Penonomé & Toabré

by Roy

During the week, Yami invited me to spend a day with her at her clinic, in the tiny hamlet of Toabré in the hills outside Penonome. In order for dentists and doctors to receive permission from the government to work as medical professionals in Panama, upon completion of their degree/doctorates, they must complete two years as an intern, which basically involves working for the Ministry of Health in the ‘interior’ of Panama (i.e in the country, away from Panama City). New dentists and doctors are assigned clinics in which they will work, and are provided accommodation.

Yami had been assigned accommodation in Penonomé, and assigned her first clinic in Toabré. In order to get to Toabré for 7am, we left at six and took two buses. When we arrived at the clinic, the locals were already queuing outside the clinic, which served as the medical centre for the whole of the mountain region in the area.

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The clinic, although basic, served its purpose well and was certainly in demand. The patients were all indigenous people, and obviously extremely poor, the poverty being evident in the state of the teeth of the patients. Children of 7 or 8 came in to have adult teeth removed due to lack of care, and most patients over the age of 40 had very few, if any teeth at all. One lady came in for a clean of her one and only tooth, one of the middle bottom incisors. It was a funny, yet sad moment, watching Yami cleaning this single tooth.

I couldn’t believe how the people had let their teeth fall in such a bad state, but Yami explained they literally did not have any money, and buying ‘luxuries’ such as toothbrushes and toothpaste was simply not an option.

Officially, Yami and the other doctors were supposed to charge for the treatments they carried out, however in reality they didn’t charge, as the majority of the patients would have been unable to pay in any case, and probably would not have came to the clinic to receive treatment in the first place.

To get any idea of the remoteness of the clinic, and the inaccessibility of the region in which these people lived, some of them – kids of six of seven included – had walked 8 hours through the rainforest just to see a doctor or dentist, and of course they had to walk the 8 hours return journey home. A pretty tough walk, especially if you have just had two or three teeth removed.

Although only three hours from Panama City, probably the most affluent city in Central America, Toabré and the highlands of Panama are a completely different world, and the vast difference in living standards between the city and the country is both disturbing and shocking, especially considering it is a country that has a unique commodity (the canal) that generates billions of dollars per year.

Although I had seen a lot of poverty in the previous 300 or so days, I never really saw with such proximity, or interacted with people who literally have nothing, not even the money to buy a toothbrush or toothpaste. Thinking about the plight of the indigenous communities in Panama, I couldn’t decide if it was a sad reflection on the failures of the US administration in Panama, past and present governments or the distribution of wealth and resources of the country, but something was definitely amiss.

On a plus note, after Yami had seen all her patients for the day, she gave my teeth the once-over and a clean! Unfortunately my camera had died on the beach in Pedasi, so I didn’t manage to get any pictures of the clinic or the locals. I do have one of Yami working, though this wasn’t taken that day!

Yami working