Janiuay

January 25th to 28th


The morning of January 25th we left Iloilo with the St. Paul's nursing students and travelled to the province of Janiuay. This was a unique week as we were going to be living with the students at the university's staff house. There were 22 people staying at the staff house, including both groups of students, two faculty members from SPU, Dr. Mahli Brindamour and Dr. Ryan Meili, from Saskatoon. While staying at the staff house the students took turns with cooking and cleaning duties. This was a new experience for us as we not only had to learn how to cook Filipino dishes and buy food from the market, but also how to cook over an open coal fire.

While in Janiuay we spent our mornings in Rural Health Unit (RHU) which is the main health center for this area. RHU provides many different services within a small facility. We were paired up with our buddies at different stations and were able to rotate posts throughout the week. Some of our experiences including working at the IMCI desk, the assessment area, the prenatal area, treatment room which included immunizations and wound dressings, and consultations with the doctors. This clinic also includes a labour and delivery room where we were on call during our time in Janiuay.

When clients arrive at the clinic they are first seen at the assessment desk. At this station we take the client's vital signs, chief complaint, history, and then do a focused assessment. Anyone under the age of five years old is managed through IMCI, anyone over five years is seen by the doctor. This was exciting for us because in Canada we have not yet had the opportunity to be the first person doing the initial assessment. Some of the cases consisted of hypertension, cold and fever, breast pain with a possible lump, abdominal pain, diarrhea, nausea and ear pain. Considering we are Canadian students who do not speak the native languages of the Philippines, we relied heavily on our buddies to assist us with all of our interactions with clients. "Effective communication and teamwork is essential for the delivery of high quality, safe patient care. Communication failures are an extremely common cause of inadvertent patient harm" (Leonard, Graham, Bonacum, 2004). We also had to rely more on the clients non-verbal communication in an attempt to pick up anything missed in translation.

At the IMCI station we used the standardized framework to further assess all children under 5 years old. If the child is showing any of the 4 danger signs (convulsions, vomits everything, not able to drink or breastfeed, or abnormally sleepy or difficult to awaken) they will be seen by the doctor. If not they are diagnosed, treated and cared for by the nurses. The different conditions which IMCI is assessing includes measles, dengue hemorrhagic fever, malnutrition and anemia, ear problems, fever, malaria, and diarrhea. The most common cases we saw were cough and fever.

We were able to work along side Dr. Mahli Brindamour and Dr. Ryan Meili during their consultations with patients. This is something that we rarely have the opportunity to do in Saskatchewan, so we are very grateful. During this time the doctors also relied on the SPU students for translation. Some of the cases observed were patients with a cough and cold, hypertension, kidney infections, query pneumonia, infected wounds, and dengue fever. The positive diagnosis of dengue fever was achieved though the tourniquet test. This was our first opportunity to ever observe this test.

During our prenatal assessments we were able to further advance our skills. Here we took the mothers blood pressure, measured fundal heights, auscultated the fetus's heart rate, did Leopold's maneuvers, and gave the mother necessary tetanus injections.

In the treatment area we were able to give many immunizations. Here we were able to give injections children under 5, which we have not had the opportunity to do in Canada. Some of he injections included Hepatitis B, measles, tetanus, DPT (diphtheria, pertussis and typhoid). We also got to administer the oral polio vaccine. There were also many wounds we were able to clean and dress.

Our afternoons were spent in Sitio Asinan and Sitio Gamad, which are 2 Barangays in Juniuay. Here we chose one family in which we did a complete family assessment. We assessed such things as living conditions, medical history, income, education levels, work life, spirituality, physical and mental status, relationships, community involvement, and what the community feel they need most. These families were extremely welcoming not only to the Filipino students but also to us. We also went into other homes to assess vital signs.
One of the major problems we observed in these communities was the lack of toilet facilities, running water and proper garbage disposal. The majority of the parents within the community had a low level of education and some of the children were not attending school. These families had small incomes which made it difficult to purchase food and proper footwear. The combination of all of these determinants increases the risk of contracting parasites and infections (Nematian, Nematian, Gholamrezanezhad & Asgari, 2004).


