Day 91 Boracay, Philippines

Today is our last night in Boracay (we'll be leaving tomorrow). We topped off our visit by going para-sailing and taking a night walk along the beach!

Day 90 Boracay, Philippines

Today was our second day in Boracay and we went helmet diving and snorkeling!
Here's a video of the helmet dive!

And here's some snorkeling pictures and us just chilling on the beach.

We also got to see a bit of the night life. 

I thought this one was pretty funny. Boracay Obama Grill. 

This design was carved and painted on a living coconut tree.

Day 89 Boracay, Philippines

Today we left for Boracay Island, which is north of Cebu. The plane ride was pretty quick.

As I said in the previous post, Boracay is a tourist destination so when we got there it was loaded with people from all over the world. Anyway we took a banana boat ride today and planned our next two days which will be helmet diving, snorkeling, and para-sailing.

Anyway, here's a bunch of pictures and a clip of the first day!

Waiting at the airport.

Take off!

En route.

En route.

Apparently Manny Pacquiao regularly buys out this hotel when
he visits Boracay.

Banana boat!

About to set sail.

All of us.

Sunset. 

On a side-note, one of the coolest things about traveling with nurses is that their nursing skills go with them. When we landed on the island and got lunch, one of the nurses needed an IV injection of Ranitidine to help manage her hyperacidity. Unlike in the US, pharmacies sells syringes and injections over the counter because it's still one of the most widely used routes for administration of medication in the Philippines. The nurses offered to let me deliver the injection but I declined because I didn't want to waste the medication in case I missed, so I acted as the tourniquet instead. Here's a video clip (you can hear a little bit of Bisaya, the language, in the clip).

Day 65 Cebu City, Cebu

Today my cousin took my sister and I to a zip-line/bird reserve/animal farm place. Here's a video of the zip-line.

I also found out that I have the ability to talk to Turkeys.

And, finally, here are some pictures:

Day 64 Cebu City, Cebu

Today I went with my family to Macatan Island, which is jest a few kilometers away from Cebu Island. It's close enough that there's a bridge connecting the two so we drove across to see the Alegre guitar factory and the Lapu-Lapu monument. Alegre is one of the Philippines most famous guitar manufactures and at the factory in Mactan they still make them by hand. The monument we went and visited stands to commemorate the first Filipino hero Lapu-Lapu. Lapu-Lapu is credited for killing Magellan, therefore becoming the first Filipino to resist foreign occupation. Anyway, here's a video and some pictures!

Day 60 Dalaguete, Cebu

Today I went back to Dalaguete to celebrate New Years. On the way, we stopped by an old church dedicated to the Mother Mary. It was pretty interesting because there were statues of Mary representing different cultures from all over the world: Africa, Asian, American, European, etc. (and of course Filipino). We also stopped by a nature preserve/zoo and saw different types of monkeys and other reptiles. The monkey's you gotta be careful around. I was trying to take a picture of one with my phone and it reached out and tried to grab it -- his hands actually wrapped around my phone but I pulled it back before he could get a good grip on it. Anyway, here's a picture from the zoo (sadly my camera battery was dead so I couldn't take any myself):

 

Distant relatives? Thanks Shila for the picture!

Here's some footage of New Years:

Here's what it sounds like:

Day 44 Cebu City, Cebu

I went around Cebu City today with my cousins and visited an old church. We also went back to Tops and I tried zip-lining for the first time.

Day 33 Dalaguete, Philippines #DPC CPR, IV Insertion

Typhoon Pablo made landfall in Dalaguete today. Luckily, the news reported that it had lost a lot of momentum once it came in contact with land. It was rainy and windy all day and around 5:00PM the hospital and all of Dalaguete experienced a brownout.

The ER was busy today because actual emergencies (instead of OPD or checkups) occurred. What made it even harder was the brownout. It gets dark here around 5:00PM and around 4:30PM our first ER patient came in. He was a construction worker and had somehow had his arm caught and twisted in an excavator. His left arm was dislocated and fractured at the forearm. The doctor order an IV line and gave him an anesthetic (I can't recall what the drug was), then order an X-ray to confirm the break. Because this is a primary hospital, it's not set up for long term casting, so during the X-ray the doctor order the nurses to construct a splint out of whatever they could find. The ended up using cardboard and neotape and immobilized the patients arm so that he could be referred to the city. However, the patient ended up being admitted because the weather was too severe to be transported to the city.

