Saturday, February 27, 2010

Palawan - Underground River

Our third and final day trip in Palawan was to the Puerto Princesa Underground River tour. The river itself is called the St. Paul River. Roughly the final 8 km of its length is through the cave of limestone and marble. The Puerto Princesa Underground River is vying to become one of the New 7 Wonders of Nature. Everyone should go vote for it. I think it's in 13th or 14th place right now out of 28 finalists.

Our Underground River trip began at about 8. It is about a 2 hour drive to get the river from Puerto Princesa City proper, although the entire trip and the river itself are technically in city limits. In fact, Puerto Princesa City covers a large portion of the central part of Palawan from one coast to the other. The road to the river took us past Honda Bay again and then wound up through the hills and eventually across the island to the other side and to the north. Our tour guide joked with us when we started out that there was a free 5 minute massage included in our trip-part of the road isn't paved, it just has mostly gravel and larger rocks. Actually, I was impressed with the condition of the road in general, especially closer to the city proper. There were guardrails when necessary and most of the road was paved with concrete, however, some of the turns were a little tight. My legs and arms were definitely a little tired by the time we got to the river and when we got back to our resort in the afternoon because I was using them to balance myself the entire time.

When we arrived at our destination, we registered and were told that our boat from the Sabang Wharf to the mouth of the river would be leaving at 1:30. It was only 10:00, so we went to another river nearby, within walking distance. Here the locals give tours in small boats to the people waiting to tour the underground river. This river water is brackish (essentially a mix of fresh and saltwater) and therefore Mangrove trees line the banks of the river. The tour lasted about 25 minutes and included our tour guide singing the Mangrove tree song complete with the Tagalog and English versions just for us that has probably been passed down in their culture for many years. After that we ate dinner which included more Pansit (which I like), pork, chicken, fish, and of course rice. Then it was about time for us to walk back to the wharf and get on our outrigger boats for the 20 minute ride to the mouth of the river. This ride on the South China Sea was definitely in the open more and was a lot more wavy than our ride in Manila Bay to Corregidor or our ride in Honda Bay. Once we got to the mouth of the river, we waited about 10 more minutes and hopped on a much smaller boat. Once again it was just us and our tour guide. Our tour guide was very good and made sure to point out the formations inside the cave that have been named over the years. There was the Virgin Mary, the Three Kings, the Holy Family, and yes, the Sexy Lady. There were also a lot of bats. Abi had her big flash along that worked sporadically, but we still have probably 20-30 good photos inside the cave. The tour itself last 45 minutes and tourists are only allowed to go into the cave up to 1.5 of the 8 km. From there we got back on our outrigger boat and headed back to the wharf. Once there, we bought some drinks from the vendors, jumped in our vans, and headed back to our resort.

That night we decided to stay in at our resort and spent some time in the pool. Our resort opens to the public most nights, and there was a birthday party there at the pool with kids running around with noisemakers. One of the boys liked us and was trying to show off for us at the pool and while we were eating with his noisemaker. They were all pretty cute kids.

Palawan - Honda Bay

We woke up right on time at 6:30.  We had breakfast set for 7am, then were getting picked up around 7:30.  We weren't sure which tour we were doing so we had to double check, then go change into swimming suits for the Honda Bay tour.  Our breakfast choices were 'Filipino' or 'American'.  We both played it safe with the American breakfast - toast, scrambled eggs, ham (spam) and coffee.  Yes, Bry tried the Nescafe fake coffee and he actually liked it. 

Our van picked us up a little after 7:30.  We were #'s 5 and 6 to get in - a group of 4 Filipino accountants from Makati joined us.  We headed to the Honda Bay wharf which took about 20 minutes.  At the wharf we bought bread to feed the fishes, an underwater camera (Erica- they actually had them here!  They were like P900 though) and rented snorkel gear from our tour guide, Gloria.  Then we loaded into a small banca or outrigger with two balancing bamboo branches on either side.  It had a questionable motor and two questionable banqueros, but we made it out to the middle of Honda Bay. (BTW, Honda is pronounced " 'Onda", drop the H.)  For those of you astute readers, Honda Bay was the site of an Abu Sayyaf kidnapping raid a few years ago.  They targeted a ritzy resort in the middle of the Bay, all by itself. We have been totally safe and are staying in town just to be sure.

