Eli's last post

I just want to reflect on the different environment that we were in in Panama, and how things differed from what we expected. Where we worked in the clinics, it was fascinating even to just observe. The nurses and doctor's operated really quite similarly to how we do in the US, but the patient's seemed different. I do think that the language barrier and even just our presence as students contributed to this, but they seemed even a little afraid of having to be in a clinic to get help at all. Most conversations were very short, with simple answers to detailed questions by the practitioners. Patients were incredibly hesitant to go to hospitals even in emergencies. It seems to me that there is a pretty big gap between what health care is there, and how it is perceived by the natives. I heard that another students research showed that pap smears are often thought of to be birth control, and to protect against STD's... This misunderstanding could explain the high incidence of STD's and cervical cancer there, and shows that much more education is needed, and quite honestly could probably be more helpful than some of the services that the people there are getting. At the health fair there was a pretty impressive turnout, although communities within a mile told us that they didn't even know it was happening. The nurses really seemed to love their jobs there, and also seemed very up to date, showing that despite the incredible distance between real civilization they were able to stay on top of their education. I can see how working in health care in this area could be mentally exhausting though, seeing the hardships of the people and having limited access to help them was even frustrating for us in our brief visit there.

Second post from Eli

Although the people of the Comarca are faced with poverty and adversity greater than many of us could even imagine, there is still much we could learn from their culture. The resourcefulnes of the inhabitants was amazing. They utilized just about everything they had around them, from building brooms out of palm tree limbs to building entire houses out of bamboo. Unlike our culture, if something broke they tended to fix it rather than throw it out. Familiy and community structure seemed to operate in a different manner as well. The kids were offten free to roam from house to house in the village being watched by the whole community rather than only their parents. Most of the families welcomed us into thier houses and were more than willing to offer us what little they had, which is nearly opposite to the actions toward strangers that you see in the US. Coming from a culture that is often considered to place too much value on material things, it was enlightening to witness a culture that embraces the simple things in life.

Eli's Blog Uno-health fair in Alto Caballero

(I'm writing through Addie's login because I've have been unable to sign into the group) Being a part of the CoN in panama was an amazing experience for so many reasons. The entire group of instructors, students and even Dario the bus driver were great! It was such an amazing blend of personalities; everyone brought something to the table and did it with a smile. Panama had so much to offer, the countryside, the rain forest, the volcano Baru, the Pacific, the Caribbean, the wildlife, and the people, everything about the trip was nothing short of breathtaking. Even though the majority of the people that we came in contact with during our trip in the Comarca were impoverished beyond anything that I could have previously imagined, they still found a way to smile and invite you into their home and offer even the little that they had. What I learned while in the Comarca will go with me for the rest of my life, and if I take nothing else with me, I will have at least gained an immense appreciation for all that I have in life and all the opportunity that I posses.

La Clinica de Soloy

I spent most of my clinical time in the community of Soloy. On our first day in the clinic we didn’t really know what to expect. The clinic itself was a free-standing building with sections for child well-visits, maternity, and an urgent care section as well. There was a large central waiting room, and each section of the clinic would call for their patients individually. On day one, I shadowed what we would consider in the U.S. a primary care physician for a few hours and tried to keep up with what she was saying. She spoke a little English and I spoke a little Spanish, so there was a substantial amount of gesturing and squinting to try to convey what we were trying to say to each other. Luckily, many of the drug names looked very similar, and some of the diagnostic terms were similar as well. Interestingly, acetaminophen is the same in English and in Spanish; the key difference being its pronunciation.

On our second day in the community, we arrived better prepared. We brought paper and crayons and set up a little station to keep the kids occupied until they or their parents were called to be seen. We didn’t actually have coloring books, so Christine and I drew shapes for them to color. They called Christine "maestra" which means teacher; it was absolutely adorable.

At one point, Dr. Cadena came over and told Addie and I that it would be a good idea to do a little patient education for all of the adults in the waiting room. We gently tore the influenza poster off the wall and tried our best to make sense in Spanish as we read the poster to the men and women in the waiting room. I’m assuming we got our point across because we got a few laughs when Addie pretended to sneeze on her hand and then touch me, and I acted like I was really disgusted. We were trying to teach them to do the Dracula sneeze into their elbows. We ended up having a lot of fun at the clinics!

