A look back....

After having a week to settle in and get back to a "normal" way of life....I find myself constantly thinking about the most amazing three weeks of my life. I got to experience some things that I will never have the change to do again. I learned so much from this beautiful country and truly had the time of my life. After being so lucky to have experienced all that we did in Panama, I can't help but feel different after returning home. I will not take things for granted as much as I did before (like hot water, clean beds, AC, alcohol pads, gloves, sharps containers, PYXIS, private rooms...the list could go on and on!). I have learned from the Panamanian way of nursing. One that is not focused on the task, technology, or politics, but on the patient. The way nursing is supposed to be. Like the Dean of UP said "what we lack in technology, we make up for with our hearts". A nurse cannot be so impersonal or out of touch as many American nurses have become. She needs to be connected with her patients and truly care for their well being. I hope after this experience, I will be a be a better nurse. I am so happy that I was able to have this once-in-a-lifetime experience!

At the end.

So our three weeks in Panama have come to an end! I have learned so much regarding both community and public health and life in general. Overall, I realize that we in the United States are very fortunate in many aspects.

The last week in Panama, we visited the children's hospital. It was located near the city district right across from the Santo Tomas Hospital. The children's wards were mostly full. Different departments in the children's hospital were Oncology and Hematology, Orthopaedics, Bone Marrow Transplantation, Pediatric ICU, Neonatal ICU, and a surgical ward. One of the biggest surprises to me, was the level of technology in the Neonatal ICU. They had very up to date machines and equipment. Another interesting fact was that they had almost one hundred beds. That seems like a lot considering the acuity level of the patients in this department. Yet another interesting aspect was the "permanent" patients who have become residents in several of the wards. For instance, there was a twenty-two year old who was a hemodialysis patient since he was a baby. Because the hospital was so far from his family's home, they were not able to travel the three neccessary time per week. Instead, he has taken residence in the hospital so that he can get his weekly treatments. This brings up a dilemma worth considering. What happens as he continues to age? Should he stay at the hospital and continue to get treatments? What are his other options? Or does he have any? There were several other very interesting aspects of this hospital.

At the end of the week, I was excited to go home but sad to leave. It is nice to be back where there is not such a language barrier- everyone understands me and vice versa. However, I miss all the interesting and new scenery and the day-to-day learning experiences. Overall, I had an awesome experience on this trip!

The Last Week

Our last week in Panama was spent with us revisiting the University of Panama and presenting our presnetations. Our information was well recieved not only by the faculty there but also by the students who attended. We were also to tour some of the different hospitals in Panama city such as the Childrens Hospital and the Oncology Hospital. WE enjoyed our last week and we were all sad to leave. It's amazing how our last week flew by and I can't believe that I am already home. This trip has allowed many of us not only to learn from one another but also from the helath care system in Panama. This trip has left us with many experiences and memeories of each other. This trip was amazing and I am very thankful for this chance and experience.

Goodbye Panama

I still cannot believe the trip we have been planning for months is now over. My experience in Panama was absolutely amazing. All of us had the opportunity to accomplish so many tasks we have not even thought about completing at our point in school. After working with so many children throughout the trip, it made me realize how much more I want to be a pediatric nurse. Although it may seem like Panama's healthcare facilities are not technilogically advanced, or they may not be as sterile as our hospitals, but it is amazing how educated the nurses are and how anyone and everyone in the country is able to receive medical attention. There were many instances throughout the trip that showed me how responsible the nurses are. The main thing is the ratio of patients to nurses. Many nurses in the states complain when they have 6 patients for their shift, while Panama's nurses may have up to 30 patients for their shift, yet they LOVE their job! Another situation was in the labor and delivery unit. I was amazed to see the delivery room containing only nurses and nursing students. The doctor simply walked in (while on his cell phone) looked at the patient and walked out. Seeing the responsibilities held by the nurses puts a whole new perspective on nursing in my head. Being in another country and focusing on their healthcare systems the entire time opened up my eyes to the different cultures and communities in our world. Although our country may be extremely advanced in healthcare and technology, it does not mean other countries, less fortunate, don't have as many benefits, if not more, than more advanced countries. Overall, I wish Panama had some healthcare changes, such as the resources to be more sanitary, but their system is very successful for their population.

