Adventures in Chitré: Volume 2

Educating the Community: A Key to Preventative Health

Today we were not mere observers in public health, we engaged the community via service learning activities working with two different populations in Chitré, Panama. During our first stop we worked with aging adults to discuss the importance of physical activity and demonstrated several low impact exercises. Our second stop was at an elementary school in an at-risk area right outside of Chitré.  Here we worked with Kindergarten and 1st grade students to teach the importance of and techniques for hand washing and dental hygiene and with 4th graders to discuss vector borne diseases and vector control. We completed the day by traveling with fourth year nursing students from the University of Panama to learn about their community assessment of the neighborhood where the elementary school children reside which gave context to the student’s daily lives.

Dancing for Health

Our first stop was at a community center operated by the University of Panama and the CSS (the Social Security Fund in Panama). The center offers a variety of services to retired individuals including classes on language, dancing, handcrafts, and exercises. The center also offers jobs and skills training through its University of Trabajo including the creation of handcrafts, house ornaments, and sewing. The courses empower the people, primarily women, by teaching them a trade.

For our project, we worked with a group of retired women between the ages of 65 and 80 discussing the importance of remaining physically active. We provided an introduction to the benefits of physical activity including improving quality of life and reducing chronic illnesses. We engaged in conversation by asking the ladies whether they were physically active and what activities they enjoyed, most of which replied they enjoyed dancing. From there, we taught a few seated exercises and provided the ladies a handout of the exercises to practice on their own. After our seated instruction, we taught a few popular ‘line’ dances that we enjoy in the United States (i.e., the Cha-Cha Slide, the Electric Slide, and the Macareña.) The ladies, in turn, promised to teach us a few Panamanian dances, but only if we danced with them, which of course, we did. At the end of our energetic service-learning activity, we parted friends and appreciated the enriching cultural exchange.

The Eneida M. Castillero School

Yesterday, we spent time at the Hipolito Perez Tello School, a top-ranked elementary school in the country. Today, we visited with students at the Eneida M. Castillero School, which serves a low-income population and has limited resources. This school is more representative of what you would see in other rural areas of the country. As students studying public health, it is vital to understand disparities, and the area that this school serves stands out in stark contrast to what we saw yesterday.

Our service learning began by meeting with fourth year nursing students from the University of Panama. The nursing students have been working in this community to complete a community needs assessment of the neighborhood and have been working to treat the elementary school students in the area with iron supplements due to a nutrient deficiency, as well as to provide needed vaccinations. After learning a little about the community and the children in the school from the nursing students, we split into four groups, two groups taught oral hygiene and the importance of handwashing to Kindergartners and 1st graders while the other groups taught vector control to 4th graders.

As we walked into the Kindergarten class, we were greeted by the children singing a welcome song. We introduced ourselves to the class and explained that we would like to discuss why and how they wash their hands and brush their teeth. The lesson for hand washing included teaching the children the English words for hands, wash, water, and soap. We asked the children to demonstrate how to wash their hands and asked children to recall the English words they learned. A little boy in the front of the class was eager to participate and set the tone for the class by answering questions. The young boy was ecstatic to win a little Blaze mascot for answering the question correctly and immediately opened the package to play with his new toy. For brushing your teeth, we taught the English words for teeth, toothpaste, and brush, which we asked for the children to recall and they did quite well. Then it was our turn to play a song for the students. We played a song about how to brush your teeth in Spanish and acted out brushing our teeth. The Kindergartners enthusiastically joined in on the second round and were excited to receive their goody bag that included a dental hygiene activity book and dental care supplies. We spent about 30 minutes with the students and ended our time by taking a group picture.

Walking into the 4th  grade class, all of the students, and the teacher, gave us their full attention and were actively engaged throughout the entire experience. We started with a question-and-answer session to gauge prior knowledge about the topic of vectors and vector control, with our wonderful translator/USF representative Rolando Trejos. The children did not recognize the word vector when asked, but they had substantial knowledge about mosquitoes, fumigation, and how to protect themselves from vector borne illnesses. After our Q&A, we moved on to our activity which consisted of using a flipchart to identify where mosquitoes breed. The students were very excited to participate in the activity and were awarded prizes for correct answers. The first child to answer a question correctly, immediately put on his prize, a UAB t-shirt. The children were great at recalling and demonstrating that they understood the lesson. At the end of the lesson, we asked if there were any questions and a little boy energetically raised his hand and reminded us to not fumigate at night! The class told us to not forget them and waved goodbye as we departed on the bus.

The Community

After we left the school, we visited the community and were able to observe the social determinants of health and health inequities that directly impact the children we just met. The majority of the people who live in this community are low-income families who struggle to make ends meet. It is a common practice for parents to take their children out of school so they can keep the government allocated stipend for public school tuition. Due to the extreme poverty, parents are faced with the harsh reality of deciding whether they want their child to eat or attend school. Shortly into the community observation, we approached a landfill that was located in the center of the community. As we drove into the entrance of the landfill, we immediately noticed malnourished livestock feeding off of garbage and the sparse polluted grass. The nursing students explained to us that this is where all of the trash from the district of Herrera is dumped. They further explained that community members sometimes fight over trash when they are desperate for food or resources to sell for an income. This is clearly a social determinant of health as poverty and the polluted environment are impacting the health of the community.

Next, we traveled to a nearby port on a polluted river where men were weighing, sorting, and gutting the local catch. The local guide explained to us that it was a common practice for families to rely on subsistence fishing from the river. This concerned us since we know that eating fish from an unclean water source for an extended period of time can result in serious adverse health effects such as liver damage, gastrointestinal distress, and cancer. We know this first-hand because of the negative health outcomes associated with subsistence fishing on the Warrior River in Alabama. As we concluded our tour, we realized how many representations of social determinants of health we had seen. The quality of the water, access to food, housing, education, and ability to have a steady income, all contribute to the communities overall health and the ability of current and future generations to reach their full potential.

Our goal today was to create a culture of prevention. We were able to teach older adults the importance of exercise while at the same time demonstrating fun physical activities. Elementary -aged children were taught to recall their knowledge of handwashing, dental hygiene, and vector control while teaching new knowledge to emphasize the importance of these preventative health practices. The entire healthcare system in Panama is centered around prevention rather than reaction and establishing healthy practices is vital to effectively prevent negative health outcomes, such as vector borne diseases and chronic illnesses associated with dental health, physical activity levels, and handwashing to promote health for all.

Team 1 –

Nekayla Anderson (Public Health Undergrad)

Sloan Oliver (Public Health Undergrad)

Jennifer Schusterman (HCOP Graduate Student)

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