The Trip is Done!

All and all the trip was AMAZING! Though there were some frustrating times, in the end I learned so much and could not imagine not doing the trip.

The past 3 weeks are kind of a blur. We did so much in such a short amount of time. I got to see different parts of the country from driving from place to place and experience health care in the jungle and in the city. I also had the pleasure of learning about what nursing school is like in Panama. (Their students have 4 years of actual nursing school, where we only have 2.) I went on a 16 mile hike, four-wheeling, and zip lining. It really was a jam-packed trip. I even got to have the lovely experience of being a patient in a Panamanian hospital when I stepped on a needle that was supposedly used to anesthetize a goat before castrating it. So many things to tell, but that would go on for pages. Panama is a very diverse country and I would love to go back and experience more of it!

¡Adiós Amigos!

Leaving Panama and returning to Tampa has been very bittersweet. While I know we made a positive impact on the people in the Comarcas, it's hard to say goodbye when there is still such a huge need for outside help. The past three weeks have been both very rewarding and eye-opening. I learned about the Panamanian culture and adjusting to "Panama Time" which is very different from the inflexible agendas most Americans follow. This journey also taught me that the amenities I would once label as "essentials" are considered luxury items in other parts of the world. I vow to never again take clean drinking water, hot showers, or toilet paper for granted.

I left for Panama expecting to learn about a new culture, gain more clinical practice, and most importantly avoid taking community during the fall semester. As I return to Tampa I realize I'm bringing back so much more, including once in a lifetime experiences and a handful of unexpected new friendships. I won't soon forget all of our patients in the clinics or Victor, my innocent, sweet, little friend from the orphanage. I had never seen such beautiful scenery until we climbed Volcán Barú and went zip lining in Boquete, both adventures I would go on again in a heartbeat. Everyday was full of learning, not just about the culture but also about tolerance and friendship. I learned a lot about myself too and the way others perceive me. I think everyone who went will agree it was a memorable trip and provided us with experiences that will help shape us into better nurses.

I would like to both thank and congratulate Dr. Cadena and Eloisa for making this trip a success.

"Our fingertips don't fade from the lives we touch..."

i'll never forget you, panama

written on June 10, 2011

Today is our last day in Panama. It is bittersweet; although I miss home, I can't imagine what life is like back in the states. I've made so many great friends here and I know that I will miss them tremendously.

Monday was our last day in the communities in Chiriqui. The clinic in Soloy was amazing, and I learned and witnessed a lot of different things. I gave many injections, immunizations, IVs, and much more. When we were leaving, we said goodbye to everyone and the amazing staff of nurses and doctors who helped us throughout our stay in the Comarca. When we were eating lunch on the bus in front of the clinic, a little 8 year old girl holding her sister came to the window. She looked hungry and desperate, so I gave her the rest of my lunch. She ate it in a blink ofan eye, and the rest of my classmates gave what they could to her. She was very grateful.

Tuesday was our last day in the Comarca in Chiriqui. We ventured out early (of course!) and made it to David to the Jose Domingo children andwomen's hospital. The week prior when we visited the hospital, I had witnessed my first live birth. It was amazing and very humbling. The Panamanian women generally do not use anesthesia during birth, which is very different from the States. On Tuesday, I was in a small group and we were on the post-partum floor. We saw many different things. We also got to hold tiny babies for a few hours. I think some of us fell in love...

My stay here in Panama was amazing. It seems that 3 weeks just wasn't enough time. Although we worked hard in the communities and brought an American touch of health care to Panama, we had a lot of time to connect with each other and bond as classmates. I will never forget the 24 other people who came to Panama with me. Some of them taught me more things about myself than I knew. I learned to push myself in ways I didn't know I could. Thank you to everyone who made my Panama trip so memorable. And thank you to Dr. Cadena and Eloisa for everything.

Its Been Fun!

Today we leave to go home from Panama. I am going to miss it here. I have had such a great experience here! I have had the opportunity to learn so much in such a short period of time. My favorite part of the entire trip was definitely when we went to the orphanage in Boquete. At the orphanage we met with one of the volunteers who moved down to Panama from the U.S. and has been living in Boquete and volunteering at the orphanage for the past year. There were about 60 kids at the orphanage and a lot of them were there for reasons of domestic violence and abuse, so they are considered “unadoptable” because the government is hoping that they will be able to repair the situation at home and return the children to their families. This was the hardest part about seeing all of these children; I wish I could see them and have the hope the one day they will all be adopted by a family who will take care of them. The kids at the orphanage were all so sweet and so excited about the little toys and candies that we brought them. We would open up a package of crayons, and literally hand out single crayons to the children and they would be so excited to get this single crayon. The gratitude of the children that I have seen here in Panama has been so inspiring. I am so glad that I got the opportunity to come here for this 3 week session. I have learned so much from the people that I have come into contact with here and love the cultural experience that I have had.

Hasta Luego Comarca!

This past week was our last week in the Comarca. While at the Clinic in Soloy I have had the opportunity to learn lots of clinical skills (I did 30 vaccinations!) and see a new culture face to face. The experiences that I have had here are so different from those that I have had in the states. People literally walk for days to get to this clinic (one morning we picked a woman up in the bus on the way to the clinic who was being carried in a hammock by two men to get to the clinic. Just by us driving her for the last 20 minutes of our drive to the clinic, we probably shortened their journey by hours.) While it was heartbreaking to see these people suffering from preventable diseases and infections, such as gastroenteritis caused by unclean water and improper food handling, respiratory problems caused by having wood burning stoves in their living spaces, and skin infections and diseases caused by poor personal hygiene, there was also hope in seeing how the medical professionals at the clinics responded to help the people in the Comarca. It must seem like a daunting task for the doctors and nurses who treat the Ngobe-Bugle people, treating only the outcomes, and not being able to properly address the causes because of the vast shortages of water and hygiene supplies. Even with these daunting tasks ahead of them, the doctors and nurses treat the people of the Comarca daily with empathy and compassion, and I feel as if I have definitely learned from them, how to treat and care for patients. Also in response to the needs of the Ngobe people, there were three health promoters who go out into the community (sometimes literally door to door, and sometimes holding little seminars at community meeting places) and teach about clean water collection, moving stoves to outside to prevent respiratory problems, nutrition, and importance of vaccinations and prenatal care. While the experience in the Comarca opened my eyes to the struggles and needs of another culture, It also demonstrated to me how the people of this country are working together to better the lives of the less fortunate and help the Ngobe people to learn how to improve their standard of living, and move forward with a generation of healthier Ngobe people.

