December 30 Blog

By: Paige Thune

We started out our day with orientation to Mary Johnston hospital. From the college we walk through a walkway that connects straight into the hospital. We watched an orientation video that reminded us of the history of Mary Johnston Hospital. It was Mr. Daniel Johnston from St. Paul Minnesota, who donated $12,500 for the hospital to be built. The hospital is located in the heart of some of the greatest poverty in Manila. We then toured the hospital units and were introduced to the different areas that we will be working in during our clinicals next week. They included: Medical ICU, OB, NICU, operating room, pediatrics, pediatric ICU, medical surgical floor, and ER. While in the ER, we had an eye opening experience. As we entered, a man was really struggling.  His heart rate was in the 170's, he was substernal breathing, and was on the verge of coding any minute. He needed to be intubated immediately and the doctor was explaining this to the patient's daughter. The daughter was asking the doctor to wait, in order to go find her mother as she was the one that would be making the decision about the care. As we debriefed about our orientation back at the college, Gina explained that this situation in the ER wouldn't happen in the US. If a patient was brought into the ER back home, the care providers would have "implied consent," and intubate them right away. But here in Manila, before anything is done they need a down payment or agree that they will be able to put a down payment for the treatment. The family needs to consider if it is possible to make the payment that the treatment will require. So this family was stuck. And they kept having to repeat "no wait," while this patient was failing.  We, then as a group were asked the questions: How would this feel if you were the doctor caring for this patient? Or the nurse? How could you stand by and not do anything while knowing that the reason for holding back life saving treatment is money? This devastating dilemma is something that occurs all the time in Mary Johnston hospital, and if we encounter it next week it is going to be a dramatic change from what we are used to in the hospitals back home. I myself, would really struggle having to stand by and watch nothing being done when it determines if the patients life would be saved or not. Although this may be one challenge, after orientation we were so excited to begin our clinical experience next week! It was made aware that we are going to have opportunities here in Manila that we would never have back home! So we are very anxious to see what next week brings :) We then packed up and began our two hour drive to the Camayan Resort. After we drove out of the city of Manila we began to see another side of the Philippines. We passed by rice fields, sugar cane fields, mountains, and small towns among the farming and the mountainside. When we finally stepped into the resort we couldn't believe how beautiful it was! The sun was shining, flowers decorated the grounds and the ocean and beach in front of us was surrounded by mountains. We spent the rest of the day in the water, laying out in the sun on the beach, and enjoying the view. Finally, we ended the night with dinner and enjoyed the warm weather on the beach listening to live music. It is very exciting to know we have another day and a half to enjoy here!

LInk to Mary Johnston Hospital (history)

https://www.youtube.com/watch?v=-zWwNHvZD7E

Mabuhay- LIVE, Tumawa-LAUGH, Pagalingin-HEAL 

(Thanks to Google translation!)

Dec 29 blog

By: Shannon Krueger

What a busy day! So much happened today that it’s hard to summarize it in one short blog. We started the day by going to Asociacion De Damas De Filipinas, the settlement house. The orphanage’s philosophy is Settlement house believes that a young child be nurtured and guided. Teach him, love him, and implant in his mind what is still vital, necessary, and righteous, as soon as possible. Delay may mean defeat, and to wait will be to make the task harder and perhaps even hopeless. On the way to the orphanage Paula explained to us how it was run. The orphanage is fully funded by donations. The orphanage coordinator is Mina, a Mary Johnston school of nursing graduate.  She gave a brief history and orientation before we met the children. Currently the orphanage has 11 resident children who live there full time and the rest are either dependent children, meaning their parents can’t financially support them, or abandoned children.  Another option was for children to be left for a daycare service. Upon arrival to the orphanage, the children were a bit shy, but by the time we left we couldn’t go anywhere without them by our side. The children love to sing and dance so they performed multiple songs for us and even had us join in and dance; Yes, Gina and Paula were out on the dance for doing the cha cha too! We played on the playground with the children as well. Before we left, we helped serve them lunch and gave them each a stuffed animal to have. Hannah’s grandmother sewed some pillowcase dresses to share with the girls as well. It was so enlightening to see that even though they were in an orphanage these children were as happy as could be. There was so much laughter that filled the room the entire morning…although maybe it was partially because we were so tall and some of us had “white” hair. It was hard to say goodbye to the children, but it made me happy knowing we could make their day just a little bit better. We used some of the money donated as a gift to the orphanage.