Our first stop was not an island but a large area of preserved coral reef.  Dynamite fishing has been banned in this region so the reef is pristine.  This area is part of the coral triangle and has some of the best snorkeling and diving sites in the world.  We dove right into the water and didn't have to swim far to find an amazing variety of fish and many colored coral.  We got to paddle around here for about 45 min and had the place to ourselves for over half of that time.  It was really neat.  Bry enjoyed his first attempt at snorkeling.  We had to wear our life jackets the whole time so that no one could dive down and disturb the coral.  (Our tour guide mentioned Koreans by name.....maybe they're more prone to disturbing the coral???!)

Our second stop was Pandan island.  Pandan is a type of tree that is common here in the Philippines.  The island is one of the only ones in Honda Bay to have its own water supply.  The whole island is set up for tourists with canopies and huts to use.  Soft, white sand beaches with crabs, shells, crystal clear water.....it's perfect.  We left the other guests to take pictures and have a walk on the beach.  We found sand dollars and crabs all over the beach.  Then we hopped in and went snorkeling again.  This time we passed people who were surrounded by hundreds of fish - they were feeding them the bread!  Our guide and the rest of the guests joined us in a little bit and they gave us some bread to hand out too.  Hundreds of fish would swarm around you - many different varieties and it was pretty neat.  Here we didn't have to wear our life jackets so we had some more freedom.  The only problem was that the fish couldn't discern between pieces of bread and white-people-toes - we got a few nibbles ourselves.

We ate lunch next and had a great meal of rice, pork, fish, squid, chicken, and sea grapes.  While these veggies look amazing (like long bunches of mini green grapes) they burst in your mouth leaving a stringy, salt-watery clear mucousy goo behind.  Not too appetizing.  Bry DID try some - so be impressed.  He also got to try some coconut - for P25 I bought him a coconut and he had a true island experience.

After lunch we headed to Snake Island.  We only had about 40 minutes here since the other people had to catch a flight.  We shared our bread with them and were once again surrounded by fishies.  The water was clear again, super nice.  We really had a nice time and enjoyed the boat ride home.

When we got back to Kawayanan we realized one mistake:  While applying our sunscreen liberally to our faces, we forgot that we would be on our BELLIES the whole day.  Both of us had burned the backs of our legs pretty good, Abi's shoulders too.  Duh!  And let's go sit on a plane for a couple hundred hours now too!  Oh well, hopefully the burn won't last too long.

For dinner we headed into town.  This was another adventure since the local transportation is a Tricycle.  This is a motorcycle with a Larry-Boettcher-type contraption attached to it to hold other people.  We sat in the cramped space and bargained with the driver to take us to three stops: 1) the bank to get some cash 2) the grocery store to buy some water 3) Badjao Seafront Restaurant.  Once again, it's a good thing I had a map along because there are 2 places named Badjao - and we had to turn around.  This tricycle thing is a little scary, especially since Abi's back was facing front.  In case of accident, I told Bry, I would most definitely be paralyzed.  Anywhoo, we made it to the restaurant.  This place wasn't kidding when they said "seafront", it is built on stilts out ON the ocean.  There are tons of Mangrove trees growing along the walkway and it's a gorgeous place for sunset.

Palawan - Day 1

We made it!  We're in Palawan.  It is truly gorgeous - reminds me of the Big Island on Hawaii except larger and more mountainous.  We have already been able to see a lot and are having a terrific time.  My pictures aren't uploaded yet, we're focusing on our vacation, but I wanted to update the Blog a little bit so my mom doesn't alert the authorities......

