Last week in Antipolo

This past Monday we were lucky enough to have been asked to join a Barangay health workers graduation ceremony in Antipolo. The graduation took place in an outdoor community hall. Those in attendance included a Dr. from Chicago that works in partnership with UERM, the community midwife, barangay health workers and the ceremony was conducted by the junior residents of UERM. This was a very exciting time for both the barangay health workers graduating and for the community. The graduates consist of members of the local community who were interested in helping their community and therefore chose to become health care volunteers. They then went through six months of training to learn assessment skills such as taking vital signs and health teaching about common illnesses such as colds, fevers, and diarrhea. Since there is a lack of nurses, doctors and midwives especially in remote neighbourhood’s barangay health workers fill a gap in the delivery of health care and become one of the most valued members of the health care team focusing on Primary Health Care. The graduation ceremonies consisted of introductions, speeches and the presentation of the graduation certificates. The health care workers then presented a dance they had worked on. After it was time for a snack and picture taking. It was a very interesting event and we could really see how the community works together for the good of its people. That afternoon we were off to UERM for orientation.  The eight students staying for their acute practicum received their hospital orientation while the other four met their buddies and learned what they would be doing in the community for the week. Both groups had an opportunity to take a tour of the hospital at UERM. There are two types of hospitals in the Philippines, private and government/charity.  The hospital at UERM is classified as both a private and public hospital because it is affiliated with the university.  If a patient is able to pay for the medical services needed then they will be placed on the private side.  However, if for some reason the patient is unable to afford the price of treatment they will be placed on the public side where the government pays for the bed and the doctors but the patient is still responsible for paying for any medicine and tests they may need.  We learned from our Filipino buddies that it is common for patients on the public side to attempt to leave without paying the bill for services during their stay and if this occurs it is the nurse that is responsible for paying the bill for any medication that she/he administers. After the tour we were invited to an alumni supper were we were treated to good food and entertainment.

Tuesday morning we went into the community to perform assessments involved in the Integrated Management of Childhood Illnesses (IMCI). We assessed a couple children with coughs and colds and identified 3 children with Tuberculosis. After lunch we all sat down to discuss subjects to talk about with the community members on Wednesday afternoon at our focus group. We then surveyed a couple houses with regards to a major health problem in the community which we were able to identify as hypertension.

Wednesday we once again had the opportunity to practice giving immunizations through the Expanded Program of Immunizations (EPI) at two health units in the community. In the afternoon we conducted our focus group were we gathered community members together and discussed what they felt were some of the major health issues in the community.  We also enquired about what we could do to help them become empowered to engage in a healthier lifestyle and ultimately reduce the prevalence of health problems such as hypertension.  Through our discussion we identified that they were interested in learning more about healthier food choices that they could make and exercise activities that they could perform during their daily routine that did not involve making a commitment to organized activity because most are unable to leave their stores which for many is their only source of income.

Thursday morning we went to the Broadway Health Center where we were able to help with prenatal assessments. We assessed 4 mothers by performing Leopalds Maneouvers and listening for the fetal heart beat. In the afternoon we planned for our implementation of health teaching regarding an appropriate diet and exercise routine for a person with hypertension that we will be delivering to the members of the community on Friday morning. Following this planning session we went back out into the community to perform the Metro Manila Development Screening Tool (MMDST) which is an assessment tool used to screen for developmental delays in children under the age of five.  It is an adaptation of the Denver Screening Tool used for assessing children in Canada and the United States.  We were able to assist with the assessment of a four year old girl who we had encountered earlier in the week during our home visits.  We were informed by her aunt that the child has not spoken since birth.  We concluded that the child was within normal limits in all categories except that of language and we were able to inform her mother that it would be beneficial to have a referral to a speech therapist.  The mother was very receptive to our suggestions and it was a good way to end off the day.