Panama Experience

The trip is over and although I am very happy to be home with my family, I miss being in Panama. This study abroad trip has been the most rewarding experience and I am truly thankful for being able to participate in the journey. Overall, I believe this trip was a true success even though there were many stumbling blocks along the way. I have come back to America with a greater appreciation for the profession I am becoming a part of and for the kind of healthcare that this country provides. Panama has really opened my eyes with regards to community nursing. I do not think that I truly understood how other countries could have such different styles of healthcare, but Panama proved to me that different is not necesarily worse. Panama's nurses amazed me because of how much responsibility and skills they must have. It was interesting to note that the nursing profession is well respected in Panama, just like in the U.S. Even though nurses do not make the same kind of salary as we do here, they are happy and completely satisfied with their profession. Panama's healthcare system truly amazed me because they make it work with limited resources. I am so greatful to have been able to experience Panama; it was an awesome journey!

7-8-09

Today we went down to St. Tomas Hospital. We took a tour of the hospital and spent time in the labor and delivery room. This was a great experience. I got see a birth and go to the nursery and see all the new little babies! I feel like I am a little more ahead of everyone else in the class because I got to have some hands on experience with pediatrics and OB. It was interesting to see the difference in the health care systems. Women do not have the option here to have a private room. You walk in to the labor room and you see around thirty beds filled with women that are in labor. The men are not part of the birthing process. It was a good day and we saw and learned a lot.

Posted By Sarah Dailey

7-2-09

Today we went down to University of Panama and vaccinated the students. We worked along side the University of Panama students. It was interesting to see how the two different nursing programs are. We finished off our day by going to a barbecue. One of the preceptors in the clinic asked us to come to her house for a barbecue. The food was amazing and the house was gorgeous. It was on the mountain side were cows and horses roamed. The house had a wrap around porch with rocking chairs and hammocks. The food was delicious and the best part is that they let us ride their horses. Everyone down here is warm and friendly. They are all interested in our culture but yet so proud of theirs. The people are so proud of their country and want every one of us to experience their culture.

6-30-09

The clinical experience has been amazing in Panama. Today was our second day in the clinic. The nurses here are so sweet and helpful. They really take their time and show you things step by step. They also, want us to experience the culture here. Our preceptor went out and bought us local bread, candy and souvenirs. I also, have received a lot of practice with immunizations. We went to the local police department and vaccinated a hundred police officers.

On our way home

Well the three weeks are up! Its been an amazing experience and we have seen and learned so much! I'm sure that we will all remember this experience for the rest of our lives! This past week we visited a clinic in Panama city, the mental health institute, Panama's biggest and "best" hospital Santo Thomas and the children hospital. While it was very sad in some parts of the children's hospital, the care they provided was phenomenal. The technology at the hospital was some of the best in Panama. We had our last dinner at an amazing restaurant on the Causeway last night. Now its time to leave this beautiful county and take our experiences back to the US. Speaking for myself, this experience has expanded my views of nursing and of the world. This trip has prepared me to be an even more well-rounded nurse and given me an amazing understanding of community nursing.

Our last day

We are leaving Panama today and I am more excited then ever to go back home. I look back on this trip and I am so happy that I took this opportunity. I have memories to last a lifetime and have made new friends. This trip was fun, hard, full of experiences, and crazy all at the same time. Learning about a whole new culture was really great for me and I found the Panamanian culture interesting. I am proud of myself for surviving this trip and I took many new opportunities that I would have never taken if I were in America. I gained many new experiences that I don't think I may ever get to experience as a nurse in the U.S. I am also proud of myself for getting through the language barrier. I learned new spanish words that I hope will help me as a nurse if I ever have a spanish-speaking patient. I am happy I went to Panama and I now have many great moments and experiences to look back on and smile.

