Christina Bennett Blog 2 3/14

Today was such an amazing day.  We drove over an hour or longer to Las Minas, a small mountainous community west of Chitré.  We started our day with visiting the Centro de Salud de Las Minas, a social security facility.  The building was sparse, to say the least, but nursing staff seems to be able to provide adequate, thorough care to the community.  We were all astounded by the low cost of dental work!  No service, including root canals, was more than $20.

We then drove through a very remote, isolated mountain terrain to reach a two-room schoolhouse government-funded school house at the top of a mountain.  The panoramic view from the school was incredible.  We learned that they did not have electricity or running water.  Three dilapidated outhouses served as restroom facilities.  There were two teachers and approximately 35 children, ranging in ages from 5 to 14 years old. The kids, nor the teachers, knew we were coming that day.  Apparently, the school had not had any visitors from outside of the Las Minas community in four years!  The children have to walk to school, many walking over an hour to reach the school.  Most of the family homes in the area are also without running water or electricity, so these children do not have water to carry with them on hot days when they walk.  They also lacked proper footwear.  Many wore sandals or flip flops which are not conducive to walking on the rocking, dry, climbing road.

We held a Feria de Salud (Health Fair) for the kids.  We had five stations: dental care, hygiene (hand washing, coughing in your sleeve, etc.), nutrition, human values, and healthy choices.  The children were given a Pasaporte de Salud (Health Passport) at the beginning of the activities, and upon completion of the activity, they were given a “stamp” (sticker) and were allowed to move to the next one.  The kids won prizes and were given toys and hygiene items that were donated to us (THANK YOU ALL WHO DONATED AND COLLECTED ITEMS FOR OUR TRIP!!!).

My group, which consisted of Ping, Sujin, and Scott focused on dental hygiene.  We started off with asking the kids how many times a day they should brush their teeth.  Much to our surprise, all of them responded with three times per day: after breakfast, lunch, and dinner.  We then did a skit where I played the mom, Scott was my stubborn son, and Ping was a pretty girl.  We taught them a song on how to brush my teeth and demonstrated with them using donated toothbrushes.  We also taught them how to floss.  We played a game where all the kids stood in a line and had to jump to the “healthy” food side or the “bad” food side when we showed them a picture of food.  We talked about how many teeth they will have at 12 years and 18 years old and then counted their teeth.  Many of the children had missing or rotten teeth from lack of care.  Most of the families in the area do not have running water in their homes, so even with the knowledge that they are supposed to brush three times a day and with the new information we gave them on how to brush and floss, it is likely that these children would not be able apply it in their homes.  Very sad.

We hope to hold a shoe drive and possibly do some fundraising to get a water well built for the school.  Hopefully, we can make an impact on the quality of life of these kids!

Christina Bennett Blog 1 3/12-3/13

When I first arrived in Panama after not visiting in 14 years, I was overwhelmed with how much it had changed!  My mother is from Panama and my grandmother and most of my mother's family still lives here, and I used to visit nearly every year from two months old until age 16, but I hadn't been back since.  The city has at least triple the amount of skyscrapers and will eventually have an underground metro rail.  It has less smog, surprisingly, but I've been told that it is attributed to more cars running on gasoline engines instead of diesel.  Overall, the Ciudad de Panama (Panama City-capital) is much more metropolitan than it was 14 years ago.

We spent our first two clinic days at the Centro de Salud de Chitré, a poly-health clinic run on social security funding, and at Hospital Cecilio A. Castillero for women and children, a public hospital.  We worked with Evelyn, a university nursing faculty member and employee at the Centro de Salud, as well as staff nurses.  They were so warm and welcoming to us!  I have had very few preceptors in the U.S. that have been so willing to be “inconvenienced” by students.  I worked first in the fetal monitoring area, then did postpartum follow-up visits with a nurse at the hospital.  Then, I spent the remainder of my first day in the vaccination room.  The Panamanian government vaccine schedule is so thorough and everyone is vaccinated free of charge.  I learned so much that afternoon about using proper technique of drawing up medication and administering the injection.  The nurses in Panama aspirate before delivering the medication in a deep intramuscular injection, something that we do not do in the U.S.  Also, they only use sterile water to clean the site of injection because their protocol states that cleaning the site with alcohol would degrade the vaccine.  Again, this is something quite different than in the U.S. 

On my second day, I spent my morning with the nursing staff in the pediatric area, measuring weight, length, head circumference, and temperature on infants.  I then worked with Dr. Camargo, a pediatric physician on her newborn exams.  She was so thorough and I was more than pleased when she included nearly 15 minutes of teaching on the importance of breastfeeding exclusively until six months of age, a World Health Organization (WHO) recommendation.  I then spent my afternoon in the gynecological area observing Pap smears.