July 6, 2010

This was my journal entry our last day in San Felix:

Last day in San Felix!! Not going to lie, we're all glad to be leaving. No more trickling showers. No more wearing shoes every waking moment of every day. No applying bugspray immediately following a shower. No more sharing a room with 15 other people. No mas! No mas! No mas!

Our final presentations were due at 9am today - we presented to the health staff here in La Comarca. The nurses and some of the doctors we had been working with at the clinics in Alto Caballero, Soloy, and Hato Juli were present. My group was the environment and health portion of our trip. We basically talked about the different things we saw. We pointed out positive things we saw (like health promotion for TB and malaria) and negative things too (like biohazardous waste being dumped into holes in the ground). For my group's particular topics, it was hard not to be negative because most of what we saw were not good, healthy practices. Thankfully, none of this was news to these health officials. We made sure to point out issues that America shared with them. For instance, we discussed litter and trash here. No matter where you go, litter is everywhere. In the urban areas, in the rural areas... It doesn't matter. We shared with them that litter is a problem in the states too.

The other groups were 'the nurses role in the community,' 'school visits,' and 'Survey statistics.' The other groups summarized those very things. Because one of the main reasons for our visit was to conduct the domestic violence surveys, the health officials were interested primarily in the prelimenary statistics that were presented. They were very thankful that we came and for all our efforts.

The presentations took about 3 hours - so it was lunch time after that. The health officials and our translators (that we worked with the first week) stayed for lunch and were presented with certificates of thanks from USF Health. It was a nice gesture, I thought. Lunch was.... Drum roll please.... Chicken and rice!!! Haha.

After lunch we left for the UNACHI (The University of Chiriqui) for a formal welcome from their faculty and a tour of the campus. The school was part of the university of Panama for years, but they've since become their own entity - completely independent. The college of nursing is only about 12 years old - total they've had 340 graduates. One of the faculty told us that there are only 60 students admitted each year. They have two classrooms for nursing classes, and a very small lab. The lab consisted of a table, some books, and maybe some sample NG tubes and such to practice with. There were no mannequins, or dummys like we have at USF. Dr. Cadena told the faculty about our simulation lab - and they were just in awe of what she was saying. Our dummies can birth babies... They couldn't believe it!

This was the first time USF had any type of formal meeting with UNACHI - so it was cool to be a part of it. They are very receptive to accomodating more students next summer and it being more of a partnership with their school. We didn't really know about them until this last week. So, we didn't work with their students at all. They started discussing how our trips would benefit them, and I hope there will be opportunity and funds to support some of their students coming to USF to study. They would be amazed!

Because Dr. Cadena is good with money and budgeting, we had enough money for us all to go to dinner tonight. We chose TGIF, which was one of the only American restuarants that we saw in David. It was fantastic. I had real diet coke (I have pictures of the experience), and pasta. It was lovely. They even had wifi, so I was able to get online for a bit.

Some of us spent some time talking about how the trip has affected us when we got back to the compound and how we think it will change (or has changed) who we are...
Amanda brought up that we get to leave... we get to leave the poverty and sickness behind. We get to leave the dirty water and lack of electricty behind. We leave the domestic violence behind. These people stay. Their children stay.

Unfortunately, because politics play such a role in health care there will be no immediate change. The soap we handed out will be gone by next week... so will the toothpaste. The shoes and clothes and shampoo we're leaving will hopefully be useful... for a while. And the research we did? If it results in some policy changes, we won't see it for another 7-10 years. And that's just the policy changes... that doesn't include the actual implementation of the new policies.

It's a little bit sobering to realize those things. I hope USF has more opportunities in the future to be apart of improving health care here in Panama - especially in the Comarca among the Ngobe Bugle.

I would come again in a heartbeat. Even with cold showers, constant shoe and bugspray wearing, and even with sharing a room and bathroom with 15 other girls for 3 weeks. God brought me here for a reason. I hope I don't forget...

