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

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.

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:

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!

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