Antipolo Week 3

Last week our focus was on school health. We started off our school nursing experience with courtesy calls to the Assistant Superintendant and the supervisors of the Antipolo School Division. We learned that the main health concerns for the students within the division are the presence of head lice, dental carries, and skin conditions. Next we visited two Barangay Bagong Nayon Elementary Schools, numbers II and IV, which are the schools we were placed at for the week. The elementary schools here go from kindergarten to grade six and they are generally designed with a large outdoor gymnasium/auditorium in the center and classrooms around the perimeter. They serve a very large student population; for example, Bagong Nayon Elementary School II has a shocking 5000 pupils. We introduced ourselves to all the grade one classrooms that we were to assess the next day. We also met the nurse of the school division. He teaches for two hours every day and must visit each of the division’s 60 elementary schools every week. We felt some disbelief upon learning of his extremely large workload. In the evening of Monday January 24th, we met up with the other six Canadian students that came over from Iloilo to join us in Antipolo for the week.

On Tuesday January 25th, we spent the day conducting physical assessments on grade one students. The assessments included vital signs, height, weight, heart, lungs, eyes, ears, nose, throat, mouth, neck, skin, scalp, and extremities. At Bagong Nayon Elementary School II, the number of assessments reached well over 500 in one day. Some common findings were head lice, dental carries, impacted ear wax, poor vision, low weight, and nasal discharge. The amount of lice was alarming to us, as more children had it than not.

            The following day we spent the morning administering childhood immunizations in the barangay health clinics as we did in the first week. Then we proceeded to the schools to attend an open meeting with parents in the afternoon. At the meeting we presented the results from the previous day’s assessments and gave health teachings for some of the common findings. The floor was also opened up for parents to ask questions and express their thoughts. It was really positive to see the high number of parents in attendance.

            We returned to the barangay health clinic the next day to assist with prenatal assessments, as in the first week. Then we went back to St. Michael’s for an early lunch and to change into some nicer clothes for the afternoon. We drove down to the UERM campus to attend the 5th Dean Emeritus Evangelina M. Dumlao Lecture Series. Our Canadian clinical instructor, Susan Fowler-Kerry, was the keynote speaker with a presentation about pediatric pain. We were reminded of the need for nurses worldwide to join forces with one another to advocate on behalf of children. After the presentation, we were treated to a catered merienda (snack) that was large enough to be a meal, in what we are learning is typical Filipino hospitality.

            On Friday January 28th, we did a postpartum home visit in the community. The mother was a mute teenager, with no father in the picture. At birth the baby weighed 2.5 kg, and on Friday at nearly four weeks of age she weighed only 2.7 kg. She had sunken fontanels and decreased skin turgor – her skin was loose, wrinkly, and “old” looking. She was very lethargic and difficult to awaken with either touch or sound. The home visit consisted of a lot of teaching with the mother. She was shown how to use a needleless syringe as an improvised breast pump. We asked her to try to feed the baby more often even if it means waking the baby for feedings. We tried to offer lots of encouragement to the struggling mother. It was a very difficult situation to see. It made us appreciate the children’s rights and social services back home in Canada. It is heartbreaking to say that at the end of the visit every single one of us walked away wondering how much longer the baby would be alive.

The above pictures were taken with consent.

Last week in Iloilo

All photos have been posted with permission from the subjects within them

After nurse’s week at St. Paul’s University our group went back out to Janiuay for our second week of the community exposure. On Wednesday the 19^th we spent the morning working at the Rural Health Unit. Some of the students got to practice giving immunizations. There were not enough vaccines to be able to immunize all the children that came to the clinic. The experience of having to turn away patients was new for us. It is experiences like that, that help us appreciate all the health resources we have back home in Canada. The remainder of the students assessed children under five using the IMCI assessment tool. We all really appreciate having our Filipino nursing student buddies to help us translate when working with the patients at the Rural Health Unit.  That afternoon, we had planned to head out on the trek to the Boranguay Mantag-ub to do home visits. It was an extremely hot day out, so we had to postpone heading out for a few hours until the extreme heat of the day had passed. While we waited, we made use of our time by brainstorming about possible action plans to help address some of the challenges faced in the community. For example; a lot of the community people have no way of making a lively hood. One of the ways the students want to help the community address this issue is to help them establish some mushroom crops to sell for profit. In this way the community members will be doing the work to earn the profit. Eventually, the sun started to go down and we headed out to the Boranguay. In groups of three we visited individual family homes to assess their living conditions, learn about their health challenges, take vital signs and address any other medical concerns they had. This was an eye opening experience for us, as the living conditions are far from what we are use to back home.