Health Fair

Today, a small community called Alto Caballero hosted a Health Fair for all the people living in the area. They expected approximately 4000 people to show up for immunizations, Pap smears, screenings, urgent care, dentistry and physicals. After the day was done, the clinic members noted that only about 600 people showed up for the event.

Our role in the health fair included taking blood pressures and pulses, giving immunizations, observing/participating in Pap smears, and taking the height and weight of the community members. Each community member had an immunization card (if it hadn’t been lost) that showed what immunizations the patient has received and when they last received it. This system seemed to work well when patients came to the immunization station. It allowed the nurses to easily identify which immunizations, if any, the patients needed. Most of the patients, both pediatric and adult, received the influenza vaccine.

By around 2:00pm the fair was starting to end. The people of the communities were starting to leave. We were informed by one of our translators that the reason the people get to the clinics so early in the morning and leave for home by early afternoon is because of the rains. It usually rained in the mid afternoon so the people tried to beat the rains. We were also told by our translator that it is not uncommon for people to walk up to 4 hours to get to the clinics.

The compund

After 2 days in Panama City and a long bus ride half way across the country, we finally made it to San Felix where we will be staying for the next two and a half weeks. The Compound is called IHS (not sure what it stands for), but the locals know it as “El Padre’s”. Compound is dormitory style with guys in one room and girls in the other. The back portion of the compound’s property housed goats, chickens and pigs as well as a labyrinth of slippery, algae covered concrete walkways winding between tropical plants.

Every night at 6:00pm a bell rang to signal dinner was ready. And, every night at 6:00pm we would walk up to the cafeteria to find a plate of chicken and white rice waiting for us. By the end of the trip, we were all really tired of rice and chicken. On our bus ride back to Panama City, two and a half weeks later, we stopped at McDonald’s. McDonald’s has never tasted so good before.

From the compound we divided into three groups and went to three different tribal communities for clinical. While in our clinical setting. We worked in the clinics, the school and also conducted a door-to-door survey about domestic violence and substance abuse. Our transportation to these communities varied daily from a taxi truck, ambulance, chicken truck or our tour bus. Of the three communities, one was only about 15 minutes away while the other two were about an hour to an hour and fifteen minutes away.

The health fair

I have to say out of everything I did and experienced in Panama the best time I had was at the health fair. It was great to feel like I participated in something that helped the native people of Panama. It was some what overwhelming to see the enormous need of the people and the lack of resources that exists there. I know that many of my peers and I felt the pressure when we were giving the immunizations. Two nurses where shouting out what to give and to whom but there were so many people around that you had to triple check to make sure that you had the right drug and the right person. The language barrier added to this stressful situation. In the U.S. the environment is so controlled and an atmosphere like this would be unacceptable. Everytime I come in to my hospital now I am extremely grateful for all the resources that are available and the regulations that attempt to make patient care more safe. 

Fun time

While in Panama I got the chance to do many activities that I have never done before. The weekend that we went away I went zip lining. This was an awesome experience. Being so high up in the mountains zooming over the trees and streams, it was so beautiful. After that experience I got to trek through the woods to find the hot springs and the river. It was a great contrast as the river was freezing cold which was great after the long hot walk and the hot springs were steaming, great for relaxation. The next day I went rock climbing which was very challenging and probably not anything I would have ever done if I was not in Panama. After the rock climbing I went horse back riding in the rain. Lets just say I definitely know I am not a lover of that but I wouldn't know this if I had not tried it. All in all great experiences that I will remember for the rest of my life. 

Watching the birth of a baby

While in Panama I got the chance to watch a baby be born. It was in the hospital down the road from the compound in San Felix. In comparison to the U.S. the facility seemed to be lacking the equipment and pharmaceuticals to deliver a baby. The soon to be mother was only given IBuprofen which was very surprising to myself and my peers. Once she was 9 cm dilated she had to get up, walk across the hall, and then climb on to a bed. Once she was on the bed the baby basically fell out. There was a complication as the umbilical cord was wrapped around it's neck. The physician acted quickly and cut the cord. He then worked with a baby for about a min until it finally started to breath. He then pulled the sack out and assessed the patient. It was an amazing experience as it was and being that I got to experience my first birth in Panama makes it all the more special. 

