Mariah Campbell's Blog 3

As we prepare to leave Panama I am left thinking of all the amazing experiences I have had since coming here, and how much I have learned. After being here almost 3 weeks, I feel like I have had the privilege to get just a little glimpse of the culture and how the people here live.

While in the Soloy clinic, I got the opportunity to do, and see things I probably never would have while working as a nurse in the United States. During my first week in the clinic, I learned was how to read and administer nebulizer treatments, which is something that normally respiratory therapy does where we are from. I also saw an “ambulance” made by the indigenous people that looked very similar to a hammock, but with large stick added in order for people to carry individuals that are sick or injured. Unfortunately, although this man made contraption may make transportation a little easier on them; they often still must travel 4-6 hours by foot to even reach the clinic. Another thing I got to do was pap smears. Since this is normally a skill outside of the nurses practice in the U.S., it was a great opportunity for me to experience and learn here. After speaking with the doctors, I learned that as a part of their culture, it is considered acceptable for men to have sexual relations with multiple women. For that reason, many members of the community have sexually transmitted diseases. In an interview with one of the nurses at the clinic, I was surprised when he told me cervical cancer isn’t all that common in Ngöbe-Buglé community; and when seen, it tends to be more in women over 50. However, many other STD’s such as HIV, gonorrhea, chlamydia, etc. are quite common. As previously discussed in my 2^nd blog, respiratory infections are also prevalent in this area, especially Tuberculosis. Since the majority of the population live in poverty; most people are poorly nourished, and forced to live under unsanitary conditions. For this reason, they have an increased risk of acquiring infections and diseases. However, In efforts to improve health, the government will actually provide monetary incentives to families for coming to the clinic to get their physicals, vaccinations, pap smears, etc. Because these families are so poor, I found this to be a great way to encourage families to participate in necessary health care needs. Another great thing they do here is provide free health care to everyone. I was very surprised to hear this at first because all I could think of was how different that is in comparison to the U.S., where we are just constantly hearing about the high cost of medical bills & insurance.

Example of the Nurse from our clinic - out in the community
checking medical records    

Walking through the part of the Ngöbe-Buglé community,
going door-to-door giving vaccinations

Giving this women an influenza vaccine.
Poor baby crying because I had just giving her a shot too  :( 

Overall, I would have to say my favorite experience of the trip was being out in the community. Seeing how these people live from day to day was such an eye-opening experience, and being able to help (even a little) was very rewarding. I especially enjoyed getting to opportunity to see the role of the community nurse carried out, as one day we went house to house in the community checking each and every person’s medical record then providing shots to those that needed them. Since access for them is so hard to come by, it was awesome to see nurses from the clinic going that extra step walking around door-to-door and traveling to really ensure treatment was being provided. In addition to giving vaccinations, I also noticed the nurses would assess other possible health concerns they found in the community then work to find a remedy to the situation. I still can just not stop thinking about how hard these health care professional work to improve the lives of community members; and how great of a job they do despite the poor conditions and access to materials. After seeing all this, I have a whole new respect for the people that work and live in this community; and I am very grateful to have all the luxuries I do in the US. I am definitely very happy in making my decision to come on this trip and truly feel this was a great experience I will never forget! 

Some of our group together with my favorite nurse during our last day at the Soloy Clinic.

Meeting Needs

Our second weekend brought us to Boquete, Panama! A beautiful mountain city with much to explore and do. Boquete is more developed than San Felix and the communities we have been working with. There were also other tourists! A lovely couple from Paris, France took this picture of Brittany and I. We spent the morning exploring the town. Turns out that bartering is still going strong there too! We stole some great deals on souvenirs for family and friends. The lovely artisans of Toucan Tile were hard at work within their shop-so many beautiful tiles! While in Boquete we also went zip-lining! The first time I have ever gone! It was a blast, as well as breathtaking. You feel a little bit like you are flying too. 

Artisans at work.

The zip-lining crew.

As we headed back to the communities for our final week of clinical, we had the excitement of sutures, pap smears, labor and delivery, injections, injections, and more injections. At Buenos Aries we had a patient come in with a thorn lodged in a joint of her finger. Our doctor had to make an incision, and Chiara had the privilege of suturing it shut!

Chiara finishing up her sutures.

The baby!

