The following is a travelogue that I wrote during our trip to Panama in 2003.
On Thursday October 16, 2003 we signed up for a snorkeling trip in Bocas Del Torro. Bocas Del Torro is an island off the coast of Panama on the Caribbean side. It was an all day trip that would take us to a variety of sites, including Red Frog Beach, which yes, really does have the famous red frogs (which I really wanted to see). The basic terrain in this area is small islands doting the Caribbean, but much of the islands are mangrove forests and many of the islands were so small that all one would see were many miniature mangrove forests.
At the first two spots snorkeling spots we saw colorful soft corals and very small reef fish. To even see the fish we had to dive down about five feet to the coral and very close to the corals were colorful reef fish in miniature. The general feel was similar to swimming in inland fresh water because the water was not very clear, but very calm and the seaweed was more like freshwater lake vegetation than Pacific Ocean seaweed.
After our second stop we went to lunch at a restaurant that was perched over the water and appeared to have sprung out of mangrove forest. After lunch we were heading towards Red Frog Beach and having a great time. The water was warm and the day was sunny.
Suddenly I looked at Larry and something was terribly terribly wrong. The other people in the boat soon noticed too and the boat was stopped. It was apparent that his newly replaced hip had slipped out of joint. The boat was slowed down to minimize the pounding and an ambulance was called to meet us at the dock. At the slower speed it took about 20 minutes to reach the dock. Larry was in extreme pain, could not move and reported seeing very bright lights. One of the few things he was able to articulate was "I don't care what it costs get me to a good hospital."
A hodge podge group had gathered at the pier and conferences in rapid Spanish were held to try to determine how to remove him from the boat. Eventually the stretcher was placed in the boat and some how Larry was jockeyed on to it. Because he is bigger and heavier than the average Panamanian it took the assistance of several other passengers to remove him and the stretcher from the boat. The ambulance was some kind of old Toyota passenger van. We did a slow drive to the hospital because the road was too pot-holed to go fast, fortunately the hospital was only about five very slow minutes away.
Bocas Del Torro is the main town on an Island called Isla Colon in a group of islands off the Northern coast of Panama. We were taken to the regional hospital which looked like a photo from National Geographic. Larry was wheeled into an examining room on a stretcher that did not go up. We were greeted by a very young female doctor in a red Hello Kitty smock and a macramé and shell necklace. My first words to her were "Can we medivac him to Panama City?" she responded that they first had to confirm what was wrong. So I asked her to give him pain killers. The doctor spoke reasonable English and I was able to explain the hip problem and answer some basic questions.
A very dark round faced no nonsense nurse, who spoke no English, inserted a sterile IV plug into the top of Larry's hand and gave him a shot through the insertion point. He was then wheeled down a long dirty corridor, past a variety of patients on stretchers, children crying and decades of peeling yellow paint. We went into a very old x-ray room where our young doctor learned that the x-ray machine did not have a movable arm and that Larry would have to be moved on to the x-ray table. An assortment of people came to move him, but every time they tried to move him he screamed in pain. I suggested that maybe they could slide something rigid under him so that he could be moved without being bent. Eventually someone brought in an orange rescue board, but again, there was the problem of sliding it under him without injuring him further. To add to the problem, the stretcher did not go totally flat. The doctor then told me that they would give him a shot that would put him out for about fifteen minutes so he could be moved. While we were waiting for the shot to arrive an older doctor came in and told Larry to just relax and be moved. He called several men into the room and directed how they were going to quickly move him. Larry moaned. Fortunately, before Doctor Take Charge's orders could be carried out, Mrs. Nurse No Nonsense returned with the shot. When the x-ray was prepared, I followed the lead of the nurses and scurried way down the hall away from the x-ray machine. After the x-ray I helped one of the nurses move Larry back into the examination room because everyone else had disappeared. This is a very small regional hospital and there were no spare personnel. The doctor and I looked at the x-ray which clearly showed Larry's hip bone out of the socket and off to the side.
I again asked for him to be medivaced to Panama City. I had actually asked this several times at this point to anyone who I thought might speak a little bit of English. The doctor in very patient English said "There are no more planes today, you saw the planes, they are very small, we do not have air ambulance here." This was very clearly a situation that more money was not going to solve. I then asked if he could be flown to Panama City tonight and she said the problem had to be solved tonight or severe nerve damage would occur.