Back to reality

Since being back I have constantly been asked "So how was Panama? Tell me all about it." Truth is, words can't describe the experience I had while I was in Panama. There are only so many photos/videos I can show and stories describing the culture, people, and my time spent there, but really nothing gives it justice. My experience in Panama was amazing. Those of us who went all challenged ourselves to be immersed in a culture outside of ourselves and be flexible with the change in food, living environment (both sleeping and bathing), and the language. I definitely grew as an individual and realized a lot about myself. I guess sometimes it takes being outside of your comfort zone to really appreciate all you have and learn your potential. Now thats i'm home, I constantly find myself waking up in the morning, taking a HOT shower, checking for emails/messages via my Blackberry, and driving to work in my own car. I then think "wow..." and reflect back on the communities we visited, with people who didn't even have running water, shoes on their feet, or a floor in their homes. I was definitely impacted by this trip and hope to continue to remember the good/bad of the experience. I hope to do traveling nursing and think that Panama was a great introduction to my plan. I would definitely go again in a heart beat and recommend the experience to other nursing students.

The faces of Panama

Teaching in Soloy

My group did our teaching in the town of Soloy. We taught the kids how to brush and floss there teeth, wash their hands and "The Monkey" in english. It was one of the most rewarding days in Panama because you really feel like you're really teaching the kids something important that will help their health. The picture I posted is us helping the kids with recycling in the community. They are being taught that they should keep their community clean which is a problem in the area. Change starts with teaching the future.

Our Journey

Panama has really been wonderful so far. We started our journey in Panama City and have already crossed the country and returned in the past couple of weeks. We’ve gone from a city with air conditioning and hot water to an extremely rural area with open windows and cold showers and back again. We’ve seen two different Panamanian cultures and their similarities. Interestingly, the love for bright colors seems to be universal here in Panama; it adds to the energy that you already feel being in the gateway between the Americas and also so very close to the equator. It’s been one interesting bus ride after another, and we’ve been so lucky to be involved in the different activities with the nearby communities of the Comarca. We’ve been up and down countless mountains and seen some breathtaking landscapes. We’ve butchered many Spanish sentences, gestured through our days here, and learned quite a few phrases on the way. Our most used phrases probably were “muchas gracias,” and “con permiso.” With gestures and those two phrases, we got around surprisingly well. Luckily, even with our language barrier and odd appearance, people had little reservation in letting us care for them. Underneath our staggering Spanish, we were very fortunate they saw our sincere smiles and thanked us for our help. For me, this experience has put the world in a new perspective, and I want to see more already.

GRACIAS!

Taking Community and Public Health in Panama has been such a blessed experience. I am so thankful for this opportunity, to be a part of something that truly has an impact on the lives of others. I would love to say that I have changed Panama, but the truth is Panama has changed me. I have always known that I wanted to work in other countries as a Registered Nurse, but I never really knew what that meant. It was sort of glorified in my mind because I had never done it. However, after this experience I am aware of the hardships that come with working in other countries. It is not easy being taken out of your element and not speaking the native language. It is far less easy however to see the poverty in which others live. A poverty that is so bad, I wouldn't want my dog to live there. There is a beauty that comes with working in other countries though. One that will never be matched in any other area of my life. I was able to get to know this entirely different population, and help them in whatever manner I was able to. It sparked something in me that I knew I had, but never fully understood. It has always been my dream to go to Africa and work with Doctors without Borders; but, now I think I might want something more permanent, like the joining the Peace Corps. I never knew I could do something so drastic, but this trip has helped me realize my potential. I pushed myself in Panama more than I ever have in my life. I climbed a Volcano, I learned how to surf, I learned about a totally different culture, I made new friendships, and most importantly, I became a better nurse. Whatever I end up doing in life, I will never forget this class and the friendships I have made.
Special thanks to Dr. Cadena, Ms. Metzger and Mr. Stewart. Without you guys, this trip wouldn't have worked! Also, thank you to my fellow students! Getting to know you all has been amazing!

