I have just come to terms with the fact that while I am here in Panama, I will be sticky and uncomfortable. I am a Michigan girl and I thought Florida was humid ... until I came here. It is hot. It is humid...I'm pretty sure I could cut the air it's so thick. And, it rains everyday. With that said, I love it here.

I have really only been exposed to nursing in the United States and this experience of working in a rural clinic in the mountains of Panama has been an eye opening experience. This is something I will never forget. There are so many cultural differences between the indigenous people of Chami and the people of Saint Petersburg, Florida. I was sitting in on a prenatal visit for a women - or a girl rather - who was 17 weeks pregnant. In her previous pregnancy, her pap smear had come back abnormal with bacterial vaginosis but she never came back for a follow up to be treated. Now after this pap smear it was apparent that she was still infected. Without waiting for the results of the pap smear the Doctor decided to send her home on an anti-biotic. We began asking the Doctor what the about her husband and if was to be treated as well...Come to find out that she was not married and her "partner" was gone for a few months working. Dr Barry said that was common in this culture and that it was very likely he was finding prostitutse while he was away, potentially contracting diseases and bringing them back to her. Apparently, there is a law in the Chami community that says men can be promiscuous.  The women do not necessarily agree with it but they accept it. As a nurse or Doctor in the community, they do their best to educate them and encourage the men to come in and be treated when they return so they the disease or infection is not continually spread.

As a community nurse, my role is to promote health, prevent illness, advocate for my community. Here in Chami, I am continually amazed at the use of the primary prevention of vaccinations. They really pride themselves in the fact that their community is up to date on their vaccinations. One day last week Chanel, Amanda, David and I packed up supplies and went down to the school to administered flu shots for the kids. The next day Laura and Lauren went out in the mountainous community to administer flu shots to the family members that could not make it to the clinic. The health personal of the Chami community really own the fact that their responsibility is to promote health and prevent illness. I admire the heart of every employee in the clinic ... most of whom leave at 4 am everyday to get there or come to stay Monday and until Friday because they care.

After the first week in the clinic several things have left a lasting impact on me:

1. Every blood pressure I took, no matter how old the patient was, was under 110/60.  I will rarely have a patient in the US with a BP so low and I think it proves the point that diet and exercise really DO have an impact. These people walk everywhere - I had one women who had walked 3 hours just to the clinic for and "rash" all over her skin - and they do not eat fried chicken with an extra side of grease. As Americans we have access to so many healthy
 options yet our lifestyles do not usually reflect that.

2. The leading cause of death in children in Chami were respiratory infections, malnutrition, and GI complications. All preventable diseases.... Innocent child dying from preventable diseases daily while many Americans CHOOSE to make health decisions that will lead to a premature death. As a nurse, it is a frustrating fact to face.