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

Sunday, January 4th

Today we woke up and headed to the buffet breakfast where we were able to have omelettes and waffles (tasted better than ever before). After that, we started our hike to the hidden valley waterfall. The path was made out of bamboo and a fallen tree. The ants were everywhere but that did not take away from the amazing view. After arriving back to the resort we quickly took our last warm shower and enjoyed the buffet lunch (with a fresh fruit smoothie as dessert). The bus left at 2..... little did we know it would take 2 hours to drive 5 miles. The traffic was extra busy due to the students returning to college and the holiday break coming to an end.

After 4 hours on the bus (normally 2) we arrived back at Mary Johnston where we were greeted by the students. They were very welcoming and excited. They treated us to their special dinner tradition called "boodle fight"....which required us to eat all the traditional food by hand as well fight for what we wanted. After stuffing ourselves with food we had a fellowship with the students which involved singing, games, and food tasting. Molly and Paige were daring enough to try "balut" which is a Filipino delicacy (Google to find out more information). Other students tasted quail eggs which were breaded.

We ended the night with Filipino ice cream treats and took our cold shower and headed to bed to prepare for the long day of presenting.

Molly and Paige!

Saturday January 3rd

Saturday we woke up around 6:30 and had breakfast here at the school. We left for the day around 8:00 am but returned shortly to the school after our bus broke down. We didn't get on the road till about 9:30 am with a new bus. We drove about an hour until we stopped at Starbucks and had a bathroom break. It is still hard to get used to public bathrooms with no toilet paper, no soap, and no flushing. After another hour of driving we arrived in Tanauan Batangas where we met Dr. Opulencia. We visited his ancestral home, which is also a museum, cafe, and a ENT clinic. He was very welcoming and showed up his tools and helped Lindsay decongest her nose with a suction and nasal spray. He let us see in Lindsay's nose and ears through his camera scope. He also looked in Alison's throat, and showed us her larynx and airway. Then he showed us all around his home, where he literally collects everything and anything! It was very organized and included things like cameras, T.Vs, microphones, computers, paintings, books, records, irons, beer, license plates, and animal fur. These items dated back years and he had a lot of all of them. After the tour, he served us an amazing lunch which was prepared in his home cafe. We enjoyed shrimp, pork egg rolls, noodles, rice, pickled egg, water buffalo cheese, and casava cake.

After leaving his place around 2:30 we ventured deep into the rain forest! Our resort was beautiful and very secluded. We all stayed in little huts or cottages. We all were anxious to go swimming in the hot springs. There were about 7 different swimming areas with different temperatures. We all goofed around and played swimming games like marco polo, hand-stand contests, and made a natural whirl pool. After swimming for a few hours, we all got ready for dinner. Dinner was a buffet style, and most everyone enjoyed the pasta, meat, fruit, salad, and desserts. Dinner was outside with lights hanging in the trees and pretty candles on the table. After, we debriefed as a whole group about the trip so far, and how it was affecting everyone. It was an overall feeling that we are all grateful for what we have, and how appreciative we are for our parents and those who gave us this opportunity. Most of us turned in early after that around 9-10 pm. The day was long and eventful!

Love, Kelsey Braatz and Ashley Derynck

Day 3 New Years Eve

New Years Eve 12/31/14


 I think we can speak for everyone when we say that we've been looking forward to this day for a long time. Today we are off to the beautiful city of Subic Bay where we will be staying at the Camayan Resort. Our bus ride was around two hours and we stopped along the way at a gas station/gift shops to enjoy a nice break. Gina and Josie picked up a few different foods/candies for all of us to try including, casava chips, yamas, otap (breaded biscuit), and many others.
The countryside landscape was beautiful, filled with mountains, green valleys, rice fields, cattle, horses, and even a dormant volcano (Mount Areia). Soon enough we arrived and were able to check into our rooms that over looked the large ocean.
 We enjoyed a delicious lunch of iced tea, egg flour soup, caprese salad, bbq ribs, rice and vegetables. Half way through lunch we witnessed one of the monkeys steal a guest's bag of pretzels and run up the tree to enjoy a quick snack. Although the monkeys are cute and furry we found out quickly they have large sharp teeth and hiss when one gets close. During the afternoon many of us relaxed, laid on the beach, snorkled, and soaked up the warm sun. Around seven we all sat down for a dinner of beef stroganoff. The resort also had entertainment all night that included a special preview of the African Acrobats and a small cover band that sang many familiar songs we were all able to sing along to. Together we all counted down to midnight and watched the fireworks go off across the ocean as the new year of 2015 began. Just as we were all ready to head up to our rooms for the night we turned to see a large sea turtle making its way back into the ocean after laying her eggs. This was a New Years Eve filled with wonderful memories we will remember for a long time.