Verdad?!?

Wow...I can't believe this 3 week experience is already over. This trip has really allowed me to broaden my horizons and realize just how lucky we are to live the life we live in the US. I really enjoyed seeing how other cultures practice health care, and realize that the American way of doing things is not the only way. I am leaving feeling more competent with my nursing skills I practiced here including IM injections, starting IVs and performing prenatal care. I have made tremendous friendships while here and although I am missing home I wish my time here in Panama could last just a little bit longer.

CRISTINA RONDOLINO- Bitter sweet goodbye

Last day in Panama and I think we are all a little sad. A week ago we would have killed to go home. But, now that we are at the City of Knowledge and easing ourselves back to the luxurious life of semi-hot showers and not sleeping in a room with 17 other girls, I think we will be sad to leave. Last night we went to the discotcca and we all danced our last night in Panama away.
I wont be leaving Panama with just a bag full of coffee and souvenirs. I am leaving having made some really great friends and with an experience that will stay with me forever. This experience was truly invaluable to me because it opened my eyes to the struggles that people around the world go through. The Alto Caballero community had no running water or a safe source of drinking water. It infiltrated every aspect of their lives. I will think of them the next time that I am faced with a dilemma and realize that I am lucky to have the resources I have.
We saw the people wait patiently outside the clinics for hours and sometimes would not get the help they came for and still never once complained, or made a scene. I will think of the Ngobe Bugle people the next time I am impatient (which is often) and realize ,again, that I am lucky.
And next time a storm is rolling in, I will not be sad that it ruined my beach day, but I will be happy that is is bringing lives most precious resource to me and I will think of the Ngobe Bugle people rejoicing when the rain came.
I am also leaving, a lot more confident in my clinical skills. I was able to start an IV for the first time on this trip and I probably did 60 IM injections. I got a head start on pediatrics and OB. I measured the fundus, found the fetal heart beat and, oh yeah, I saw birth! I brushed up on my Spanish speaking skills as well.
All in all it was a wonderful trip. A little rocky at times with what seemed like one catastrophe after another, but it all just adds to the memory. AMERICA HERE WE COME!

oh baby, baby!

Hola!

So, I witnessed the miracle of birth at the hospital. It all happened much faster than I expected. We were ushered into a fairly large room just as the mother was getting ready to push. The thing that I found to be the most bizarre was the fact that the doors stayed wide open throughout the entire birth. Patient privacy definitely does NOT exist in Panama! The mother needed an episiotomy which was performed by a doctor and a med student. As soon as the incision had been made it was smooth sailing from there and a beautiful baby girl was born within a few minutes. The attention was turned to the newborn as they suctioned the nose and mouth, performed the apgar, and all the other necessary immediate tasks. The mother was unbelievably calm and the look on her face as she smiled at her new baby almost made me tear up. This trip has offered me so many new experiences and I wouldn't trade the last 3 weeks for anything.. well except for maybe a lettuce wrap. (JK!) :)

Dr. Best Friend - leading Friendologist of Amrrica

This is Will Boland, I cannot create my own account for some reason.

In Boquete we had a needed break from clinical activities. First we went to some orphanages and a home for boys. At the orphanage most of the kids were under 12 years old. They loved gettin held in the air so they can touch the ceiling or spun around. This is the same kind of playing I used to do with my little brothers. I dont think they get that kind of playing around often since theyre all so young and the people that work there already do so much for them. It was nice to go there and maybe make that day the best day of their week.

Many of us chose to climb the Volcano (what volcano?). This sounded like a great idea with the promise of a panoramic view of the pacific and atlantic oceans at the top. About 45mins into it....I realized this was Not a great idea. It wasnt bad going up, except for the breaks and communication. Going down the mountain I felt like I was gonna throw up and it was raining the entire way, jumping over streams and slipping on rocks. Oh, and at the top all we saw was clouds, yaaaay. My BF got headaches from concentrating on which rocks to step on next. It was fun looking back at it now though, as are all things that suck while youre actually doing them. I can say I climbed a Volcano and the highest mountain in Panama, and so can many of my fellow nursing students.

We are now at COK and the trip is ending. It wasnt exactly what I expected, but it was fun and educational for sure, and that was the goal. Weve been in class with people for about an entire year, but dont realy talk to them. In 3 weeks Ive gotten to know more people outside of my clinical group than I did in an entire year. I still know very little spanish, but I feel like my vocabulary has expanded 10times. Ive learned about a country I knew very little about. Ive learned about a people I never even knew existed (Ngobe). Ive given an IV to a baby for the first time, and seen a baby born. Now its time to go home, and back to normal life and hot showers!

Me llamo Will

This is Will Boland, I cannot create an account for some reason.





Our last clinical days came and went. I have to say it was an interesting experience for the most part. The Doctors at Soloy were very helpful and wanted to exchange knowledge and practices. The last day there was a patient with a venomous snake bite, we were lucky enough to have a Dr that spoke english and he explained to us their treatment protocols and how and where they transport him etc. I gave him some splinting supplies, a tourniquet and a pressure bandage. They may have to use the supplies shortly, whereas for me they were for practice or for "just in case".


