Friday, January 30, 2009

The end of our experience as Paulinians

Sunday, January 25

Today Sir Sunshine Troy was allowed a morning off of wake-up call duty as we awoke to the sound of the drums of Dinagyang. I have come to notice that when Filipinos celebrate, they celebrate. Just when you think they have completely outdone themselves you hear and feel the vibrations of fireworks. Dinagyang is only one of the many festivals that take place annually. This festival is to honor the Christening of the native people and to respect the holy Senor Santo Nino (Holy Child Jesus). Each group creatively honors Senor Santo Nino by incorporating a figure of him within their dance and chanting words honor to His name. We spent the morning at one of the 5 stations that all 17 groups of dancers and drummers march between to perform their dance. By the end of the day I am sure they must sweat off a good portion of the black or brown paint they have coated their bodies in to portray the look of the particular tribe. Each group had something like 60 dancers, 30 drummers, and support staff; some groups begin practicing as early as October to prepare the dance, music and costumes for the competition. At each station there are judges who evaluate each group according to various criterion such as choreography, costume, synchronization, etc. I am not sure if there is prize for the top groups, but as each group has sponsors, I am guessing that finishing in the top would increase the likeliness of sponsorship. Sponsorship is a great way to advertise as people come from all over to watch the performances. Among these people are some who live in remote areas with little money and resources. They come to the festival to beg as there are many festival attendees passing by. After the festival they return to their communities with their slim makings. The array of people in an array of different situations is overwhelming. I think Morgan is planning on writing more about some of our thoughts on this more in the excerpt of our return to Manila.

Note: Today Ma'am Sue left us to go back to Manila and then onward back to Canada. We are going to miss what a great teacher, mother, counsellor, and various other support forms she has been to us in preparation and during this trip. We've already warned her that she has got herself into 6 reference lists on 6 resumes.



Monday, January 26

A culminating activity this morning marked the beginning of our goodbyes. The culminating activity consisted of BP monitoring, weighing and measuring children, assessing any sick children, bathing children, exercise, games, health teaching on topics such as rabies and making of SLK (a cough and cold herbal remedy), and of course there was food. Culminating activities are always done at the end of a community rotation to bring closure between those particular students and the community. After the festivities were over we thanked the community for sharing their time with us, returned the babies to their mothers and took our last walk back through the rice patties. Goodbye to Janiuay.

After lunch we participated in the greatest cultural practice that we would all like to adopt: a siesta. I guess a full morning in the sun did more to us than evidenced by Troy’s lobster face. We went a little overboard and zonked out; I mean dead to the world zonked. When you are that far gone, it takes time to recover and come back to life. Life however doesn’t always want to give you the recovery time that you need; it was straight from pillow to dance floor for us. I don’t think the girl who volunteered to finish teaching us this Filipino folk dance was prepared for our zombie-like state. Somehow we polished up the steps though with only a few moments of hopelessness. After going through the whole 2 minute struggle of a dance a few times we were satisfied with just being able to get through it. We may regret this when we have to bring the dance out of the closet later on in Antipolo. I was relieved to see that the traditional costume was a skirt that would conceal all my mis-steps throughout the dance. This was before I tried it on though. As our hips and good new honest friend Hansel tell us that we eat like Filipino men, I had to pull the skirt so high in order to do it up that my feet were exposed. Humbug.

For supper we were privileged once again to dine with the Sisters in the convent. I could eat in the company of the Sisters everyday and not get tired of it. They are a great hospitable bunch each with their own character. I think they were happy to dine with us also because at every special event ice cream is served. Tonight I realized that I need to be cautious in how much I express my appreciation of the Sisters though because now that my singleness is revealed I am a prospect future Sister. The fact that I am not Catholic is only a minor detail. With enough prayer by the Sisters I will be back with a habit on before I know it. Thank you to the Sisters reading this, we enjoyed your company thoroughly. Communal dish washing is a new love of mine!

The rest of the evening was spent with the student’s at Carmelle’s beautiful home for one last hurrah! The people at SPU have all really made Iloilo our home away from home. As Jazzper (one of the students) put it: “it’s like we are old friends who haven’t seen each other in a long time.” It’s comfortable/we click. The students outdid themselves once again by generously presenting to us a slideshow of our stay along with personal gifts from our buddies. We hope they all know that we are serious about their longstanding invitation to visit us in Saskatchewan. See you soon?

Tuesday, January 27, 2009

This evening we will be departing Iloilo to move on to Antipolo so as at the end of every course, evaluations were in store. The top two things that stick out to me from the evaluation discussion about or experience in Iloilo are the importance of the mutual relationship/attitude and the need for a longer length of time to better understand the process of community health at SPU. We are all very impressed by the authentic experience that SPU facilitated and could not think of much more that we could ask for. We have learnt so much about health and culture through the experiences provided and through the conversations within the relationships that we were able to build.

The afternoon was spent shopping with the students. Since I am not much of a shopper I don’t have much to add. We ended the day with a hug fest and exchange of emails and we were off to the airport. Salamet SPU! We are honored to leave here as the title given: Canasians.

Thursday, January 29, 2009

Pictures from our last days in Iloilo City


Last day in Iloilo; posing with our new friends from St Paul University:

Saying goodbye after eating with the sisters at the convent:
Dinagyang festival; dancing with Santo Nino:
Morgan with one of the babies in the community:
Bathing the kids at the culminating activity

Culminating activity being led by Felina & Krystle:

Sunday, January 25, 2009

Last days in Ilo Ilo

            Greetings, its day 18 here on our tour de Philippines! We’ve now been in Ilo Ilo since last Saturday (1 week). The weather here feels much hotter than Manila (Ilo Ilo is about 500 Km south of Manila) in terms of our Canadian standards with the average day this week being well into the 30’s. Yes most Canadians are able to withstand 30 + temperatures but the humidity seems to be the number one challenge to our acclimatizing here. It is humid! Our cheeks are a constant glisten and our skin is stick stick sticky. We’re thankful for air conditioners, and my group members were very grateful to return to their cool sleeping quarters here at the dorm after spending some time in the rural community setting where the only air was the breeze from outside(I however didn’t get the chance to sleep in the guest house due to illness!).

