Day 11

Our day began with a trip to the Oncology Hospital. We took an extensive tour through the facility and discussed many aspects of care for the oncology patient in Panama. The hospital used to be an American military hospital, but was turned over to Panama in 1999. Cancer is the number one killer of Panamanians, but unfortunately this is the only hospital for patients to go to. Treatment options depend on the protocol for the particular cancer. One of the positive differences for patients who have head or neck cancer is the wire face mask for radiation therapy. Instead of making permanent marks on the face, doctors can use the face shield to mark the target area with tape on the shield. Another difference with cancer in Panama is the leading types of cancer. In the States, lung cancer is the top killer. For Panama, cervical cancer and breast cancer for women and prostate cancer in men are of great concern. Panama keeps lung cancer rates low by targeting kids in elementary schools (ages 4-6) with smoking education. The expensive treatment is covered by a combination of social security, the ministry of health and the institution itself. Our time at the hospital was informative.

For a lunch break, we ate at Nikos Café. After lunch we spent more time at the Universidad de Panama. While we were waiting for Ms. Lordes (our guide), the students offered their computer lab for us to catch up on email. After the lab, the students welcomed us into the classroom for an introduction and picture time. We were given a tour of their clinical labs, both the adults and women/children's. We also discussed our plans to visit again on Monday.The university is so welcoming and we look forward to strengthening our ties. As a parting gift, we were presented with a cake and key chains. We used the cake to celebrate Sandy’s birthday. Right before the birthday party, we had a brief class discussion. The day ended with the party and an early night to bed in preparation for an early day tomorrow!

Day 10

Today we began our day visiting the Santo Tomas Hospital. We spent our time in the maternity center. It is known as the most popular hospital for patients who have no insurance or little money. It was different than the hospitals of the United States in that there were no private rooms. All the patients shared a common area with 50-60 beds per floor. One of the more interesting floors we visited was the high risk pregnancy floor.

The highlight of our day was the labor and delivery experience. We were all fortunate to have been able to see the birth of a child. The hospital was very busy and it was a challenge to get us in but the nurse managed to find a place for us. We all went in groups of about 3-4 students per delivery room. The first two groups of four students witnessed very quick deliveries and the final group had the opportunity to watch a lengthy delivery, placental removal and the suturing of an episiotomy.

In the postpartum period the hospital emphasizes a lot of health education about breast feeding. We passed by a section where mothers are taught to breast feed and care for their newborns. Our maternity clinical day exceeded our expectations because from the beginning of our trip we did not anticipate being able to observe the labor and delivery process.

After the hospital we had lunch and some people did laundry. We then headed to the Pan American Health Organization (PAHO) in the City of Knowledge. This agency functions as the disaster relief program for the Americas. PAHO is the regional form of the World Health Organization. We had an interesting presentation which focused on PAHO’s role with hospital disaster management.

The day concluded with a quiet evening spent at our villas.

Day 9

We started off the day at 8:30 a.m. and headed for Panama’s only mental health facility. Unlike in the U.S. the institute had a variety of interventions in treating their patients. The five areas of focus were: therapeutic gardening, self-image/self-esteem building, art therapy, psychoeducational groups and occupational therapy. The art that some of the patient’s created were for purchase and the money raised went back to funding the mental health center. Some of the art was very impressive, it looked professional. As for the self-image/self-esteem building, patients are encouraged to participate in manicures, pedicures and hair styling. Among the many addictions treated, gambling was one of them. The focus seems to be that they want the patient’s to go back to there families after the 30 days treatment. Just like in the U.S., medicine compliance is a problem. Not for financial reasons, but because the patients believe that that their conditions aren’t chronic and that after therapy they are cured.
After, the mental health institute we stopped by the grocery store. Tonight it was Amanda W., Mary, Jolene, Brittany and I’s turn to cook for the group. I wish that I could have helped more with dinner but couldn’t due to there being a respiratory infection going around. We made Tacos and attempted to make rice, but the rice turned out a disaster. However, the rest of the meal turned out great, everyone enjoyed it and overall it was a good group effort.
Towards the end of the night, Amanda and Brittany had trouble with their laundry. Since there is only one washer and dryer, another individual took it upon themself to take their clothes out of the washer and dump them on top of the dryer. They were not very happy campers and will be up late tonight making sure that there laundry gets done properly.

