Mia Davis – 2022 IWU Freeman Asia

The Hospital

This week we continued our experience in the chemotherapy department. We were able to start more patients on their treatment with IV insertions, fluid administration, medication administration, and chemo drug preparation, rate setting, and more. We got lots of practice in this unit and were able to grow in comfortability and confidence with IV starts and IV administration. It was particularly interesting to experience the differences. For example, Cabrini is still waiting on a full safety cabinet because right now they use a single hood (that isn’t always implemented from my experience this week).

This week we also spent a day at station 1 to finalize our case presentation. Last week we picked a patient with CKD, interviewed her, did a head to toe assessment, and gathered information for her chart all to be combined into our presentation. We worked on this assignment in and out of the hospital and learned how to incorporate our Daily Sheet formats with their “case pre” format.

The weekend!

This weekend was out last full weekend in The Philippines! How crazy is that? We spent it with all of the people that we have grown closer to over these last two months. On Friday we took the day off of work, cleaned and decorated our house, and bought all sorts of goodies in preparation for a party for all of our new friends! We invited all of the nurses that we’ve met over the course of our internship. To recap-this has included nurses from Station 1 (med-surge/general ward), OR, Hemodialysis, ER, ICU, and Chemo). We taught our guests lots of games that we would play with our friends and enjoyed one of our last nights with the people that have helped us the most with this cultural transition and experience. Most notably, this night also included by first Balut experience since one of the nurses brought some for us to try. Balut, the delicacy that would make a trip to The Philippines complete, is a fertilized and partially developed duck egg that is cooked and prepared for consumption. It tasted better than I expected but the texture, or the multiple textures, are something to get used to. I am glad that I got to eat it before we left! The rest of the night we had lots of fun, danced, played card games, and socialized. It was a pretty good time – hopefully we didn’t keep our neighbors up!

On Sunday Sir Jeff brought us to SM Lipa to watch Jurassic World and play some games at the arcade. No matter how many malls I’ve seen here I am always surprised by the amount of people and activity going on – especially considering how dead malls are at home. We enjoyed sour cream flavored popcorn during the movie and went straight to the arcade where we played multiple rounds of the basketball game and then watched Sir Jeff win a stuffed animal from the claw machine. It was a good day and a great way to finish off our last weekend of our internship.

working in the hospital

This week we rotated back to our first placement, station one, which is a general ward. Our goal for the week was to pick a patient to complete a nursing care study on. We will present this case on July 26th to a panel from the hospital on the same day that another group of nurses from Cabrini. So, we spent most of our time taking care (passing meds, interviewing, and doing assessments) on our patient and reviewing her chart. It is important to note that at SFCMC the charting is done all on paper – requiring the nurses to be masters at deciphering the code that doctors call handwriting. Learning the new formatting of charting and figuring out what the handwriting said made it much more difficult to get all of the information we needed than it does to get information for our clinical assignments at home. Never again will I complain about having too many buttons to press or information to sort through! Once our patient was discharged we left station one and started our rotation on our very last unit, chemotherapy. We spent the morning taking VS of all the patients that came in. Then, we each started a patient’s IV and once the nurses received the orders we administered all of the meds needed for their pretreatments like hydration (ex: NS, D5W, LRs), diphenhydramine, and ondansetron. Then we used a closed system to draw up the chemotherapy drugs and hooked them up to the patients. We will also be on this unit next week and I am excited to get even more practice and experience with IV insertions, chemotherapy drugs, rip rates, pumps, patient communication, etc!

the weekend

This weekend we Jake, Aileen, and I were accompanied to Batangas, a local beach spot, by a classmate’s family. Ate Melissa, our classmate’s aunt, along with her husband, brother, daughter, and caretaker have treated us to many fun weekends before this. They showed us around Tagaytay, Manila, and now Batangas. We are very lucky to have met and connected with them. On Saturday they drove us about two hours to the beach resort we were staying at. We spent the afternoon swimming in the ocean and the pool. We also took a boat ride with the family. We were able to take in the beautiful view and even swim around and snorkel a little bit! It was so fun! Then, we had a delicious unlimited bbq dinner. On Sunday we had breakfast at the hotel – another buffet. After that, Aileen and I decided to ride a jet ski which was super exciting and fun. We had lunch on our way back to Sto. Tomas at a 60s-themed diner. This weekend was the perfect combination of relaxation and excitement.

