Philippines Blog #2 By Lindsey Rask and Brandy Rousson February 14, 2013

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1 1 Philippines Blog #2 By Lindsey Rask and Brandy Rousson February 14, 2013 Blog #2 Philippines Part 1 After finishing our first week in A ntipolo and being integrated into the community, we have become well-adjusted to the cultural differences and more comfortable in our surroundings. Our second week began with developing a program plan for the families in the community. Based on the assessments we carried out last week, our goal for the program was to increase the nutritional status of school aged children. A part of this program was to implement health teaching to the mothers within the community. The health teaching portion consisted of a presentation on proper hand hygiene, safe food handling and storage, an overview of the Filipino Food Guide along with a sample meal plan.

2 2 We decided on a soup kitchen for the families where the mothers would watch and help us prepare the vegetables, which the mothers had identified as easily accessible and affordable for them. The turnout we had was more than we had expected and although we ran into some minor complications such as lack of supplies, we were able to pull together and gather enough supplies to feed all the families that were part of our program as well as other community children. All the mothers were very welcoming of our presence and willingly participated in the activities. The children were full of excitement to see us again, and at some points had to do crowd control because they wanted to be right directly in the action. It was a long and exhausting day, but in the end it was a gratifying and humbling experience for everyone. Seeing everyone enjoy the food and the smiles on their faces made it all worth it!

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6 6 Blog #2 Philippines Part 2 Throughout the second week we also began the assessment process as well as the program planning for the clients of the Geriatric Center. The time we spent at the Geriatric Center was always a pleasurable experience as they showed a great deal of interest in who we are and where we come from. The center is designed for seniors within the community to come two to three times a week where they can be assessed for any health concerns, as well as to participate in the daily activities such as a ten minute exercise regimen, followed by socializing and dancing. During these first couple encounters, we along with the Filipino nursing students, organized games and activities to play with the clients as an ice breaker. The Filipino girls played a game that was familiar to their culture, whereas we Canadian girls had them participate in musical chairs, a game in which they were not familiar with. This was a huge success and we all had a great time laughing and joking with one another. Through this we were able to get an idea of what type of issues were relevant to the clients in order to begin the development of a program with plans to implement for the following week. P. Ilusorio Center for Geriatric Care

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8 8 Blog #2 Philippines Part 3 By mid-week we spent time at one of the health clinics where we spent the morning obtaining babies weights and temperatures, administered immunizations and gave health teaching to the mothers.

9 9 Blog #2 Philippines Part 4 Towards the end of the week we then began the process of the next program plan for the elementary school children. After meeting the principal and the teachers who were head of their grades, we were informed of the many differences of their school system. For instance, the school has over 8,000 children. Grade 6 alone has 22 sections and each section has approximately 55 students. The section numbers rank from highest intellect to lowest. Classes run from 6am-10am for the first group of kids, 10am- 2pm for the next group and 2pm-6pm for the last. We took a tour of the class rooms we were going to be assessing, introduced ourselves and informed them of the clinic we were going to be starting as of the next day. The children greeted us in a synchronized welcome, which caught us by surprise but definitely made us laugh. We began to carry out assessments first thing the following day. Although the children are taught their classes in English, they are quite shy and it was difficult to get a response from them in English when we asked questions. Our instructor said this was because they were "awe struck" by us. By midday we quickly realized we had an extremely big job ahead of us as we did not have a realistic amount of time to be able to perform a proper head to toe assessment of the 22 sections (approx students) in the time allotted. However in the third week, after some trial and error, we were able to get through over half of the grade 6 sections and therefore determine what the prevalent health issues were.

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13 13 Blog #2 Philippines Part 5 On the weekend we stayed at the Bosi Resort and water park coated right in Antipolo city. The resort had 9 different pools including a storm wave pool. The resort is a popular weekend get-away for many Filipino families. Our last week of our community rotation in Antipolo picked up where we left off with our continuation of assessment on the grade six students. We broke up into four groups, one Canadian student paired with one of the Filipino students and carried out assessments at each station. Our goal was to do a complete head to toe assessment so the stations covered lung and heart, skin and scalp, abdominal and spin, and last eye/ears/nose/throat. Majority of our findings fell into normal perimeters with the exception of skin/scalp (lice) and oral (dental carries and poor hygiene). By midweek we had completed enough assessments and were able to determine that the most prevalent issue that needed to be addressed was oral hygiene. We then began to put together our health teaching portion of the program plan and were implementing it in the classrooms by the end of the week. We chose to do a presentation on types of nutritional foods to eat and what types of food to avoid, proper brushing and flossing technique, and discussion on regular visits to the dentist.

