Homeward Bound

               For our last night in Panama City, we went to Crepes & Waffles, or "cray-pays and waff-lays" as Cadena, our prof., tried to translate for our Panamanian bus driver, for dinner. This woman apparently has a Colombian husband who speaks fluent Spanish, her daughter speaks fluently, she has Rosetta Stone at home, and has been leading this trip to Panama for eight years!  How do you not know a lick of Spanish with all of that exposure?  Has been a thorn in my side for the last three weeks, had to rant a little :).
Moving on, dinner was delicious and we were able to stay in a renovated dorm in the City of Knowledge which had air conditioning, cable TV, and lukewarm water (at least it wasn't freezing cold).  Not a bad way to end the trip.

Dessert crepe - Nutella, strawberries, coconut ice cream :)

The next day, only 2 trips to the airport were included in the bus contract: one at 4am, and the next at 9:15.  Or, we could hang out and take a $30 cab ride from downtown  - I opted to use the time at the airport to do homework.  I found out when I got there that the people from Spirit don't arrive until 11pm because they only have one flight leaving from the Panama City airport at 2am.  I had plenty of time to kill and the only thing on this side of security was a 24 hour cafe, so it really was a productive afternoon!  I also ended up meeting a girl in the Peace Corps in her second year in Paraguay.  She does agricultural work with the people there, showing them how to farm, rotate crops, compost soil, etc.  She had visited a friend in the area of the Comarca that we had been working in over the last three weeks, so we talked a lot about that. There was also a giant group of missionaries from Orlando, FL in fluorescent green T-shirts so I at least had some good people watching while I waited :).
               When I finally got to check in for my flight, they informed me that there was a delay and I would miss my connection in Fort Lauderdale.  When was their next available flight from Ft. Lauderdale to Tampa?  8:15 in the evening when my flight was arriving more than 12 hours prior and I had just spent an entire day in an airport.  So, I bit the bullet and spent the extra money to hop a bus at 8:30am  to be home by 2.  I suppose this just proves that all things come full circle - I have issues with my airline leaving the country and again coming back home.  At least I got to spend most of Father's day with  my Dad, and man, it's good to be home :).

           

Last Day

  Our last day in San Felix/David began with a presentation of our findings from our work in each of the three communities in the Comarca.  Each group had a particular focus such as childhood development, women's health, or traditional medicine, and incorporated statistics and photos from each region.  It was probably a little longer than needed, but I think we managed to hold the audience's attention through most of it!
             Next on our agenda was an evening at the hospital in David, working alongside the Unachi nursing students doing their clinical rotations.  The first half of the evening was pretty uneventful.  There weren't a ton of patients on the floor, but my student, Cristela, and I got to hang blood and I did a head-to-toe assessment (in Spanish).  Despite lack of hands-on work, I did learn a few things:

- Nurses (and students) hand write everything!  They don't have any electronic charting, it's all on paper.
- Mercury thermometers are really hard to read
- Counting respirations/pulses for 15 seconds and multiplying by 4 doesn't fly here
- Students sometimes have to work doubles (7a-11p!)
- And then they have to go home and do homework for their morning classes
- There is only 1 nurse per unit which means each one can have 30-40 patients at once!
       (In the US, nurses complain when they have more than 5 patients)
- Nurses here make an average of $3/hour
       (Meanwhile food, gas, and many other things are priced equivalently to the US)
- Students are required to wear makeup and have their hair up in a neat bun
- All nurses wear little caps, and the various colors on them indicate where the nurse is from
        (i.e. green = Panama City, yellow = Chiriqui)
- Regardless of where they're from or the language they speak, nursing students have the same sense of
       humor :)

            I really enjoyed my time working with the girls in David, and I wish we had more time to spend with them!  They are held to such a high standard both academically and professionally, and I think they set a great example for nursing students everywhere.  They were incredibly patient with us, taking the time to explain things several times in order to make sure we understood, and never seemed to mind that we couldn't speak their language.  I, and I think we all, felt so welcome here that I can't wait to come back someday!

The students let us borrow their caps :)

Hospital in David

             On Thursday, June 7, we went to the hospital in David to work alongside the Unachi nursing students (the hospital's full name is "Hospital Materno Infantil Jose Domingo de Obaldia in David."