            Yesterday, we attended a luncheon with all the faculty members of St. Pauls University.  The meal was put on by the culinary collage here and was excellent.

The afternoon events of Friday were the highlight of the day. It was arranged at the beginning of this week for us to take part in a circumcision experience here. Con Con, one of the faculty who has been leading our activities for this week, arranged for her dad who is a government employed physician to oversee our experience.  There were 10 boys ranging from about age 5 to age 10 who were chosen by a social worker as the participating patients. Unlike North America where circumcision is no longer a recommended practice, in the Philippines the majority of males are circumcised. The procedure’s outcomes are considered more beneficial in a developing nation where sanitization and cleanliness is much more difficult to achieve. The procedure is also promoted in large part because of cultural practices and is viewed by many as a step into manhood.  So along with the therapeutic advantages and cultural incentives to be circumcised, the patients were also offered the procedure for no cost, with free transportation to and from the procedure.

Before heading into the experience several of us wondered if the patients would be anxious and apprehensive prior to having the procedure done. We also wondered weather there would be cries of pain and discomfort following. In reflecting back upon the experience now, it was clear that the patients appeared just slightly agitated if not excited before the procedure and stoic and comfortable afterwards. While the procedure was being done, responses from the patients weren’t much different that the before or after; the patients appeared calm, relaxed, and seemed to experience minimal discomfort or pain, which was surprising with only the use of 2% lidocain (no epinephrine) to freeze the area. Some of the boys were even distracted by our presence and had no difficulty engaging with us as the procedure was going on.

As for our experience, we all had the opportunity to take part in assisting with or leading one or more of the procedures. It had been a while since sterile gloves had been put on, and most of us were eager to partake in this minor medical procedure. After observing the skill of suturing all of us had the opportunity to practice the skill ourselves. Two of the members of our group were even as bold to cut the minor incision. Just as many of the rest of our experiences have been, this was something I’m sure the majority of us will never have the opportunity to participate in again. Although participating in this procedure seemed contradictory to our practices home in Canada we all enjoyed having the opportunity to assist in this surgical procedure and will take from this experience a different kind of appreciation for the skill and expertise carried out by the surgical teams back home in Canada.

After having some down time at the beach on Saturday we returned to our residence at St. Pauls University and in no time we were all informed that Carmelita, who is the dean at the last University we are to visit in Manila, has requested we learn one of the native Filipino dance routines, so that we can perform the number next Saturday at a cultural show at the University! After getting over the initial astounded phase of this unusual request we all banned together as a group and learned in just one hour the steps to a nearly two minute routine! On top of mastering steps to this native routine we also mastered the maneuvers of the bamboo hand clappers that we hold in both hands and clap in coordination to the steps of the dance! Our lovely teachers were extremely patient and encouraging and forgiving of our lack of Filipino elegance. We’re all very optimistic that we will look the part of the graceful Canadian elephants and I’m thankful everyone in the group has a good sense of humor to accompany our sweet dance moves! Stay posted, as I’m sure there will be a video posted and pictures to come!

As we head into our last week here in the Philippines we’re ready for anything and can’t wait to see what else this trip could possibly have in store!

From Jenny and the rest of the Philippines nursing Crew!

Saturday, January 24, 2009

Adventures in Janiuay

Chelsea getting ready for some IMCI with Friah & Carmelle
The female sleeping quarters out in the staff house - where we didn't get much sleep
Chelsea and I with Adrien and his proud mother (among others):
Chelsea performing baby care with Bernadine:
Kristinn & the girls cooking some supper - stuffing the squid!

Wednesday January 21


After a long first night in the staff house in Januiay (we have learned that the Filipino students don’t value sleep in quite the same way we do, and they also don’t mind leaving the lights on all night long...), we started our first official day working in the community with our student buddies. Wednesdays are the official day here in the Philippines where every community health clinic in the country has baby clinics where children come to get their immunizations that are covered by the government, as well as when many of them get seen by health professionals if they are sick. We finally got the chance to put the IMCI program that we learned earlier this week into practice, as well as having the opportunity to practice giving more childhood immunizations. Kristinn and Chelsea were assigned to immunization duty while Troy and I were given the task of assessing the sick children using IMCI. Unfortunately Jenny and Morgan were still very sick so they weren’t able to join us for the day, they stayed back at the university to rest. Soon after beginning the assessments, I was told that there was a woman in labour waiting to deliver! Before I knew it, it was my turn to deliver a baby! The mother progressed very quickly, going from 7 cm dilation to being fully dilated in one hour. Suddenly her membranes ruptured (literally exploded - thankfully no one was in the line of fire this time) and it was time to push. The baby was crowning within seconds and then the head was out. I had a slight scare in that the cord was around the baby’s neck, but the midwife was at my side helping me through the situation. Then in no time at all, it was over, and it was a boy!! Little baby boy Adrien. Following his birth, I also delivered the placenta and checked to make sure it was all intact while Chelsea gave all the baby care. Overall it was an amazing experience!

The rest of the morning was a whirlwind of immunizations, IMCI assessments, and wound dressings. Many of us were also able to give our first Tetanus immunizations on the adults who were receiving wound dressings (it is standard practice here in the Philippines that individuals who are wounded by anything that may be dirty or rusty, including road rash, receiving tetanus immunizations following the dressings unless they can be sure that the individual has had their booster shots within the last 10 years). Before we knew it, it was time to return to the staff house to prepare and eat our lunch, followed by an hour long siesta (rest time).

