Panama
Would You Like to Join the Floating Doctors Onboard in Panama?
Thanks for your interest in joining the Floating Doctors medical mission. Enclosed in this packet is the
information you need to get involved. We aim for a variety of doctors, nurses and other healthcare professionals, but
welcome ANYONE with a positive attitude, a willingness to work hard, and a desire to help others. Please feel free to
familiarize yourself with our project and clinical locations on www.floatingdoctors.com.
The Southern Wind, our 76 foot cruising vessel is docked at the Bocas Marina and serves as our launching pad
while in Panama. As you begin to plan your trip, please keep in contact with us at [email protected]
to confirm that space is available onboard before committing to travel plans. We allow for nearly any length stay
(available accommodation permitting) with no minimum or maximum commitment. Volunteers have stayed anywhere
from a week to more than 6 months. Once you have contacted us and we have confirmed availability, please note that we
ask for a donation of $200 per week to cover all your food, housing, and operational expenses. Volunteers are responsible
for their own travel arrangements to Bocas Del Toro and travel insurance. We cannot currently offer any salary, but
promise the opportunity to have the trip of a lifetime and the chance to travel to Panama while making real differences in
the lives of the people you will meet.
In the enclosed packet, you will find:
1) What to expect during your stay
2) Transportation and Maps
3) Vaccination Requirements
4) Packing List
5) Is your Spanish Rusty?
6) Patient Treatment Record
7) Patient Treatment Record Intake Guide
8) Physical Exam Script
9) Consulting in Panama
10) Waiver
11) Medical History
After looking through this packet, please contact us with any remaining questions or comments. We are looking forward
to working with you on the shores of a distant sea…
What to expect during your visit
While working with the Floating Doctors team, you will participate in all aspects of our operations. Successful volunteers
are flexible and able to take charge of their individual projects as well as willing to jump in to help others.
There are a variety of ongoing projects that form the core of the Floating Doctors presence in Bocas. All volunteers
participate fully in all of these activities:
1) Mobile clinics: 3 times per week the Floating Doctors board the launch boat and head out to a rural clinic site.
We usually set up the clinic and start seeing patients by 9AM and finish up around 4 PM in time to return to
Southern Wind before dark. During clinics, all volunteers get the chance to work one-on-one with patients and
doctors with a variety of backgrounds. These clinics provide an invaluable experience of seeing unusual disease
presentations and advanced cases of conditions that are treated earlier in the developed world.
2) Asilo: The Asilo is a geriatric live-in facility in down town Bocas. This government funded facility serves people
suffering from mental or physical illnesses. The Floating Doctors make bi-weekly visits to provide medical
attention and companionship to the residents.
3) Consultorio: The Floating Doctors conduct a small clinic twice a week for the Bocas community. This clinic
provides volunteers time to see patients in a more classic healthcare setting.
4) Boat maintenance: Living aboard a boat means there is a growing list of maintenance projects to be done,
including cleaning, sanding, constructing and repairing old parts. All volunteers are expected to take part in these
projects.
5) Cooking and cleaning: Communal living requires that everyone on board does their fair share. We all work
together to create dinners and keep the boat clean.
Every volunteer brings their own strengths, we encourage thinking about the type of project you want to accomplish
before you arrive so that you are able to jump right in and effectively use the time you spend in Panama. We have had a
variety of smaller projects conducted by volunteers.
1) Health Education: First-aid education for local firemen and sailors
2) Natural Medicine: Ethnobotany projects with local medicine men
3) Public Health: Public health research projects and data collection
Typical Weekly schedule:
Monday
Tuesday
Wednesday
Thursday
Friday
Mobile Clinic
Projects and
Asilo visit
in morning
Mobile
Clinic
Projects and
Asilo visit
in morning
Mobile Clinic
(9-4)
Consultorio
(3-6 pm)
(9-4
Consultorio
(3-6 pm)
(9-4)
Saturday
Sunday
Day off, trip,
special events,
Day off, trip,
special events,
Multiday clinic
every other
weekend
Multiday clinic
every other
weekend
Transportation and Maps
Transportation: Getting from Panama City to Bocas
Plane: All international flights into Panama come in to Tocuman International Airport in Panama City. To get to Bocas,
there are two airlines to choose from. Air Panama, or Aero Perlas both fly directly to Bocas from Albrook Airport or
there is a new service from Tocuman International Airport ($116 with tax). It is a more expensive cab ride from
Tocumen, so if you plan on spending time in Panama City, fly out of Albrook. The cab ride from Tocumen into the center
of Panama City should cost you no more than $30. Cab rides to Albrook Airport from downtown are around $5-10.