Nursing students :)

I was assigned to the labor/delivery unit, which we will be rotating through next semester, and found that it was not like anything I had experienced yet as a student.  First we were brought into a waiting room where all of the women in labor were awaiting transfer to the delivery room.  After observing several measurements, one was finally ready to go and we were allowed to follow her.  This was her third child, so apparently things moved relatively quickly, but the entire procedure was performed by a nursing student!  We don't get the opportunity to do that as students in the US, so that was really cool to see.  There were a number of differences between US and Panamanian deliveries:  first, the mother showed no emotion during the entire thing, including when they handed her child to her and the nurse had to place the mother's hands on her child because she kept them by her side.  Second, they do not use epidurals - not just in Panama, but largely anywhere outside of North America (apparently we are just wimpy in the States).  Third, the doctor poked his head in once to make sure everything was running smoothly, but was more or less absent otherwise.  Evidently they are only called in if surgery is required (i.e. c-section), but any minor sutures are, again, done by the nursing student.  Lastly, there were four USF students and an instructor, five Unachi students and an instructor, plus on-duty nurses in the room with the poor woman, and they were all standing around educating us on various aspects of the delivery process, taking pictures, laughing, but not really paying much attention to mother and baby.  It was great for us, but I felt rather bad for her.

It's a girl!

               I suppose that the nursing students here are required to have this type of experience because it occurs more frequently here, especially among the indigenous people.  In the United States, most families have between one and three children and the parents are getting older with each generation.  Here, however, more than half of the population is under 19 years old (at least in Chami, our community), and many of the women have their first children before the age of 20.  I realize that part of it is cultural, but after seeing so  many women struggling to feed themselves I'm wondering if there ought to be a better effort to promote education on birth control.  In our clinics, Dr. Barry and his staff were very good about making it a point to mention the various implements and injections available, but most of the women I observed were reluctant to discuss it.

A family in Hato Chami

Boquete

Friday June 8

Playing duck, duck, goose (or "pato, pato, ganso" in Spanish )

              Today we left early in the morning to get to an orphanage just outside of David where we would be conducting educational activities with the children.  We were divided into groups which would focus on nutrition, hygiene (tooth brushing and hand washing primarily), and exercise, and we would be joined by several of the Unachi students who would be doing vaccinations and medication donations.  I was fortunate enough to be in the exercise group :).  We would be working with kids between the ages of 2 and 12, and planned on doing different activities with the different age groups.  The sun stayed hidden behind clouds and we had the most fun with the "difficult to handle" group of young boys who, of course, wanted to play soccer.  They were quite good and more sportsmanlike than I would have anticipated.  Unfortunately, many of these kids are taken from their homes due to abuse, neglect, or worse, so we were not allowed to take any photos of or with them (but I snapped a couple before we were told not to :).

               After lunch, we took a big group picture and headed to Boquete where we would be staying for the weekend.  We settled into our hostel, Refugio del Rio, and could not get over how luxurious it all felt in comparison to our accommodations at "the compound."  Our host, Lucini, was the kindest, most helpful hostel owner I have come across.  He let us choose the foods we wished to have for breakfast, gave us a ton of recommendations for things to do and places to eat around the area, and even made us reservations for Saturday night (with a two-for-one deal thrown in)!  We tried looking up a place to go for dinner, but ultimately decided to just explore the town and decide based upon what looked good at the time.  Interestingly enough, we all ended up at the same place in the end - a great Peruvian restaurant specializing in seafood :).

Lovely table cloth at the restaurant

Pretty painting

The bar of course...

My new favorite drink - Polly, this might be the next signature cocktail :)

So I went to church...

Padre talking to a family

... and I'm so glad I did.  I have had a hard time getting used to my family's new church so I haven't gone at all recently, but I really enjoyed this one!  I grew up in a Congregational church, and although this was a Catholic mass it had tons of lively music with guitars, tambourines, and drums, and we only had to kneel once :).  The padre is the man who owns the "compound" where we are staying in San Felix, but this was my first time meeting him.  He only speaks Spanish, but he was a really sweet guy and made a point of welcoming us during his sermon.  The other thing I loved about this church, and really about many buildings in Central America, was that they leave the doors and windows wide open so you are constantly surrounded by fresh air.  The sun was shining, the fans were going, it was really very pleasant.

            After church we went back to the compound for lunch and then some of the group went to Las Lajas (a beach nearby) and some of us stayed behind to try to catch up on school work.  This was the first time in two weeks that we weren't ALL together, so having some peace and quite was soooo nice!  I have to say, this trip has been incredible and I have learned a ton about the people here and my classmates, but more than anything it has made me realize how much I value spending time alone.  With 22 people living, working, eating, and sleeping together finding any time or space to be by yourself is nearly impossible.
               