The doctor said they could not help him in Bocas Del Torro and we would have to go to the town of Almirante by hospital boat because they have an orthopedic specialist there. She said that if the Almirante doctor could not handle it we would go to Changuinola by Ambulance. Almirante is owned almost entirely by the company that owns Chiquita Bananas and it sports the seaport that Chiquita Banana uses to ship bananas out of Panama. Changuinola is a slightly larger banana town with a population of about 40,000.
I told the doctor I would have to go back to the guest house to get a few things. She told me to hurry up. Our hotel was about a five minute run from the hospital. I ran into the guest house, explained to Jean, the proprietress, that we had a medical emergency. She came upstairs with me while I explained what happened and tossed money, credit cards, passports, a change of clothes and a toothbrush into a knapsack. As I ran out the door she handed me our Spanish phase book and said you better take this.
Back at the hospital we had another wait because the fire boat had seats that would not accommodate the stretcher and they were not sure of the other boat. I asked for paperwork and the x-rays so that the next hospital would know what had been done. Nurse No Nonsense held them and seemed to indicate they would be transported, it was apparent that this was not a task that I was going to be trusted with. Larry continued to moan in pain in a consciousness that was acutely aware of pain, but not much else. I asked for more pain medication, but they said they would have to wait an hour before they could safely give him another shot. After about twenty minutes Mrs. Nurse No Nonsense escorted us back into the ambulance and we were taken to a very rickety covered pier, with a red cross on the doorway. This boat had a pretty good bench type seat to accommodate a stretcher. Larry was loaded into the boat along with myself, Nurse No Nonsense, the paperwork, a boat driver and another guy. The boat was fired up and quickly died. Fired up again and sputtered out. The fuel ball was squeezed some more and the engine flooded. Eventually the boat was coaxed to life and we departed. I noted that the boat did not carry a radio and from what I would tell, the only five people in Bocas Del Torro who did not own cellular phones were on a boat together.
Emergency Dock
Almirante was about 45 minutes away and as soon as we left the dock it started to rain. The boat had a canopy overhead, but not in front. I was able to shelter Larry from the majority of the rain. Nurse No Nonsense covered me with a large boat cushion to keep the majority of the rain off. It was unfortunate that we were unable to enjoy the ride because it was very scenic and the working harbor of Almirante looked very interesting. Another ambulance met us at the dock and by this time it appeared that the Panamanians were getting the hang of removing large Americans on stretchers from boats. Also, by this time he was strapped down into the rescue board, which minimized movement and did not increase pain. The hospital was actually at the pier and the ambulance was just to move him around to the emergency entrance, where it was explained that we had to wait for the doctor. They were not going to remove him from the ambulance until the doctor arrived.
This was clearly going to be an expensive excursion and periodically Larry would have a lucid moment and moan another access code to another debit card to me (believe it or not I actually remembered the codes). For about 25 minutes people would tell me in very broken English that the doctor would be there soon. It was also explained to me by the assistant boat driver that the doctor did not speak English. Finally a small wiry doctor appeared and I went into the clinic to review the x-rays with him. He said we would have to go to Changuinola. I said can we medivac him to Panama City? He said no. He was able to convey in pantomime that he could re-set the bone without surgery, but that general anesthesia would be required, which they could not do in Almirante because they did not have an anesthesiologist. The Almirante hospital was also out of an old national geographic, so it is unlikely I would have let them do surgery there anyway (like I really had a choice in the matter). The doctor explained that Nurse No Nonsense would do a blood test, the results would be read and then we would go.
