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.