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.