Rising from my hammock on Thursday morning, I slowly oriented myself to thel world around me in my usual delayed fashion. Looking at my watch, I noticed it was just after 7:00 AM, and shortly the team would gather for breakfast at 7:30. Taking my time, I whiningly sat up in my hammock to greet the day and slithered out onto the floor beneath me.

I have never been a morning person.

This morning, I noticed an unusual stir from many of my comrades. Immediately after getting up I saw Trenton, one of our volunteers from northern California. 

‘How you feelin bro?’ he said.

‘Good man,’ I answered.

‘You’re not feeling sick at all?’ 

‘Not really,’ I said, laying a hand on my stomach. ‘Just never sleep particularly well in these hammocks.’

‘True true,’ he said. ‘I wasn’t meaning anything by it, I think there’s something going around. Jelmer and I think a few others were up all night vomiting with diarrhoea.’

‘Oh damn,’ I answered.

As I walked around our hammock city I caught a few people who echoed the same message. Around three or four of our 16 staff members had fallen ill to something. Several theories immediately began circulating about where the culprit may lie, whether it was the dinner from the night before, or some extension of the rampant flu strains we had seen throughout the communities was hard to say. For now, it just meant a lot of stressed out adults second guessing their every physical sensation, excessive hand washing, and several empty chairs at breakfast. I for one was feeling okay, which made me feel oddly proud. By convention, I was usually the one to get sick.. I sought out those who felt unwell to offer my support while being cautious not to look too smug about my own preservation.

Loading up the bus took a little bit longer given a few hands were out of commission, but we got everything loaded on time before rolling and bobbing through the jungle once more. During the ride I sat in silence, soaking in my surroundings. I always enjoyed these journeys back from clinic; they served me nicely to reflect on the week, where things went well and where they didn’t. Similarly, by the time we reached Almirante, the sun soared in a big blue sky perfect for sailing. As we came up to base, I saw a boat docked I didn’t recognize. Over the next thirty minutes, it became clear that our outbreak in the community was not a fluke – several kitchen staff had gotten sick during the week, including one who came in that day and looked so unwell with uncontrolled vomiting that she was sent to the hospital on that very boat. Not good.

That evening, the healthcare providers met to discuss plans for the upcoming midwife conference meant to take place that weekend on base. It had been in the works for several months. We began talking about the plans for different components of the conference, with mannequins, education sessions on the stages of labour, and question and answer periods for the more experienced midwives from the communities. It was an ambitious undertaking that was now being threatened. It begged the question: if there is an active outbreak afflicting several staff members, what are the potential harms of bringing all these midwives to base for a conference? It posed a dilemma that fortunately or unfortunately fell on the shoulders of Fermin and the education team. After careful deliberation, leadership decided the risks outweighed the benefits. The conference would have to take place another day. It sucks, but as we’ve all learned over the past few years, sometimes these things happen. An inevitable air of doom and gloom took residence throughout base that evening, as some of the more sick laid uncomfortably in their beds, and some of the more well lived with the guilt of the associated fallout. 

In an attempt to salvage the mood, I took a guitar down to the dock and fiddled my way into the darkness. After a time Shane joined me and we sang songs together before eventually packing in, both hoping that the next day would bring better winds.

Thankfully, we rose the next day to hear that most of the ill were feeling better. A relief. Crisis averted. Still, the obvious presence of a viral breakout made the risk of spread still ever present, so in true population health fashion, facilities including showers, toilets, and dining room tables were marked for segregation of those with the ailment and those without. 

I spent the day helping to pack the pelicans and counting medicine stockpiles. In addition, while I was away, the lady I saw at a home visit with progressive inflammatory arthritis had reached out to our medical provider phone number. She told us that she had presented to hospital as instructed and been given a lot of papers and medication that she didn’t understand. I immediately remembered how common, and equally frustrating this was. The ensuing process usually involved us trying to get photographs of forms or medications to make sense of what kind of diagnosis was made, on what grounds, what imaging and lab work was done, and where things need to go next. It’s not always easy to tell either, with poor handwriting in conjunction with lack of savviness navigating the local healthcare structures coming together to make for a lot of frustration in determining where to direct the patient next. In this case, she had been given a slip of paper detailing more lab work she’d have to get done, unclear where or how, as well as being given a document with information for her to call to make an appointment to see a rheumatologist. Thankfully, FD had contacts inside the medical system that could help with these things, so after a few hours spent getting all the pieces together I was able to hand off the case to the staff. Just another reminder of all the small details we take for granted that someone has to figure out in order for things to work in an orderly manner.

This brought me to Friday afternoon, and this particular afternoon was mightily special. It was the World Cup quarter finals between Argentina and the Netherlands, historic rivals and a cracking spectacle of epic proportions. Given a fairly even split of Dutch and Argentinian nationals on base, with around four to five a piece respectively, it carried more weight on a personal level for those among us with national investment. The group decided collectively to wrap things up a little early to give us ample time to boat to town. We went to a taco house that had become our nexus for the world cup with a decent television and a couple of Argentinean waiters.

‘Ey! Mi amigo,’ they’d say. ‘Sentate papa, have a seat.’

What they didn’t necessarily expect this time around was for us to also bring a contingent of loud hooligans dressed in Oranje. Either way, it was all well and good, and in the end it wound up being a classic match, ripe with emotions, a lot of screaming, and a real rollercoaster. In many ways, futbol is one of the ways that most easily enables me to connect with my homeland. A lifetime of appreciation for the sport, watching games with my family, and an instant in to melt walls when chatting with other Argentinians is part of what makes it such a special game. The match filled me with a spectrum of emotions that could never be elicited in any other way, equal parts elation watching Messi;s scintillating pass to set up the first goal, contrasting with cataclysmic disbelief when the Dutch equalised in the dying moments of the second half to make it 2-2. When the game went on to penalties, I felt my heart burst in my chest. My mind immediately drifted to my dad, who found penalties so nerve-wracking he’d often go upstairs and just listen, since he could never bear to watch. When Argentina sealed the win, I felt a lump in my throat and my eyes welled up with pure relief, but also melancholy. 

No matter how sweet a win, it hurt me not to be with my family. This second time around in Panama, I was starting to take a wider appreciation for the implications of  building a life working in the field and those things I was likely giving up: World Cups with my family, regular contact with my friends from childhood, lack of stability for a relationship, the list goes on. Maybe it was a sign of maturation, a sign of self-doubt, or simply the wearing off of novelty, but I felt it more notably every time. Missing my family as much as I did at that moment, I immediately called them on whastapp and exchanged messages. Also worth noting was the several shots of tequila that had been spoon-fed to me throughout the game by my brothers in arms behind the bar (your boy was positively sauced). The rest of the night took me to several bars throughout Bocas and carries little importance, but let’s just say it involved more drinks and a poor night of sleep spent in uncomfortable places.

Sleepwalking through most of Saturday, I rented a surfboard with Trenton, and did my best to make sense of that flat plane in the ocean. I have never been great with boards, and it turns out surfing is actually kind of hard. Enjoyable experience, made some rewarding progress. Would try again. 

Putting behind me the emotions of the weekend I took some time to reflect on Sunday night about just how far I had come since the last time I was here as a green-eyed medical student. The next day, we were set to sail out to a place where I had the most transformative experience of my life, which indubitably marked me forever. As fortune would have it, we were going back to run clinics at the one place I could never forget, no matter how much I tried. We were setting sail across the Chiriquí Lagoon and the Canal de Tigre for my Mecca.

We were setting sail for Ensenada.