The second patient was brought into the ER by her family because her NGT was dislodged and needed reinsertion. By this time it was already dark and we had to work by candlelight and flashlights. The hospital has a generator here but it isn't hooked up because they're still waiting for the fire department to process the paperwork. From what I've heard, they've been waiting a few years now. Anyway, the nurse removed the old NGT and the doctor inserted a newer one. However, there was a problem. After the doctor confirmed the correct placement by listening to the stomach (use a stethoscope, push in a little air via plunger, and listen for a gurgling sound), the water he used to flush the new NGT wasn't traveling down the tube freely. If an NGT is placed correctly, water flows fairly quickly through the tubing. This wasn't the case. The doctor reinserted it but placed it a little shallower, reconfirmed the placement, then tried flushing again. This time, there was backflow from the tubing. After a third attempt, a third conformation of placement, and a third failure of correct flow, the family then told the doctor that she hadn't had a bowel movement for 5-6 days. The doctor told the nursing staff to administer a suppository because it was likely that there was an obstruction. Even after the patient was given the suppository, she still didn't have a bowel movement. The doctor told them they should refer to the city in order to get an emergency scan of her stomach and colon since it was likely that she had an obstruction of some sort. The family decided to wait until the next day due to the weather.

The next patient that came in had a deep laceration on her leg exposing part of the Gastrocnemius muscle. Apparently a tin roof had come flying off a house and hit her on the leg. The doctor said, luckily, it was a clean linear laceration so stitching it would be simpler. I've worked with cadavers before, but they were prepared down to the muscle, so this was the first time I'd seen the hypodermis stripped away from the underlying muscle. The nursing staff cleaned the wound, the doctor injected a local anesthetic, stitched the wound, and the nursing staff dressed it. All of this was done using flashlights because of the power outage.

Here is some footage from the ER during PM shift. WARNING, this video shows a minor surgical procedure (the deep laceration). I've grey-scaled any footage that shows blood, but if you don't like looking at wounds or dislocated arms, do not watch this video. Again, I am grateful for the ability to capture these moments on film and will do my best to maintain anonymity and  dignity for those filmed.

I ended up spending the night at the hospital because of the weather, so I also experienced my first night shift. Around 12:00AM a patient was brought in because she had suffered a heart attack. The nurse on duty at the ER started CPR while I used the BVM to give rescue breaths. I'm CPR certified, but that was the first time I had ever seen CPR administered on a real person. I'm definitely glad I got to see how actual CPR looks because it requires a lot more effort than any dummy or training can accurately portray. Sadly, the patient was DOA and we were unable to revive her.

The last thing I want to talk about is IV insertion. Last night one of the nurses here let me try inserting an IV in her. It took me three tries to get it right, and she was totally ok with it. Back in the US, you have to take classes and practice and all that – but here you just have to learn to do it. Most of the nurses here have never taken an official class for IV insertions. Their training was the doctor (or another nurse that already knows how to insert IV's) telling them to insert an IV on a patient while they watch. Their “graduation” from IV school is the second after they insert an IV correctly. The hospital here is understaffed and IV's play a huge role in primary care, so it's important the the nurses all know how to insert IV's. What impresses me the most about this place is the youth. It's the youth giving first care response. Giving CPR. Applying pressure to wounds. It's the youth passing medication. Doing intravenous injections. Intramuscular injections. It's a whole bunch of early to mid twenty-something year olds literally saving lives by reviving. By stabilizing. It boggles my mind how much responsibility is shoulder by the youth and how well they perform given the immense pressure and expectations. The overall health of Dalaguete relies on the ability and dedication of its youth.

Day 31 Dalaguete, Philippines

Today was the feeding program! The turnout was around 200 children and some of their parents. In total, around 250. The Guardian Brotherhood started making the food around 5AM and me and some of the nurses arrived at the distribution center around 12:30 to prepare our presentations beforehand. The nurses were nice enough to just write down what I had to say about hand washing, but my Bisaya still had a very American accent to it. Anyway, here's what it all looked like:

Day 29 Cebu City, Philippines

It was my day off so my friend and I went and explored Cebu City. Here's what the traffic looked like on the way out sped up 10 times:

Just before I started filming, the bus we were taking stopped working as soon as we started moving up an overpass. It was one of the last buses to leave for Dalaguete so we waited for about 45 minutes hoping they'd figure out what was wrong. Luckily they did. Five minutes after that, the bus driver accidentally backed into a taxi, so we had to wait another 45 minutes for them to sort that out. We left the bus station around 8:00pm and with all the traffic and delays we finally arrived a little after 12:00am. Anyway, a long ride home but fun nonetheless.