Volcan Baru

One of my most memorable experiences was the hike up Volcan Baru in Boquete. We had the joys of leaving San Felix for the weekend, which was much needed! I went on the 17 mile hike with the "Metzger" group and we all rocked it. It was probably one of the hardest physical challenges I have ever done in my life but once I reached the top, it was all worth it. The view was amazing! We were told that this was the highest point in Panama and from the summit we were able to see both the Pacific and Caribbean oceans. To be among the clouds literally felt like I was on top of the world and for a second I seemed to forget how exhausting the 7 hour hike up had been. We ate lunch at 13,000 ft and then trekked down in the rain, which really made the experience that much more fun (especially all the falls in the dirt and how delirious we all were). I was amazed by the change in weather that occurred so quickly. As we walked up, you could feel the temperature drop by several degrees. I couldn't believe we were in 50 degree weather with layers of clothes on, when days before we were dying from the heat/humidity. Our guide told us that the hike up Volcan Baru is the hardest in Panama, Central & South America. To have finished the 12 hour hike was a great feeling of accomplishment. We laughed and compared the hike to nursing school, in which "if it doesn't kill you, it makes you stronger." It was truely an unforgettable experience.

Reflection

Now that I have returned home and have gotten a chance to reflect on my whole community abroad experience, I have come to realize how fortunate I was to be able to go on such an unforgettable, once in a lifetime trip. This trip has not only widened my eyes on how other third-world countries live, but has given me the opportunity to become a better, well rounded nurse. Upon coming on this trip, I knew slim to no Spanish. I literally only knew the phrases “Hello” and “Thank you”, and how to count from one to ten. That was it. Most of the other students who went had at least some knowledge of Spanish, whether they were fluent due to their family background, or had a small background in it from high school. I, on the other hand, was one of the few that had no familiarity in it whatsoever. Going into these communities, I found the communication aspect of it very, I wouldn’t say frustrating, but rather just plain difficult. A big part of being a nurse is communicating with your patients and educating them about their problems. I wasn’t able to do any of the above. Most of the time while in the communities, I felt as if I was constantly surrounded by “jibber-jabberish”. If a translator was not right by my side, I had to solely rely on the nonverbal ques I picked up and any type of communication I wanted to partake in became part of a hand guesture/pointing game.
During our trip, when I would come across an individual who spoke English, particularly when we were traveling through Boquete, I found myself to be overjoyed. Just to hear someone speak in my own language and to be able to understand what they were saying was such a nice change and made me feel more at ease. I think this is one of the many, and best lessons I have taken away from Panama. When I become a nurse, or even now while in clinical, and come across a patient who does not speak English (which I have many times before), to really take the time and go the extra mile to communicate with them in a way that’s easy for them to understand. There are so many services out there and available to them that there’s really no excuse not to use them to help the patient feel more at ease at a time that’s hard to do so. This trip for me has really made the aspect of communication in nursing a huge priority in my care.

Alto Caballero

We’ve made it to San Felix! Today, we broke off into groups and went within the Comarca to different communities for the first time. My group went to Alto Caballero, meaning High Horse. Upon arriving there, I was absolutely awe stricken by the intense poverty I saw. It almost reminded me of something you would see straight out of a movie. The houses were made out of thin pieces of wood, with no windows or doors. The roofs were either thin sheets of metal loosely secured or leaves, making their houses literally huts. Clay was their ground. Wild dogs, pigs, and chickens roamed freely throughout their houses. In the “backyards”, trash was scattered. Women were dressed in colorful native dresses that they sewed with a hand sewing machine. Children ran around with ragged clothes, most with no shoes. Most people had no cars. Horses were their main transportation; although this was probably best considering that the roads were clay and had a lot of steep hills that I don’t think cars could have made up. The scenery was very beautiful though. There were lots of mountains and greenery.
Seeing all of this, I wasn’t quite sure what to think. For a split second I was sad. Sad that these people had to live like this and in such extreme poverty. But then I thought, by thinking that, doesn’t that make me ignorant and judgmental? Who am I to judge what a good life is and what is not?? Just because they don’t have all of the luxuries that we Americans do, does that make their life bad or any less good than mine? I’m hoping that with the more surveys we do, and the more people I come across and speak with, I’ll get the chance to answer my own question.