Looking forward

As I am posting this I only have 13 more days here in The Philippines. The light at the end of the tunnel is illuminating the many things I’ve learned here and I have started to reflect on this experience’s impact. Over the 40+ days, I’ve had moments of doubt, fear, anxiety, sadness, homesickness, frustration, annoyance, and so much more. Despite this, I’ve also found time to laugh, express gratitude, learn, and overcome adversities. There are many things to take away from this experience and to learn from the Filipino culture and people. I want to spend the last two weeks of this experience soaking it in while also being thankful to have loving people and comfortable home to return to. I think that this experience has made me stronger, and more confident in myself and my skills.

Another week of this experience is in the books! This week we spent a short time in the hemodialysis (HD) unit and a long weekend visiting friends near Manila. Read below for more!

Working in the hospital

As I mentioned, this week we got the awesome opportunity to rotate through the HD unit. Hemodialysis is a treatment modality used for patients with chronic kidney failure. Once a patient needs HD it means that their kidneys, for a variety of reasons, are unable to filter which can lead to excess waste products and fluid. So they get hooked up to a machine that extracts, cleans, and returns their blood for them – it’s basically a robot kidney. In the beginning, this machine was as complicated as it sounds. But, throughout our three days on the unit we were able to grow more knowledgeable and confident with the process. (The nurses on this unit take three months to master these skills before starting patient care) The patients getting HD treatment come in waves (6am, 10am, 2pm) every 4 hours. There is a rhythm to how the nurses work – brief moments of lots of tasks and long periods of observation while the dialyzer is working.

On our very first day, we were able to set up the tubing and prime the lines after we observed the nurses and aids quickly do it before and after each patient. We also got paired with a nurse who we observed cannulate and decannulated patients. On our second day, we started to decannulate patients and I learned the different techniques that each nurse uses as I rotated through the patients with them. We left that day confident that we would not cannulate a patient. To start HD the nurse places two 15-17 gauge needles (more like swords) into a surgically created fistula (I got to see this procedure done as a surgical assist the week before this). Cannulating seemed like a lot of pressure for us students and a lot of pain for the patients. But, we surprised ourselves and took on the challenge of cannulating at least once. It was smoother and easier than I thought and I was really excited that we got to do this! In only 3 days we were able to face our fears, learn the entire process, and help set up and take down the machine.

This weekend

This weekend Jake, Aileen, and I made our way to visit some of the other IWU Freeman Asia interns posted at FNRI. To get from Sto. Tomas to Manila we took one long tricycle ride, one short tricycle ride, a bus, a cab, and a grab (uber). But, once we got there we had just enough time to get to the local mall (SM Bicutan), eat some lunch, and catch a movie! If you know me you know that I am kind of a kid at heart and I love the minions. So, when the opportunity came to see Minions in theaters, I was pumped! It was so good and made me so happy. If you haven’t seen it – you definitely should 🙂 Then we met up with Maddy, Ankush, and Neal to stay with them for the weekend. They hosted some work friends who were lovely to meet and spend the night with. No matter how many people I meet I am continually touched by the kindness of Filipinos. The next day we swam in their pool, went shopping at Greenhills (a popular knock-off mall), and hit up some social spots in Manila. Again, it was so refreshing to be in a city. On Sunday we got lunch with Maddy, a good friend and one of our nursing classmates, and spent most of the day traveling back to Sto. Tomas. This travel included a grab, the bus, and a long jeepney ride which we had stop right outside of Jollibee so we could get a delicious dinner. This weekend was super fun and it was really comforting, exciting, and energizing to see familiar faces. Shoutout to Maddy, Ankush, and Neal for hosting us!