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15 15 During the week we also returned to the Geriatric Centre were we continued to interact with seniors, gathering subjective health assessments. The Geriatric Center is always a fun experience as we enjoy participating in their morning exercises followed by activities such as "Simon Says" and dancing. By the end of the week we had determined that the most common issue among the seniors was arthritis and therefore we chose to do a lunch and learn where we provided tuna sandwiches and avocado tea while implementing a health teaching on arthritis. The focus was on exercises to help improve mobility and types of foods to avoid which can cause inflammation of the joints. We finished our week by saying our goodbyes to all the teachers and staff within the school division, city hall and the health centers. Our preceptor took us along with the Filipino student to I ntramuros for the morning, a historical park where we all bought an authentic original painting to bring home. We then finished off the afternoon with our evaluations at a place near the Intramuros.

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21 21 One the weekend the four of us Canadian girls hired a driver to take us to Nasugbu, Batangas and stayed at Johndel Resort. This is the area of Taal Twin Lakes and Taal volcano. Unfortunately we did not get to do the tour of the volcano but the area was beautiful regardless with black sand beaches and valleys that over looked the ocean.

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23 23 Blog #2 Philippines Part 6 Our first week in the hospital began with us meeting our new instructor Belinda Capistrano. The day was all orientation and we began with learning and memorizing the instruments used in the OR. This task looked daunting when she first brought out the tools but once we started we soon realized it wasn't going to be as bad as it seemed. After we memorized the instruments, we reviewed and practiced the steps of gloving and gowning for scrubbing in for surgery. Once that was done we went to the hospital and toured the CCU, OR and ER where we were introduced to the staff we would be working with over the next couple of weeks. the schedule for the next two weeks was to go as followed: Tuesday & Wednesday Kayla in the OR as scrub and circulating nurse and Sara in the ER, and switching roles for Thursday and Friday, Brandy and Lindsey in the CCU with patient care assignment Tuesday to Friday. The next week resumed with Lindsey in the OR as scrub and circulating nurse on Monday and Tuesday, Brandy in the ER and switching roles for Wednesday and Thursday, Kayla and Sara in the CCU with patient care assignments.

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30 30 Blog #2 Philippines Part 6.5 After our first day being orientated to the hospital, the Dean of Nursing invited us to the Medical Alumni Reunion being held at the UERM University. Medical graduates for the past 50 years were there to attend the celebration and the evening was filled with food, dancing, and many laughs. It was a great way to get to know our instructors and have a night of fun and enjoyment. During the social gathering, they were able to listen to the presentation of the UERM future direction by the President of the University.

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32 U of S student nurses with the Dean of Nursing UERM 32

33 Belinda Capistrano (left), Joy Molo (right) 33

34 34 Blog #2 Part 7 During our experience in the hospital we have discovered many differences within the hospital and how they operate in comparison to Canada. One major difference is their charting system. Instead of charting by exception like we do, they use SOAPIE (subjective, objective, analysis, plan, interventions, evaluation). This is done once for every eight hour shift by the nurse who is in charge. All documentation is handwritten and they use pencil for transcribing of orders including medications in the kardex. Medications are signed for right after the medication is given, or before the end of the 8 hour day shift. The UERM hospital is a teaching hospital and therefore there are several residents assigned to each patient (5-6/pt). The residents are responsible for doing monitoring of the vital signs, ins and outs, and all surgical dressing are to be done only by the attending surgical physician. Collaborative efforts are being made in the monitoring of vital signs, and interventions that student nurses should learn. Respiratory Techs are responsible for administration of all nebulizers at all times. The nursing uniforms for the staff nurses on the charity wards are the white dress, cap, white nylons and white duty shoes. In wards such as OR, ER, and CCU they wear scrubs and they are color coded. For example on the CCU, the nurses in pink are Acute Stroke nurses, in blue are CCU staff nurses and in peach/pink are the special care aids.

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36 Hair must be worn back in a bun 36

37 Male nursing uniforms 37

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