SARA DOMINIC LARISSA POLLOCK ASHLEY HUESMAN DANIELLE GARCIA SHANA UDELL PAYTON BEAVERS EMMA FLECK CHARITY GRESSNER Panama Clinical Experience

Clinical Setting/Agency Community health Fair

Client Population Women Women of childbearing age or sexually active

Health Needs of the Population “Cervical cancer is the second most common cancer and the third leading cause of cancer death in women in Panama. Almost half of patients with cervical cancer will die from their disease in Panama” (PRI, 2009). It is not common to receive Pap smears routinely, so it is important for the women of Panama to know how important they are (PRI, 2009). “The HPV vaccine isn’t completely effective; it doesn’t block the strains of HPV that cause about a third of cervical cancer” (PRI, 2009). The women of Panama need to learn how to protect themselves by practicing safe sex to prevent sexually transmitted diseases and to reduce their risk of developing cervical cancer

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Service Learning Project The goal of the service learning project is to teach the women of Panama and the community about the risk of developing cervical cancer and the ways reduce the chances of obtaining cervical cancer. By presenting our brochure, we hope to provide the community with information to protect themselves from cervical cancer and the women will be able to understand how important it is to practice safe sex, get a routine pap smear, and to receive all three doses of the HPV vaccination.

Rationale for SLP Cervical cancer is very prevalent in the country of Panama, so it is important that we educate the women of this country about the risks of developing this disease. We want to provide relevant, updated information and important teachings that may lead to a healthier population of Panamanian women.

Healthy People 2020 Objective  Reduce the death rate from cancer of the uterine cervix  Baseline: 2.4 uterine cervix cancer deaths per 100,000 females were reported in  Target: 2.2 deaths per 100,000 females  Method: 10 percent improvement  Reduce invasive uterine cervical cancer  Baseline: 7.9 new cases of invasive uterine cancer per 100,000 females were reported in  Target: 7.1 new cases per 100,000 females  Method: 10 percent improvement  Increase the proportion of women who receive a cervical cancer screening based on the most recent guidelines  Baseline: 84.5 percent of females aged 21 to 65 years received a cervical cancer screening based on the most recent guidelines in 2008  Target: 93.0 percent  Method: 10 percent improvement  Increase the proportion of women who were counseled by their providers about Pap tests  Baseline: 60.2 percent of females aged 21 to 65 years were counseled by their providers about Pap tests in 2008  Target: 66.2 percent  Method: 10 percent improvement

Healthy People 2020 to SLP  In 2008, out of 426 women diagnosed with cervical cancer in Panama, 211 died ("Human papillomavirus and," 2010).  Based on this information form WHO, cervical cancer has a higher death rate in Panama than the US. It is important to reduce the death rate by at least 10 percent in Panama just as it is in the US.  Early cervical cancer may have no signs or symptoms (Mayo Clinic Staff, 2012).  It is important for Panamanian women to get routine health screenings, Pap tests, and examinations by a provider. It is also important that these women know they can receive the HPV vaccination for free at a local clinic or health department.  Girls should have their first visit with an obstetrician-gynecologist between 13-15, or before beginning sexual activity. Screening should begin at age 21 (Mayo Clinic Staff, 2012).  As we have learned in our Pre-Panama clinicals, many Panamanian women do not have access to optimal health care and do not receive routine women check-ups yearly. Therefore, these women would not have adequate counseling about the importance of Pap tests. Pap tests are a preventative measure toward cervical cancer and are an important tool in diagnosing HPV and cervical cancer in the early stages when it is the most treatable.

SLP Description We are teaching the women of Panama the causes, risk factors, and preventative measures for cervical cancer. We created a brochure for the audience to read and take with them after the presentation.

Goals & Objectives of SLP Goals: We are aware of the increasing number of women who have contracted cervical cancer in Panama. By presenting our lecture, we hope to provide the community with information to protect themselves from this disease. After completing the presentation on cervical cancer, the women of panama will be able to identify at least 2 risk factors, at least 5 signs and symptoms, at least 2 complications, at least 2 causes, at least 2 treatments, and at least 3 preventative measures for cervical cancer. Objectives: -Comprehend and apply education presented regarding the impact of cervical cancer in the Panamanian culture -Identify risk factors for cervical cancer (2) -Identify signs and symptoms of cervical cancer (5) -Identify complications associated with cervical cancer (2) -Identify causes of cervical cancer (2) -Identify possible treatments for cervical cancer (2) -Identify preventative measures for cervical cancer (HPV) (3) -Apply the knowledge given by answering specific questions regarding the presented material

Modifications Made -Directing our focus more toward the correlation between sexual relations and the risk of cervical cancer -Changing our presentation to Layman's terms to ensure a better understanding of the information -Learning to incorporate questions into our presentation to find out the baseline knowledge of the population we are addressing to give us an idea of where we should start the education process

Implementation For our SLP we will hand out brochures to the women of Panama. We will then explain to them the risk factors, causes, signs, symptoms, prevention methods, and treatments of Cervical Cancer. After our presentation of information, we will hand out a “post test” asking them questions on Cervical CA to test retention and how well the information was presented. We will also hand out teal ribbons to signify the importance of Cervical CA prevention and awareness.

Participant Response Very open and receptive to what we had to share Many women were very hospitable to us Not afraid to share their health history with us Many women were very knowledgeable about cervical cancer Many women were up to date with Pap’s

See For Yourself! VISUAL OF BROCHURE, RIBBONS, & POST TEST

What Can Be Done in the Future? Be prepared for numerous settings to present our information  We were expecting to present in front of a large group of people, when in reality, we were going house to house within the community Have an active role in communicating the information  As we were going house to house, we were not able to speak to the people about our topic. Instead we just gave them the brochure we made and relied on the Panamanian nursing students to speak for us

Health Policy on Health Care, Clinical Agency, & SLP Everyone has access to health care coverage- as long as they are employed.  Example: In the clinics, insured patients pay nothing, those who do not have coverage pay only $1.00 per visit.  Very personal care  Depending on which clinical agency you visit, health policy varies o In the clinics, gloves are seldom used, little access to hand sanitation. In the hospital, gloves are widely available with plenty of opportunity for hand sanitation. o Infestation control o Climate control o Educational posters available in both sites.  SLP o Ministry of health makes community rounds to educate residents of a wide variety of diseases and helps to prevent such. o Very Personal- welcoming.

References: Calvo,A., McCormack Brown, K., McDermott, R., Bryant, C., Coreil, J., & Loseke, D. (2012). Social construction of cervical cancer screening among panamanian women. American Journal of Health Education, 43(), doi: / Centers for Disease Control and Prevention. (2013). Gynecologic cancers. Cervical Cancer. Retrieved from: Mayo Clinic Staff. (2012, March 17). Cervical cancer in the republic of panama. Retrieved from PRI, (2009, April 20). Panama's fight against cervical cancer. Retrieved June 6,2013, from Reeves, W.C., Brenes, M,M., De Britton, R., Valdes, P., & Joplin, C. (1984). Cervical cancer in the republic of panama. American Journal of Epidemiology, 119(5), U.S. Department of Health and Human Services. (2013, March 08) topics & objectives: Cancer. Retrieved from : World Health Organization. (2010). Human papillomavirus and related cancers in panama. WHO/ICO Information Centre on HPV and Cervical Cancer, Retrieved from: