Medical/Clinic days

The last 4 days of the trip were clinic days.  The first day we visited a different indigenous community and set up a clinic in their gathering place/church.  This was a really cool experience because they would describe their medical problems in such a different way than we are used to.  Like to say they were having pain somewhere they would sometimes describe it as that body part "falling asleep."  They used a lot of metaphors.  It was kind of confusing at first to understand what was wrong with them, but with patience we were able to figure it out.  Again we had to have 2 translators, one from their indigenous language and another into Spanish which made understanding the metaphors even more difficult.  Here we saw a lot of parasites, scabies, and I got to even see my first indirect inguinal hernia. It was on a man and he even allowed me to exam him which apparently was a big deal for this community because it has taken them a while to get warmed up to Global Brigades.  That made me feel good that I made him feel comfortable and the whole day was a success in terms of medical care and building a stronger relationship with this community.

The last 3 days we went to another Latin community and set up the clinic in their school.  This was a little bit easier because they all spoke Spanish and were more accustomed to medical care and our medical terms (I think they have clinics here every couple of weeks).  Dr. Lyons, one of the pediatric physicians with us, showed me how to do a newborn exam which was really exciting for me.  Again we saw a lot of parasites and scabies on the kids.  We also saw 2 cases of Leishmaniasis.  Before we got to Panama Dr. Michelfelder who has done like 16 trips like this had us all pick common diseases in the area and do just a short presentation on them so we could know what to look for.  I wasn't too excited to be doing work the day after school ended, but really this was SO helpful.  Not only was it a good review, but we also had a Panamanian doctor so he was able to tell us if the statistics we found were actually relevant in his practice and what he knew.  That was one of my favorite parts of the trip as well.  

The clinics worked kind of like an assembly line... vitals, medical clinic, dental clinic, and pharmacy.  Each medical student got a chance to do all of them except dental unless they wanted to go shadow.  The physicians from Loyola were so amazing in the medical clinic and took the time to show Becca Ludwig and I (the two students from SLU) how to listen to heart and lungs, exam the eyes, ears, and throat, and random other exams that the other students already knew how to do.  They also would take the time to explain anything that we saw that we had questions and pushed us to make our exam skills better.  The first time I heard wheezing and was right I was so excited!  It felt like I was a 3rd year already telling them what I thought we should do for the patient... sometimes I was right and obviously a lot of times I was wrong but it was such good practice and in a different country with different diseases!  I learned how to take out stitches and I even took a cockroach out of a man's ear!  So cool.  

We brought over $10,000 worth of meds... mostly parasite meds and vitamins because every patient received those when they went through the pharmacy as well as soap, shampoo/conditioner, and a toothbrush/toothpaste.

The first day we had to sort through all of the meds to be able to divide and distribute at the clinics. 

Dr. Michelfelder brought a bunch of balloons for us to blow up in the morning and hand out to the kids as we walked out the bus.  It kind of felt like we were a circus but the kids loved it and it made for a good first impression!

She liked the balloons!

The outside of the school. 

Having so much fun in clinic!

My favorite picture... I think she liked me.  Julie (Loyola) would translate while I just played with the baby/wrote notes and came up with questions to ask.  

The end of our first day of clinic... tired but feeling good!

Sorting through meds/making labels after the first day.  

The pharmacy transported by donated suitcases.  We divided them up by class of drugs and it actually worked really well.

Dr. Michelfelder was such a good teacher.  

We would see them as families and they usually were around 5-6 people we would see at once starting with the youngest and working up to the oldest.  

Obsessed with this little girl.  She didn't want to give me a high five because I would tickle her.

Teaching us the neuro exam.  

Becca (SLU) working with Tom (Loyola) who organized most of the trip.  We had 4 stations of a table and chairs and our gloves and other supplies on the table.  We switched off working in vitals and pharmacy and working with each other.

Med students would see the family first and then present to the physician who would then come check up on diagnoses/plan.  

Dr. Lyons, the pediatric physician working the a newborn.  

Ginny (second to the left) was an amazing translator.  A lot of our translators were students also who were just really good at Spanish... not me though I did get better towards the end.  

Matt (Loyola) teaching a kid how to use the stethoscope.  

Our clinic/stations.  

This was such an amazing part of our trip.  At the end of our 4th clinic day all of the girls in the group met with some of the teenagers from the Latin community and talked to them about women's health issues.  The girls ranged from 12-18 years old so we talked about the menstrual cycle and pregnancy.  We also made it kind of an empowerment talk and just basically told them that they can do whatever they want to and shared our stories.  The girls were shy at first but then we started talking about what they wanted to be when they grew up and they opened up.  I really felt like I was making a difference by talking to and empowering these girls.  Definitely a great memory from the trip.  

Saying goodbye on the last day.  I look so legit with my stethoscope and scrubs.  

View from the school... this never gets old.  