In Panama, the nurses deliver babies, not doctors! It is required that they deliver a certain number of babies before they practice. This is quite different from the USA. The picture above shows Kaliope, an UNACHI student, with the baby she delivered. We had the privilege of performing a newborn assessment and learning about labor and delivery from our instructor Jessica Gordon. The community health nurse needs to be equipped to deliver babies out in the communities-very different from home! Culturally the delivery was different as well-no one was in the delivery room with the mother, and the baby is not given directly to the mother. Once the baby is given to the mother though, they remain together in the same bed post-partem. Such an interesting experience, and quite different from the birthing experience at home. They also closely examine the placenta in Panama to determine if there is anything out of the ordinary, a practice that is not done in the USA. We finished up our elementary school teachings with 5th and 6th graders and taught nutrition. The activity was a hit, and so was the food we brought to share! 

Our last day of clinical was a health fair in Chami-elementary school students came to have their weight and height recorded and get caught up on immunizations. I am not sure if the USA has anything of comparison for students. It is a great way to keep track of the population and help prevent illness and educate the younger generations. 

Panama was quite the experience. Exhilarating, heart breaking, rewarding, eye-opening...I am now back in Florida, and I am still not quite ready to be back. The desperate need for nursing care in Panama continues to weigh on my heart. I admire the extent and knowledge of the nurses in Panama-they are extremely well prepared. The role of the community nurse is far greater and far more significant than I had originally known. I don't think I will ever take my education for granted again. I will also never take air conditioning and hot water for granted either. It is amazing what a difference it makes in your worldview and perspectives when you work with a culture vastly different from your own. I have walked away with not only nursing education and experience, but life experiences as well. 

Nos reuniremos de nuevo Panama......



Flying home..... Bittersweet

The final post. We are finally back home in the USA!!! It felt to nice to come home yesterday. But driving down familiar streets, that didn't look so familiar anymore was a strange feeling. Pulling up to my house and not really processing that I am home b/c home was somewhere else for the last 3 weeks was emotional... But seeing family, friends, and my boyfriend embrace me really cemented that I was finally home. Going into this trip I didn't think I would make it. The first week was pretty rocky for me. New environment, a bunch of people I don't know, unorganized chaos at times, lack of communication back home, no AC lol.... seriously though, that was the cherry on top. I thought I was gonna be one of those girls that throws the towel in early & heads back home on an airplane mid trip. But as the weeks went on the more we were involved in our communities, the more we saw of Panama, the more I learned about myself, the more I got to know everyone else, the more I didn't want to leave.... The last 2 weeks flew by and it was so sad to see it go at the end of it all. The mountains, Beunos Aires, Dr. Eric, Dr. Vlatamir, Adelina, the patients, the dogs, the chickens, San Felix and all it's glory, all us girls crammed in our little dorm, the long bus rides filled with naps and conversation, the delicious fried bread dipped in the as delicious coffee, my attempts and fails at speaking & understanding Spanish, the freezing cold showers, the bugs it will forever be in my heart. As I travel through life and my career, I'll reflect back on this trip to remember that fire inside of me that brought me to Panama in the first place. I am so grateful to have experienced all that I have experienced on this trip and I hope one day I can go back to Panama…

I will miss this so much

For my last post I wanted to focus on the health care in the hospital because my other post focused more on our community clinic experience. My first impression of the hospital was that it was super nice. I was surprised at how much it looked like a hospital back home. After seeing the clinic in Beunos Aires, I wasn’t sure what to expect from the hospital. I also noticed the types of patients at the hospital were much different than those at the clinic. These folks were nicely dressed (to a certain extent), appeared cleaner, healthier, and spoke as if they were more educated. They were also more outgoing, friendlier, and they seemed like they had more energy. The pregnant women we saw seemed much more excited about their pregnancies and smiled a lot more than those at the clinic.

My amazing group that I shared the hospital experience with

So our first day in the hospital, we got to experience the birth of a little girl. It was one of the most amazing experiences of my life thus far. I was trying to think back to a time on the trip that I felt this excited or this happy and I think this time tops it all. I knew I always wanted to go in to midwifery or OBGYN…. but when I felt the emotions I did when seeing the whole birthing process, it really confirmed the idea. It was neat to see the UNACHI students do all the work. The doctor only peeked his head in once during it all & continued on his way…as one nursing student handled the rest. I guess as a nursing student you have to help with 17 pregnancies to graduate! I was like sign me up lol. I am unsure of the number of births we have to do back home. It was interesting to see the mother interaction with her babygirl. She wanted nothing to do with her. She didn’t want to hold her, touch her, or even as much as look at her… I don’t know the story behind her pregnancy, but I do know this was her 3^rd child and she was only 23 years old. If she didn’t want the child, you would think after 3 times you would know how to prevent it...

