My role in the hospital in The Philippines was totally different to working in the UK. For the first week, I spent time in the X-ray Department, which has two X-ray rooms — one fluoroscopy and one CR/DR room — both located in the Emergency Department. While I’ve been here we’ve seen an average of 200 patients per day.
The Fluoroscopy room is used for special procedures like barium swallows, colonograms, cystourethrograms, and IVPs to name but a few! The X-ray department provides 24/7 services to local people, mostly from low-income backgrounds. The majority of diagnostic services like X-ray and CT scans aren’t free, but still cost half of the price you would pay in a private hospital here.
I’ve also been shown how to use an automatic processor in the dark room, which is now officially a piece of X-ray history. The automatic processor was used to reduce film processing time when compared to manual development. It’s amazing to know that it was still used as recently as a year ago. It really shows the difference in the speed of progress when compared to the developed world.
New technologies were introduced to the hospital last year. Now, both rooms are equipped with CR/DR Shimadzu Carestream machines.
The condition and functionality of the machines in the hospital varies. There’s one operational CT machine in the department, yet the MRI machine has been broken for a while due to the problems with its power supply.
The Radiotherapy Cobalt suite hasn’t worked for over two years and local people have to travel as far as Manila to get the required radiotherapy treatment. It’s a real learning experience to see how amazing the local professionals are at performing their jobs the limited resources they have.
There is, however, good news on the horizon. A mammography machine is just being brought in from from China and will be installed within the next few months.
During my working X-ray week, I noticed significant differences from my placement back home. Apart from justifications and protocols being different to what I am used to, there were differences in the way things were done — for example manual handling, patient privacy, infection control, and radiation protection.
What’s more, families were bringing patients into the room and assisting in patient positioning, manual handling - and on some occasions holding patient during the exposure.
Not many of the patients spoke English, which made communication challenging. Learning basic Hiligaynon — the most commonly spoken local language in Iloilo — helped, but understanding patients’ detailed responses to my questions was difficult. However, all the staff were really supportive, and spoke to me in excellent English when translating on behalf of the patients.
I have also noticed that radiographers here don’t have much communication with the patient during the positioning, and very few instructions are given to the patient before the exposure.
As I said before, the radiographer would position the patient with the assistance of a patient's relative. There were various trauma patients on the trolley that came from wards with relatives, as there was a shortage of doctors.
Trauma patients were positioned and moved by the Rad Techs. The reporting radiologists were based in the department next door and worked long hours — sometimes 24-hour shifts and up to 60 hours per week.
The radiologist on duty handled reports for CT and X-ray, special procedures (interventional radiology) and Ultrasound, plus answered patient questions and other staff queries during the reporting sessions.
At first, the way things were done surprised me, but I soon came to realise that all staff are totally aware of safer procedures, just lack the resources necessary to carry them out. It makes me feel very fortunate to have such a comprehensive nationalised health service back at home. I really admire the staff for working so hard, such long hours compare to what we’re used to.
In my first week I saw a lot of trauma patients (the majority due to a RTA) and many patients with pulmonary tuberculosis (TB). I have noticed that the majority of the patients had conditions not normally seen in the UK. Also, due to the cost of healthcare, patients often can’t afford to come to the hospital in the first instance, and see it as the last resort.
It was an emotional experience and I felt grateful to all the staff who worked so very hard with such limited resources to provide the best care they can for the patients. All the staff are very experienced and I've actually learned many new positioning techniques. I’m also grateful to all the staff and local students for working with me and helping me along the way — I felt immediately immersed into the Filipino culture.
I’m excited that I’ve still got a week left in The Philippines, so I’ll report back when the week is out to let you know how the last days went!
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