Flights from Panama City to Bocas happen daily around 6AM and 3PM.
Bus: Another option is to take an overnight bus from Panama City to Bocas ($25)
Hostels in Panama City: Some of our volunteers have happily stayed at Luna’s Castle ($14 for a dorm style bed) in the
old part of the city (tel. 262-1540, http://lunacastle.com).
Before you arrive, send your flight information to us and we will meet you at the airport in Bocas!
Maps:
For a map of Bocas and important places for the Floating Doctors, go to: (http://g.co/maps/t2sqb)
For a map of our mobile clinic sites, go to: (http://g.co/maps/qgwjs)
Links to Informational Videos about Floating Doctors
http://www.youtube.com/watch?v=klrc2ThY-tY
http://www.youtube.com/watch?v=UK40956Oufk&feature=related
http://www.youtube.com/watch?v=Pz3fXBs1uWM&list=UU2YGG4m0muTM0C8wQkem2qg&index=5&feature=
plcp
Vaccination Requirements
To participate in our project, you will need vaccination coverage for Panama. For up to date information on your
vaccination requirements, please see the Center for Disease Control’s website at
http://wwwnc.cdc.gov/travel/destinations/panama.htm.
Typically, the following vaccines (which many people have had in childhood) are required to be current:
o
o
o
o
Chickenpox
Polio
MMR (Measles/Mumps/Rubella)
DPT (Diptheria/Pertussis/Tetanus)
The following vaccines are recommended by the CDC for Panama:
o
o
o
o
o
Hepatitis A
Hepatitis B (this vaccination takes 3 injections over several months; it is not required for entry into any
country but we require that the series has at least been started prior to participation in our project)
Typhoid
Yellow Fever (many countries do not allow entrance unless you show your vaccination “shot book”
which we recommend guarding with your life! Fortunately, Panama is not one of these countries)
Rabies
Lastly, there is Malaria in Panama. Fortunately, Bocas does not fall in the high risk region. We do not require Malaria
prophylaxis, but leave the decision up to you the individual volunteer. Vaccinations and prescriptions for Malaria
prophylaxis can be arranged either through your own GP physician or any Travel Health clinic.
Please ensure that your vaccinations are up to date. If you are missing vaccinations, it is unsafe to travel in regions where
these diseases are endemic and you will not be allowed to volunteer with the Floating Doctors. Some vaccinations, such as
Hepatitis B, require three injections given over several months, so plan well in advance to have your shots in order and we
will see you onboard!
Packing List
Packing: Here’s a list of things to bring—and some things to leave at home! In terms of ‘luggage,’ due to the limitations
of living on a boat, packing lightly is encouraged. Please limit yourself to no more than 2 small duffel bags or one travel
backpack for clothes and personal possessions, and a small daypack for clinic days (a school backpack works fine). We
recommend leaving any expensive jewelry behind, as well as any particularly valuable clothing or personal items, as they
may be lost or dirtied during our activities. If you have any questions, please feel free to contact us.
What to bring:
o Valid passport: (check that you have at LEAST 6 months before expiration; many countries do not allow
entry of passports with less than 6 months of validity)
o Travel insurance
o Immunization Record: Please read the immunizations section to find out which immunizations we
recommend
o Color photocopies of your important documents (passport (x5), driver’s license (x5), bank cards, travel
insurance, prescriptions etc.)
o Headlamp/flashlight (extra batteries)
o Any personal medical equipment you might prefer to use (stethoscope, etc)
o Sunglasses
o Computer (You are welcome to bring your own laptop if you have one that is easy to travel with, but as a
precaution we strongly recommend that you back up all your files before you join us.)
o Bug spray (with DEET)…there are sometimes lots of no-see-ums/sand flies and they are fierce!
o Calamine lotion to sooth itchy bug bites
o Sunscreen and aloe vera
o Thumb drive/external hard drive to share music/photos
o Water bottle or camel back (2 liters)
o Small daypack
o Toiletries (shampoo, toothbrush/paste, soap, deodorant, hair ties, shaving gear, etc.)
