A school day in Hato Juli

Yesterday we spent a couple of hours teaching basic hygiene and nutrition to a kindergarten class. We focused on hand washing, teeth brushing, and nutritious fruits. There are mango trees everywhere, as well as coconut, grapefruit, and orange trees. The grocery stores here in Chiriqui do not sell fruit; instead, a fruit truck drives through the community periodically with fruit for sale. However, most of the fruit falls to the ground and is allowed to rot, as fruit is not generally included in the indiginous diet. So we introduced the concept of vitamins A, B, C, D, and E by holding up paper with the letter on it and linking it with a fruit. Several minutes into our presentation, we learned the children only knew vowels, so we also introduced them to consonants! Then the children were all given different fruits which they had to toss at the person holding the appropriate vitamin letter. These normally reticent and impassive kids were very enthusiastic with this activity! Hand washing techniques were improvised as best as we could, given that we had to bring our own bowls, soap and towels. Our group, in Hato Juli, was very fortunate in that the teacher had a large pot of water ready for us in the classroom when we arrived. Compare this with the groups who valiantly attempted to teach handwashing skills without the benefit of anything with which to rinse! Our small, doe-eyed pupils gazed at us with wonder when we showed them how to clean their nails with a nailbrush, ultimately admitting that none among the group had ever attempted such a feat. Everyone received a new toothbrush after a demonstration on the most effective cleaning method for the prevention of cavities. Most of the adults and older children have uniformly straight, gleaming white teeth, but the primary teeth seem to be ignored in terms of hygiene - perhaps in a reality with such scarce resources, teeth that will be discarded by the body within a few years are not considered worth any expenditure in effort. Whatever the reason, our audience with their shy, gap-toothed smiles seem perpetually entertained by their "gringos!"

Today is the first day I have been able to blog so I have alot to say. This trip has been a lot different than I expected but in a good way. I am at a clinic at Soloy which is in the Comarca (indian reservation) of the Ngobe Bugle people. I have had the oppotunity to do lots of shots and vaccinations in the clinic along with learning a lot about this different culture of the Ngobe Bugle people. Today we taught at the local elementary school. I was awesome! The children are so eager to learn and excited that we are there, not to mention that they are absolutely adorable! For the teaching today we taught 3 first grade classes, and 1 second grade class about hand washing, teeth brushing, nutrition, and a few words in english. The kids just couldn´t get enough of it, they were literally lining up to wash their hands in a little bowl that we brough, and so so excited that the tooth brushes that we handed out were for them to take home. Overall today has been one of my favorite days since we have been here, I never though I would see kids so excited to simply have a toothbrush in their hands that is their own. Tomorrow we go back to the school to teach about recycling, I am so excited!

Panama 2011

Today is pretty much half way through the trip! It really has been an amazing experience, I've definitely adjusted to a different lifestyle. Clinicals have been good so far, I've been able to give many IM injections which I hadn't done before coming to Panama. I haven't seen a live birth yet but I'm hoping I will be able to see one before I leave. The community where I am doing clinicals is called Soloy. It is a very poor community that has little health care and no filtered water. The clinic is unsanitary. My group is doing clinicals along with the UNACHI nursing students which is pretty cool because they teach us how they do certain things and we teach them how we do. I was in their Emergency Room yesterday and it is nothing like it is back home. It's an open room with no indicidual private rooms. Everything basically happens in the open, which is completely different thaN the U.S because we are very strict in practicing patient privacy. The school that is up the street from the clinic has over 700 students. The classrooms aren't merely as sophisticated as the classrooms I've seen back home. But students don't know anyhing else so they are content with what they have. Today we taught 4 different classes dental hygine, proper handwashing and about the different vitamins found in fruits and vegetables. It felt good to inform these children on things can do to prevent getting sick and transmitting bacteria. Tomorrow we will be going back to the school and teaching the students about the importance of recycling. Overall, I've noticed the people living in these communities are living the simple life. It doesn't get any more simple then living their life. Goin out into the communities a d seeing all these families that have lived their whole life without clean filtered water is amazing. I've definitely taken drinking water from the faucet as granted. Their lifestyle has given me a new prospective on life. I hope the next few days are filled with good experiences! :)