On our last day in the community we held an assembly for both of the Barangays. At the assembly we had all of the guest register which included checking vital signs, as well as heights and weight of those under 5 years. The Canadian students created a modified version of snakes and ladders which included health teachings the children. The Filipino students were responsible for creating a game for the mothers. We also participated in role playing to help teach the mothers proper parenting regarding feeding. This assembly helps the Filipino students, who will be working in these Barangays in the next several weeks, evaluate the health status and needs of the communities. Following the games we performed a dance to the popular song, ‘nobody’ and handed out healthy snacks for everyone.



Thursday, January 28th we spent the morning presenting research to each other on different health concerns prevalent in the Philippines. In the afternoon we attended Januiay's festival and then travelled back to Iloilo.

Top picture: Us in our Iloilo uniforms
Second picture: Kirsten, Chelsea and JP doing wound care
Third picture: Melissa assessing a family
Bottom picture: Us playing our game with the children at the assembly

Arriving in Iloilo

January 21st-24th, 2010

We've made it to Iloilo save and sound after our brief relaxtion period in El Nido. Sister Carol and the rest of St. Paul's University (SPU) has welcomed us into the community with open arms and hearts. We have spent the last few days becoming acquainted with not only the students and faculty, but also the community at large.

January 21st
We were invited to dinner with the Sister's of St. Paul's and had the chance to try several Filipino dishes, including delicious Mango ice cream. We also met our "buddy" students, who we will be partnered with throughout our community immersion in Janiuay next week. The students include: John Paul (J.P), Arielle, Tanya, Jovan, Stella, Kaye, Clecile, Irina, Diane, and Valerie. Faculty who are aiding in the facilitation of this experience include, Ruby Ann Duguesa, Maria Thelma Servidad, Dulce Ma Tilos, Vanessa Traje, and Ma Lalaine Nolasce, and of course Sister's of St. Paul's. We also joined the company of Dr. Ryan Meili and Dr. Mahli Brindamour, both affiliated with the University Saskatchewan and will be participating in our Janiuay experience.


January 22nd
The day began with visits to various local community members. Susan R. Cuevas (RN, MN, Nurse VI) informed us about several nutrition initiatives within the Iloilo community. A quick visit to the Department of Health allowed us to meet Ariel L. Valencia (M.D), the current Regional Health Officer. The DOH is in charge of various initiatives, which adhere to WHO standards, such as DOTS, HIV/AIDS program, and immunization/vaccination clinics. The DOH is highly focused on outreach programs and increasing healthcare access for Iloilo's growing population. While visiting the DOH we were able to tour the cold room, where they store the vaccinations according to WHO standards.

We met the Governor of Iloilo, Neil D. Tupas SR, who welcomed us to the community and provided us with tickets to the Dinagyang Fiesta 2010. This fiesta is celebrated every fourth weekend of January to honor the Christianization of the natives and to respect the Holy Child Jesus.

In the afternoon we traveled to Janiuay (an hour outside of Iloilo) to tour the community. This involved visiting the staff house (our home for next week) and Dr. Bienvenido P. Margarico, mayor of Janiuay.

January 23rd
We were orientated to St. Paul's College of Nursing and their BSN curriculum. The aim of their program is to develop values, attitudes, knowledge and skills. St. Paul's nursing students also encompass the competencies of a caring, creative, contemplative, critical, and collegial nurse. Throughout this orientation we noted several similarities between both the St.Pau'ls BSN program and the U of S BSN program. Although both programs are span over four years the St. Paul's nursing students enter a common freshman program consisting of generalized classes before they offically enter the nursing program. This means they have the opportunity to "soul search" before commiting to becoming a nurse. Another key difference we noted between the two programs was that St. Paul's nursing students have the opportunity to act as charge nurse on a ward, in their fourth year, to apply knowledge and theory acquired in their management and leadership course. We felt this would be a useful within our own program, as it helps to clarify nursing responsibilities and further develop management/organizational skills.

In the afternoon we had a presentation on IMCI (Integrated Management of Childhood Illnesses). This is a strategy developed by WHO to aid developing countries in treating childhood illnesses within outpatient settings (WHO, 2008). The program has two main objectives: 1) Decrease the global mortality and morbidity rates of children and 2) Increase healthy growth and development of children worldwide. It is currently being utilized by Iloilo community health nurses, and the nursing students of St. Paul's University, to help treat children suffering acute respiratory infections, fever, diarrhea, ear problems and malnutrition.

