Dr Noemi Welsch / Specialty Registrar, Obstetrics & Gynaecology / Rottweil, Germany
From hammocks, mosquitoes, and beaches in paradise, to health care and humanitarian work in the jungles of Panama. Noemi is a physician specialising in gynaecology and obstetrics. She has an interest in mountain and expedition medicine following successful completion of both Diploma in Mountain Medicine and Masters in Extreme Medicine. Her passion lies in providing humanitarian care in remote and rural environments. Noemi is especially keen to advocate for women’s health, and in this article describes her work with Floating Doctors in August 2023.
Why Humanitarian Work? And Why Floating Doctors?
Choosing to engage in humanitarian work is not a decision to be taken lightly; it is a deeply personal choice that requires careful consideration. You must recognise the responsibility it entails, as well as your own abilities and the potential challenges you may face.
Finding the right organisation that aligns with your values can be a complex task and demands thorough research. Ultimately, I chose to work with Floating Doctors. This organisation provides community-based healthcare to rural, indigenous communities, where issues such as women’s and maternal health are particularly significant.
About Floating Doctors
The foundation for Floating Doctors’ mission was laid in 2010 during the massive earthquake in Haiti. Floating Doctors travelled there in the converted aid ship Southern Wind with 20,000 pounds of medical relief supplies.
Since 2011, Floating Doctors in Panama has been working to build and establish a permanent, sustainable programme for rural health services and community development aid in Panama. The programme covers a large part of the many small islands of Bocas del Toro, some of the more remote rural areas and is often the only medical, veterinary, or dental help within a radius of several kilometres. The Floating Doctors mission is “To reduce the present and future burden of disease in the developing world, and to improve healthcare delivery worldwide.”
For more information about Floating Doctors, see here.
What to expect upon arriving in Bocas del Toro and at the Floating Doctors Base
From Bocas del Toro, a boat transports all the volunteers to the Floating Doctors Base on Cristóbal Island. I arrived on a Sunday accompanied by six other volunteers. After settling into our rooms and receiving a brief introduction we gathered for dinner. During the meal everyone introduced themselves, both volunteers and permanent staff. The atmosphere at the Base was warm and welcoming, which immediately created a positive vibe. The volunteers came from diverse backgrounds, including doctors, dentists, veterinarians, physiotherapists, and nurses, as well as non-medical volunteers who assist with logistics and the general upkeep of the Base. People had travelled from all over the world.
Life on the Floating Doctors Base
The Base is powered by solar energy. There is a volunteer house where all the volunteers sleep, usually in bunk beds, with rooms accommodating up to four people. During my stay however, each volunteer had their own room. The number of volunteers fluctuates regularly. Mosquito nets and fans are provided for comfort. There is also a large washhouse with showers and toilets, as well as smaller cabins by the seaside for the permanent staff. The central communal building houses the kitchen, dining area, pharmacy and there is also a small meeting room available for general use. Three meals are served each day on weekdays and the food is always delicious. In your free time you can play volleyball, enjoy the surrounding sea, go snorkeling or try fishing. You can also experience the stunning bioluminescence in the water and gaze at the breathtaking stars in the sky.
Days at Clinics
Every day after breakfast, the cayuco (a traditional boat) is loaded with all the necessary equipment for the clinics. Everyone pitches in to help carry everything. Clinic weeks are organised into single-day and multi-day clinics.
Single-day clinic from Tuesday to Thursday
Monday serves as an introduction day, providing time to prepare for the clinic days ahead. From Tuesday to Thursday, we load the boat in the mornings and travel to the community. Once there, we set up the clinic and treat patients throughout the day. Around 4:00-4:30 p.m., everything is packed up, the cayuco is loaded, and we return to the Floating Doctors Base where we primarily sleep.
Multi-day clinic from Monday to Thursday
For communities that are further away, where a return trip within a day isn’t possible, a multi-day clinic is organised and we stay on-site overnight. These communities are typically large, with the number of patients exceeding the capacity of a single day, so treatment is spread over several days. During a multi-day clinic, volunteers sleep in hammocks within the community, and local residents cook for us.
Depending on your proficiency in Spanish, you will be assigned a translator from the Floating Doctors team. The team makeup changes daily, which allows you to get to know a broad range of colleagues quickly. An additional table is set up for nurses during clinics to record the vital signs of all patients, which may also include tests such as pregnancy or blood sugar measurements if necessary. Dentists, veterinarians, and physiotherapists usually work in separate areas with their patients when possible. Each community is generally visited by the Floating Doctors team approximately every three months.
Common illnesses and presentations
The most common conditions we encountered included fever, worms, scabies, various rashes, coughs, hypertension, diabetes, cataracts, musculoskeletal pain, headaches, dehydration and contraceptive injections. We also saw rarer conditions, such as leishmaniasis and a cheek abscess.
In general all doctors work as general practitioners, though they also treat patients related to their specialties. Given my training in obstetrics and gynaecology, I primarily cared for pregnant women and women with gynaecological concerns. Whenever questions arose regarding unclear or complex medical cases during the clinic, we could always refer to the treatment guidelines to determine the best course of action according to Floating Doctors’ standards. If needed, we could also seek advice from the Lead Medical Provider.