Panama es mi favorito

Today's clinical experience was definitely the most memorable yet. There was a 21 year old pregnant woman that was in labor, so the ambulance was called but took hours to get to the clinic so the doctor delivered the baby there. It was amazing that he was sitting in his office seeing patients, then had to go deliver a baby while the line of patients got longer and longer, and then after the birth he had to see all of them. He has so much responsibility and always stays so calm. Witnessing the birth of the baby was such a unique experience. The woman only received topical lidocaine for pain, and even though she would moan a little through the pain she was never screaming. I was really scared for a while because one of the techs thought the umbilical cord might be wrapped around the baby's neck because the birth was delayed. Thankfully it wasn't, but when the baby was born she barely cried and was very blue. She finally let out a soft cry which gave my huge relief. I got to hold her and she was so precious! There is usually only a birth there about every 2 months so my group was so lucky to be able to see it.

We also went to the school today to teach the children how to brush their teeth. It was a little difficult since the school didn't have any running water. We were able to have them brush their teeth using basins of water, but it made me realize how hard it is for them to be able to do that at home. 2 people from the peace corps were able to talk to us last night and that was also awesome to hear about. One of them is an engineer who has been building aqueducts and another is an English teacher at a school. When they were describing their hut that didn't have electricity and how many snakes, bats and spiders they have come across, it made me even more thankful for the compound we are staying in!

A new life :)

On our drive up the mountain to the clinic in Alto Cabiliero we happened to see Diyana, the nurse at our clinic sitting outside a restaurant in civilian clothes. We thought this was strange, but when we got to the clinic it was immediately put out of our minds as we saw the multitude of people waiting there for treatment. An even more pressing issue was the fact that there was a young woman in labor, who was already dilated 5 cm. An ambulance was supposed to arrive to take her to the hospital but as we sat with her and her contractions came quicker and quicker we realized that the baby was coming much quicker than anticipated. Everyone in our group crowded into the tiny, stifling hot exam room along with the doctor, the mother, the grandmother, and several techs. The doctor was upset because the clinic did not have the capacity to deliver a high risk pregnancy, but he was very calm and patient with all of the students. As the mother moaned with each contraction and the doctor began to cut open her perineum and vagina, I felt like I was going through each cut and pain with her. When the baby's head began to come out I had my hands clasped together and I think that I was more stressed out from just watching than anyone who was actually helping with the procedure. When the mother gave her final push and the baby slid out with a burst of fluids and myconium I breathed a sigh of relief. When I saw the baby however I was shocked. She was a blueish gray color and did not make a sound. The doctor suctioned the fluid out of her mouth, and still she didn't cry. The tech was bringing in the ambu-bag when she finally let out a short wail. I think you could actually feel the tension being lifted when she cried out. As the tech took her to be cleaned off I realized that I had tears in my eyes. I'm not sure if it was just a build up of stress that was suddenly lifted or if it was the immense joy of seeing a new life being brought into the world. When we finally brought the baby into the room where her mother was, she didn't really want to take her it seemed. We told her the baby needed to be fed though and Liz and I helped the baby attach itself to the breast. After she was fed she looked up at her mother as if she was trying to imprint her face in her memory. I told the mother that her baby was looking at her and she looked down at her child, and maybe I was just already Feeling sentimental from the whole experience, but it seemed like you could feel the love between them in their gaze. It was a beautiful experience.
As beautiful as it was though I think I can rule out OB as my future specialty. And what a terrible day not to have a nurse on duty! All of the doctor's time was taken up with these two patients and when we left, he still had a clinic full of people waiting to be seen. I felt bad for them, but they didn't seem to mind. In fact, when we brouht the baby out to be measured and weighed most of them smiled and seemed happy for the child and her mother. All in all it was a fantastic experience and I am very happy that we were blessed with the opportunity to see a new life coming into the world.

Half Way Point

Today is our 11th day out of 22. Its hard to believe that it is half way already. I am missing home, and will be glad to head back, however I will truley miss being here. Panama is quite intriguing. Since I last wrote, we have been to Hato Juli, my clinic, 3 more times and had a fun weekend at the beach.

Clinically I have gotten to do some cool things. Probably my favorite, thus far, was getting to feel a 27 week pregnant woman´s baby. It was amazing to feel such a little head and listen to its heart beat with my stethoscope. Embarrassing but it is the truth, that I finally have done my first manual blood pressure. Infact, I have done many. I know by the end of this trip I will be an expert at manual blood pressures and vaccinations. Panamanians love to get vaccinated! Sadly I have also seen severe cases of scabes. Today, I saw a 2 month old baby and mother with a terrible case. There are so many things, I could go on and on.

