When I visited the Comarca Ngöbe-Buglé last summer, Few for Change Co-Director Gillian Locascio and I stopped by the health center so that she could look for a doctor she needed to see about some research she was doing. The doctor wasn’t there, but a nurse was, as were a waiting room full of women and children. My mom and I quickly used the bathroom, and also quickly discovered that there was no toilet paper or soap. This was considered a very nice facility, and one of the larger health centers. One of the great things about health care in the Comarca, however, is that it is all free of charge. This is huge for the many, many people who would be completely blocked from receiving services if they had to pay. Despite this, health status in indigenous regions of Panama is much lower than in Panama as a whole. For example, infant mortality is almost twice as high in indigenous regions than the national average. Average life expectancy is also significantly lower in indigenous regions (PAHO).1
Health posts
Health care in the Comarca is organized on four different levels. Basic care can be provided at rural health posts, where there is generally a nurse or someone with basic medical training. The level of care provided depends on the level of training of staff at each post. For example, most of the medical technicians who staff these health posts are not allowed to dispense anti-venom. This means that if someone is bitten by a poisonous snake, he or she has to travel to the nearest health center to receive treatment, which could be hours away. These hours could be the difference between life and death.
Health centers
The health centers comprise the next level of health care. These are larger hubs that are almost always staffed by one, sometimes two, doctors. The centers vary in size and services provided. For example, the one in Chamí, where Few for Change scholar Lorena Carpintero goes to school, provides dental service and has the capability to deliver babies, whereas smaller health centers might not have these services.
Hospitals
The third level of care is hospitals, which are few and far between. There is only one hospital within the Comarca; there are also somewhat nearby ones in San Felix and David to the south. David, the capital of the Chiriquí province (south of the Comarca), recently built a new children’s and maternity hospital with funding from the U.N., with great facilities and amazing care. Transportation to both the health centers and the hospitals can be difficult given the mountainous terrain of the Comarca, and the fact that those in greatest need of medical care are most likely not up to walking long distances.
Roving health care vans
Roving vans offer another type of health care service. These vans travel around the Comarca visiting schools and other community locations. Nurses and doctors from the health centers travel in these vans to give out fluoride and vaccines. These vans offer services in areas where lack of infrastructure might otherwise block health care access.
Financial barriers
The most prevalent places for health care in the Comarca are the health posts. They provide a closer resource for those who need any kind of basic care. Once a health post is built, as long as it meets government regulations, the government will staff it with personnel (or a person) and run it. The problem with this is that the actual building has to be constructed entirely with money and labor from the community and has to meet very specific government requirements. For example, health posts used to have a minimum requirement of three rooms, but the minimum numbers of rooms was just increased to five. This means that the cost of building a health post jumped from $23,000 to $45,000 per project almost overnight. One community raised all of the funds necessary to build the three room health post, but was then informed that they actually had to almost double their funding because the requirement had changed during their fundraising process.
Cultural barriers
The health posts are staffed in the same way that teachers are assigned to schools. The government assigns medical personnel to the post, and these staff can be from anywhere in Panama. Although they try to give preference to staff who live locally, people are often forced to either work far from their families or relocate their families to whatever community they are assigned. This results in a situation whereby any medical staff who do not speak Ngobere (the native language of the Ngöbe) provide care in a setting where there is no official translation. There is also rarely any orientation to bi-cultural medicine.
In a culture that is completely different even from the rest of “Panamanian” culture, there are some interesting cultural barriers to western medicine in the Comarca. Often people are used to herbal remedies and traditional medicines. When they go to a clinic, they go expecting to be given a certain treatment for a certain problem and, when presented with other medications, may complain that the clinic does not have the “right” medicine for their ailment.
When Few for Change member Tim Soo was in the Comarca, he interviewed a woman about her health practices:
I asked, “what do you do for medicine?” She replied, "The land gives us nothing.”
I tried again asking, “If your child was sick, what would you do? Where would you go?” Again she replied, “but the land gives us nothing.”
She later showed me the graves of many children she had taken care of that became sick and passed away, as there was nothing she could do. Taking care of six children at her age, her main concern was simply making sure there was some sort of food on the table. Aside from that, she had little energy left to even worry about what to do when the kids fell ill. So when I asked her about medicine, it made sense that her answer was that "the land gives [her] nothing." That was her primary concern and that was as close as she could come to worrying about medicine. It was humbling, to say the least.
Tim also talked to a curandero (a traditional healer), who explained to him the widespread prevalence of natural and herbal remedies in the Comarca. Although there was a clinic in the neighboring town, he felt that the woman he interviewed never used it and possibly didn’t even know about the availability of this clinic.
The next generation
According to Gillian, there are only 10 Ngöbe doctors. Of those ten, only 8 are actually practicing in the Comarca, while the other two have gone to work in Panamá City and the U.S. We hope that, with the educational opportunities that Few for Change provides, some of our scholars will go on to be the next generation of Ngöbe doctors.
1. "Health in the Americas: Panama." Pan American Health Organization, 2007. Web.
<http://www.paho.org/hia/archivosvol2/paisesing/Panama%20English.pdf>.