Im glad we went to the hospital in David, because from a medical experience standpoint much more was gained there. I saw a birth, thorocenticis, gave an IV to a baby, and more. I hope the birth excludes me from seeing one in semester 4! As great of an experience it was, I would prefer not to see that again. It was interesting that they only received some pain meds and family was not allowed in, and they werent even in the hospital as far as I understood.

Adios Panamá

My experience at the hospital Jose Domingo de Obaldia was wonderful. It was my first time working with kids in the hospital, and as much as I loved it it broke my heart to see so many children in pain! One little 2 year old in particular caught my attention. He had no family because he was abandoned so he lived at the hospital, and he was mentally retarded and had a pulmonary infection and only weighed 16 pounds. It took almost an hour to feed him his lunch but I enjoyed taking the time to do it. Unfortunately it is common in Panama for babies to be abandoned at the hospital. I also saw a bone marrow aspiration in the hospital on an 8 year old boy, and that's when I knew for sure I couldn't do pediatrics because I just couldn't handle seeing him in pain! One thing that really amazed me at the hospital was how little they used gloves. The nurses would start IVs without wearing gloves and blood would spill on them. It was also interesting to see all their paperwork and how they pass their meds without the use of a computer system. All of their patients' meds were on little index cards and categorized by what time they were given. The nurse I was with said she had 60-80 patients, I can't even imagine! I get overwhelmed when my preceptor has four! These nurses are sincerely hard workers and I admire them for taking responsibility for so many patients!

I have had such an amazing three weeks and I am so thankful for this unique experience :)

Adios Panama..

Last days in Panama are here. I feel sad for leaving such a beautiful place. I learned so much here, staring with my first IM injection to vaccinating many patients. Giving my first IM injection was the scariest thing for me since I had to give it dorsogluteal injection, but everything went pretty well with great guidance from nurse Rosio. From Panama I am taking a lot especially Panama patience, which is the best lecture that I have learned in Panama just to have patience and everything else will work out itself. This experience in Panama was experience of no toilet paper and cold showers, but overall I loved this trip and I am also excited to go home and take a worm shower.

Gracias Panama por todo. Gracias Dr.Cadena por todo.

Hato Juli Classroom Visit

As part of our clinical experience we were given the amazing opportunity to each visit one of the schools in our communities. For days preceding the visit, our group spent much time planning ways that we could make our time spent there beneficial to the students. We bought supplies and thought of important topics that we could educate a group of students on. After meeting with the director of the school, she selected a kindergarten class for us to visit. That morning, when we walked in to the classroom, I immediately saw the excitement in the children's faces. Even the older students were gathered around the windows and doorways, trying to catch a peak at what was going on inside the classroom. We began our education with a presentation on handwashing. It was surprising to me to learn that most of the children had never even washed their hands before. Our next bit of education was on proper dental hygiene. Following this information, we handed out toothbrushes to each of the students, as well as to many of the students who were peering in to the room. The last, and most exciting event, was teaching the children about the different nutrients found in fruits. Lourdes was great with the children, and she turned the vitamin teaching into a game that the children really seemed to enjoy. She asked the children to throw the fruits to the corresponding nursing student who was holding the sign with the correct vitamin letter on it that the fruit contained. Finally, before leaving the classroom we gave each of the children one of the goodie bags we had prepared for them. The excitement on their faces made the experience so much better. The smallest gifts (such as markers and stickers) made them all so happy. It was a great feeling to know that we had made such an impact in each of these children's lives. I am extremely grateful to have had this experience, it is definitely one that I will never forget!

We are pretty much at the end of our trip. I must say this has really been a good experience. Aside from being homesick at times and hbing hot showers, we all managed to enjoy our time in Panama to the fullest. Our last day at Soloy was a pretty exciting one. A man came in with a snake bite and had brought in the tail of the snake so the doctor could identify it. Unfourtunately, the clinic did not have the antecdote and the doctor had to call an ambulance which took over an hour. The snake had bitten him on his left lower calf. After an hour of being in the clinic his whole leg and foot were extremely swollen and the venum was spreading. There was also a lady who was close to giving birth so the ambulance took them both to David. I have a lot of injections to children, there was no school that day so the clinic was full. At the end of our clinical day we thanked the nurses and doctors and gave them gifts. The following day we went to the hospital in David and I had the opportunity to go into labor and delivery. Unfortunately, I didn't get to see a live birth. I didn't do much that day. After the hospital we went to UNACHI and did our final presentations, which in my opinion went very well. Today we drove back to Panama City and are spending the rest of the day at the villas. Overall, this has been a very successful trip. I've definitely learned a lot and appreciate everything I had. I know that I am very lucky to have such an amazing family and friends. I'm glad I came on this trip and I wouldn't trade my time here for anything. I want to thank everyone who made this trip possible!

Farewell Panama

Well, this is it. We have had our last day at the clinics, and our last day at the maternal-child teaching hospital for UNACHI, the only university in western Panama with a nursing program. I was very intrigued by the similarities and differences between the hospital where I am employed as a Registered Nurse in Tampa and the hospital here in David. One obvious difference is the reduced emphasis on isolation precautions. Panama has not yet fallen victim to the epidemic of antibiotic-resistant bacteria that has swept across the United States, most likely due to less reliance on broad-spectrum antibiotics in both the human population and the livestock industry. So there is much more sharing of space in the hospital - 6 person wards, new mothers holding each others' babies, and infants being collected three at a time in one bassinet for procedures such as tuberculosis vaccinations and hearing tests. The exception to this is the burn room, where a cloth barrier was placed across the door opening to limit the transmission of infection. There also appears to be less fear of child abduction. It is common to walk into a ward and find four of the beds occupied by moms and babies, and the other two beds containing only a tiny, bundled newborn, with no mother in sight. But there were many aspects that made me feel right at home. The nurses were engaged in the performance of the choreographed dance that is hospital nursing around the world - in and out of the med room, responding to situations before they become crises, educating patients and family members, following up on new orders, and trying to find time for the ever-present responsibility of documentation. I found it a comfortable and familiar atmosphere in spite of the language barrier and the unique culture of the Ngobe Bugle patients. Now tomorrow we are going to the International Children's Hospital in Panama City. Another opportunity to compare health systems; this time rural versus urban within the country of Panama itself. And then the next day we are leaving these amazing people behind as we head home, but we are taking with us memories that will last a lifetime, friendships that were forged through sharing basic necessities and accommodations, and a renewed dedication to the calling that is nursing.