o Extra glasses or contact lenses/solution
o If you are on any prescribed medication, make sure to bring more than enough for your entire stay with us.
o To-go coffee mugs
o Books to read (we encourage people to bring books that they can leave behind in our library for
o future crew members to enjoy; we also gratefully accept donated DVDs)
o iPod
o Travel towel
o Camera
o Waterproof bags (not necessary, but really useful on boats and during heavy rains)
o Money for personal incidentals; we recommend bringing $100 per week (although you will probably use far
less). We have had volunteers use as little as $50 in three weeks. This all depends on what you want to do
during your stay. Panama uses the US dollar and money can conveniently be withdrawn at the bank in
downtown Bocas.
Clothes: Bring clothes that can (and probably will) get dirty
o
o
o
o
o
o
o
o
Clothes for hot weather (T-shirts, tank tops, shorts, lightweight jeans or cargo pants, swimsuit, quick drying
board shorts/pants, underwear, pajamas),
Lightweight/full coverage clothing to protect from bugs/sun (tights, sunhat, long-sleeve shirts)
Sandels that are easy to wash and good to wear in wet/muddy conditions (flipflops/Croc Chacos/Tevas/etc.)
Wetsuit booties, watersocks or full-foot sandels are useful for amphibious activities if you have them
Sturdy shoes that can get wet and muddy while hiking (old sneakers/hiking boots)
Rain poncho
Sun hat with wide brim to protect from sun
Scrubs for clinical work (if you have them)
What is provided onboard the Southern Wind:
o
o
o
o
o
o
o
o
o
Bedding (sheets, pillows, blankets)
Towels
Dishware
Communal dinners, food for breakfast and lunch
Hot showers at Bocas Marina
1 Computer with internet
Wi-Fi access on boat (personal computers can receive Wi-Fi for $30/month or $10/week from the marina)
Outlets are standard U.S. outlets, 110 volts
Air conditioning in cabins
What NOT to bring:
o
o
o
o
o
o
o
Hard suitcases or trunks (unless previously cleared with Floating Doctors)
Weapons of any kind
Illegal or Recreational Drugs
Jewelry, sentimental personal items or anything that you can’t afford to lose or would make you a target of
thieves
Any fireworks or explosive/incendiary devices
Any medication not prescribed to you
A bad attitude!
Supplies that we are ALWAYS in need of if you have access to them:
o
o
o
o
o
o
Thermometers
Condoms
Toothbrushes
Children’s chewable multivitamins
Costco/Sam’s club bottles of Ibuprofen, Naproxen and Acetaminophen
Stickers/candy/bubbles for young patients!
Is your Spanish rusty?
Having a working knowledge of Spanish is very useful when you first arrive. We have a few books to recommend that
help polish off that rusty Spanish especially to be able to interact effectively with patients.
1) “Spanish for Health Care professionals”—book of useful phrases and vocabulary
2) “Spanish Phrasebook for Health Care Providers”---Small phrasebook of basic phrases and vocabulary,
this also comes with a CD to help with pronunciations.
We also complete “Patient Treatment Records” for every patient seen in clinic. The form on the following page, which
consists of the basic components of a medical history are filled out by volunteers. Thinking about how to ask the
questions on this form is a good way to prepare for the Mobile clinics and be ready to hit the ground running when you
arrive.
FD Patient Treatment Record
Location:
D.O.B/I.D.#:
Patient Name: _______________________________Sex: M / F Age: ______Date:_________
Weight:
Height:
BP:
HR:
Temp:
Pregnant: Yes / No
Breastfeeding: Yes / No
Presenting Complaint:
Past Medical/Surgical History (Illnesses/Injuries & Treatments/Outcome):
Vaccinations up to date?
