VI. Multi-Day Clinic in Cayo de Agua and Quebrada Sal

After yet another fun weekend of exploring the beautiful, natural islands of Bocas it was time for Nica and me to start our third and final week with Floating Doctors. This week we were heading to Cayo de Agua for two days of clinic followed by a day of clinic in Quebrada Sal (Salt Creek). Nica and I had certainly felt more comfortable in transitioning to the provider role this week but we had no idea how much was in store for us during this final week.

Our Floating Doctors crew on beautiful Isla Zapatillas during our off time in the weekend! One of our favorite things to do during the weekends at FD is to explore the beautiful nature and beaches that Bocas del Toro has to offer. Pictured from left to right: Chris, Konrad, Nica, Ashley, Mar, Marie, Sienna, Quentin

We started off our week on Sunday by meeting several new volunteers from the Netherlands – one physician, one nurse, and two pre-clinical medical students – and another returning volunteer – an ER nurse from Canada. They were all extremely excited to start with FD. Twinges of sadness crept in as we watched them receive the tour of base that we received what felt like months ago but was only two weeks prior. We viewed this as an opportunity to offer any mentorship we could do the new volunteers to ensure the incredible spirit of FD continued.

Taking the Panga out for a ride.

On Monday we packed up our lunches, loaded up both the cayuco and the panga and set sail for Cayo de Agua – a 2-2.5 hr ride. We had nice weather for our ride out, but that certainly didn’t stop the wakes of the boat from splashing us thoroughly for the entirety of the ride. We were soaked by the time we arrived, but we didn’t care because we were welcomed with an incredible view of a village immediately on the coast.

Nica catching some z’s before starting a busy week at Cayo de Agua.
A beautiful view of the ocean from our clinic site in Cayo de Agua.

As soon as we had arrived and unloaded, we got to work with clinic. Nica and I were each assigned to start the day on intake station with a new Dutch medical student volunteer paired with each of us. Having been in their shoes and skill-levels at FD only a couple of years ago it was quite special to get to come full circle and mentor them in medicine and the flow of FD the way we were mentored by our senior peers. We had the opportunity to work with each of the new volunteers and were impressed by the work ethic and spirit of all of them – a testament to the type of people that FD attracts.

Two of our new volunteers getting familiar with the flow of FD on their first day. They certainly picked things up quickly and became assets to the team in no time. Sterre (L) is a nurse from the Netherlands and Emme (R) is a medical student from the Netherlands.

By mid-day we could tell it was shaping up to be a crazy busy clinic day full of lots of patients and complex (time-consuming) cases. Our providers were swamped. During lunch our clinic manager Jack came over to Nica and me and asked if we’d be willing to go ahead and transition to providing. We immediately consulted with our respective intake partners to make sure they felt comfortable running intake alone. They both said yes, so Nica and I swapped over to providing.

(soon-to-be) Dr. Nica and her Spanish translator (and one of our great friends from the trip) Mar – a pre-clinical medical student from the Netherlands.

As always it felt great to be back in a provider role! As the weeks have gone on we’ve felt slowly more and more autonomous and confident in our ability to provide and help. It was always funny to pull a patient from the provider queue that we had done the intake on. So essentially we’d introduce ourselves twice – the first time getting their vitals and a brief story and the second time as the provider who is actually going to address their concerns.

Clinic day in Cayo de Agua. How can you beat having a clinic with that view.

The day was moving along when I heard that there was an emergency home visit that needed to be done. I immediately went to Jack and asked what was going on and if I could help with the emergency. He agreed and had me wait for the other provider who would be going with me – Eliza. I’ve included a link to a more detailed account of the emergency case here. But for the sake of brevity, I’ll say that it was a true emergency and an extremely meaningful case that I got to play a large role in. After the case was done, we were down a provider for the remainder of the week because Eliza accompanied the patient to the hospital. As such, Nica and I were called upon to serve as providers for the remainder of the multi-day clinic week.

A glimpse into the homes of Cayo de Agua.

Once the first day of clinic came to a close everybody was totally exhausted. It ended up being one of our busiest days. However we had something fun to look forward to in the evening. Some of the patients had invited our group to go join their volleyball game that evening, so we made a 15 minute hike to their volleyball court just before dinner. Some of us joined the game and had a great time while others of us (Nica and myself included) were very content to watch and play with the kids and not get sweaty before bedtime. After dinner and sharing sodas at the tienda, we all conked out in our hammocks.

Volleyball with the locals of Cayo de Agua.
Several of us spectating the volleyball match…
… and playing with the bright-eyed kiddos. The kiddos absolutely loved Mar.

We started our next day in Cayo de Agua waking up with a beautiful coastal view that was truly special. As Jack prepared us for clinic and went over assignments, he re-assigned Nica and me to intake with partners. However he gave the caveat that as soon as we saw the provider line getting long or we felt ready we could transition over to providing. Nica and I were beyond excited. As the day started, my intake partner Sterre (a neurology nurse from the Netherlands) and I were working so well and efficiently together. It wasn’t long before we realized that the intake line had grown short and the provider station had become the bottle neck. So to transition, Sterre and I began doing intake/providing on patients (start to finish) which was such a pleasure to have her to bounce ideas off of. Eventually, both the intake and provider lines grew, so I confirmed that Sterre felt comfortable enough in her Spanish to do intake on her own and transitioned over to providing on my own (with a physician supervising). I noticed Nica was making the same transition and we began working our butts off. There were several moments when we looked at each other and had proud moments of appreciation for how we had both come since the last time we were here.

