Ngäbe-Buglé Comarca’s Challenges | Health / Medical Assistance: Part 5



🙃 Get up to a 60% DISCOUNT OFF ONLINE PRIVATE LESSONS or up to a 40% OFF ONLINE GROUP LESSONS when you submit your payment by TUESDAY AUGUST 31ST

Or find out more about ONLINE SPANISH LESSONS HERE...

JUMP TO blog post titled:
"Ngäbe-Buglé Comarca’s Challenges | Health / Medical Assistance: Part 5".

Search our blog about all things Panama! From must dos, where to party or eat, to which beaches and hiking trails you shouldn't miss, in our blog you'll find great insider info about Bocas del Toro, Panama City and Boquete, as well as Panamanian culture, customs and traditions, and certainly tips and advice for learning Spanish! We've been writing about all things Panama for over 15 years and nothing beats local knowledge from the locals themselves.


🙃 Get up to a 60% DISCOUNT OFF ONLINE PRIVATE LESSONS or up to a 40% OFF ONLINE GROUP LESSONS when you submit your payment by TUESDAY AUGUST 31ST

Or find out more about ONLINE SPANISH LESSONS HERE...

🦠 Due to the COVID-19 Pandemic we're currently only offering ✅ Online Spanish Lessons and ✅ Spanish classes in a TRAVELING CLASSROOM instead of at the school, delivering a teacher directly to you in a COVID safe way wherever you are, be it your hotel, home, park, on tour, at the beach or in any other place where social distancing is comfortably and safely possible. CONTACT US TODAY!


🚨 On October 7th 2020 we declared a CLIMATE AND ECOLOGICAL EMERGENCY because we're facing an 😱 existential threat as Planet Earth is on track for a 🌡4°C increase in average global temperatures by the end of this century, which means 💀 BILLIONS OF HUMANS DYING along the way if we don't CHANGE COURSE NOW!


🤔 So instead of 🛫 flying to learn Spanish 🛬 — it's not really essential travel, specially in the midst of the ongoing 😷 COVID-19 PANDEMIC — pumping even more C02 into the atmosphere that will end up crashing our common home, impacting countries in the tropics first, 🎧 LEARN SPANISH ONLINE 💻 from the comfort, convenience and safety of your office or home!

📍 If you do find yourself in the vicinity of any of our locations — 🌄 Boquete, ⛱ Bocas del Toro and 🌇 Panama City — we'd love to have your as our student. CONTACT US AND MAKE IT HAPPEN...
Travel to us in eco-friendly ways and get automatic access to a 👯 50% DISCOUNT!!!

🚦 Now... do you want to do something about the Climate and Ecological Crisis?

🙏 And finally one last plea to help us ensure a just transition for our staff and Spanish teachers: please don't fly to learn Spanish because you can do it online without destroying our future as there's no Planet B regardless of what Elon Musk wants you to believe; besides dreaming of Mars, he also wants you to buy electrical cars as if that's the solution to this Planetary Crisis... spoiler alert: it's not!


Ngäbe-Buglé Comarca’s Challenges | Health / Medical Assistance: Part 5

Posted by |

This is the fifth and last of a 5-part series about the biggest problems in the Comarca Ngäbe-Buglé and how they are being addressed. You can click here to see the 1st part here about Physical Infrastructure, here for the 2nd part about Social Problems, here for the 3rd part about Education or here for the 4th part about Labor and Work.

The top 5 challenges currently facing the Comarca Ngäbe-Buglé are:

  1. Physical Infrastructure
  2. Social Problems
  3. Education
  4. Labor/Work
  5. Health/Medical Assistance

Today we will cover Problem #5: Health / Medical Assistance.

The biggest health threat to the Ngäbes is the lack of clean water supply. Contaminated water (typically by fecal contamination either by animals or humans) causes deadly intestinal problems, especially in babies and children. 10.3% of all deaths in the Comarca in 2012 were caused by diarrhea and gastroenteritis caused by infections (2nd most common reason for death behind “Accidents/Suicides/Homicides/Violence”).

Providing clean water systems to communities is not difficult, especially in communities where there are already sufficient water sources (plenty of rainforests in Panama), but unfortunately the Ministry of Health of Panama (MINSA) has gone about it the wrong way.