As a previous Anthropology and Latin American Studies major, I was pleasantly surprised by the level of cultural competence displayed by the nurses in at the hospital. When some the indigenous women dar a luz (translations: figurative-give birth; literal-“give light”), they put cotton in their ears and don’t wash their hair for 40 days postpartum because they believe that cold air will get in their ears and prevent their uterus from healing.  They also are encouraged to use their traditional medicines like an herbal tea that they drink to aid in pelvic healing and promote breast milk production.

I am looking forward to the remainder of my week!  I hadn’t realized that we would be learning so much from our nurses.  They are truly a gift to their community.

Hospital Gustavo, 3/15/12

Today, I went to the newest hospital in Chitre, Hospital Dr. Gustavo Nelson Collado Rios. The construction of the hospital was completed in November. It was very similar to our American hospitals, with a few exceptions. First, men and women patients were separated to opposite sides of the hall. Second, patients did not have individual rooms. Instead, about 6-8 patients were housed in one large room.
At the beginning of the day, I was in the ICU, which had 6 beds. Again, it was very similar to American ICUs, with the exception of lack of private rooms. Also, there are no HIPAA laws in Panama, so patients' charts were in full view, and it is acceptable to take pictures of the patients there. Another difference was in Panama, nurses are in charge of patients' ventilators. In the United States, respiratory therapists monitor them. The nurses told us that in Panama City, there are respiratory therapists, but because Chitre is small, they do not have this specialty.
For the second part of the day, I was in the ER, where I administered a tetanus shot and started a vaccine. In the ER, nurses work 6-hour shifts, which is very different from our 12-hour shifts in the U.S. All of the doctors and nurses were very friendly, despite the language barrier. The hospital was a great experience.

Las Minas Grade School 3/14/12

Today, we went to Las Minas to work at an elementary school. This was a considerably impoverished area. There were approximately 25 students and 2 classrooms. The school had no running water and very poor restroom facilities. The principal of the schoool and his wife live there during the week and return home on the weekends. We broke up into separate groups to teach the children healthy habits. The groups included handwashing, brushing teeth, learning about respect and trust, healthy decisions, and nutrition. I was a part of the nutrition group, where we taught the children proper nutritional choices. All of the children enjoyed the day, as did we, but we noticed obvious needs at the school. For instance, some children have to walk an hour and a half to school each way everyday. Most of the children have very worn shoes. New shoes and healthy drinking water are much needed at this school.

Alexa Blog 2 and 3

Blog 2

3/14/2012
Today we went to the elementary school in Las Minas. It was an early start time and a long drive there, but what an experience!!! The school was located in a mountainous area and the children walked long distances to get there. As we were driving down the road we saw children as young as five walking on their own to get to school and it struck me as such a sharp contrast to the United States where we don’t even let children walk two blocks to get to the bus stop! Our group did a game where we talked about good vs. bad choices in life and how to make good decisions. In order to teach the kids, we had a big game board and the children rolled two dice and jumped along the game board whatever number spaces they rolled. Then they told us whether the picture they landed on represented a good choice or a bad one. Back in the United States the game seemed perfect and very appropriate…after all, seat belts are always good and hamburgers and French fries are always bad. However, when we got there it was clear many of the children had never seen a seat belt or a bicycle helmet in their lives. And who were we to tell a child who might only receive a glass of sugar water for dinner at night that a hamburger (source of protein) was bad for them? The reality was very different then we could have imagined. 
The school was a little surprised when we showed up that day as apparently the letter confirming we were coming had never arrived. In spite of this, after we got done teaching they provided an amazing lunch for all of us. It was humbling to have people who had nothing, share what little food they had with us. We take so many things for granted in our own lives, that to see this little town where people still get their water from a pond, and a hole in the ground with a seat over it is considered a nice bathroom was a good reminder of how blessed we really are. 
After Las Minas we got the chance to go to a beach near Chitré to hang out for the afternoon/evening. It was a nice chance to be able to relax and let loose a little as a group. The beach was beautiful and hanging out together gave us a good chance to bond a little more cohesively as a group and to get to know each other on a more personal level.
-Alexa Ann McIntyre