Las Olas, Playa La Barqueta

Throughout our stay in Panama, we got the opportunity to go on some amazing weekend get-a-ways. My favorite of the whole trip, by far, would have to be Las Olas, Playa La Barqueta. We had only been staying at the compound and working at our clinical sites a few days, but those few days without the luxuries of home, made going to the beautiful, lavish Las Olas that much better. The resort was located right on the Pacific Ocean, and was equipped with a pool, huge tennis courts, a restaurant, bar, and spa where you could enjoy being pampered. During the day, we were able to order delicious food (other than chicken, rice, and beans), swim in the pool and Pacific Ocean, go on a kayaking adventure, battle the monstrous waves of the Pacific, and take a surfing lesson if we so chose. The surfing lesson was my most memorable memory of the trip. I’ve always wanted to try surfing, so I thought there was no better time than to do it in Panama! We started off with a few warm up exercises and then proceeded to practice how to get up on the board on the land. This was the easiest part I would soon come to realize. Once the instructors took us into the water, I then had to fight through the waves with my board; easier said than done. Throughout the lesson, my instructor helped me find the perfect waves and I must have tried to stand up on my board at least twenty times…. I only succeeded once. But I had a blast doing it! I can’t wait to try it again!

Clinicals in Hato Juli

We went to the town of Hato Juli to do our clinicals for two days. Its up in the mountain's and has beautiful views. The clinic is across from the school and has indoor plumbing and a toilet, luxuries in this rural part of the country. The picture above is of me giving a 3 month old a assessment. I learned many things that should come in handy during my peds rotation next semester. We found out that these families need basic things like toys for the children. Toys help with development of fine motor control and critical thinking skills. Our nurse was telling the patients that even a bottle and a bottle cap would be good to help the children's dexterity.

Volcan Baru

While we were in the town of Boquete the self titled "Metzger" group hiked to the top of Volcan Baru. It took 12 hours, 17 miles, and we reached a hight of over 12,000 feet. We can now say that we have been to the highest point in the country of Panama. From the summit we could see both the Pacific and Caribbean oceans. It was one of the most amazing experience I have ever done in my life. Our guide told us that if we could hike this volcano then we could hike any mountain or volcano in central or south America excluding the Andes. Now I cant wait for my next hiking adventure!

My Experience in Panama

Now that we have been back home for a few days, I have had some time to reflect on my experience in Panama. I cannot say how many things that I have learned from this trip and the memories that I have made. This trip made me re-think what I want to do as a nurse. There is so much more to nursing than I imagined and I have found that I would love to travel around the world and help various communities as much as I can. At first, seeing the way some of the people lived in the communities was very disturbing to me. Hearing what the Women of the communities have had to live with and their way of life was also difficult to comprehend. Knowing that one day that we may be able to make their lives a little bit better whether it is through health promotion or establishing structure within their community really made all the difference. This trip was very full-filling and really opened my eyes as to how fortunate we really are. I have many favorite parts of the trip but I especially liked being able to work in the communities, with the children and the women when conducting surveys. The health fair day was also a great experience. There is not one part that I liked any more than the other. I think Dr. Cadena said it best when she described Panama as "a small country, with a big heart." I really enjoyed my time in Panama and I cannot wait to begin my next adventure!

Volcan Baru

Just thought I would do a quick blog to remind us of how awesome (and painful) it was to climb the Volcano in Boquete, and to make it to the highest point in Panama!! The whole way down the mountain I was thinking "There is no way we just made it to the top of this thing!". I want to say thanks to Metsker and to all of her 'team' for their hard work, caring and teamwork to get us all to the top. I also still think it's really awesome that a lot of us (myself included) achieved something that while we thought was almost impossible on the journey up. Considering some of the things and people that we saw and worked with while in San Felix, I think this is something that we should really take to heart. I beleive that some of the people probably feel every day that they are working towards something that cannot possibly end in victory, and that there may not even be hope for victory, or even for something better. I hope that as the USF CON returns and more attention is brought to the area, that these people know that things can improve.