Coming up this week we will be going to our different clinics through Wednesday, and then Thursday we will be going to the hospital in David, that will be exciting!

Rhymes with Shmanama

This is WILL BOLAND, Im writing under this blog because for some reason I cannot create my own that will allow me to contribute to the CON blog.

Our time in the clinic has been interesting, educational, and sometimes uneventful. I like to see the differences in how the ¨system¨ works. They run their clinics relatively the same as America. They state why theyre here then are treated according to priority, and transferred if the level of care is beyond the scope of the facility. The Panamanians do have limited resources so they do things like spray cotton swabs with alcohol or use gloves as tourniquets. However with few resources, I would think they would be more careful in how they use them, and take better care of their equipment.

The Nursing students here have much more hands on task-oriented practice than most of us do. They also have different techniques of performing those tasks. They rarely start IVs in the AC, they prefer the hand. This is a basic rule, that nobody really goes by in America, because you can infuse fluid in the distal to an already punctured vein. I explained (or tried to) to one of the nurses that we mostly start in the AC because it hurts less and its easier.

I can only fix one problem at a time. Sorry about that headache.

When we went to our clinical areas for the first time we saw that basically everyone in Soloy sits in one big unairconditioned room waiting to be called. I stayed in the Doctor’s room the first day as she took patients. Each person had to say one thing only that they came there for. This is different than we’re used to because if you have a problem with anything else than say stomach pains you can talk to your doctor about your recurring headaches and have both taken care of at the same time. The doctor was very ademate about only one problem that could be taken care of. She did a lot of teaching with the women she saw and tried to be certain that they understood her directions. One of the biggest cultural differences I have found is the fact that many men have girlfriends as well as a wife. I know you’re thinking that this is the same as America but in Panama they’re very open about it and seem to accept it. Several other differences are that there aren’t many trashcans, soap dispensers look to be about ten years old, and no one seems to know what sterile technique is. We went to the Comarca also, which is the Indian reservation in Chiriquí. Their houses are mostly made out of pieces of wood and straw roofs. As I passed out candy I saw how little these people really have. Some of children have little to no clothing. I told one woman that we were going to be helping teach hand washing at the local school and she asked me how we were supposed to teach that when they couldn’t afford to buy soap, not to mention the fact that the water is unsuitable for use. I really didn’t know how to answer that because what can you really say? You can’t say it’s going to be OK because it’s not alright that they have to live like this. Even though these people don’t have much money they are happy especially when they’re playing in the river or walking their pet monkey, one that was happy jumping on our heads.

Soloy Clinic

My first day at Soloy clinic was culture shock. The clinic is small and very unclean, with dogs and cats walking in and out of the clinic. There is no water nor electricity in the clinic. For population of 23,000 of patients registered at the clinic there are 3 doctors, 2 nurses and also there are the promoters that go to the community to speak to people about how to clean water, not to drink dirty water, teach them about healthy living and educate about birth control.

I was placed at the ER with doctor, nurse and nursing student. I gave 3 IM injections all of them antibiotics. Doctor disclosed that he prescribes antibiotics to all patients in IM form due to patients forgetting to take medications or loose medications so they don’t take the prescribed dose of antibiotics that are necessary to be completed in full prescribed dose to kill the infection. According to doctor, patients don’t believe in waking up and taking medications on time. During my day at the clinic I observed that Panamanian people don’t talk much even doctor to patient, their conversations are very short and to the point. I also observed a problem with trust. It seemed to me that Panamanians trust their doctors in that way that they don’t even question doctors what are the side effects of the certain medications or what exactly are they for, they just pick medications and take them. I wished there was more teaching involved. Also there is little trust given to us “gringos” at the clinic. My goal is to work my best in next week or so to get their trust and I think I am slowly getting there now that I was there for 3 days. In addition I think that there is hardly anything that can be done as drastic help until we fix the water problem.

Bienvenidos a Panama!