Ya terminamos

Here we are at the end of the 21 day trip to Panama. What an experience it has been. It's hard to go on trips like this because sometimes it is easy to be disappointed, but when you walk into this with an open mind, eager to learn, and try to make the most of every opportunity that presents itself it can become one of the best trips of your life. Looking back over the past three weeks, I have learned so much not only of medical skills, but of a language, a people, a culture, and great food. In Panama, they have what is called "Ojaldra". It is fried bread that only costs $0.15 each. You can make sandwiches by putting some meet and cheese in between two of them or you can just throw some sugar on top and you are set. I am going to try and make these when I get home to share a little of what I have learned with my friends and family.

I loved being in Panama. I was born to travel and can't wait to see what the future holds for my life. I want to thank Dr. Cadena for all the hard work put into this trip and Eloisa as well for coming along, helping lead, and all the translation. Eloisa, you did a fantastic job. I hope to be as fluent as you one day. I want to say thanks to all my classmates for a wonderful trip and that it was great to get to know each of you, away from the norm and even sometimes at your worst.

Post 3

For my last post we found ourselves traveling to the town of Boquete. It is a very nice mountain town that reminds me a lot of small towns present in California and Colorado. It was very "Americanized" compared to the previous parts of Panama we had been in.

While in Boquete I had the chance to partake in the many outdoor activities present. The first day we did a 16 mile round trip hike to the top of Baru volcano standing at 11,000 ft. The second day we did a 14 platform zip-line down another local mountain, which was very exhilarating, followed by a 2 hour four wheeling trip through some local trails.

Also we had the chance to stop at a local school for troubled boys and an orphanage. At the boys school, two other students and I played an intense hour plus game of soccer before heading off to the orphanage. I really enjoyed the orphanage, all the kids were very young and affectionate. We spent the majority of our time there giving out gifts and playing with the kids, it was one of my favorite parts of the trip.

We are now back at the City of Knowledge preparing to leave on Friday and I am looking forward to getting back home to my loved ones and all the amenities I've been without. I will always cherish this trip to the country of Panama and all the great people and experiences I encountered during my stay!!

Post 2

This week we did work in the clinics at the local Comarca. My group was assigned to the Alto Cabellero district, which was an hours drive from where we stayed. I got the opportunity to learn and experience a lot of new skills including suturing, and baby delivery. My only complaint was the lagging drive to and from the district we had to make everyday.

We also spent a large amount of time at the local K-6 school teaching the local children about hand washing, teeth brushing and recycling. It was a very nice experience and this kids were awesome. I really enjoyed participating in the soccer games that occurred on the playground at the end of each school day.

In comparing the education system we witnessed in the Comarca, to the one I experienced growing up in the U.S, there were vast differences. Here in Panama, school is free as long as you have a form of transportation to get there, where as in the U.S that is not the case. Also, the facilities present here are not on level with even the poorest of schools back home. Lastly, the standards of education here are far below that of the U.S.

Weekend in Boquete

My favorite highlight in Boquete was experienced at an orphanage that we had the opportunity to go to. This particular orphanage had babies ranging from a few months old up to seventeen year old teenage girls, some of whom were parents of these babies. We ended up bringing toys, candy, bookbags, and fruit for the kids. When we were giving these away, the look on these kids faces was priceless. They were all filled with glee and excitement. After handing everything out, the excitement did not end there. We had the chance to play with the kids for a good hour. I found this one little boy who appeared to be five years old, away from all the other kids. When I approached him, he was timid and did not open up when I asked his name. However, that changed after I reached in my pocket and handed him a piece of candy. The little boy ended up giving me a hug afterwards. I then took him on the swings followed by me picking him up and throwing him up in the air. He seemed to enjoy that, so we did it several times, until he became exhausted. Play time was unfortunately over and we ended up saying our goodbyes to the kids. I felt great knowing that I made the boy's day.

The following morning, several classmates and I decided to do something daring and bold. We were going to hike up a volcano. I talked to several people that had done it before and they said it was very strenous both mentally and physically. However, I brushed it off because I thought they were exagerrating as to how difficult it was. Boy was I wrong! It was by far the hardest thing that I have ever done. The first twenty minutes of the hike was the most difficult for all of us. Mainly, because of how steep the incline was. I wanted to go back to the car and drive back home. We had to take numerous breaks just to recuperate from the countless inclines we had to hike up. But after about six hours or so of hiking, we eventually made it to the top! We all felt accomplished. Unfortunately since it was cloudy, the view wasn't so great from the top of the volcano. However, it still felt good knowing that I was up there. After about thirty mintues or so of enjoying the view and recuperating, we ended up walking back down the volcano. Unfortunately, it began to downpour on us, which made it even more difficult for us because the rocks were slippery. Luckily after three hours of hiking back down, we reached the bottom of the volcano safely.

"Winners take time to relish their work, knowing that scaling the mountain is what makes the view from the top so exhilarating." -Denis Waitley

Cleanup Slash Orphanage Visit - Kristen´s post

Education groups were interesting, to be sure. It wasn´t just a learning experience for the kids, but for me as well. I´m not a very good teacher, but since Kate and I and Suzi were responsible for putting together the activities, I had to step up and get especially creative. It wasn´t like our audience was going to be particularly difficult. First and second graders, but it was still a little bit of a challenge.