In the afternoon we headed out to the sitio of Gamad (a sub-division of a barangay) where we walked along rice patties and performed an ocular survey of our surroundings. Most, if not all, of the homes did not have running water, many people had to walk a fair ways to get to a communal well, and their toilets consisted of holes in the ground. You literally didn’t want to slip off the edge of the rice patty - what you would land in is not pretty. Despite these conditions, as per usual here in the Philippines, all of the people were very hospitable and happy. During this experience we also did home visits with our student buddies, who allowed us to perform the family assessment while acting solely as our interpreters. I really appreciated getting the chance to do rather then watch. During our adventures in Gamad, we also happened across someone’s pet monkey/baboon that was chained up in the backyard. It quickly took a disliking to Troy and threw a coconut at him! He was obviously jealous of Troy’s stature, too much competition for the females.

That night we had the pleasure (or pain?) of having James (Troy’s buddy) teach us how to properly eat Balut. Balut is a type of egg that you eat hard-boiled but there’s a catch - the duck fetus is still inside! Following his lesson and graphic description, only Troy was brave enough (or insane enough?) to try it. He said that the fetus was not the worst part, the egg white was too chewy and the consistency never changes, just breaks down into smaller pieces. We really owe a big thanks to Troy because he has so far tried EVERYTHING that they offer us, chicken intestines and all.


Thursday January 22


Well, after another late night in the staff house the group headed out again to the rural health unit to practice more IMCI assessments as well as prenatal checkups. Today Morgan and Jenny began to feel better, so they made the trip out to join us.

After lunch we headed back to Iloilo City to attend the Paulinian Olympics here at St Paul’s University. The Paulinian Olympics are a talent competition here at the university that is very serious competition. We watched a few events; vocal duet, folk dancing, lip-synching (a new event this year), and group hip-hop dance. It was really fun and entertaining to say the least. These students are amazingly talented and creative, and to win the competition they must meet very high standards of judging. Halfway through the events, we were introduced as the Canadian guests and our student buddies showed a slideshow to all the attendees that focused on the past few days we spent in Januiay. It was a really nice slideshow, we hope to get it up on the blog at some point. Following supper Troy, Kristinn, and I also went and watched the volleyball final - Nursing vs Physiotherapy/Hotel Tourism Management (nursing is so big that other colleges have to be combined so that they stand a chance of winning). Nursing lost the match in the end, unfortunately. Overall the past two days have been great. We are continuing to learn so much from everyone here. Stay tuned… Next entry: Circumcision adventures.. :)


Lindsay and the Philippines nursing crew



Friday, January 23, 2009


It's another baby boy!! Kristin and I along with the Filipino nursing students and Ms. Ruby one of their instructors


January 20th



Today was a day of introductions and meeting the officials of St. Paul University and St. Paul’s Hospital in Iloilo city. We toured around the university and the hospital encountering welcoming and friendly individuals everywhere we turned. We were all given a welcome package that contained an amazing little book called Integrated Management of Childhood Illness. It is a guide created for health care in the Philippines by The World Health Organization, Unicef, The Department of Health for the Republic of the Philippines, and AusAID. It is a manual to help classify and diagnose a few of the pertinent childhood illnesses such as pneumonia, dehydration, diarrhea, malaria, measles, dengue, ear infections, malnutrition, and anemia. Step by step it helps you to classify the severity of the illness and how to go about treating, educating, and referring the client to a physician if need be. Here in the Philippines nurses do have the ability to prescribe some medications so it gives guide lines and restrictions on these as well. It is an amazing book that makes it easy to help guide these clients in the right direction towards recovery. We all agree that even though some of the pertinent childhood illnesses may not be present in Canada it would still be a useful guide especially in the rural areas up North.
The remainder of the day was spent preparing for our few nights in the staff night out in the rural community of Janiauy.

January 21st




Three soldiers down!!! Jenny and Morgan fell ill this morning and Lindsay felt a little off later on. Not to worry moms and dads Susan has been taking amazing care of them and will ensure that they recover as fast as possible.



The majority of today was spent meeting officials such as the Governor of the province of Iloilo, the provincial health officer, the mayor of Janiauy (a municipality of they province of Iloilo), and the officials of the public health office. We were on a role. While at the public health office we saw their cold room where they keep the various vaccines for the entire province of Iloilo. The province of Iloilo has around 3-4 million people and their statistics show that they vaccinate around 85% of the children…….so that’s a lot of money tied up into that little cold room.
The staff house is amazing!!! I feel as though I am staying in a really big tree house. We cook all our meals in between our long hours at the community clinic and try to live as a Janiauy resident would live- limited amenities and technology. Even though stray dogs are constantly barking and fighting it is still much more peaceful than the noises of big city Manila.



Hooray Kristinn, Troy, and I participated in a birth later this afternoon!!!! Kristinn did a fabulous job of delivering a healthy baby boy. However she also had the joy of experiencing amniotic fluid in between her bare toes!! Ha ha ha! That’s right everyone wears open toe sandals in the delivery room even if you don’t have socks on!! Different sanitation rules that’s for sure. At this clinic they do complete many of the same assessments that we do back home, however not as thoroughly or as often.



That evening we chatted away with the students as if we were old friends who had not seen each other in a very long time. The students here are absolutely amazing. We have been treated like royalty for one but we are developing friendships that I am sure will last much longer than his trip.

Preparing for dinner





The staff house




Dinner time!!