The flight was short and sweet.  Of course, our taxi driver tried to cheat us - I asked to use the meter and he got pissed so he kept on adding cost to the trip - I could see him!  I was so mad at the end that I wanted to say something very mean, but I didn't want Bry to leave me so I reigned it in.  The domestic terminal is brand new and SUPER nice so we enjoyed our 2 hour stay there before the flight.

Palawan is a series of islands that just jut up out of the sea.  It's pretty incredible from the air.  The airport is a single runway and single baggage claim, pretty rustic.  We had a very nice reception from Joy from Kawayanan Resort.  Kawayanan means Bamboo in Tagolog.  The driver was very nice and Joy pointed out some landmarks as we drove to the resort.  We got a double bed with private bath and A/C.  The pool is super large and very nice - pictures to follow.  We dove right into the pool and had it all to ourselves on Thursday morning.

At 1:00 we were picked up for the Puerto Princesa City Tour.  We were joined by a very nice Filipino couple - she was a flight attendant.  We visited the wharf, the bay, a church, the site of an American massacre during WWII, a weaving place, Irawan crocodile farm, Irawhig Penal Colony and a large ranch overlooking Honda Bay. Yeah, it was a lot, and we kinda felt rushed to get out, snap a photo, buy a souvenir and get back into the van.  It took just over 3 hours so we got back to the resort in time for dinner.  We ate dinner right there in the resort and it was pretty good.  Bry was introduced to my dear friend, San Miguel Pale Pilsen.  He also became a fan.  We were feeling pretty beat so we hit the hay early on - around 7:30.  Not to worry - we had an alarm set and enjoyed almost 11 hours of sleep before waking up.....

Friday, February 26, 2010

Corrigedor II

We got up early at 6:05.  We quietly got ready to go so the roomies could get some sleep on their last day.  We left for the ferry around 6:45 and this time Bry saw Manila  in daylight.  The street-folk didn't disappoint and he got the full feel of morning in a developing country with whole families eating breakfast on the sidewalk.  The traffic was a bit crazier this time too.  We got to the ticket place just after 7 and then waited for the boat to leave at 8 am.  (They say to be there at 7 so that people on "Filipino Time" will show up by 7:45.)

Bry enjoyed the boat ride and got to see just how big Manila is.  The skyline is HUGE - like if you took downtown Chicago and stretched it out for over 5 miles.  Awesome.  As we got out further we could see the smog line too. The rest of the boat ride we spent outside on the back of the boat, enjoying the view.

Arriving at Corrigedor is pretty neat.  It was once a US base - a pretty sweet gig before the war.  They said over 15,000 US and Filipino troops and Civilians once lived there.  Our guide was again Steve - the same on I had before.  He was terrific and we were happy to join his tour.  Well, Bry was, anyways.  Who could have guessed that the first day I see my husband he finds a history loving - conservative - Twins baseball fan --- in the Philippines???  Bry and Steve hit it off and they had a wonderful "date."  (Abi nearly asked where Mrs. Steve was so she could have someone to talk to too!)  Bry really enjoyed the whole tour, and a lot more sank in for Abi her second time around.  Got some great photos because there were hardly any people there to ruin my shots.

After the tour (with lunch and a light-and-sound-show in Malinta Tunnel) we headed back to Manila.  Bry got to meet the Roomies and Abi got to pack her big suitcase to send back with them.  The roomies were split about where to get dinner so 3 went to TGI Fridays and 4 (Bry too) went to Kashmir - our new favorite Indian restaurant with the best Mint Chutney in the entire world.  We had a relaxing time and then walked Bry through PGH grounds.  I took him into the ED just to see it - his eyes said it all.  He was a little shell-shocked from all of it - the filth, the beggars, the cracks in the sidewalks and roads, the population - and we realized just how natural it had all become in the past 4 weeks.  Bry hit the hay around 7:30 and Abi stayed up until 9 to say goodbye to the roomies.