"Every year in the world's developing countries, approximately 12 million children under the age of 5 die of illnesses that have been controlled or overcome by developed countries" (SciELO Public Health, 1997). Considering the Philippines is a developing nation this tool is very helpful within the community of Iloilo, which continues to experiecence high numbers of childhood mortality and morbidity. The IMCI trains nurses in basic assessment and classification of common childhood illnesses within the region. Physicians are therefore not required to do the initial assessment and have time to deal with a greater number of cases. The IMCI follows a case management process which allows the nurse to assess, classify, identify treatment options, treat/refer to physician, counsel, and follow-up. (Somewhat resembling the nursing process).

Learning about this classification tool was very helpful and informative, as it is used to identify many illnesses not commonly seen in Canada. This includes illnesses such as malaria, measles, typhoid, dengue, pertussis and dysentry. We are looking forward to putting this new knowledge into practice while in Januiay in the upcoming week and will be having several debriefing sessions to discuss our observations regarding exposure to such diseases. The knowledge we have obtained from this experience has been beneficial to all of us and we will be able to apply it in future nursing practice, regardless of the setting.

January 24th
Sister Carol kindly extended an invitation to St. Paul's Sunday Morning Mass, which we accepted. Following mass, we were able to attend the Dinagyang Fiesta tribal dance competition. It was an amazing experience which allowed us to observe several traditional tribes from Iloilo area. As more and more tribes from Barangays, schools, and nearby towns and provinces participate, the contest has become more competitive in terms of costumes, choreography, and sounds.

Top picture: U of S Nursing Students with Sister Carol

Middle picture: St. Paul's and U of S Nursing Students and Faculty

Bottom picture : Dancers at the Dinagyang Fiesta 2010

El Nido, Palawan

January 17th-20th, 2010


On January 17th we got on a 19-passenger plane and went to Miniloc Island Resort in El Nido for a short vacation. The resort was absolutely beautiful. While we were threre we did various activities such as snorkeling, beach volleyball, island hopping, sea kayaking, watched and participated in a cultural show, and took in the numerous sights. Here are some pictures for your enjoyment!

Our resort!

Another view!

On our way into the Big Lagoon.

Our view from one of the islands.

Building Fred the turtle.

Us in the limestone caves.

San Juan, Batangas - Part 3

Friday, January 15, 2010

Today we spent the morning doing a “Charity” clinic at the RHU Health Center in San Juan. Here we had the opportunity to interact with, assess, and follow through with patients. Some of the most prominent conditions we observed include: cough for 2 or more weeks, TB follow-ups, lacerations needing Tetanus treatment, prenatal care, suspected nephritic syndrome, and hypertension.

Certain aspects of the clinic were difficult for us to experience, such as clients being unable to afford medications and treatments. Some examples were the inability to pay for hypertension medications, Tetanus skin tests, have blood tests done, and inhalers. As Canadian citizens who utilize a universal health care system, which is defined as, “…health care coverage for all eligible residents of a political region and often covers medical, dental and mental health care,” (Wikipedia, 2010) it was sad to see treatments being altered or denied based on a client’s inability to pay.

Health care in the Philippines is governed by a two-tier system; 60% private, and 40% public or charity (Moveforward, 2009). For Filipino residents who can afford private health care, modern and up-to-date technology and tests are used, but at a high cost. The majority of the population utilizing modern (rather than traditional) medical care visit public clinics. These clinics have limited funds, causing a lack of supplies such as blood pressure cuffs, weigh scales, thermometers, private examination rooms, and makeshift charting systems.

Creative ways the clinic works around costs are stocking a pharmacy that offers some medications free of charge. However, it is only stocked four times a year, so often runs short on supplies. Furthermore, other supplies are limited such as swabs, which are used to culture bacteria. In addition, old mercury thermometers are used, examination rooms are shared, and alternate tests and treatment are offered. What was impressed upon us most was that health care workers utilize the space and supplies most available to them and use critical thinking and creativity when faced with less-ideal situations.

The World Health Organization (WHO) states: “The social determinants of health are the conditions in which people are born, grow, live, work and age, including the health system,” (World Health Organization, 2010). Furthermore, they assert that the social determinants of health are the main factors contributing to unfair differences in health status (WHO, 2010). From the above accounts of clients being unable to afford and therefore receive treatments and medications, there are large inequalities in health status amongst the population.