Day 8

We started off our day with breakfast at the El Valle restaurant and some last minute shopping at the market. I must admit, it was nice to buy fruit this morning for 5 cents. After that we packed up, left the hotel, and went to the only clinic located in El Valle called Centro Materno Infantil de El Valle de Anton. Some people travel from 6 hours away just to go there! There are only two doctors and two nurses for the whole clinic. One of the things we learned while at the clinic was that there is no health prevention or health teaching for the community as of yet, but it is one of the goals they are working toward. We were also able to see Kevin, a new baby just born at the clinic 5 o’clock that morning with his mother. We learned at the clinic that they only do natural births because there are no types of anesthesia available. They also have to send mothers 45 minutes away to another hospital if they have any complications with their delivery. After the hospital we went to a nursing home, Casa Hogar, run by a local church. Everyone found it interesting because it was run very different than any of the nursing homes in the US. The church members would actually go out into the community and find older people that needed more assistance than their families could provide for them. They would then ask the families permission to put them in the nursing home and provide extra care for them. For the people of El Valle it was free. The residents of the nursing home consisted of 7 men and 2 women who all shared the same room together. After the nursing home we all had lunch together at Sla Librada. The dish of choice was mostly Sancocho, a popular Panamanian style soup with chicken, yucca, and cilantro. I can say the Sancocho was good, but trying out new things here has definitely been an adventure! After that it was a two hour bus ride out of El Valle and back to the City of Knowledge. It is good to be home :)
*Jolene

Day 7

We had an early morning start with our day that consisted of visiting a quaint mountain village. The drive up to el Valle took two hours of snoozing away the miles. The highway from Panama City to the mountain village was flat and straight. When we entered the foot of the mountains, the roads changed from calm straight-away to a zigzagging, body shifting nightmarish drive with a beautiful backdrop of mountains with clouds melding with the peaks and forest covered mountain sides.
Our instructor had warned us not to expect too much of the hotel that we were suppose to stay over night. However, when we arrived at the hotel, it was much better than we expected. It was a three story building with vibrant colors and its own restaurant. The rooms were small, but decorated with the local artworks (tree trunks with pictures of birds in flight). Some rooms had two beds while others had a queen sized bed and a bunk bed that roomed three people. Located on the third floor was a rooftop patio, half-covered by a roof and the other half was open to the sky. Under the roof covered area were multicolored and very comfortable hammocks, hardwood tables and chairs. While standing on this rooftop patio, you can appreciate the full beauty of the small community within the mountains. You can almost feel the mountains looming above. One specific section of mountain peaks was a main topic by the people in el Valle. They say that the mountain peaks resembled a woman lying on her back with one arm resting on a side of the mountain and the other arm supporting her head on the ground. Some of us saw this woman, but others could not.
The village had many things that you could visit, for a cheap price. There was the zoo that contained many indigenous animals from panama; animals ranging from avian species, reptilian species, and some mammals…some of Panama’s flora were also included in the exhibits. The only disappointing thing about the zoo was that they advertised a golden frog, with all the walking we did that day throughout the zoo; we did not see a glimpse of this supposed golden frog. The admission cost for the zoo was only a dollar, which balanced out the disappointment from not viewing the golden frog.
Another activity we truly enjoyed while we visited el Valle was the zip line above the rain forest floor. Twelve of us decided that we would do the four lines, which were so high above the ground that we had to drive up the mountain and walk 10 minutes within the forest to reach the first pad and pay $47.50 to experience it. The scenery within the forest was surreal. We even saw those ants that chopped up leaves and carried them in this single filed line from a tree trunk across the path to another tree trunk. Amazing! Something that is usually seen on television came to life before our eyes during a great adventure within the forest. Another amazing event was the waterfall we were able to take pictures of while we hung hundreds of feet above the river bed below us. That was a truly breath taking view of the waterfall while exhilarated with adrenaline.
And then, the group was very excited to jump into the “hot springs” for some relaxation after the exciting flight through cable within the forest canopy. I must say that the best part of these hot springs were the volcanic face mask that cost a dollar, the .50 cent admission price, and leaving the hot springs! These springs were pools of dirty brown water layered with body gunk. You could not even view the bottom of these pools with the use of the Hubble telescope.
With that being said, our experience over all was great! After a full day of fun, we all sat down for a great dinner at the roof patio while accompanied with all the bugs of Panama. And tomorrow is another day of adventure and fun.
-Holy-

Day 6 - Monkey Island

Well, today was a pretty relaxing day. It was a wonderful
day to sleep in and get some much needed homework done. We left for the Gamboa Resort at 12:30 this afternoon. When we arrived to the beautiful resort we had some time to walk around and admire the gorgeous view of the rain forest surrounding the Panama Canal. Several from the group went and ate at the Resort's restaurant (which took an incredibly long time and made them nervous about missing the boat tour) while several others walked down by the canal and explored. We then took a shuttle to the docks to load up our boat. When we got all of us on the boat and headed out the engine stuttered a little bit. We had turn to turn back to the shore while they fixed it pretty quickly. Then we were off to Monkey Island. It was about a twenty minute boat ride through the canal out to the first island. We saw several White-faced monkeys in the trees.

On the boat, ready for our adventure!