               At dinner later that night we were hoping to get to have a movie night (a bunch of girls brought DVDs with them and there is a TV and player in one of the rooms), but that idea was squashed by a last minute meeting to discuss assignments.  Most of us are taking three classes this summer, and the one we are in Panama for seems to have new work added left and right (i.e. tallies of what we do in the clinics each day, having to translate our projects into Spanish instead of being able to deliver them in English, group papers, etc.).  However, I was able to catch my family and Nick on Skype that night which totally made my day :).  As I said before, I have really enjoyed the experiences I have had in Costa Rica and here in Panama, but I think I'm ready to head home.

The church

Las Olas

June 2, 2012

               Today was beach day!  We went to a resort called Las Olas ("waves") about an hour outside of David, Panama.  The first thing we did once we got our wrist bands was go down to the beach to check it out.  There were actual waves, not little ankle lickers, but real waves big enough to body surf on!  Aside from the hot black sand and 80 degree water it reminded me of beaches back home :).

               After playing around for a bit, we decided to take some group photos.  Trying to coordinate 16 girls doing handstands, cartwheels, and cheer jumps was a little difficult but really fun.

               We pretty much took over the resort.  There was also a pool with two swim up bars and a little snack bar, so we ate lunch and dinner there and left around 9pm.  A much needed day away from work and "the compound"  :).

Unachi

June 1, 2012

"Live to Serve"

            Today we went to Unachi, a university in the town of David about an hour away from San Felix.  Dr. Cadena (our fearless leader) and some of the school's staff were presenting to the nursing students what exactly we are doing here.  She explained that we were developing a relationship with the school, the students, and the indigenous communities in the region.  Apparently the university is in the process of getting an accreditation of sorts and Cadena has been helping to support their efforts.  Following the lecture we were given a tour of their nursing school building which is currently being renovated.  We got to see their simulation lab which uses iStan dummies like we have at USF.  They have about the same number of students as we do yet only a fraction of the equipment which, although I complain at times about the lack of organization in the program, made me appreciate all of the resources we have available to us.

Simulation lab at Unachi

               After our tour we were led back to the auditorium where we were presented with a fashion show and dancing in traditional Panamanian styles from throughout history.  This time we were able to sit wherever we wanted (as opposed to the front row) and we got to mingle with some of the Unachi students.  It was surprising how easily we could communicate even though we only know a little Spanish, and they only knew a little English.  After the final dances and bows and applause, the presenters ran into the audience and pulled random people up on stage to dance together.   It was really entertaining watching all of the professoras shaking their booties!








We had lunch at the school and were then permitted to walk around campus and check out the bookstore if so desired while Dr. Cadena met with some of the Unachi faculty.  We attempted to play a joke on her by getting the bus driver to hide the bus around the side of the school, but when she showed up an hour and a half later than she was supposed to (Panamanian time) it didn't quite have the same effect.  From Unachi we went to TGI Fridays for happy hour, and from there to Pizza Hut!  This was the first time many of us had had American food in over a week, and everyone dove right in.  To top it off, Jessie surprised us all with McDonald's sundaes after dinner!  By far, the best food day we have had.

Happy hour long islands!

Mas vacunas!

May 31, 2012

               Today was another clinic day, and Chanel and I were assigned to triage in the morning.  For each patient we took heights and weights, and for babies we also measured their head circumference and for adults we took their blood pressures.  It was difficult getting used to measuring in kilograms and centimeters instead of pounds and inches, and then having to yell them out in Spanish to the nurse documenting them, but it was fun getting to hold the little guys as their parents were measured!
               We were finished relatively quickly in triage, and then moved into the nurse's office where immunizations are performed.  Chanel had JUST stuck herself the day before, but she jumped right in!  We helped immunize several children and adults (including our bus driver, Luis!), and then we had two school classes come in.  After all of the kids we did at the school we were well prepared this time!

Chanel giving a little boy a vaccination

Lauren giving Luis a flu shot

School Vaccinations

May 29, 2012

               The Ministerio de Salud, or health department, of Panama is very focused on health promotion and disease prevention.  Therefore, people's immunizations are very closely watched and individuals are literally tracked down to their homes if they miss one.  Health care workers are also responsible for going to the schools in their area and vaccinating the children.  Today, it was flu shot day, and we got to help.  We walked from the clinic (the school is right up the road) and set up several tables.  A couple of nurses from the clinic and four of us were responsible for administering the vaccine while Jessie and several other staff members did the accompanying paperwork.  It was pretty much a never ending assembly line.   By lunch time we had each vaccinated an entire grade amounting to over 60 students apiece. Unfortunately, during the chaos, one of my classmates accidentally stuck herself with one of the needles and needed to be taken back to San Felix for blood work and prophylactic antiviral treatment.  So it was a very short, but very productive day.