Our last week

The last week in panama was full of observations and great experiences! We toured the St. Thomas hospital which was very impressive. We go to see the ICU along with other units. After we toured we went to the maternity unit dressed down into srcubs and went towards the birthing center. It was very different to see all the women in labor were all stationed in the same room until they are moved to a private delivery room to give birth. After we got to see the area where the newborn babies are taken to recieve care until the mother leaves the delivery room and moves to recovery. We all got to see the children's hospital and the oncology institute. We also went and visited the U.S. Embassy and was presented a very informative session about the roles of the US Embassy in Panama.

Today we are leaving for the airport and I am kinda sad to leave. These three weeks have been some of the best weeks ever. I learned so many new skills and had so many great experiences. I'm going to miss spending everywaking moment with my villa mates!!

Looking back at Panama

Wow, were to begin... when I first planned to come on this trip I couldn't have imagined how amazing it would be. Looking back now through my pictures I cant believe how much we all saw! Out of the gate things weren't looking so good when we stayed an unexpected night in Miami. But, getting through the rough spots with airlines, bugs, and ranchos were totally worth it and made our group strong. The ability to adjust to the elements of the trip was a great oppurtunity to practice patience and teamwork. Things I didn't realize I would work on during this trip but was a great aspect of it!! I am thankful for the other girls on the trip being with them made it easier to get through the rough spots on the trip and really fun to explore. The Chitre clinics and El Valle were definitely the highlights of the trip for me. The Chitre clinics were humble but they proved that anything can be done even if you have limited staff and resources. These small clinics saw hundreds of people and provided them with healthcare with a smile on there face, even with no air conditioning in some areas of the clinic. They were hard working and welcoming to all students. It really inspired me to always have a smile on my face and to try new thing, my confidence in my skills was greatly increased by their constant enthuiasm. I couldn't be more thankful for that part of the trip. I know it will always influence my nursing practice. El Valle was a great retreat after a week on long days in Chitre. The valley town in the clouds let us all relax. Day one was amazing with a walk to the spring and a relaxing mud mask and dip in the warm water. Day two was high energy as we hiked and ziplined through the mountains and over a waterfall! I of course wish for more time there but am so happy for the time we did get. Leaving was hard but getting to the City of Knowledge was a nice familiarity. Kaley and I closed our trip a few days early but I think we made the most of it! I am thankful I didnt have to miss out on the entire trip due to scheduling conflicts! Thank you Panama and all the people there that supported our program!

Alto!

Now that our final presentations and community clinicals are complete, the experience in Panama has come to an end. The experience in Panama has afforded many new learning opportunities, many which could not have been possible in the States. As I reflect on the course of our trip it is apparent that this trip was very successful and the knowledge that I have acquired has been unfathomable. I have learned that health promotion, prevention and the treatment of illnesses are the essential pillars of community health nursing. The time spent here will be one that I cherish for a lifetime. My most memorable experience was witnessing the miracle of life as one of the patients in Santo Tomas hospital gave birth to her first child. This moment will forever be sketched in my mind. The nurses that I have been fortunate to learn from are truly deserving of recognition for their selfless work. The nurses are few but the hours are long and the patients seem to be endless. The Panamanian healthcare system has broadened my perspective of healthcare. This experience has facilitated my learning tremendously, the lessons learned and skills gained have equipped me to become a competent healthcare professional when I start practicing in the very near future. Overall I would consider myself very fortunate to have experience this opportunity.

