All good things come to an end

As our journey in Panama comes to a close, I have only good things to say about the people I have encountered and the experience I have had. I have been lucky enough to have experienced many new "firsts" while in Panama, including witnessing the births of two baby boys, assisting with an STD check, and listening to a doctor spend nearly an hour solely on education regarding safe sexual practices. This last facet was very nice to see; in the United States, it would be nearly impossible to find a doctor who was willing to dedicate that much time just to teach a patient about condoms. The last few days spent in Buenos Aires and Chami have only reinforced the importance of cultural competency. Healthcare for the people of Panama is much different than in the States. I have had to adapt to my environment and work through the difficulties that arised. Despite this, I feel like my experiences have been extremely fulfilling. It has been enlightening to see how much responsibility the community nurse takes and how many duties she or he must perform. The scope of practice for a nurse is much wider here, yet the nurse does not seem to get overwhelmed. Perhaps we have much to learn as American nurses. I am so happy to have met so many kind and welcoming people and I hope that I will have an opportunity to revisit them and the communities again at some point. I have learned so much from this experience and will truly miss the people I have come to be friends with. I will always treasure the time I spent here.

A baby is born

At the hospital on Thursday, I was afforded the opportunity to spend time in Labor and Delivery.  From the moment we walked in, a young woman was crying.  I immediately walked over to hold her hand.  I asked her how old she was and whether this was her first pregnancy.  She is 20 and this was her second pregnancy.  She seemed very scared and nervous.  She told me she was in a lot of pain.  I didn't know what to do other than hold her hand and try to comfort her.  She gave birth to a healthy baby boy within about an hour.  I was able to hold her hand and stay with her the entire time.  After the doctor finished assessing the baby, I asked when the mother could hold him.  The doctor informed me that I could pick him up and give him to his mom immediately.  It was a very moving experience to hand a newborn baby to his mother for the first time. The mother informed me that her first child had passed away.  At that point, my heart broke for her and I understood the level of fear she was experiencing during labor.  I tried to reassure her that her son was healthy and everything was fine.  Unfortunately, I'm not fluent in Spanish.  Dr. Cadena asked Jessi to assist us in explaining to her that her son was fine. I asked her permission to have a photograph with her and her son and she agreed.

Culturally Competent Care

At the clinic, the head nurse was providing immunizations to a lot of the community members.  We participated and administered the injections.  I introduced myself to my patient in Spanish before drawing up the influenza vaccination.  She seemed confused when I spoke to her.  The nurse explained that the patient understands Spanish but speaks mainly Ngobe, the native language of the indigenous people in the area surrounding the clinic. The nurse helped me translate some basic sentences from Spanish to Ngobe.  The nurse was fluent in both Spanish and Ngobe.  She explained everything to the patient.
One of the doctors, on the other hand, claimed that Ngobe is a useless language.  He could not understand why the people do not just learn Spanish.  He has refused to learn any words in Ngobe and communicates with the patients in Spanish only.
I was very impressed with the level of care the nurse provided and confused by the doctor's comments.

The Trip is Coming Close to the End!

Now that I truly understand that general nurses practitioner most often care for one patient at a time, but community health nurses care for entire populations. For instance, Soloy clinic nurses work with entire Comerica Noble Bugle community. They are able to educate community about health issues, improve health and safety, and increase access to care. Panamanians community health care has implemented health education campaigns and disease prevention activities, such as immunizations and screenings. They tell the community they serving about locally available health care programs. They also provide direct health care services to vulnerable and those at risk populations.

Last week, we visited at the hospital (Hospital Materno Infantil, Jose Dmingo De Obaldia) with UNACHI faculties and working with students side by side. We have given a brief tour and have introduced different departments and their staff members. We have divided in to six groups and assigned to three or four departments.  First few hours our group spent emergency triage pregnancy and then moved to labor and delivery. According to UNACHI students state that they deliver three babies per semester as part their curriculum. The students are prepared to handle any primary care may arise from the community they are serving except when things are complicated.

    
So far I have had a wonderful experience. It has been an interesting trip in Panama. Panamanian gave us warmest welcome to their community. I was with friendly the faculties, students, and the hospital staffs members. I have found it easy to communicate with the faculties, students, and the community in general. I had a great time interacting with the UNACHI students and communicating with mixed Italian, Spanish and English. It was a great experience being at the hospital and I learned a great deal about the differences in culture at the hospital and language barriers between us.  


 

Yesterday we went back to UNACHI and the hospital one more time. We worked with faculties and students in GYN department. We also said with final goodbye with faculties and students. Our Panama trip is coming to close and soon we will back to the states. I am feeling that being in Panama has increased my skills and awareness of different cultures that exist within Panama. I am very thankful that I had the opportunity to be with Comarca Ngobe Bugle community for this trip.  


