Faith Burgis – 2023 IWU Freeman Asia

Hello Everyone!

This week was a short work week because we spend Monday, and Tuesday in Japan! But, after that, we spent the rest of the week in the ER and giving COVID vaccines.

On Monday (7/17), we woke up early and got on a bullet train to Kyoto, Japan. Kyoto is 279 miles away from Tokyo and would have been a 6-hour drive. But, the bullet train can reach 200 mph and only took a little over two hours! When we got to Kyoto we went to the Arashiyama Monkey Park. This is a park in the Arashiyama bamboo forest where you can see wild Japanese Macaque monkeys! You had to hike up a hill for 20 minutes, in sweltering heat. But, seeing the monkeys and the view was worth it! The monkeys were so funny and cute to watch. We even got to feed some right out of our hands!

After a while, we hiked back down to the town and went to the Kimono forest. The Kimono Forest is an art installation with 600 pillars adorned with kimono textiles.

Then, we walked over to Tenryu-ji. This is a Buddhist temple made in 1339! It is a registered UNESCO World Heritage Site and has an expansive zen garden and palace. It was gorgeous to just sit and take in the gorgeous nature surrounding us.

Next, we walked through more of the Arashiyama bamboo forest and saw some shrines. We even stopped and got banana juice from a stand and it was delicious!

Then, we continued to walk around Kyoto, until we were ready to head back to Tokyo!

Tuesday (7/18), we woke up early and headed to the airport to fly back to Manila. Nothing too eventful happened, just a full day of traveling!

Wednesday (7/19), we went back to the hospital and headed to the ER. Surprisingly there wasn’t much going on. A couple patients came in to get another round of their rabies shots. Animal bites are a big problem in the Philippines due to all the stray animals. And, to fight off rabies it takes multiple rounds of shots, so patients have to come in every couple of weeks to get their next dose. We had a couple workers come in from an accident that happened on a job site, but no major injuries.

Thursday (7/20), we were still in the ER and saw a lot of similar types of patients we saw on Wednesday. I got to try to insert an IV in an older patient, but I wasn’t able to get a patent line.

Friday (7/21), the hospital was having a covid vaccine clinic so Sam and I got to give vaccines. I’ve had the opportunity in the States to work at several vaccine clinics, but it’s always good practice for giving IM injections.

Saturday, and Sunday (7/22-7/23), I think I was still pretty tired from traveling and being on the go. So, I took this weekend to just sleep, lounge around, and not really do anything. Which was a very nice change of pace.

My last week here starts tomorrow!!

Thank you, talk to you next week!

Hello Everyone!

This week Sam and I were in the OR department. Monday (7/10), we watched the end of a laparoscopic cholecystectomy. This operation is performed by inserting a tiny video camera and special surgical tools through four small incisions to see inside your abdomen and remove the gallbladder. Then, we say part of vaginal childbirth. But, the midwife ended up asking us to leave which she explained to us later was because the mother and baby were in distress and she didn’t want us to witness a baby or mother passing away. Luckily, the baby and mother both survived and were healthy. Then, Monday afternoon we went to the ICU and helped take vitals, and bathe patients.

On Tuesday (7/11), We say another C-Section and a total hip replacement. C-sections are always fascinating to watch because they’re surprisingly quick, and it’s always a big relief when the baby comes out healthy. The total hip replacement was my favorite surgery I’ve seen by far! What made this surgery so interesting was that the patient had already had a full hip replacement, but there was some kind of complication. So the surgeon had to remove his already healed, and fused implants from his body, and implant new ones. When the orthopedic surgeon assistant came in to set up the instruments for the operation it could easily have been mistaken for Ace Hardware power tools! The surgeon used hammers, and saws to remove the old implant. And, the operating room looked like a scene from a horror movie, bone fragments and blood got everywhere! We ended up not being able to see the end of the operation because we had to go home. But, it was fascinating to watch.

On Wednesday (7/12), we say another C-section. And then in the afternoon, we watched two circumcisions. In the Philippines, they perform circumcisions when the patient reaches 9-12 years old! So, that was a little odd to watch but an interesting part of their culture to witness.

