Before I go any further, I would like to address a few things that people have asked me about. Mainly this is pertaining to patient follow up, or whether I ever find out what happens to many of the people we see. It seems insane, but oftentimes we have no real way of knowing what happens to them once they’ve been given a letter to go for hospital. At times it’s hard to guarantee that they will go at all. Whether they are seen, and what kind of care they receive remains just outside our reach, and the difficulty in communicating leaves us with little chance to truly follow up. The most common outcome is that we just hope to see them again at the next clinic in three months’ time. For example, the lady I saw in la Sabana with a breast mass got a letter sent to her with travel money to go for a scan. We dispatched that bundle via post to a gas station outside Pueblo Nuevo, and arranged for a trusted community contact to pick it up and drop it at the health outpost there until somebody came through heading up to La Sabana that could take it with them. We do our best to be discreet with the packaging so it isn’t obvious that there is anything of value inside, but I can’t say with any certainty that the letter and travel money got to her. Hopefully she got it, and hopefully she went to hospital and has been seen, but we won’t find out until our next clinic there. Same goes for the woman I saw there with a hernia.

The little boy who got hit by the horse, we saw later that second night while we were in clinic and he seemed still a bit concussed, if you get what I mean. I have no idea if he is still post concussive, normal, or suffering from debilitating headaches.

There was one patient I had in Bisira, a 15 year old girl with concerning neurological signs, who I think might have some kind of brain tumour. I made a lot of phone calls to get her an appointment in the David children’s hospital which is a decent trek away. I managed to get one for her within the month. I sent a letter and cash in the bundle up the river to her with all the instructions on how to get there, where to go, and what to do. Three weeks later, on the day of the appointment I got a whatsapp from the clinic secretary that she never turned up. I can’t know if she didn’t turn up because she got lost on the way, didn’t get the letter, used the money for something else, or fell off a cliff. The other lady I saw in Bisira with the strange gait and neurological findings that agreed to be recorded could have potentially gotten better and seen all of that resolve on her anti-epileptic medications, but again I have no way to know. Potentially she could be seizure free but no better.

Our girl who came back in the boat from Ensenada, the 16 year old which I thought was on the verge of sepsis, who was discharged from Bocas and then sent to Changuinola did have something wrong with her, and I did hear from her again, but we will get to that in due time (no spoilers). The other girl in that community that I think has a toxic fetus told me she would travel to Bocas that same Friday, and I hope she didn’t lose her baby, but I don’t know. If I had to guess I’d probably say its 50/50 that she might have lost the pregnancy.

Every patient that got creams for a rash, Nexium for gastritis, Vitamins to treat anemia, or a combination of painkillers for joint pain would remain to me unknown since I’d be leaving before we circled back. Someday I will see some of them again when I do my second tour. I really hope I get the chance. Furthermore, as our budget tightened, we didn’t have the funds to even send money for transport anymore, and the likelihood that people would attend the services we direct them to was also getting smaller. A hard pill to swallow, but that’s part of the gig.

The only patient I have kept up with is our lady with anemia who crashed on me, because she lives 5 minutes from the base in Valle Escondido. Her daughter came by that Saturday to tell us that she had been diagnosed with Cancer, and that they would be meeting with a specialist on the matter within the week. I have the feeling I will see her again, she was a lucky one with us so close. It always puts things into perspective when you hear news like that. There’s not much that you can do except for offering support. A lot of people don’t know what to say, which is completely normal. What they don’t realise is that nothing has to be said at all. All you have to do is reach out and listen.

On Friday after our Valle Escondido clinic, Nicole was finally a free woman, and it coincided perfectly with Chrys’s birthday celebration. A cake was made and hidden in the oven over night. This was to hide the cake primarily, but also turned out to be the perfect protective device from another danger: the base Kinkajou, which is like a cross between a raccoon and a lemur, was on the loose.

His name was Max, he ate a papaya a day, and chilled in his cage which was situated below the stairs on the way up to the dining room. A nocturnal animal, he’d sleep all day and make noises at night, which once or twice caught me by surprise when I was still in isolation. He was the base pet, who had initially been rescued as a munchkin from circumstances that I don’t know the details of. That Thursday, remodelling work was begun on the stairs, and he was put into one of the rooms of the bunkhouse. He was a wild animal at heart, despite his pseudo-domestication, and found a way to bust out of his containment during the night. When I was walking up the stairs on Friday morning, he stepped into my line of sight and we locked eyes. He was a friendly little guy, at least to me, and in no time at all he was at my feet licking my toes. I reached out to pet him, and he held on to my arm like a little branch as I scratched his peanut butter fur.

That night after work, we celebrated with cake and went into town for drinks, which was still public health approved because of impressively low numbers of covid in the islands. Like so many of us, I forgot what it was like to go out, and we had a gay old time. I met an uncle and half dozen cousins of our staff, a pair of Dutch girls, one or two gringos, and Marlon’s children. Passionfruit margaritas were on special, and it only took a few to get me singing. I didn’t sing alone however, and along with the margaritas there was fried calamari and plantain chips to keep my stomach full and prevent me from acting a bollox. I learned that one of our volunteers on base was a former professional country singer in 1980s Texas, spoke with our captains about their relationship with the Ocean, talked to a coder about the importance of front end and back end languages, and found out that I was having drinks with a descendent of Rembrandt (who it turns out might have actually been a huge jerk). It’s incredible to me how much human interaction just provides the spice of life. It is the coal that lights my furnace.

That night we got back to base and the celebration continued with our select few, only for a time however, until I retired to bed with the moon in view. In my room I found there were ashes from my chitra incense in the shape of tiny footprints all over the desk and my computer, no doubt the work of Max. After I went to sleep I missed the real party. It turns out that Max, the clever devil that he is, busted out of the bunkhouse again and again throughout the night. He wedged himself through wooden panels in one room, ate through the mesh above the door inside another, and was a general menace to keep locked down. At this point the details of what happened next remain contested, as there was a lot of inebriation amongst the parties involved, but the fact are outlined as such:

The kinkajou broke into Jack’s room, potentially hyped up after having eaten a solid rock of cacao, and bit him in the leg six times. Apparently this caused a huge ruckus, waking everybody up except for me as Jack went toe to toe in a bout of fisticuffs with the honey bear in his casita. There was medical intervention at 1am, bandaging, and antibiotics all involved in the fallout. The aftermath of his reign of terror is still being uncovered as we speak. Now two weeks later, I just realised an hour ago that he bit through the side my pepto bismol bottle right here in my room.

At the very least his bowels are probably feeling nice.