On a sad note, a friend from work (in Oregon) notified me that one of the residents there had passed away. I know you're not supposed to "get close" with any of the residents you work with, but as anyone that has ever worked in the medical field can tell you, it's impossible not to form some sort of relationship with the people you are caring for. Anyway, this particular resident was extremely nice and very thoughtful and I will miss him/her greatly.

Day 24 Mantalongon, Philippines

I became a godfather today, or as they say here, a Ninong. My godchild's name is Raymond. Raymond's father, Migs, and I now call each other Pare as is the custom here.

My Godchild, Raymond.

My pare, Migs (in yellow), and I.

The ceremony was in Mantalongon. This is the part of Dalaguete known as the "Vegetable Basket" because it's high in the mountains and produces a large percentage of vegetables that make its way to Cebu City. The weather up there felt great and reminded me of Oregon!

Anyway, here's what it all looked like:

At the very end of the video they two men are loading and firing a home made cannon. The fire it during celebrations because it's cheaper than fireworks!

Day 22 Dalaguete, Philippines

Another routine day. IVT's, tube feeding, refilling prescriptions, etc. The nurses here have started putting me in charge of taking and recording all the pediatric patients vitals. I was a little unsure at first because infants have a broader normal range in terms of heart rate and respiration, so the first few times I took them I thought I was reading them incorrectly.

The doctor on duty also said I should put my number on the bulletin board so I can be on call in case anything interesting happens. Hopefully something interesting happens soon.

Anyway, here's a video of me loading syringes.

Day 16 Cebu City, Philippines

My Aunt and cousins took me to the bukid (the mountains) today. My aunt has an investment in pigs up in the mountains so she wanted to see how they were doing. Investing in pigs here is fairly common. It takes at least two people and works like this:

1. You front money for piglets or for breeding (in this case, my aunt invested in breeding since it's cheaper to breed piglets than it is to buy)
   
2. The pigs are now “yours” so you help pay for food and medicine.
   
3. The second person keeps the pig on their land and manages the upkeep.
   
4. Once the pigs reach a certain age, you can either slaughter the pig and sell the meat, or sell the full grown pig directly to another buyer.
   
5. The profit is split between you and the second person.

It's insane how the people that live up in the bukid get around. Motorcycles, motorcycles, and Caribou. The motorcycles they use definitely aren't built for off road traveling, but the people here modify stock parts in order to make it work. The motorcycles here built for two at most, but here in the bukid it's normal to see up to four people piled on one dinky little bike that's chugging along overtaking slower bikes and occasional work trucks. The most intense part was the ride back down. There were three of us, full grown men, riding on one motorcycle flying downhill. All I could think of was F = ma.

Anyway, getting to the bukid is an adrenaline rush. Some trucks might be able to make the climb, but the roads get alarmingly narrow the higher up you go and pavement begins to disappear completely. It'd be more fun just to show you (I was able to film on the way up, but on the way down I definitely needed both hands to hang on):

Mom and Dad: I'll definitely invest in a helmet soon.

Day 10 Dalaguete, Philippines

It's another day off for me here in Dalaguete. It rained pretty hard for quite awhile today. I was raised in Oregon, so I know how hard it can rain when it pours. It was definitely pouring today.

It was steady rainfall like that for several hours.

Anyway, when it stopped raining super hard, I went with Ricky to one of his Brotherhood meetings. Ricky is part of a local group that refers to themselves as the "Brotherhood," and they support the community by organizing beach cleanups, feeding the hungry children, and whatever else helps benefit the community. I'm not sure what Ricky's position is, but all the members "blessed" him when they came in.

