This is the end... Of the experience, but not the impact of it!

January 31st

Shortly after 0600 we left Antipolo and were on our way to go see the Taal Volcano. Dean Divinagracia wanted us to see this famous site of the Philippines before we left the country. We got to go to an establishment which had a large patio that overlooks the volcano and lake. The scenery here in the Philippines is definitely beautiful, a perfect compliment to the beauty of the inhabitants and their culture.

We returned to Manila for lunch and a quick tour of the UERM hospital and campus. Then we were taken to our accommodations, where we had stayed previously when in Manila. A quick goodbye to Dean Divinagracia and Tita Elvie, and just like that, it was over… Now it was time for the task of packing, as the plane taking us back towards home was scheduled to leave the next morning.

It is like a dream. So much has happened in these past few weeks. I think none of us will be able to fully comprehend what impact it will have on us as individuals, and as nurses, until we reflect on some of the experiences, look at photographs, and read in our journals. Many a time during our travels and experiences I would shake my head and think “Wow!” My (and I am sure for the others as well) outlook on the world will never quite be the same. This is not a bad thing. Living and working here cannot be compared to looking at pictures on the web or in a book. The sights, smells, sounds, physical sensations, and temperature have informed our minds in the way that only living an experience can.

We offer our sincerest thanks to Dean Butler and Dr. Fowler-Kerry as well as all other persons involved at the University of Saskatchewan for the opportunities provided for us. We thank our hosts and friends in each of the three institutions we were at; the University of the Philippines, Manila, St. Paul’s University, Iloilo, and the University of the East Ramon Magsaysay (UERM), Quezon City (Metro Manila), for their most gracious and abundant hospitality and their commitment in ensuring we had the best possible experiences to fulfill our learning goals and course objectives. This experience in the Philippines has surpassed all expectations.

I head back to Canada on February 2nd. I hope that my student counterparts that will continue travelling in South Korea and some in Japan continue to have a safe and educational trip.

Troy T. Moore

Last Day of Our Community Practicum

January 30th

Today was our official last day of clinical experiences. In the morning we were taken to an outdoor venue where Junior Medical Interns from UERM were doing a presentation on “Waste Management” in the community. Their goal was to educate the Barangay Health Workers (BHWs) about the concepts of cleanliness and sanitation as they correlate to the reduction and prevention of disease. The start of the presentation was actually presented in the form of interpretive dance. This is something that some of my classmates and I have talked about in a joking manner when referring to some presentations we have had to do over the past three and a half years… No joke here as dance is an important part of Filipino culture (more on that later). Another part of the presentation involved gauging the current knowledge of the BHWs by playing a multiple choice game where participants lined up behind the answer they believed to be correct. It also served as a means of keeping the attention and interacting with the BHWs by the Junior Medical Interns. Everyone enjoyed the activity, as evidenced by the laughter and undoubtedly learned more about waste management in the process. Certainly the need for teaching the BHWs (who will then disseminate this information into the community) about waste management was reasonable as garbage and animal feces could be seen on nearly every street travelled in the area this was being presented.

After lunch it was time for the Culminating Activity for our brief time in Antipolo with UERM. Nursing students from different years, including our 6 counterparts from 4th year put on an elaborate program. There were several different dances performed and a fashion show which displayed the different school uniforms that are worn in different years and in different areas. A power point highlighting the different activities that we had participated in was also presented. Then came the moment we were a bit nervous about, we were asked to perform a Filipino dance we had been taught when we were in Iloilo. The girls poked fun at me a bit as they could hear the “click-clack” of castanets coming from my room at different times for a few days following our initial instruction on the dance known to us as the “Jota” (hoe-ta) when we were still in Iloilo. All of them, without any additional practice, were able to perform the dance quite proficiently. I am not a dancer, which I am sure I proved beyond a shadow of a doubt. The music was started and we did our best to wind our feet in the required way and click our castanets at the right time, while at the same time trying to smile! The Filipinos dance from grade school onwards and can make it look easy. Our performance, while not graceful (speaking for myself), was another important component of being culturally competent. We received much encouragement and praise from our hosts. It was actually fun, once you forgot about being embarrassed. Oh, but the fun didn’t end there. It was now time for another dance, the “Tinikling”. Two people are squatted on the ground holding two bamboo poles which are tapped and struck together rhythmically while a couple hop/dance on either side and between them. The Tinikling is considered the national folk dance of the Philippines. After a fine demonstration by a couple of Nursing students in full costume we were invited to try. For me it was quite a bit easier than the Jota but still a challenge. Once again we were honoured by our hosts in a manner similar to the other areas of the Philippines we had been. Truly, Filipino hospitality is second to none.

Following supper we bid farewell to the students and faculty that we had worked with the past few days. It was too short a time, but was a time where we experienced different aspects of community health that we had not previously, namely; health screening/ physical assessment of school-aged children and promoting social interaction and physical activity with geriatrics at their activity centre.