Last day in Panama

The final day in Panama is here. This has been an unbelievable experience. Before this journey I never imaged living in another country for three weeks and receiving course credits for it. I can honestly say that this has been my first one in a lifetime opportunity. Panama is such a beautiful green country, even though some areas were succumbed by mounds of roadside trash. But the mountains in Elle Valle were the most beautiful scenic place that I have ever seen, the mountains in Colorado do not even compare. The Panamanian people that I had the honor of meeting on this trip have been very welcoming with very vivid and spunky personalities. This experience has not only provided me with these unforgettable memories but also has advanced my clinical nursing skills such as giving injections, height weight, and performing pap smears. I would have never been able to perform a pap smear in an undergraduate nursing program within the United States, only at the graduate level. Exposure to the pediatric and labor and delivery area in the hospital has been beneficial since I will be enrolled in those courses the first half of this upcoming semester. Witnessing the labor process and seeing firsthand the intensity of the pain the mothers be going through was a learning experience within itself. Even though I did not see a delivery up close I did witness the cutting of the umbilical cord from the hallway which I enjoyed every moment of it. Overall this has been a fun filled yet education experience. I’ve learned so much about the Panamanian healthcare system which is similar but also has pronounced differences from the US healthcare system. The UP faculty and nursing students were accepting and made me feel as if I would always be welcome there if I decided to come back to Panama, a thought that has crossed my mind in terms of volunteering in the Peace Corp. The real world awaits me when I get back to the states a guess that’s all a part of life, mostly hard work and some leisure time. The best twenty-one days of my life thus far.

Pediatric

I was also very excited to do the Pediatric rotation. We got to go to the Children's Hospital and there I met 2 great nurses that we very helpful and informative. We were able to go to the P.I.C.U. and observe the unit. My favorite part was to see the newborns. Seeing them reinforced my passion for working in neonatal nursing. Although, for some, visiting the N.I.C.U. might have been too much to bear, for me it was not the case. I just think that it is amazing what the nursing practice can do to help save babies lives and get them to were they need to be to lead a healthy and improved quality of life. According to the nurses, the common major problem that is seen in the N.I.C.U. is prematurity, which did not surprise me. A problem that was mentioned to be common in pediatric child growth and development in the San Juan de Dios Clinic in Chitre last week was that the children take longer to walk than normal and they say it's because the family always carry the baby and don't give them much opportunity to be on the floor in order to learn how to walk. Another interesting thing, which also relates to maternity as well, is that here in Panama there is a law that women have to breastfeed for the first 6 months. I think that it is a great law because it is very important for babies to receive mothers milk in order to receive the vital nutrients that is the backbone in establishing a healthy strong immune system among many other important things. Overall, I noticed that here in Panama nurses are very big on educating their patients and they have a very intimate relationship with their patients that in the United States might even be considered crossing the line of a therapeutic nursing to patient relationship. Interestingly enough, it seems that because they do have such an intimate relationship with the patients, it seems to further strengthen the relationship and comfort between them allowing the nurse to be able to seamlessly talk about very personal, important and intimate details that are crutial to know in order to provide optimal care. That relationship also seemed to make it that much easier to educate them and really get through to them without seeming negatively authoratative. The experience I have had here in Panama was great. I am very fortunate to have been a part of such a great opportunity to learn and practive community nursing here. I will treasure these moments and take with me the knowledge, experience and friends I have made along the way.

Maternity

The day we had maternity I have to admit I was extremely excited. I was very much looking forward to seeing the delivery of a baby. Considering I want to work with neonatal, mother/baby or labor and delivery I am sure my excitement does not come as a surprise. Although, I was not one of the fortunate ones to witness the miracle of life, it was still a very great experience. I was able to see the maternity unit and got to speak with one of the patients who was there to give birth to her second child. While I observed the unit I noticed how many of the women were in a lot of pain, again no suprise there. However, there was a woman that was not in any sign of pain and it was very interesting to know that she was of indigenious descent and that in their culture they do not convey pain. Surely enough, it was she who was the one that some of the students were able to see give birth. Again, they mentioned her lack of portrayal of pain. Even though I was disappointed to not have the opportunity to witness the delivery of a baby I was able to obeserve and still had a great experience and I am still looking forward to the moment I get to witness the miracle of life.

