The last 2 weeks I've been observing various procedures in the OR and helping the nurses as much as I can. Some surgeries that I've observed include: cesarean sections, a vaginal delivery, cataract removal, hangnail/toenail removal, wart removal, tubal ligation, laparoscopic inguinal hernia repair, fibroadenoma removal, dilation and curettage, endoscopy procedures, wound debridement, laparoscopic cholecystectomy, and an AV graft placement. I was able to do some hands-on patient care such as post-op vital signs and newborn hearing and screening tests. In the OR, I also assisted the nurses and surgeons by adjusting lights and adding instruments to the sterile field.
The OR nurses are very resourceful and flexible. Since Cabrini is a smaller hospital, pre-operative care and post-operative care are both done within the OR. The same nurse is responsible for prepping the patient for surgery, scrubbing into the surgery, documenting the surgery afterwards, doing post-op monitoring/vitals, and then discharging or transferring the patient to the unit. There is also usually just 1 circulating nurse that rotates between multiple surgeries at a time. For the most part, sterility is maintained, but they aren't as conscious about sterility compared to ORs that I've observed in the US. Several times I witnessed a break in sterility; both by the nurses and the surgeons. Doctors are revered so if a nurse would question a surgeon it would be frowned upon. They are also much more relaxed about counting instruments and sponges. It's not taken as seriously, but they reported that it's rare that something would be left inside a patient. Overall, the healthcare team recognizes that policies and procedures could be better, but it's hard to act upon it due to lack of resources and personnel.
The nursing shortage is ever present. The most qualified and best nurses usually go abroad to earn a better salary and then send money home to support their family. As reported by a physician, this then leaves nurses who are less-qualified to work and sometimes provide suboptimal care. 9/10 nurses that I've talked to are in the process of going abroad to work. It's alarming because the Filipino government isn't really trying to do anything to increase the salary of nurses. The government is actually trying to pass a regulation where nurses must work in the Philippines for at least 3 years before going abroad. This might aid in retaining nurses for a longer period of time, but it does nothing to fix the core of the problem... which is inadequate pay. The nurses are shocked that I would want to come and observe in the Philippines because their desire to leave is so strong. It humbles me knowing how fortunate enough I am to be a nursing student in the US. Any of these nurses would jump at the opportunity to be in my position. With that being said, to be a nurse in the Philippines you truly have to love what you do. Despite not paying close to what they deserve, the nurses are compassionate and do their best with the resources provided. These nurses are creative and always look for alternative solutions. They truly are patient advocates and try to lessen the financial burden of healthcare as much as possible.
With that being said, insurance is a luxury in the Philippines that many people don't have. A majority of medical care is paid out of pocket. Even people with good, well-paying, stable jobs don't have insurance. As someone with a chronic medical condition, I can't fathom having to pay out of pocket for my medical supplies and treatment. Since Cabrini is a private hospital, medical care is extremely expensive. Cabrini is even more expensive than some of the private hospitals in Manila. Transplants are also a luxury many people simply can't afford. Many people participate in "medical tourism" and seek transplants or treatments in other countries. There's also a stark difference between the private sector and the public sector of healthcare. Government hospitals (public hospitals) are often inundated with patients and wait times are astronomical. Care is adequate, but the goal is to save as much money as possible, especially since many patients can't afford healthcare. For example, if someone comes in with a smashed finger it would be preferred to simply cut-off the finger in the ED rather than go to the OR and us anesthesia to save time, resources, and money. Even at Cabrini, the goal is to save money for the patient. For example, I observed an AV graft placement done under local anesthesia instead of general simply to save money. The procedure to place an AV graft is pretty invasive and you could tell the patient was in pain despite the lidocaine. Even the surgeon stated that he'd prefer to do the patient under general anesthesia. If someone were to go to a government hospital and couldn't afford treatment, the government simply absorbs the costs. The Filipino government is working on universal healthcare, but it's a long process that doesn't seem feasible in the near future.
As you can see, the Philippine medical system is a work in progress. Despite being a work in progress, care is still being adequately given. It might not be up to the standards of the US or other developed countries, but they make do with what they have. The doctors and nurses that I've observed are highly trained professionals who know what they are doing. Despite the barriers they have to delivering healthcare, they make do with the resources that are available and deliver the best care possible. Since the Philippines is a developing country, many people might have some misconceptions on the quality of care provided by healthcare providers. However, much of the time the quality of care if just as good as anywhere else. Modern equipment is still utilized and doctors and nurses (at least in the Philippines) are trained similarly as healthcare providers in the US. The Philippines might be a little behind in terms of modernization but the quality of care is still present.
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