               After leaving the orphanage, we went to Max’s for lunch. It was a nice little sit down restaurant known for their fried chicken; they literally fry a chicken whole and bring it out on a plate. We tried many different things during our meal including a peanut butter based soup with ox tail, tendon and part of ox large intestine.  The second soup was a tamarind based stock with whole prawns (eyes and legs) Filipino spinach and okra. There was also fried boneless milk fish. Some of us had a whole young coconut cut to be served as a drink. Needless to say it was an interesting but, yet again, delicious meal! Although I think I could go without ever trying intestine again!

               When we got done eating we left and went to The City within the Walls known as Fort Santiago. It is a Filipino monument where national hero Jose Rizal was killed. One of the interesting things was walking into the wall. There were golden footprints on the ground where Jose Rizal took his final footsteps. It was an intense feeling to be in such a historical place. There was a lot of history to take in, but it was very interesting to hear about how the Filipino culture came to be. On our horse drawn carriage tour, we also got to see two gorgeous cathedrals, San Agustin church and Manila Cathedral. While we were around the cathedrals, there were three different wedding parties that we saw. People reserve these cathedrals a year in advance, and there can be as many as six weddings per day in a cathedral. This final stop on the tour was the gift shop, and I think there were only three people who made it out of there without buying pearls. The Philippines is known for their pearls and they are gorgeous here.

               Next we headed to Shakey’s for pizza and a locally brewed beer called San Miguel. I felt like we were back in the US, but none the less the food was delicious and we all had fun chatting about the days events.

               To finish the night we headed to the Bayleaf skydeck bar. The rooftop had an amazing view of the city’s skyscrapers and lights. The beautiful scene made for a relaxing end to a very busy day. I think we’ll all sleep well tonight.

By Shannon Krueger

December 28th Blog Post

Started today waking up at 6am. We arrived late last night in the Philippines and got around four hours of sleep after being awake for 24+ hours flying. Breakfast included some fried eggs, cereal, white toast with a choice of PB and Jelly, an interesting red colored sweet pork sausage, watermelon, coffee, and yogurt. As I walked out of the mens

sleeping cabin I was greeted by a few stray cats and a very noisy street packed with people, cars that never stop honking, motorcycles, and other vehicles. There are Jeepneys which are vehicles left by the American military now functioning as group open air taxis. After breakfast we loaded up the coach bus and headed to St. Lukes hospital for a tour. This hospital was the first in the Philippines to be accredited by the Joint Commission. Their next goal is to be awarded magnet status. We were able to see many different types of floors. Lunchtime came next at a restaurant called Abe. We ordered multiple large family sized plates and passed them around for everyone to share. Lunch included Lumpia which is young coconut stacks with carrots in a wrap (similar to spring roll), Pla-Pla (fish) which is tilapia deep fried, roast pork, gising-gising (spicy veggie with coconut milk. Most people ordered a ripe mango shake, pineapple shake, tamarind shake, or watermelon shake. For desert we had Halo-Halo which includes sweetened fruits, purple yams, beans and ice cream. After lunch we went to 'Market Market' and exchanged our American dollars into Pesos (1 American dollar=47 pesos) and went shopping. One of the favorites of the market are pearls. They are much less expensive than in the U.S. After the market we headed back to the college and ate dinner. We ate pasta and banana egg rolls. After dinner everyone headed to bed around 8pm to get some well needed rest. By: Luke McKenzie

Minneapolis to Manila. Travel Day.

By: Nate Hemann

Since we are about 14 hours ahead of all of you back home, I'm writing this about a day late. We left Minneapolis at 11:30AM with a slight delay for deicing. We proceeded North from there to cover Canada, Alaska, and the Arctic Circle before our decent over Russia. I was intrigued that we hardly flew over the Pacific at all. It took us just under 13 hours to land in Japan's Tokyo/Narita Airport. On the flight many enjoyed watching movies, reading, sleeping, and Gina's personal favorite, getting to sit by our flight's version of Django. Django was a nice country looking man with a killer mustache and about enough cologne to make her have a little nausea, and of course he traveled from Minneapolis all the way to Manila with us. After departing Narita, Japan at around 6:00PM we landed in Manila at around 10:00PM. We rode in a massive, double decker plane from Japan to Manila that was 10 rows across. Once in Manila we collected our baggage, and the man from Immigration asked if Gina was my mother (clearly my height of 6'5" and German features of blonde hair and blue eyes gave it away that she was in fact my mother). If I hip-checked Gina, I would probably break her neck because of how short she is... Anyway, we met our friend from the school of Mary Johnston, Bhebe, outside after getting our bags and she led us to our bus that would take us to our home for the next two weeks. The traffic in this city is UNREAL. No Minnesotan would survive having inches if not less between each car, the honking (we need our little Minnesotan bubble at all times), or the disobeying of general traffic laws, including red lights. Nonetheless, the bus driver was patient and phenomenal at getting us to the college. Once arrived, it was after midnight so we all crawled into our little twin beds (that of course my feet hang off the end by about 6 inches) for a very short night of sleep.