Final Days

I'd be lying if I said I'm not ready to leave. Although I'm well past the point of wanting to leave I can honsetly say this has been one of the most life enriching 3 weeks of my life. For me, being here has bought a whole new meaning to the term cultural awarness. Being aware of another culture is one thing but being able to respect a persons culture and way of life is a totally different thing. I like to consider myself a person who is aware of many walks of life. I know and associate with people from different socioeconomic status, races, cultures and backgrounds but that is all within the US. To be in Panama, a place out of my comfort zone observing and even at times living within a new culture has allowed me to gain a new found respect and understanding of other cultures.
I feel beyond blessed to have been giving this opportunity. To be welcomed and embraced someplace outside of "home" and at the same time gain knowledge and experience in a field I love so much. Today we had our final presentations in front of the University of Panama nursing students and I felt there was still so much we could learn from each other. The few facilitated conversations between us and them was like two worlds coming together as one with one common interest; nursing.
This trip has definitely opened the door for more international travels. I can't say they all will be in the interest of nursing, but there will be more. To all of you who have been here with me. We all know it has not been as easy trip. 22 women, 22 different personalities and 1 small bus does not always make the best combination but we have made it and I hope many all of you leave here with broaden perspective.

Pediatric Hospital

Yesterday we were able to visit the pediatric hospital here in Panama City. The experience was wonderful, but very heart breaking. I came to Panama believing that pediatric ICU was my calling and after being able to visit these patients, I definitely think this is my area. I wanted to jump right in and start helping those children. They were absolutely adorable and precious! One area that specifically grabbed my attention was the oncology unit. There was a separate room with the blinds closed that they put the terminal children in. I understand that the other children in the hospital really shouldn't witness their friends dying, but to completely isolate them in a different room with no one to comfort them seems very disturbing to me. I would not want to be left alone with complete closure from the outside world if I were the child about to die. It really touched my heart. I really enjoyed the NICU at this hospital. It was very large and I was kind of shocked when I realized how technologically advanced the unit was. They had a lot of machines in this specific unit and more "beds" than any of the other units within the hospital. It is interesting to see how much fathers are not involved in their child's care. I saw maybe 5 or 6 dads with their children at this hospital. The majority of visitors were women, which is not necessarily the case in the U.S. Overall, my experience at the pediatric hospital was extremely valuable and I really enjoyed being able to take a tour.

Nervous to present!

Hola everyone!

Today we are all presenting our group topics to the University of Panama and I am a little nervous! My group's project that we will focus on were the differences between American and Panamanian healthcare systems. We mainly will discuss the difference that Panama has universal healthcare, and how the US is run by private insurance. We also compared and contrasted simalarities in the hospitals, clinics, schooling for nurses, and staffing in the hospitals. Although there are many differences in the nursing world between the two countries, nurses are looked up to as respected role models in each country, which gives me pride for our profession.

Tonight we are going out for our last meal in Panama :(. I am sad we will be leaving ALREADY, but I am eager to get back into routine of Tampa life. Panama took all of us in with open arms, and I cannot express what an amazing and interesting time we have had here. I am so happy to tell all of my family and friends of the adventures we went on, and the clinics we we got to practice our skills in. I hope one day I can come back to this beautiful country!

Ciao!

Ashley

Santo Tomas Hospital

Today we visited the Santo Tomas Hospital. After taking the tour of the hospital we went to the Maternity Ward of the Hospital. Once we got there they divided us into two groups (eleven in each). We first got to visit the nursery where two of the students got to feed and burp a newborn. The most interesting observation was that I recognized was the fact that the infants that were born to mothers with HIV had red biohazard bags tied to the newborns bassinets. We were also informed that red biohazard bags are tied to a newborns bassinet when the mother chart is missing or is not brought up with the patient, for precautionary reasons. Some of the infants were in the incubator beds. One cultural difference that I noticed between the US and Panama is the fact the Panamanians give their newborns their first drink of milk out of a small four ounce cup instead of them being feed from a bottle or breast. The Panamanian instructor really did not give the rationale behind this action, but it is interesting that they did that.