Yes…No….Doesn’t know
Social History:
Family History:
-Work:
-Mother: Alive / RIP Age at death:
-Father: Alive / RIP Age at death:
-Alcohol (Units/Week): 0 - 5 - 10 - 15 - 20 - 25 - 30 - 30+
Cause:
Cause:
-Smoking (Pack Years): 0 - 2 - 5 - 10 - 15 - 20 - 25 - 30 - 30+
-Siblings: ♂x
-Travel: None / Province / National / International:
-Spouse/Partner: None / Alive / Absent / Deceased (
-Animal Contact: Dog / Cat / Chicken / Pig / Cow / Other:
-Living Situation: Homeless/Apart./Small House/Other:
- # Residents:
Allergies: None Food (
♀
-Children: ♂x
♀
x
)
x
-Number of Pregnancies (if child died obtain details, age, disease, miscarriage, abortion,
etc.):
) Medication (
) Other:
Current Medications:
Systems Review:
Cardio: Normal/abnormal
chest pain, palpitations, dyspnoea, edema, intermit. claudication, ↑BMI, ↑BP, ↑Cholesterol, rheuma&c fever, endocardi&s, clubbing
Respiratory: Normal/abnormal
cough, sputum (color: ______ amount:_______), dyspnea, hemoptysis, wheeze, chest pain, sinusitis, night sweats, apnoea
GIT: Normal/abnormal
↑↓ appe&te, weight loss/gain, dysphagia, dental impairment, heartburn, ulcers, IBD, Celiac, diarrhea, cons&pa&on, pain, mucus,
frank blood, melena, pale stools, hemorrhoids,
Urogenital: Normal/abnormal
dysuria, anuria, nocturia, frequency, urgency, incontinence, discharge, hematuria, ↓stream, grit, sexual dysfx
Menstrual Hx: Age of Menarche: ____ Regular: Y or N
Endocrine: Normal/abnormal
Last Period: ___________ Menopause: _____________
diabetes, hyper/hypothyroid, goiter
Hepato/Biliary: Normal/abnormal
jaundice, pale stools, pruritis
Musculoskeletal: Normal/abnormal
arthralgia (site: _____________), myalgia, back pain, foot pain, impaired mobility, weakness
Neuro/Optho: Normal/abnormal
change in vision, headache, fits, parasthesia/anesthesia _____________ dizziness, vertigo, falls, tremor/Involuntary
movements, speech disturbance, neuralgia _____________psychiatric _____________
Dermatology: Normal/abnormal
Physical Exam:
CVS: HS I + II:
Rhythm: Regular / Irregular
QuickTime™ and a
decompressor
are needed to see this picture.
*
Diagnosis:
Diagnosis Code:
Treatment Code:
Treatment Plan:
Needs Specific Follow-Up? YES NO
Vision Care List?
YES NO
Patient Treatment Record Intake Guide
Basic Info:
Remember, babies often are not named until they are a year or two old. Just list them as ‘Baby’ for the first name and
the mother or father’s name for the last name. Some people may be unsure of their own age. Don’t press the issue.
What is your name? What is your last name? ¿Cuál es tu nombre? ¿Cuál es tu apellido?
How old are you? ¿Qué edad tienes? ¿Qué edad tiene él / ella?
How old is he / she?
Presenting Complaint:
Remember—never assume the kind of general health knowledge that is considered common knowledge in developed
nations. People of all cultures, when made to feel a health ignorance of which they previously were unaware, can feel
shamed and embarrassed. Endeavor to avoid this. They are likely to have been given no details of their condition if
chronic or previously treated, and may not understand the nature of their presenting complaint.
Using basic terms, just try and identify the major issues that they are presenting with. In communities that do now yet
know us well, many patients may believe that they must have symptoms in order to get checked by a doctor. If they feel
healthy but want to be checked by a doctor, or given vitamins or similar health promotion, make sure they realize that it
is ok.
Use basic terms and short sentences, especially if working through a translator. Don’t hammer the patient for lots of
specific details; if they are unsure, move on. Certain basic aspects of any presenting complaint are useful for triage; if
possible, list and note the basic aspects of the major issues the patient is concerned about.
What is the problem? ¿Cuál es el problema?
How long have you had this problem? ¿Cuánto tiempo ha tenido este problema?
Is this the first time you have had this problem? ¿Es esta la primera vez que he tenido este problema?
Is there anything that makes it worse / better? ¿Hay algo que lo hace peor / mejor?
Is it better or worse than when it started? ¿Es mejor o peor que cuando empezó?
Do you take any medicine for the problem? ¿Toma algún medicamento para el problema?
Do you do anything that makes it better? ¿Hace algo que lo hace mejor?
