Panama 2013

USIG/International Project Summary

Location: Bocas Del Toro, Panama
Duration of trip: 3-4 weeks

 

Student Travelers: Lauren Sims (simsl@uci.edu), Christy Tabit, Lauryn Gabby, Katherine Hom, Shane Tipton, Lesly Martinez, Shaudee Parvinjah, Sarah Abedi, Esther Jun

Faculty Advisor: Dr. Vinita Speir (vinitaj@uci.edu) and Dr. Jon Steller (jsteller@uci.edu)

 International Organization/University: Floating Doctors (www.floatingdoctors.com)

 

Description of Project:

We traveled to Panama this summer with the primary objective of training parteras in basic OB ultrasound skills. The original concept behind the project was created by Floating Doctors and expanded upon by a group of medical students from UC Irvine.  In preparation for the trip we (UC Irvine medical students) went through extensive obstetric ultrasound training on top of and in addition to the ultrasound curriculum already in place for first year medical students. We spent hours planning the trip and strategizing on the best way to present a foundation of ultrasound skills to local midwives in the Ngobe communities. We quickly learned upon arriving in Panama that we needed to adapt our original project from day one. As suggested to us by Floating Doctors, our original intention was to train a group of eight to ten parteras from several communities in one group over a series of sessions. Immediately, we realized that was not a feasible option and that we would need to revamp our intended training approach. For the majority of the communities we visited, we ended up having two days with the parteras either scheduled over the course of two weeks or back-to-back days if we were on a multi-day clinic. Through interacting with these women we learned from them as much as they learned from us. Our goal of evaluating them through pre and post competency exams proved to not be the most effective way to utilize our time. Instead we found ourselves interviewing them about their position in society, their interest in ultrasound and their methods for delivery. After gaining a better perspective of their receptiveness to ultrasound and the feasibility of utilizing ultrasound in their communities, we would then proceed to introduce the parteras to ultrasound. Our time with them was in no way extensive enough to expect them to be competent and it was in no way fare to examine their skills. However, we did establish that they were eager to learn and add to their skill set to provide additional care for the women in their community.

 

Please see floatingdoctors.com for more information on their non-profit organization

 

Outlook for Summer 2014:

Adapting the role of the Partera

Over the course of six weeks in Panama we were able to spend many hours working side by side with parteras in their communities. The majority of the scans were performed in the homes of the pregnant women or in the partera’s house.  We had the privilege of forming intimate and organic relationships with these women. We were inspired by their receptiveness to our modern advanced technology and know there is potential in our original intentions. However, we foresee their future role in our project slightly different than we originally attended.  It was a steep learning curve for us as well. It was difficult at first for us to see outside the box as we were so focused on the success of our original intent of training the parteras to be competent at our scanning objectives.  As soon as we stepped back and looked at the bigger picture of the primary objective of our project, providing prenatal care to women who currently do not have access to it, we were able to adapt their role in our project. Now with the experience of hands on ultrasound training, the parteras are excited about what access to ultrasound scans can provide for their communities. They also have a fundamental understanding of the importance of ultrasound and more broadly of prenatal care after meeting with our group. When asked they were excited about the possibility of receiving additional prenatal care training. As their society adapts and more women choose to deliver at the hospital so to do the parteras wish to adapt and expand their skill set to best serve their community. With all of this in mind we have two primary objectives for the future role of the parteras in our project.

 

Establish their role as prenatal providers through ultrasound: We would provide and train the parteras with a system to keep a running list of the women in their communities who are pregnant. They would be instructed on how to take a basic medical history with regards to OB history and other important and relevant pregnancy topics. We would teach them how to calculate gestational age based on their last menstrual period. Having the parteras serve this role would open up many doors with regards to their ability to provide prenatal care, With regards to our original ultrasound mindset, it would also allow for the parteras to serve as the link between those providing ultrasound scans and the women in the communities. It is unknown at this time how many women in the communities who are pregnant receive a scan at a Floating Doctors clinic or by other means. This is a topic to definitely be explored in the future. Most of the women when asked replied this was the first time they had received an ultrasound, which suggests the majority are not currently receiving scans at this time.