Monday, January 19, 2009





I will start off this blog’s entry by writing about the birthing experience I shared with Kristinn the other day. First of all…..IT WAS AMAZING!! Coming from someone who would love to develop and practice the skills of a midwife I was in my glory as the quiet and calm Filipino woman pushed through a 7 hour labour without any pain killers.
Throughout the hours you could observe how the woman’s labour was progressing: her physical stance and facial expressions slowly changed to ones of more discomfort and her belly slowly descended. Even though she became more and more uncomfortable she did not make a single peep. Kristinn and I participated in examining the expectant mother and were lucky enough to scrub in for the delivery! As we waited with our sterile gloves pointing straight upwards, terrified of breaking our sterile field, we watched how amazing Susan was with the woman: supporting her, rubbing her back, and comforting her. The fathers do not come into the delivery room with the woman. According to the midwives Filipino women are much stronger when the men are not present. As odd as this may sound this statement was proven to be true after the arrival of the baby (I will get into that in a bit).
Once the woman was 10cm dilated she was still encouraged to be walking about and squatting throughout the contractions- please remember that there were NO pain medications given and this woman was not even making a peep!!! Now I was unfortunate and was not able to have a clinical rotation in labour and delivery however I highly doubt that the woman back home in Canada would be quietly squatting and walking about at 10cm dilation, let alone with no medication!!!! I know I would have would not be able to anyways.
At one point there was talk that the woman may have to undergo a caesarean section since there was meconium in the amniotic fluid and the fetal heart rate was slowly decelerating. However after speaking with the family we discovered that they were not able to afford a c-section and strongly wanted to have the birth at the clinic. Therefore the doctor delivered the baby instead of the midwife, just in case there were more complications. If the situation would have gotten much worse I’m sure they would have been insistent on the c-sec and the family would have had to repay the hospital over time or they would be able to have it completed on one of the charity wards. I am not certain of this however after learning about the Filipino health care system this is my hypothesis of what would have happened.
Alright, now into the part that you all really want to hear about!! The time finally arrived and the baby was nearly here. The doctor told me to be ready since once she completed the episiotomy the baby would pop right out…..and it did!! POP there was the head!! Oh Lord I’m sure my eyes were as huge as watermelons as I watched little Marvin arrive. BUT WAIT….the cord was around the neck! The doc slipped in there snipped the cord and then baby needed to come out asap. I had the head in my hands and they told me to pull. Honestly I thought I was going to pull the poor child’s head off but they kept saying “pull pull pull,” so I pulled!! I had to pull downwards and then upwards to guide the shoulders out and then POOF there was Marvin! I was holding onto that child for dear life, worried that I might drop the slippery cute little infant. I vigorously rubbed his back since he was not crying until he was swooped away by a midwife. There I was in awe by the whole event. The doctor then took the time to teach me every step while she stitched up the mother.
All of the garbage such as bandages, gloves, and even the placenta is put in a plastic bag and the family takes it home to bury it….different. The tiered mother seemed alert and fine until the husband came in and then she appeared as if she was a ragdoll (exactly what the midwife had said- Filipino women are much stronger when their husbands are not around). There was no stretcher so the husband carried her to a bed.
The mother did not breastfeed the baby right away or even hold him. This I found typically odd since all of the mothers we have seen in the communities have been very attached to their young. I wonder if breastfeeding right after birth is uncommon here or it was just the case in this particular situation. Hopefully a few other students will be able to take part in a child birth and we can compare notes!! Stay tuned!

Chelsea and the nursing students in the Philippines

Sunday, January 18, 2009

From Manila to Iloilo!

17th January.

It was great to be back in Manila for Friday night. A city that seemed so foreign for us when we first arrived, is now easy to navigate to get the essentials (Internet, food, and laundry, and yes at times it is in this order) at least in the area we have become familiar with.

Saturday morning most of us took advantage of sleeping in a bit. Dr. Fowler-Kerry and Troy went on a quick shopping trip, at 0700, with Ma'am Bethel and Ma'am Carmelita to an area known as "168" (one-six-eight).

At 1230 we were all checked out of our rooms and picked up by Dean Josephina of The University of the Philippines to tour the historic part of the city in central Manila called Intramuros. She gave us a brief history from the colonization by Spain, the occupation by the United States, and the devastation of the Japanese during World War II. Intramuros was the center of Spanish rule in this area which was a walled city, and a military installation, Fort Santiago. The walls are still there along with many period structures. The architecture is beautiful. We toured the San Augustin Church and Fort Santiago in addition to enjoying all there was to see as we drove through the area. Dean Josephina treated us to lunch at a restaurant which serves Spanish dishes that are more traditional. Following our time there we were back to the hotel to pick up our bags and we carried onto the airport.

One thing that seems almost surreal at times is the economic disparity you can see as you look from your left to your right. An example would be the mall that is around a block away from our accommodations that we have stayed at during both of our times in Manila. Inside it is beautiful, with more stores than you can see the contents of during several visits, teeming with affluent Filipinos. While across the street outside are street vendors peddling pirated DVDs, cigarettes, candies, various foods, etcetera. There are also people begging. This is on the same street, within one block, not across town somewhere. Just an observation that will hopefully make you think a little differently. Seeing it has had an impact on all of us, though I don't think it will sink in to the degree it eventually will until we have time to reflect on all of our experiences here. We see new things all the time that are of a similar vein, like the kids crouched in the middle of the busy street, which we were told is done in hopes of being struck by a vehicle. The driver would be sued, which would be income for the family of the unfortunate child. You see desperation here which is driven by poverty. As Canadians, with the life we have known our whole lives it is hard to wrap our heads around the situation, and understand the full impact of the glimpses we have been witness to.