Being in charge of those kids and trying to teach them essential hygeinic tasks started out as a mild test of trial and error. At first they weren´t very cooperative, but when we finally looked like we were having fun, then they started to have fun. The sad part was that while we had the opportunity to pass out toothbrushes and let these children wash their hands, we knew that most of them didn´t have access to those resources for the long term. Many of the kids had hands so dirty that the water we used was cloudy after just a few hand washes, and several had damage to their teeth.

The next day we attempted a different, more hands on kind of teaching. We took three hundred elementary schoolers out on a march to save the planet, passing out garbage bags and gloves and taking the kids on a hike to clean up the community. We and this herd of children carried banners and picked up garbage, separating the recyclable materials from the ´basura´or regular trash and continuing on our way. It was really neat to see all of these kids working together, and after the face the road sides really looked much much better.

A few days later we got to see children in a different kind of environment. The orphanage we visited near boquette was a small establishment tucked away in the mountains, housing over thirty children ranging from ages zero to 12 for boys, and zero to 18 for girls. I could feel my heart break as we passed out crayons and toys and handed out fruit, each of us taking turns carrying babies and playing hide and go seek as we milled around the compound and just absorbed what we were seeing. We didn´t stay for very long, but the little faces were permanently imprinted in my memory, especially the face of one particular little girl, who was no bigger than a four year old, and was seven in reality. She didn´t know how to talk, but she was a commanding little presence, dragging us around and smiling and insisting to be held.

Making them smile was probably the best thing I could have done for them, and it warmed my heart. I was sad to leave those children who needed nothing more than someone to love on them. It was an amazing experience.

First Day at the Clinic

We had finally arrived at our clinic, Alto Caballero. As I stepped out of the van, I was astonished by the number of people awaiting to be seen by the doctor and nurses. The patients ranged from the babies in their early months of life all the way up to women in middle adulthood. Our instructor set us up into four different stations: Immunizations, height and weight measurements, critical care, and shadowing the doctor. Initially I got placed at the immunization station. As different patients were walking in to get immunized, the nurse tech who does them was explaining to me what each medication was in each vial, the route it was given, the dosage amount being withdrawn from the vial, and the technique used in terms of how each shot was done. There were several differences that I found compared to what we do in the states. First and foremost, the nurses normally don´t wear gloves when they give vaccinations. Additionally, when they were withdrawing medication from the ampule, they don´t use a filter needle first. Moreover, instead of tauting the skin for an intramuscular shot, they would pinch the skin. Lastly, the nurse would aspirate during a subcutaneous shot as opposed to just injecting the medication. After observing the nurse do several injections, I felt comfortable doing them on my own. I had the chance to do four vaccinations on four different patients. Two of the patients that I had the chance to do it on was a three year old kid and an eight month old. I was nervous because I have never given a shot to a pediatric patient, but the nurse tech was there right by my side, which made me much more at ease. When I was doing the injection on the three year old kid, he was smiling throughout the entire process. It was comforting to know that he was in no agony or pain at all when I was doing it. I then had the chance to do several height and weight measurements. I had trouble remembering the spanish numeric system, but luckily my partner that I was paired with had a better grasp of it.

After going to the clinic, we visited the elementary school. We had the chance to talk to the assistant director of the school and we asked him several questions, which he gladly answered. Some things that I was fascinated with was the distance and how long it would take for the students to walk to school. He said it roughly took them an hour and a half. Another thing that caught my eye was how they were only given milk for breakfast and nothing to drink for lunch. Some students therefore brought water bottles to school. After we finished talking to him, we had the opportunity to meet up with an English teacher and his students. They sang the ¨Head, shoulders, knees, and toes¨ song to us. After leaving the school, we headed back to the bus. As we were walking along the street, I turned around only to see a horde of students walking with us. We ended up walking with most of them for nearly twenty minutes, until they reached their house. I was amazed by how close the sibling relationship was. They would all just hold hands as they were walking, which I rarely see back at home. After making it back to the van, we said our goodbyes to the students.

Go Bulls!

Bienvenidos a Panama

May 20, 2011

The day had finally arrived! At six in the morning, I would be leaving for Panama. I’ve heard so many so many stories about this experience from friends, both good and bad. Ranging from the excursions they went on like climbing a volcano and ziplining, to having no hot water and air conditioner. When they informed me about having no hot water and air conditioner, I wasn’t bummed about it at all. I wanted to get the most out of this experience as possible. So if going without either of these for the next three weeks, then I’m all for it.

We finally arrived in Panama after a four hour flight. The weather was humid and a lot hotter compared to Florida. After going through customs and getting our bags, we were all welcomed by a few Panamanians holding a “USF HEALTH” sign. Then we all got on a bus. Most of us thought we weren’t going to be able to fit all twenty-five of us in this bus because it was compact. Not to mention, our bags used the last two back rows of seats. But we managed to fit all of us in. As we headed to the city towards where we were going to stay for the next couple of days, the “City of Knowledge”, we got the chance to enjoy the scenery. There were so many buildings compared to what I was used to. I was also surprised by the amount of people that drove. I was expecting everyone to be on foot walking to their destination. Additionally, gas prices were relatively the same as well compared to Florida, which was at $3.83 for regular. Moreover, we got to see the Panamanian flag at its highest point. When we arrived at the City of Knowledge, the area was huge. My instructor told me that it used to be a military base. The place where we were living was spacious as well. There were three bedrooms and two bathrooms. Each bedroom had two beds. Furthermore, it had a full sized kitchen along with a dining and living room area. After we all got settled in, we had some leisure time to do whatever. A group of us went out to one of the two soccer fields that they had and played ultimate frisbee. After we got all sweaty from the game, we headed to the Olympic-sized pool. All the girls had to wear a cap. The guys, including myself, were chuckling and making jokes saying that they need to do some synchronized swimming. Furthermore, they had this diving board that was about 30 feet high, where some of us jumped off of. One girl unfortunately lost part of her toenail from the dive. Luckily, she was okay. After cooling off at the pool, we had dinner at our instructor’s place. She along with another instructor cooked us spaghetti, bread, and salad, which was phenomenal. Overall, my first day in Panama was amazing!