On Thursday (7/13), there weren’t any surgeries in the morning so we just helped clean and restock the OR. In the afternoon we saw the beginning of a low anterior resection (LAR) with total mesorectal excision (TME). Total mesorectal excision (TME) is a common procedure used in the treatment of colorectal cancer in which a significant length of the bowel around the tumor is removed.

On Friday (7/14), it was the hospital’s 25th anniversary so they had a basketball tournament where all the different units compete against each other. I woke up that morning and wasn’t feeling well so my supervisor said I didn’t need to come in. But, later that night I had to trek up to Manila since we had a flight to Tokyo, Japan at 4 am!

Saturday (7/15) at 2:30 am we left for the airport! We landed in Tokyo at 10 am, the flight was 4 hours but there’s a time difference. When we landed we navigated the train system into Tokyo and explored the area around our hotel until we could check in. The area we were in was called Asakusabishi. We got ramen from a small, cute, local restaurant. Then, we walked across the Sumida River to a real Sumo gym! We couldn’t go in and see the sumo wrestlers but the arena was very impressive. Then, we checked into the hotel, showered, and took a little nap. After our nap, we went and explored Shinjuku. Shinjuku is an area of Tokyo that has a lot of restaurants, and bars. We sat at a restaurant/bar that had a DJ and it was a lively environment and entertaining.

Sunday (7/16) we explored Harajuku, Shibuya, and the Ginza area. We did a lot of shopping, and just enjoyed the energy and busyness of Tokyo. Later that night we went to Tokyo Bay to watch the Sunset.

Hello Everyone!

This week Sam and I were placed on the general med-surg floor. On Monday (6/26), we picked a patient to focus on for the case study presentation we have to give at the end of our internship. We chose an 83-year-old, female, with Hodgkin’s lymphoma hospitalized for pneumonia. In our case study, we have to cover the history of the present illness, past medical history, genogram with family history, social data, lifestyle, developmental history, anatomy and physiology, pathophysiology, lab and diagnostic findings, medical and surgical management, drug regimen information, nursing care plan, prognosis, and clinical management. To acquire all the information we needed for our case study, we performed a full head-to-toe physical assessment and asked her family questions.

On Tuesday (6/27), we continued to work on our case study in the morning. And, then in the afternoon, we watched case study presentations from the health science students at Cabrini.

Wednesday (6/28), we had off due to it being a Muslim holiday. So, Sam and I didn’t do much but we went to the gym and, ran some necessary errands.

Thursday, and Friday (6/29-6/30), Honestly, we did not do much in the hospital. We just continued to work on our case study. Friday night, we met up with Hunter (another IWU intern) in Calamba and then came back to Santo Thomas. Saturday (7/1), Hunter and Sam went to Los Banos to visit other IWU interns, but I wasn’t feeling great so I stayed back.

Overall, this week wasn’t as eventful as the previous ones, but this upcoming week we are stationed in the ER, so I hope that will give us a lot to do!

Thank you! Talk to you next week!

Hello everyone! This week started off slow and relaxing because Monday (6/12) was Philippines Independence day, so we got the day off! We used this as a day to explore Santo Thomas, and get some shopping, and laundry out of the way. On Tuesday we had our first day on the chemo unit! We mostly observed and got to see what a typical day is composed of there. The unit is all outpatient so first, patients typically come in, get their vital signs taken (manual BP readings!), and height and weight recorded. Then, they get a primary IV line put in, and they start running D5W to hydrate the patient before starting the chemo therapy. While the patient is getting hydrated, the Chemo Pharmacist is getting orders from the physician for what medications to prepare for each patient.

The process of mixing chemo drugs is very complex because of how toxic the medication is. First, the pharmacist puts on full PPE (KN95, hair net, double gloves, full sterile gown, and shoe covers). Then, they check what medication the patient is getting, and calculate the dosage. Then, they fill a 50 cc syringe with air to use during the drug mixing process. After that, they turn on the fume hood before opening any of the medications, creating a vacuum to not let any chemicals from the drugs spread in the air. Next, they open the medication and push a protector into the vial. This traps all the air and medication in one place so it can be discarded all together without contaminating anything else around it. Then, an injector in attached to a syringe, and that snaps into a port of the protector, and the medication is drawn up. Lastly, the syringe is connected to an infusion adapter that is attached to IV fluids, then the medication is pushed into the compatible fluid to dilute the drug, and then it is safely ready to be given to the patient. I have attached a picture below of the protector, injector, and infusion adapter.