Girls - it was a great month and I enjoyed staying and traveling with all of you.  We made a great team and a lot of great memories.  Anybody who wants to play Up-and-Down-The-River just give me a call!

Wednesday, February 24, 2010

Tuesday

Tuesday morning we all took it pretty easy.  Some of the girls were avoiding the sun due to some late "i'm-going-back-to-the-tundra-better-get-some-sun" burns.  Only poor Carol had to go into PGH.  We kinda lolled about - went to Robinson's Mall, ate a lot of eggs and toast and random other items to clear the fridge.

The evening was a bit more fun - we had another pizza party.  This time we ordered from Yellow Cab Pizza and it was SUPER good pizza.  Unfortunately, the only US branch of the chain is in Cincinnatti, OH.  Before, during and after we tried to finish off our liquor.  We also had another game of up-and-down-the-river that was fun.  Around 9 pm some girls headed to Ka Freddie's to hear a band that Schuckit told them about.  Apparently there was some on stage dancing and much frivolity - I've been forbidden to post photos......

I left for the Airport around 10:30.  Bry's plane was supposed to be in at 11:05pm and I wanted to be there and waiting. Just to give you an idea of the language barrier I will repeat my conversation with the driver:
Me: "Did you start the meter?"
Him: "Yes, Ma'am"
Me: "How long will it take to get to the airport?"
Him: "Airport?"
Me: "Yes, how LONG will it be to the airport?"
Him: "Airport, Ma'am"
Me: "No, no, what is the TIME to the airport?"
Him: (looking at the clock) "10:30, Ma'am"
Me: "Um, thank you."
Me: dead silence for the rest of the 20 minute ride.

So I get to the airport and I have to wait outside in a sea of others expecting loved ones.  Luckily, I was one of only 3 white people, and by virtue of being 5'2", also one of the tallest in the crowd.  It took Bry about 45 minutes to come out and I was so happy he'd kept it simple with the Twins baseball cap and matching sweatshirt - hard to miss.  It was good to see him and he got a glimpse of Manila at night - disappointingly though the traffic was surprisingly good.  We got home and he met most of the roomies and we went to bed.

Monday, February 22, 2010

Last Day at PGH

We started out our last day....late.  We strolled into the ED around 9am.  We saw a few patients, but it was really slow, as Monday's tend to be.  We put in some IVs and NG tubes - I hate that I'm just NOW "getting" how it all works there, and then we leave.  Shannon was an IV pro even on old man rolling veins.  I put an NG tube into a guy, I only knew his name.  When a BUNCH of blood started pouring out I totally freaked.  I asked the resident about his history and he had liver disease - I had just ruptured one of his esophageal varices.  Nearly sweating, I was worried that now he'd bleed out and I'd have killed my 5th person in a few days.....but the resident said "I expected a lot of blood, now we know it's an upper GI bleed and not a lower one."  Well....the next time you know something important like that how about you let ME know too!! Needless to say, the guy did NOT bleed out so no harm done.

We left for lunch around 11:30.  We opted to get dressed up (like going to a funeral) for our presentation at 12:30.  Our presentation was about Thyroid Storm - a literal 1:1,000,000 event in the US and a daily occurrence at PGH.  The consultants went pretty easy on us and it was over pretty soon.  The next girl was not so lucky - she got pretty much grilled on her presentation.  The thing is, the stuff they nit-pick over is stuff like protocol, procedures, not following rules.  They can't really grill the residents on things like not having supplies, not ventilating someone because there is no mask, not seeing someone for 30 minutes who has an emergent problem.  These things are beyond the control of the residents.  We wonder what it would be like to present one of those cases at a Froedtert M&M. (M&M means Morbidity and Mortality - you give a talk on a patient who had a bad outcome and supposedly learn what to never do again.)