Our flight was without incident and we arrived in Iloilo City just before 2000. As we are waiting to get our luggage we notice the banner outside being held by some excited people. It is faculty and students from the University of St. Paul holding a banner which read "Welcome Canadians from the University of Saskatchewan". How cool is that? Very cool, but it gets better... Once we get outside to meet them we are presented garlands around our neck that are ribbons and fresh orchids. Following brief introductions we are whisked away in a van to go get something to eat before going to our accommodations. We drive up to a hotel that has trees with white lights in them on each side of the lane. It is a very nice hotel. As it turns out it was an Alumni Homecoming dinner and dance for St. Paul University. Yeah, we are a bit under-dressed and less fresh than when we started our day, but our hosts assured us we were fine. As we enter the room that the event is being hosted in we are introduced over the sound system to all in attendance. There are also two photographers and a videographer capturing our images from all angles. We are led to the buffet table for our meal. As we sat and ate we are introduced to many people by Sister Carol, who was also waiting to greet us as we arrived. It was like a dream, a fairytale if you will. From the banner to this it was almost too much to believe. Our hospitality has been great wherever we have been, but this was so much all at once it was hard to compute.

Following our meal and conversation as we enjoyed the people dancing to the music we took our leave to get settled in our new home away from home. We are staying in student accommodations at St. Paul University. By 2230 most of us are going to bed. What a day!

18th January

The day started with attending mass with Sister Carol at 0730. The singing in the dialect of this area was pleasant to the ears. Following mass we were served breakfast on a veranda. The hospitality so far has been second to none.

The remainder of the day brought adventure as we toured different barangays. We stopped at a couple of cathedrals from the Spanish era. The architecture is amazing. A real contrast between the magnificence of the cathedrals when juxtaposed with the average home in the vicinity. We also got to sample some fresh seafood at a local establishment. The shrimp are whole and you peel them yourself, the oysters are boiled in the shell, and the crabs are complete as well. Much different than Red Lobster in Saskatoon! It tasted great and we had a good time getting to know our hosts a bit better in the process. Some of us visited a local fabric shop where the material is made on-site with traditional looms. There is a particular fabric renowned in this area of which Dr. Fowler-Kerry and Troy (for his wife) purchased several metres. It is an art form, really and cool to meet the people who made the fabric that will one day be a piece of clothing.

In the evening we were invited to have dinner in the convent with Sister Carol and the members of her order. Some of the students joined us as well. It is a rare exception that anyone dines with them. Another shining example of the special reception we have received here. The food and the company were again amazing. We were informed that usually they have very simple meals, but that they had special food for us today. On the menu was Blue Marlin, ripe mangoes, and ice cream to name a few of the most tasty items. We have all agreed that any thoughts of "losing weight" on this trip are simply not going to happen.

Thoughts so far by Troy;

One thing that has really impressed me about the way that Nurses work here is the real and tangible empowerment of people. In Canada we talk about it, but here we have witnessed it happening in many different and creative ways. It is the Nursing students making the most impact as they fulfill their clinical requirements in the community. The shortage of Nurses here is related to funding of positions, not lack of qualified Nurses. In Canada we must put a more concerted effort into empowering people at the community level to take responsibility for their own health as well as the way they access our health system. We have it so good in Canada that we take it for granted. Many of the things we have been a part of here so far inspires me to work hard for sustainable and appropriate change in our own populations back in Saskatchewan. It is about being good stewards with what we have, not about having more expensive technology.

Saturday, January 17, 2009

Our fearless leader Sir Jerry Eating Chicken intestines with Troy since the rest of us wouldn't.
After the teaching session on hypertension in the mountains.
Coconut man.
Ralph.
Transportation in the mountains.
The mountains.
After the delivery. 


Baby boy we helped deliver.
Basketball!
Life-sized snakes and ladders nutrition game.


Children at the Nutrifair.






I appologize for gramatical errors due to my own weakness and computer technical difficulties.

Jan 15 - Every year before Christmas my Grandma hosted a pyjama party for all us kids. The much anticipated event consisted of activities that my Grandma and Auntie Cheryl creatively came up with and a new pair of pyjamas to wear at the party. One year the creative juices were sparse so my Grandma threw in the Video cassette tape Heidi. Boring! Is what we thought as kids. Today as I walked through the mountains, Heidi was my imaginary Character. As we hopped off the Jeepney to walk the rest of the way up the mountain to where the nursing students were to host a hypertension teaching session I took the opportunity to breath deeply in the fresh mountain air. The people in the mountains live just like Heidi and her grandfather: living off the land, their means of transportation being their feet or an animal, and just as when Heidi’s Grandfather got sick health care is challenging to access. We are noticing that the nursing students in the community here really play a huge role in the care and education of the people as they go into the homes. At the end of the teaching session we assessed all the attendees’ blood pressures. As we had readings ranging from 160-230 systolic, we were all a bit concerned. Untreated hypertension is the reality here though, and with expensive medications all the students can do is educate and give the people strategies to decrease their pressures through lifestyle modifications. For me, just living on this mountain would decrease my blood pressure through the elimination of stress. Ah the simple life.
Heidi by day; midwife by afternoon. Chelsea and I got to assist in delivering dear little Marvin. I will let Chelsea elaborate on the experience though as she was the one to pull out the 3.2 kg baby boy. So stay tuned for that. The post natal care I will write about: when Marvin came out he had been lying on his cord so they had to cut the cord when he was only half way out as it was being compressed between mom and baby. Marvin was quite blue and quite flaccid. The midwife took him into the back room for suctioning as there had been meconium in the amniotic fluid that the baby may have aspirated. When we got into the room, the suctioning was not hooked up; no big deal. Everything was so relaxed; another midwife brought in suction tubing and got it hooked up while another midwife took a call on her cell phone. There were no apgars, no vital signs or other assessments done on baby. They clean the baby off first with baby oil and comb the tissue remnants out of its hair followed by a full bath with warm water and ivory soap that the family has brought (the family provides most of the materials needed for the birth). This was a bit shocking as we usually use only water on babies in Canada and try not to immerse the umbilical cord. They also clamp and dress the umbilical cords which we leave open to air. Erythromycin and Vitamin K are given the same. The baby is then wrapped with arms at its sides and legs straight like a mummy. Mom is briefly shown the baby and then it is put in a crib. In Canada mom usually feeds right away both for bonding and to replenish the babies glucose. Here there was very little interaction between mom and baby. Although many things were done differently than what we do in Canada, I would trust these midwifes with my birthing process in an instant. They know their stuff.