Is it a sharp pain, like a knife or hot spike? ¿Es un dolor agudo, como un cuchillo o un punto caliente?
Where does it hurt? ¿Dónde le duele?
Where is the problem? ¿Dónde está el problema?
Show me where it hurts. Muéstrame dónde le duele.
How long does it last? ¿Cuánto tiempo dura?
How many: days? weeks? years? Cuantos: días? semanas? años?
Are you pregnant? ¿Está embarazada?
How many months are you pregnant? ¿Cuántos meses que está embarazada?
Past Medical/Surgical History:
Any major operations or any illness requiring a visit to hospital. They are likely to have been poorly informed by their
clinicians so any basic info is ok: “heart problem and went to hospital several years ago; no treatment” or “operation on
abdomen 7 yrs ago; no complications” or “broken leg 10 years ago; well healed” is fine.
“Have you ever had to go to a hospital or doctor for anything?”
¿Alguna vez has tenido que ir a un hospital oa un médico para algo?
“Has a doctor ever told you that you had any major illness?”
Alguna vez un médico le dijo que usted tenía alguna enfermedad grave?
Vaccinations Up To Date?
Many patients will have received at least some vaccinations, but will frequently be unaware of what vaccinations. Just
ask if they have ever received vaccinations or not. If they are unsure, mark it and move on.
“Have you ever received vaccinations? When you were a child?”
¿Alguna vez ha recibido las vacunas? Cuando eras un niño?
Social History:
Work: If they manage a household, do not disrespect them by not considering that ‘work.’ Enter it as ‘Casa’ in the space
provided.
What kind of work do you do? ¿Qué tipo de trabajo hace usted?
You manage the household? Usted administra el hogar?
Do you work at farming? ¿Trabajas en la agricultura?
Do you work as a fisherman? ¿Usted trabaja como pescador?
Do you work in construction? ¿Usted trabaja en la construcción?
Do you work in a shop? ¿Trabaja en una tienda?
Alcohol: Very few Ngabe women drink alcohol; alcohol consumption is likely to be higher (or present at all) in
communities with more regular contact or closer proximity to urban centres. The men are more likely to consume
alcohol. Regular drinking, as well as long periods of relative abstinence with ocasional community binge drinking occurs.
Patients are very likely to under-report alcohol consumption due to cultural shame and assumption that any medical
mission is religious, and reporting low or no alcohol intake will result in better treatment. Always lead with overestimation: “Do you drink beer or alcohol? How much—10-15 beers per day?” “Oh no, only 8-10 beers per day.” This
approach works in every culture to give more accurate results.
Report in ‘Units/Week:’ (1 unit of alcohol = half a pint of beer, small wine glass, one bar shot of liquor). Don’t press the
issue for specifics; make a best estimate in your head).
Do you drink beer or alcohol? How much—10-15 beers per day?
¿Usted bebe cerveza o alcohol? Cuánto-10-15 cervezas por día?
Smoking: Use the same techniques for smoking (and again, very few Ngabe women smoke). Report in Pack Years:
Packs Smoked Per Day x Years Smoked
Do you smoke? How much, 2-3 packs per day?
¿Fuma usted? Cuánto, 2-3 paquetes al día?
How many years have you smoked?
¿Cuántos años ha fumado?
Animal Contact: Communal living means that if one family has a dog, the whole community has contact. Look around
as you enter the community—if you see dogs, cats, livestock, or other animals, circle it in on each patients’ chart and
save time by skipping the question.
Do you have any animals?
¿Tiene algún animal?
Living Situation: In rural communities, few people are ‘homeless’ though many people live in conditions similar to
developed world indigents. Look around as you enter the community—if all you see are nearly indentical small square
shacks, just circle ‘small house.’ In urban communities, it is more appropriate to differentiate in living situations.
Do you live in an apartment / house?
¿Vive en un apartamento / casa?
Including you, how many people live in your home?
Incluido usted, ¿cuántas personas viven en su casa
Family History: Often they may not know at what age their parents passed away, or from what. Don’t press the issue.
Are your mother and father still alive?
¿Es tu madre y tu padre aún vive?
How old was your mother / father when he / she died?
¿Cuántos años tenía tu madre / padre cuando él / ella murió?
What did your mother / father die from?