The following day, we all went on a city tour. Describing what we saw does not do it justice, so here are a few pictures that I took:

The beautiful city in the background

Panama Canal

A group of us went to go check out a waterfall. The man who took the picture apparently missed the memo when I said to get the waterfall in the background. Oh well, still a great picture.

One of the many streets we walked along

After our city tour, we went back to the “City of Knowledge”, which was the place where we were staying, and got dressed for dinner. We had some free time before dinner, so some of us went on a quick stroll around the complex. We ended up taking some pictures in front of the City of Knowledge sign and walked along the railroad tracks to bypass the time. When dinner came around, we went to this nice restaurant. The service was a little slow, but the food was well worth the wait. I ordered the fajitas and they were amazing. To top off the night, there was a firework display going on as we were eating. Fortunately, we were eating outside, so we had a great view of the light show. The first two days spent in Panama were amazing. Hopefully there will be more days like this to come.

Cuidad del Saber in English means City of Knowledge

Trying to maintain their balance on the railroad track

Una Nina!

Written Tuesday, May 31st

Today was definitely my favorite day so far! The one thing I wanted to do while in Panama was help deliver a baby and I got to do just that today. When we arrived at Alto Caballero this morning we were told that two separate women were in labor. One was a 16 year old who the doctor suspected was having twins because she was huge and he had detected two separate heart beats with the Doppler. The other one was a 20 year old pregnant for the first time who was already 5 cm dilated and wasn't due for another month. We were told that they would both be going to the hospital by an ambulance that was on the way but we all secretly wanted to see a birth at the clinic. Cristina, Tina, and I stayed with the 20 year old and we started noticing that her contractions were getting closer and more intense pretty rapidly. Then we noticed that her nagua was wet and we assumed that her water had broken. No one who worked at the clinic seemed to notice the changes that were occurring so we decided to take it upon ourselves and tell the doctor what was happening. Once he came in and examined her we realized that with no ambulance in site and the closest hospital about 45 minutes away, this baby was going to be born at the clinic and we all would get to witness it! We then moved the women into the room that was prepared for delivery just in case it were to take place at the clinic and we all piled in too. All nine of us, the doctor, Melvin (the nurse), and the girl's mother were crammed in this tiny room to see this new life be born. I got to stand right by her side and help her push with every contraction and after about 5 or so pushes the head was out. This is when it got a little scary. The doctor was worried that the cord had been wrapped around the baby's neck because the baby was blue. He suctioned the baby's nose and with the next push the baby was out. It's was a little girl! :) The cord was not wrapped around her neck but she did not start crying right away so we all started to worry but after about a minute she let out her first little cry. Thank goodness for a healthy baby and a healthy mom! Today was truly incredible and is definitely a memory I will cherish forever. I can't wait to see what is still to come here in Panama!  

Me llamo Suzi y esoty sucia.

Panama could definitely be one of the best experiences of my life thus far. I've been able to expand my education, make new friends, and truly enjoy and appreciate the Panamanian culture.

I was able to see a birth at the clinic in Alto Caballero, which was such an amaaaaazing experience to see, especially in the clinic setting where things aren't as official as a hospital. I was literally right behind the doctor watching the baby come out. Then I was able to help clean the minutes-old nina.

In Boquete, we climbed to the top of the Volcano Baru for 12 hours. Those 12 hours I hope to delete from my memory because I didn't like it!! I'm glad to say I completed it, but I would not climb that much unless I had been training for it. We also went zip lining through the mountains which was breathtaking.

Before coming on this trip, I had misjudged some people. But through my time here, I have been able to truly get to know people and realize my mistakes. Just because a girl talks about lettuce wraps for 20 minutes doesn't mean that she's as weird and stuck up as I thought. There is actually a song about how driving a tractor will cut the grass faster..and I know alot of the lyrics. You can get your doctorate in friendology and metrology, in just a matter of one short week. Little friends named Deebra should be kept in your backpack for safe keeping. And apparently Panamanians like blondes and booties. So many inside jokes, created in only two weeks in a foreign country. The three best friends that anyone-could-ever-haveeee!

Thanks everyone on the trip, Dr. Cadeeeens, Eloisa, and Daaarrriioo!