According to Commission on Social Determinants of Health (CSDH), launched by WHO in 2008, three recommendations to address the disparities are: “Improve daily living conditions; tackle the inequitable distribution of power, money, and resources; and measure and understand the problem and assess the impact of action,” (2010). Bringing all these observations and theory back to something meaningful for Canadian health care, we believe that spending a significant amount of time assessing the needs of a community and implementing nursing care like the UP students are doing in San Juan is an effective way to manage health. Furthermore, our ability to meet with political leaders in the area provided key stakeholders capable of providing power and resources necessary to bring about change. If given similar opportunities in Canada, we would be enabled to promote primary health care in practical ways.

As a farewell to the community, we were invited to celebrate the 83rd birthday of Municipal Councillor Hon. Meynardo V. Robles’ father. We’d like to extend a warm thanks for the hospitality and generosity of the people we were in contact with in San Juan.

Pictured:

Top Left - Jessica Key and Joelle Link doing Leopold's Maneuvers on a labouring mother.

Center - Kirsten Finlay counting respirations on a sleeping infant.

Bottom Right - Nursing students and Susan at Meynardo V. Robles’ father's 83rd birthday party.

References

Health care in the Philippines (August 8, 2009). Retrieved January 20, 2010 from Moveforward website: http://www.expatforum.com/articles/health/health-care-in-the-

philippines.html

Social determinants of health (2010). Retrieved January 20, 2010 from World Health

Organization website: http://www.who.int/social_determinants/en/

Universal health care (2010). Retrieved January 20, 2010 from Wikipedia website:

http://en.wikipedia.org/wiki/Universal_health_care

San Juan, Batangas- part 2

January 13, 2010

We started our day at an immunization clinic. The clinic has a family focus, which primarily concentrates on infants and pregnant women. It was over crowded with babies and their caregivers. Although the clinic seemed chaotic to us, the midwife and nursing students had a systematic approach in delivering their nursing care . In the Philippines, the BCG vaccine is given to all infants to prevent manifestations of tuberculosis (TB). This is no longer a required vaccine in Canada because it is not as prevalent. The other immunizations we observed being administered were measles, DPT (diphtheria, pertussis, tetanus), and Hepatitis B. We administered the polio vaccine orally, as well as paracetamol, which is an oral analgesic. The vaccines themselves are free, but the care givers were required to purchase their own syringes for 10 pesos each. The nurses explained that this minimal fee allows them to take an active role in their health care.

We noticed some differences in the techniques used to administer the vaccines. For example, the clinic used one inch needles for all injections. In Canada, we have access to a variety of different sized needles, allowing us to accommodate to each individual patient. When giving immunizations to infants at home, we use the vastus lateralis; in comparison, the clinic used a more anterior aspect of the thigh.

We also noticed cultural differences in the way the infants reacted to the immunizations. We observed that they were soothed and comforted promptly after this painful procedure; whereas the children in Saskatchewan take longer to be consoled. The article, Development of Behavioral Distress in Reaction to Acute Pain In 2 Cultures, found that if the care giver physically or verbally sooths the child during a painful procedure, the child has been shown to react differently then without (van Aken, van Lieshout, Katz, and Heezen, 1989). We have observed here in the Philippines, that there is always someone to support and console the child. In Saskatchewan, parents appear to display anxious behaviours; whereas, the caregivers in the Philippines appear very relaxed and transferring that energy to their child. The health workers were very hospitable to us following the clinic, as they prepared a traditional Filipino lunch for us.

After lunch, we were taken to an elementary school in the Pulangbato Barangay. This school consists of 300 students. We assisted the nursing students in collecting the heights and weights of the grade five class. We were told that 70% of the children in this area are underweight. We measured the average weight to be between 20-40kg and height to be between 120-140cm.

January 14, 2010

We started our day with a meeting at the San Juan clinic. We met Dr. Paterno (PhD. in nursing), who shared how the health care system and UP work together with the community. Their focus is based on an interprofessional approach to provide a holistic practice. Interprofessional holistic practice views all aspects of the patients well being and by collaborating, the patients health is optimized. Implementing this approach will not only benefit the individual but the community as a whole (Price, Howard, Hilts, Dolovich, McCarthy, Walsh & Dykeman, 2009). In San Juan, students from medicine, nursing, physical therapy and speech pathology are immersed into the community and work together with the patients to empower them to ultimately sustain an optimal health status. A five year contract is created between the health care workers and the community members to produce independence and strengthen the community. This is essential due to the limited access to health care services within these rural communities.

We had an opportunity to join some of the students to a home visit. We observed the physiotherapist performing passive range of motion and active strengthening exercises with his patient.