Jan 16 – This morning we participated in an aerobics session led by the next Richard Simmons (only Filipino). The session was to encourage physical activity to reduce the risk of hypertension. We were once again met by the Filipino hospitality as the young boys climbed the backyard coconut trees to retrieve coconuts for our consumption. Chelsea and Troy attempted to help but never managed to climb past their own height. The children remain to gawk at us upon exposure but in good time they realize that we are a friendly sort. You know you are foreign though when even the babies stop blinking. Here, I also finally got my basketball fill. We have been passing small dirt courts dispersed within our travels and I have been longing to play. We took on some of the guys playing on the small court; despite their classic street ball moves we took it 5:4. It was not due skill though but I think more to the unobjected rules we broke.
In the afternoon while waiting for the Nutrifair to start, we went to a nearby cockfight that was taking place. This particular cockfight was to raise money for a family in mourning as tradition. The owners of the roosters pay a fee to the mourning family in order to participate. Then people come to gamble on the roosters, if the rooster wins the owner gets a portion of the bet put on his rooster and gets to eat the enemy bird has supper. I guess we stood out being women and white because they cleared a portion of the front row inside the pit for us when we arrived. We sat down and all the men around us started yelling out bets and cheering. Then the fight begins. They start by allowing the roosters to peck each other to get them all rattled up. Then the cover off the sharp and shimmering blade tied to the right leg of each rooster is taken off (it feels like you can actually hear the shing of the blade as the cover is being taken off). Now they are left to defend their territory. Morgan and I held each other in the front row and cringed as they flocked at each other and blood began to be shed. And then with a blink of an eye the roosters were slamming against the boards in front of us squirting blood onto out scrubs. I think we were probably close to as entertaining as the actual fight. The man beside me was kind enough to let me know I also had a streak of blood on my cheek. I think I know why we were the only women in the crowd.
The last thing we did in San Juan was a Nutrifair. Here they taught the women how to cook nutritiously and affordably. Families who have been found as malnourished were invited to attend. We even got to taste the example dishes that they taught the women how to make; delicious. We are even bringing the recipes home with us. The chicken intestines that they bought for us to try however were only tasted by Troy and will not be adopted by us. As the children at the Nutrifair called out bye Auntie Kristinn, I find it hard to think that I may never be in this community again. Or maybe these memories will give me a reason to return. We really got a taste of how the people live here through this experience.

Friday, January 16, 2009

San Juan.. Post 2

Giving injections at the baby clinic:
After the teaching session at the barangay preschool
Very smart children!! Placing food items on the food pyramid:
Our Jeepny for the week! Don't you want to ride?
At a health clinic with some of the University of the Philippines students:



Hello again from San Juan, Batangas! As usual we have been kept very busy by our extremely hospitable hosts here in the Philippines. Tuesday we started the day by attending a preschool where 3 nursing students were doing health teaching with the students with the help from 4 volunteer Barangay health workers. Barangay health workers are individuals in the community who volunteer their time to learn how to do basic assessment skills, such taking vital signs of the individuals in the Barangay. The preschool health teaching consisted of teaching the children basic health promoting activities. The nursing students began the session by reading a storybook that they created on proper cough and sneeze etiquette. They then involved the children in their teaching session about the food pyramid by giving them stickers and getting them to place it in the appropriate place on the pyramid. It was amazing that they knew the food pyramid so well that they were able to place the foods in the correct category! This is something we would never see in Canada at that age. They have done a really good job here of educating the children at a very young age of the principles of the pyramid (or food guide in Canada).
The last health teaching they did with the children was proper hand washing and the nursing students used a song to accompany the proper technique, and used return demonstration which we have learned to be an effective teaching strategy with young children, along with visual and kinesthetic aids. Following the children learning the song, they each had a chance to wash their hands in front of the Barangay health workers to ensure they had the correct technique. I found that the nursing students really know their target audience, and in this case they taught the technique by using buckets of water because many of these children may not have running water at home.
In the afternoon we took the Jeepny to a more remote barangay, which took about an hour to get to. Many of the roads in the remote areas aren’t really roads at all, they are very similar to hiking trails in northern Sask, only with tropical growth instead of forest. We reached the house where 3 nursing students were doing family education on cough, colds, and pneumonia, and found the area to be very peaceful compared to the other areas of the Philippines we have been to. The nursing students then did a one and a half hour education session with the barangay members who attended on the above topic, using many of the principles of adult learning that we learned back in the second year of our program. They involved the participants a lot, kept the session relatively short (in the past these session used to be 4 hours in length!), and they used many visual aids. The students explained to us that this topic is important for this barangay because they don’t access health care workers as readily since they are remote, and because many of them self-prescribe antibiotics (a problem in Canada as well). The session taught them about basic signs and symptoms of coughs, colds, and of pneumonia, as well as when they should be seeking medical attention. They also taught them the importance of not self-medicating. At the end of the session they give each participant a certificate for the completion of the course, which gives them a sense of accomplishment and helps to increase self-confidence and empowerment.
Following the family teaching session, we were served with the local coffee (which was very sweet and kind of fruity) and caramelized plantain. We have found that the Filipino people are very hospitable and everywhere we go we are served with either drinks or food or both! So don’t worry moms and dads, we are being very well fed!! While we were socializing with the families and children who attended the session, some men from the community began getting some coconuts down from the palm trees using very long tools that looked like bamboo poles. So we had the chance to drink from very young coconuts (not the kind you drink from on the beaches of Hawaii, or so we are told by Susan), and we tasted the coconut “flesh”. It was different… :) Some of us liked it, some we indifferent towards it. Susan says that more mature coconuts are much tastier.
Wednesday was another busy day as well! In the morning we were split up into two groups, one (Chelsea, Lindsay & Troy) went to a health clinic that was hosting a baby clinic where all the babies in the barangay were being immunized, while group two (Kristinn, Morgan, & Jenny) were supposed to go to a different health clinic for the same thing but no one showed up. So group two ended up going to a farm where they held newborn pigs instead of babies! The baby clinic was very interesting to be at, I have never seen so many babies in one room at one time! They all ranged from 2 weeks of age up to 9 months. We had the chance to actually give the immunizations for the time we were there in the morning, which was a really great experience for those of us who haven’t had a lot of experience giving injections, especially on infants. Following the baby clinic we had to check out of the place we had been staying at for the first three nights here in San Juan, pack all of our bags into the bag of the jeepny, pack ourselves in there too (it was a tight squeeze!), and take the hour drive over to the Kabayan resort, on the ocean, where we are currently staying until we return to Manila on Friday before flying to Iloilo City on Saturday.
After a quick break and lunch we headed back into the center of San Juan where we attended a community teaching session held by two of the fourth year nursing students on hypertension. I was once again blown away by their ease of public speaking and educating groups. They clearly have a lot of practice in the area, and I can truly see how intelligent these student are (especially considering the University of the Philippines is the top choice for all applicants, therefore these are the top 70 nursing students in the entire country!). They are so good at interacting with the community members, getting them involved, and they work very hard on empowering the entire community. From the little I have seen, I can tell that they are making a tremendous impact on the city of San Juan.
We also learn a few interesting facts about the cities and barangays that we visit each day, and today we learned that the alcoholic drink of choice in the particular barangay we were in today is one that is made by fermenting coconut juice, and is 90% proof!! Even more amazing is that they drink it straight up like they were drinking wine. This is something the nursing students are trying to discourage (among many other bad habits) in order to decrease the incidence of hypertension in the barangay.
The days here are long, but we have been learning so much here and we are also learning many community nursing techniques that we feel could really benefit communities back in Canada that we hope to one day put into practice.