Expand upon the role of the partera: In addition to the parteras serving as the link for access to ultrasound scans in their communities, we have identified a few other vital skills that would greatly benefit prenatal care. Dispensing of prenatal vitamins, advice on lifestyle changes (particularly water intake), measuring blood pressure and testing for gestational diabetes all have been noted as feasible skills for the parteras to obtain. This would be a project for future medical and nursing student volunteers to explore as the role of the partera changes throughout the coarse of our project in the future. It has been mentioned that UCLA nursing student groups could possibly aid in this process in the future.

 

The Red Cross- Our new target-training group

Contact Information:

Celia- 67587831

Thompson- 68182602

celiabent5@hotmail.com

 

Towards the end of our time in Panama we had the opportunity to meet with Celia and Thompson, both long standing leaders of the Red Cross in the Bocas del Toro region of Panama. Celia has been with the Red Cross for twenty-five years and Thompson for thirty years. We discussed with them the original intentions of our project and what we learned throughout our time in Panama. They were enthusiastic about our intentions to improve Ngobe women’s access to prenatal care through ultrasound. We shared with them how impressed we were by the receptiveness of the parteras in the community to incorporating ultrasound and prenatal skills as part of their role. We discussed the barriers we encountered with regards to physically providing ultrasounds for each community and teaching parteras in each community to be proficient and competent at the basics of OB ultrasound. We proposed to them the idea of training a small group (potentially five) of Red Cross members in the future on the same basic OB ultrasound skills we set out to teach the parteras this summer. Celia and Thompson were very receptive to the idea and excited about the potential it holds to increase access to health care for the women of these Ngobe communities. They said they could easily identify five competent nurses and medical technicians who would be enthusiastic about receiving this training in the future. The vision would be for the Red Cross members to work side by side with Floating Doctors and a network of parteras to orchestrate scans particularly in the second and third trimesters. The Red Cross noted the largest barrier to implementing what we envision would be transportation. The solution we foresee to this barrier would be to have the ultrasound trained Red Cross members travel with Floating Doctors to their clinics and to setup a transportation fund for them to be able to travel to communities independently. The parteras would be aware of these ultrasound scan days whether they were to take place concurrently with a Floating Doctors clinic or independently and arrange for the women in their communities to be ready to be scanned. From there if potential impending emergencies were identified Floating Doctors would arrange for transportation and follow up care when needed. The hope would be in the future to write a grant for the Red Cross to receive SonoSite ultrasound machines. The ultimate vision would be to link the parteras, the Red Cross and Floating Doctors into a sustainable relationship that would provide a system of routine access to ultrasound scans for Ngobe women.

 

Future UCI Medical Student Volunteers

The plan would be to recruit a group of medical students between their first and second year to return and continue the ultrasound training in the summer of 2014. A group of motivated medical students would need to be identified. It required an extensive amount of training above and beyond our already rigorous medical school curriculum to become competent to teach basic obstetric ultrasound skills. Once a group was established their training program in Panama would focus on the five or so individuals chosen by the Red Cross. These students would utilize the training program in a similar fashion to how our group planned to for the summer 2013 trip. Once arriving in Panama they would focus their time on training Red Cross members and traveling to Ngobe communities to introduce the parteras to the Red Cross members. This would also provide access to pregnant women for Red Cross members to practice on. It would immediately establish a connection between the women in the communities, the Red Cross and the parteras.

 

In addition to future UCI medical students focusing on training the Red Cross they would potentially help Floating Doctors train the parteras on how to track the pregnant women in their communities with a list and obtain a basic medical history. These details would need to be worked out between Floating Doctors and future UCI volunteers. If there are additional Floating Doctors volunteers who could focus their efforts on other aspects of training the parteras it might speed up the efficiency of implementing the main objectives of the renovated plan for our original project. These volunteers could begin working with the parteras prior to UCI medical students returning to train the Red Cross team. This would aid in the efficiency of developing connections when UCI students arrive.

 

Ultrasound machines/supplies:

We borrowed one SonoSite NanoMaxx machine from UC Irvine and used two machines that Floating Doctors (SonoSite Edge and SonoSite Turbo).

 

 

Breakdown of budget/travel expenses:

Item Amount
Transportation $750 (roundtrip flight from LA to Panama City)$250 (roundtrip flight from Panama City to Bocas del Toro)

Total Transportation = $1000

Board $200/week*4 weeks = $800
Food $100/week*4 weeks = $400
Total per person $2,200
Total for group $2,200*6 = $13,200

 

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