On Thursday we went back to the Rural Health Unit in the morning to do prenatal check ups on mothers. We measured fundal height to see if the fetus is growing appropriately for gestational age. Lastly, we did Leopold’s Maneuvers to assess how the fetus is positioned in order to find the fetal back to listen to the heart rate. We checked fetal heart rate, using a dopler, to assess the health status of the fetus. That afternoon we took a tour of Janiuay that the mayor organized for us. Some of the sights included the community’s famous historic cemetery as well as the church that they are beginning to restablish. In the afternoon we observed a traditional Filipino Hilot (healer) provide their services to a patient. In the Philippines many people are unable to afford health services, so they may end up going to these healers as a more affordable option. It was great to observe this experience to further our understanding of local traditional forms of health care. In the evening we attended a carnival with the students in the town square.

On Friday, half of the group went back out to the Boranguay Mantag-ub to host a community assembly. The assembly consisted of health teachings on diseases that the community members are at risk for, further assessment about community challenges, and provided lunch for the community members. The other half of the group was able to take part in a labor at the Rural Health Unit. We were divided into three different positions. The assistant monitored the mother’s vital signs and the fetal heart rate, they helped coach the mother as the father is not allowed in the delivery room, and they administered a medication after the delivery of the placenta to help prevent postpartal hemorrhage. The handler gets to assist the midwife in the actual delivery of the baby, cutting of the umbilical cord, delivery of the placenta, and then with stitching after the delivery if the mother experiences any tearing. The baby care student is in charge of cleaning the baby, taking the vital signs of the infant, taking measurements, and administering the necessary medications. As women, it is very empowering for us to see such a natural birthing process take place and for the mother to cope so well. They receive no pain medications, and are instructed to walk around and do squats in order to naturally speed up the labor. We also stimulate the nipples and abdomen to help bring on contractions and speed the delivery. Following the delivery we performed postpartal checks on the mother for two hours. The mother had a beautiful healthy baby girl and did extremely well. In the afternoon, we took part in a farewell celebration with the students and our clinical instructors. We were welcomed in by one of our instructor’s aunts to her beautiful home for a delicious feast and pool party. We cannot say enough good things about the overwhelming hospitality of all the people we have met during our time here in the Philippines.

On the weekend we were able to have some fun with the students and take part in karaoke, which is very popular in the Philippines. We now understand why, as it was such an amazing time. On Sunday we attended the Dinagyang festival. The governor of Iloilo invited us to sit in his reserved section to view the dancing. At this festival the tribes had choreographed dances with extensive sets and props to show the coming of the Christ child, or Senior Santa Nino. The show was amazing and we were very lucky to be able to have such a close view of the program. Following the festival, one of the Sisters from the university invited us to her friend’s house for another great Filipino meal.

 Early Monday morning we packed up our things and headed to the airport. It was hard to believe our time in Iloilo had come to an end. It went by so fast and was filled with some amazing learning opportunities, extraordinary people, and many great memories. We are very appreciative to all of the people (instructors, staff, students, and families) that made our stay in Iloilo so amazing. We exchanged our goodbyes, hugs and tears with our instructors and student buddies as they all escorted us to the airport to send us off. We boarded the plane and were off to Manila. We then drove out to Antipolo to be reunited with the other six Canadian students. We will be spending two weeks here with the staff and students from the University of East Ramon. Everyone will be taking part in community exposure this week. Next week, we will be split up with eight of the students going into their acute practicum and four of the students will continue with their last week of their community practicum.

Iloilo Week 1 Cont'd.

Weekend in Aklan and Boracay (January 15 & 16th, 2011)

Not only are we getting to improve our nursing skills we are also getting the chance to experience the Filipino culture. Saturday we woke up bright and early at 4 am to travel to the city of Kalibo, 4 hours away from Iloilo. We were welcomed into two of the students’ homes. In the afternoon we had the opportunity to go to Sampaguita gardens which is the former home of the creator of the precious moment’s figurines. From there we went to the Sto. Nino Ati-Atihan Festival. This is a festival that celebrates all of the native and modern tribes of the province of Aklan. Each tribe dresses up in costume, some paint their bodies with black paint and they all dance in the streets. The spectators if they so choose can dance with them in the streets. After dancing at the festival it was time to eat. We went to one of the students’ home, where we were fed a traditional Filipino meal: whole roasted pig with apple in mouth and an assortment of other traditional foods and desserts. After a long day it was time to get some sleep. Sunday morning we woke up to thunder lightening and lots of rain but that didn’t stop us from going to the most famous beach in the Philippines: Boracay Beach, which we had been told numerous times since arriving in the Philippines that we should visit. So after a two hour drive, a boat ride across the ocean and a tricycle ride we finally made it to the beach. Not long after we got there it stopped raining, so we quickly changed into our bathing suites and were off to swim in the Indian Ocean. The beach was amazing, the white sand was so soft and swimming in the ocean was the perfect way to end a busy clinical week. After a quick but relaxing trip it was time for our 6 hour drive back to Iloilo. Overall it was an enjoyable weekend getaway. 

Nurses' Week at St.Paul's University (January 17 & 18th, 2011)

Monday morning kicked off nurses’ week at St.Paul's University which involved two days of competitions between the juniors, sophomores and senior nursing students.  The theme behind nurses’ week is to bring the students together to enhance unity, to showcase students’ talents, and also as a stress reliever. The two days were comprised of competition in many different domains including dance, singing, sports, board games, public speaking, acting, and creative skills like face painting, murals and music video production. While the competition is fierce sportsmanship is at the forefront of the whole event.  Tuesday afternoon it was our turn to show off our Canadian moves as we danced with our Filipino peers to the song Waka Waka by Shakira. Overall the two days were very interesting and exciting to be part of. The students showed so much enthusiasm and it really brought the whole college of nursing together.

Anti-polo Week 2

Monday January, 17, 2011
We awoke bright and early (thanks to the help of our neighboring rooster) and enjoyed yet another feast from St. Michael’s splendid cooks. We then traveled to Pilusorio Center for Geriatric Care for a courtesy call and environmental assessment. We were pleasantly surprised at how active and vigorous the Filipino geriatric population was. After a warm greeting from the geriatric center's coordinators, we attempted a greeting and introduction in English to the seniors present. Thankfully our Filipino nursing partners translated into Tagalog for us. We traveled to Maximillian Industry Inc, in the afternoon for an environmental survey and the beginning exposure to Occupational Health. We were very excited for this opportunity, as very few of us have had the chance to experience this back in Canada. We were orientated to the factory and the product, as well as being given the chance to ask the manager questions on work hours and health standards being followed. Following our tour of the factory we returned to St. Michaels to collaborate with our Filipino nursing students and prepare for tomorrow’s activities with our geriatric patients and plan for out assessment for Occupation Health. It was interesting to see the difference in health and safety within the factory and geriatric center as well as getting the chance to put our community theory leanings into practice. It is fascinating to see the theories that we learn back home actually being implemented by students over in Philippines. It has caused many of us to question why we cannot do this type of involvement within our own core populations in Saskatchewan.
Tuesday, January 18, 2011
Today we were privileged to see our planning put into action. We returned to Pilusorio Center for Geriatric Care to implement our planned games. We started by partaking in a vigorous stretching and warm-up routine. Amazed by the stamina of our patients who could stretch, jump and twist as if in their mid-twenties. Trish and Leia went on to lead the group of 40 seniors and 12 nursing students in learning the Cha Cha. The swaying of our hips and the up-beat music resulted in many delighted peals of laughter. We followed this with a round of Hokey Pokey, Musical Chairs, Charades and the Filipino favorite "Hep Hep Hooray." After a lengthy and educational lunch we returned to the factory for our health assessments of the factory workers. We had them fill out a survey, conducted blood pressure, lung sounds, forced expiratory rate (breathing in as deep as possible, then blowing it out as fast as possible, the normal being blowing it out within 4 seconds), heart rate, and respiratory rates on as many workers as we could within 15 minute break period. We managed to assess 42 out of 65 workers. It was definitely a different experience compared to the assessments that we do back in Canada. The same assessment would have probably taken 20 minutes per person in a hospital in Canada, and it was amazing to see how fast and thorough our Filipino counterparts were at their assessments. It was also quite the experience to try and explain the survey questions to the workers in English. It really gave us an appreciation for what it must be like to be a minority who cannot speak the mainstream language. Following our surveys we returned to St. Michaels to tally results, the results showing that educational teaching was needed in the areas of proper mask application and hand hygiene. Together with our Filipino students we went on to plan appropriate health teachings to impart to the workers, and what refreshments to offer to entice the workers to listen. St. Michaels was hosting a wedding party in the evening. From our usual supper positions on the balcony we were able to view our first Filipino wedding, complete with fireworks. It is safe to say we have never seen a more beautiful display of white gardenias and climbing vines. A lovely ending to an eventful day.
Wednesday 19, 2011
We gathered to prepare tuna sandwiches to hand out to our geriatric and factory worker populations. With a little bit of teamwork, and a new learning experience (apparently in the Philippines they do not use the ends of bread, as it is looked at as disrespectful) we accomplished making sandwiches to hand out. We loaded into the van, with our wonderful and skilled driver Arnel and headed to Pilusorio Center for Geriatric Care. On arrival we were greeted with great enthusiasm by the seniors who were ready to Cha Cha up a storm. Unfortunately we have been experiencing unseasonably rainy and cool weather and it choose to pour down upon our dance lesson. We moved the activities into the much less spacious quarters inside. Even packed inside like sardines the seniors and ourselves managed to continue the fun. This included a round of telephone ‘Filipino style) and many pictures.
After lunch we headed back to Maximilian Systems Inc and set out lunch and drinks for the workers. Although it decided to resume the down pour (not the spitting we Canadians call pouring but a real heavy river created by the falling of water) we arranged for the workers to sit and listen to our role-play. Trish and Amy explain the proper way to wear a mask along with the positive and negatives side of wearing/not wearing one. Carol and Valerie role acted in the background, with an energetic dance moves from Carol (much appreciated from the workers). The health teaching was well received, this was demonstrated by the fact that the workers were seen practicing later on in the afternoon. After the teachings and a brief stop at the grocery store to pick up art supplies for tomorrow’s presentations. We ended a busy day with reflection and post conference.
Thursday 20, 2011
This morning we all met in time to review our plans for the day. Two of our nursing students told us about an event that they witnessed last night on the way home. They explained how they witnessed a man commit suicide and how they tried to prevent it. They recalled the fear and despair that they felt when they realized it was too late. This story showed us how there are many disparities existing in the day to day lives of Filipino workers. It was a reality check on the many needs that still exist within this country, and a reminder as to our goals while staying here. We headed back for our final day at Pilusorio Center for Geriatric Care, were we enjoyed a final day of dancing and health teaching with the senior citizens. After a brief lunch break we headed back to Maximilian Systems Inc. where we went on to share our findings from our earlier surveys, and our Filipino partners presented the proper way to wash hands. We proceeded to immunize 28 workers for tetanus.
We had a interesting and unusual experience to follow, Maximilian Systems Inc asked all of us to pose for a photo shoot as they are planning on expanding their products into women’s wear, under the brand of Hijo. After a star treatment of getting our hair styled and being put in clothing, photos were taken, and pizza followed. After a long day we headed back to St. Michaels were we went on to immunize nine of the St. Michael’s staff members. Safe to say everyone will be ready for bed tonight
Paalam!

Note: all pictures above were posted with the permission of those within them.

First Week of Community Clinical in Iloilo

Week 1

January 11-17^th, 2011

Location: Janiuay, Iloilo

Students: Jill Peacock, Kristin Carmichael, Cara Burgess, Brianne Suderman, Cristina Santoro & Melanie Fontaine

          We have officially completed week 1 of our community health nursing in Janiuay (phonetically- honey why). Our week began with courtesy calls to official members of the community such as the Minister of Health, the Mayor of Iloilo city, the Governer of Iloilo province and the Mayor of Janiuay. We were warmly welcomed to this new community and were introduced to the staff house. During our stay in the staff house, we are required to work together by cooking meals, washing dishes, gardening and housekeeping. By doing this, we have been able to quickly build relationships with the Filipino nursing students and our clinical instructors.