Lindsay, the Philippines nursing crew

Tuesday, January 13, 2009

San Juan Experience

Since Friday we’ve left Manila and travelled to the rural setting of San Juan, which is a village of approximately 100 000 people and is located in the province of Batangaas. The four hour drive to our rural setting, consisted of a serene peaceful landscape with tropical trees of many sorts, rice patty’s, corn fields, pineapple fields and several fresh fruit stands lining the highway and small communities along the way. On our journey through the country to San Juan we were accompanied by Mr. Alejo, or as we like to call him “Jerry”. Jerry is a junior faculty member at the University of the Philippines and for the first day served as a gracious and skilled tour guide. After driving for about two and half hours we approached the volcano upon which the beautiful province of Batangas is spread over.  Upon arriving to San Juan we proceeded to our new place of residence “ The Plaza Villa”. To our surprise, we arrived just as a traditional Filipino wedding was underway.  I’m sure the guests were just a surprised to see seven white Canadians strolling up during their wedding festivities, as their looks seemed to reveal. We proceeded to settle into our new home for the week. Our accommodation here in San Juan is a small bamboo bungalow with a quaint, comfortable feel, situated conveniently in close walking and “tricycling” distance from the town’s central district.

After settling into the Plaza villa, we continued via van onto tour some more of San Juan and area, accompanied by some local San Juan community members, one named Grace who holds her RN degree (who also works in partnership with the University of the Philippines) and another lady named Alleta who serves the University of the Philippines Collage of Nursing by boarding students from various health professions while they do their clinical rotations in the rural community setting.

             Following our drive around San Juan and area, we proceeded to the local Market to purchase fresh fruit for our weeks stay. The market is a site to behold with stall upon stall of fresh fruits and vegetables all offering incredibly delicious local grown produce. Most of us made purchases of bananas, oranges, apples, mangos and San Juan famous locally grown coffee beans!

            After the market is was of course time for supper, and so were escorted by our guides to a local authentic restaurant called the “orange grill”, where we happened to bump into the village mayor at the tail end of a lions club meeting!  How interesting to witness such a common community practice transferred from culture to culture from one side of the globe to the other.

            Monday began by first meeting with Professor Anonuevo, one of the faculty members who facilitate’ the clinical rotations for the nursing students in San Juan. Our first stop was the San Juan Rural Health Center, where we toured the facility and met the head nurse and community doctor. Following the tour of health center we proceeded to the Municipality building and met again with the Mayor in his office, more formal setting this time around! The rest of the day which was lead by Professor Anonuevo, consisted of visiting two of the foster families where nursing students stay and one family receiving visits from the student health care workers. The family visit was likely the highlight of the day.  The visit consisted of observing a speech pathologist student and a physical therapy student provide therapy to a six-year-old girl with cerebral palsy. The interaction we witnessed was, in a brief description; heart warming, endearing, personable, professional, and admirable.  This home visit was just another commendable testimony of the dedication to the utilization of true community development practices. The community health system here in the Philippines has shown us that they not only learn in theory the teachings of community development and community empowerment but as we seen time and time again they put these philosophies into effective practice.  In the experiences over the last two days we have witnessed a different pace of life, however just as one finds when travelling from Canada to the Philippines, moving from an urban to rural setting still holds the common thread of health challenges and setbacks found primarily in the social determinants of health.

We are enjoying the open space, fresh air and quiet atmosphere of rural Philippines and are looking forward to the experiences of the remaining week.

                                                From Jenny and the rest of the Philippines crew

Saturday, January 10, 2009


University of the Philippines Nursing students and our clinical group after they presented us with some nice bags!

