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What I Learned in a Week as a Medical Volunteer in Panama ⟩
December 13, 2024, by Guest Author

Classes Community Diversity Getting Involved International

By Carly Martinez OTR/L, USC Chan Post-Professional OTD student

When you read the name of the country Panama, what comes to mind? If you’re anything like me until about a month ago, your knowledge consists solely of the famed Panama Canal. After spending 8 days there as a medical volunteer, I won’t pretend to be an expert, but I can give you a brief glimpse into my journey. 

During the first semester of my post-professional OTD, I decided I would take what I thought would be my final elective, MEDS 577, Global Palliative Care with Dr. Ben LaBrot. It felt significant for me as a practitioner because I had learned a little bit about hospice and palliative care through my master’s program at USC, and knew that occupational therapy (OT) had a role to play in that area. At the same time, it still felt like we had only skimmed the surface. Through that course, I learned a lot about autonomy and dignity, values my professional OT education had espoused, however, this was a deeper dive into this particular context.

A few weeks into the course, Dr. LaBrot shared that he would have to record class since he would be in Panama. After class the following week, some students stayed after class to ask the professor about another course he taught. While unintentionally eavesdropping, I learned that he was the founder of a medical volunteering organization, Floating Doctors, based out of Panama. Excited at the possibility of going abroad again as part of my OT education, I asked if his program accepted occupational therapists. He was enthusiastic about my participation and clearly an ally of occupational therapy through what he shared in the curriculum. It would count as my final elective, and I could get credit for volunteering through MEDS 554.

Months later, I would find myself in a rainforest, translating for a classmate who graduated from medical school in Indonesia, learning how best to explain things to individuals who grew up in a completely different context than myself. Floating Doctors works with the members of the Ngäbe, an indigenous population in the Bocas Del Toro province of Panama. This region is designated as part of the Ngäbe-Buglé comarca, an officially recognized province that is part of how the nation is divided, similar to statehood, which allows for self-governance among the indigenous population. To get there, I flew from LAX to Panama City, then travelled to a second, smaller airport in Panama City to fly to Bocas del Toro, an island in the northern archipelago region of the country.

During clinic, we slept outdoors in the rancho where we provided services in hammocks strung from metal beams and bathed in the river, as do the community members. However, I will say that it was not the most rugged camping experience of my life. We had indoor plumbing, could purchase wifi from a nearby home, and had meals cooked for us by local women. Patients brought goods to sell, like the best chicken empanadas I’ve ever tasted, sizable chicken tamales wrapped in banana leaves, and artisanal breads. Some families told me they walked for a day through the mountainous terrain to be seen by the doctors. Did I mention that the weather hovered around 90 degrees and 100% humidity? The patients came well-dressed, with women in nice dresses and men in polos and jeans. I got the feeling they were dressed up to see us, but also because they would be seen by many other people who were also attending the clinic.

Visitors to the clinic generally fall into two categories: fast lane or chronic. Fast lane is for new or relatively simple cases, such as needing paracetamol to manage fever, albendazole for concerns about parasites, or birth control injections. Chronic patients are seen every three months, as the team returns to each site regularly, cycling through the 28 sites they service. Though the providers change, there is still consistent care for diabetes, hypertension, and asthma, to name a few of the more common conditions. Patients can have their names put on a list for a doctor who comes by to perform cataract surgery as part of another program. Referrals can also be given in cases where a patient requires more or specialist care, such as the case of a 6-year-old girl who seemed to be struggling in school, based on her mother’s description. Though I did an informal writing assessment, she would need more testing to determine if she was reaching developmental milestones, something the organization is not equipped to offer at this time.

To be seen by specialist medical providers, they would need to go to a major town nearby. Although this community had a medical clinic nearby, the resources there were limited. Travel to David, a town with more medical resources, would require a bus ticket and potentially a stay in the city, a prohibitively expensive expenditure for some of the patients. Boquete is closer, though it is not as well-resourced and still requires a bus ticket to get through the mountains on rocky dirt roads, which do not have lights, limiting travel for safety reasons.

This trip felt challenging to my professional identity. As a new practitioner, I worry about the role OT can play in different contexts. The lead medical provider for the week was not familiar with OT, or Ergotherapy as it is often referred to in Europe. He told me that this does not exist in his home country of Russia. The World Federation of OT only credentialed the University of Panama’s OT program last year, in 2023. I wondered about the relevance of the profession to people whose activities of daily living (ADLs) likely consist of more life-sustaining occupations than mine do, such as gathering water or washing clothes by smacking them against rocks in the river, in addition to household management tasks like washing dishes and cleaning the house.

I could see the applications of OT for those who worked cutting bananas, as they suffer from repetitive motion injuries, for children in school, and likely, for individuals with mental health concerns, if I were to speculate. However, I also acknowledge that I don’t really know much about their everyday lives because I didn’t have the opportunity to get to know them in the ways that would be necessary for an OT evaluation. I longed to know more about what an average day is like, as this would allow me to begin imagining what role occupational science (OS) could play in trying to understand what life is like for the Ngäbe. If OS has taught me anything, it is that I am not an expert on the culture of the Ngäbe. In order to work with a population in a way that garners buy-in, one has to try to understand the values to support what is important to their patients.

All of this is not to paint a picture of an area with fewer resources; after all, there are rural areas of the US with limited access to hospitals or routine medical care. Instead, I hope that Panama provides opportunities for OT and OS to continue to develop in multiple contexts, ranging from the traditional academic experiences OT graduates may have in the larger metropolitan areas, to the volunteer OT services with Floating Doctors, as well as others yet to come.

For my final occupational therapy doctorate (OTD) project, I created a set of OT practice guidelines or a white paper, in support of the development of OT services for Floating Doctors. The hope is that this will allow for the expansion of OT services within the organization, encouraging more OT volunteers to attend, and familiarize the individual medical providers with the scope and potential interventions OT can provide. It will also be part of the information Floating Doctors provides the Panamanian government to continue its services there.

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