When we arrived in Panama it was exactly what I thought it’d be like: some large buildings with a lot of family owned shops and rundown apartment buildings. When we first got to the City of Knowledge it really was like its own little town. There was a gym, pool, and fields for almost every sport. It really was a nice area with all the modern appliances I’m used to. Panama City is almost like towns in America with small convenience stores and plenty of beautiful churches. Each of these churches has its own unique history. It makes you wonder how anyone chooses which one to attend. Most of the city is familiar except everything is in Spanish. I know everyone speaks Spanish here but it was strange that almost everything has Spanish on it. I was glad that I’m able to understand most of it. It’s really frustrating though when you don’t know every word and can’t completely communicate. After a day we left for Chiriquí, about an eight hour bus ride away. We stopped by a local outdoor cafeteria and had some really good food, even though I’m not really sure exactly what I ate. While I’m here I’m really trying to eat as much of the local food as I can because you can get McDonald’s anytime. The compound where we’re staying at is run by a Jesuit priest. The scenery is gorgeous and everything is so colorful. I met two little boys last night, Enrique and Daniel, and Kayla showed them a picture of one of the priest’s four dogs. I asked them if they wanted a dog and Enrique, who is four, said “Yes, but we’re not rich so we can’t have one”. It was so great to see their reactions to things they haven’t seen before. The compound is better than I expected because I didn’t think there would be running water. We can at least take showers everyday even if the water is freezing. There’s even a filtration system here. I think the best thing about this country is how peaceful it is and how people go along on their own time.

que diferencia

today is our free day here at la playa de barqueta. we are enjoying the beach with 5 to 6 foot waves, black sand, beautiful pool, with perfect weather whereas we were previously in the comarca of panama serving the community through health education, administration of vaccinations, and information collection on how to better serve the people. it hits me so hard every time to see the drastic difference within the same country. what makes me even more sad is that i know within 2 weeks i will be back home with all of my amenities and comforts of home and they will remain in their poverty stricken communities where the basic necessity of water is hard to come by. it breaks my heart to see people like that. in the midst of such a difficult situation, you see a child smile and it breaks through all the darkness around. how a child can smile and have that happiness is beyond me, but i think it has to do with the innocence of a child where they dont quite understand what is going on. they are just living life with high aspirations.

i am having the time of my life and cant wait to see wait is yet to come.

me llamo...AMERRRICUHH

Yesterday (Thursday), my group and I, accompanied by Dr. Cadena, headed to our clinical site. I was grouped with seven of my classmates (Kelsie, Will, Kristen, Kate, Merdijana, Winnie, and Marcela) to the community clinic of Soloy. On Monday, all 23 students toured the three different clinics in the community which we chose to do our clinicals at--Soloy, Alto Cabellero, and Hato Juli. I picked Soloy because it seemed to have the most going on, and served 23,000 community members. Today we took our bus out to the community and the local elementary school. When we arrived in our big white bus, the children all just stared at us. They all gathered around and were interested in us immediately. We exchanged what words we could and took pictures with the children. They LOVED the cameras and seeing their images on the tiny screen. I am so eager to get back to the elementary school next Tuesday and Wednesday and talk to the children more about community health.

Wednesday was our first day in Soloy. We got seperated and assigned different tasks. Kelsie and I were paired up and worked along side the doctor and student nurse. Dr. Cadena informed us that the doctor knew a little bit of spanish, but she lied. All in good fun, though. The doctor would talk to us in spanish (very fast, it seemed), then Kelsie and I would look at eachother, exchanged what words we understood from the doctor, and decide what he said. Hand signals and sherades helped a lot. We got to measure pregnant women´s abdomens and the doctor would tell us when they started their pregnancy, and he would have us (in spanish) tell him what week they were in, what trimester they were in, and when their expected due date was.

Today in the clinic of Soloy, Marcela and I started with immunizations, mostly flu shots. I was happy to be there for Marcela´s first IM injection--she did awesome! And she´s fluent in spanish which helps enormously. After I gave about seven IM injections, I traveled over to the clinic´s Emergency Room, which is very different from the ER back in the states. In the Soloy ER today, I mostly did antibiotic IM injections and other IM injections. I assisted in an IV as well, along with the nurse´s help.

I am very excited for my clinical experiences in Soloy, as well as the other clinical experiences that we have yet to see. The community here in Chiriqui is amazing, and the people are so welcoming (although we are like aliens to them). Tomorrow we are heading to la playa in David, about an hour away from our compound. I am excited to hang out with friends, surf, and enjoy the sun and the Pacific ocean.

panamanian love

(Written on Sunday, May 22, 2011--just got hold of internet for the first time!)

Today, we arrived in Ngobe Bugle, Chiriqui and the comarca. We are staying at the Padre´s IHS compound. Although the accommodations here are not as nice as Panama City, I still have nothing to complain about. It is actually nicer here than I had expected. Living with 18 other girls in one room can get hectic at times, but I think we are all getting along perfectly.