The tour guide would make a calling noise and eventually they jumped down onto our boat. The cutest was when we saw a mother with her baby on her back. They came onto the boat and ate food from the guide's hand. After leaving that island, we went to a different island to see the Howler monkey. We could not approach this island because the Howler monkeys are more aggressive, so we just saw them from a distance. After our rainforest adventure, we headed back to the house to work some more on projects, readings, and laundry!

P.S. Our internet is struggling so we are having some troubles posting (especially pictures). We will get the posts up as we are able! Makes us a little more appreciative of our wonderful technology back home!

Day 5

Today was our first hands on experience in Panama. We started our day at 7 am and we split up into 2 groups - 10 students went to a clinic called Parque Lefevre with Dr. Johnson-Mallard and 5 students went to another clinic called Santa Ana with Dr. Cadena. Each of the clinics had different specialty areas that we were able to participate in. At the Parque Lefevre clinic we rotated through the OB clinic, Pediatrics, and an adult area doing a range of skills from injections, blood pressures, heights and weights, observing pap smears (2 students were able to perform one) and observing colposcopies. At the Santa Ana clinic the students had the same stations, but they also were able to go out into the community. They talked to people and familes in the communities, took blood pressures, and inspected their home surroundings.

There were many differences in the clinics here in Panama versus the clinics and hospitals in the States. One of the biggest things we noticed was that they do not use alcohol swabs before injections as we do. Instead they just use water to clean the area. Also, as far as the pap smears are concerned - here the nurses do the pap smear by themselves without even having a doctor in the room, whereas in the US the doctor performs them. Another difference is that they hardly ever wear gloves where as we wear gloves for everything. Mercury thermometers are also used here, as well as, the scale they weigh patients on is set for both kilos and pounds. Education is another major difference. Here in Panama the nurses seem to do a lot more education sessions with the patients one on one than we are used to.















We left the clinics around 12, and then stopped at Niko's cafe once again for lunch. We were able to come back to our Villa for some much needed downtime before we headed out to dinner.

We went to a dinner theater called Tinajas. We had a really great time. The dancers had beautiful costumes, the food was good, and we had front row seats! 2 of our students even got invited to go up on stage and dance with them at the end.















Tomorrow we will be going to Monkey Island for the day, and we are all looking forward to that!
~Melissa

Day 4

Today on our fourth day in Panama, we toured two universities, the university of Panama (a public university) and the Latin University (a private university). The public university was significantly cheaper and simpler than the private university. The private university was more technologically advanced, although their virtual lab consisted of only two beds and a dummy on which to practice skills.
Nursing school is a 4 year program in Panama. There is much focus on the community aspect of nursing as nurses serve both the general Panamanian population and the indigenous population.
At the University of Panama we had lectures from faculty and students which helped us to understand how university policies worked there and how students obtained the resources they needed in order to afford their schooling. Fortunately, we had our three wonderful translators (Sandy, Ida, and Mary…kudos!) sweating bullets to translate what all was being said!
Following the presentation we experienced the cafeteria cuisine of the University of Panama. Our food options were pollo, papas, gelatina, arroz, platinos and liver (chicken, potatoes, jello, and rice, respectively). The meal was only one dollar for a whole lot food. Most of us thought the food was good, but some were less than thrilled. Luckily for them, the private university served us food yet again! The nursing students there also pinned us at the end of their presentation. Pretty cool! Oh yeah, and at the University of Panama we got nursing caps because that is what nurses wear in the hospitals here. I’m thinking we need a group picture of us in our old school attire.
We returned to our villas to a torrential down pour. Some of us braved a run in the dark and were delighted to see lightning bugs! Then we did some more homework and went to Dr. Cadena’s and Dr. Johnson Mallard’s for spaghetti dinner. It was a lot of fun. We are very fortunate to be working under them!
Now it is time to hit the sack early because tomorrow we go to the clinics to do some hands on nursing work! Pap smears are a possibility. Until then…
*Amanda Neuman