When we first got into the labor and delivery unit of the hospital we witnessed from the hallway of the unit a woman who just delivered a baby being sutured and the nurses were removing the placenta. Then we attempted to see a delivery but the patient did not want us to observe the delivery so we respected her wishes and left the area. We spent the majority of our time in the unit with approximately ten pregnant women who were receiving care from the nurses in preparation for the delivery. Even though we did not have the opportunity to witness a birth having this experience made me realize that I really do not know what I want to specialize in after graduation. I never imagined that labor and delivery would spark my interest as much as it did. I believe that I possibly want to work with newborns due to the fact that I love interacting and caring for infants and children. Fortunately, I have some time to evaluate my options. I love the fact that we get an opportunity to get some exposure to Peds and OB before the upcoming and final semester in the nursing program.

El Valle

It was a very relaxing and adventurous day in El Valle. The morning began around 6:45am. After doing my daily routine I packed my belongings and grabbed 2 cups of coffee before loading up on the bus to go Zip Lining in the rainforest at the Macho Waterfall. Once we made it to our destination we were able to take a brief hike while we waited for the manager to come to negotiate a reasonable price for doing the five platform zip lining course. The original price of this specific course was priced at $52.50 but we were able to get a five dollar discount ($47.50). We also had the option of doing a shorter one (platform-to-platform) for $12.50. I originally wanted to do the cheaper course because of the price but I thought to myself this is a once in a lifetime opportunity. I’m glad that I did because I will never forget this unbelievable experience.

The most tiring aspect of zip lining is the hike to the top of the mountain. I really don’t know if we went to the top of the mountain but we hiked at least twenty minutes continuously without a break. It was worth the hike to the top and if I was given the opportunity to do it again before the end of this trip, I would not hesitate. I would honestly have to say that zip lining is the memorable experience thus far on this trip. I’m usually afraid of heights but I was so excited and I never got scared while doing it. My favorite part of this experience was when the zip line instructor stopped me right over the waterfall for about two minutes. That view was breath taking and it’s an image that I will never leave my memory. The entire experience was so exhilarating. I was so disappointed when the string on my camera broke, so I was unable to take photos while I hung over the waterfall. I could not chance dropping my camera into the water below. No matter photos of the experience will never be as vivid as my memories. I must say that this was the most memorable experience of my life thus far. I cannot wait to do it again.

Clinical Experience

Time has surely flown by during our stay in Panama. This week has been filled with new opportunities and experiences that have fashioned my perspective on healthcare. Yesterday we traveled to a near by hospital called Santo Tomas. Upon our arrival at the hospital, the nurses briefly presented on the hospital’s history, mission, and specialty areas. We then were oriented to the maternal and newborn ward. During our rotation we witness women who were in labor and preparing for delivery which was quite informative as well as memorable. The nurses and staff were very helpful in their demonstrations and were to willing explain the different dynamics of child birthing. At the university we interacted with other nursing students as well as professors and learned more about the health care system in Panama. The professors were very knowledgeable in their areas of specialization and facilitated our learning greatly.

Last Week

Yesterday, I was almost able to see a delivery. However, it was a false alert, but some of the other students were able to see a quick delivery! It was still exciting to see a baby almost get delivered. We also saw a couple of indigenous women in labor and was informed that they do not show obvious emotions of pain verbally. So the nurses have to highly observe the indigenous women because they may be under-treated with pain medication (if they even consent to using any pain medication) and/or they may not notice that it is time to deliver.

