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 :)

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!"