On Wednesday (6/14), we got to assist the pharmacist in mixing chemo meds, and monitoring the patients. Wednesday was the units busiest day, they saw over 20 patients! I got to give patients IV push, and oral pre-medications. These were anti-nausea, anti-histamine, and a diuretic to help ease the chemo side effects. Before this I was unaware that chemo patients were given a diuretic. But, this is administered because chemo creates fluid retention and edema, so this drug is given to help the patient excrete extra fluid and salt out of the body. But, because of the diuretic patients can become dehydrated, which is why D5W is given pre-chemo, and drinking lots of water in encouraged. The diuretics also cause patients to get up and go to the bathroom a lot, which can cause other health problems, such as additional fatigue, and fall risks because of trying to navigate the IV tubing, and poll. So, it was important to assist and watch patients coming in and out of the bathroom. Additionally, I got to give subcutaneous shots to a couple patients, who received that type of chemo instead of IVF (IV fluid).

Thursday (6/15) was a very exciting day! We went up to observe in the OR because no chemo patients came in that day. In the OR we got to see a Arteriovenous fistula (AVF) created, and a total thyroidectomy! An AVF is a surgically created connection of an artery and vein, this was done on this patient for dialysis access. But, during the surgery a 6.2 magnitude earthquake hit Batangas! This resulted in the operating table, and equipment shaking violently. But, everyone was safe where we were, and the shaking only lasted a couple minutes. But, that was definitely an experience I will never forget! Then, later in the day we got to see a total thyroidectomy. This is when the surgeon takes out the entire thyroid gland. This surgery was also full of excitement because the power went out in the middle of the operation! And, everyone that wasn’t sterile had to pull out their cellphone flash lights to help the surgeon see what he was doing. Luckily, a couple minutes later the power came back on, and the thyroid was successfully removed.

On Friday (6/16) we were back on the chemo unit. I helped take vitals, give medications, and monitor patients. There were only 10 patients that came in that day so we were done by noon. But, it was one of the chemo nurses birthday so she brought in a Lechon (whole, roasted piglet) for everyone to enjoy! After the birthday feast we went back up to the ER to watch a laparoscopic cholecystectomy, which is the removal of the gallbladder. Thankfully no power went out during this operation! Then, Sam got to assist a surgeon in the excision of a patients back mass. And, then once we were done we left from the hospital to catch a bus to Manila!

We got to Manila around 8pm on Friday night, and we met up with other IWU Freeman Asia interns! We all went out to a nice dinner and had a great time. Then, on Saturday (6/17) we explored SM city Bicutan, and hung out in the pool till the sun went down.

Finally, on Sunday (6/18) Sam and I took the bus and jeepney back to Santo Thomas. And now, it is time to prepare for a week on the hemodialysis unit!

Thank you for reading, stay tuned for next week!

Hello Everyone!

I have survived my first week in the Philippines! Before I start talking about my experiences here. I’ll take you back to June 3rd, which is when we left Chicago to fly thirteen hours to Abu Dhabi! Something that stuck out to me on the flight was that the plane had a Mecca location pointer so Muslim passengers were able to pray in the direction of Mecca even in the air! I thought that was a very considerate, and thoughtful feature for the flight company to include. Overall, the flight was not too uncomfortable, I finally started feeling cramped at around the nine-hour mark, but I knew we were in the home stretch so I was able to persevere. Once landing in Abu Dhabi we got a van to the hotel and started exploring!

In Abu Dhabi, all the interns met on the rooftop pool and hung out, and decompressed from the flight. After a little bit, we all decided to try to find something to eat. Surprisingly this was a trickier task than expected! We walked around quite a bit in the blistering heat, and humid desert air before we threw in the towel and just went back to the hotel restaurant. I took a short nap, and then it was time to head back to the airport!