Good Morning Antipolo

January 27, 2009 -PM

“They’re like mushrooms…they pop up anywhere,” said Tita Alvie, our designated mother for our 4 days with University of the East. She was referring to the people. On the drive to our accommodation in Antiopolo city, we were reminded of the population in Manila, and the surprising locales where the poor ‘hang their hats.’ Meridians, under overpasses, and just about anywhere it is physically possible to hang a tarp and some corrugated metal. Tita went on to explain how people from the provinces (rural areas) come to Manila dreaming they will find work and have an enhanced quality of life, which for most people, turns out to be a just that, a dream. It was somewhat staggering coming from a less densely populated area in Iloilo, and for some reason the reality of the poverty really slapped me in the face that night more than before…I’m sure fatigue had something to do with it.
Let me tell you about our drive to the retreat center in Antipolo…All started out fine and dandy…than midway into our 2 hour drive, the air started to get a little warm, and we were informed by the driver that the ‘air con’ wasn’t working. For some of us who get motion sickness on a prairie road…one can imagine how it feels in a hot humid vehicle, shoulder to shoulder, stopping and starting on the winding roads in the Philippines. Needless to say, gravol has come in handy on more than one occasion. So after the ‘air con’ went, I thought it was funny how we couldn’t really see very far ahead of the vehicle…I heard the conversation between Tita Alvie and the driver, and it involved ‘alternator.’ The driver checked the headlights, and there was about enough light that you would generate from a windup flashlight. Up the winding road, not knowing how much further our retreat house would be, hoping for the drive to end soon I gave out a yell “DOG!”…there was a dog straight in front of the vehicle, that I thought for sure would be a goner. The driver didn’t flinch. I should have known by now, the dogs are so used to being unleashed and running wild, they are more than accustomed to moving away from moving vehicles…so unlike the animals, especially deer, in our neck of the woods! The dog was safe, I settled down, and we arrived safe and sound at St. Michael’s retreat center. A beautiful site, with amazing greenery surrounding the property and the most beautiful courtyard right in the middle.

Jan 28, 2009

We began the day with a brief orientation to the UERRM nursing program in the community. We toured one of their barangay health clinic and the geriatric center in Antipolo. We did a courtesy call to the mayor in Antipolo as well as the school divisions superintendents’ office. We have made at least 15 courtesy calls while in the Philippines. One of the nursing faculty members explained that before you do any work in the community it is imperative that you gain the ‘blessing’ of the authorities (ex. Mayor) by doing a courtesy call. Considering this is not a common practice in our communities, it took me some time to fully understand the purpose.

January 29, 2009

We started out the day by having a discussion with a group of the barangay health workers (BHWs) at one of the barangay health clinics. We were given time to ask the health workers about their experience as volunteers. It amazes me that all of the women have been volunteering as health workers for over 8 years, the average length of service was around 10 years. Only recently has the government offered them an honorarium for their work. When we asked them what their primary motivation is to volunteer, they all had a similar response. To help their community and be of service to the people. Evidently the honorarium has not been a prime motivator, as they have been volunteering for much longer than the inception of the honorarium. What amazes me about these workers is their devotion to the clinics and ultimately their community. The BHW’s spend between 2-5 mornings per week in the clinic (most work more) and spend time in the afternoons going to patients homes. We grew a great respect for the BHW’s generously giving their time to their community in addition to their family and household responsibilities. They pay for their own transportation to and from the clinic. We have come to realize that the BHWs are an integral part of the healthcare system in the Philippines, and increase the accessibility to basic healthcare in the rural and urban communities.
We popped into the geriatric center where nursing students were implementing recreational programming for seniors. We had the opportunity to join in some of their games, and listen to the winners of the karaoke competition. Even the seniors in the Philippines are crazy about karaoke!
In the afternoon we went to one of the elementary schools where the university has implemented a health clinic into the school. A head to toe physical health assessment is done on each student by a nursing student, and kept on file for the following year. The program, from what I understand, has been implemented not for the individual but to find common trends within the assessments and base the school health programs on the findings (population health promotion type thing). The most common findings in the children tend to be lice, malnutrition and dental caries. It has been evident in all the places we have visited the children had very noticeable dental decay. The examples of tooth decay we have only seen in our textbooks live in the mouths of the many of the children we have met…something we don’t see as often in Canada.

We finished off the day by attending a meeting the nursing students had arranged, for the teen population in the community. The meeting was in regards to waste management. The teens were encouraged to brainstorm various ways in which the youth could become involved in improving the waste management techniques in the community. Some of the details were hard to follow as the language spoken was tagalong. Present at the meeting was a local hip hop dance group, as well as representatives from the community high school. A few of the teens played a pop song on acoustic guitar. We have come to realize that most events involve some sort of music or dance performance…So it didn’t come as much of a surprise! Music and dance must be one of their ways of engaging people in their presentations, and keeping them from snoozing…It’s a good idea if you ask me!

I guess you may all be wondering, what I myself am wondering. After seeing what we’ve seen, and experiencing the things we have experienced, at the end of the day what can we do to make a change? Seeing the poverty in Manila and speckled throughout the provinces, the way people seem to survive in living situations we would likely deem unbearable, on next to nothing, we may ask ourselves what can be done? What can we learn from this? Many things come to mind, but one sticks out the most. Something my mother taught me… an attitude of gratitude. I can hear her saying it right now. I feel like I could spend my entire life throwing my money at a charitable organization to help the poor, or donate money to various causes in the country, but I realize that my lifetime income wouldn’t scratch the surface of the financial need of the poor in an entire nation. I hope to maintain my own attitude of gratitude, especially going back to heath care in Canada. I am extremely grateful for our socialized healthcare system. We don’t necessarily have it all together, and we can learn a lot from the Philippines, but I am sure proud to be from the land of Tommy Douglas.
-Morgan and the nursing students in the Philippines