Transcultural Nursing Philippines Experience 2015-16 Travel Blog

Nineteen Traditional Undergraduate Nursing students will be traveling to Manila, Philippines during winter break. Two nursing faculty will be leading the group, Gina Diaz and Paula Byrne. The group is excited for this upcoming trip.

Pre-Departure Blog Post (December 19)

By: Victoria Westlund

We leave in just a couple days, and I know everyone is extremely excited! Finals are over, and now all we have to focus on and look forward to is the Philippines trip. For me, I have never been anywhere outside of the United States, so it is a lot of excitement and a little bit of nerves as I finish up my packing today. The longest flight I have been on is a little over 3 hours, so adding ten more to that is going to be interesting. I am going through my head as to what is the most important thing to not forget (plane tickets, passport, etc.), what and how much of everything I need, and what I can/can’t bring on a plane. It’s kind of a lot to remember!

On the ninth of December, we had our last meeting as a group at CSS. It was a pretty high-energy class, especially when Gina and Paula started handing out the plane tickets! It finally started to feel real. This semester has been quite busy, so being able to feel like we are ACTUALLY close to leaving for the Philippines was thrilling. At the final meeting, we were also given stories/advice from previous students who had gone on the trip. It was really insightful, and nice to hear their personal experiences. As we were munching on our Erberts and Gerberts sandwiches courtesy of Paula and Gina, we read those stories and talked about packing, what we were excited about, and many, many questions were asked and answered!

After we talked and ate, we started packing the different donations. We filed into Gina’s office and grabbed huge duffle bags, and began hastily filling them with the various items. I don’t think I have ever seen so many stuffed in my life! Aside from the millions (give or take a couple) of stuffed animals, there were also multiple different medical supplies items, books, and other toy-like objects. I believe we filled about 7 bags, and most of them were pushing the 50 pound limit! There are also other items still coming in, and those are being packed by others and they are bringing them to the airport themselves.

Personally, I am very excited for everything on this trip, and I also am looking forward to getting to know my classmates better! I have no doubt it will be an experience I will never forget. At this moment, I am going to finish packing my stuff in Duluth, and then I’m headed to Wisconsin for Christmas. The next time I see everyone, it will be at the airport on Saturday. Merry Christmas, everyone!

Daily Clinical Reflections

“I am very nervous about working in a whole new environment where I am the outsider. I think the language barrier will be the most difficult part. I learned a lot from being an “honorary charge nurse”. It was interesting to see how much work went into it. I also was able to see the interaction between the doctors and nurses which was really neat. The one thing I had any patient interaction was when I was pulled into inserting a straight catheter. It was my first time and it was the most difficult thing I've done”.

“I am nervous about being in a foreign hospital with different language. I really enjoyed working with the staff-I was able to help hold the retractor, cut sutures, and just witness the whole thing (appendectomy). Today was a good day”.

“The biggest challenge today was trying to stand the whole shift (I did not succeed I had to sit down every now and then). I was able to give oral meds and IV push med that you draw up out of ampule. I learned some Tagalog phrases and feeling more comfortable entering patient’s room. Waiting to give meds until family brings them; this was a huge difference to me because at home we will not give meds patients bring from home”.

“I got to assist in the birth of a beautiful baby girl. It was an amazing experience and being able to do something rather than just watch was so great! The cultural experience I got to witness was how private the culture is and just how much privacy is important and providing it no matter what; for example a lot of our patients opted for their families to provide cares rather than the nurses just to allow more privacy. I feel like back home we would rather have a nurse rather than a family member, or maybe that’s just me”.

“I am not getting used to the whole 4:45 am wakeup call, but when I go and see their smiles it makes it all worth it. I got to work on my mechanical BP and vitals which was a good refresher.  I also got a lot of experience with medications and giving NG feedings. I gain more and more of a knowledge base of the Philippines and I am so grateful for it”.

“Working with my student nurse partner and the rest of the staff went really well. They were all very helpful and willing to teach, especially with med administration which turned out to be quite different from how we do it in the States. Although things are done a little bit differently here, they are all done for the same reason”.