Escuela

We all took a day and went to visit the school in each community to teach them some basic things to the little ones. They were so cute! The class my group went to was a kindergarten class and they were all 5 and 6 years old just like in America. They had lots of colorful posters and calenders. And i was really surprised to see how many colored pencils and crayons they had. We brought the mouthwash that turns your teeth blue. and then they brushed it all away. Then we taught them how to floss their teeth and we demonstrated it on egg cartons. Flossing was way over their heads. They had no idea what was going on.  Then we moved on to handwashing. We put green glitter on half of the class's hands and red glitter on the other half's hands. Then we had them shake hands with other people in the class so they would have green and red glitter to represent transmission of germs. They had no idea what was going on but it was a really cool idea!!! Then we had them wash their hands. We packed each student up with a toothbrush, toothpaste, and a peice of soap. Finally we played a little ball with them and sang them the monkey song. It was fun to hang out with the kids and see their faces smiling. But at the end of the day I dont think what we taught them was practical for them. We should have taught them how to keep their food clean and about trying to keep their water clean. In the community they have rice on a tarp and all the chickens and dogs run over it with their dirty feet and then they eat it. They dont even have enough water to drink but we are teaching them to wash their hands and brush their teeth. But we went in meaning well and that is all that matters. Next time we will come more prepared.

ITS A BOY!

On our trip at the San Felix hospital a group of us got to watch a lady give birth. It was my most memerable experience of the entire trip since I want to be a midwife. This was also the biggest culture shock to me. I was fully prepared for the poverty we saw on the trip but nothing could prepare me for this experience. When we got there she was in a room with the doctors but they were setting things up in another room. Apparently they have to wait in one room until the women in 9cm dilated and then she has to get up and walk to the other room to deliver her baby! Never in America could u get a pregnant lady fully dilated to walk across the hall and climb up steps to get onto the table to deliver her baby, and might i mention with nothing but IBUprofen! It was crazy talk! Anyways, literally as soon as she got on the table the baby started to come out. She didn't even push! And when we saw the head it was completely purple and blue and we knew something was wrong. The umbilical cord was wrapped around his neck. The next few seconds felt like they lasted minutes while he tried to cut it off. But the doctor got it off and the baby practically flew out! The doctor almost dropped him. Then it took awhile to get the baby going. He was purple for a long time but then he started to turn red and then he cried and we all we so relieved. After they cleaned the baby up they wrapped him up and showed the mom and she just looked at him and then they took the baby away. She didn't smile or anything. We were all shocked. We wanted to say congrats but it didn't seem like she was happy. Must be something with their culture I guess. But I am so glad I got to be apart of that experience and I will never forget it. Not too many people can say the first time they saw a birth was in panama but I can!

Our last dinner, and my last blog

We ended our amazing trip with a last night out to dinner at a nice restaurant called Las Tinajas in Panama City. We all dressed up and everyone looked great...we needed to feel beautiful after spending a week and a half in the hot and humid weather! We didn't get as much food on our plates as we had expected for the prices, but the disappointment was made up for by the show that we enjoyed toward the end of dinner (and the amazing sangria they had there). A small group of men and women dressed up in a few of their traditional dance outfits, dancing to their traditional music, played by 2 men on small drums, a guitarist, and a female singer. All the dresses were very colorful and decorated with jewelry, and the headdresses that the women wore were very intricate and beautiful. It was pretty amusing to also see the men dancing in very thin sandals, flipping their feet about on stage with their little hats. Then came the 2 men wearing these very devilish masks, playing castanets with their hands. I'm surprised they could really even see where they were going with those large masks on, but then again they did run into the wall on their way off stage. Overall it was a great evening, and I was a little sad to know that this was our last night out before we left the next morning.

As hard as we worked on our trip, we did manage to fit some play time in here and there. When we first arrived in Panama City we spent a day touring the Old City and the Panama Canal. Some of us were also able to sneak away to a salsa lesson one night! After starting work in the Comarca we took a quick day trip to the beach in Las Olas. It was a much needed break and day of fun. Here we swam in the Pacific Ocean, which was a first for many. Some just laid in the sun and enjoyed the pool while others surfed, again some for the first time! A large group of us also ventured out on a kayak tour in the cold gross murky water and turned out rain. What an adventure that turned out to be! Our guide got us lost and took us almost an extra hour out of the way. Something I'm sure none of us will ever forget. The most fun we had was our weekend in Boquete. Here we were able to enjoy the mountains and rain forests of Panama. A group of us climbed to the top of Volcan Baru, the highest point in Panama and a round trip total of almost 18 miles! Others were able to go horse back riding and rock climbing. We were also able to zip line! We managed to pack a lot a fun and great memories into our short breaks. I'd say we worked extra hard but we played hard too! :)