The whole group.  I seriously loved getting to know each and every one of these people and working with them.  Everyone was dedicated, caring, and hard working and together we were able to see over 400 patients during the clinics... people who can't afford and don't have very much access to healthcare, nothing like what we are used to here.  The physicians were great teachers and I loved getting to know people from other medical schools... that is definitely what made this trip so unique and so great.  This trip definitely sparked my interest in going on more medical trips abroad... it is a different experience but the reward is so worth it.  I will definitely remember this and take the lessons I learned from it for the rest of my life.  

Exploring Panama

In between the public health and medical portions of the trip we had 2 days to explore some of the communities in the area and get all of our meds ready for the upcoming clinic days.

A picture of the group after our hike up a small "mountain" to get an aerial view of the Embera village below.  This is one of the indigenous tribes in this area of Panama.

The Embera village... the people recently moved their homes to be closer to the only road that goes through this part of Panama called the Panamanian highway.  Because of this some of their farms are 2-3 miles away from where they live.  That's a long commute to work on foot.

We were able to visit with a family in the village and ask them about how they practice medicine.  The older guy in the middle sitting on the chair we guessed had to be over 100 years old because he could remember the Panama Canal being built which was finished in 1914.  His daughter is to his right and she said she was in her 80's.  They would speak in their indigenous language and then her daughter would translate into Spanish for us which would finally be translated to English.  The daughter was in her 30's but she looked like she was 16.  Finally, she had her children there so in total there were 4 generations living in that house!  That was remarkable.  They all looked very young for their age... the doctors with us on the trip told us it was probably because they have not been exposed to so many pollutants as we are.  What was even more remarkable was how white their teeth were and that the woman in her 80s still had a mouth full of teeth!  Apparently they chew on this gum from one of the trees and it turns their teeth black for a couple of days but it eventually comes off.  Only recently have they started to use toothpaste.  They thought their teeth were getting worse now because there was a shop nearby that sold Coke!  

It was really interesting to talk with this family because I was able to get a different perspective on medicine.  The grandmother was very cautious about sharing information with us and she didn't want to give away their culture's secrets and she didn't want to be told if we thought their customs didn't really work.  Their medicine is completely plant based from the various trees and grass that are around them.  The entire village also participates in the medical care and each family has someone that is a special at some sort of medical ailment.  This grandmother seemed to be like the midwife and helped deliver babies when there was a problem.  Other people in the community dealt with other ailments. 

A couple of days later a bunch of the members of the Embera community came to our compound dressed in their traditional gear and explained more about their culture and beliefs.  That was really cool because as an indigenous community their experience is so different from ours.  This lady is wearing their traditional dress.  The paint on her body is made from a nearby plant.  I think they said that because she has writing on her stomach that means that she is not single and I guess her husband picks the certain pattern that is painted on her.  

They played music and showed us one of their traditional dances.  In this community only the women are allowed to dance while the men are in charge of playing music.  After this we were able to buy various artifacts and crafts made by the village.  

One of the days we saw a sloth trying to cross the road so one of the Global Brigades staff helped him move along.  Apparently if a sloth has it set that he is going somewhere he has to go there so we had to move him across the road towards the tree he wanted or else he would have just jumped in front of traffic again!

We went on a mini hike in the Latin community where we built the latrines and saw the monkeys.  You can hear them from so far away!

It rains every day so we saw a lot of rainbows.  I really liked this picture because it showed the beautiful landscape of Panama.

A picture looking down from our hike in the rainforest one morning.  This was definitely one of the highlights of the trip.  This is only about 2 miles from where we were living... we definitely were staying in the middle of the rainforest!

During our hike we saw the tree that the Embera people use to make their houses and everything else out of wood.  This tree is so special and important to their culture and it was really cool to get to see it first hand. 

Public health/Building the latrines

The first part of our trip we worked with 3 families in a Latin community called Platania to help them build compost latrines.  A latrine is basically an outhouse that the family can use as a bathroom but is also cool because it eventually makes fertilizer for their land.  A big problem in Panama is sanitation.  Most of these families before this project started were just using pit latrines.  This is basically just a hole in the ground.  The problem is that it rains everyday in Panama and so the pit latrines would constantly overflow causing a huge mess and lots of sanitation issues.  (Some of the poorer parts of the communities that couldn't afford pit latrines would just have to go in the woods or the river which is obviously a way bigger issue).

 Global Brigades started this project in this community by gathering people at town meetings and really getting them excited to have these latrines.  The people who showed interest by attending all of the meetings but also had additional funds to pay for supplies would be able to get a latrine.  The family I was assigned was the house of Senor Domingo.  His wife was actually chosen to be the leader of the Platania latrine committee which was really cool because we knew that our hard work would actually get put to use!

My family was absolutely amazing and so hospitable.  Senor Domingo was there with us all day every day helping out and his wife and daughters were so sweet.  Senora Domingo brought us each a glass of soda at lunch on the first day which we ate on their front porch.  One of the daughters and her aunt made us these traditional Panamanian sugar and fruit ice pops that were absolutely delicious and a great break to the heat. They were a long three days and a lot of work, but it was so rewarding to make such a big difference for this sweet family.