“I felt a lot more comfortable today in my skills, especially BP, as I haven’t done manual BPs in a long time. I am grateful for this experience as I have been reminded that we cannot always rely on our electronic/automatic supplies. I was able to ask more questions today, and could communicate well with everyone on the floor. I believed I displayed cultural competence by allowing patients to decide when they wished to have their cares done, encouraged family time, and spent time discussing culture with my patient. She proudly told me where she was from, and asked many questions about where I had been”.

“I learned a lot today on the medicine-annex unit. I did rounds with other students and was able to practice my manual blood pressures. I was also able to practice some of my Tagalog by saying “salamat po” (thank you) when I left and “magandang umaga” (good morning) when I entered the room. It was really fun learning to adapt to another culture. I also spoke with the students and nurses on the unit about how we use the EHR to document and give medications in the US. It was fun to be able to talk and compare the way things are done here versus at home”.

“I think the biggest way I practiced cultural fluency was by asking tons of questions when I didn't understand something and then explaining also what I know. I also tried to interact with the patients as much as possible even though none of them spoke English. Another way I demonstrated cultural fluency was by learning skills from my students nurse partner and not trying to do things the “States way”, but learning and doing stuff their way. It was interesting to use their Math formulas and IV skills!”

“I got to see a lot of different things, and gave my first newborn bath! It was really difficult to understand everyone even when they spoke English. Also even conversing with my MJ student was hard sometimes because we have different names for everything. While giving the baby’s bath, the mother asked to take pictures of me while bathing her baby”.

“It is so interesting to observe the different culture and see how they interact and communicate. They are so buddy-buddy with the doctors and everyone seems so close. Back home I feel like you can feel the tension between a lot of nurses, and the nurses and the doctors. The Filipino people are generally just a warm and welcoming group”.

“I am most nervous about experiencing the cultural differences in our health care systems. I am also nervous about the language differences as well. I definitely experienced culture shock during our first day of clinical. It was very interesting to be placed as the one who needs a translator, but I believe it will be very beneficial for my future as a nurse”.

“One thing I thought I did well in the ER today was volunteering to do anything. I wanted to learn even though things are different here. Some things I got to do were insert an NG tube, clean up vehicle accident wounds and giving IV med”.

“I love how much families are involved in the plan of care. It is hard to get used to the fact that we had to wait 3 hours to give a med because the family had not come today yet and they needed to buy medicine and the sterile water needed for mixing”.

“I was in the ER today and right away we saw a code where a 23 year old man passed away. It was the first time I have actually witnessed someone die. It was hard for me to watch the family mourn without anyone really explaining anything to them”.

“I definitely had a culture/knowledge moment when I thought “Oh no, the baby is so dark and purple” then I remembered not everyone is as pale as we are!”

“The biggest challenge was trying to advocate for a very sick patient. I felt that our suggestions/interventions were ignored or they did not have the resources for it or it was something that the patient had to pay for. It was hard to see the healthcare team react very slowly to the terrible situation which was an emergency! I was very frustrated and it was the first time I felt helpless in a situation as a student nurse. Also, another big challenge was seeing the father of the patient try to round up money for his daughter so she could get a CT scan. After hearing that she could not get a CT scan until they provided money was heart breaking. She needed that CT scan ASAP but could not receive it due to money. I held it together for most of the day until I found out that the father was making phone calls and trying to relocate his daughter to another hospital because Mary Johnston was too expensive. That’s when I started to choke and tear up. I thought about how much the CT scan was (about 5,000 pesos) and the fact that I took out 6,000 pesos for this trip for souvenirs and fun stuff. Today really made me reflect on our healthcare system and how blessed we are to have it and to have insurance. I know it is not a perfect system but it could be a lot worse”.

Wednesday and Thursday!

