Scott Fears - 3/15/12

On Thursday we visited a psychiatric hospital that I think was located in Las Tablas.  It has been open for exactly 40 years and I have to say, I felt like I entered a time warp back to the mid 60s circa ‘One Flew Over the Cuckoo’s Nest’ when I entered the facility. It was not modern by any stretch of the imagination. In many ways it felt like an animal shelter that housed people, in terms of its physical appearance and amenities. I must stress that I felt that the patients were treated with kindness and understanding, but again, the facility was lacking. Luckily a new facility is being built right next door to replace this one.

I enjoyed my psych rotation at Sarasota Memorial immensely and have always been fascinated by psychology. It’s been one of primary hobbies since I was just a teenager. I have read countless books about evolutionary psychology, the psychology of sex, gambling, sales, you name it. I only say this to preface that I tend to find all people fascinating. Also, my gut feeling about people is that in general we are all crazy, it’s just that a majority of us are the same kind of crazy and are unable to recognize our insanity because no one tells us any different. I know that’s not scholastically correct, but it’s how I view the world. So, given this view of people, I tend to feel comfortable around most types of people because I feel we all share more in common than we have differences. Unless I feel physically threatened, I tend to feel moderately at ease around most people. At no point on this day did I feel I was in harm’s way, so I should have felt comfortable. Well…. J In walking down the men’s area I was expecting the men to get somewhat riled up over the fact that 6 young, attractive females had just entered their space. This actually did not happen, which surprised me. They kept mainly to themselves when myself and the female students progressed on our tour.

It was when we entered the female section of the facility that I was totally caught off guard. Literally within seconds of entering the female area I had women trying to give me (well, one succeeded) kisses and flirting aggressively with me. One women went literally hysterical with emotions and was taken outside. I must say, this was the last thing I expected. I began to feel uncomfortable because I don’t like to be the center of attention and I also don’t like to cause other’s pain. I also didn’t like the females in my group making comments about it. I was hoping to be a more casual observer on this day and interact in my own way. So anyway, it was an odd situation for me. I later found out we were going to go back and dance. “Oh boy”, I thought. I did dance and did my best, but I will admit it was uncomfortable.

One thing that I noticed was different about this facility was that the patients (at least some) appeared to be able to leave and come back when they wanted to. Beyond a shadow of a doubt this would not happen in the USA. To me this embodied a difference I felt the entire time in Panama. I felt a sense of community and trust among people in Panama that I rarely experience in the States. It’s very sad that I have to say this, but it’s true.

Scott Fears - 3/14/12

On Wednesday we visited a school that was literally on the top of a very steep hill in Las Minas, Panama. The wind was relentless at the top of the hill, blowing a solid 20 mph and more all day long. Several of the children walked a mile or more in hilly terrain to get to school. Most were of modest means if not poor. The school lacked electricity, had an outhouse for a bathroom, and lacked any supply of fresh water. Because of the extreme wind, I kept thinking the school house was going to blow away and this made it easy for things inside the class room to get blown off the desks. The school was composed of three small rooms. The 25 kids that attended this school were divided by rough age approximations, with 10 year olds possibly being in class with 14 year olds. They were also divided into groups of boys and girls.

The very first thing that I noticed when meeting the children was how well mannered they were. The were quiet, never fought, and were obedient. They smiled when appropriate but rarely burst out in loud laughter. I found them all to be quite endearing. My teaching group was given the task of education the children about dental hygiene. We used several approaches to accomplish this goal including a short skit, ‘simon says’, demonstrations, and some play activity. I felt like by the end of the day the children had reinforced what they had already known about tooth care and might possibly make more of an effort to take care of their teeth thanks to our efforts. We did do a cursory inspection of all the childrens’ teeth. I would say on average each child had one to two cavities but a full set of teeth.

