After a couple of weeks in the village health clinics we have our first day at the Hospital in David. It is mostly a woman's and children's hospital. We get a brief tour and get introduced to the Operation Smile office that they have here where they do a lot of cleft palate repairs and the like. We finally get up to the floor and meet the UNACHI nursing students that we are going to be paired up with for the evening. Tonight my group will start out on the high risk ob floor and then go to the gyn floor.
We all quickly make friends with our UNACHI counterparts and start trying to talk to one another about the differences in nursing between our countries. First of all we find out that when they graduate they only get paid $3 an hour!!!! I spent more than their whole days wages at the grocery store that evening. Craziness. We also discover that they have at a minimum 30 patients per nurse in the hospital and that most of the time there is only about two doctors present. Wow, that is a lot different than in the states where having 8 patients is a load and you can page a doctor whenever you need one. In the states you'll also have at least a couple of techs to help you out per floor and they don't have that in Panama. I am finding out that nurses here have a lot of responsibility and work here. Their nursing students are also put to the test more than we are back in the states. In our hardest semester in the accelerated program we had three classes and three clinical days per week Monday through Friday with our longest day being a 12 hour day. Here in Panama the UNACHI students take 5 to 6 classes at a time because they don't take prerequisites first and work about 3 days at the hospital or health clinic. They go to school 6 days a week most of the time ( Saturdays are physical fitness days where they often go swimming) and they start classes at about 7am, then go to the hospital from 3-9pm or longer if they are in the middle of a delivery or something so those are 14 hour days on a regular basis. And we thought we had it tough. They also get more experience in their clinicals. Their students were telling us that on average they put in 6 IV's per shift and back home I'm lucky if I get to see an IV put in. To be honest I still haven't even had the experience of placing an IV and they all laughed at me because it was so crazy to them that I haven't done this basic skill when they are all so proficient at it. They also get to deliver babies by themselves as nursing students here in Panama which is something we would never get to do as students back home.
So while the role of the nurse is still demanding in the hospital setting here it does not seem to as broad and all encompassing as it is in the clinic setting. Their main role is mostly that of a caregiver entailing assessments, nursing diagnoses, plans, implementations, and evaluations much like it is in the states. They go about things much like we have been taught to do back home like putting your eyes on your patient first thing and doing a 10 minute assessment. They also take the vitals since there are not techs to do it for them. Then they chart their results, in a paper chart mind you, and use plot graphs to keep track of the patient's trend in their vitals which I thought was smart. They also write in different colored ink depending on if it is night shift or day shift so that when you glance at the chart you can easily tell the difference.
Another thing that I have noticed here as well as in the clinic setting is that the nurses all seem to be pretty good at being attentive to each individual patient and their specific needs. For example there are many indigenous people even here at the hospital and they have different cultural needs than other Panamanians and I have been impressed with how well the nurses here seem to be tuned into that. For example, the indigenous people are much more reserved, private, shy, and non-emotional and the nurses here being in tune to that adapt their nursing style to accommodate.
All in all it was a really great experience being at the hospital today and I learned a great deal about the differences in nursing between our countries. I also had a great time interacting with the UNACHI students which was probably my favorite part. They also seemed to really enjoy our time together as they even made sure that they could go to dinner at the same time as us as well as swapped facebook information, took pictures and gave hugs when it was time for us to leave. Oh, and the couple of cool medical things that I got to do and see today that were new for me were to physically manipulate a pregnant ladies twins and I was able to feel one of the babies hands and its knuckles felt like little mountain ridges. I also got to see my first prolapsed uterus. It was about the size of a large papaya. It was a little hard to take because it was an older woman and she was there to get an enema in preparation for her surgery tomorrow and her whole body was shaking and it made me feel really bad for her. Especially when they started administering the enema because they sure administered a lot. It was time for us to leave at that point which was good.
We have only one more day at the hospital next week and I will get to go to the delivery floor and I am really hoping to see a baby delivered because I have never seen that before.
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