We have 2 more nights in Panama. It certainly has been a great experience. There are some major differences between the Panamanian and American health care. I believe one of the biggest difference is that everyone in Panama can receive health care for free, which is highly beneficial. Everyone in Panama has health care. But we have more resources in America. For example, the biggest hospital in Panama City did not offer peritoneal dialysis. Also, the nurse-patient ratio in America is smaller compared to a rate of about 1 nurse to 30 patients in Panama. The amount of patients a nurse receives in Panama is quadrupled compared to America.

Chitr'e

Chitre held so many new experiences for me including doing immunizations on children. By working hands on with children in the Centre de Salud Clinc made me see that I have a desire to work with kids. Even though the children do cry due to the shots, they recover quickly and are easily pleased. I had such an amazing experience in Chitre that I wouldn't change for anything. It was amazing to work with not only the staff and patients, but also challenging to have a language barrier. It has been a humbling experience and an amazing time for all of us. It was amazing as a student to do a PAP smear on two adult women since you would have to be a nurse practitioner in the states to do such a thing. The nurses here are so well trained and have learned to work with their limited resources. I hope as nurses in the states we can be as resourceful and maybe take home some of the time management skills that we have learned. Its important for us to introduce this into our work habits when we are in the hospitals to make us more efficient nurses and our time well spent.

The Miracle of Life!

What a wonderful day! Today (July 8, 2009) we ventured our way to the maternity ward of St. Tomas hospital. After a short tour of the other units in the hospital we made our way to the birthing ward. There we changed into scrubs and cute little blue hats and booties, we all felt back at home in our scrubs. We ventured through to the little changing room to the birthing area. It was a large room of about 14 beds lined around the wall, and the nursing station is in the middle. There were 3 nurses in the room, with lots of students and doctors running around. It was interesting to see the different ways the women handled the pain and contractions. Some of the women were screaming while others sat and closed their eyes to take in the pain. Our Professora Lucero mentioned to us that the silent women were indigenous Indians and in their culture, they are expected to endure the pain without making any "dramatic" noises. She also mentioned that you have to really watch these patients because they might have birth on the bed instead of in the actual birthing room. We got to observe all of the people running around checking the heart rates of the babies and checking the dilation of the mothers. It was quite overwhelming and chaotic to see all of the women in labor. Once a mother was deemed to be ready to give birth they wheeled her to the birthing room, a somewhat operating room with an incubator area to check and clean the baby. As we were watching and observing one of the women was wheeled to the room, not but a minute after they draped the cloth over her, the baby started coming out. It was quite a miracle to see, and even more amazing that the mother barely made a noise. Once the baby arrived into the world, a loud cry emerged into the room, and the mother had received a baby boy, her fifth child. Once the baby’s umbilical cord was clipped, he was immediately taken to the incubator area and the doctor suctioned the nose and cleaned up his body, all the while inspecting and listening. This little boy was 37 weeks and was going to need a little extra attention, but should be heading home in the next couple days. In all, it was a wonderful experience. I never thought that I have such an opportunity on this trip. The joy that the mother had and the beauty of a brand new life was enough to make any one smile. It makes me even more interested in labor and delivery.

Maternity

It was very interesting to visit the Maternity Ward at the Santo Tomas Hospital this week. I work as a tech on a labor and delivery floor back home in Florida so I could definately see the comparisons between Panama and the US. When we first arrived we had to change into our scrubs and wear a hair cap, masks, and booties over our shoes. All geared up, we did a short tour around the floor. First we saw the laboring room. Back in Florida each patient has their own room where they can have family and friends support them through the laboring process. Once they are ready to deliver the labor bed converts into a delivery bed and they can deliver their babies right there with their husband or significant other by their side. In Panama there was one large room with beds lining the perimeter. There were probably about 6 or 7 patients all in active labor next to each other, moaning in pain. No family members or husbands were present. Once they are ready to deliver they are moved to a different room with windows on the doors that didn't have curtains or anything. Passing by we were able to peek right in and see someone getting sewn up and someone else delivering. I was told by one of the nurses that they are trained how to do the actual delivery because at night there is usually only one doctor and if there are more than one person delivering, the nurse and sometimes the nurse techs or students have to take over and deliver the baby. I can imagine this happens quite often because they only had 5 delivery rooms. We then went to the nursery where the babies are kept after delivery. This was a tiny room but had a LOT of babies. Some of the incubators had 3 babies in one! In this room they do the baths and the first feeding. Interestingly, the first feeding is done out of a cup, not a bottle, not a nipple, and not with the mother. I definitely learned a lot and thought it was amazing how the different health care systems work in each area.