Breathtaking sunsets from our clinic/sleeping site at Cayo de Agua.

Thankfully, the rest of the day ended up going fairly smoothly without any crazy unexpected surprises like the emergency patient the day prior. Nica had certainly settled into her pediatric niche and was taking every pediatric case that she could get her hands on and knocking them out of the park. Towards the end of clinic day, the lead provider came up to us and asked if we wanted to do a home visit together. We realized that we had not yet worked with each other once and were so excited for the opportunity. We both agreed and went on a home visit (which was only 100 feet or so away) for a blind, chronic patient of FD. The case ended up being relatively straightforward but it was nevertheless special to provide care for a patient with each other.

Nica and I with Aurelio in Cayo de Agua. Aurelio is the current outreach coordinator for FD and an excellent photographer for Floating Doctors.

After clinic finished, we held another charla with one of our closest friends made at FD – Konrad. As I’ve mentioned before, FD is making a public health education effort in its communities and Konrad is the spearhead of these efforts. At this point in time, he is working hard to develop charla’s for numerous other topics including dental hygiene and nutrition. We are still keeping in touch with Konrad and excited to see what he puts together over the course of his year with FD. We truly believe in the power of public health education in these communities and in populations in general.

Preparing the clinic site for a charla (seminar) about dehydration.

After our charla, we packed up the boat and headed over to Quebrada Sal (Salt Creek). Quebrada Sal is another beautiful village near the beach that is a 10-15 minute hike from the boat dock which makes unloading heavy pelicans and boxes of rice a fun challenge. It was just a little before dinner time by the time we finished unloading the boat. Several folks decided to make the ~15 trek to the beach for the evening. A few of us (Nica and myself included) stuck behind to try to get a freshwater shower – something we hadn’t had since we left for Cayo de Agua two days prior. We managed to get a shower using somebody’s shower pack which is essentially a backpack that fills with water and has a shower head nozzle that spouts water with gravity. It was honestly one of the most appreciated showers of either of our lives.

Coming into dock at Quebrada Sal.

The next morning, we woke up and got ready for clinic again. The day started off very similar to the day prior with Nica and me working intake until we were ready to provide. As it turns out, however, the patient population at Quebrada Sal had some relatively complex pathology and there simply were quite a lot of patients. The day quickly evolved into our most hectic and busiest day at FD yet. Nica and I moved to providing rapidly to help ease the load and we were seeing everything from machete wounds to non-specific, complex urinary complaints to a whole array of complex pediatric diseases and infections. I even had the opportunity to do a new patient home visit as the sole provider with Iona – a Canadian ER nurse volunteer – accompanying me. However, one of my absolute favorite moments of the day was when I overheard one of the lead medical providers saying, “hmm. I need a pediatric consult for this complicated child.. Does anybody know where Nica is?” At the end of the day Nica and I looked at each other and we could both see that the other was exhausted yet feeling totally accomplished and content with the work we had done. It was a fittingly crazy and satisfying last day of clinic for our last clinic day of FD. Or at least, we thought it would be our last day of clinic with FD. More on that later.

Active clinic day at Quebrada Sal – easily our busiest and most hectic clinic day of our time there.

One other interesting thing about Quebrada Sal is that it is located relatively near a beach resort that has a publicly accessible beautiful beach. After an extremely long and tiring day, all of the Floating Doctors team swung by a tienda, picked up an ice cold soda, and trekked to the beach to relax and unwind.

Making the hike to the beach resort at Quebrada Sal.
Stunning views on the beach for our last clinic day.
Chilling on the Quebrada Sal beach after a long clinic day. Anne (L) is another pre-clinic medical student from the Netherlands. Next to her is Sterre (R).
Chilling at the tienda. Ice cold soda never tastes as good as it does after a long, sweaty clinic day. Pictured from left to right: Emme, Anne, Iona (ER nurse from Canada).

We had a delicious dinner that evening, reflected on a busy day, played a fun Dutch card game provided by fellow volunteer Rose – a Dutch physician – and turned into our hammocks for the last time. The next morning, we were heading back to base.

Our last night sleeping in hammocks for a while.

Once we arrived back to base on Thursday, we got to work on pharmacy tasks to prepare for the next week. Those were over within a couple of hours, so Nica went to the dock to kick back and relax while I went to go play a game of volleyball with Fermin, Kevin, Quentin, Jack, and Konrad.

Taking in the views of base from the crow’s nest one more time.

On Friday, Nica and I were asked to man the weekly base-clinic since it was our last day. The day started off quiet with no patients which was an ominous sign for what was to come. As base clinic hours was coming to a close, I was notified that a patient came in with a big gaping machete wound across his palm – suture time. Nica was gracious enough to let me take that case since she knew that was more in my domain of interest. And it’s a good thing that she did because not two minutes later, several children and their mother showed up seeking consults. So as our very last hours at FD were coming to a close, I’m performing an E.R. procedure while Nica is handling multiple pediatric patients at once. We worked through lunch to finish everything and felt so satisfied that we did. It was a perfect last case for each of us on our last day of Floating Doctors (for now).

A last dinner with so many incredible people that we met at FD.


Our time at Floating Doctors has always been and always will be truly special. We’ve met some of the most incredible people here (staff, volunteers, and patients), gained so many formative life experiences, and truly felt like we were able to use our passions for the benefit of others in a safe, responsible way. We hope that Floating Doctors continues to do great work and serve its communities to the fullest. It’s always a pleasure to play a part. Until next time, Floating Doctors. Fair winds.

~Chris & Nica


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