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.