          Our community experience began  in the Rural Health Unit (RHU) a publicly funded facility. Implementing IMCI (Integrated Management of Childhood Illnesses), providing immunizations, and assisting in deliveries are among some nursing skills we have practiced so far. In our practice we have observed that the supplies are scarce and less than ideal. A reality very difficult to understand comparing to our rich supply of materials within our Canadian health care systems. Improvizing and or reusing supplies are common pratices in this facility due to lack of resources.

We have also nursed beyond the facility and set up clinics in remote communities such as those occuipied by the Atis. The Ati is a Negrito ethnic group which are identified as the Aboriginals or first inhabitants of the Philippines. We walked through small rivers, rice fields and mountainous terrain to set up a community assembly. Vital signs, wound dressings, health teaching, and discussions surrounding priority needs were identified by the community members.

In this culture, a common belief is seeking alternative treatments versus the modern biomedical models. We have come to understand the Filipino culture is very in touch with the super natural world. For example a young boy in the village had a substantial rash, identified later as scabies, on his feet. The mother of the child explained that they believed the child stepped on a dwarve`s house, hidden in small mounds of dirt, and crushed it. Doing this irritated the dwarves and they hexed his feet thus causing the severe rash. Many people in this tribe do not wear shoes which can cause further infections and delayed wound healing.

Not only do we have to understand the health concerns but we also need to embody the practice of cultural competency by respecting and including their beliefs and perceptions . In week 2, we will commence home visits to further assess and understand health priorities of this community group in order to plan and implement appropriate nursing interventions.




Staff house in Janiuay.



Cooking Filipino and Canadian meals.





Nursing in the Rural Health Unit in Janiuay - Implementing the IMCI.





Immunizations (photo granted with permission from family).





Walking through a river to reach our community !





Community assembly - Vital signs & wound dressing stations.





Dancing with the children of community (photos granted with permission from families).



University of Saskatchewan and St.Paul's University of Iloilo Nursing Students.

 

                                         Video footage granted with permission from community members.

First Week of Community Clinical in Antipolo

On Tuesday January 11^th we learned about Integrated Management of Childhood Illness (IMCI) which is a flow chart to help classify fever, diarrhoea, ear problems and cough. We went to the municipal health center to apply IMCI and we all were able to practice this on two patients. Later that day we went to Barangay Bagong Nayon, which is our community that we help out with. We assisted with their fundraiser, which was a garage sale, and the money they earn is used for future community events.

On Wednesday in the morning we served two communities Barangay Dela Paz and Barangay Bagong Nayon by providing immunizations for infants and toddlers. The six of us were split into two groups and assigned to each of the communities with our nursing buddies. The immunizations that we provided were hepatitis B, measles, oral polio, diphtheria, pertussis and tetanus, and vitamin A. In the afternoon we went back to Barangay Bagong Nayon to help again with their carnival, assist with their raffle and provide teaching on plants native to the Philippines that have medicinal purpose if the people cannot afford medication.

Thursday morning the six of us were split up again to the two communities we were at previously and provided prenatal assessments. The skills that we were able to use were taking vital signs, measuring height, weight, and fundal height (which is the measurement of the top of the woman’s uterus to her pelvis), and Leopold’s manoeuvres which helps determines the baby’s position. Later on in the morning we went to the Barangay Bagong Nayon health center and observed the training for the Barangay Health Workers. We were an intermission act and all six of us sang our Canadian national anthem which was entertainment for the Filipino people. The afternoon consisted of the Barangay Health Workers Post-Christmas party. They had a feast for us to devour and made us karaoke for them.

On Friday we were paired up with third year nursing students and we assessed the Barangay Green Forest. We did home visits in this Barangay gathering epidemiological information to pass on to the Barangay Health Workers to do follow up work. On the weekend we were able to spend some time with the Dean from University of the East Ramon Magsaysay and make a day trip to Tagaytay. We visited the fruit and flower market which were absolutely gorgeous. All of us girls had the privilege of meeting the Dean’s sister and husband and their family. They opened their beautiful home to us and we shared an amazing home cooked meal with them and thoroughly enjoyed their hospitality and warmth.