After our presentation we left and just chilled for a few hours.  I washed my clothes in the sink - my quarter eating washer and dryer is looking pretty good right now.  Then we got dressed to meet with an esteemed Pediatric Geneticist, Dr. Padilla.  She had us come to PGH and provided us with an early dinner of Filipino fried delicacies and pancit. (Pancit is a term for a noodle dish, this one had seafood and eggs, pretty tasty.)  Then she talked to us about how she's struggling to get Philippino health care to a more developed state.  The obstacles are numerous, as I'm sure you've figured out by now.  She says that over 60% of babies are delivered at home, so there is no way to enforce getting newborn testing done.  She's now working on training Midwives to go out into the provinces and spread the news.  She's hoping to increase newborn testing for things like PKU, Maple Syrup Urine Disease and other congenital problems.  She's a pretty incredible woman and sounds like she has her hands stirring many pots. 

Afterward I went to the Mall (a daily occurrence here) and bought some treats for us.  I gave some cupcakes to the two homeless kids that we pass by every night.  Sad.  Imagine occupying a 1 year old on a 2ft square cardboard mat with hundreds of people walking past and cars and motorcycles just a few feet away.  Awful.  So at least the cupcakes gave them something to do for a little while.

Went to bed and started counting down.  Bry is currently flying somewhere over Alaska or Russia.  He'll be here in less than 12 hours!  Can't wait.

Sunday, February 21, 2010

Marina, Mermaids, Massacre

Sunday morning we all kinda lounged around until 8:30.  We then headed out for Manila Ocean Park.  Along the way we noticed a few things: the streets were really empty, they smelled like urine, and we saw a kid POOPING in the gutter.  He just climbed atop a concrete block, dropped the shorts and started straining......unbelievable.  Erica pointed out that where else DO you poop if you're homeless?  But we all agreed that it was a little unsettling.  We continued our walk to the Manila Baywalk which is HOPPING on Sunday mornings.  There were about 20 people swimming in the bay (eew) and hundreds along the streets.  We walked passed the US Embassy which was devoid of street vendors and loiterers, and we were told we couldn't use our cameras in the vicinity.  Just before we got to the Ocean Park, we literally had to step over a boy about 4-5 years old, who was just conked out on the sidewalk.  Sad.

The Ocean Park was pretty nice, newly built.  We got in line for tickets and then waited for the Mermaid Show which started at 10:30.  This was rather disappointing, with females in mermaid suits swimming around to ACOUSTIC Beyonce and other rap songs, but we stayed for the show because there were all sorts of cool fish there too.  When it was over we started through the Ocean Park.  There were tons of fish, all nicely labeled, and some you could touch too.  The highlight for us though was the Doctor Fish.  These little guys are all in a pool, and for 120P ($3) you can stick your feet in for 20 minutes.  The fish will then EAT your dead skin and give you a pedicure.  It was weird, and took a while to get used to.  There was one pool with little fish, and another with bigger fish.  The bigger fish were really creepy.....but we all walked away with slightly prettier feet.

After we finished it was time for lunch so we ate at Gerry's Bar and Grill.  There were some interesting items on the menu...... I ate my Sisig again (enjoying it while I can) with a San Miguel.  Heather and Shannon had some crispy noodles with vegetables, Megan had an inedible dish (that I had almost ordered!) that tasted like bacon but the noodles were really rubbery and gross.  Erica and Carol played it "safe" - or so they thought.  Carol had some spicy chicken that tasted just like Buffalo wings.  Erica ordered the Club Sandwich.  Now, this club is like no other club I've ever heard of: bread, layer of tuna salad, bread, mayonnaise, scrambled egg, cheese, bread, more cheese.  Can you say "heart attack"?  A little strange - and when she asked for ketchup for her fries she got sweet-n-sour sauce.  Nice.