Nurse Beginning to Soften up, myself, the doctor and the ambulance driver all joined Larry in the ambulance and set off. Once again, moving at a speed suitable to accommodate thousands of pot holes. Most pot holes caused Larry to moan and some to scream. The stretcher was wedged into the ambulance, sort of, and the nurse and I had to hold Larry in place. We were soon on a narrow, winding, divided highway in the pouring rain and it was getting dark. Periodically Nurse Beginning to Soften up, would reach over and give me a little hug. The road improved and after about 40 minutes we came to a one-lane railroad bridge and the driver turned on the siren. I was not sure that Larry was going to survive the jarring of the bridge. Even with the siren going we had to wait for a long line of cars to exit the bridge. About ten minutes after the bridge we came to a town illuminated only by store lights, but no street lights. We soon pulled into the emergency entrance of a very very old hospital. A group of people came out and carefully moved Larry out of the ambulance, which was helped by the fact that the stretcher for this ambulance worked and he was raised to a normal level for pushing. He was wheeled through a crowded hallway and into an emergency room. In the emergency room, the room where emergencies were handled, a man was having his hand sewn up and an infant was screaming while a procedure was being done to it. They wheeled Larry into another hallway and we were told he had to wait for the anesthesiologist. Eventually a dapper man showed up who spoke enough English to explain who he was and ask me some basic medical questions about Larry.
The doctor returned and again explained that he was going to re-set his hip without surgery and he would be fine. I pantomimed are you strong? A nurse who had been standing by silently chuckled and said "no he is not strong." The doctor smiled and said "strength not necessary for this procedure."
I was told to wait in a small office. A happy faced large doctor sat behind a desk in this office and showed me Larry's x-rays. In good English he said, "I see that he has two prosthesis." He went on to tell me how the first one was a far superior brand than the new one and that he did not use the brand of his new one because it was not as good. He then explained he had just returned from a seminar in Florida on knee replacement. I asked if they did hip replacements in Changuinola and he said yes, "I am doing one tomorrow." We chatted some more and then he said, excuse me, I better go help the other doctor.
I went and found Nurse beginning to Soften up and we watched Spanish TV together in the little office. About twenty minutes later the doctor returned and said he was finished. I asked if Larry would be able to walk tomorrow and he said he could walk right now. The big doctor returned and it was agreed that Larry would stay in the hospital for the night and I would go to a hotel. I was unsure of how much service patients get in hospitals in Panama, but the doctor assured me Larry would be fine for one night, I did not know for sure what this meant at the time, but I had a pretty good idea that one night would be fine, but more than that may not be fine. He gave me hotel names and directions to find them. The first doctor returned and told me to go talk to Larry. Larry was awake and wanted to know when they were going to do the procedure. He refused to believe that it was done, but for the first time in hours he could actually talk. The doctor came back and said they wanted to take another x-ray so they would have a base line on file.
The big doctor came out and told me he was going home and that the ambulance would drop me off at the hotel on their way out of town.
We were met by a female doctor who spoke good English at x-ray and while we were hiding out from the radiation I commented on how impressed I was by the efficiency and speed of a Panamanian hospital. She said "what do you mean?" and I explained how this procedure would have taken hours in the U.S. She said "We know what to do, so we do it."
Larry was wheeled into the ward where he was to spend the night and I was told that I needed to pay the bill. I desperately hoped that they would take credit cards or at least give me credit until I could have money wired. Nurse Softened up took me to the business office and after much calculation I was handed a bill for US$12.00. I showed it to Nurse Softened Up and pantomimed is this correct and she said Si. I paid the bill and found the English speaking female doctor and asked her if the bill was correct for the boat ride, the ambulance ride, the procedure and the night in the hospital. She said "yes, that is alright."
Nurse Softened Up and I went back down long dirty corridors, past the babies and into a ward of about eight beds separated by curtains. All the beds were very old hospital beds and none of them matched. Larry was on a bed with a very old blue sheet and I pantomimed for some covers. Eventually a nurse returned with a very thin top sheet.
Nurse Softened Up, motioned for me to remember where he was in the hospital so I would find him the next day. When we got back to the main corridor, the ambulance driver was gone and the nurse lead me outside. After about four attempts in Spanish she was able to convey to me that she was taking me home with her.
We stopped at a small Panamanian diner and had the most delicious chicken and rice. We then loaded into a small local transport van with a lot of other people and drove for what seemed like a long way through the rain. I had no idea how far her house was and why it was not at Bocas Del Torro since that is where she works. I was sincerely regretting agreeing to come with her, but I also knew that saying no to this angel of mercy would have been very insulting. Finally we got off the van in a modest residential area and walked down a long narrow cement path past a lot of small houses. We stopped at one on the way to say hello to her father and then stopped a few more houses down and went into her house.