Special Cases
Case 1:
A little girl, around 10 years old, came to us saying that something was stuck in her ear and moving. She was so frightened that she could barely allow us to examine her. After gathering her courage, we used an otoscope and discovered a cockroach in her ear canal, which was moving but stuck. We couldn’t reach it with forceps, and the girl was too afraid to let us use them, so our Plan B was to apply coconut oil overnight to help the cockroach “slip out.”
We offered the family the option to return the following day if the condition hadn’t improved. Since the family didn’t return, we assumed the cockroach had eventually made its way out of the ear.
Case 2:
A 19-year-old pregnant woman came to our clinic. It was her first pregnancy, and she had never had a prenatal check-up. She planned to give birth at home, as is common in these communities. She reported that she could barely feel the baby moving. Given the size of her abdomen, it was clear the pregnancy was quite advanced. At that moment, the ultrasound machine was broken, and we had no ear trumpet with us, so we couldn’t check the baby’s heartbeat. After further examination and calculating her due date, we realised she was already 21 days overdue.
From a medical standpoint, it was evident that she needed to be hospitalised immediately. However, as is common in these communities, the inhabitants were very poor, and the boat ride to the mainland was prohibitively expensive. As a result, the young woman initially refused to go to a hospital. After lengthy discussions and a lot of persuasion, we were finally able to convince her to take a boat to the mainland and seek medical care at a clinic as soon as possible.
The uncertainty about whether the birth went well or whether complications arose—potentially with serious consequences—is one of the most challenging aspects of humanitarian work. It is a concern for every medical professional dedicated to helping those in need.
In a humanitarian setting diagnostic and treatment options, as well as available equipment, are often very limited. You can only provide the best advice and care possible with the resources at hand. Ultimately, it is up to the patients whether they follow the recommendations or not. Since we only visit the same community every few months, we must wait to find out if the patients followed our advice or treatment plans.
Fridays and Weekends
On Fridays, the pharmacy is thoroughly checked, and medicines are restocked, including all long term medications for patients with long-term conditions who will be seen the following week. Every Friday at 2:30 p.m., the boat to Bocas del Toro departs, allowing all volunteers to enjoy a well-deserved weekend in and around Bocas Town.
There is much to explore in and around Bocas del Toro. While Bocas itself is known as one of the most famous party destinations in Central America, the natural beauty of the islands and the surrounding smaller islands is equally stunning. Whether you’re looking to surf, snorkel, dive, or simply relax on a Caribbean beach, there’s something for everyone to enjoy.
When is the best time in your training or career to work with Floating Doctors?
While there are no minimum requirements, it is recommended to have at least two years of experience working in a hospital. I also found it very helpful to have completed a humanitarian aid course from World Extreme Medicine, which provided valuable insights and preparation for the challenges of working in a humanitarian setting.
What preparation is necessary?
The organisation provides excellent preparation. You will receive online access to all treatment guidelines and standards, as well as tips on how to reach the remote base and a list of essentials for both the base and the clinic.
Tips and tricks on what you should definitely bring with you:
- Crocs
- Coconut oil for the sandflies (‘chitras’)
- Mosquito repellent
- Anti-itch cream
- Snorkelling equipment
- Water bottle and lunchbox
- Power bank
- Hat, sunglasses
- Sun cream
- Raincoat
- Drysack for boat rides to the communities
Is it possible to work with Floating Doctors in the long term or to help as a non-medical practitioner?
Yes. It is possible to take on a long-term position of 6 months or more, either as part of a fellowship or in a non-medical role at the base. There are several positions you can apply for, including:
- Volunteer Coordinator
- Facilities Manager
- Medical Director
- Lead Allied Healthcare Provider
- Lead Medical Provider
- Operations Manager
- Lead Veterinary Provider
- Health Education Coordinator
- Communications Coordinator
- Lead Dental Provider
- Pharmacy Manager
- Dental Coordinator
- Clinic Manager
- Base Supervisor
- Executive Director
Further details and requirements can be found here.
What is the application process for volunteering with Floating Doctors?
The application process was straightforward and completed directly on their website here. Within a few hours, I received a welcoming response from the organisation confirming my acceptance.
For physician applications, the following documents were required:
- A copy of the licence to practise medicine
- A copy of the certificate of graduation
- A background check with information on criminal history or child protective investigations
- A coloured passport photo
- A copy of a curriculum vitae
- Proof of vaccination against COVID-19
- Distribution Fee for Volunteers depending on the term of the stay
Is there any way to help without volunteering?
Yes! There is always the possibility to donate here.
My experience – would I recommend it?
Working with Floating Doctors was an unforgettable experience. The combination of beautiful Caribbean islands, incredible people, and the chance to provide medical care and support to local communities made it a truly enriching journey. While there were challenging emotional moments and encounters with patients facing serious health issues, there were also many rewarding treatments and individuals who left the clinic in better health. It was deeply moving to experience life alongside the locals, who welcomed me with open arms and warmth. This experience has been invaluable, and I would gladly work with Floating Doctors again in the future.
