JCAPN Volume 17, Number 4, October-December, 2004 139 In fall 2001, the Pan American Health Organization (PAHO) asked the International Society of Psychiatric-Mental Health Nurses (ISPN) to work with them to establish mental health nursing competencies for Central and South America. Over the last 3 years, ISPN has been working with PAHO and has added the Nursing Honor Society of Nursing, Sigma Theta Tau International (STTI), as a partner. The University of Maryland School of Nursing WHO Collaborating Center and the University of Alberta School of Nursing WHO Collaborat- ing Center are serving as consultants to the project. The goal of the partnership is to improve the access of quality care provided by mental health personnel through the development of competencies for mental health clinical nursing practice based on the current mental health service structure. After some fact find- ing by PAHO to determine a country with a mental health struc- ture that was ready for change, a political climate, and nursing workforce that could serve as a pilot for this work, Panama was identified as a country with a developing infrastructure in mental health nursing that could support further development. There is a three-tier health system in Panama, with the first level being the facilities for the unemployed and rural populations. The next tier is funded by the Ministry of Health, and the third and best tier is funded by Social Security. Social Security is the system working citizens pay into to support the health and social infrastructure of the country. Panama is a country with great potential, but one that faces multiple mental health issues. The poverty in Panama is deep and wide, with an unemploy- ment rate of about 20%. The healthcare system, and especially mental health, has been in decay for some time. The country has made a commitment to improve health care and is attempt- ing to decentralize the treatment for mental health while im- proving the quality of the care delivered. Accidents, suicide, and violence are the leading causes of death. Substance abuse has been identified as a priority health prob- lem. The nurses who work in mental health in Panama are eager to establish competencies to guide their practice. There are 350 mental health nurse specialists who have had at least 1 year of postbaccalaureate education in mental health nursing. These nurses have formed a network and organized themselves into a force that has the potential to move mental health toward an effective system characterized by quality care and standards. The nurse responsible for mental health nursing for Social Se- curity in the country has a comprehensive plan to move mental health nursing forward, but there is a lack of funding. Elena de la Motte, dean emerita of the School of Nursing at the University of Panama, is a mental health nurse and a major leader in nursing. Through her efforts and networking, the three authors were given the opportunity of a lifetime. She in- vited us to attend two meetings: the National Association of Nursing of the Republic of Panama and the Central American and the Caribbean Congress, which both took place in Panama City in August. Approximately 500 nurses attended these joint meetings from Central America and the Caribbean. Their hospitality was overwhelming, and in spite of the language dif- ferences, we were made to feel welcome as honored guests. Elena and the three of us saw the trip as an opportunity to do a needs assessment and fact finding that will be useful in further development of the project and in our efforts to find financial resources. We did not stop for a minute during our visit and, besides the joint meetings that were taking place, we had the opportunity to meet with a group of mental health nurse spe- cialists attending the conference, tour mental health facilities throughout the country, and meet with faculty and students at the School of Nursing at the University of Panama. We were given a complete and honest overview of the mental health sys- tem and the potential for growth and improvement. The experi- ence was not only an eye opener for us, but also one of hope and determination to help make a difference in this country. Our first day was a 4-hour trip to the interior of Panama to visit a rural hospital that included three mental health units. You know nothing about heat until you ride into the interior of Panama on a two-lane road in a small past-its-prime minibus with 12 other people. When we pulled up to a stop, we thought we were just stopping to ask for directions at an abandoned building site, but we had arrived at the hospital. The hospital was a cinderblock building with no glass windowsonly bars or decorative holes in the cinderblock. As we stared into the rubble of the building, we began to see nurses dressed in white and what appeared to be chronically ill patients standing in an open room around the nurses station. We have to say, we were shocked by the decaying structure and lack of cleanliness, but the patients were well cared for and content. In fact, it was ap- parent the nurses cared for the patients as if they were family, yet they had very little in the way of necessities such as plumb- ing; a sound, clean structure; supplies; and staffing. Editorial The Vision of Mental Health Nursing in Panama Linda M. Finke, PhD, RN, Sally Raphel, MS, APRN/PMH, FAAN, and Edilma Lynch Yearwood, PhD, APRN, BC