This is what the latrine looked like at the end of the first day.  We had to lay down the foundation then put 5 layers of cement blocks around the outside and through the middle to make 2 different pits.  We then mortared around the entire thing for structure and to make it look nice.  I have never in my life done anything like this before and I had no idea how to mix concrete.  It was a lot harder than I thought!

This was the end of the 2nd day! We added the stairs leading up and put down the floor and the toilets. In the back we also added the doors.  There are two toilets because the family switches off using it every year.  Every time they "use the latrine" they throw a little bit of saw dust down into the chamber below to dry out the feces.  During the year that it is not being used the bacteria in the feces are killed I think by just the sun and time so that at the end of the year the material has become compost.  The family can just open the door in the back and use the compost for fertilizer for their land.  In order for this to work though and for the feces to dry out the toilet has two separate sections... one for going number one and the other for going number two.  This is the only difficult part of the system as you can imagine.  The urine just drains down a tube which we called the "pee pee ducto" and then goes into the ground.  Senor Domingo (on the very right) called me "la reina de la pee pee ducto" aka the queen of the pee pee ducto (I got made fun of because my Spanish was the worst... it had been a long time since I had practiced my Spanish).

Senor Domingo had a huge coconut tree in his yard so he cut us down fresh coconuts for use to drink.  I had never had coconut juice but it was soooo good.  There is also meat that you can eat on the inside. That was a little weird but when in Panama...

This was our finished project! We were so far ahead the last day all we had to do was put the roof on.  When the family has more materials they will have to add walls, but they didn't have those that day so when we finished we just went and helped out the other groups.  You can see Senor Domingo in the back and Senora Domingo and her daughter on the very left.  I have to say Panamanian ladies are absolutely gorgeous.  The rest of us that were on this latrine team were from the left Matt (Loyola), Julie (Loyola), me (SLU), and Christine (Creighton).  I loved my group.  

Here are some more pictures....

Finished project from far away.  It looks so pretty!

The front of their house.  This gives you kind of an idea of their living situation. The floors are concrete and it used to be a family owed store hence the writing on the front.  Dr. Michelfelder gave everyone waterguns to keep cool...turned into pictures like this.  

Pathway on the side of the house leading to the back yard area to get to the latrine.

View from Senor Domingo's backyard.  Absolutely beautiful.  The whole countryside of Panama is so green because it rains all of the time and there are mountains surrounding it.  I wouldn't mind going to the bathroom outside with this view!

Living Conditions

We arrived at the Panama airport and it was nothing what I expected it to look like.  There were skyscrapers everywhere, it felt like I was in Chicago.  As soon as we found our group and did the awkward first introductions we were quickly shipped from this metropolitan city three hours east to one of the poorest parts of the country.  We arrived at our "hotel" and I knew that in for a long 10 days ahead of me. (I took these photos at night the last day before we left so they are a little dark).

A picture from the back of the building which was completely open up the rain forest behind us.  You can see us playing with one of the balloons that we handled out to the kids during the clinic days.



The stairs up to our bedroom on the right.



This was our "bedroom." It was just concrete walls with bug nets around the windows and doors which were definitely needed since we were basically in the middle of the rain forest. My bunk was the one in front on the left.  Becca (the other student from SLU and also my good friend) was nice enough to let me have the one on top.  That didn't really stop numerous bugs from crawling up to say hi to me though.



Our friends at night... from the left Christine (Creighton), Julia (Loyola), Ginny (Loyola), and Dr. Michelfelder (Loyola) who did acupuncture to us at night so we could fall asleep better (it actually really helped!



Bathroom sink.  You couldn't drink the water so if you wanted to brush your teeth you had to use a water bottle filled up with bottled water from downstairs.  We also had to be resourceful with flushing the toilets if you can figure out what that means.  There was no hot water in the shower and you could only turn on the water after you had soaped up and were ready to rinse off, which actually wasn't a problem because it was sooooo cold anyway!



Kitchen where they cooked us traditional Panamanian food... lots of mangos and pineapple and coconut which was really fresh.

Panama- Jesuit Medical Collaborative 2012

This summer I participated in a global health project called the Jesuit Medical Collaborative.  It was actually a brand new project started this year through Loyola's School of Medicine in Chicago.  The goal was to work with all of the Jesuit medical schools in the Midwest area on a common global health project.  We were able to get 2 students from here at SLU, 3 students from Creighton, and 5 students and 3 physicians from Loyola as well as the global health director Ginny from Loyola.  The project was set up through Global Medical Brigades who recently started work in Panama and it was split up into public health and medical portions.  We spent the first 3 days building latrines (basically an outhouse) for 3 of the families in one of the Latin communities.  We then took 2 days in between to do some hiking in the rain forest and visiting with various indigenous communities in the area.  The last 4 days we set up clinics first in the church of an indigenous community and then in a school for a Latin community.  Overall the trip was 10 days long which was great for me because this was the first global health trip I had ever done and I wasn't sure how I would like it.  Needless to say it was one of the best experiences of my life.