Another day of "duty!" We all became very thankful that we only have clinical once a week, as it was very difficult to wake up at 4:30. We were all spread out among the wards, most of us in different areas from yesterday. There were a lot of eye opening situations today. A few of us experienced a situation where a patient was in critical condition but due to inexperience by the nurses and lack of financial support for the patient, the patient just lied in bed. Even though there was frustration among many of us, we all realized how much we know and that we are prepared for situations like these if we're ever found ourselves in them. We are very grateful for the modern technology in the United States, as the paper charting here has been quite the task. A few lucky students were able to assist in a delivery while in the OR. In the afternoon we all got dressed up and made our way to The St. Scholastica College. We were able to give a presentation to a group of high school students about our college and the nursing program. The students asked us questions and we gathered in small groups to get to know them a little better. We were then invited to have tea time with the Sister Mary Lois. As we walked into their "hotel" we were surprised at how realistic and beautiful the building was. This hotel is like our simulation rooms in the nursing program. Students there practice all management and culinary situations. Our mouths dropped open when they started serving our snack. This would have been a meal in the U.S. We were served bleu cheese lasagna with garlic toast and for dessert a cream filled chocolate cupcake. I think we all agreed that we were most excited about not seeing rice on our plates. On the way back to MJ, we talked Gina and Josey into letting us have a pit stop at a local store to grab local candy and snacks. Upon arriving at MJ, the students were having bible study that we quickly joined in on. Then we went onto preplanning for the next day, and got ready for bed. I believe most, if not all of us were sleeping by 9:00pm.

Last day of clinicals in the Philippines! Woke up again at 4:30, and ate breakfast. At the hospital today, it was a very slow day. Those of us in the ER and OR experienced a very unproductive day. The girls on the other wards were able to keep busy with what little they were required to do. Some of us were taken up to the Physical Therapy ward were we experienced what their physical therapy is like and the differences from our own program at CSS. It was then time to go to the Mall of Asia. If you think the Mall of America is big, then imagine an even larger mall. They had rides, an ice skating rink, and every single store imaginable. We all found our way to a souvenir store were we probably spent the majority of our remaining pesos. We enjoyed snacks throughout the mall, as well as Jollibee for dinner. During our trip, we were required to wear our coral shirts was filipino on the back. We were told by the students that it said we were missing and to please return back to Duluth, Minnesota. A few people stopped us to read our shirts and they would laugh and walk away. Some even took pictures! I think we were all exhausted from the day and ready to get back to the school so we could go to bed. On the way home we played music off our phones and sang along with all of the MJ students. It wasn't until 10:30pm that we arrived back and everyone quickly dispersed. We are all ready to be back in the United States and sleep in our own beds, but it is a little bittersweet knowing we only have one day left here in Manila. I think we can speak for everyone in saying this has truly been one of the best experiences and we have become a little family. It will be hard to leave all of the MJ students as they have just been the sweetest and we have gotten to know them all very well. We have all stated what our choice of food will be when we land in Minnesota as well as how long we will sleep before reality sets in and we have to get ready for school! We cannot wait to see our family and friends. We thank you and love you all!

Megan and Kelsey B. 

Monday and Tuesday (5th and 6th)

Monday, January 5th

Today we took part in presentations with the nursing students of Mary Johnston Nursing School in Manila. We spent the morning sharing our experiences in the nursing program at St. Scholastica as well as informing the students on the process we took throughout applying to the program through the road ahead where we take our NCLEX (needless to say we frightened the students). They in turn shared their experiences and criteria within their nursing program in the Philippines. It was very interesting to compare and contrast with one another. We spent the rest of the day acclimating to the hospital here and pre-planning for the next day of clinicals.

-Taryn and Paige

Tuesday, January 6th

Today we experienced our first rotations in a Philippine hospital. Mary Johnston hospital was very welcoming and the staff were extremely helpful. Us students were divided amongst different units such as the ER, OR, OB, ICU, Annex, and Medicine ward. I was stationed in the emergency room today and upon entering the unit at 5:30am I experienced my first code. The day went by very fast with an influx of patients experiencing things like burns from electrical outlets, heart attacks, anaphylactic shock, and car accidents. I was also able to assist in a major surgery where a woman's ovaries contained masses and therefore had to be removed. I was able to scrub in and assist in providing the surgeons with tools to cut, clamp, and secure the tissues. It was an incredible experience.

-Taryn

After finishing our shifts at the hospital we headed to a impoverished part of Tondo called Parola. Once there we assisted in feeding malnourished children soup, bread, juice, and multivitamins. The small room was packed with mothers and children trying to get food. Outside of the room children crowded the gates with bowls asking for soup also. The cooks were generous and offered us some soup as well, however we did not feel right taking any when there were hungry children yet to be fed. And so we gave our soup to the remaining children outside and did our best to keep up with the ever growing demand. The time spent there went by incredibly fast as we hurried to keep up. We then were able to collect the stuffed animals we had brought and distribute them to the children. We left the building and entered an ally where children literally swarmed us for toys. Each formed a line though and patiently waited for a stuffed animal. It was heart breaking when we ran out, but it felt very rewarding to have been able to give toys to some of them. It was a humbling experience and many of us left wishing we could have done more.

-Taryn and Paige

Balut