We also learned about the prevalence of Diabetes Mellitus (DM) in this community. The rate of DM in San Juan is 19%, which is a substantial difference to the general population of the Philippines weighing in at 4.5%. The health care workers are empowering the community by training DM patients who are self-sufficient in maintaining their health to teach other diabetics to also become independent.

San Juan, Batangas

January 11, 2010

We arrived in San Juan Sunday evening. On Monday morning Zandro, a RN affiliated with UP, picked us up in a jeepney. He served as our guide all week.

We went to the San Juan clinic for orientation and met with some of the nurses, who explained how health care is delivered within the community. They utilize various programs, such as: Control of Acute Respiratory Infection(CARI), a nutrition program, family planning, Expanded Program on Immunizations (EPI), Directly Observed Treatment Shortcourse (DOTS), and Control of Diarrhea Cases (CDC). They also hope to implement an animal bite center in the near future. DOTS is a program designed to detect and treat tuberculosis (TB) efficiently within the community. The goal is to reduce the prevalence of TB within this dense population. San Juan has 100 000 people, which is divided into 42 Barangas. There are only 3 doctors, 8 nurses, 1 dentist, 20 midwives, 1 med-tech and 2 sanitary inspectors in all of San Juan.

Above Photo: Zandro (in red); 3 nurses in white from the left - Gigi, Ludy & Arlene; Dr. Mariana (in green)

We had the pleasure of meeting the Mayor of San Juan, Danilo S. Mindanao and the Vice Mayor, Octavio Antonio L. Marasigan (Anthony) and many of the town councilmen. Anthony graciously invited us along with the orientation team to lunch at the Orange Garden restaurant.

Following lunch, we visited the Lipahan clinic and day care center. Here we observed nursing students training the Barangay health workers (BHW), who are individuals from Lipahan. They are trained to measure vital signs and perform basic assessments. They utilize a disease management model that helps rate the severity of the disease and indicates when further services are needed. BHW are used in these communities to increase access to health services within the remote location. One of the challenges the community faces is malnourishment; therefore, a nutrition program has been implemented, which consists of 30 children. The World Health Organization specifies that socioeconomic status (SES) is the most important determinate of health. SES directly affects the accessibility of affordable, healthy food. During our experience we observed many families with low SES, which is a challenge that affects the other determinants of health as well as the individuals ability to reach an optimal well being.

January 12, 2010

We started our day early with a tour of seascape, a protected area within San Juan. This area is a potential resource for the community to increase their social revenue by being able to attract tourists. Councilman, Noel M. Pasco gave us the opportunity to snorkel in an area that was vast with coral and fish.

We visited Catmon Barangay, which has 1300 people. We worked with three nursing students, Nelli, Abby and Jek. These students were immersed into this community, living with foster families. This allowed them to interact as members of the community, which increased their understanding of the priority needs. Their nursing practice focuses on 4 aspects: research, community diagnosis, priority families and community building. Each student works with 5 priority families during their clinical rotation and together they base their diagnosis on what the community feels they need.

The health issues prevalent in this Barangay are mainly preventable and communicable diseases. Parasites are common due to poor hygiene and sanitation within the community. Hypertension is seen throughout, due to the high salt content in their ocean based diet. Another recurrent challenge is respiratory infections, which is exacerbated by the smoke from the outdoor cooking stoves and the burning of garbage. Other predominant conditions include, unknown skin diseases, diarrhea and tooth decay.

In the afternoon we gathered in the health center with the nursing students and the children from the community. The students did health teaching on hand washing as an intervention to prevent the spread of parasites and increase their overall hygiene. We demonstrated proper hand washing techniques along with the children. This practice was similar to the one we would use, except it was slightly adapted using water that was collected rather than running water from a faucet. Our interaction with the children was a very positive experience. After meeting the children, they were very curious and excited to get to know us. We handed out stickers and gave them high fives as we said goodbye.

On the way home, we met with Noel and toured more ecological sites. He explained to us how to protect and preserve the environment and we had the opportunity to do some bird watching.

Nursing in the Community

Friday January 8th, 2010

Today we returned to Pateros where we were paired with UP Manila nursing students. Their assignment was to utilize the family care approach while visiting clients in their homes. The clients presented with either diabetes or a history of stroke.

The experience was very rewarding and allowed us to work allongside the UP students and collaborate while delivering care. All of the U of S students noted how thoroughly the UP students assessed their clients and built a strong and trusting relationship with the family.

