NURSING AT McLEAN

A Path Less Traveled

by Paula Bolton, RN/NP

As a nurse, I know that my professional skills may be unexpectedly useful away from a work setting. However, when I embarked on a mission trip to Panama with a group from my church in July, the focus was on faith-based work with youth groups in schools, community centers, and orphanages. It was not a medical mission, but I was the only medical person in our diverse group of 14 adults and 15 teens, ranging in age from 13 to 60 years of age, and so I became the “group nurse.” My experience as a medical nurse practitioner and infection control nurse was useful surprisingly often during the ten days I was in Panama, where we operated in a radically different setting from our home environment, in a country of lush forests and beautiful mountains.

During July, the temperature hovers around 90 degrees, with 90% humidity every day. Nothing ever dries out, and we walked through a lot of mud in our rural camp. One day, it rained so hard and for so long that the creek running through the camp became a raging river, flooding the road bridge and a section of the girl’s dorm with water from the nearby leach fields and farmlands. The sickening stench from this brown frothy water forced us to re-locate our accommodations until the floodwaters receded, and the rooms could be hosed down with bleach. The relocation itself necessitated a trip to the dorm in a four-wheel truck through the raging water. Unfortunately, the truck got stuck on the wrong side of the river. While the camp worker drove, another middle-aged woman and I managed to push the truck out, while getting fully covered in mud. Some of our group waded through the dirty water to get supplies, which led to a trip to “Nurse Paula” for a thorough inspection of miscellaneous cuts and bruises, followed by disinfection and application of prophylactic antibiotic ointment to open areas.

Dealing with wildlife in the rural setting presented us with challenges. Bats were plentiful, and our dorms were infested with the critters. Thankfully, we had no exposures, although swooping bats provoked many screams from teenage girls. We also had to deal with scorpions. One camp member chased a bat in the dorm in his bare feet and stepped on a scorpion. The scorpion sting is painful. I cleaned the affected area with alcohol, elevated his foot, and applied ice multiple times, while wishing that we weren’t hours away from an emergency room, or that I at least had access to the Internet to answer my questions about what to do for scorpion sting. Thankfully, the Panama natives were experienced and helpful, and 24 hours later the young man’s foot swelling and pain were down. Cellulitis or other complications did not develop.

On a mountain climb during some downtime, I expected nothing more than exercise and beautiful views as 20 members of our group – a mixture of teens and adults – embarked on the strenuous two-hour ascent. The views of surrounding areas and the Pacific Ocean were, indeed, spectacular. Unfortunately, as we headed down the mountain, a woman slipped and injured her quadriceps muscle. She experienced severe pain and symptoms of shock (nausea, lightheadedness, thready pulse), which meant that she needed to lie down on the narrow trail near the summit, with her legs elevated, for about 45 minutes. I fashioned a support for her injured muscle with the first aid supplies I had carried from place to place during our trip. Using gauze and the gauze packaging and tape, I wrapped her thigh to support the pulled muscle. A walking stick was fashioned from two branches taped together. Her husband donated his belt, which we used to help support her weight and prevent further falls.

Slowly, we made our way down, inching along. There is no 911 to call in Panama; however, we devised our own search and rescue team. A camp worker drove the same truck that had got stuck in the mud up the mountain to meet us about halfway. From there, it was a harrowing ride down, over boulders and steep inclines, to base camp. Ice packs, rest, and ibuprofen helped ease the problem, and our team member walked around, albeit with a limp, for the rest of the trip.

Our work was rewarding, but emotional. At one church center where we put on a children’s program, I met a young mother with four of her six children, including a four-month-old baby. I used my limited Spanish to engage her children, who participated in our activities with shy grins. However, the mother remained withdrawn. When I asked a translator to talk with her, we learned that her husband had recently left her. She was barely coping. Our group connected her with the pastor of the small church and provided her with some food, as well as with shoes and clothing for her family. I felt frustrated by our inability to do more for this woman, who may have had post-partum depression, exacerbated by her life circumstances. The lack of resources for basic needs and for mental health services in rural Panama, was striking.

As we moved from our camp to an inner-city community center, we experienced a different environment. Armed guards accompanied us into the “safe haven” for kids in the middle of the drug-ridden section of the city, and a motorcyclist who used a gun instead of a horn to alert us that he wanted our bus to pull over so that he could pass startled us. At an orphanage, we saw children living under harsh conditions, including prison-like “lock downs.” These memories are tinged with sadness, but I would rather focus on the more positive aspects of the trip. For example, the people I encountered in Panama were extraordinary. Many had few material possessions, yet they were polite, open to listening to us, and grateful for anything that we provided for them.

The things that I have come to take for granted in my world are not easily available to many Panamanians. Access to healthcare is limited outside the cities. Immediate medical attention is not always available. And life is just plain hard for many people. “Making do” becomes the norm and not the exception. Yet, in the midst of trying circumstances, the resiliency of people is evident, and the joy they find in simple pleasures is infectious. Our group felt eager to share its faith with the people we encountered, and the warmth of the Panamanians we met encouraged us. The trip was an amazing personal adventure of faith and hope on a path I don’t usually travel. Experiences along the way reminded me that nurses carry their professional vocations with them wherever they go.

Revised by LVH on August 25, 2010

09.2011