Day 3

In addition to our technical difficulties in trying to put up pictures, I am having difficulty signing onto my blog account; therefore, I will be using my friend’s. With that said, today is our third day in Panama. Today we were able to get a little bit of a later start (at 11am). Therefore, some of us decided to hit the nature trail for our daily workout. Along the way, we even ran into our leader, Dr. Cadena, coming back from her morning walk. We went to the Arraijan clinic which is a local clinic for both insured and uninsured patients. The clinic is quite different from what you’d find in a clinic in the US. The cost for a consult at the clinic is ‘uno balboa (which is equivalent to one US dollar)’. Panama has a healthcare system where no one will be denied care when it is needed. The clinic was small, and not equipped with high technical equipment that we are so familiar with. This district had a problem with overcrowding. The rooms were situated such that there was a waiting room for all ages with all different problems (ie: there were no distinctions for chronic verses acute diseases/situations or for pediatrics verses geriatrics). The central waiting rooms were connected to a hallway with “specialty rooms (maternal health, pediatrics, vaccinations).” However, these specialty rooms were comparable to bedrooms; not the more spacious areas of the hospital we are used to in the States.
The procedures of the nurses were also quite different. For example, isolation precautions are not taken in Panama. Although tuberculosis and HIV are two very prevalent diseases there are no special masks, no gloves, or other protective clothing devices that healthcare members use in the States. Although most everyone in Panama would test positive for having been exposed to TB, the transmission rate is not necessarily as high as one would think. The compliance rate is quite good, and treatment is approximately 80% successful. The patients are given their medications for any disease, regardless of their ability to pay.
Another interesting concept was that HIV patients received their medications in the same room as the TB patients. This is of significance because HIV patients are susceptible to tuberculosis because of immunosuppression. It was very interesting to see how other places run their clinics.
Following the clinic visit, we went to see the Valle de las Rosas which is a picture of poverty amidst a breath-taking tropical paradise. It was quite sad to see where the squatters put up these shackles in attempt to shelter themselves. We will be working in places such as these to bring health services to this population.









After this we went back to our villas and jumped into our business casuals to go to the University of Panama. We were introduced to faculty of the University (which was an intimidating event due to the language barrier and the Panamanian big wigs (President, deans, etc) in their formal business attire).
Now alas, at about 6:00pm we are back in our villas, sheltered from the rain, and doing all the coursework we must do and scratching up some food for the night. Watermelon for dinner anyone? Until tomorrow then…
*Amanda N.

Day 2

We woke up at about 7:30am and took a shower with cold water, at least most of us. It was pouring rain all morning, but we went to the Panama Canal anyway. We were able to see the ships go through the canal and watched first hand how the lock system works. Then we went to see a short film on the past, present and future of the Panama Canal. Did you know that there will be another lock system completed within the next 7 to 8 years? We then went to the museum, which was 4 floors, all about the canal. Some of us bought a few things at the gift shop, like a guide book about the history of the Panama Canal and post cards.
By this time we were hungry so we went to Nicko's Cafe and ate really good desserts, coffee sandwiches and natural fruit juices. We took a ride to the three islands called the Amador Causeway (because the islands form a causeway) and stopped to watch the yachts and shop in a duty free (tax free) mini plaza.














After buying more souvenirs, we drove through an area of poverty, we saw the Mayor's house, the plaza major and the Panama cathedral. We saw the townspeople and their homemade beaded necklaces, bracelets, bags and pictures. Then by this time we were hungry again and were taken to the local mall, which is much nicer then you may think.

They amazingly had many modern stores like Calvin Klein, Levi's, Kenneth Cole, Tommy Hilfiger. We ate huge steaks for less then 10 dollars, had gellato (ice cream), and one store had undergarments for 35 cents!!!!!! Then we stopped at Rey's Supermarket AGAIN because, of course as a group of mostly girls, we had more things to buy. We got home at 5pm and had a group meeting. Then we went back home and worked on our homework and assigned readings. We ended the night with a group of us trying to stay a little in shape while we are here and doing a few really cool 80's style workout videos. One student just observed and took blackmail pictures. She says pictures will come soon, but we will see.... We are still trying to put pictures up, but we will see!
*Sandy

Day 1

We finally arrived in PANAMA. Yeah!! The flight was a little over 2 hours and it wasn't too bad. At the airport we were welcomed with USF Health signs and a white bus, not too shabby, at least it had an air conditioner. The luggage guys took most of the luggage to the bus and looked around after they were given a 5 dollar tip, so a few of us gave them another 5 dollars and we left. The bus driver took us to Rey's Supermarket to buy a few food items to eat for breakfast and lunch the next day. By this time most of us were starving and hoping to eat as soon as possible. We then arrived to the Villas at Clayton Army Base in the City of Knowledge (Ciudad de Saber). We were given 3 duplexes that each contained: 1 couch, 2 chairs, 1 coffee table, a TV (but only 5 channels that work and only 1 channel is partially English music videos), 2 desks, 1 dinning table with 5 chairs, one group has a stove, another has a full sized refrigerator, some have pots, pans, plates, and cups, some have internet access and phones, some have hot water and others are not so lucky, 2 twin beds in each room, but on a good note we all have central air conditioner, some have holes in their front door, 1 room doesn't have a working toilet and they have to take the toilet top off and pull the chain every time they go to the bathroom, some don't have light in the bathroom, BUT at least they had toilet paper for us. We then got settled in and went and ate at local restaurants on the base. Some of us had subs and others pizza or salads. We got a whole 16" pizza for 8 dollars and a can of coke for 70 cents which is a great deal for a college student studying abroad in Panama. We came back to our villas and sleep till the next morning.
*Sandy