To wrap up our two days in Pateros we went to Jollibee with Sir Jerry and the students. Here we were able to try a variety of things from sweet spaghetti (with ham and hotdog pieces) to Yum burgers. (For those of you who don't know, Jollibee is the number 1 fast food chain in the Philippines... Not even McDonald's trumps it)

(Above: The Canadian and UP Manila Nursing students at the health clinic)

(Left: Sweet Spaghetti, another Pateros delicacy)

University of the Philippines

Thursday January 7th, 2010


Our first week has come to an end and so far so good. We have been kept busy with activities since starting school January 6th. On January 7th we joined our clinical instructor Jerry and partook in a day trip to Pateros. Here we were orientated to the community by Francisca Cuevas, the Municipal Health officer, and Doctor Ronald Raymondo.


(Above: Sir Jerry, RN, the 7 students, and Honourable Joey Medina)

We were informed that Pateros is the only Municipality within Manila. The community is considered to be small on Philippine standards, however, as Canadians, we felt that 60, 110 people within approximately a 2 km radius was quite populated. Some of the community health services includes, 3 physicians, 5 nurses, and one ambulance. With so few health care workers, this community strongly relies on an integrated team approach to serve the population.

Also, we were interested to discover that the health trends within this community are very similar to what we see in Canada. The most prevalent diseases are diabetes, cardiovascular disease, hypertension, cerebrovascular disease, cancer, COPD, and renal failure.

Our day concluded with a visit to the Mayor of Pateros, Hon. Joey Medina, where he welcomed us to the community. The Mayor encouraged us to try Pateros' traditional dish, Balut (duck embryo). Joelle Link was the sole student brave enough to eat the embryo.

(Above: Joelle Link and embryo)

Orientation to UP Manila

Wednesday, January 6, 2010

Today we were oriented to the College of Nursing at UP Manila. We toured the Philippine General Hospital and met many faculty and staff members. Philippine General Hospital (PGH) serves as the main healthcare facility for Manila and surrounding provinces. What was most impressed upon us during the tour was the cleanliness and lack of clutter in the hallways.

At PGH, clients have the option of paying for private rooms, or occupying public charity rooms. The private suites were spacious, furnished, and designed to allow many family members to visit comfortably. Rooms are designed in this manner based on the belief that the presence of family members improves the health outcomes of clients. Charity rooms provide space for the care of anywhere from six to fifty patients per room, and no curtains or dividers between clients, limiting privacy. On some wards, nurses provide care for as many as 12 to 18 patients. As you can imagine, nursing staff must be incredibly efficient in the delivery of care in order to provide safe, competent, and compassionate care. One initiative we observed and believe could benefit health care delivery in Canada is the practice of educating family members on the ward in a group setting. Topics that are covered during this time are: patient care initiatives, health care forms and referrals, and health teaching. Education sessions are held weekly, further reinforcing the information.

Dinner with the Canadian Ambassador of the Philippines

Tuesday, January 5, 2010

Today was the first day we came together as a group here in Manila, Philippines. We received a warm welcome to the country from the Canadian Ambassador of the Philippines, Robert Desjardins, and his wife at their lovely home in Makati. This evening we were also introduced to the Deans of Nursing and faculty of UP Manila, Iloilo, and East Ramon.

During dinner, we discussed health concerns common to both Canada and the Philippines. We also acknowledged the potential for reciprocal learning opportunities between both participating parties in the area of Primary Health Care delivery. Following the meal, Whitney Palmer entertained the guests by playing the piano. It was a great honour to be invited to this event, and we would like to extend a thank-you to Sir Robert Desjardins for the wonderful evening.

Top Photo (Left to Right): Ashley McDonald, Kirsten Finlay, Dr. Jaime Galvez Tan, Jessica Key, Whitney Palmer, Melissa Edgar, Mr. & Mrs. Desjardins, Dr. Josefina Tuazon, Joelle Link, Chelsea Rewuski, & Dr. Susan Fowler-Kerry.

Bottom Photo: Whitney Palmer

Arrived in the Philippines

After a long and tedious journey, which equalled 19 hours in the air, and 42 hours total of travel time, we arrived in Manila, Philippines! Our practicum begins in Manila on January 4, 2010 and finishes February 6, 2010. We will add posts throughout the trip, so keep checking for updates!

- The 7