Hato Chami

May 28, 2012

            Monday morning we were assigned to clinical groups.  I was in one with Laura, Bekah, Lauren, and David from my clinical group at USF and a girl named Chanel from another group.  We would be led by Jessica, a professor at USF who is also fluent in Spanish, and would be going to a village called Chami located about 45 minutes outside of San Felix.  At the clinic we were put into groups of two and assigned to various areas - two in triage, two with one of the nurses doing immunizations, and two with the medico (doctor).  Chanel and I were assigned to work with the doctor, Barry, who sees patients on an appointment basis.  Our first patient came in complaining of a headache.  Dr. Barry concluded that she probably has anemia, a chronic issue among these people since they lack access to rich sources of iron.  He also found that she was due for a pap/pelvic which we were lucky enough to perform for him with his help!  Sounds pretty mundane, but in the States it's out of our scope of practice, so it was pretty neat that we got to do it here.

My clinical group
(David, Bekah, me, Chanel, Lauren, Laura)

Rooster in the clinic

The clinic

             









                Following lunch at the clinic we went up the road to the school where we would be shown around.   This school has 700 students - those from kindergarten to the fourth grade attend in the morning, and the older students attend in the afternoon.  In Panama, it is only required that children attend school up until the 6th grade, so many do not continue their studies beyond that point.  The school offers students lunch, so the students each bring their own bowl and spoon and are given rice or crema (a corn-based cereal like cream of wheat) and little crackers for snack.  If they live particularly far from the school they can come on Sunday night and stay there through Friday, but most kids walk quite far, up and down mountains to get to school.

Kids at school

Boys playing baseball

Classroom

The kids LOVE seeing their pictures :)

             
















































             After seeing the school, we climbed back into the van and returned to San Felix.  We joined the rest of our group to tour the hospital which is right down the street from our compound.  If there is a patient with a condition that can't be treated in the remote clinics, he or she would be transported to this hospital.  I call it a hospital, but really it's just a slightly larger clinic with a few additional pieces of equipment.  We were also presented with statistics and brief history of the Comarca, which is the overall area inhabited by indigenous people in Panama.

Delivery room table
(complete with black plastic trash bag)

Delivery room table

           















               

ER in San Felix 

                Seeing what the staff in the clinics and hospitals in this area have to work with in comparison to all that we have available to us in our rotations in the United States was remarkable.  The stark difference between homes and schools here and those back home was also something I was not expecting.  They told us that we would be going into "rural" communities, which these are, but they did not tell us how poor these people are.  It has all been a very humbling experience.  

San Felix

May 28, 2012

            Today was moving day.  22 people on a bus with just enough seats plus all of our luggage.   Dario, our bus driver, was planning on strapping all of our suitcases to the roof of the bus.  Everyone was to have their bags out on the curb first thing, which they did, but when it came time to actually start loading them up there was no one to be found (namely the two boys, both of whom are head and shoulders taller than most of the girls).  I offered to help by being the middle man on the ladder transferring the bags from the people on the ground to Dario on the roof of the bus.  Olivia and I switched off for a while until Dave finally showed up and was guilted into helping (he’s a bit of a Diva – his nickname is Princess if that gives you any indication).  Once the bags were on, they were covered with two tarps and tied down with rope.  Finally, we were ready to go.  

Loaded bus

            We stopped at a few places along the way for lunch and to pick up any necessities at the grocery store before we arrived at San Felix, our destination.  Lunch was, once more, at a cafeteria type place, and none of the menu items looked appealing. Instead, I took my $5 allotment and went down the street to a bakery that also happened to have ice cream.  The "Panamanian" ice cream was in a liquid form, and I was not brave enough to try it.   They had another which was vanilla ice cream with what seemed like grape nuts in it, and that's the one I went with.  I thought it was a good decision :).  The entire ride took about 6 hours and was relatively uneventful.  
            When we arrived at the "compound," as our professor calls it, we were shown our rooms and allowed to unpack.  Dinner would be at 6pm, and until then we were free to roam around the grounds.  The compound is affiliated with a Catholic church in town, and locals simply call it "Padre's."  It is entirely self sufficient and has crops, pigs, chickens, sheep, and who knows what else.   The whole compound is gated as well, and therefore quite safe to roam around.  The church holds Sunday school classes here after mass and offers some adult courses during the week so there are also several classrooms.  Apparently they used to have a full time school, but it is no longer operating.  In addition, local people are permitted to work for food and lodging, so some of the housing is set aside for that.  Our room is a dorm with 6 bunk beds and 18 females.  Luckily the windows open and there are several ceiling fans, so we don't die of the heat.

