Aaron Becker ’17 – I recently had the privilege of taking part in a medical internship for the month of June in the Philippines through Child Family Health International. CFHI is dedicated to providing community-based global health education programs, which focuses on empowering local communities. The entirety of my trip was focused on global health, the Philippines’ healthcare system, public health, and community health. For the first week of the program I had the opportunity to visit a number of different healthcare facilities in Manila, the capital of the Philippines. I was joined by two other undergraduate students, Sara and Zoe, from New York and New Jersey. We were guided by two doctors, Dr. Paolo and Dr. Joel, through places such as the Department of Health, World Health Organization, University of Saint Thomas medical school and hospital, Philippines General Hospital, University of the Philippines medical school, and even the smallest volcano in the world at Tagaytay. The time that I spent in Manila was incredibly eye opening. I was able to try all kinds of different Filipino foods, visit a number of different malls, ride in Jeepneys, see historical sites, and of course visit the different health care facilities. Perhaps the most memorable part about seeing the different healthcare facilities was the stark contrast between different wards in Philippines General Hospital. On one side of the hospital there were wards that were only for patients covered by PhilHealth, their national healthcare coverage. These had no air conditioning, heavily crowded rooms, and insanely long lines. We met one patient that had been there for five hours and was only just getting seen to have his x-ray examined to be cleared for work. Yet, in another section of the hospital, there were wards for patients who paid higher premiums for their coverage. These had air conditioning, nicer waiting rooms, shorter lines, and smaller room for greater privacy. It was shocking to see such obvious differences in provided facilities for those who were able to pay versus those who could not; especially considering that the wards were in the same hospital where those who couldn’t pay could see.

After the first week in Manila I spent the next two and a half weeks in the remote island town of Quezon, Quezon. We were guided and instructed by Dr. Jana and the group of nurses and midwives that she worked with. Our time was spent shadowing Dr. Jana and the nurses as they handled consultations, emergencies, and child births. We were able to travel throughout the island by motorcycle/tricycle with the nurses to visit smaller health stations and reach even more remote regions. A typical day consisted of shadowing the nurses from 8 AM to 5 PM at the Rural Health Unit (RHU). However, we also took trips to Barangay Health Stations (BHS) with one or two nurses to reach patients even closer to their homes. These are smaller stations that are located within every Barangay, which are smaller sections of the town. Patients presented with a variety of different health concerns but some of the most common concerns included: high blood pressure, high cholesterol, cough, cold, fever, and prenatal checkups. However, the most interesting thing that I was able to witness was a live birth. The RHU has a side building dedicated to births and caring for mothers before and after they give birth. The room itself has no air-conditioning and no windows making it the hottest room I have ever been in. Fortunately, even in the extreme heat, Dr. Jana and the nurses were able to deliver the healthy baby without any incidents. Seeing a baby birthed did not make me want to be an OBGYN, but it was certainly an amazing thing to witness.

Another highlight from my time in Quezon was being a part of their first ever dengue virus school vaccination. Like malaria, dengue commonly spreads through mosquito bit, and can cause intense fevers and rashes. Dengue has just begun to emerge in the Philippines and the vaccination has only recently been developed. We went to three different schools to administer the vaccinations and ensure that each of the students received a card detailing their follow-up dates. Though the three of us were not able to actually give the vaccinations we were still able to assist the nurses in preparing them and interact with the children. This was my first real taste of having to honor medical ethics outside of the United States. Though I likely could have easily administered the vaccinations I agreed with CFHI’s stance on having us not administer them. It made me feel a bit useless at times not being able to perform the regular tasks of the nurses, but it was certainly an important lesson in ethics and humility.

The trip has transformed me in a number of ways. First, it has given me confidence in the kind of medicine that I want to practice. I am much more certain that I want to be a family physician and that I want to work in a community setting. It was incredible to see how influential Dr. Jana was on the island. Everyone recognized her as the town’s doctor and trusted her to care for them to the best of her ability. They knew that she was a part of their community and had a genuine concern for their health; that’s the kind of setting that I want to be in. Second, this trip has taught me a lot about the influence of religion. The Philippines has a majority of Catholic followers and it has a strong effect on government policy. The church had recently shown its disapproval of a healthcare bill that would have provided greater access to contraceptives and lobbied to have to bill blocked. The bill did end up passing, but the budget for the bill was slashed, making it nearly ineffective. Whether or not this decision is morally right, it is interesting to see how great an impact the Catholic church has on the Philippine’s government in comparison to the United States’ government. My religious studies at Wabash have mostly covered religion’s impact relative to America and seeing its effects on the Philippines has broadened my understanding of its impact. That leads me to my third take away: perspective. I have never had the chance to see healthcare, culture, and life in general outside of the United States until this trip and it gave me an entirely new outlook on all of them. My perspective on global issues and topics had been fairly shallow due to my lack of global experience. However, now that I have had the opportunity to live in and experience another country I feel much more prepared to consider global issues. In particular, this trip has made me consider our healthcare system, what can and should be done to improve it, while also giving me a better appreciation for the strengths that it has. My experience in the Philippines will be one that I never forget and will take with me no matter what career path I end up taking.