Typically MINSA is called to a community after much pleading with district representatives. Depending on the project, either MINSA staff or a contracted civil engineering company go to the community, do their job (build a tank, lay tubing, etc.), show one or two community members how things work, and then leave.

Indigenous boy standing by aqueduct
Indigenous boy standing by aqueduct.

Great, the community has water! But how will it be managed? Who is responsible (and trained) for the ongoing maintenance? What happens if something breaks or the water stops running?

The community has to appeal to their representative (the local authority elected by the community), who has to go through bureaucratic hoops to finally get a MINSA engineer to return to fix the problem. Maybe the solution will be explained to the community members so that they could fix it themselves in the future, or maybe not. Or maybe the problem will be so bad that it can’t be fixed and they have to start all over again (because the first system wasn’t built well for whatever reason), meaning maybe a year or five later they will get a new system.

Men laying tubes for water system
Men laying tubes for water system.

This is a BAD way to solve a problem. A better plan would be to work with the community and survey the land and the community members to develop a system that works for the community. Then form a group of dedicated community members who will be responsible for maintenance of the system and general administration in the community (collecting dues, etc.). This community group will work with the engineers to build the system to understand how it works. Then when the engineers leave, the community will be much better equipped to manage the system themselves and will only call MINSA in dire emergencies. MINSA should ideally check up with the community annually to check the system and answer any questions that the community has.

Girl washing dishes at the only water outlet in her community.
Girl washing dishes at the only water outlet in her community..

It really boggles my mind that an important government agency is run so backwards. Of course my proposal has a notably longer project duration on the front end, but clearly better long-term benefits for the community and the agency.

The other preventable health threat is hygiene, which leads to fecal contamination, diarrhea, and sometimes death. Believe it or not, some communities in the Comarca still do not have latrines or any proper sewage system. Of course this should be a priority of MINSA (the Ministry of Health) to work with the communities to build latrines and teach them how to use and care for them.

After seeing a Latrine in person, I've promised to never give a normal toilet for granted again.
Little shop in La Comarca.

But even for the communities that do have latrines, hygiene is not practiced. Hand-washing with soap is extremely rare simply because of lack of education and lack of money to purchase soap. MINSA should also be leading the way in hygiene education.

There is also the issue of medical facilities. There is one hospital in the Comarca (technically located just outside of the border). The hospital has 40 beds and admitted 2,081 patients in 2012. There were 16,211 emergency cases reported for that year, and 18,854 total consultations. The hospital has a variety of basic services, including general medicine, nursing, laboratory, pharmaceutical and some other technicians. It provides care in the categories of promotion of health, prevention of illness, diagnostic and treatment (through x-ray, laboratory and pharmacy). The hospital’s emergency clinic is open 24 hours a day.

Yep. Only 1 hospital in this area spanning from Panama's Pacific to the Caribbean.
Yep. Only 1 hospital in this area spanning from Panama's Pacific to the Caribbean.

There is a Health Center in every district in the Comarca (9 with beds, 1 without beds), servicing a total of around 35,000 people directly, which is about 18.42% of the total Comarca population (the people who live in these towns and don’t have to travel far). These 10 Health Centers have a total of 60 beds and admitted 1,832 patients in 2012. They have almost the same capabilities of the Hospital, but with more specialists in obstetrics/gynecology and pediatrics. Also, they are not open 24 hours/day.

Subcentro de Salud in Chichica
Subcentro de Salud in Chichica.

Additionally, there are Health Posts in smaller towns scattered throughout the Comarca to give immediate help to the locals. There are 83 functioning Health Posts in the Comarca. A trained medical assistant is stationed at each Health Post and they give first aid, promote health and prevention of illness. They have basic equipment and medicine, distributed from the closest Health Center.

This is clearly an indication of something wrong, since less than 20% of the inhabitants of the Comarca have access to a proper clinic (the Health Post is not a proper clinic, it’s more like a very small pharmacy). Also, taking a look at the reality of these clinics, the biggest problem is that they are under-supplied, especially with medicines, and many are dilapidated due to disrepair. As in the Education sector, the newer nurses and doctors are sent to these posts, which bring about all the problems previously noted in the Education section of this series.