Blog 3

3/19/2012
Our trip is officially over and we are back home. The final two days in Chitré we spent at the new Social Security hospital and at the Psychiatric Institution. The hospital was an awesome experience since we were able to spend some time in the Emergency department (my favorite place!). One thing which really stuck out to me about the emergency department was how many IVs they did there. In the Panamanian healthcare system, people don’t feel as though they have been “treated” if they are given pills and sent home, so many times they are treated with IV medications or injections as opposed to prescriptions. For this reason, it was an awesome place to practice my IV placement skills! 
The Psychiatric hospital was a unique experience as well. Although I work on the wing of a psych hospital in the United States, this was more of an institution rather than a hospital, so it was a very different experience. Many of these people had lived at the hospital for 20+ years and would probably never return to life outside of the walls of this institution. The hospital received little support and funding from the government and was in desperate need of supplies and manpower. The nurse on duty explained to us that many times there was only one nurse for 50+ psych patients, and that in the evenings they may not have a nurse at all since they had limited staff. Some of the patients were nude, since their conditions made it difficult to keep clothes on them. The patients were very low functioning for the most part, so many of the activities we had prepared needed to be revised in order to make them  suitable for the patients. 
However, the stories of the patients from this institution will forever stay with me. There was one patient who was mute, and she had been in the hospital for over 30 years. Everyone called her “La Muda” (the mute). Two years ago, one of the nurses realized she needed a name, so they baptized her and gave her the name “Marionetta”. Because that nurse cared, she has a name now! Another patient was the daughter of a high ranking government official, she was high functioning and could have lived outside of the institution with minimal family support; but the family didn’t want her, so she remains in the hospital. Other patient’s whole faces would light up when you paid attention to them or interacted with them, and you realized how desperately these people needed to be loved. That day, I felt like I made a difference… it was a good day.
Looking back at the time I spent in Panama, it was such an amazing experience! I saw people who had so little, but were willing to give so much to others. I learned that while technology is nice, there are other ways of providing medical care that are just as good. I perfected skills such as breaking ampoules, giving deep muscle injections and calculating drop factors. I was exposed to new experiences, such as giving Pap exams, that I never would have had experience with in the United States. And finally, through this trip I developed friendships with other students in the program which will be lifelong friendships because of these shared experiences. This was, hands down, the best experience I have had in my nursing program!
Alexa Ann McIntyre

Andrea Elibero Blog 3

Blog 3

Andrea Elibero

March 16, 2012

Today I was in the private hospital in Chitre. This hospital was quite modern and shared a lot of similarities with US hospitals. I spent half the day in the ICU and half the day in the ER. The patients in the ICU do not get their own rooms, but are divided by curtains. I noticed that they did not use IV pumps very frequently and when I asked about this, the nurse told me that there aren’t many pumps available so only certain medications are put on pumps. Generally, a gravity drip is used. I also learned that the nurses aren’t assigned specific patients, but each nurse takes care of every patient. I was also told that the doctors (and not the nurses) drop NG tubes, insert foley catheters, and do blood draws. The charting is very different. There is no computer charting, instead there is a paper chart and a large piece of paper where the nurses record I&Os, medications, nursing notes, etc. Another interesting thing I noticed is that the physician was emptying the Foleys, recording the I&Os, and checking the vitals. That is something that you would never see in the US, as the doctors here rush in and out of the patient rooms very quickly. I appreciate how much time the nurses and physicians spend with the patients. The biggest negative I noticed was that there is a strict visitation policy in the hospital. The visitors are only allowed one hour a day during a specific time and cannot stay overnight with the patient. I found this unfortunate, as having emotional support is important for the patient’s recovery. On the surface, the ICU seemed similar to the ICU in the US, but when taking a closer look I noticed many differences. I found the patient care to be quite adequate and I wouldn’t hesitate to be a patient in a hospital in Panama. That is something I wasn’t expecting before spending the day in the hospital. I have great respect for the health care professionals in Panama and I believe that the training they receive is better than ours in some ways. 

Andrea Elibero Blog 2

Blog 2

Andrea Elibero

March 14, 2012

Today we went to a two-room school house outside of Las Minas. The school did not have electricity or running water. There were about 30 children of various ages who walk over an hour to attend school here. My group taught the students about hygiene. With some help from the teachers, we talked about germs, played a game that taught the kids how germs are spread, and learned proper hand washing technique with an additional game. The students were extremely well behaved and respectful. They participated and did what we asked of them. I hope that they had as much fun as we did! Unlike the previous two days, I felt like we were able to provide more of a service here and our visit was helpful to the school. We brought supplies and gave the kids some toys and stickers that they were excited about. The hospitality was amazing as well. They didn’t know we were coming, but provided us with a home-cooked lunch. We are also planning on organizing a shoe drive to provide the students with better footwear for their long drive. This was a very rewarding day. I noticed that, although the children do not have much money, they were very happy. They are more appreciative than children in the US who have almost everything they could want at their fingertips. It is important to remember to think about communities like this one when complaining about inconsequential things that happen in life.