Let me explain "blessing." In the Philippines, when you greet an elder (it doesn't matter if you're related to them or not) you take their right hand, palm down, and bring the back of their hand towards your forehead. It's a sign of respect, and during holiday's, the elders will sometimes sit in a line and when the children bless them, the elders give them a little bit of money. I was raised to do this to my parents and to other Filipino's, but it's something that tends to phase out once you get older.

I'm assuming Ricky is the leader because he organized the flow of the meeting and because everyone that came in blessed him even if they were older.

A few nights ago Ricky was explaining how they were going to start raising money to help feed the starving children in the community. They've done it before and they make a type of dish called puspas. It's basically a rice porridge, but they add eggs, meat, and all types of vegetables in order to give it a full compliment of vitamins and minerals. He told me last time they fed close to three hundred children and that I could help once they're ready. I asked him how much it costs to fund a session like that and he told me 5,000 pesos. At the current rate of exchange, that's only $125 dollars. I offered to fund it so they wouldn't have to wait so long. Before I left for the Philippines, I calculated that I would have 4,000 pesos per week, but didn't realize I had another check coming from work. Plus, 4,000 pesos is already more than enough to survive a week here so I'll have a surplus anyway. Besides, if you do the math, it means the price of feeding each child is less than 50 cents!

Ideally, what I'd like to do is propose an outreach program to my work once I get back to Oregon. This is how I envision the outreach program working. I'm going to make a conservative estimate and say there are probably 50 people on the payroll back where I work as a CNA (Avamere Court at Keizer). If every payday, those 50 people donated just one dollar from their paycheck, that would be enough to basically fund one feeding program per month (we get paid biweekly, so $2 per month). In actuality, there are probably more like 100 people on the payroll, so essentially, if those 100 people donated just 50 cents per paycheck (or $1 per month), it would go towards feeding 300 starving children once per month. I know feeding children once per month doesn't seem like much, but imagine what the Brotherhood chapter in Dalaguete could do with 5,000 pesos that wasn't spent towards their monthly feeding program! I'm inspired by the people here because, even though everyone is suffering from poverty, they are still willing to help those who are even more impoverished. Anyway, the feeding date is set for December 2, so I'll make sure to take lots of pictures and videos so I can bring it back and prepare a presentation for work.

Anyway, I'll leave you with a video clip and picture. If you don't like eight legged creatures, you better not look at the picture.

This is what it sounds like outside of the hospital. What is that noise? Frogs, geckos, and probably birds.

Found this sucker between my bed and the wall the other night. It could've easily fill up my entire palm. Not even kidding. I'd been waking up with bites that were definitely not from mosquitoes, so I didn't feel bad for squishing it with my flip-flops. I'm not sure if those bites were from this guy, but I'd rather be safe than sorry. Needless to say, I wrapped myself up in a thin blanket that night and just ignored the fact that I felt hot.

Day 9 Dalaguete, Philippines

Today was my day off, so all afternoon I watched and took notes on these videos:

I'm super glad I found these online because it focuses on the overall grammar of the language. Basically, I  just have to memorize vocabulary and I can start using these rules to start speaking broken Bisaya. One of the most basic, but most important things I've learned by watching these is the general sentence structure:

Verb :: Subject :: Object.
Though, with adjectives, it varies a little bit.

This one rule alone has already helped me pick up on what people here are saying. The second most valuable thing I've learned from these videos is how Bisaya uses existential verbs in sentence structures. I would highly recommend watching the 5th video even if you aren't interested in learning Bisaya because the concept of how Filipinos structure their language is, in itself, interesting.

[Graphic/Weak stomach warning ahead].

We went back to Boljoon tonight to finish celebrating the Fiesta (the Fiesta's last for two days). While I was there I had a very good in depth conversation with a couple of Ricky's friends explaining my reasoning for wanting to help slaughter some animals while I'm here. What surprised me is how they wanted me to understand I didn't have to prove anything. I told them how I felt it was necessary to experience killing the animal if I'm going to eat it, and they told me it's sufficient enough that I understand the importance of killing an animal for survival. They let me know it's difficult to kill larger animals because you can hear them suffer. I think what they really wanted me to know is that, even here, where taking an animals life is an everyday occurrence, the butchers are there in order to prevent people from having to physically kill animals on a regular basis. The butchers slaughter the animals to spare others from having to do so. (This next part will be honest, which means graphic, in order to fully convey my message) The crux of the whole conversation was to point out that the physical act of killing can be less helpful in the long run because it can make it harder to consume the animal afterwards (what's the point of killing the animal yourself if you won't be able to eat it afterwards?). Watching the slaughter is important for understanding the respect you must have for animals. However, physically taking a knife and holding it up against another living creatures neck, then slicing, and watching the animal hemorrhage massive amounts of blood while it squeals in agony mere inches from you -- being the one to actually carry that out isn't for everyone. They also pointed out that, if I fail to slaughter the animal correctly, I'll prolong the animals suffering, which in turn will increase my suffering. I'm considering their words carefully because just watching pigs being slaughtered was difficult. Talking with them has helped me look at butchers here in a totally new way. In a sense, they jeopardize a piece of their humanity so the rest of us don't have to.