Muchas gracia!

Homeward bound

As our trip draws towards a close, I can’t help but be thankful to be going home to a comfortable bed and a clean bathroom.  This leads me to reality that the people in the villages and our clients at the clinics don’t have this luxury.  They never have.  With the persistence of community nurses and public health officials, this will hopefully change one day.  Hopefully one day they too will have clean water and toilets for waste.  We have spent the last few days gathering and analyzing information from individuals in the communities with the intent of presenting our findings with students and faculty at UNACHI in the morning to hopefully contribute to this cause.  Our hopes are that our information will provide UNACHI with the resources they need to continue to research these rural communities.

There are many cultural differences between ourselves and the Ngobe Bugle people living in the communities, however, language seems to have been the be the largest barrier to truly understanding each other.  Assessments of the people included living environment, family size, health concerns, and community history and leadership, none of which can be assessed without understanding each other’s language.  Although their views on health are very different from ours, each student has found effective ways to communicate in our own medical language.

I have taken away many skills and experiences from our three weeks here in Panama.  I understand just how different a culture can really be.  It is helpful to understand what it might be like to be the one who doesn’t speak the language or understand what normal is for a culture.  I hope I will be able to use these experiences in my future career as a nurse.  As for now, I’m ready to pack my bags and get on a plane for Florida!! 

Welcome to the Jungle

The last two weeks, we have had an amazing experience at the clinics surrounding San Feliz.  Our clinic is in a small village called Buenos Aires and serves about 2,000 residents in the area, as well as villagers who walk for up to ten hours from the mountains just to get to the clinic.  The clinic staff consists of two doctors, a nurse, a nutritionist, a dentist, and a health promoter.    

Panama as a country prides itself the vaccination of its people.  This is very apparent in the setup of the local clinic.  Upon registration every patients’ immunization record is checked by the nurse, and any missing immunizations or vaccinations are given and signed off on their form before seeing the doctor.   In addition, nurses also deliver vaccinations at health fairs in the community; as well as going door to door among the houses and businesses to make sure that everybody is up to date on their vaccinations, and if not their receive the shots on the spot.

There are also differences in the scope of practice for Panamanian nurses, as they have a much wider scope compared to nurses in the U.S.. For example, the other morning Kelsey and I shared doing a pap smear on a young woman at the clinic.  It was a personal experience for everybody involved, and one that probably wouldn’t have happened in the United States.  Panamanian nursing students are also required to deliver a certain amount of babies before graduation, and can do so without the assistance of a doctor in the room!

Today we are headed up to the mountain town of Boquete.  We will be doing some education with students at an orphanage on the way, and tonight some of us will attempt to summit the Baru volcano.  Let’s hope we all make it to the top!!! 

-Chiara Stetson

We Made It to the Top!!!

Well I am happy to announce that our final week in Panama has been successful! We have preformed new nursing skills, enjoyed a relaxing weekend in the mountain town of Boquete, and have said goodbye to what has become family at our clinic in Buenos Aires.  A major theme running through nursing school at USF has been collaboration amongst the interdisciplinary healthcare team.  That title has a whole new meaning in Panama!

            I have learned and experienced very much in my time here in Panama, but the thing that has left a lasting impression on me was the welcoming and giving nature of the Panamanian people.  From our first day in the clinic the staff treated us like family. They presented a bunch of strangers (us) who didn’t speak their language with welcoming presents and emotional goodbyes.  Since there was usually just one nurse on duty at a time in our clinic, the collaborations between the interdisciplinary team was more like a team of family members.  Throughout our three weeks at the clinic everyone sacrificed and went out of their way to help teach us new skills, act as our interpreters in the community, and foster our understanding of their culture. 

            Working in a small and isolated community health clinic the nurse is able to get to know and build relationships with the patients.  This enables the nurses to know the thorough health history of their patients and possibly partake in better health promotion efforts since they know the patients on a personal basis. 

            Within the past week I have done my first stitches, observed physicians teach about family planning and prevention of STD’s, and taught local elementary students about nutrition.  A group of us successfully summited the highest volcano in the country towering at 11,398 feet, and we all did screening assessments at a community health fair in Chami.  Overall the trip was a great success and I am sad to be leaving the hospitality and friends that we have made in Buenos Aires. I am leaving Panama with a new appreciation for all of the opportunities that have been granted to me throughout my life-access to quality healthcare, nutrition, education, and my family.  I hope one day to return to this beautiful place and expand on my nursing skills and my understanding of the Spanish language…but that will require just a bit more time!


-Chiara Stetson