CRISTINA RONDOLINO- The beauty of birth

Written Tuesday May 31st
Wow, today was an amazing day. When we arrived at the clinic, Alto Caballero, we were told that there were two women in labor. One was a sixteen year old who was possibly pregnant with twins because her belly was huge and they detected two heart beats! Our clinic does not have fancy high tech ultra sounds only a Doppler to detect fetal heart rate. The other woman was a twenty year old who was pregnant with her first child and was not due for another month but was already 5 cm dialated. The staff called for the ambulance. I wanted to see a birth so badly, but the clinic usually calls the ambulance to take them to another clinic because they are more well equipt to handle complications. They said they rarely have births at the clinic, maybe about one every two months. Liz, Tina and I stayed with the twenty year old while she had contractions. We noticed that there was some liquid on her nagua (native dress) and we believed her water had broken. Shortly after we agreed that her contractions seemed quite frequent, so we began to time them. At first it was about two minutes and then it progressed to a minute and a half. We decided that we should tell the doctor because no one had been there to check on her in a while. When I told him, he seemed calm and just said "Okay." Were we making a big deal out of this because we had never experienced the birthing process before, or are we just anxious Americans?
The doctor came into the room about 5 minute later and examened her. Then he let me exam her too and I was able to feel the head of the baby! With the ambulance still no where to be found and the San Felix clinic still 50 minutes away, I knew then that this birth was going to happen at our clinic, and soon!
We helped her up off the exam table and more amniotic fluid came out. We brought her into the room that had already been prepared, just in case. We all piled in to the small room, and tried to make ourselfs useful. Liz, Suzi and I were holding her hands, wiping off her face and fanning her. J.J. (Hota-hota) and Matt were taking bets on if it was going to be a nina or a nino (and hoping not pass out). Victoria was getting her portable fan, Brooke was passing out gloves, and Tina was being our good luck charm!
The doctor came in and told us to help move her down on the table and put her legs in the stirrups. He had her push with every contraction. After about five contractions with little progress he asked for lidocane and numbed her before he cut her. I think all of our hearts went out to the mother at that point just imagining the pain. Then we started to see the head with the next few pushes. It seemed to be progressing slowly and the nurse said that she was concerned the cord was wrapped around the child's neck. After that was said we were all scared for the health and well-being of the baby, as well as the mother.
With a few more pushes the head came out. I stared to cry because there REALLY WAS a little person in there! He suctioned the nasal passages and with the next push they pulled the whole child out. The mother screamed louder than ever at that point. Una Nina! The cord was not wrapped around the neck, but she came out blue. She did not cry right away, at first maybe I was in blissful ignorance that, maybe, this was normal. But, when I saw Eloisa praying, I grew more fearful. It was probably about two minutes before she cried. And when she did, so did I.
She slowly began to get more color and Suzi helped with the umbilical cord and swaddling her. Meanwhile, I was still in the room with the mom. The umbilical cord was still hanging out of her and it just looks so foreign it is almost creepy. The doctor.clamped it and began to twist it around the forceps and slowly pull out. Eventually he pulled out the placenta. It was interesting to see this side of child birth because I feel like it is rarely spoken about or included in movies.
Being that we are in a tribal culture I think we were all a bit curious as to what the practice is regaurding what is done with the placenta after the birth. I know that some tribal communities will cook it and eat it because of how high in nutrients it is. Thankfully, the doctor put it in the trash, but I was also a bit disturbed when I let my mind wander thinking about where that bag was going to end up.
Matt was able to help the doctor stitch her up afterwards. He was thrilled and he said he could do that all day, although he may have preffered a different location. As they were stitching her up, the girls came in and presented the baby to the mom for the first time and the mom said she named her Diyana. She weighed 2.8kg and is a beautiful babygirl.
Needless to see we had an incredible day at the clinic today and the doctor told us that we were all really helpful and that we worked well as a team. Panama sure has been an adventure so far, I can't wait to see what more is to come.

Blog #3

Wow, a lot has happened since my last blog!

Sunday, May 29th a few of us got to experience a church mass in San Felix. It was interesting to see a mass in another country, especially with my limited church experience. The church was beautifully painted. We went to La Barquete and Las Lajas beach that weekend too-- it was very fun.

More has happened in the clinics as well (aside from vaccinations!). All of us at Hato Juli got to perform STD checks on a patient. It was a great experience as we probably won't get the chance as RNs to insert a speculum and swab a cervix. I am fairly confident now that I am not interested in women's health nursing, however!

We also got to go across the street to the school, play with the children, and teach them about handwashing, vitamins in fruit, and dental hygiene. We also walked around the community with the students and pick up trash/recycle paper, plastic, and glass with them. Although, with all of our effort, once we were done picking up trash in the community we handed out candy to the students, and all of them threw the wrappers on the ground! It seemed our teachings did not completely register, or the language barrier was too severe.

After our clinic days, we went to the women and children hospital for a day in David. At first the day started slowly, but after lunch myself and a few other students got to witness a live birth! It was the first birth I had ever seen in person. It was truly amazing to witness the beginning of life! The mother was a Ngabe Bugle indian, so her lack of emotion after seeing her new baby for the first time took us by surprise, but it is a part of their culture to not display their feelings.

This past weekend we all drove to Boquete, Panama. On the way we stopped at a boys home for abused/neglected/court ordered boys aged 12-18. We also stopped at a children's home/orphanage and handed out fruit and school supplies. Playing with the children was so much fun, and it was heartbreaking to leave. I wish we could have had more time at the orphanage and hope future groups get to have the same incredible experience we had there.

Boquete is a completely different city than San Felix. It's more elevated, so cooler, and is renowned for its coffee. We got the chance to tour a coffee plantation and learn about that aspect of Panama's culture, not to mention try the delicious coffee! Boquete is more urbanized, and has a downtown area with shops and bars. It's been a fun stay, but back to San Felix we go in a couple of hours!

Panama has been an incredible experience and I can't believe we've been here for 17 days! The time is flying and I can't wait to experience all we have left before we leave on Friday. We only have one more clinical day, one more day in the hospital/presentations, a day to bus ride back to Panama City, one more day to shop in Panama City, and then we're home!

Thanks to everyone who has made this trip such a success and so much fun!

