My first day began with an early start, in order to get to the hospital in good time for the Monday morning flag-raising ceremony. A second medical student had arrived later on the previous evening, so it was nice to have somebody whose body-clock was in similar disarray along for the ride. In any case, our bleary eyes were soon opened wide as we took in the sights on the journey over.
The hospital is just a 10-15 minute ride away in a local bus – called a jeepney – which can be easily flagged down from the top of our road. They are reasonably comfortable - at least in comparison to transport I have experienced in other countries - good fun and shockingly cheap (the going rate for a local journey like this is about 12p). Alternatively a taxi would be about ten times this price, which is still pretty reasonable, and the great thing about this is it means you can afford to make mistakes when catching a jeepney to new locations around the city; if you end up in totally the wrong place you can jump out, chalk it up to experience and just jump in a taxi.
Arriving at the hospital was a strange experience. We had been told by Mishie, the Work the World Programme Manager, that “everyone” was “very excited” about our arrival, which is not an idea which sits well with either my natural tendency towards shrinking violetism or my uncanny ability to disappoint. But when we walked into the hospital grounds it was hard to separate those who were expecting us from those who were simply curious at the oversized, sweaty, white person who had arrived in their midst. After a few introductions to people who were doubtless important figures in the hospital, but whose names and faces I instantly forgot in the anticipation of what was to come, we were ushered out for the ceremony. A group of representatives from all the various hospital departments stood respectfully outside the front entrance of the hospital whilst a flag was raised, the national anthem sung, important messages were read out and two slightly bewildered students from England were introduced.
when there are 2 or maybe 3 patients to a bed it is vital that family members are involved in their relative’s care
After the ceremony we were taken on a tour of the entire hospital, minus the infectious wards and the CT-scanner – which is currently broken and awaiting the arrival of “a man from Manila”. It’s hard to sum up in words exactly the impact that this tour had on the two of us, but I think it is safe to say that it was such that if you were to cut our electives short by putting us on a return flight home right now we would nevertheless return with an infinitely enhanced appreciation of the National Health Service and what it has done for the people of Britain.
Easily the most striking feature was the bed-sharing; on some wards there were three patients to a bed! I wouldn’t have even considered this a possibility before today. Then there was the heat...I can’t imagine feeling as ill as some of these people clearly were, in temperatures of around 35 degrees and where it is so muggy that the sweat drips off you continually. And then there is the poor staff to patient ratio; as our tour guide explained, the hospital is only staffed for around 400 patients, at ratios that are already quite unfavourable. So when there are 2 or maybe 3 patients to a bed it is vital that family members are involved in their relative’s care. In some instances, where a family could not afford to hire the necessary machines to support their loved one’s breathing, this meant the relatives had to maintain a round-the-clock bedside vigil, continually squeezing and releasing an air bag connected directly into their loved one's lungs.
After leaving the hospital we went on a jeepney tour of all the important parts of the city. It seems that, although the city is quite spaced out, the Work the World house is in a good central position, from where it is possible to get to everywhere we need to go with relative ease. There is a large mall just a short taxi ride away which is pretty much the same as a shopping mall back home, except it is considerably cheaper and the people in it a fair amount smaller (in weight as well as height – it doesn’t seem like obesity is much of an issue here in the Philippines).
In the other direction is the Downtown area, where you can find banks, the immigration office (you are likely to have to visit here to get a visa extension at some point in your trip), the bus station and the port. And a healthy stroll along the riverside boardwalk is Smallville – which is home to a nice collection of restaurants, hotels, bars and clubs. It is exactly the kind of place I can see medical elective students causing minor dramas on a regular basis, and doubtless too it will be popular with other healthcare students alike.
If there is anything you have forgotten to bring with you, or anything you may require, such as a local SIM card (it is a sensible idea to bring an old phone with you if you have one, although these can also be purchased) then Mishie and Nellie will seemingly bend over backward to help you find it during the orientation. They will also take you out for lunch; we thought it would be a good idea to let them order so we could taste some traditional Filipino fare and we weren’t disappointed with the results. Plus it was good to spend an hour or so talking with them rather than following them around like lost sheep. Today has given me a very good feeling about my placement in general. I can see that some bits of it are likely to be tough, but then again if I wanted an easy ride I would be doing a Dermatology elective in Guildford...
Rob is a 5th year medical student from Barts & The London, Queen Mary's School of Medicine & Dentistry