Puesto de Salud in Cayo Paloma (Comarca)
Puesto de Salud in Cayo Paloma (Comarca).

As I mentioned before, the infrastructure in the Comarca is bad. This makes it extremely difficult for very sick people to make it to a doctor. Additionally, pregnant women are at a huge disadvantage during labor. In 2012, only 56.8% of babies were born with professional help and 24.3% of births were in a medical facility. Life expectancy at birth was 69.33% in 2012. The infant mortality rate for that year was 17.9 per every 1,000 births. The leading cause of infant death was from problems that originated in the perinatal period (19.3% of all deaths of infants 1 year and younger).

Ngobe baby being bathed.
Ngobe baby being bathed.

Last but not least is the issue of health in regards to their diet. The Comarca stretches from the plains on the Pacific side to mountains in the center and down to the beaches at the Caribbean Sea. The terrain goes from thick jungle and mangroves on the coast to coniferous forest in the high mountain climates and out to grasslands at the southern border. The mountains are very rocky and difficult to farm. The tropical jungle climate is not good for farming vegetables and grains. With limited access to markets outside of their community and very little cash or credit, their diet mainly consists of what they can produce locally. The staple foods are (this varies by region): green bananas, plantains, starchy vegetables such as yucca and ñame, corn, rice (usually bought), and eggs. Coastal communities cook often with coconut milk. Clearly this is not a balanced diet full of vitamins, minerals and proteins.

Ngobe in farm within la Comarca

Through all of the problems, there are a few lights at the end of the tunnel.

The former First Lady of Panamá, Marta Linares de Martinelli, made a special effort to increase maternal health and labor. She created a unit called “Early Childhood Development” which coordinates projects through the Health Ministry, Education Ministry, Social Development Ministry, NGOs and the private sector. In 2012, they completed the construction of 4 maternal clinics in the Comarca Ngäbe-Buglé to promote maternal health and provide better services to pregnant women and infants.

Ngobes in front of Centro de Salud

This unit also supports Nutre Hogar, an NGO, which has a project in the Comarca to promote family gardens. Currently over 600 families have received kits with basic gardening tools, seeds, and agricultural training from local organizations. This project has been very successful, as the families are eating much healthier and are able to sell their extra produce locally.

The “Early Childhood Development” unit and Nutre Hogar collaborated to bring medical personnel to a community in the Comarca in April 2012 to specifically focus on checkups for children under the age of 6. They also gave full medical exams to women, including EKGs, pap smears, injections (birth control), and health/diet advice. They also gifted items such as baskets, blankets, toiletry items, shoes, jackets, food and other things. Temporary help is appreciated, but can only do so much good since it is temporary.

Ngobes in front of Centro de Salud

Patronato de Nutrición is another NGO which promotes community gardens for healthier choices within the local families and also for income production. They have multiple projects in the Comarca.

An important new force in the health arena in the Comarca is the NGO Floating Doctors based out of Bocas del Toro, Panamá. It is a group of volunteer doctors from around the world who travel around in their sailboat offering medical assistance. They realized the great medical need in the Comarca Ngäbe-Buglé and now coordinate monthly trips to villages on the coastal side of the Comarca to provide medical checkups. They just recently finished their first remote medical outpost in the Comarca where they will be able to give care in a private environment on a more frequent basis.

Floating Doctor's Playa Verde outpost
Floating Doctor's Playa Verde outpost

Last but not least, a group of religious-affiliated people from the United States formed an NGO called Faithful Servant Missions and in 2007 they built an orphanage and community center in an area outside of the Comarca where many Ngäbes travel to work each year. They also provide food monthly for 40 indigenous families in the area.



BE THE FIRST to get updates about Contests, News and Discounts!

Search our blog if you're visiting Panama! From must do's, where to party or eat, to which beaches and hiking trails you shouldn't miss, you'll find great insider info about Bocas del Toro, Panama City and Boquete, as well as Panamanian culture, customs and traditions, and certainly tips and advice for learning Spanish while in our country! We've been writing about all things Panama for over 10 years and nothing beats local knowledge from the locals themselves.

You can follow any responses to this entry through the. You can leave a response, or trackback from your own site.

About You
Your comment
Please put a check mark before hitting submit to confirm you're a human (and wait for green tick to appear).