In Panama City, we stayed at an old American military base that is located literally right across from the Panama Canal. The Panama Canal is a remarkable thing--we watched ships go in and out of the canal for probably two hours, at least. Later that night, Matt, Will, Suzi, and I went to a local restaurant on the base that had a great view of the canal; we watched the sunset and saw an enormous cargo ship approach teh canal. Later that night, all 23 of us students and Dr. Cadena and Eloisa went out to dinner and enjoyed the local tastes of Panama. We all bonded and shared stories.

After that second night in Panama City, I realized that I am experiencing an amazing opportunity with amazing friends, and I wouldn´t want to be anywhere else in the world right now.

Blog #2

Today was our third day in the clinic at Hato Juli. It has been an incredible experience so far!

Wednesday I started off by taking a bunch of vital signs prior to the patients receiving vaccinations (vacunes en espanol). Then I got the opportunity to shadow the internist, Dr. Iro Montezuma. He assessed a few patients and prescribed some medications for scabies, cold, GI upset, parasites, headaches, etc. Unfortunately a nurse was not present, so I was limited on the procedures I could take part in. Regardless, it was amazing to be immersed in such a different community as the Ngobe tribe.

Yesterday we got the opportunity to follow the community promotor into the community instead of staying at the clinic. Since he had already been to the area close to the clinic, we got to talk to the people, play with the children, and do some cancer risk surveys for class. It was incredible to interact with people even with such a limited understanding of their language. It has been a challenge practicing my Spanish, but I do think it is coming along!

Today a nurse was finally present and myself and fellow students got the chance to give IM vaccination injections to women, men and children. It was a learning experience! We each did about three or four vaccines.

I find it so interesting how things work in the comarca. Nurse techs are allowed to give vaccines, doctors do not run labs to diagnose and prescribe, the people have no potable water source, all of the women wear (beautiful) long colorful dresses, etc. The houses in the comarca all seem to have clay floors and are very open-- I don´t recall seeing any doors. I am curious to see what the Ngobe people think of us Gringos being here and how they feel about their healthcare system (which is socialized in Panama).

Mas luego!

I'm on a tractor..I cut the grass faster!!

May 25, 2011. Wednesday

Today was our first day in our separate clinical groups. I went to the town of Alto Caballero. There was a long line of women and children waiting to get in to the clinic. Hours are 7a-3p Monday -Friday, so it is usually busy in the morning. It is usually women with their children; very few men were there unless they were the ones sick.

We all split up into pairs and jumped right into helping. The first place I was at was with the doctor , who happened to speak some English. He saw a couple of patients and then explained what was going on with the patient and what he was prescribing. After about 30-45 minutes, we switched stations. I worked with in "triage", so the tech would call in the patient, and my partner & I would weigh, measure height, and take blood pressure (BP for adults, no BP for children). This part was pretty fun because I got to practice saying my numbers in Spanish! The last rotation I was at was giving IM injections to the adults and children.

A couple of things I found to be very interesting about this clinic. First, there is no running water during the "dry season", which is from December-March. They can't even wash their hands! The clinic is all open, and uses minimal electricity. Also, when the nurse showed us how to give the injections, she didn't wear gloves and she recapped the needles, which increases the risk for an accidental needle stick. I was very surprised at how patient the people were as they waited to be seen. They walked hours to get to the clinic, then waited for hours, and no one complained. No one yelled or got angry. So different from America!!

We also visited the elementary school down the street. We spoke to the assistant director and asked him lots of questions regarding the school & community.

Here are some highlights:
-no running water during the dry season, since there is not enough water pressure to push it through the aquaduct.
-enriched rice everyday for lunch. No drinks
-hardly any discipline. Students are well behaved.
-no corporal punishments. They only talk to the parents if there is a problem
- kids walk up to 1.5 hrs to get to school, by themselves. No worries about kidnapping.

I can't wait to get back to school and teach the children about health care. They were friendly and adorable!!

I'm Dr. Friend..Dr. Best Friend.

Tuesday May 24th.

We traveled to the city of David. I read in the travel guide that it is the 2nd largest city in Panama. David has the University of Chiriqui, which is one of two colleges in Panama (public at least, from what I gathered). The day started out with speakers from the faculty of the nursing part of the university. All I could really understand was "welcome" and "students from the University of South Florida. The rest of the Spanish went over my head.