One more week in the books! This week included lots of learning experiences, some stressful events, relaxation, and more.

the hospital

This week Sir Jeff led us through our rotation to the Operating Room/Delivery room. working in the OR this week allowed us to make more connections with the nursing staff at Cabrini, learn the tools use in surgery, see how sterilization is done, and so much more. The coolest thing about this week is that we each got the unique experience to scrub into a procedure and assist the surgeon! This is an opportunity that would pretty much never happen for a nursing student in the U.S. We saw lots of cases from minor excisions, to scope procedures, major surgeries, and a newborn assessment. Personally, I got to scrub in on an AVF procedure. It was meaningful to me because I had a loved one who had this procedure done and I finally got a good picture of what she might have experienced. The surgeon I was assisting was very kind and was genuinely asking me questions about myself and my experiences. Again, something that would not happen very often in the U.S.

Solving problems

Technically the rainy season in the Philippines starts in June. This became obvious this week. Each day around 3 or 4 it downpoured and left us drenched by the time we got home. Usually, I enjoy the rain but this week it caused us a few issues. When we returned from work on Monday we walked in on water flooding into our home from the back door. We spent quite a few hours problem solving and trying to find the best way to get rid of the water that was collecting around a drain that would not drain. We used everything we could find – spoons, forks, syringes, chemicals, buckets, etc. Eventually, we got rid of as much water as we could but were not able to fix the drain on our own. Although the situation was smelly, frustrating, gross, and tiring, I’m proud of how we handled it. The next evening, a kind repairman came and also spent a few hours tackling the drain. We haven’t had any problems since, so keep your fingers crossed that that remains true!

activities

This week we spent a lot of our downtime relaxing and catching up on rest from the early wake-up calls for early surgeries. On Thursday, Jake and I joined Sir Jeff and some other guys from Cabrini for weekly basketball, which I always enjoy. They are all WAY better than me but it is so fun to be able to be active and play.

This weekend we stayed at home making friendship bracelets, hanging out, and watching TV. It was nice to have some time to myself and chill.

This was another week full of adventure while figuring out life in The Philippines! I’ve enjoyed getting to know more people, exploring new parts of the town, learning so many skills in the hospital, experiencing nursing “firsts,” and topping it off with traveling to Manila! You can read more about the highlights of this week below!

The Hospital

This week we had our rotation, led by Sir Jeff, in the ICU. It was my first time working in the ICU and was a really neat experience. It was also my first time working a 12-hour shift (we had two this week). Because of our experience this week, I feel more prepared and confident to start our critical care clinicals next year. We got to care for patients in a more severe state where they require much closer monitoring and are not as autonomous as a gen floor patient is. Some patients were there with infections, seizures, sepsis, TBI, and more. We wore protective PPE when in the ICU and in patient rooms. We became pros at NG feedings since they are done as often as anyone else would normally eat. Along with doing feedings, I assisted in an NG insertion, foley insertion, and IV insertions.

It was neat to see how the status of the patients we saw in the ICU changed. Unfortunately, one of the patients we cared for did pass away. There was another patient there who we had worked with all week but improved so much by the end of it that he could finally recognize that there were a bunch of foreigners in his room. We introduced ourselves and he could communicate (via another nurse’s translation) just a bit! We also saw how the nurses interacted with doctors, patients, and families and could compare how that environment differed from the general ward and the ER.

One of our most memorable experiences was when one of the ER nurses called us down to help in/observe a code situation. We assisted in reviving a 12 yo 3 times until our measures outweighed her physiologic state. I drew up medications, took her blood glucose, and suctioned her trach during the codes. The health care team eventually abided by the family’s wishes and let her pass. After the family had their time with her, Jake, Aileen, and I assisted in performing post-mortum care. It was a tremendously emotional experience to be a part of my first code and patient death, especially with a child.

Weekday Activities

Because we worked two 12s, we were able to take a day off to do a hike with Sir Jeff and his father-in-law! They picked us up bright and early on Thursday morning so that we could beat the Filipino heat. It started with a McDonald’s breakfast and a drive to a nearby mountain. Our plan was to hike up it but we learned from some locals that it is still closed due to COVID. So, we took another “hike” down to Taal Lake. It was 1,500 steps down with beautiful views along the way. Once down, Sir Jeff’s Father-in-law cut down some mangoes for us. We caught our breath, ate our mangoes, skipped some rocks, took pictures, and enjoyed the view. Then, we trekked back up the stairs for our workout of the week. After that, Sir Jeff took us to his family business – a store and a restaurant. I ate some yummy Lomi at their lomi house before they took us to see their backyard – full of livestock like chickens, turkeys, pigs, and more! They even had people climb a palm tree and cut down bukos (coconuts) for us! We hung out with them and made our own buko juice (fresh coconut water, condensed milk, and brown sugar), and ate some hard-boiled duck eggs which were even better than chicken eggs. It was a really awesome day and a great way to break up the week.