¿Qué dijo tu madre / padre murió?
How many brothers / sisters do you have?
¿Cuántos hermanos / hermanas tiene usted?
Is your spouse or partner alive and well?
¿Es su cónyuge o pareja sana y salva?
Do you have children?
¿Tiene hijos?
How many sons / daughters do you have?
¿Cuántos hijos / hijas tiene usted?
How many times have you been pregnant?
¿Cuántas veces ha estado embarazada?
This leads to a sensitive question—asking what happened to children who have died. I have not included Spanish
phrases to ascertain children’s cause of death because you should not ask these questions without being able to
comunícate well. If your Spanish is poor—even in your eagerness to try hard to comunícate, or if the patient seems
reluctant to answer, LET IT GO. They don’t have to answer ANY of these questions if they don’t want to, so don’t press
them hard for answers that don’t come quickly.
Allergies: Appreciate that many patients will not have the same level of conceptual understanding of allergies that you
are accustomed to. The second question is more likely to be understoof
Do you have any allergies? Do you have bad reactions to any food or medicine or anything else?
¿Tiene alguna alergia? ¿Tiene usted una mala reacción a un alimento o un medicamento o cualquier otra cosa?
Current Medications:
Remember, they MAY know exactly what medicine they are on and what it is for, but they are very likely not to know,
or to know that it is for a ‘heart problem,’ or to know that they take ‘1 pill per day’ as far as dosing goes. If they take
anything, they may take it intermittently, like taking blood pressure pills when they ‘feel’ like their BP is high. Or months
or years may go between treatments (when they can afford it or get access to it).
Do you take any medicine?
¿Toma algún medicamento?
Are you taking medicine for anything now?
¿Está tomando medicamentos para algo ahora?
Does it help?
¿Ayuda?
PHYSICAL EXAM
LE EXAMEN FISICO
General Instructions
Instrucciones Generales
I am going to examine you
Please
- lie down (on your back)
- Sit down
- Stand up
- Lean forward
- Lean backward
- Relax
- Turn
Lift your shirt
Are you comfortable?
This won’t hurt
Show me your hands
Open your mouth
Stick out your tongue
I am going to feel your
- neck/armpit/groin for lymph nodes
Voy a examinarle
Por favour
- acuéstese (boca arriba)
- Siéntese
- Levántese
- Inclínese hacia delante
- Inclínese hacia atrás
- Descanse
- Dese vuelta
Levante su chemise
Esta cómodo (a)?
Esto no le dolerá
Muéstrame tus manos
Abra la boca
Saque la lengua
Voy a sentir su
cuello, la axila y la ingle delos ganglios linfáticos
I am going to examine your abdomen
Voy a examiner su estomago
Point to the pain
What are these scars from?
When was the operation?
I am going to touch your abdomen now
- Don’t cross your legs
- Breathe in
- Breathe out
- Cough
- Inflate your stomach
- Suck In your stomach
- Does this hurt?
Señale le duele
¿cuáles son estas cicatrices?
¿Cuándo fue la operación?
Voy a tocar su abdomen ahora
- No cruce las piernas
- Aspirar
- Exhaler
- Tosa
- Infle el estomago
- Meta el estomago
- Le duele esto?
I am going to examine your lungs and your heart
Voy a examinarle los pulmones es el Corazon
Please don’t talk
Breathe deeply through your open mouth…
And again….hold it
Breath normally
Say ‘thirty three’
Por favour no hable
Respire profunda con la boca abierta….
otra vez….no saque el aire
Respire normalmente
Diga ‘treinta y tres’
Musculoskeletal System
Examen fisico del sistema musculoesqueletico
Raise your arm/leg
Relax and let me move your arm/leg
Don’t let me move your arm/leg
Push against my hand as hard as you can
Squeeze my fingers as hard as you can
Levante el brazo/la pierna
Relájese y déjeme moverle el brazo/la pierna
No me deje mover su brazo/pierna
Empuje fuerte mu mano
Apriete fuerte mis dedos
Nervous System
Examen fisico del sistema nervioso
Don’t let me open your mouth/eyes
Smile
Shrug your shoulders
Move your tongue
Close your eyes
Tell me when you feel something
Where do you feel it?
