Final Days within the Philippines

On our last day of clinical we participated in a mass immunization for a measles outbreak occurring in Mayamot Elementary School.

This was followed by a culminating activity to sum up our experiences of the past month. Here we were able to share many of our personal experiences and stories with the Filipino nursing students and faculty. The Dean’s of nursing from St. Paul’s University, University of the

Philippines, and University of East Ramon were all able to speak to us in regards to the global partnership being built between our schools and their hopes to continue this relationship for years to come. Lorna Butler, the University of Saskatchewan’s Dean of Nursing, was at hand to voice our desire to maintain a strong bond in the future. As nursing students, we feel this experience has impacted how we will practice in the future and therefore strongly believe in maintaining this partnership for the benefit of future NEPS students.

As this experience marked our last day in clinical, the time has finally come to close our blog. The past six weeks have offered ample learning opportunities in regards to community health care delivery within the Philippines. It also provided us with the chance to grasp a greater understanding and appreciation of the Filipino culture. Not only did we learn a lot about a very unique and interesting population, but we also learned a lot about ourselves along the way. One of the most valuable lessons we will take away from this experience is learning how to work effectively as a team. Considering we spent a lot of “quality” time together throughout the past month we learned quickly the importance of becoming a functional team member. Knowing how to work effectively as a team member is a valuable quality to have as a nurse and we feel this experience has aided us in developing this quality.

We would now like to take this opportunity to thank all of those who helped facilitate our time in the Philippines. These include, but are not limited to, the Dean’s of nursing Dr. J. Tuazon, UPM, Dr. C. Divinagracia, UERMMMC, and Sr. Carolina Agravante, SPC, President, St. Paul Univeristy, Iloilo, all of whom welcomed us into their schools whole heartedly. Also, the many faculty members who helped us receive an extraordinary clinical experience, including Jerry, Ruby, Mrs. Lim, Ms. Castro, Ms. Mollo, and Zandro. You were all amazing and taught us so much, thanks! We would like to extend another huge thank you to all of the nursing students who acted as our “buddies” and our personal translators while working in the community. We have formed new and lasting friendships and are looking forward to maintaining these contacts in the future. Thanks goes out to Lorna Butler from the University of Saskatchewan, who helped make this trip possible, as well as our instructor Susan Fowler-Kerry who believed in us enough to allow us to partake in this experience. Lastly, thank you to all of those who followed our blog and took interest in sharing our experiences. We bid you adieu.

Top picture: Ashley and Melissa preparing syringes with the measles vaccine.

Middle picture: Nursing student performing the Filipino Tinikling dance.

Bottom picture: (top-bottom, left-right) Bethel, Ashley, Sr. Carolina Agravante, Dr. C. Divinagracia, Lorna Butler, Dr. J. Tuazon, Kirsten, Ms. Molo, Mrs. Lim, Ruby, Chelsea, Melissa, Joelle, Whitney and Jessica

East Ramon / Antipolo

February 1 - 3, 2010

February 1st marked our last day in Ilo Ilo city. Our plane left at 12:45 and we began our journey to the University of East Ramon (UERMMMCI). Here we met up with the Dean of Nursing from the University of Saskatchewan, Lorna Butler and were orientated to our planned activities for the week. We were paired off with UERM nursing students and we had a chance to get to know each other. Later, we were invited to an alumni dinner where we enjoyed a variety of entertainment and delicious food. We then travelled to St. Michael's Retreat House in Antipolo, which is our home base for the week.

February 2nd began with courtesy calls starting with Dr. Antonio G. Reillo, the Manicipal Health Officer of Antipolo. He provided us with information regarding Antipolo's health care system. The area is populated by 700 000 people and is staffed with 6 nurses, 7 doctors and 200 barangay health care workers to meet this large populations health needs. This further illustrates how thinly stretched health care workers are within Filipino communities. Next we visited the Assistant Superintendent of the Department of Education, Maria Luz Salvador who welcomed us to the community.

Our next activity took us to Sta. Cruz Elementary School where we assisted 4th year nursing students in testing children's eyesight. The school has 7292 children ranging from grades 1 to 6. Due to the abundance of students enrolled at Sta. Cruz, they are taught in 2 different shifts organized into 6 hour blocks. This occurs because it is not possible to accommodate all of them at once. The goal of today's activity was to assess the eyesight of Grade 2 students using the Snellen visual acuity chart. Visual impairment can be one of the many reasons for poor academic achievement in school aged children (Karande & Kulkarni, 2005). Administering eye exams allows health care providers to rule out visual impairment as an indicator of poor school performance. Early detection of visual impairment is a good example of primary health care, as diagnosis can greatly improve their quality of learning. We observed several children who demonstrated the less than desired 20/20 vision, with one of the worst cases presenting as 70/20. After diagnosis, the UERM students will be working on fundraising in order to provide glasses for the children who need them.

In the afternoon we were able to observe health teaching and activities provided by the UERM nursing students. The activities reinforced learning on environmental health and safety, physical activity and proper diet and nutrition.

