Which vaccinations or medications will you take before you leave home?

Complete Both Case Studies, Chapter 20.
Theorize how the economics, politics, geographical location, technology, and cultures affect the health and healthcare of residents of Israel in relation to Israel’s major health issues.
Compare and contrast the health and healthcare system of the country of Georgia with other countries established from the former Soviet Union and other developing countries.

CASE STUDY: CROSS-CULTURAL LEARNING
McDowell Memorial Medical Center and a state university have joined forces to sponsor sending 10 nursing students and 10 nursing staff to Panama for a 2-week cross-cultural learning experience. Students and staff come from maternal–child, pediatric, medical–surgical, community, and psychiatric nursing. All students and staff identify with the dominant American culture. Only one student and two staff nurses have traveled outside the United States; their travel experiences were in Rio de Janeiro, Brazil; Ontario, Canada; and London, England. Three of the participants have limited experience with the Spanish language from high school; the remainder know only a few expressions in Spanish.
Brenda Polek, a nurse manager from the Medical Center, and Alan Hardy, a faculty member from the university, will accompany the group. Both feel they have a “fair” understanding of the Spanish language. The main reason for students to participate in this experience is to complete an elective course on international nursing. Multidisciplinary staff nurses are participating in the trip to specifically learn about the Panamanian culture because the medical center has increasing numbers of Panamanians on maternal–child, pediatric, and medical–surgical inpatient units and outpatient departments. All students and staff will be housed with Panamanian families throughout their travels.
All students in this cultural immersion experience will be able to attend classes in the nursing programs while in Panama. When in the clinical areas, staff and students will be accompanied with staff nurses in outpatient clinics and on inpatient units. Not all students and staff will get the same clinical rotations. They will be in formal learning experiences 4 days each week and have 3 days each week for traveling and sightseeing. Journaling, in which students and staff record their observations and experiences, will be a large part of this program.
Brenda Polek and Alan Hardy, in conjunction with faculty and staff in Panama, will arrange housing and clinical experiences; some of them will be with indigenous Indian groups. The students and staff nurses will plan any other details before they leave for Panama.
Case Study Questions
1.
How would you feel about staying with a family in Panama if you do not speak the Spanish language well?
2.
How might you prepare to improve your Spanish language skills before you depart from home?
3.
What are the passport and visa requirements for traveling to Panama? (These requirements will change depending on your country of origin.)
4.
Which vaccinations or medications will you take before you leave home? Where will you go to find out what is currently recommended for traveling to Panama?
5.
What do you need to know about verbal communication practices of Panamanians so as not to violate social taboos?
6.
What do you need to know about nonverbal communication practices of Panamanians so as not to violate social taboos?
7.
How might you go about visiting a traditional healer while in Panama?
8.
A few Panamanians, especially the younger generation, are anti-American because of U.S. influence in the Canal Zone, the environmental concerns left by the military in the Canal Zone, and the Manuel Noriega experience. How might you handle negative comments from Panamanian students about Americans?
9.
What do you need to know about arthropod-borne diseases and food-borne and waterborne illnesses you may encounter on your trip?
10.
Make a list of at least 10 strategies to maintain your health, your personal safety, and the safety of your group while traveling in Panama.
CASE STUDY: PANAMANIAN CHALLENGES TO CARE
Leticia Maria de Isaacs Blancas y Chamorro, age 35, is married with four children, ages 15, 12, 10, and 6. Her husband, Omedo, works on a banana plantation distant from their small orange and banana farm in rural Panama; he makes it home only every other weekend. Leticia has been overweight since the birth of their first child and has never seen it as a problem. Approximately 3 months ago, she began losing weight, even though she was eating her usual diet and drinking a lot of carbonated beverages. She also has a rash on her arms and legs for which she has been using a poultice made from eucalyptus that helps the itching but does not clear up the rash.
Because going to the bathroom several times during the night was interfering with her sleep, Leticia sought advice from her mother. Her mother suggested a trip to the local botanica for herbs that a cousin used several years ago for the same condition. After trying the herbs for 2 weeks without improvement, she sought advice from a local curandera, who recommended guanabano and ginseng because Leticia was also having frequent bowel movements that she attributed to parasites. The curandera also recommended an antibiotic that did not require a prescription. Leticia obtained the antibiotic from the farmacia (pharmacist) and took it for 5 days, with no apparent improvement. In fact, her diarrhea and thirst worsened.
Leticia left her children with her younger sister and mother and took a bus 42 miles to a city with a physician. The physician wanted to admit Leticia to the hospital for a few days for a more complete health workup for diabetes mellitus. However, Leticia refused, saying that she needed to return home to her children. The physician reluctantly gave her an oral hypoglycemic prescription and an instruction for a weight-reduction diabetic diet and encouraged her to return in one week. Leticia agreed to return if her husband came home that weekend with money so she could afford a second bus trip to the city. She also stated that if she could not return the following week, the curandera, whom she has know since she was an infant, would help her.
You are a public health nurse (health worker) who lives in the same town as Leticia and have heard of her health problems being discussed at local stores. You plan to make a visit to Leticia and offer advice if she will see you.
Case Study Questions
1.
Leticia has a rather long name. What is her married name? What is the family name of her father? What is the family name of her mother?
2.
What might you do to build a trusting relationship with Leticia before giving her health advice?
3.
Which advantages might there be in visiting Leticia in her home?
4.
Which disadvantages might there be in visiting Leticia in her home?
5.
What do you think has caused the rashes on Leticia’s arms and legs?
6.
Would you encourage or discourage Leticia from using eucalyptus on the rashes?
7.
Would you encourage her to take antibiotic and herbal medicine recommended by the curandera along with the hypoglycemic prescription?
8.
What do you think might happen if you advised Leticia to refrain from taking the antibiotic and herbal medicine recommended by the curandera along with the hypoglycemic prescription?
9.
How might you help Leticia integrate the care recommended by the physician and curandera?
10.
Would you discourage Leticia from seeing the curandera completely?
11.
Leticia tells you that she does not want to lose any more weight because her husband likes her being “stout.” She eats a “traditional” Panamanian diet, which is high in fat but replete with fresh fruits and vegetables. Which dietary recommendations would you make to negotiate an acceptable weight and still maintain control of her diabetes?
12.
If Leticia agrees to be admitted to a hospital for treatment, would she be admitted to a Social Security hospital or a Ministry of Health hospital?

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