Scott Fears - 3/13/12

On Tuesday I shadowed as well as helped the nurses give vaccinations to kids as well as adults in the Policlinica. The public health system puts much effort into insuring that citizens are up to date on a wide range of vaccinations. I noticed each patient had a ‘health booklet’ that they kept with them. This booklet contained a majority of the person’s health records, including vaccination dates. No electronic files were kept for the patients. All records were kept hard copy. I saw no drawback to this approach. As a matter of fact, I saw some advantages in that the patient’s were encouraged to maintain their file, understand its contents, and bring it with them to their health care provider. On this day I gave approximately 20 vaccinations. Some were oral (polio and hantavirus), some were subcutaneous, and some were intramuscular. It was good for me to have so much practice, as practice makes perfect. I found the most challenging injection to be the intramuscular injection into the deltoid of young children. This is a difficult area to stabilize and if/when the child moves quickly it is quite easy to botch the injection. I learned to error on being firm as opposed to gentle when stabilizing the children’s arm. All in all, I felt both Monday and Tuesday were very good learning experiences at the Policlinica.

Scott Fears - 3/12/12

I spent my first two days of clinical work in the Policlinica in Chitre, Panama. On Monday I spent a majority of my time with a nurse in the pediatric unit who was dedicated to assessing the development of children from newborn to 15 years of age. She focused on seven primary areas of development (including cognitive, emotional, motor coordination, etc.) and made sure that each child was progressing at a proper pace for his/her developmental milestones. She used various physical, motor, cognitive, and emotional testing approaches to determine each child’s development. In addition, she made sure that each child was on schedule with his vaccination regimen. Lastly, the nurse asked multiple questions about the child’s diet and educated both the child (if old enough) and the parent on the necessity of good nutrition. If for some reason a child appeared to be lagging in a particular area of development, the nurse could recommend that the child see a specialist for further evaluation. I was impressed with the amount of time that each patient received and the effort that the nurse placed into patient education.

Christina Bennett Blog 3 3/15

Today was…interesting?  We visited a psychiatric hospital that I believe was in Las Tablas.  Edy and Gisela were the two extraordinary nurses that assisted us that day.  It was first opened in 1971 and is a government-run facility.  A new hospital is under construction next door and it seemed as if the current hospital had been neglected for years.  I felt like I was stepping to into the scene of a horror film.  The nurses all still where the traditional nurses cap and nurses orthopedic shoes.  The walls were a faded mint green and peeling.  Padlocked iron gates were left open.  Naked patients attempted to climb the fences.  Screeches, howls, incoherent babbling, and uncontrollable fits of laughter and crying echoed through the halls. 

The facility had an acute intake area, and four long-term resident wings separated by padlocked iron gates.  The patients were separated by sex and level of chronicity or acuity of their disease.  Several male patients were in their own area because they prefer to be naked and urinate or defecate on themselves.  The patients on the male units seemed withdrawn, sullen, forgotten.  Although, one gregarious patient had several of us fooled into thinking he was a representative of the hospital.  The women, on the other hand, were a much livelier bunch.  One grabbed Scott’s face with a wrestling sleeper hold death grip and planted a juicy kiss on his cheek.

We had planned several activities with the patients based on ones we had successfully completed with our patients in the U.S. during out Psych clinical last semester, but it was apparent early on that the patients at this facility lacked the capacity to participate fully.  We modified our exercise routine, ball toss exercise and art therapy activities.  We then improvised with impromptu makeovers and manicures!  The women’s wing had a beauty room with donated make up where they have a hairstylist cut the patients’ hair once a month.  There was such a remarkable difference in the attitudes of the women once we gave them their makeovers.  There moods were lightened and they all started walking around with their heads held higher.  One woman changed her outfit to a nice blouse and skirt.  We then invited the men over and had a dance party!

I was surprised by level of freedom afforded to the patients.  Males and females, acute and chronic patients were free to roam about through the seemingly secure areas.  They have occupational therapists that come for an hour a day, Monday through Friday to help rehabilitate them, although most patients will live at the hospital for the remainder of their lives.  Most of these patients’ families abandoned them years ago and they are now wards of the state.  The nurses have become their family.

For those of you that want to help, these patients need sheets, towels, linens, and personal hygiene items.