Valle Escondido holds a special place in the Floating Doctors repertoire. By virtue of its proximity, we can easily pack up and transport there in a matter of minutes. Additionally, many of our staff live there, and as a result many members of our team hold meaningful personal connections in the village. I recall my own experience visiting there under Anselmo’s wing one New Years’ Eve on my first adventure here (details excluded from my previous writings). This time around, I had only been there for a few days when one of the cooks said something to me as I was walking through the pharmacy:

‘I recognize you from your pants (this in reference to my hand-cut track pants that formed a staple in my island wardrobe). You are the one who came and danced in Valle.’

I have been known to bust a move from time to time.

The clinic was well structured and run, as I had realised was the way things operated now. Surprisingly, it was actually the veterinary clinic that seemed to get the most action. That was something I took notice of over the first few weeks while I was here. The other divisions of Floating Doctors made sense to me: physiotherapy, health education, dentistry, but veterinarian? Initially, I had mixed feelings about the vet program. I mean sure, it’s great, don’t get me wrong. Animals deserve access to care as well and the general reduction of organism suffering through health and well-being is an aspirational feature for every community in the world. It made extra sense to me in agrarian communities that depend on their livestock like some of the Ngabe. I realised after the first little while though that seldom did the vets treat horses, cattle, or sheep. The vast majority of their visits were household pets or community dogs and cats. I asked myself when I arrived how high the yield was, especially given the patient I saw with heart failure whose likelihood of mortality is skyhigh in the setting of being unable to just get into a boat to see a doctor however many miles away. A part of me maybe felt that animals were just animals and maybe the focus should be on the humans who are already in so much need. 

But then I saw them work.

I saw family after family bring in sick dog after sick dog. I learned how invested the children were when the few that couldn’t be salvaged had to be put down. I saw how much these people cared for their animals and how their animals’ health served as an extension of the health and appreciation of their communities. I watched our Polish vet work without taking breaks and deal with owners who were perhaps more unreasonable and demanding when it came to their dogs’ health than their own. In the end I made a drastic shift in my feelings towards the non-human healthcare arms of Floating Doctors. If we’re going to commit to helping these communities improve their quality of life then why not offer them support in those things that bring them real joy as well. Healthcare, as noble as it is, doesn’t give people meaning in their life. It’s through things like community, affection, and compassion that people find real meaning. Not to mention that healthy pets reduce the parasitic burden of worms, lice, fleas, scabies, and other nasty little buggers. It makes loads of sense when you think about it, and even more when you see it in action.

While the vets and the doctors were busy seeing patients (biped and quadruped alike), our health education team was nowhere to be seen at the clinic. They were doing something that I think is far more valuable: getting entrenched into the village schools and spreading general health education for anyone who would listen. This was a part of Floating Doctors that I had never seen before, and really, I think it’s probably the single most important thing they do, more than any medication or treatment administered. A medical group like ours can treat diseases until the cows come home, but generational change has to come from within, and it can be inspired through education. A population can only make demands from themselves and their healthcare networks when they understand the value in healthcare and how it affects quality of living. I would almost say there’s nearly no point in treating disease unless you are willing to teach people that they need to demand care from their institutional frameworks. As I deliberate my own understanding of where underprivileged living comes from, I think I have come to realise that real privilege is not financial, it’s intellectual. A population with all the money in the world can still live disadvantaged lives due to poor health, poor social connections and lack of meaning – one only has to look at many parts of the so-called developed world to find that in spades. It’s when crises rob a generation of their education, or when oppressive regimes butcher a population’s knowledge and connection to their own identities (thinking of the Canadian residential school atrocities) that inequality truly manifests itself. I saw many communities during my time here that despite their comparatively low incomes live lives just as fulfilling as the high and middle income world. I don’t think of those communities as underprivileged. It’s only in the places where I see where poverty, lack of education, and lack of community manifest together that real inequality needs to be corrected. You can start to change all of that, slowly, through planting the seeds of education. Helping people understand their own bodies, like the women who came to us asking for community talks on menopause for changes they didn’t comprehend, or helping people understand safe water sanitation practices and healthy eating. If people have the weaponry to understand where their systems are failing them, they can begin to generate changes from within.

While all of this unfolded in the background, my clinic day actually wound up being fairly ordinary. Since these people live so close to base, many of them got regular visits with us periodically on our Friday base clinics. I got to do a home visit with one of the other students to see a man I knew from before. He had suffered a fall many years ago, and was now paraplegic. He remembered me when I came in despite us having shared together just a thirty minute visit two years ago, with so many other white doctors in between. He was busy sewing when I came in. I remember I walked my medical student through his neuro exam, the exact same one I did on him, still as a student all that time ago, that made me understand spinal cord injuries for the first time. It was like a cycle had come around and met its end to start anew. We shared a few laughs before I took off, and I remember hearing the sound of school children outside his home as I walked back to the rancho; they were rehearsing for a holiday concert.

Overall, our clinic in Valle left me with a lot to contemplate, despite seeing few patients due to an oddly quiet clinic day. I had learned so much from Floating Doctors already about myself and about medicine the first time around, and I realised now I was only beginning to scratch the surface of what it really means to improve the health of a community. 

I had a lot more questions than answers, and this was only the beginning.