Cara visited the Western Visayas Medical Centre in the Philippines
"I was awarded the Outstanding Student Nurse of the Year award for my dedication to mental health services, particularly those for children and young people, which I demonstrate through many hours of voluntary work helping to develop services around the south of England. My scholarship funded a four week trip to the Philippines, organised through Work the World. They arranged for me to spend three weeks in the Department of Psychiatry and one week in the Emergency Room of the Western Visayas Medical Centre, a small government funded hospital in the city of Iloilo.
"The first thing that struck me when starting placement at the hospital was how incredibly welcome I was made to feel by both staff and patients. Although English is widely spoken there was still a language barrier at times, and despite how busy the wards were I was always included and made to feel as though I was part of the team.
"My days started with riding a jeepney (the most common form of public transport) to the hospital, arriving to start work at 08:30am. Although I arrived promptly each day it became clear over time that starting times are quite flexible for the nurses and doctors! Handover began around 9:00am then medication was dispensed. All medical notes and handovers were in English so I was able to learn about patients their histories with ease. The history taking was incredibly detailed, perhaps even more so than in England, and I was very impressed with how much information was available for each patient as it really helped with getting to know them. A daily exercise class ran after the medication round, which everybody took part in. Throughout the day the patients would then be provided with various activities such as drawing, jewellery making, and a favourite of the Philippines, karaoke.
"I was able to attend two case conferences delivered by the junior psychiatrists, which were again presented in English. A ‘typical’ diagnosis for someone admitted to the ward was bipolar disorder or schizophrenia but there were also many people with substance misuse difficulties, a widespread problem in the Philippines. I was surprised to learn that the evidence base staff use to plan care is up-to-date and relevant, and that they use the same diagnostic tools as we do. The doctors and nurses were very knowledgeable about their field and it was apparent that hierarchies between professions didn’t seem to exist.
"The particularly interesting aspect of learning about the knowledge and evidence base the staff used was seeing how the lack of resources made it impossible for them to put what they knew into practice. As in our health care system, mental health is incredibly underfunded. However, I don’t think I appreciated quite how deprived the hospital would be, and consequently what impact this would have on the DoP. The ward consisted of 20 wooden beds with no mattresses, although sometimes extra beds would be placed in the corridors. Each patient had to have a member of their family with them at all times called a bantay, or ‘watcher’, so the beds had to sleep two people or the watcher slept on the floor. Each side of the bed had three holes which were used to tie strips of fabric through, as very unwell and distressed patients were tied to the beds if they became aggressive or at risk of harming themselves. Although I was made aware that this practice occurred before commencing my placement, it was still very difficult to witness first hand as it could be quite barbaric and goes against everything we learn throughout our training at home. Although this practice isn’t something I agree with, I was able to rationalise it by accepting that there were not enough nurses or facilities to keep some of the most unwell people safe, therefore they were working with what they had available to them.
"The role of the nurse is quite different in the Philippines as much of the care, other than medication, is delivered by the watcher. There is no Mental Health Act or similar legislation in place, therefore the doctor has no say as to whether a patient is admitted or discharged. It is up to the watcher to decide whether to admit or discharge their family member, and if the watcher refuses to stay, the patient must go too. As the hospital is government run it is free to have a bed on the ward. However, although medication is subsidised, it is still expensive, and food and drink is not provided. The watchers would go to the onsite pharmacy to buy medication for their family member, but often could only afford one or two tablets at a time. Unfortunately, the inability to afford medication is what lead to frequent relapses and repeat admissions for many of the patients on the ward.
"What struck me most about the people admitted to the ward and their families was how incredibly grateful they were to be receiving help and how they made the most out of every situation."
"I saw people in extreme poverty sharing food, water and blankets, people of all backgrounds supporting each another and doing activities together, watchers offering each other respite. There was no discrimination on any level; they were all in this situation together and were going to make the best of it, and it was kindness on a level that I hadn’t seen before.
"My short time in the ER was also eye opening for different reasons. Mental health nursing students have all placements within psychiatric services, so although we become experts in our field we have little exposure to anything above a basic level of physical health care. Knowing this would be my only opportunity to experience nursing like this, I jumped at the chance to get involved. I was part of a resuscitation team within 15 minutes of my first day, and although unfortunately the patient didn’t survive, it gave me a chance to actually observe and use my immediate life support skills in practice, something which I think will be invaluable for me to carry forward with me. I was also present for a number of clinical procedures and was even invited into the trauma department to observe a man who had lost his hand receive pre-surgical care.
"Despite working within challenging conditions I felt very sad to be leaving the hospital on my last day. I had a lovely send off in the form of a song from the patients in the DoP who also presented me with drawings and handmade bracelets."
"When not at placement I was able to explore the city I was staying in and surrounding islands, all of which were breath taking. One of my favourite visits was to the SOS Children’s Village, an orphanage about an hour from our house. We took along toys and books and I expected to find myself somewhere very sad. Instead what I found was a beautiful little community of large houses; each one occupied by a ‘house mother’ and her several foster children. Many of the children came from extreme poverty and were orphaned or removed from their families at a young age, but were now able to be cared for in a wonderful environment where they could go to school and play with children their own age whilst being looked after in a family environment. It was important for me to have this experience as working with young people is something I feel very passionately about and I know how important the early years of life are to future mental health. It was reassuring to see that children who had such a difficult start in life were now somewhere so safe and supportive.
"I have never found myself surrounded by so many generous and welcoming people, something which made my trip all the more unforgettable. Thank you so much to Cavell Nurses Trust for giving me this opportunity that will not only undoubtedly enhance my practice as a nurse, but also allowed me to be opened up to so much kindness, something I hope to hold on to for many years to come."
Cara was the 2016 winner of the Outstanding Student Nurse Award. To find out more about our awards and to apply, please click on the link below:
Cara studies Mental Health nursing at the University of Southampton. Find out more about being a nursing student here