Day 11 Dalaguete, Philippines #DPC Foley Catheter Insertion

It was pretty busy at the hospital today. Lots of admits with lots of fevers. I got to perform my first catheter insertion today! The doctor on duty showed me how to put on sterile surgical gloves and guided me through the process of inserting a Foley catheter.

1. Take the Foley catheter and wrap it around your non-dominant hand leaving slack near the bladder opening. Wrapping the catheter tubing around your hand ensures the tube won't accidentally touch a non-sterile surface.
   
2. The nurse or nurse assistant will then take lubricant and apply a fair amount on the back side of your dominant hand. In order to maintain sterile conditions, the nurse/nurse assistant will make sure the tip of the lubricant bottle never touches your gloves – she/he will squeeze and wait until the lubricant disconnects from the opening on it's own.
   
3. Take the bladder opening portion of the Foley catheter and apply a generous amount of lubricant. This is done by simply twisting the tip on the back side of your dominant hand.
   
4. Insert the catheter by using your dominant hand to pull up on the tip of the penis. This is the reason you want the catheter to be in your non-dominant hand – maneuvering of the penis requires more dexterity.
   
5. Insert the catheter until drainage starts to appear in the tube. In this case, drainage didn't appear for me until I had reached the fork between the urine drainage port and the balloon port. As soon as the happens, the nurse/nurse assistant will inject saline into the balloon port in order to anchor the catheter in place.
   
6. Last is to measure the output rate. Do this by kinking the tube then un-kinking at five minutes, allowing 100cc of fluid to drain. After 100cc is reached, re-kink and wait another five minutes. Do this until the output can no longer reach 100cc after five minutes. Once this point is reached discontinue kinking and allow the catheter to flow normally. 100cc/5mins is a flow rate of 20cc/min. I'm not quite sure how this is useful, or what the doctor would do with this information, but it's a quick way to establish a flow rate. I'm guessing there's an average amount of times a healthy person will fill the bag with this given flow rate, so maybe it's just a way to gauge whether or not there's something wrong with either the patients bladder, or with the insertion of the tube. 

Along with fevers, car accidents, and UTI's diabetes is a huge problem here, especially among the older population. There's not enough supplies for preventative maintenance (i.e. insulin) and the food consumed here is often high in sodium and cholesterol leading to high blood pressure further aggravating diabetic conditions. The high cholesterol intake causes most of the population to develop early onset arthritis caused by the buildup of uric acid. The onset of arthritis prevents regular exercise allowing diabetes to gain an even stronger foothold among the population.

A patient came in because her right toe was slowly decaying. The reason? Diabetes. The doctor cleaned her toe as best he could, then refereed her to another hospital to get it treated or perhaps amputated.

It's a complex situation here. The natural diet of Filipino's is rather healthy, especially in Dalaguete because of the abundance of fresh vegetables and seafood. However, as technology allows the transportation of food more quickly and at a lower cost, the intake of pork, beef, and chicken is steadily rising causing an increase in sodium and cholesterol intake. This is also a culture that doesn't like to waste food so every part of the animal is consumed, even if a lot of those parts are unhealthy to eat. Pork and beef used to be more expensive, so they weren't consumed so often, but now, it's different. That combined with high intake of white rice are probably the root cause of diabetes here and in most places in the Philippines. Luckily, people here know that their diet is causing diabetes, so most of the parents here teach their children to eat a balanced meal.