Just being here is almost indescribable. There are only a few instance in my life where I can point out I was molded as a person (moving to a public school, meeting my best friends, the deaths of friends, working on cadavers, taking summer physics, and working as a CNA). This will be, and already has been, one of those moments. I've never fully understood my parents because I've never fully understood the Philippines. I know that even after three months, there will be things I'll never fully understand about the Philippines, things I'll never come to know, but I can at least try and appreciate the differences. How will this relate to my career as a PA? If I truly want to understand why I'm driven towards a career in medicine, I have to first fully understand myself.

And I've come to this conclusion:
To know myself, is to know my parents.
To know my parents, is to know the Philippines.

Anyway, bah, enough of that sappy stuff. I'm planning to compile a video comprised of one to two second clips for everyday that I'm in the Philippines. So I'll leave you with a tiny clip of us in Boljoon during the middle of a brown out:

Day 8 Dalaguete, Philippines

It's my Friday! The hospital has decided to let me keep a state side work schedule, so I'll get Saturday's and Sunday's off as well as major holidays. It's starting to feel fairly routine, I know what to do when patients come into the ER. The only thing I'm still nervous about is approaching patients without other nurses present because of the language barrier. I'm starting to catch clips and phrases of the speech easier, but I can't exactly understand an entire conversation. I like listening to the nurses talk to each other because it gives me a chance to work on my bisaya comprehension skills.

I almost got to do an IM injection, but the patient was nervous since I had never done it before and requested that a nurse do it instead. Can't say I blame her. Would you feel comfortable if a foreigner who doesn't even speak the language wanted to stick a needle in your arm?

I spoke with Sister Reginal Pastrana (the head of administration here at the hospital, and the person who graciously allowed me to come volunteer) today and we talked about how the hospital was founded.

Apparently the late Catholic Cardinal of the region witnessed numerous motor vehicle accidents occurring during the transportation of vegetables from Dalagute. He decided to have a building donated for use as a hospital in order to provide primary care and stabilization for serious injuries until patients are able to receive care at tertiary facilities. She wanted me to understand that the hospital here is underfunded, but that in the major cities the hospital are comparable with the rest of the world. I totally believe that, but primary facilities like this one are of immeasurable importance because of the amount of early care given. On a macroscopic scale, hospitals like this keep the entire country healthy because they keep economic highways healthy. What I mean is, places like Dalaguete are where natural resources are abundant (in this case, vegetables), but they are far from bulk populations. By keeping the population of outlying regions healthy, the rest of the country can continue to function.

Anyway, here are some pictures from first few weeks in the Philippines:

Mr. Vonnegut helped me survive the 11 hour flight from Seattle to Korea.

Typhoon helped me out with the flight, too.

My Grandma and Grandpa's house in Cebu City.

Animal feed sold at the market in Dalaguete.

The best way to get around in the city.

Some of my awesome coworkers! From left to right: Lim Lim, Natalie, and Ian.

Me prepping a syringe for a skin test.

This is the girl from my previous post who knocked out her front teeth
in a motor vehicle accident. I'm cleaning one of the wounds here.

After work, Ricky and his family took me to a fiesta in one of the neighboring towns. A fiesta here in the Philippines is actually a celebration for the patron saint of the town. Here's what it looked like: 

That's the closest I've ever been to commercial fireworks! We were probably about 20 yards away from the launching tubes. A few times I could feels bits of material on my face that fell after the fireworks exploded. This video doesn't do it justice, but the fireworks were loud enough to set off a car alarm.