After a little wait in the airport, we started our nine-hour journey to the Philippines! I was able to sleep quite a bit on the plane so that made the trek easier. Soon, we finally landed in Manila! We went through customs and collected our bags. Then we met up with Tito Mon and his son, they gave us some instructions, and then let us go explore the airport while we waited for the other interns to come in. We ended up walking all over the airport just to finally settle at Denny’s for our first meal in the Philippines. After dinner, Kennedy and I decided to get a massage to pass the time, which ended up being the highlight of my travel journey! Finally, the other interns joined us and we left the airport to go to Los Baños. I encountered a bit of culture shock on the drive to the hotel. It was my first time seeing the living environment of some people here, and I started to think I may have been too ambitious in taking this internship, and that I might be in over my head. But, slowly that feeling has been going away, especially when I got to interact with Filipino people and experience how nice, and welcoming everyone is.

On the first day in Los Baños, I went to Breakfast/Lunch with two other interns, and then we met up with everyone else for our orientation with Tito Mon and his family! The orientation was very helpful and made me ready, and excited to go out and experience the Philipines! We learned some common Tagalog phrases and tried Buko Pie (Buko pie is made with young coconuts (buko in Tagalog), and uses sweetened condensed milk, which makes it denser than cream-based custard pies). Some of the phrases we learned were:

• Kuya- older 
•  Ata-older 
•  Aka po ay si= I am 
•  Taga= from – ako P.O.
•  Pakikipag-kapwa tao= getting along with others 
•  Masarap= delicious 
•  Ma-ta-mis= sweet 
•  Ma-a-sim= sour 
•  Ma-pa-it= bitter
•  Ma-al-at= salty
•  Ma-ang-hang= spicy
•  Salamat = Thank you 
•  Para= stop 
•  Bayad po. Pakiabot po. salamat pa.= Iiving payment to jeepney 

After the orientation, we all went to dinner and tried traditional Filipino food. The restaurant was gorgeous with plenty of trees, and even a fish pond in the middle of all the tables. The ambiance added to the fantastic dinner. We ate grilled tilapia (bones, and eyeballs included!), chicken adobo, pancit, sour soup, and of course rice! After dinner, Sam Ocker and I left to go to our home for the stay, Santo Thomas!

On, June 7th we had our first day at St.Frances Cabrini Medical Center! We met up with Sir Jeff (our supervisor in the hospital) and went over more orientation information and an overview of what we would be doing in the hospital. During our internship, we will be getting experience on multiple different floors. They include a general med surg unit, OR, chemotherapy unit, dialysis unit, ICU/NICU, and ER.

This first week we spent most of our time in the general med-surg unit. But, when we had the opportunity we would go up to the OR. Sam and I both got to insert multiple IVs! We also got to watch two colonoscopies and a C-Section! The C-Section was fascinating, I learned that they insert a Foley catheter into the patient to drain the bladder to make sure it is not in the way during the operation. I also saw all the different layers of skin, fat, and muscle the surgeon has to cut through to finally get to the baby. Another shocking detail about the C-section was that from the first incision to the baby being removed it was only 20 minutes! I am so grateful I got the experience to see this operation and feel that I learned a lot. Also, happily, the mother and baby boy were both healthy and happy after the C-section!

Finally, here are some observations I have made about the differences between the Philippines and the United States. First of all, Filipinos are very happy people. Everywhere you go people are smiling and waving at you. Also, respect is super important. Everyone you meet we call ma’am or sir. It is also especially important to respect doctors in the hospital. Every time a doctor walks into the room everyone greets him or her even before they look up or make eye contact with anyone. it is also important to offer up your seat to the physician. Also, outside of the hospital it has become common for people to take pictures and ask to take pictures with Sam and me. Aside from customs and personality differences. The hospital is quite different from any I’ve had clinicals at in the States. First of all, the hospital is mostly reliant on paper records. While most hospitals in the states are paperless. There is also many more dialysis patient than I have ever seen in the States. I asked Sir Jeff and he said this is most likely due to the Filipino diet being high in sodium, and other unhealthy life habits. But, to conclude on a sweet moment, when Sam and I were walking around our neighborhood we passed a little girl, and her older brother. As we walked past I overheard her say to him “They look like the people from the movies!”.

Overall, this first week has been very educational, and I can already tell this will be a life-changing experience!

Stay tuned for next week’s update!