Amor,
Tami

Panama

Well ladies and gentlemen, this will be my last post for the Panama trip 2011 and I have just a few more things to share! First off, I'll talk about my clinical experience. My clinic was Hato Juli, which is place almost near the top of the mountain in the cumarca. It is a tiny place that usually sees about twenty to thirty patients a day. When I last spoke of my clinical experience, I told of how I was able to perform my first vaccinations and try to start an IV line on a child. In the days to follow, I was able to start perfecting my technique of vaccination giving and I was able to do a female STD check. The STD check was quite an experience to say the least. With my nurse, Lourdes, looking over my shoulder and building my confidence, I placed the speculum into the vagina and located the cervix. The cervix was pink, round and of normal size. Once I had identified the cervix and everything looked good, I continued on and obtained samples of cells to be sent to the lab to make sure everything is fine on the cellular level. However, my clinical days were not isolated to just the clinic, I was able to visit the elementary school that is directly across the street. My group made two seperate visits to the school in order to teach the kids about the importance of handwashing, eating fruits for their vitamins, and picking up trash around their community. The first day there, we did the teaching of handwashing and fruit to the Kindergarten class and they loved it! Lourdes was amazing with the kids by getting them to actually participate! We bought some stickers and each time a child answered a question correctly, they received a sticker...and a peice of candy as an added bonus. The activity they enjoyed the most was being able to throw fruit and my colleagues and I. In order to teach them about fruits and their vitamins, we bought some fruit and made labels to represent vitamins A-E that me and a few others wore around our necks. Lourdes had the brilliant idea to get the children to understand which fruit contains which vitamin, they should throw them at us! This theory proved to be correct as most every child threw the correct fruit at the correct vitamin. I considered that day a success. Next, we took groups of chrildren throughout the community and picked up trash to teach the kids about recycling. Im not too sure how successful that was because, when we finished and handed out candy, the kids threw the wrappers down on the ground! The clinic days are over and now on Tuesday I am going to be in the labor and delivery room at a hospital in David! The only down point on this trip was that I got a twenty-four hour virus on my twenty-first birthday! Other than that, thank you Dr. Cadena and thank you Panama for a great experience!

Birth

I cried for the first time during clinicals. Thank God they were happy tears! I witnessed my first birth at the Women and Children's hospital in David, Panama. The woman was 19 and it was her first child. The woman started to bleed more frequently right before she got a strong contraction. I could see tufts of black hair. A few more contractions and I could see a quarter of the head. the worse part was watching the episiotomy. I knew I wasn't the one being cut, but I still cringed. After two more big pushes and all of the mother's energy the baby plopped right out. I was so excited for her and all I could do was smile all day. Witnessing the entire labor and procedures to follow definitely made me think twice about having children. When the time is right and with the right person!
After the healthy baby boy was delivered the doctor tied and cut off the umbilical cord did a quick exam to evaluate for any abnormalities. The mother was happy but in a lot of pain. Once the doctor carefully pulled out the placenta she felt more relieved. It's amazing how much can fit in a woman in addition to all her internal organs. Afterwards I got to witness another birth and this time it was a baby girl. I was thankful again that the staff and mothers let us watch because the hospital does not even allow the fathers to watch. I will never forget this day! Every day is a new adventure and the entire trip has felt like a vacation with new experiences and education.

First IM Injection 05-27-11

Today was awesome because the nurse was finally here at Hato Juli to monitor our team to administer IM injections. It was the first time for the majority of us. I was nervous, but I felt more at ease giving an IM injection here than I would have back in the states. The people here tolerate pain very well and are compliant with their free, annual immunizations. I gave the injection in the left arm of an adult patient. I was so surprised to find out that the needle went through like butter and not like the punch pads back home in the USF nursing lab. Afterwards the patient smiled and thanked me. Some patients smiled and chuckled at us for being nervous and taking pictures. As the day went on I became more comfortable and went from slight shaking to no shaking. It was like riding a bicycle. Towards the end of the day it was my turn to inject a child. On the child they administer Influenza on the vastus lateralis from infant to two years-old. I was nervous slightly because most of the children cry and they are so tiny and precious. Again, everything went smooth and the indigenous people trusted us with there children. I am thankful that they allowed us to practice our skills even though the majority of us could not speak their language fluently and the fact that we are just students. The Camarca must think we are the crazy "Gringos" and "Gringas". I definetly feel like we are making a difference, but they are teaching and making more of a difference in ourselves. For instance, I appreciate water more than I have ever before. Things we take for granted!

End of a journey

Many people here seen to have on average four kids and they're only in their mid-20s sometimes. I have my first IM injection which was birth control. Women stand in line with their vials of contraceptives that I drew up. Here in Panama all of the IM injections are give in the glutteus. Luckily I had a great nurse that showed me the right technique. My day in the ER was like an assembly line of injections. Many women come here to planificar or family planning. These injections are easier for compliance and last for a month. Some of the women have to walk for hours (or be carried in a hammock if they're pregnant) to get to the clinic. So the longer their birth control lasts the less they have to come to the clinic and the better the compliance.

Another thing that has surprised me is the stigma that is place on mental health here. Even though in the US many are unwilling to discuss psychiatric illness and are uncomfortable when it's talked about, in Panama it is almost unmentionable. When I asked one nurse what psychiatric nurses do she told me that they give meds and lead support groups. Then she said that if you stay in the field for more than ten years you'll go crazy yourself. Not very encouraging to potential psychiatric nurses.

One of the experiences that affected me the most was when we went to the orphanage. The kids there for the most part aren't adoptable. It's so sad that these kids have had such a rough start in life and all I can do is hope for the best.

Panama has taught me so much from the culture to its native Ngobe Bugle population. I know that we have done so much but when I go home in less than a week I'll be able to take a warm shower and eat out. Meanwhile many in the Comarca and other areas still don't have clean water to drink and the children run around with skin infections, lice, and sometimes HIV. I wish that I could fix all of their problems but that's not realistic. All I know is that I was able to help many of these people in small ways, assisted with the birth of a new life, and put a smile on a few faces.

Hi my name is Abigail..

Week two in Panama! I saw a baby being born for the first time and it was amazing. I was so excited that I got to witness such an incredible miracle and was fine with only seeing one birth in my lifetime. However, I got the chance to see a few more today and now I´m pretty sure I´m going to adopt.. On a better note, the babies were adorable! God is really showing me a lot about myself and making me truly thankful for how much I have. Some of the children in the hospital were just left there and abandoned by their parents at birth due to a birth defect or inability to care for the child. I met a little boy today that had a mental problem and had been abandoned, but he was the cutest child, weighing in at 6.5 kg at age 2, he captured the hearts of all the students he encountered. I got the opportunity to start an IV on a baby and was ecstatic that it was successful the first time. Overall, this trip has been quite an experience so far and I´m loving all the skill practice that I´ve been getting. I can finally say that I´m comfortable with IM injections and starting IVs :)