Hello, Iloilo: my nursing placement in the Philippines – part one

My name is Courtney, and I’m in my third year studying BSc (Hons) Nursing (Adult) – Mid Yorkshire Hospitals. I've always wanted to care for people at their most vulnerable. I got the chance during my 28-day placement in the Philippines.

Days 1 and 2

I departed from London Heathrow for the Philippines. It was a 26-hour flight over three planes. On arrival, we had a tour of the house we'd be staying in. A flag parade was held for us - as new students to the hospital - and hospital staff treated us to a buffet lunch.

We were given a language lesson. Speaking Filipino really put a smile on the nurses' faces.

We also got loads of free time during this placement, and you can read about that in part two of my blog, Exploring Iloilo: culture, friendship and village life.

Days 3-6

My first day of placement! I watched two cannulations, administered four units of insulin and discussed vital signs with the head nurse. Then, I completed a full medication round and administered IV antibiotics, plus visited the theatre to watch a tracheotomy and a hysterectomy with bilateral salpingo-oophorectomy.

I then headed straight down to the operating room and floated between three surgeries - a knee realignment, an appendectomy and a hip replacement. After that, I went to endoscopy and watched a bronchoscopy and colonoscopy before coming back up to surgery for the lunchtime medication round.

Days 9-13

I had a mandatory donning and doffing session - where you put on and take off personal protective equipment (PPE) - at a different hospital. Then, after a tour, I was introduced to my new ward, the intensive care unit (ICU). I started on medical ICU observing the medication round at noon.

Then, I spent time on medical ICU and surgical ICU assisting bed baths. We discussed the different procedures they have in place compared to UK. Patients here are ventilated without any anaesthesia and are awake. This leads to patients losing teeth as they bite down on the endotracheal tube.

The nurse explained the paper medical charts and how to log medication. In the UK, this is all electronic. I watched a deep suctioning on a ventilated patient who was awake with no sedation or anaesthesia.

The nurse explained that if a patient has a Glasgow Coma Scale of 3 - meaning they don't respond at all to external stimuli - they transfer them out of ICU to a general ward to be with their family for the patient to pass away. They believe there is no recovery for a patient in this condition and they will die regardless of what the hospital does for them.

Days 14 and 15 

Days off. Read about what I got up to in part two of my blog.

Days 16-20

I spent this period in obstetrics and gynaecology, assisting in labour and delivery. I watched a caesarean section of a 34-week premature baby who wasn’t breathing on delivery. I watched them deliver breaths with a bag and mask before putting the baby on a ventilator.

I also observed the ward and got to see mothers breastfeeding. Bottle feeding is controversial here, as it’s believed all mothers should breastfeed their child. Formula is marketed aggressively but there are hygiene and handling risks when manufacturing.

Mothers share their bed with their baby and look after them independently as no ‘bantay’ (family/friends/neighbours) are allowed. Some mothers had to share the same bed as their babies as they didn’t have the bed capacity to fit everyone in their own.

I observed an ultrasound and watched another caesarean on someone who had already had one. Here, they believe that once a baby is delivered by caesarean, all consecutive babies should be delivered that way.

I also watched a natural birth. The patient was standing by her bed doing squats to try help delivery. When she reached 9cm dilation, they had her laid on her back with her legs in stirrups. This position is no longer practised in the UK now but is still used in the Philippines.

Days 23 - 26

These days were spent in the emergency department at Sara District Hospital. This level one hospital - meaning it's got only basic facilities - had only a 70-bed capacity but hundreds of patients were admitted, either sharing beds or having to sit on chairs in the corridor.

I saw a trauma patient's wound cleaned and sutured. In theatre, a mother suffered a tear during birth and was administered lidocaine. She was then sutured, but could feel the needle and was still in pain.

Back in the emergency room, a patient was put on oxygen and cannulated while seizing. Another came in with a high temperature and benign fibril seizure - the patient's mother used ice in a cloth to help cool him.

I went to a different hospital, also a level one hospital, with 73 beds. Here only two nurses worked in the emergency department (ED). I watched a patient get cannulated in the trauma room and gave him some IV hydrocortisone that I mixed myself. I took a different patient's blood glucose level and watched two paediatric cannulations. There were four trauma patients in ED: one from a jellyfish, one from a motorcycle accident and two from a hit-and-run. 

An hour into my shift a woman in labour arrived. The nurse had to unwrap the umbilical cord from the baby's neck to help deliver the baby. Once he was out they pulled out, they severed the placenta and sutured a small tear.

The anaesthesiologist was over three hours late for the next procedure. I was told he works between multiple hospitals and the operation was delayed until he arrived. 

When I arrived, there were three patients who had been in a motorcycle accident which left them badly bruised and bleeding. There was also one patient in with a myocardial infarction - I took his blood glucose - plus a few other patients with minor illnesses. I saw a caesarean and talked to the staff there and got to hold the baby boy.

Day 27

Final day in surgery! There were two pregnant women there. One was 9cm dilated and the other was 6cm dilated. They would move around and squat down, rubbing their stomach to try progress into labour. But for the duration of my shift, neither of them did.

Day 28

Long flight back home.

See the world. Be the difference.

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