After all the speaking, they gave us cups of delicious fresh fruit and small boxes of chicken bites with french fries. They we headed over the the pediatric hospital. Here we got wifi (YAY!!) and a tour of each floor of the hospital. They showed us the dental chair on one of the floors. It's strange to see a dentist chair in the hospital!

I'm looking forward to coming back to the hospital in the upcoming weeks.

Panama

This is my second blog and there is quite a bit to share! Since my last post, I have been to El Universidad de Unachi, visited a women and pediatric hospital, and began work at my clinical site of Hato Juli. Lets begin with the trip to the University. When we first arrived, the whole group filed into an auditorium style classroom for the nursing students of Unachi and a representative of the nursing began to welcome us all to Panama and thank us for being willing to experience another culture. She also showed us a PowerPoint presentation about what their nursing school experience is like and how much they emphasize community in their schooling. Thankfully we had a translator because my head was beginning to spin! When the representative finished her presentation, a few of the nursing students, dressed in all white, began to serve us french fries and chicken nuggets. I was starving and played right in to the stereotype that Americans love fried food! When the meet and greet with the Unachi nursing students concluded, we headed for our next destination, a hospital for women and pediatrics. As we began to tour the hospital, I was thinking to myself that I am excited to see how the layout and how it compared to the United States. We were able to take a glimpse into the Pediatric ICU, and for anyone with a heart, it is hard to see those children hooked up to tubing and not knowing if death awaits them in the near future. As we continued the tour and saw the general floors, I noticed a difference between the Panamanian hospital and one in the United States. each floor in this hospital only had two or three nurses that cared for about thirty patients. In the States, nurses usually only care for about four patients but here they may have up to twenty patients to look after! Lastly, I want to talk about my clinical experience in Hato Juli. The first day I was there, I was basically the triage nurse taking vital signs and getting weights and heights for each patient. Next, we were able to go out into the community more and interact more with the people. This was an awesome experience as I was able to see how they live and go about their daily activities. Today was the first day of giving vaccinations. I gave four vaccinations and attempted and IV insertion on a nine month old. I was not able to find the vein but I gained valuable experience for my next try. Thank you for reading my blog and now tomorrow I head to the beach!

Cristina Rondolino- Semana una en Panama

My time in Panama so far has been truely eye opening. The issues that the people of Panama face are so much different then what people face in America. The clinic I am placed at, Alto Cabellero, has no running water. The whole town has no running water for half of the year and the people rejoyce when the rain comes because it means. Clean water and a chance to bathe. The school has no running water, and we are planning on going there and teaching them to wash their hands and brush their teeth, but it makes it a lot more difficult when there no running water! We talked about how when we went to the Panama canal we learned that with each transit 52 million gallons of water are wasted and there are 38 transits a day. That is 3,364 million gallons a day. It is just interesting that same thing that drives the countries economy in such a tremendous way, comes at the expense of its most precious resourse.
The people of the Comarca are unbelievably peaceful. When waiting in line for the clinics they wait patiently for hours, some times all day and never complain. There is very little crime here because people.have so much respect of one another. If I could bring one souvenirs back with me tho the states it would be the peace that I have felt here. It is something that America has gotten so far away from.
We have only been in the clinics for two days and I already feel like it has been a life changing experience. I have given multiple vaccinations and antibiotics, I have gotten to speak with people and watch the language barrier fall down. It is truely amazing. I am really enjoying being able to practice my Spanish but I am finding that I can understand a lot but I do not know how to respond. Some how everything works out though.
The man at the clinic who gives the vaccinations, Aldo, was a great teacher even though he did not speak any Spanish. He taught me how to give intramuscular injections on people of all ages and was very helpful. At the end of the day he told us that he was not going to be at that clinic anymore because he was just there to help out temporarily. He took pictures with all of us and then gave us all bracelets that he made us!
I am really loving being here and trying to make the most out of every second. There is so much to write about but I think I hit some of the high points.
- Cristina

First week in Panama

Wow, so this first week has been amazing! I'm in the clinic Alto Caballero and everyone has been so friendly and helpful. The doctor speaks some English and taught us a lot. His cousin came to the clinic and invited our whole group into her home. She also spoke English because she lived in the US for 2 years. We were so grateful for her generosity, she even gave all of us delicious pear juice! We asked her about what she did to prevent illness and she was very knowledgable about having to wash hands and clean, etc. But she also said during the "dry season" when there is no water they have to wait for the rain to shower and do laundry. She also said they don't have much access
to fruit and vegetables. Going out into the community and talking to the people is my favorite part, especially when we were able to go to the school and interact with the children. The clinic experience has also been great, I've been able to give a lot of vaccines! I'm definitely excited for the next 2 weeks!