Put your hands like this
Push/pull
Hold your arms out straight
Walk heel to toe (like this)
Put your heel on your ankle.
Run your heel up and down your leg
Do it faster/with the other hand
No me deje abrir su boca/sus ojos
Sonría
Levante sus hombros
Muévala le lengua
Cierre los ojos
Dígame cuando sienta algo
Donde lo siente?
Ponga las manos así
Empuje/tirar
Extienda sus brazos al frente
Camine con un pie delante del otro (así)
Tóquese el tobillo con el talon
Deslice el talon sobre su pierna
Hágalo más rápido/con la otra mano
Consulting In Bocas Del Toro
When practicing medicine in a foreign language and culture, clinicians often face significant communication challenges,
resulting in fewer patients being seen and in poorer diagnoses and treatment outcomes. Working through a translator is
common, and Translation Medicine can be a huge barrier to practitioners in foreign settings.
Here are some handy tips to keep in mind to make sure you are able to communicate effectively and provide appropriate
care to your patients.
•
Use short statements, giving your translator time to mentally process what you are saying and translate correctly.
•
Use basic vocabulary and grammar—many of your patients and translators will have a limited vocabulary (they
could be Ngobe, speaking Spanish as a second language to your translator, who may be Ngobe and speaking
English as a third language to you)
BAD EXAMPLE: “You are experiencing the symptoms of acute hypotension secondary to dehydration”
GOOD EXAMPLE: “You feel bad because the pressure of your blood is low. [pause for translation]
“The pressure of your blood is low because you don’t drink enough water.”
•
Give time between statements for your translator to think and to translate.
•
Never assume your patient can read, but provide basic written instructions with all treatments.
•
Many people in the developing world have very limited health knowledge; explain everything beginning with
basic principles—from better understanding comes better patient compliance and better outcomes!
•
Don’t be afraid to ask your patients to explain something another way, or to re-phrase things several times for
your translator.
•
Throw out all scales of pain reporting you used in the US…the “1 out of 10” scale is rarely of use; pain is more
subjective here.
•
Make sure your advice is appropriate to the setting…you can’t tell a manual laborer to stay off his feet for 6
weeks. Imagine what will be possible and acceptable to your patient, and work with that to get the best result you
can.
•
If giving dietary advice, be sure to use what is locally obtainable.
•
Remember that your translator may be local, and therefore a potential source of secondary patient history
information (and also someone your patient may know personally, and not want to share knowledge of their
embarrassing discharge with).
•
Many have used natural medicine for remedies, so be sure to ask when assessing any medications used.
•
If no medications need to be dispensed, it is helpful to positively reinforce health care seeking behavior by
providing vitamins, soap, electrolytes, children’s acetaminophen for a mother with 13 children who happen to all
have no fevers at the moment, etc.
•
If they need referral to a more advanced setting, do what you can to control symptoms and provide them with a
referral letter in Spanish to take with them to hospital. For acute issues, refer to the clinic manager for assessment
of transport assistance.
Remember, many have never had experience with modern health care at all, and the vast majority of those who have
experienced health care services locally have felt very poorly treated both as patients as human beings. The vast
majority of Ngobe we have experienced profess great disappointment, anger, and frustration at local health services
and generally believe that if they get sick or injured, it will get better…or it won’t, and our experiences helping
facilitate patient care in the local services has supported this assessment.
For 500 years, nearly every interaction they have had with non-Ngobe has been to disenfranchise them in some way.
This is your chance to plant the seeds of change in health care social culture. If you manage to ensure that your
patient’s experience with health care is a positive one, then no matter where they may attend in future they will
always have another reference point for comparison.
Floating Doctors Medical Mission Waiver
General Release, Waiver, and Assumption of Risk: Please read this general release, waiver, assumption of
risk (“agreement”) CAREFULLY before signing it. It is a legal document which affects your legal rights.