Diabetic Clinic

Blood Pressure Clinic

Filipino Poverotti

Manila...Post 2

So we just finished our second day of our experience in Pateros. We started the past 2 days off rather early…earlier than most clinical days, as it takes 1 hour by car to the borangay (village/municipality) of Pateros. We were met at one of the community clinics with song and dance... literally! As we entered the room filled with the diabetic clinical participants, we were met with such enthusiasm! I can honestly say I have never felt so welcome in my life as they made us feel that morning. One of the volunteers serenaded us with traditional Filipino music, and a few English classics, like 'happy birthday'. He called himself the Filipino Poverotti. Before we knew it we were all paired up with ladies from the group, dancing in the middle of the room. It was an amazing start to our day. The clinic was hosting its weekly diabetes clinic, run mostly by volunteers.

On our way to Pateros on Friday, we requested a stop at Starbucks, as we wanted to prevent our caffeine withdrawal headaches experienced the day prior…It was nice to step into a somewhat familiar environment, even for just a moment. The constant noise from the tricycle bikes, and jippni’s (public transportation jeeps made using leftover scraps from american occupation), and concentrations of people, has felt rather overwhelming at times, in addition to soaking up all the information possible about healthcare and the living standards here. We had the opportunity to do home visits with the Filipino nursing students in the borangay of Pateros. What an experience...seeing where the residents live, and the conditions that are their reality was a real eye opener...families of 5-6 living in an area about the size of our typical living rooms. Despite the conditions, the houses were tidy and spelled relatively clean. The children were clean and well taken care of. The houses are so close together...merging into one another between small alleyways,tarps and cement walls. No wonder the community is so close. The people were so eager to have us come into their homes, and incredibly hospitable...offering us coffee, even when you could see they cannot afford much. We were so impressed with the level of community involvement in the health centers and the locally run programming...the programming is run almost solely on volunteers (ex.diabetic clinic). We saw this in the hospital as well with what they call 'watchers' our Canadian equivelent of 'sitters' but watchers are family members, who are with the patient at all times, and trained by nursing staff to know what signs to look for if the patient needs help and to notify staff...a strategy to deal with high nurse patient ratios.
We have found that we have learned so much from the Filipino nursing students and the UP college in terms of community development and community nursing. Going into this practicum, I anticipated that we would be teaching them more than they would teach us...ethnocentric I know...but honest. They got it together in so many areas...school uniforms, rapport with community, and setting up programming in the community that prevents reliance on organizations and outside funding.. For example, the nursing students found 5 volunteers in the community who they trained to take blood pressures. These volunteers can now check community members BP's at no cost, and will serve as a sustainable intervention for the community once the college is no longer involved in the community.

We leave for San Jaun tomorrow morning for the next week...there will hopefully be less smog and more space...and hopefully still lots of coffee.

Thanks for reading...we are doing well and enjoying our time here...don't worry mom's and dad's...we are a-okay! The University here is treating us very well!

Morgan and the Philippines Nursing crew

Wednesday, January 7, 2009

Well hello from the Philippines!! Well our 1st few days in Manila have been early risers and intense however they have been amazing. From the moment we arrived we were graced with warm weather which the locals consider cold for this time of year, but hey from what I hear from back home I will take +27 over -50 any day!!
Our 1st Philippino meal tasted great however was quite interesting since throughout the meal we found mini fishes and pieces of chicken heart/liver scattered in and amongst the majority of the dishes. Not what we were expecting but hey, thats traveling.
Today was the 1st day of many that was full of learning opportunities. We met with faculty as well as the vice chancellors since the chancellor was unable to attend due to a meeting from the UP University of Manila. Everyone has been so welcoming and hospitable.  We learnt about their curriculum, compared it to ours at the U of S and learnt how they approach health care for individuals, the family, the population, and the communities. We were then given a tour of the Philippines General Hospital. It is absolutely massive! They have 1500 beds; compare that to the approximate 500 beds that the RUH has! 
The health care system here is partly funded by the government and partly private. The citizens must apply for the government funding but needless to say many do not do so until they or their family member needs the care. If you think waits in the hospitals in Canada take a long time you should consider this: the outpatient department of the Philippine General Hospital serves around 3500 patients PER DAY! That means that the wait line starts at about 2am and could mean that they stop accepting individuals by 7am! Unreal. There were people scattered all over waiting for care.
Since there are so many people that cannot afford proper health care there are "charity wards" which provide care for these individuals. The 1st 3 floors are delegated to these charity wards and the other 6 floors are for paying customers. They literally have wards for every type of care you can think of in both the charity and the paying wards. The burn unit even had their own operating rooms so they did not have to share with the other surgical ward. There was also 2 of nearly all wards- one for men and one for women. It was absolutely astounding! 
The supplies in the hospitals are obviously limited and therefore many health care professionals must be innovated and creative when it comes to their resources. An example: a young child was in traction (for those who do not know what this is it is when a bone is broken such as a femur they attach weights to the leg to align the bones before they set it) the hospital had run out of weights therefore they used a 4L jug with water instead. I'm sure this is just one of the many creative interventions that we will see during our time over here.
A major portion of the hospital is actually open to the "fresh" air therefore allowing cats to roam throughout. But I guess, which would you rater cats or vermin?? Even though these strays were present this hospital was unbelievably clean. It smelt clean and no ward had the typical smell that many wards that we have all visited do. In a hospital such as this I would have expected to have smelt many of the unpleasant human smells however this was not present at all.
WOW! I could go on and on... Just a few more tidbits
-Filipinos are very religious and therefore we were told that they DO NOT believe in divorce, they DO NOT believe in abortion, therefore women must go "under ground" to receive the procedure which must be ridiculously unsanitary and unsafe
- we were also told that HIV is  only brought in by oversea workers and that there is a very low rate here however the STI rates are very high?? Well what do you think about this comment??

Anyways I could go on and on but I must have an early night because they like their mornings bright and early here!!

Chelsea and the Philippine nursing crew