Panamaaa

Wow, I can´t believe we have already been here for a week! What an incredible experience it has been. The most eye opening part about the trip so far is the fact that in Alto Caballero, which is the community I have been assigned for my clinicals has no running water unless it has rained. This seems to be a huge problem for the country of Panama which is kind of interesting considering that Panama is also the home of the Panama Canal which does not recycle water that is used in locks system. The lock system uses 52 million gallons of water for one transit and makes 38 transits a day. Just think of all that water that is going to waste just a few hundred miles away from Alto Caballero where they do not even have enough water to wash their hands with. That is 1,976,000,000 gallons of water a day. Ay, caramba! After being at the internet cafe for over an hour hopefully I can actually get this to post this time.

A welcoming experience

Today was such an amazing day for the 9 of us at Alto Caballero. We worked in the clinic in the morning where it was especially crowded due to today being the day that the government checks came. I worked in critical care and mostly did IM injections and nebulizer treatments, but I also got to do my first IV today! It was a lot easier than when I attempted in the States because the people are so reserved here. The lady who I put an IV into had no facial expression, nor did she speak, even though I was obviously performing the procedure for the first time. Afterwards, I asked her if it hurt and again, expressionless, she shook her head no. Her lack of nervousness helped to make me less nervous as well and I think I can go back to TGH and insert an IV with confidence now.
Besides having my first go at an IV, our group had a few amazing things happen to us today. First of all, a woman came into the clinic who spoke almost perfect English and invited us to her home. Turns out she had been an exchange student in the US for 2 years. When we went to her house we found out that her family ran a small store and were reasonably well off. She is studying to be an English teacher and she helped us out by doing a survey. She went out of her way to make us feel welcome and gave us all drinks and had seats for us. We all felt so welcome.
The next experience we had was equally welcoming. On our way up to the birthing center after lunch we ran into a very friendly older lady with her granddaughter. Most of the women here give us blank stares or smile shyly. Very few actually talk to us, and when we try to talk to them they tend to giggle or just ignore us. This lady welcomed us though and told us she liked foreigners. We spent at least 15 to 20 minutes just shootin the breeze with her before she gave us directions to the birthing center. When we parted from them we left them with bubbles and plenty of candy for her granddaughter. The birthing center turned out to be empty but I'm glad that we went down there because on our way back up to the main road we found a house. From a distance we saw a child come out and even from where we were standing we could tell he was malnourished. This was my first experience seeing starvation up close. We had already given away the leftovers from our lunch, but luckily I still had a Nutella sandwich left. Elouisa and I walked down to the house and while she talked with his parents I gave him my sandwich. Up close he looked as if he had been through the Holocaust. I couldn't tell how old he was because he was so small and sickly looking, but had the face of an old man. I tried speaking what little Spanish I know and asked his name. He had some kind of mental retardation perhaps due to his malnutrition, and could only make unintelligible noises though. I think he understood what I said though because he would nod his head to answer my questions. He then reached out with his skinny little arm and grabbed my hand, which I can only assume was a thank you. His parents told Elouisa that he had been abandoned 2 years earlier and that he ate a lot but had never gained any weight since they took him in. They had even sent him to a nutrition program. We suspected that he had a parasite if some sort. As we were walking down the mountain I had to hold back tears for him, and I pestered Elouisa to ask the doctor at the clinic what can be done for him. It's amazing how much you can feel for the people here even when you barely know them. During the day we were talking about how much we want to do for them, how we want to go above and beyond in our help for them. It's kind of frustrating that we are only here for 3 weeks and we won't have a chance
to tackle some of these problems that really need to be dealt with. In this course we are learning about advocacy in a community, but it feels like we really just don't have the time to be
A community advocate in our time here.

A day to remember

Today has by far been the best day of the trip! I followed a health promoter, along with 3 other classmates, through the community of Hato July. All of the families in that area like in homes which they made themselves, some out of wood, the nicer ones out of concrete blocks. We met one family in particular who we helped sweep up the floors and the guys chopped some wood. The woman of the house allowed me to try on one of her dresses and ended up asking me to choose one to keep as a rememberance. I was extrememly touched by the experience and amazed to see how generous and welcoming these people were, even though they had almost nothing themselves. I will definitely remember this encounter my entire life.