- Tracy & Martina :)

Sunday night-- Returned to Mary Johnson College where we were welcomed by the Filipino nursing students who have returned from Christmas break.They shared a traditional meal called Boddle Fight served on banana leaves and eaten without utensils

Spent the last 24 hours at Hidden Valley Resort. A secluded and stunning resort in the middle of a tropical rain forest paradise.

New foods we have tried in the Phillipines. Yum!

Church of San Agustine. The oldest church in all of Asia

The doors to Church San Agustin

Entering the Church

Damas Photos

               

                                                          Alyson and her little sisters!

Ashley and Kelsey T playing basketball with the kiddos!

Josey instructing away on objectives for the day

January 2nd, 2015

Today we had the opportunity to visit the children at the Damas Orphanage here in Manila.  The Damas Orphanage was started in 1913 and originally was for both widowed women and children.  In 1998 there was a fire that destroyed the building completely and everyone inside perished   In 1999 with help from the President Estrada the orphanage was rebuilt on the same grounds as we saw today.  Today the orphanage is a child service agency that takes in children whose parents are unable to care for them at this moment in time along with children who have been abandoned.  Damas Orphanage serves over 90 children today with their goal of returning the children back to their families as they are able to provide proper care for them.  Each Thursday a physician and nurse provide check ups for the children.

Upon our arrival today we were greeted by 30 smiling faces and were welcomed by multiple songs and dances that they had prepared for us.  It was amazing and very heartwarming.  Following this we ate lunch and they sang and danced around some more.  We were then paired up with 1 or 2 children and were able to play and run around at their playground.  We attempted to assess their levels of development and did quite adequately with their gross motor skills as well as their fine motor skills.  Some children did have developmental delays as well as forms of ADHD.  They all enjoyed playing and laughing with their "American Sisters".  We played duck, duck, goose to wrap up the day and what a sight it is to see children so happy whom are from so many backgrounds!  As we started to end the day we gave stuffed animals to our little friends and left with tears in our eyes as they sang one last time a final farewell to us.

Late afternoon we went to the oldest church in all of Asia.  Church of San Agustin has been through many wars and seen many years!  During World War II it was the only building left standing as it was thought to be a Red Cross.  It was one of the grandest churches we have seen with an enormous wooden door for entrance and the most elaborate ceiling!

We came back to enjoy dinner at Mary Johnston School of Nursing and after this long day we went to sleep!



Chelsea Ekeberg & Kelsey Thompson

    

New Years Eve Charades on the beach

Camayan Beach Resort in Subic Bay

Beach

January 1, 2015
Today was the fourth day we have been in the Philippines so far, and the first day of the new year.  It was weird being 14 hours ahead of our family and friends back home, watching them celebrate New Years all over again via Snapchat and FaceTime.  None the less we had a great time celebrating with each other at the resort in Subic Bay.  Today was our free day and we were able to spend the day doing activities of our choosing.  Unfortunately it started to rain early in the afternoon, but that didn't stop us from enjoying taking advantage of all the resort had to offer.
 
Many of us enjoyed the time snorkeling where we saw many starfish, coral, and other varieties of fish, some even swimming right up next to us.  As a group, we overcame many obstacles including goggle and mouthfuls of water, the fear of getting pulled out by the current to the vast darkness of the ocean, and being devoured by a shark, but don't worry, we made it!  Others spent this time relaxing on the beach soaking up what little sun we had today.  After lunch we were fortunate enough to experience swimming with the dolphins at Ocean Adventures.  The water was chilly with the rain and wind, but we all still had a great time, as this was also a first for many of us.  Luckily, we had massages scheduled after our dolphin encounter, so we had an excuse to get out of the rain.  We were also kept busy with dolphin and sea lion shows throughout the afternoon.

Once dinner approached everyone seemed to be pretty exhausted after a nonstop day of activities, so those who didn't have late massages packed up and went to bed early.  This appears to be the part of the trip where we have overcome the jet lag, but some of us seem to be come down with different types of illnesses from colds to "upset tummies"...Good thing we are all a bunch of nursing students!  Despite the rain and oncoming illnesses, we had a wonderful start to 2015.  Happy New Year everyone!!

With Love,
Lindsay & Alexa <3  

Views from Rizal Park and The Manila Hotel