It was also interesting to see the nurses & how they interacted with the mother. From what I could see there was no comfort or reassurance offered during the whole event. Right after the baby was born & the nurse clamped the umbilical cord and took the little baby to the heat lamp- everyone abandoned the mom. There was no baby - mommy bonding time. I know here in the States doctors make it a point to have the baby lay on the mother’s chest to create an in sync breathing pattern between the two of them. And I know the mom at least gets to hold her baby soon after the birth (as long as there are no problems). But this mother did not have the opportunity to hold her baby until 30-45 minutes afterwards. And this is after the baby got sent around the room to take pictures with everybody….. I would be livid if I was lying there watching everyone else embrace my baby before I even got the chance. But the health care professionals there didn’t think anything of it from what I saw. I was surprised at how much they were concerned with sterile technique, the scrubbed in like a surgeon would, had the other nurse place their gloves on for them, everything was opened with sterile technique in mind. Back at the Buenos Aires clinic it would be a shocker to see our doctor wear gloves. During stitches, blood drawls, IVs…no gloves. So it was nice to see the proper precautions taken in the hospital at least. But we also saw quite a few women come in for infection post C-section so it makes you wonder…


dont shoot me lauren ;-) this picture just truly captures
the silliness we shared on the trip!

One of the many parties our friends at UNACHI threw for us....

Our next visit to the hospital my group & I were in gynecology for the entire shift. There was a lot of blood pressure checks, temperature checks, RR checks, pulse checks... definitely not as exciting as seeing a baby being born, but we made it through. The UNACHI students were great to work with. They were so patient, welcoming, kind, and full of so much energy. I lost track of the number of parties they threw of and I completely lost track of how many different times we said goodbye to them lol. We had our final party, said all our goodbyes, went back to the floor, ran into them, worked with them for an hour or so, and said all our goodbyes all over again. I will certainly miss them, along with the nurses and doctors in Panama. The time they take to teach you, the passion they have, and their kind spirits really made this experience that much more awesome. Kind of wish some of the nurses/preceptors here in the USA would go to Panama to learn a thing or two ;-)



I suppose I will add a few pictures to wrap this post up :-) I am so thankful to everyone on this trip who made these last 3 weeks worthwhile! Too bad second degree & upper division are going our owns ways now :-/ We should all do a reunion trip in Panama a few years from now when everyone is actually working & have their own nursing licenses (hmmm, maybe that is not a good idea lol). Well for now this is goodbye! Adios Panama! ;-)

Last night of the trip

SO many memories....



CHOW ;-)

 -Brittany Brewer

Adios Panama Blog 3

As I am writing my third blog for this trip, I can’t believe this trip is coming to an end.  We have had a busy week working in the clinics, in the hospitals, and preparing for all our assignments.  I wanted to touch on my hospital experience because it was very different that what I have experienced in the US.

When I first arrived in the hospital, I was stationed in the triage area for women’s health.  Most of the women on this floor were pregnant and I had the opportunity to assess patients with the doctor.  Not only did I learn how to measure the fundal height, but I also learned how to measure my patient’s cervix.  I listened to fetal heart sounds with a Doppler and also had the opportunity to view an ultrasound. 

After working in the triage, I moved to the labor and delivery unit.  I was fortunate enough to watch the birth of a baby for the first time.  The mother that gave her first birth was fifteen years old.  During her delivery, I truly didn’t know what to expect.  At first I couldn’t believe how much blood was coming out.  She tried several times to push, but the head wouldn’t come out.  When she finally delivered the baby, I still couldn’t believe how oval-shaped the baby’s head was.   The nurses did a newborn assessment and made sure the baby was healthy.  I also learned about the placenta and watched the nurses remove it 15 minutes after the baby was born.  I think it’s incredible that nurses in Panama deliver babies.  Watching this birth was an amazing experience that I will remember for the rest of my life.

           

On my second visit to the hospital, I was assigned to a woman’s floor.  I was assigned to work with two Unachi students.  Although I speak a little Spanish, we often communicated through a Spanish-English dictionary application on my iPhone.  I started and IV here and also gave my first my first enema.  I really enjoyed the opportunity to work the Unachi students and their teacher.  The Unachi teacher was very patient with me and made sure I was doing everything correctly.  I really enjoyed my hospital experience and I wish that I was able to spend more time in the hospital, working with the local students.  Community nurses play a very important role in Panama.  Even with limited resources, they are continuing to provide care to those in need.  I hope that I can come back to Panama and work with the indigenous people in the future. 