Weekend Travel – Manila

This weekend we also found our way to Manila. It was so refreshing to be in a city. Never have I ever even imagined so many malls in one area! Not only were they everywhere, but they were huge! Our hotel was right across the SM Megamall where we happily spent our morning and afternoon watching basketball competitions, shopping, eating, and people-watching. We didn’t participate but we also could have ice skated, bowled, or done archery in this mall! We explored a little of Manila on our own during the day but it wasn’t until one of our classmate’s aunts took us out that we saw more of what Manila has to offer. She brought us to a shopping area and a fun bar/bistro on Saturday night. On Sunday we stuffed ourselves full of all-you-can-eat Korean bbq in, you guessed it, another mall. It was delicious! After that, we visited a knock-off market which was so fun to look around in and see. We also visited a coffee/donut shop to hold us over for the drive back to Sto. Tomas.

We’ve been living and working here for a little over two weeks now. Throughout this last week we have had many new experiences, been challenged, seen lots of new things in the hospital and town. We’ve deepened our new frienships and even created some new ones. We also took this week to try almost every restaurant around the hospital which has been fun. Along with the exciting new experinces of cultural immersion we have also faced adversities.

The Hospital

This week we worked on Monday and Wednesday-Friday (we were off tuesday so our preceptor could spend the day with his family). These four days were much different and more exciting than any other clinical experience I’ve had because we got to work in the ER. I could immediately tell that there was a vast difference in the personality, pace, and work balance in this area of the hospital. While we were there we treated lots of animal bites (with tetanus and rabies vaccines), observed the cleaning and dressing of one puncture wound to the hand as a result of a metal saw accident, triaged a woman who came into the ED in labor, observed sutures get put in and removed, took the vitals of many sick kids, and lots more! It was really cool to experience this area of nursing. We also got to be a part of the station 1 monthly meeting on Wednesday morning. I feel like I learned a lot about patient communication, medications, emergencies, triage, and procedures this week.

Our Activities

During our breaks from work our favorite thing to look forward to is getting coffee/tea at a nearby shop and finding new places to eat (mostly fast food that is dangerously enjoyable). One day our preceptor took us to a stand right outside of the hospital and I ate isaw (chicken intestine), lumpia (egg roll), fish balls, and kwekkwek (quail egg). I enjoyed all of these street foods more than I expected! It was fun to explore some new foods especially with our preceptor, Sir Jeff who showed us how to eat these goodies like a pro. On tuesday (our day off) our friend Kit drove us to SM Calamba and another mall to experience what it is like and do some shopping. We also stopped for pizza before heading home. Of course, I also enjoy our frequent trips to the local store, AllHomes. Thursday night was spent at Sir Jeff’s house where we got to eat, play basketball, and see his business (chickens, pigs, turkeys, etc!) On Friday night I hung out with Jake, Kit, and some of Kit’s friends and got to know them which was fun. On saturday we were picked up by a family of a classmate who drove all the way from Manila to bring us to Tagaytay, a cute and popular town for locals. While there we ate at a great Filipino restaurant with a view of Taal lake, saw the largest puzzle and puzzle collection in the world, explored the People’s Park in the Sky, and ate at Ruined Project while it downpoured. It was so kind of them to take such good care of us for the day.

Hi there! My name is Mia Davis, a rising senior nursing major at IWU. I recently returned from another study abroad opportunity in Hawaii! I just arrived home with what seems like just enough time to unpack, do laundry, and pack it all back up! I am equally nervous and excited about the adventure ahead. Follow along here as I post weekly blog updates on the things I do, see, try, and learn!

Mia