February 3rd we visited a geriatric centre. Here we were given the opportunity to socialize and interact with senior citizens of the community. Positive social interaction is therapeutic in recovering from illness and essential in maintaining morale (Stephens, Kinney, Norris & Ritchie, 1987). This centre provides elderly clients within the community both access to health teaching and activities, planned and implemented by 4th year nursing students. Our experience demonstrated the positive results of socialization as the elderly clients enthusiastically participated in activities and built relationships with others. We were able to participate in activities such as, dancing, singing and charades. This experience was memorable for both the people of the community and ourselves.

After visiting the geriatric centre, we participated in an immunization clinic. Here, we were able to immunize infants who were scheduled for DPT, Hepatitis B, OPV and measles. There were approximately 50 infants present at the clinic who commuted from surrounding barangays.

In the afternoon, we joined medical students and barangay health workers for an organized socialization. Here, we had the opportunity to ask questions regarding their role within the community health setting. We were able to observe how UERM nursing and medical students interact side by side.

First Picture: Ashley McDonald with 4th year UERM nursing students

Second Picture: Courtesy call to Dr. Antonio G. Reillo's office

Third Picture: Joelle using Snellen's visual acuity chart

Fourth Picture: Melissa giving instruction to a student

Fifth Picture: Group picture at the geriatric centre

Sixth Picture: Having fun with the UERM nursing and medical students

Medical-Surgical Mission

Friday, January 29, 2010

St. Paul’s University went the extra mile to provide allow us to experience a clinic focusing on prenatal care and pediatric circumcisions. This was a medical mission established for the school, providing an opportunity for male community members between the ages of 9 and 14 to receive free circumcisions. Circumcisions are recommended for all males in the Philippines in order to prevent infections from swimming in contaminated water supplies, improve hygiene, and decrease the prevalence of sexually transmitted infections.





Pictured:

1. The surgical room where circumcisions were performed.
2. Kirsten ready to assist with a circumcision.
3. Our team with the medical doctor who performed the circumcisions.

Birthing Experience at a Rural Health Unit (RHU)

Tuesday, January 26, 2010

After labouring over fire and coals for three hours, we were able to enjoy a “Canadian” meal with our Filipino friends. It was a challenging task having to cook for 22 people, and we were all covered in sweat and soot by the end, but it was a rewarding experience to share part of our culture with the students since they have shared so much with us.

Following dinner, we began getting ready for bed, and received a call at 2100h from a midwife at the RHU clinic regarding a delivery that we were invited to attend. Jessica, Kirsten, Ashley, and Whitney quickly changed and ran (literally) to the clinic to participate in the delivery.

When we arrived at the clinic, we discovered that there were two women labouring: one primpara who was in active labour, and one multipara who was walking around the clinic trying to progress through the labour process in a natural manner. While assisting in the two deliveries, we learned that at the RHU clinic all women deliver without analgesic. Also, labour is augmented through rubbing the woman’s nipples, stimulating the production of oxytocin, which enhances uterine contractions. Furthermore, 10U of oxytocin is administered IM following the delivery of the placenta.

From both lecture content and personal experience in the delivery room, we have noted that in Canada many women receive epidural analgesic during labour and delivery, are given IV syntocinon to augment uterine contractions, and receive additional oxytocin IM following the delivery of the baby’s anterior shoulder. Masking pain related to childbirth and augmenting contractions through synthetic pharmacological methods can be referred to as “medicalization”. Parry (2008) refers to medicalization as changing normal bodily states and processes into complicated, pathological events. Furthermore, Parry (2008) asserts that medicalization occurs when a biomedical field perceives natural life events such as labour and delivery to be risky and dangerous. Through experiencing traditional deliveries in a rural health center, we have come to appreciate the benefits of natural rather than medicalized birthing methods. This is because in Canada, the focus of labour and delivery has become viewed as a process of treating an illness state, which medical professionals are trained to “…determine, control, and rectify…” (Parry, 2008, p. 786). By approaching the birthing process as something that needs to be fixed or controlled, the success of the delivery and overall family experience can be negatively affected.

After experiencing two natural deliveries, we can see positive aspects that could be implemented in Canada. Some of these include: shifting our focus from progressing through the stages of labour in a timely manner to assisting and coaching the mother in transitioning through her personal birthing experience; and decreasing the overuse of pharmacological treatments during the birthing process. This would create a more meaningful and family-centered life event.

Overall, this was a very exciting and rewarding experience since some of us have never experienced or assisted with deliveries before. We would like to thank the midwives, clinical instructors, and students for going the extra mile to make this experience possible!

Pictured:

1. Whitney and Chelsea helping prepare the "Canadian" meal.

2. Jovan, Irina, Arielle, and Jessica wearing their labour and delivery scrubs waiting for the second delivery.

3. The birthing stretchers in the delivery room.

4. Infant assessment area and bassinette in the delivery room.

References

Parry, D. C. (2008). “We wanted a birth experience, not a medical experience”: exploring Canadian women’s use of midwifery. Department of Recreation and Leisure Studies, University of Waterloo, Waterloo, Canada 29, 784–806.