A doctor in Panama鈥檚 jungle builds trust among Indigenous groups
| San F茅lix, Panama
Not long after C茅sar Gantes received his medical degree, he received a call from Panama鈥檚 health minister.
The government, Dr. Gantes recounts, wanted him to develop a public health network in the Ng盲be-Bugl茅 comarca, as the territory is known. It鈥檚 some 2,700 square miles of sticky-hot, mountainous terrain stretching from the Caribbean coast almost to the Pacific Ocean. Carved out in 1997, the jungle region had no formal health services, and its residents 鈥� the Indigenous Ng盲be and Bugl茅 peoples 鈥� had a reputation for resisting and distrusting outsiders.聽
Dr. Gantes had never traveled far outside his home of Panama City. In his first months in the comarca, he says, he would sit on a river dock to watch the sunset and cry, longing for his family and urban life. To add to the challenges, the region saw a rapid rise in HIV cases just a few years after he arrived. His task, especially as an outsider, felt daunting.
Why We Wrote This
A story focused onThe Ng盲be and Bugl茅 peoples in Panama have a reputation for resisting and distrusting outsiders. One doctor has made huge inroads by listening to patients and, in the process, changing the conversation around HIV.
But three decades after his long-held desire to help others led him to this hard-to-reach swath of western Panama, Dr. Gantes is nationally known for his ability to gain trust through community-building 鈥� and shifting views around HIV.
He 鈥渉as changed the conversation on HIV in Panama,鈥� says Orlando Quintero, the executive director of Probidsida, a Panama-based advocacy group or people living with HIV and AIDS.
Dr. Gantes鈥� approach has also changed the comarca, says Amanda Gabster, an epidemiology researcher at Florida State University who has worked in the Ng盲be-Bugl茅 territory since 2007. Dr. Gantes is likely one of the first here 鈥渢o focus attention on the importance of involving traditional healers, midwives, and artisans in HIV testing and treatment,鈥� she says.聽
An 鈥渦ncontrolled epidemic鈥�
On most days at the San F茅lix antiretroviral clinic, a line of patients extends from the dimly lit lobby, out through the center鈥檚 purple front door, and into the sweltering parking lot.
The men and women, mostly from the Ng盲be and Bugl茅 groups, are here to see Dr. Gantes. According to the Panama Health Ministry, of the country鈥檚 15 provinces, the territory that is home to these groups has the highest number of confirmed HIV cases per 100,000 residents in the country. In 2023, the HIV incidence rate there was double the national average, and HIV was the top cause of death among the groups鈥� young men. It was deemed an 鈥渦ncontrolled epidemic鈥� in a 2022 study.
Dr. Gantes believes several factors are behind the high rates of infection here, including a lack of sexual education.
鈥淣o one should die from HIV,鈥� he says. 鈥淲e鈥檙e trying to test every last person鈥� of the more than 210,000 people living in the Ng盲be-Bugl茅 comarca.
Dr. Gantes鈥� dedication to slowing HIV has earned him national recognition, even if there鈥檚 still a lot of work to be done.聽
鈥淚 realized early on that introducing Western medicine into a region where traditional medicine is the preferred method of treatment involved a spiritual and religious component,鈥� he says. 鈥淚nstead of focusing on the differences ... I looked for things the two [methods] had in common.鈥�
For example, he says he worked to use inclusive language that shows respect for Indigenous traditions, and he never says one approach is 鈥渞ight鈥� or better than the other.
Committed to serving
Dr. Gantes, with dark-framed glasses and neatly trimmed hair, says he spent his childhood dreaming of becoming a priest. He changed course toward the end of high school in search of a profession that would help him support his single mother in Panama City. He scored high enough on medical school entrance exams to earn a scholarship.聽
Dr. Gantes鈥� family shaped his approach to work and service. Raised primarily by his mother and grandparents in a devout Catholic household, Dr. Gantes spent time under the wing of a neighborhood priest, who organized projects in small farming communities. There he saw firsthand the impact of community development in impoverished areas.
鈥淚 felt a spiritual commitment鈥� to community-building initiatives, Dr. Gantes says.
The Ng盲be-Bugl茅 comarca is Panama鈥檚 poorest region. Even today, most residents lack basic services such as running water and electricity. For Dr. Gantes, it was a shock at first. 鈥淚 was accustomed to a lot of privileges that come with living in an urban area,鈥� he says.
But he made inroads, slowly earning patients鈥� trust. In time, he notes, 鈥淭he Ng盲be-Bugl茅 made me part of their community.鈥�
On his desk in San F茅lix, Dr. Gantes has a binder full of photos from the 1990s. There鈥檚 one of him, fresh-faced, in a wooden boat full of medical supplies on a rainforest river. Another shows him performing a checkup on an Indigenous child.
In 2001, a few years after Dr. Gantes arrived in the comarca, the first cases of HIV were detected within the Ng盲be and Bugl茅 groups. The virus spread quickly, outpacing national statistics. Dr. Gantes and his team petitioned the health ministry to open a local HIV clinic, which launched in 2009 and became the first to offer antiretroviral medication to Ng盲be and Bugl茅 patients.
Dr. Gantes often starts his day early in San F茅lix with consultations, and then travels to rural rainforest villages to deliver medication. His phone is always in hand; a seemingly never-ending flow of messages arrives 鈥� the result of giving out his number to everyone he encounters who seeks his assistance. And most nights, he heads to a local theater, where he oversees musical production.
鈥淚鈥檝e always considered music to be the best medicine for stress,鈥� he says. 鈥淚t soothes my soul after long days.鈥�
In his clinic, Dr. Gantes speaks to patients candidly about HIV prevention and risks. He sits behind a wooden desk but beckons patients to sit in a chair beside him so that they can talk without barriers. He takes notes by hand. Even when a patient has abandoned his or her medication, the doctor is gentle but direct.聽
鈥淚 come here because I can have an open conversation,鈥� says Nacor Trejos, who during an August visit to the clinic learned about medication that can reduce the risk of HIV infection.
It鈥檚 common to find informational brochures about HIV and AIDS written and distributed by Dr. Gantes and his colleagues in homes and schools across the comarca. Even shamans who use traditional medicinal plants to treat illnesses direct HIV-positive patients his way.
In a humble home with a tin roof, Mariano Rodr铆guez 鈥� a carpenter and traditional medicine provider 鈥� has a thin booklet with pages of health information delivered to his home directly by Dr. Gantes. He doesn鈥檛 view the doctor as a threat to tradition, but as a partner committed to the community鈥檚 health.
If a community member with HIV 鈥渃omes to me or other traditional doctors for help, we know to take them to [Dr. Gantes鈥橾 clinic,鈥� Mr. Rodr铆guez says.
Reporting for this article was supported by the International Center for Journalists as part of a series on health innovation.