By this time I had ascertained that her name is Dalali. Dalali's house was a modest, but clean and orderly two bedroom cinderblock house with the tin roof. It was apparent she had been gone for a few days, which would indicate that she stays at Bocas Del Torro when she works. She went outside and filled a bucket with water and brought it into the shower area in the indoor bathroom. She showed me a bar of soap, a bottle of shampoo and handed me a towel and a little nylon nightie. I then had the best cold water scooper shower of my life. After the shower she gave me a cup of water and directed me to brush my teeth at the kitchen sink. We made some small talk using the phrase book and then went to bed.
I slept until about 5:00 a.m. when I was awoken by the sounds of Panama. Chickens, children, people, music. I quietly stayed put enjoying the sounds of the neighborhood because I did not want to wake Dalali by getting up. She must have been doing the same thing because when I finally got up at 6:20, she got up right after me.
She made me a breakfast of fried plantains, oatmeal and a deep fried hot dog and motioned that she would make breakfast for Larry Albert too. She packed fried plantains and oatmeal into the equivalent of Parkay containers and we returned to the hospital on the local transport van.
The hospital was far scarier in the morning. Humanity, primarily in the form of women and children packed every hallway. We made our way to Larry Albert's ward (We did not do very well when they asked me his name at the first hospital) and he was awake and very relieved to see us.
I had suspected that the nurses only provide basic medical care and no personal care, a suspicion that was confirmed by the fact that other families had brought breakfast and the other beds were dressed with sheets and blankets from home. Larry was very happy to be presented with Dalali's homemade breakfast.
The female doctor was there and she told me he could go, but that I had to go pick up his prescription first, a pain killer-anti-inflammatory. Dalali lead me to the pharmacy, collected paperwork, lead me to the cashier's office so I could pay (US$0.30) and then back to the pharmacy. We went back to collect Larry Albert and then waited at the pharmacy (with about a thousand sick Panamanians). Once we were all settled, Dalali, lead us outside, hailed a cab told him to take us to the airport and motioned for me not to pay more than a dollar to get to the airport. We hugged and thanked Dalali profusely and left. We booked a flight back to Bocas Del Torro leaving in less than an hour and I used the time to tell Larry of the events of the night before beginning with his realization on the boat that something was wrong.
I wanted to collect our stuff and return to Panama City so we could be near good medical care if necessary. Larry convinced me that he could rest just as well in Bocas Del Torro and then I could still do a few of the things we had planned. While somewhat sore, he was actually feeling pretty good and the plan did have merit.
We settled back in and while walking to lunch ran into one of the guys who had been on our boat trip. He was very concerned and we apologized profusely for ruining their boat trip. He said that after were left they conferenced the situation and decided there was nothing else they could do so they continued the trip and had a great time.
The situation again under control, we discovered that Bocas Del Torro was low on water and the serious conservation measures were in effect. Water was off from 11:00 p.m. to 6:00 a.m., on from 6:00 a.m. to 8:00 a.m. and maybe an hour at night. Our guest house had 250 gallons of emergency water, but the tank was half empty at this point. Finally, we were urged to leave the island. I booked a flight for early the next morning and soon learned that we got about the last two seats for the next three days.
Before we left I returned to the hospital to thank the Hello Kitty doctor and to let her know that Larry Albert is fine. She explained that she is a first year doctor and that all first year doctors practice in the country first before they can return to work in the city.
Back in Panama City Larry moved slowly and sorely, but he was fine. The reason he dislocated is that he simultaneously broken just about every rule he had been given to prevent dislocation. Provided he did not break any more rules anytime soon he would be fine. The medical facilities in Panama City are state of the art (so we have been told). We did some sedate touring and shopping. And Larry was not able to put on his own socks for a while.
When I initially wrote this in an internet café in Panama City right after the incident, I marveled at the amount of communication that occurred considering that I speak no Spanish and the majority of the medical personnel spoke no English. I will always be impressed by how much the Panamanian doctors did with so little, by the caring bestowed upon us by the Panamanian medical personnel and by the kindness shown to me by a Panamanian nurse.
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