School Day

During our time in Panama, we’ve had multiple clinical days in different community settings. Among our experiences, we’ve traveled out into the communities on foot, spend days in the clinics, and assisted in a health fair. One of my favorite experiences was our day spent at the school in Alto Caballero. Before we originally left for Panama, we had a group which was in charge of preparing the necessary supplies and activities to teach the children about several health topics. I didn’t get to see all of the hard work of that group until we were discussing the projects and separating the supplies for the following day. The piles were huge! We had a tough time getting transportation to the school the next day, but, by ambulance, we finally made it. I spent most of my time at the handwashing station and did my best to make sense when I explained to them in Spanish how to wash their hands. I picked up the kids who couldn’t climb onto the chair to reach the water bowls and motioned to them how to use friction and rinsing to get their hands clean. I was amazed and shocked at how quickly the water became murky. I suppose the hands of children are always in the dirt regardless of what country they’re in, but the fact that they’re lacking running water in many of the homes and communities makes it difficult for those little hands to ever be clean. As nursing students, we always hear that handwashing is the number one way to prevent the spread of infection, and I think that through our fun activity, we taught some of that importance to the kindergarten classes of Alto Caballero.

Soloy

I spent my first 2 days while in the Comarca in a community called Soloy. This community along the river was about a one hour trip by bus up and down many winding roads through the mountains. Once we reached Soloy, I was immediately shocked by a dog which was laying in the waiting room (this later became customary) of the clinic--my first thought was sanitation?! As we walked along the river toward the town, there were women washing their clothes in the river, while on the other side people were bathing. There was also a lady cooking in a firepit outside of her hut for her children, while another hung clothes to dry on the trees. It made me quickly realize that the people within this community make do with what little they have. I spent these 2 days partaking in the reseach project on domestic violence. It was a very difficult subject to listen to the women talk about, but something that is very common there. I found it interesting that many of the women were abused but did not show any emotion during the interviews. This could have been because of the culture and the fact that this subject was rarely discussed, or because we had an interpreter as well as 2 students interviewing. To be immersed in the community of Soloy was a very humbling experience. The homes, built along the clay hill, were literally the size of my car. They did not have windows or doors, and were made from anything available to their owners, whether it be wood, metal scraps, plastic, sheets, etc with a clay floor. Chickens, dogs and cats were free to roam among the huts. As a matter of fact, the people seemed to just walk as they pleased in and out of eachother's homes. I was taken back when a little boy, about the age of 6, climbed into his bed. It was a plank of wood raised off the ground, with an empty corn sack he was using as a blanket. It really made me stop and look around, and be grateful for all that I have.

Clinicals

We were able to spend six amazing days immersed in the communities and clinics of the Comarca. We were able to help and meet some of the needs of three communities; those being Soloy, Alto Caballero, and Hato Juli. Our first two days were spent working directly in the villages. We had the amazing opportunity to conduct some surveys that allowed us the speak one on one with members of the Ngobe Bugle tribe. We walked through their villages, mingled and played with the children, and were invited into the homes. The third and fourth days were spent working in the various clinics. Here we helped give vaccinations, assess patients, perform pap smears, start IV’s, administer medications and injections, and jump in wherever we were needed. The fifth day we were all together as a large group in Alto Caballero for a big health fair. Assessments, nutritional counseling, vaccinations, pap smears, and emergency medications were performed on a much larger scale. Our final day in the communities was spent in the schools were we were able to spend some time educating the kiddos. We were fortunate enough to bring some supplies with us so each child received a toothbrush, toothpaste and a small bar of soap to take home with them. We went over how to brush and floss teeth and how to properly wash hands. There was also a little play time thrown in there. As a group we were able to accomplish a lot in such a short period of time. But those six days were an unforgettable cultural and learning experience.