One Week in Chami

                So far we have been working in Chami for a week.  We started our day today at the clinic with me hoping to get a chance to hear some fetal heart tones which, seeing as we haven’t done L&D or OB yet, I haven’t had the opportunity to do.  However, our first patient was a middle aged woman complaining of a painful rash on her skin.  It was still interesting, especially since most of the skin issues I see in Florida are pressure ulcers.  Dr. Barry prescribed anti-inflammatory cream and Jessie convinced him to also include antibiotic ointment.  Laura was able to show her how to put it on and make sure she covered the whole area and rubbed it in all the way.
                The one male in our group (who asked to remain nameless) was invited to perform a breast examination on this same patient.  Lauren, who had already done one, was to show him how and he was to report his findings.  When he finished, Jessie asked him to report his findings.  He reported on symmetry, coloration, lack of masses, etc., and when asked about size he says “umm,  ummm, I don’t know, maybe a 34-B?”  It had the whole room just about dying laughing.  Definitely a highlight of the day. 
                As a community health nurse, one of the most difficult things is not being able to see the progression of treatment.  In the hospital setting you watch your patient over the course of their stay and are able to see if the prescribed treatments are working.  Here, the patients are sent home with their creams, lotions, pills, and recommendations but you never know if they will use them appropriately, if they will come back for follow up care, or if they will go home and put their medications on a shelf and forget about them.     I would imagine that this could be very frustrating for some nurses, especially if they are like me and would prefer to see a patient’s progression from beginning to end.

                Looking back, I never thought community health was particularly interesting, probably because you don’t often see all of the time and effort that goes into making changes in the community.  This experience has certainly opened my eyes to all that is involved in community health nursing, and has given me a great respect for the men and women out there every day trying to create change.   

6/11/12 Last Day at the Clinic

Today we did our final teaching at the school. We taught 5^th and 6^th graders about nutrition and had them cut out the various food groups and glue them on a plate. The kids really enjoyed the activity and loved the fruits and vegetables that we gave them afterwards. Dr. Eric was a great help in translating the presentation. Unfortunately Kevin was not in town, so he could not help us and we did not get to say goodbye to him. We left him a USF CON T-shirt and a card, so hopefully he will remember us (I’m sure he will since we greatly abused his translation skills).

I was able to try an IV on a baby today, but unfortunately I did not get it. The first attempt was ruined because the catheter kept slipping above the needle, and then the vein disappeared! The second attempt I got the flash, but blew the vein. I was discouraged, but this was only my second time trying IVs and infants are difficult. Adelina, the nurse, even had difficulty getting the IV in and she is amazing at inserting IV’s. I can tell she has a lot of experience and enjoys her job because she is efficient and always has a smile on her face! She never hesitates to educate the people at the clinic on how they can remain in good health. She is not from the community but knows how to speak to the people so that they will understand why they need to prevent illness and how to do so.

Performing my first IV EVER on an 11 year old boy with Dehydration.

We also got to see Dr. Eric take a thorn out of a woman’s finger. Her finger looked a little swollen with a small entry wound that looked infected. Dr. Eric decided to make an incision to see if he could find the source of infection. He injected with lidocaine and the woman began to cry. I was surprised that she showed such emotion because most of the people are very stoic and strong. She cried into Kayla’s arms as the doctor injected the lidocaine. This was a memorable moment signifying the bond that we have formed with the community and their growing trust in us. Dr. Eric used a scalpel to cut a two inch incision in the finger and immediately puss began to drain. We could see a brown spot which was the foreign object in the finger. Dr. Eric tried to pull it out with tweezers, but the object would not come out. He pushed on the opposite side of the finger and POP! Out came the inch long thorn, so he grabbed it with the tweezers and completely removed it. I think all of us gasped because we were not expecting the thorn to pop out like a jack-in-the-box! He laughed at us. Chiara got to stitch two of the three sutures, which was cool, and the woman was put on antibiotics and kept overnight because she lived so far.