Path

View from along the path around the compound

Frog garden

Fountain outside our dorm

Entrance to the pathway

Our cafeteria

Door to our room

The dorm

Piggy!

Chickens

           

Tourists in Panama City

May 27, 2012

             Today we got to play tourist and travel around Panama City.  Our bus arrived about 9AM which gave us time to sleep in a bit.  Our first stop was to the Casco Viejo or old section of Panama City, and our guide, Bianca, was able to give us a good deal of history about the city as we drove along.  At one of the historic churches we were let off in order to explore it and a few of the nearby streets on the way to a local market.  The church reminded me of a scaled-down version of the ones I saw in Spain with the gilded altar, stained glass windows, and dark wood.  It was significantly smaller than those, but evidently had a rather interesting past.  When the pirate Morgan invaded Panama City he and his crew looted and burned most of the town.  The people of St. Joseph's covered the altar in clay and mud so that they wouldn’t know it was gold, and apparently it worked!  Bianca informed us that under the gold the altar is wood, so it also might have been destroyed had Morgan chosen to burn it down. 

Altar at St. Joseph's

One of the walls at St. Joseph's

Stained glass (unfortunately in direct sunlight)

               

              

                Down the street a bit was an old stone monastery.  Its roof and some of its walls were gone, but it was interesting to see how it was built.  The entire floor was made of small stones from the area which was also very pretty.  

Arches at the monastery

Front of the monastery from the street

               As we left the monastery on our way to the next stop a man pushing a cart with a big metal box and several syrups came by.  The guide told us it was one of the best ways to cool off in Panama, and seeing as it was only 10 and quite warm, we stopped him to give it a try.  Actually, it was a Panamanian snow cone, which the man made by scraping a metal tool across a giant block of ice (under the metal box) and then adding the syrup.  I had one with passion fruit and strawberry, and it was delicious!  Much better than the ones you get in the States, which never have enough syrup.  It came with a straw too so you can drink the juice as it melts.

Panamanian snow cones :)

                 After the snow cones, we eventually made it to the market which was set up along paths in a park next to the ocean.  The vendors were mostly indigenous people from the area along with a few transplants from other countries trying to make a few bucks.  They were nearly all handcrafted, so there were unique items at each of the tables.  We probably spent a good hour/hour and a half walking around and looking at what they had to offer.  Unfortunately, our professor led us to believe that the other market we would be seeing later in the afternoon would have more to offer at lower prices – she was wrong, and many of us were disappointed that we didn’t purchase more at the first one.  Nonetheless, some people did pick up some souvenirs and from there we left for lunch.  Most of my classmates were hoping to have some local fare as they arrived with Cadena and had only eaten what they purchased at the grocery store last night.  Unfortunately, Dr. Cadena (professor) thought we would have more options at a cafeteria, so we went there on a budget of $5 each.  There was almost nothing edible (lots of meat, a wilty salad of nothing but lettuce and carrot shavings, or sandwiches).  I opted for a cheese sandwich which, unfortunately, came with ketchup on it.  Not a good start.

                Following lunch we went to the second market which, as I mentioned, was rather disappointing, and then to the Panama Canal.  Apparently there are actually three different sets of locks along the Canal.  We went to the Miraflores locks which have a little museum showing the building of the Canal and several observation platforms.  The platforms were very crowded as one might expect, but the museum was nearly empty and, I thought, more entertaining.  They had a bunch of artifacts from the construction including model ships and trains to show how they dredged the Canal and freighted rocks out of the area.  I wish I had taken notes, because what the workers were able to accomplish with the technology available to them is incredible.  

Me in front of the locks

Ship passing through the locks

               

Ship waiting to enter the locks

               After a couple of hours of roaming around the locks, we loaded back on the bus to head back to the City of Knowledge to freshen up for dinner.  Dinner was at a “local” Panamanian place near the water that we had passed in our travels earlier that day.  Jenn and I split a seafood plate consisting of clams, shrimp, prawns, octopus, and calamari sautéed in a garlic sauce served with fried plantains (patacones) and vegetables.  It was really, really good – as was the bottle of wine we split J.  Following dinner we went back to the house and went to bed to rest up for the nice 8 hour bus ride the next day.