Leaving the country for the first time!

Leaving the country for my very first time has definitely been quite the experience. I had always assumed I would be making the journey with my family one day, and here I am, alone in Panama. Just a few short month ago I did not even own a passport! Living in Florida my entire place I couldn't have even imagined what a place like Panama would look like before seeing it myself. I have been forced to communicate with the little Spanish I know, had rice and beans for both lunch and dinner almost 5 nights in a row now, and taken nothing but cold showers. However, I must say I am really enjoying the experience! It is important to be able to see how others who are less fortunate live in this world. This is an experience that could never come from any textbook or television set. The landscape is beautiful and the people are all so welcoming and proud to share their culture with us. I can't wait to see what the rest of this trip has to offer!

End of Week One

Well, this is the end of week one in Panama. What a country this is! There is so much to write about, but I will try to focus on the health care. Working amongst the Ngobe Bugle people of the Comarca is a study of how to perform nursing with incredibly scarce supplies. Amenities that we take for granted in the United States are simply not available to most of this population. Today I was at the home of a family consisting of fourteen people. Surrounded by lush greenery offset by the packed red earth of their floor, we were asked to examine an adolescent boy who has been suffering from a GI ailment for a week, with diarrhea and episodic vomiting, mostly after he eats. On hearing that he is able to keep water down, we suggested to his mother that she make a broth of the most nutritious leaves with perhaps some chicken for protein. She informed us that the PVC pipe lying on the ground and attached to a faucet on a stump has been dry for five years. There is a well in the near distance (10 to 15 minutes walk), but it is also getting low as this is the end of the dry season. When it goes dry, they simply search for a water supply at ever greater distances. They face this reality with passive acceptance - it is what is. While discouraged by how little we could do to help this mother and her son, I was surprised by how quickly my brain has become dependant on the tests and procedures that surround nursing in the US. I wanted a CBC, CMP, stool for parasites, a sputum sample for his cough, and IV fluids started, probably with potassium because of the diarrhea! Instead we educated her to try to keep him hydrated and bring him to the clinic on Monday if he is not showing signs of improvement. Upon returning to the clinic, the medico affirmed our suggestion, and told us that usually by the time they do come to see him, they may be critically ill. Desperation in a land of profusion.

Health Care in Panama

Panama health care is based on Germany´s healthcare where everyone had healthcare.Its provided by the government and free which is totally opposite from what we have in United States,where everyone has to pay for their own health insurance. Today I was at the health center in Soloy where I was suprised by the knowledge that nurses have. In one emergencey room that serves 23,000 of patients there was only one doctor, one nurse, one nursing tech and one nursing student in her last semester of nursing school. I was pleasently suprised with the knowledge that all of them have. For 4 hours the emergency room was left with only 1 nursing student and doctor I was impressed with the knowledge that this nursing student had. She took care of all patients and documented every move that she did in the patient´s chart, and also documented in her own records every patient that she took care of. Her knowledge and her qualifications for me where much higher then the ones that we have in United States.

Ohhh Panamaaa!

Hola! I´m sitting in what may be the slowest internet cafe in existance, it took 25 minutes to load this website.. ¡Ay, caramba!

Today is day 5 and our first day in the clinics. I´m assigned to a clinic in Salloy and shadowed a doctor. Despite the fact that we could only communicate through a combination of what little spanish Kaleigh and I know and hand gestures, I really learned a lot. We measured pregnant women´s abdomens and determined their approximate due date. One woman was going into labor and possibly with twins but unfortunately our time was up well before she was ready to deliver. We went to a nearby school afterwards and took pictures with all the kids. It almost felt like we were an attraction at a zoo, the kids couldn´t stop staring at us and thought we were ¨doctoras¨ because of our stethoscopes. I can´t wait to go back and spend more time with the kids.

It´s raining which I´m beginning to realize is a common afternoon occurence here but during the day it is HOT which makes wearing long pants and a thick polo almost unbearable. The food has not been as bad as I imagined although the fact that I don´t like rice isn´t very convenient in this country since it is a huge staple in panamanians´ diet and included in every meal other than breakfast. My hour is up but I´ll include more details later. ADIOS!