Panama: Weeks One and Two

The first two weeks in Panama were truly an eye-opening experience. I wished I could have posted this sooner but I haven’t had reliable internet access. Panama is such a beautiful country I love being here, there is always something to learn and the culture is fascinating. The people are very welcoming and eager to collaborate with us, the food is also great. During the first week we toured the city of Panama and unloaded our belongings in our villas at the City of Knowledge. During our tour of the city we traveled to the University of Panama and interacted with other nursing students and learned about their curriculum. The professors as well as the students facilitated our learning tremendously. We traveled to another university (Latina University) and learned about their nursing curriculum through student and faculty presentations. The first week was exciting, most of the time was spent on getting acquainted with our surroundings, learning and touring the historic sites of Panama. Aside from the tourist activities we visited the local hospitals and gathered data to facilitate our learning on prevention of HPV as well as inpatient and outpatient care.

The second week in Panama was in my opinion the highlight of the trip. During one of the hospital visits to Hospital Cecilio Castillero we toured the different wards and learned about inpatient services and the Panamanian health care models. We traveled to an indigenous tribe called Embera, which was quite an experience. Upon leaving the Embera village we traveled to a city called Chitre where we divided into groups and went to the different clinics and administered immunizations including influenza, Hepatitis B, pneumoccoal and tetanus toxoid. One interesting highlight during our clinical experience at Ramiro de Diego clinic was getting the opportunity to perform pap smears which we will never have the opportunity in the States to perform as registered nurses, since this is performed at the Masters level.

"Conclusion of Chitre Expedition"

Although this week was more work than play, I was happy I learned a very important lesson. Health promotion is an important goal of community health nursing. While touring Chitre, I was able to witness first-hand how community health nurses facilitate health in the population through direct nursing interventions for health promotion in individuals, families, groups and diverse populations. The concept of health was defined in my successful administration of medication and my effective patient teaching. With the help of the kind nurses at the clinic, I was able to improve the health of Panamanians by identifying/observing major health problems and setting goals to reduce death and disability.

Mental Health and the Painful miracle of life

This is week we went to the mental health institution where we learned about the different services offered to individuals with mental conditions or dealing with substance abuse. This institution houses 21 patients and provides them with activities to incorporate them back into the community. Only 5 of those patients count with family support, which I believe is a great barrier for their rehabilitation back into society. These individuals make different handcrafts as part of occupational therapy and sell them to buy more materials; I was able to buy a painting of a mother feeding her child as an angel watches over them. This painting was made by an individual diagnosed with schizoaffective disorder; I had the privilege to meet her and she signed her piece of art for me. This really meant a lot, she was so happy to sign it, especially after one of the nurses told her “they are taking your painting to the US.”
Today I saw a baby boy being born. That was quiet the experience!! It was a very beautiful moment and at the same time very painful. The baby was 37 weeks and had some breathing problems; the mother was in tremendous amount of pain because her placenta broke within her and the doctor had to scrape it out. I have never seen anything as painful and disturbing as this; it made me think twice about having children in the future.
Overall, the mental health clinic and the obstetrician clinic were wonderful experiences and gave me the opportunity to see how Panama handles these subjects. It is a sweet-and-sour feeling to see how happy a mother can be with so much physical pain and to see how a simple gesture like buying a painting can mean so much to a person and at the same time see how society rejects this artist.