Blog #1, #2, #3

Blog #1
Today is Monday, June 20th. Spent 2-3 hrs at clinical today. We are now in Chitre, we will visit Panama City again our last weekend in Panama. The people here are all very friendly, fortunately our translators are able to understand them very well. Panama City was much more developed than I had anticipated, with several sky scrapers and hotels. Shonie, who visited Panama City 5 years ago, informed us that about 50% of the city has come up in the past 5 years. The landscape flying in was a vast abundance of forests, and mountains. The landscape was exactly what I was anticipating, as I imagined it to be very similar to Costa Rica. I visited Costa Rica for 1 week over the previous summer. I was informed on our tour that the average Panamanian lives in the governmental housing in the city. I underestimated the heat; walking around on our tour I sweat more than I do running the track and stadiums at home. Life is much simpler here, and helps put in perspective what is really important in life. As for Chitre, I had imagined us to be living in much worse conditions. We do have air conditioning. It is 2 people per room; we have 1 bathroom, a closet, TV, and 2 full size beds. There is lots of undeveloped land, but there are stores nearby, internet cafes, and even a small mall. The University here is very nice, with a tropical feel. They have a library with several working computers, have provided us with a classroom for seminars, and have a nice cafeteria. We aren’t eating the food AT the cafeteria however, because we are supplied a home-cooked meal for breakfast and lunch every week day. The food is delicious and as local as you could possibly find. The food is delivered each day to the cafeteria just for us. Today we also had our first day at clinical. I was at the Social Security Clinical and paired with Shonie in the Women’s Clinic. Mrs. Vivien was nice enough to spend the day in the women’s clinic as she knew the majority of us had never performed a papsmere on an actual human. I performed two papsmeres and did 2 breast examinations. They only took two samples at the clinic, and left out the sample of the vaginal wall. The only woman who had the vaginal wall sample done had a total hysterectomy. It feels great to have accomplished another skill, especially considering that I was most nervous about the Women’s Clinic. After our first day of clinical I am much more excited to be in Panama, I think it reminded me of why I really came. Definitely looking forward to clinical tomorrow!

Blog#2
Our first week was spent at the Social Security Clinic in the town of Chitre, Panama. As we walked in we observed that there were multiple people sitting in the waiting area, waiting for direction. It was a friendly environment and several of the people greeted us saying “Buenas!” as we walked in. There were no magazines or reading material in the waiting room. The majority of the patients were mixed Amerindian and white (Panamanian).There was a pretty good sized open space in the waiting area, although the actual rooms were much smaller. We observed that the majority of the patients arrived by the public bus. We were introduced to Maria, the head of psychology and also the Charge Nurse at the social security clinic. Maria led us to our different sections of the clinic when she was there, and was very helpful as she spoke a little English. Our clinic had three sections we were allowed to be in: pediatrics, gynecology, and injections. Once in our individual sections we noticed that the rooms were air conditioned right away, as the temperature was freezing. The general cleanliness of the clinic was very clean, and it was noticeable despite the old architecture of the building along with the old chairs and furniture. In fact a smell of bleach filled the air as soon as we got off of the bus. Shonie and my first day was in the women’s clinic doing papsmeres. We found the nurse to be very friendly and helpful as she got us in the room with the patient almost immediately. Shonie recalls her saying “To be a good nurse you need practice!” Kayla was with Kristin and Jessica in injections and asked if they could take pictures, keeping in mind we have the HIPPA laws in the US. They were surprised to find that the HIPPA laws did not seem to apply, and the nurses as well as the patients had no problems with pictures being taken. We all were surprised to find the equipment very up to date. In the Injections room we always had the proper size needle, and in the women’s clinic we used disposable speculums. There was one obese woman that I used a sterile metal speculum for. We were also all surprised with the bluntness of the nurses, and heard a couple nurses call a patient fat to their face, with students in the room. We also noticed that women were not ashamed to breast feed their children and would do so openly. We noticed there were health promotion posters covering the walls of the clinic, and while we may have those in the US, the ones at this clinic were much more direct and easier to absorb. The majority of the Panamanian population seems to be Catholic, and I observed a large poster of Jesus on the cross in the injections room. In reference to health and morbidity I did not see many chronic conditions, or communicable diseases. The majority of the people were just coming in for checkups or for their first time. The Social Security Clinic was different than what we expected but overall a great experience. We are all very grateful that we had the opportunity to expand our skills and help the people of Chitre in the process.

Blog#3
My clinical experience in Panama has been one that I will never forget. It is so interesting to get to see how a different country operates in their health care system. There are many differences between the US and Panamanian healthcare. The constant cheerful attitude, endless patience, and bold education are all things that I would like to incorporate into my own practice back in the United States.
Despite how many people were waiting to be seen, or poking their heads in asking if they’re next, the nurses never seemed overwhelmed or snapped at a patient. The nurses that I had the opportunity to work with never seemed to let a persistent patient get under their skin. Not only were the nurses typically very busy, but they also had a student in the room. Considering that I speak a very minute amount of Spanish, we can assume I take up time as if I was an additional four patients. Despite my lack of Spanish, there was one nurse in particular who always took the time to answer any of my questions to the best of her ability. She understood a good portion of my English but spoke none. She would answer my question in a couple different formats, until I was able to pick up enough words to figure out the answer. If I was unable to understand what she was saying after the first two attempts she would often exert the effort to act it out or demonstrate using her hands to help me understand. This particular nurse did this the entire day, smiling back at me and never seeming frustrated. To an extent this reminds of some patients I’ve had at the hospital who may require additional explanation. It reminded me to never get frustrated, and to realize what a difference a cheerful attitude and endless patience can really have.
Another thing that I would like to incorporate into my nursing back into the US is the bold education the Panamanian nurses would give to their patients. There was one example in clinical, in Panama, where a nurse called a patient fat to her face and proceeded to tell her the health implications being her size can have. In the US I have often seen nurses beat around the bush when talking about obesity. While I would never be blunt enough to call a patient fat, I think I will definitely make the extra effort to talk to an obese patient about their weight. They may not know the implications of being obese, or maybe they have heard of some of the implications but never from a healthcare provider. Seeing that made me realize the impact we, as health care providers, can actually have by educating our patients.
Overall I’m not only getting great clinical experience in Panama, I’m also learning new ways of how I can provide the best possible care to my patients.