I, _________________________acknowledge that I have applied to work as a volunteer with Floating Doctors. I am aware and
acknowledge the work of Floating Doctors may involve hazards to my health or life, and dangers which may include risk of injury,
illness, or death. As a volunteer, I understand that there are additional dangers inherent in travel in foreign countries including but
not limited to traveling in light airplanes or small ships, the possibility that adequate medical facilities may be unavailable should I
require them, being resident in and subject to the laws of another country, the chances of crime, terrorism, piracy, violence,
banditry, political unrest or guerilla activity as well as unsanitary health conditions and exposure to disease (i.e. hepatitis, malaria,
cholera, polio, and others). Other potential risks can include, but are not limited to exposure to dangerous terrestrial or marine life,
injury aboard our vessels during heavy weather or maneuvering/anchoring/docking/fueling, burns and chemical injury, fishing
injuries, and injuries from repair or maintenance work. I voluntarily agree to assume all of the above risks, and all other risks
associated with my participation in the work of Floating Doctors, whether known or unknown.
As consideration for being allowed by Floating Doctors to participate in its work, I hereby release and forever discharge Floating
Doctors, their directors, officers, agents, employees, volunteers, attorneys, representatives, assigns and affiliates for any and all
claims and demands of whatever kind or nature whether known or unknown that arise out of or are connected in any way
whatsoever with my voluntary participation in the work of Floating Doctors. I understand and acknowledge that any and all
documents, surveys, programs, photocopies, photographs, and video footage (edited or unedited) created during my volunteer
period is owned by Floating Doctors.
I also hereby release and forever discharge Floating Doctors, their directors, officers, agents, employees, attorneys, representatives,
assigns, and affiliates for any and all claims and demands of whatever kind of nature, known or unknown, arising from or connected
in any way whatsoever with any first aid, medical treatment, or services rendered me during my participation in or in any way
related to Floating Doctors work. I understand and agree that I am not an employee of Floating Doctors. My work is voluntary only. I
understand and agree that Floating Doctors is under no obligation to provide, and does not provide, workers’ compensation, or
malpractice insurance, nor any other employee benefits of any kind.
I understand and acknowledge that this agreement is a binding legal document that affects my legal rights and remedies. I
understand that this agreement binds not only me but my spouse, children, heirs, representatives, distributes, guardians, and
assigns. I understand and agree that this agreement is intended to be interpreted as broadly and inclusively as permitted under the
laws of the State of California. If legal proceedings are filed, I understand they will be tried only in the State of California, and any
proceedings will be brought and conducted only before the State Court of the State of California. I agree to be subject to personal
jurisdiction and venue in the State of California, and waive any right I may have to commence any litigation, administrative actions or
arbitration concerning the work of Floating Doctors in any form other than the State Court of the State of California.
I understand and agree that if any clause, sentence or provision of this agreement shall be held to be invalid or unenforceable by any
court of competent jurisdiction, the unenforceability or invalidity of such clause, sentence or provision shall not affect the validity or
enforceability of the remaining terms. I understand and agree that the terms of agreement are contractual and are conditions
precedent to my participation in the work of Floating Doctors and not mere recitals. I understand this agreement may only be
modified in writing by both Floating Doctors representative and myself, and may not be modified orally.
I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND THE CONTENTS. I HAVE HAD THE OPPORTUNITY FOR LEGAL
REVIEW OF THIS BINDING DOCUMENT AND CHOOSE TO SIGN IT VOLUNTARILY, CREATING A LEGAL CONTRACT BETWEEN FLOATING
DOCTORS AND MYSELF.
VOLUNTEER SIGNATURE_____________________________________________DATE___________
PRINT NAME AND ADDRESS______________________________________________________________
Medical History
Volunteer crew members are required to declare any previous history:
____Back injuries or back pain
____Heart Disease
____Diabetes
____Lung Disease
____Hernia
____Broken or dislocated limbs, shoulders, hips, fingers, etc.
____Allergies, food or diet restrictions, substance sensitivities (smoke, noise, dust, etc)
PLEASE SPECIFY:________________________________________________________________________
____Severe seasickness
____Alcoholism, drug dependence
____Other injury or disease that may be aggravated by or affect performance of duties
If any of the above conditions are checked, please describe the condition, circumstances, treatment, and
current status:
__________________________________________________________________________________________
__________________________________________________________________________________________
If you are on ANY medications (prescription or otherwise) please list the names, dosage and indications:
__________________________________________________________________________________________
__________________________________________________________________________________________
Travel Health Insurance (Please Provide Company Name and Policy Number):
__________________________________________________________________________________________
__________________________________________________________________________________________
Other Considerations:
__________________________________________________________________________________________
__________________________________________________________________________________________