yellow, pink, orange and purple embroidered gowns – wait patiently for their turn to see a doctor. Many have children and babies in their arms, and some have travelled hours in the sweltering heat.

Madeline Amador, 29, from the nearby town of Guayabal, says she walked an hour and a half through the rainforest with her three children, a trek she makes every time the volunteers come to town.

“There aren’t any medications in our village and so when my children have a fever or diarrhoea or a cough, we use natural remedies to try to control it,” Amador explains. “To come here and receive medical attention makes me feel better and the medications we receive are helpful in case our children become sick over the next few months,” she said.

The first day is reserved for people from nearby villages, many of whom travel on foot several hours to receive medical assistance. The next day is for residents of La Sabana.

After providing their names and medical information, and having their vitals checked, patients sit with a doctor or medical student on wooden benches and, often through a translator, describe their symptoms or concerns. In the hot muggy morning heat, the volunteers measure patients’ temperature, oxygen levels, blood pressure, weight, height, pulse and blood glucose, as well as conduct urine pregnancy tests.

“These remote communities don’t have access to quality healthcare and are isolated and even discriminated against within their own country,” said Tomas Santos, a 26-year-old doctor from Portugal who is working with the medical group for six months. “Doing this work allows us to reach people — and especially children — in poor settings to give them better education, a better quality of life and assure they are free of diseases as they grow up.”

The majority of patients are mothers of young children and pregnant women. The Ngabe-Bugle have one of Panama’s highest birth rates, averaging 5.7 children per mother, and the country’s highest maternal mortality rate, according to LaBrot.

Ultrasounds are given on a medical cot in a wooden ramshackle home just off the central clinic site. For many of the volunteer medical students, it is their first time performing the test.

LaBrot explains that a central objective of the Floating Doctors programme – beyond reducing disease in the developing world – is to provide young medical professionals, doctors and students with an experience they can carry into their careers in the field.

“Here, I’ve learned that you can come quite far with doing a good physical examination and that you can make a big change in people’s lives with just basic medicines, and you don’t always have to have the newest medicines or equipment to make a difference,” says Iris Ertugrul, a Netherlands-based doctor who is working as a Floating Doctors lead medical provider for eight months.

‘A true blessing’

At the conclusion of the second day of the clinic, the tired volunteers walk down a muddy hill to bathe in the cold waters of a nearby river, as there are few available showers in the village. They towel off, have a warm dinner and string up their hammocks for a final night.

Over the past two days, beneath the tropical heat and rain, they saw 133 patients and provided assistance and treatment for a number of maladies, from lesions and diarrhoea to fevers, cysts and pregnancy concerns.

“As a doctor, you’re always facing an uncertain and challenging environment where you’re questioning yourself,” says Dr Geoff McCullen, an orthopaedic surgeon and professor at the University of New England College of Osteopathic Medicine. “This week, I think our students learned they can face uncertainty, they can face challenges, manage these complexities simultaneously and be decisive about what a patient needs.”

After nightfall, wearing headlamps, the group discusses the medical cases they witnessed and reflects on an experience that pushed them out of their comfort zones, both as people and budding professionals.

“I’ve had so many firsts this week,” said Cristina Kontogiannis, a second-year medical student at the University of New England College of Osteopathic Medicine. “I’ve never listened to a baby’s lungs and I got to do that here, for example. It’s been such a learning experience and I’m so thankful for this opportunity.”

Serrano and the people of La Sabana are thankful as well. He said that La Sabana is a close-knit community and at their regular meetings they often praise and voice continued support for the visits from the Floating Doctors.

“We have a lot of need here. We have a lot of patients that suffer from chronic diseases and a lot of accidents such as snake bites, machete cuts or children with broken bones,” Serrano said. “We’re content and satisfied with the Floating Doctors, and they’ve taught how to be better equipped to deal with accidents and emergency issues, and that wasn’t always the case.”

On the final morning, the Floating Doctors load the duffel bags full of medical equipment and strap them to the pack horses to begin the journey back to headquarters. The descent through the humid and boggy rainforest is easier than the trek up, and there is a sense of joy among the group, who laugh and sing during the sunny morning trek.

The bus awaits the group at Pueblo Nuevo, makes a stop for lunch, and drops the group off at the port, where they load boats, strap on their lifejackets and zip back across the Caribbean. After arriving, the jubilant and exhausted team changes into swimming gear. They take a final group photo and then, together, jump into the warm and clear waters surrounding the island.

In three months' time, another group of Floating Doctors volunteers will make this same trek to La Sabana to provide care to residents in need. A few others will carry on to Wari – about an hour’s walk deeper into the rainforest – to visit Omayra.

“Because of Omayra’s condition and inability to walk, I can’t work or leave her side, and we don’t have the money to pay to transport her to the hospital,” said Julian Abrego, Omayra’s father. “The fact that the Floating Doctors come all the way to our home to care for Omayra, that’s a true blessing for us.”

Reporting for this story was supported by the International Center for Journalists (ICFJ) Health Innovation Fellowship.