We really lucked out when it comes to the doctors of the clinic. Both speak great English and they are great teachers. They could not be more excited for us to be there and we have created such a great bond with them. They have invited us to come back to the clinic any time and Dr. Eric has even said any time we want to come to Panama City we can stay with him and money is no problem! Haha. We were saying our goodbyes today because it was our last day at the clinic. When Dr. Eric was telling us how emotional he felt and how we made his heart hurt because we were leaving I felt like tearing up. If he would have kept talking I might have cried. Everyone in the clinic was extremely happy to have us there and sad to see us go. They all invited us back and said their doors will always be open for us to return to Buenos Aires. The people of the village were also grateful to have us spend time with them. They appreciated our taking interest in their community and said we are like family to them. I did not expect to get so close to the community in only three weeks; I will truly miss Buenos Aires. All of the people in Panama have been so welcoming and hospitable. We walked into their community as strangers unannounced and left as family invited back whenever we would like. This experience is one which I will never forget and actually makes me want to return to the village to visit or volunteer in the future. I would like to polish my Spanish so that I can further bond with the people of Panama.

So that's how you make cotton balls...

After leaving the City of Knowledge, we traveled to San Felix, Chiriqui to stay at a Priests Compound throughout for the duration of our time in Panama that we would be spending in the community. Three groups were formed and each was assigned to the community & clinic of either Chami, Soloy, or Buenas Aires. My group was chosen to travel to Soloy and work in the health clinic there, as well as visit the school, and Ngobe Bugle Community in the area.

Man in the clinic making cotton balls by hand 

On our first day there, we first stopped at the health clinic to get a tour and introduce ourselves to the Doctors and nurses we would be working for the next few weeks. I can remember watching out the window as the van pulled up to a grungy-looking building with tons of women and children scattered outside. Very few of these people had shoes, and there were random chickens running around everywhere. As we entered the building, there was a long line of people waiting to be seen, and stray dogs weaving in and out through the crowd until they found a chair or desk to sit under (including one in the “Emergency Room”). I was shocked this was a health clinic. As we continued on our tour, I saw cotton balls being made by hand, food being passed out to pregnant women, a little girl popping a squat in the yard out at back as a means of going to the bathroom. Later, I watched as nurses started IV’s and gave injection, after injection without wearing gloves. As we know, this type of practice would be completely unacceptable in the U.S.; however, after spending some time here I have learned there are few other options considering as is they can barely, and often even not afford the proper supplies to treat their patients let alone get gloves, and needles that automatically recap in order to protect themselves.

One of the MANY dogs lying down inside the clinic 

At the school with the kids and their new brushes we gave them!

Next, we went to the school that was just down the street, and up the hill from the clinic. Here, I again saw many children without shoes. In addition, I noticed a fair amount children with decaying teeth, and many looked as if they hadn’t showered in weeks.  As a community nurse, it is necessary to do assessments of your community. Through these assessments problems are often identified and it is the community nurse’s responsibility to find ways to improve and promote health. For this reason, the next day we returned to the school with toothbrushes, toothpaste, and other supplies. We chose to help educate, empower, and provide access to these children by teaching the importance of brushing your teeth, in addition to proper technique. We also did a presentation on health promotion; discussing with older children the aspects of personal hygiene, nutrition, exercise, and the importance of getting adequate amounts of water and rest. Since most of these children are living in poverty, we did our best to tailor the presentation to them by pointing out inexpensive foods that were common to the area but still healthy choices.

One the homes in the Community that I did my 1st assessment on. 

Upon entering the actual community where families lived, I was astonished to see what poor living conditions these people live in. I’ve seen pictures and always known there were places in the world that were like this but to really see it first hand was a truly eye opening experience. The houses were all like little huts made out tree braches and random tarp and aluminum scraps found and tied together. Most houses had over four people living there, but their whole house only consists of one room. For example, for my 1^st community assessment I interviewed a woman who lived in one of these homes with her husband, and her 3 granddaughters that had been abandoned by their mother. The inside of their home was one small room that consisted of a mattress, hammock, and little table they would do the cooking on. In addition to the cleanliness and confined living quarters, a big concern of mine was that all the cooking is done inside. While this would seem like a good practice in the U.S. because most homes there have gas or electric stoves; here they use wood or coal. Using these materials inside a home, especially one with very little air ventilation is very dangerous. After speaking with the doctors at the Soloy clinic, we learned that respiratory issues are one of the biggest problems in the community. Much of this can be contributed to the vast amount of smoke inside the home caused from cooking inside. For this reason, we worked to educate and encourage families to cook outside, since smoke inhalation is so dangerous. 

Inside the home