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In the Beginning. . . .











mission by friends Jerry Hedrick and Mary Feldbrugge, and together these four founded the Boquete Health and Hospice Foundation (BHHF). Mary was a lawyer and Jerry was also very helpful with the complicated legal aspects of setting up the foundation.

“The Panamanian government had, and still has on the books, the National Palliative Care Resolution #499, which states that every province must have a palliative care center,” remembers Babbie. “We worked hard for years trying to find someone who knew about this law. It had not been implemented, and there was not even much knowledge about what palliative care was.”

John says the concept of health support was added to the mission because there were many in the community who had little or no family in Boquete and who would need support on a temporary basis when ill or post-operative. “In this way Boquete Hospice and Health Foundation was created with two care missions,” says John.

It didn’t take long for the founders to realize just how difficult it was going to be to establish a hospice in Panamá. It was a country where they were all living as foreigners, and where there was virtually no hospice tradition. Just conforming the concept to Panamanian law was a gigantic undertaking.

“We arrived in Boquete in 1999,” Babbie recalls, “when there were about 30 expats here and most of us were without extended family and we wanted to support each other. We began researching to learn what customs and beliefs here influenced people’s view of death and dying. We also needed to learn what laws governed the establishment of a hospice here. The Panamanian cultural idea was that suffering in dying was often expected and accepted here. This was a belief that John and I hoped to dispel.”

On November 26, 2007, having met all the requirements for legal operation, BHH was born. The fledgling organization’s first steps in early 2008 included identifying trainers; creating written materials and training modules for volunteers, administrators and the public; and raising public awareness of our mission.

Early on, it became apparent that our group could also become an important source of information about death and dying in Panamá, as well as related medical and legal matters. Over the years this informational and educational function has only grown in importance. We now serve as a reputable source for the community on many topics. BHH also offers all our systems, knowledge, and written materials to any community in Panamá that wishes to start a hospice.

The first training of volunteers was held in May 2008. Mary and the team had painstakingly created a training manual culled largely from generously donated US materials—which Mary had overhauled almost completely to conform to Panamanian law and local standards. They assembled a small team of talented trainers from their then much smaller expat community.

John and Babbie supervised an inaugural group of 18 trainers and trainees. Beverly Stearns was our first training coordinator and did this job for many years. “The training attracted many people with backgrounds relevant to hospice. People shared their expertise and everyone learned a lot,” remembers Patient Care Coordinator Bev Tyler. “The plan was that members of the group would hit the ground running to create a home hospice when the need arose.”

The group bought a cell phone and Bev began answering it. “One of our nurses knew an English-speaking obstetrician who agreed to be our medical director because he understood that we really needed him.“ As Bev recalls, “Hospice was a very foreign concept in Panamá and our medical director began to introduce it to the local doctors.”

At that time, 18 volunteers were enough to attend to the needs of the much smaller expat community, and the organization had not yet begun outreach to the Panamanian population. As of Fall 2023, we have a roster of over 80 fully trained volunteers and we serve the entire greater district of Boquete.

It was the decision of the founders to initiate care by focusing on the expat community first. It was simply too much work to replicate everything in Spanish, and John Earle thinks the organization may never have gotten off the ground if we had tried to do that from the start.

Now things are quite different and almost everyone, expat or Panamanian, carries a cell phone with a translation app in their pocket or purse. Social media and machine translation have made it much easier for us to reach out to Panamanians in their native language.

We’ve also done a better job of targeting our messages to people who don’t know what services we provide, or don’t realize we provide them to ANYONE who lives in our service area. The result of this outreach has been an organic growth in the number of Panamanian callers for our services—currently about half our callers are Panamanians.

“We are the only hospice in the country,” John reminds us. “A talented, knowledgeable and devoted group of people have over the years created an organization dedicated to helping their neighbors through education, providing services, and being there to assist during some of the most vulnerable, intimate, and stressful times in life.”

BHH’s services have expanded greatly. They now include providing home comfort such as food deliveries, running an informational website and social media pages, working with trained nurses, setting up a library, and purchasing medical equipment and loaning it out. We’ve also established our extremely important blood program, which includes holding two blood drives a year, and providing blood free of charge to all residents of the Boquete District. We’ve added our amazing music team and developed a regular schedule of public speakers and public trainings in CPR, preparing for the end of life, and other topics of interest.

To better reflect our array of services, in 2021, the organization started calling itself Boquete Health & Hospice. While the official name remains Boquete Hospice and Health Foundation, we feel the new name is more inclusive of ALL our services. We don’t want people to think we are “only” about hospice.

“Babbie and I are ever grateful for all the amazing people, too numerous to list, who have kept Boquete Health & Hospice alive and flourishing,” says John Earle. “Our hearts are filled with appreciation. The work of the organization has fulfilled and surpassed our original vision.”

As Babbie says, “Not that we can plan our deaths, but we can all contemplate and incorporate various practices that might make our passing more peaceful for ourselves and our loved ones. John and I both felt it was a privilege to volunteer in hospices for forty years, both on various steering committees and sitting with patients.”

John ends his reminiscence by expressing gratitude for all who have helped to implement his and Babbie’s vision. “We are heartened by the continual support of our volunteers, our board members, administrators, nurses, trainers, and donors—all of whom make up this wonderful organization. We are so pleased that BHH continues to make a wonderful, positive contribution to our community.”

By Deb Hornstra


John and Babbie Earle and Sixteen Years
of Innovation in Community-Based Healthcare


When John Earle stepped down as our President earlier this year to become President Emeritus, it marked the end of Boquete Health and Hospice’s (BHH) first era, which might be called the “Earle-y" years. It was John and his wife Babbie who in the mid-2000s decided to form a hospice in Boquete.

John and Babbie had been hospice volunteers and committee members in Vermont and New Hampshire (at one of the very first hospices in the US) for three decades. They were firm believers in death with dignity and the importance of palliative care for the dying. They were soon joined in their

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