Of the 8 indigenous tribes living in the rural regions of Panama, the largest is the Ngöbe–Buglé comarca accounting for over half the nations indigenous population and almost 6% of the entire population of Panama.
The Ngöbe-Buglé live in the remote island and mainland communities of the Bocas Del Toro province making access to healthcare facilities extremely difficult. Figures from the national institute of statistics and census for Panama in 2016 states there are just 92 healthcare facilities for the entire population of over 200,000. There are ten Centro de Saluds, small community clinics with a varying range of available medicines, however they are frequently without the ability to do blood tests or provide oxygen. There are no hospitals available for the region and the remaining 82 facilities are sub-health posts.
Whilst Panama as a nation is enjoying improving access to clean water, there is currently 96% coverage nationally, the rural areas have only 50% coverage of improved water systems. This disparity continues when evaluating access to healthcare and those living in rural areas are disadvantaged and vulnerable. Over 90% of all reported malaria cases originated in indigenous regions and maternal mortality is almost 4 times higher in rural areas than in urban communities.
“poverty among Latin America’s indigenous 10 populations is pervasive and severe…indigenous populations suffer abysmal living conditions and severe health problems, and educational attainment is strongly correlated both with indigenous origins and with poverty…” 2
Disparities in life expectancy between urban and rural areas add further evidence that these communities are marginalised. Nationally in 2009, men could expect to live 73.2 years at birth and women 78.5 years. These figures decrease by almost 10 years when looking specifically at the Comarcas who could expect to live between 66.2 – 68.6 years.
Inequalities are not only seen when evaluating healthcare, education literacy rates being much higher in the general population than in the indigenous communities. 12.1% of the population of the Bocas Del Toro province, home to the Ngöbe–Buglé comarca are illiterate compared to a national percentage of only 5.4%.
The main means of accessing healthcare facilities in the indigenous communities is at the mobile clinics run by the US based NGO ‘floating doctors’ or the 3 monthly clinics held by MINSA, free health care clinics delivered nationally by the ministry of health of Panama.
Floating Doctors implemented their first permanent community program in the Bocas Del Toro province of Panama in 2011. They deliver mobile health clinics to over 24 communities in the Bocas Del Toro province and the Ngöbe–Buglé comarca treating a huge range of diseases such as leishmaniasis, scabies, helminthiasis and more typical non-communicable diseases; hypertension and diabetes. Whilst circulatory disease and neoplasms are the leading causes of death nationally, infectious and parasitic disease remain the leading causes of death in the communities served by Floating Doctors who display the greatest incidence of tuberculosis nationally.
A huge part of the clinics is maternal healthcare. The Bocas Del Toro province has a birthrate of 33.4 per 1,000 population, almost double the national figure. In 2009, only 61.3% of births were attended by a healthcare professional in the Ngöbe–Buglé comarca a stark contrast to the 99.9% in urban Panama. This disparity is highlighted when assessing infant mortality, which is at 26.6 per 1000 live births in Bocas Del Toro province, more than double the national rate.
A family planning survey carried out by floating doctors staff and volunteers found the average age of first pregnancy was 16.3 years yet the age at which women reported as ideal to have their first child was 21.5. Women of the Ngöbe–Buglé comarca often fall into a secondary role, the man decides how many children they are to have and their role is usually limited to reproduction. Floating doctors has been working particularly hard to reduce the barriers to family planning services following a needs assessment carried out by Mary Longacre, a Harvard medical student in 2017.
Heading into 2019, alongside their normal clinics, floating doctors are working hard on several research projects within the Ngöbe–Buglé communities including studying the causes of blindness, child malnutrition and untreated lower urinary tract problems. If you are considering joining our crew, head over to floating doctors website for more information.
- Paho, salud en las Americas, Panama report.
- World Bank Group. World Development Report, 1992
- Panama, Contralorı´a General de la Repu´blica, Instituto Nacional de Estadı´stica y Censo 2010
- A Needs Assessment of Family Planning Within a Ngöbe–Buglé Patient Population in Bocas Del Toro, Panama. Mary Longacre, Harvard Medical School