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>.

About the School Fund

Few for Change + The School Fund = Awesome!

We at Few for Change are especially excited about our partnership with the School Fund because it provides our current supporters with an even more transparent and interactive connection with our scholars, while also expanding our reach through the School Fund’s broad network of partners and supporters.  Our donors can now choose to sponsor a student directly through our page the School Fund site, or the give to our general fund, helping expand our scholarship fund and add new students to our program.  To check out our page on the School Fund’s website or sponsor a student visit www.theschoolfund.org/fewforchange.

Rubiela Carpintero -          

 Hello, I’m Rubiela Carpintero.
I’m writing to you from [Quebrada] Guabo.   I am only in middle school and I am studying, and I am going to continue, for my future. I would like to be a knowledgeable person in order to teach and explain to other people that are uneducated.

I like to study a lot, but I don’t have a lot of money.  But with what Few for Change gives me, I spend on copies for exams and for my school supplies.  I am very thankful for what you have given me.  My dream is to be a professional.
May God bless you.

Aquilino Andrades Santos -                                                                                                                             

My name is Aquilino Andrades Santos.  I want to keep studying because, for me, studying is the most important thing for a student to do.  We should try hard.  As a student, I want to keep studying, but I have a problem which is that I don’t always have a way to get to school and when I do, it is thanks to the Few for Change scholarship.  Because of that, I don’t want to stop studying, but sometimes my classes are very difficult because the teachers explain things very fast and sometimes they don’t explain how to do things well.  Because of this, some students fail some of their classes.

I am very thankful to have had the opportunity to have this scholarship.  It is the reason why I don’t want to lose my studies. Without education, we are nothing and can have nothing and I tell my classmates and friends that they should keep studying because they could also benefit from this program.
These are my thoughts.
Thank you very much.

Analida Esther Palacio -

 My name is Analida Esther Palacio and I love to study and I want to prepare myself so that I can be a professional someday.  I thank you for the help that you have given me to reach my goals.

My dream is that when I graduate I will be a teacher so I can educate children so that they can learn as well and so I can help my family.  Thank you all for giving me this scholarship and I will try to get good grades, and one day be a teacher.  When I finished sixth grade, my average was 48 (out of 50) and my mother loved that and she talked with my teacher and my teacher spoke with Few for Change and then your help came and I took advantage and studied hard.

Lorena Carpintero -

I am thankful for the help that you have given me.  Last year and this year I have begun my studies.
I am happy for this help, which for me is enough.  I hope that, with God’s help, you will be able to continue supporting us.

Hello to everyone, even though I don’t know who you are, but I have faith that I will meet you someday.  I promise you that I will keep going and with God’s help I will finish my studies.
Thank you very much and may God keep you safe.
Greetings to all.  I am doing well in school.

Odilio Sire Palacio -

For the Organization Few for Change (in English)

I wish to congratulate this organization for demonstrating values and I have to say that I feel very happy and thankful for the help that you have given me.  Thanks to Few for Change, I have been able to attend secondary school.  I am proud of this organization and may God bless you.

 Olivia Gonzalez -

I thank you for your support in the “Comarca” and I hope that you can continue supporting me because I want to keep studying because I want to be educated so that I can be someone.
Thank you for supporting me and my family and I hope that you will continue supporting me.

As the only Few for Change member who had never been to the Comarca, I always felt like I was missing a crucial part of the experience.  While my final research project in Panama focused on education and I am a firm believer in education as a method for fighting poverty, I still felt like I couldn’t quite relate to our scholars and to the Comarca in the same way that the rest of the organization could.  I was inspired by what I had read in the students’ applications and was moved to help these young leaders receive an education, but I had no faces to put to the communities that I heard the rest of the Few for Change team talk about.

Arriving at the Comarca, not an easy task

When I found out I would be traveling to Panama on a family vacation this summer with my mom and brother, I decided I had to visit the Comarca.  Few for Change Co-Director Gillian Locascio met us in San Felix and was our very gracious host for the day that we spent there, bringing us all the way into her community, Rincon.  Rincon is a small community about an hour truck ride and then a two hour walk from Quebrada Guabo, the border town at the edge of the Comarca.  Beginning with the transportation, the lack of infrastructure was one thing that really shocked me.  I had heard about this in our team meetings, but I guess I had to see it for myself before I could fully understand.  There are roads that run as far in as Rincon, but there are very few cars that pass that way, and there are many communities farther in that have even less transportation available.  Health services also become more limited as you move inward, with some centrally located health centers and then smaller health posts that are generally staffed by one person that often lack even the simplest supplies.  When I was in Rincon, the health station there had recently run out of bandaids.

Barriers to education: learning on an empty stomach

“I’m not sure if I would have made it through middle or high school if I had to fight as hard as these kids to get an education. ”

Along our journey, we saw many different groups of children walking to or from school.  Those who are lucky enough to live near a school may have a short walk, but some of them have to walk up to three hours to get to school every day.  Gillian explained to us that they walk three hours, and once they get there, the school does not provide them with lunch so they have to walk back three hours without eating anything all day.  Sometimes they get sent back home if they don’t have the “proper” uniform on, which could mean something as small as wearing the wrong sock.  I had always taken my education for granted; even after high school it was just assumed that I would continue on to college, and that my family would make sure there was a way for this to happen.  I’m not sure if I would have made it through middle or high school if I had to fight as hard as these kids to get an education.

Determination in spite of “red tape”

Since leaving the Comarca, I have been thinking a lot about different types of poverty.  Last summer, I worked in some very poor communities in Nicaragua.  At first glance, these communities were far worse off than Rincon and the other communities we drove through in the Comarca.  Their houses were made out of plastic and cardboard instead of wood or cement.  They often did not have enough food to eat, whereas the Ngobe grow a lot of their food and thus appear to have more.  They were, however, situated close to larger cities, and therefore had the advantage of being closer to water systems, health centers, transportation and schools.  One thing they had in common, however, was the extreme ability to take initiative.  I saw this in communities in Nicaragua, but I was still very impressed by the level of initiative in the Comarca.  Gillian talked a lot about work parties and how the community would come together on a given day to get a job done, knowing that it would be easier with more people.  These work parties seemed to be the norm for anything ranging from building a house to clearing land to building ponds to raise fish.  Another thing I found shocking was the number of community projects that had been killed by bureaucratic problems and “red tape”.  There was a latrine building project that was in line to be funded but the materials never showed up.  There were multiple projects that were shot down because the community’s proposal did not fit the exact requirements for the grant, often a result of guidelines that were absurdly specific and not at all realistic, such as building using certain materials that are not readily available in the Comarca.  There was a road that was built so children could get to school more easily, but the government awarded the project to the lowest bidder, who then built a road that eroded a lot of the land and became almost unusable during the rainy season.

Commitment to education, despite the odds

“[The students'] commitment to education despite all the odds is absolutely amazing…”

As discouraging as all of this is, the people of the Comarca haven’t given up.  This level of determination that I saw in the adults is the same determination that keeps our scholars going to school, despite their lack of transportation and funds.  Their commitment to education despite all the odds is absolutely amazing, and is something that I greatly admire.  I knew that the work of Few for Change was important before my trip, but it took a 2,000 mile flight, a 6 hour drive across Panama, an hour truck ride and a two hour walk for me to realize just how important it truly is.