Not long after César Gantes received his medical degree, he received a call from Panama’s health minister.
The government, Dr. Gantes recounts, wanted him to develop a public health network in the Ngäbe-Buglé comarca, as the territory is known. It’s 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 – the Indigenous Ngäbe and Buglé peoples – had a reputation for resisting and distrusting outsiders.
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.
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The Ngäbe and Buglé 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 – and shifting views around HIV.
He “has changed the conversation on HIV in Panama,” says Orlando Quintero, the executive director of Probidsida, a Panama-based advocacy group or people living with HIV and AIDS.
Dr. Gantes’ approach has also changed the comarca, says Amanda Gabster, an epidemiology researcher at Florida State University who has worked in the Ngäbe-Buglé territory since 2007. Dr. Gantes is likely one of the first here “to focus attention on the importance of involving traditional healers, midwives, and artisans in HIV testing and treatment,” she says.
An “uncontrolled epidemic”
On most days at the San Félix antiretroviral clinic, a line of patients extends from the dimly lit lobby, out through the center’s purple front door, and into the sweltering parking lot.
The men and women, mostly from the Ngäbe and Buglé groups, are here to see Dr. Gantes. According to the Panama Health Ministry, of the country’s 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’ young men. It was deemed an “uncontrolled epidemic” in a 2022 study.
Dr. Gantes believes several factors are behind the high rates of infection here, including a lack of sexual education.
“No one should die from HIV,” he says. “We’re trying to test every last person” of the more than 210,000 people living in the Ngäbe-Buglé comarca.
Dr. Gantes’ dedication to slowing HIV has earned him national recognition, even if there’s still a lot of work to be done.
“I 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,” he says. “Instead of focusing on the differences … I looked for things the two [methods] had in common.”
For example, he says he worked to use inclusive language that shows respect for Indigenous traditions, and he never says one approach is “right” 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.
Dr. Gantes’ 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.
“I felt a spiritual commitment” to community-building initiatives, Dr. Gantes says.
The Ngäbe-Buglé comarca is Panama’s poorest region. Even today, most residents lack basic services such as running water and electricity. For Dr. Gantes, it was a shock at first. “I was accustomed to a lot of privileges that come with living in an urban area,” he says.
But he made inroads, slowly earning patients’ trust. In time, he notes, “The Ngäbe-Buglé made me part of their community.”
On his desk in San Félix, Dr. Gantes has a binder full of photos from the 1990s. There’s 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 Ngäbe and Buglé 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 Ngäbe and Buglé patients.
Dr. Gantes often starts his day early in San Félix 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 – 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.
“I’ve always considered music to be the best medicine for stress,” he says. “It soothes my soul after long days.”
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.
“I come here because I can have an open conversation,” says Nacor Trejos, who during an August visit to the clinic learned about medication that can reduce the risk of HIV infection.
It’s 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 Rodríguez – a carpenter and traditional medicine provider – has a thin booklet with pages of health information delivered to his home directly by Dr. Gantes. He doesn’t view the doctor as a threat to tradition, but as a partner committed to the community’s health.
If a community member with HIV “comes to me or other traditional doctors for help, we know to take them to [Dr. Gantes’] clinic,” Mr. Rodríguez says.
Reporting for this article was supported by the International Center for Journalists as part of a series on health innovation.