After lunch we continued walking north to Fort Santiago inside Intramuros.  Along the way we saw a lot more homeless people.  Our lunch leftovers went to a little girl sleeping on a piece of cardboard on the side of the sidewalk.  There were whole families living just off the sidewalk, along a fence that kept them nicely separated from the prestigious golf course inside Intramuros.  What a comparison!

Fort Santiago was built by the Spanish in the 1500's.  It has been used by the Spanish, Filipinos, Americans and Japanese.  The Filipino here, Dr. Jose Rizal, was kept in a cell there before his execution in the 1890's.  Under Japanese control the fort served as prison camp for Americans and Filipinos.  The horrible condition of the dungeons killed many with pneumonia and disease.  As if that wasn't enough, the dungeons are below sea level so when the tides would rise the prisoners had to literally 'sink or swim', and there was nowhere to swim.  The bodies of over 600 prisoners were found after the Battle of Manila in 1945 - killed when the Japanese knew they were losing.  It was a sobering place, lots to see and think about.

We enjoyed the Manzanan Handicrafts store, and also the Intramuros Cathedral before returning home.  Erica and Carol decided to try the "Traycicle", a guy peddling a bike with a 2 seat attachment.  We were a little worried for their safety, and opted to take a cab for the rest of us.  The tricycle beat us all home, but they did pay a bit more.

Dinner was spaghetti with sauce, Parmesean cheese and frozen veggies.  Oh yeah, and wine.  And beer.  Then at 7:30 we all traipsed up to the roof to watch the Brits compete against the Chinese in a battle of fireworks.  The Brits won, in our opinion, because their fireworks were higher in the air and we could see them above the building that blocked our way.  Come on China, you guys INVENTED fireworks!

Only 46 hours till Bry lands in Manila!  Getting excited!

Saturday, February 20, 2010

Greenhills and Sushi

In the afternoon Megan and I decided to go back shopping at Greenhills mall.  Greenhills is known for cheap everything, but especially pearls.  We took a cab this time and it was nice to get to see more of the city.  There is unbelievable disconnect between the richest of the rich and the poorest of the poor.  There appears to be no middle class, although it's amazing what we're considering a "nice" neighborhood now.  The "bad" neighborhoods are slums, with corrugated tin houses stacked together, leaning every which way, with cats and trash all around and kids running in the streets, people selling this at stop lights.  The ride didn't take too long, and the taxi kept his meter on.
For sake of surprises, I won't tell you what we all purchases but we feel like we got some good deals.  We could have spent a lot more money.... lots of stuff and super cheap.  We of course fell in love with furniture and lamps, but no way to get those home :(  We did say hi to my friend Nadja, with whom I am now friends on Facebook. (Her idea!)  If anyone wants to order some pearls, I know a guy......
It was too early for dinner when we wanted to leave so we decided to kill some time and go to a different section of town for dinner.  I had heard about a good sushi restaurant in Makati, perhaps operated by some ties to the Japanese mafia.  This means the freshest seafood and the cheapest prices.  Well the cab that picked us up was a real surprise..... he was a Punjabi Indian who was born in Manila.  His family ran a number of businesses in the US, India and Manila, including his renting the taxi out.  He doesn't usually even drive the taxi - in fact, this was his FIRST TIME!!! AHHHH with the traffic in Manila Megan and I were a bit skeptical (and scared!).  He didn't know where we wanted to go so luckily I had my map with me and directed him most of the way there.  He kept stopping to ask people how to get to the place - some of them made fun of him and told him he shouldn't be driving - another crazy guy with no teeth jumped around and then demanded money for telling him where to turn!!!  Unbelievable, but we made it there.  (We also heard his life story, including his Filipina girlfriend who left him - taking his 2 kids, his mother who doesn't accept the girlfriend or the kids, his family in Sacramento, CA, his farm in Punjab - 80 acres, etc etc.)
We got out in a rather sketchy neighborhood.  Not 5 blocks away is the ritzy Greenbelt area (where Reuben and I ate) but this hole was something different.  We asked around and found the restaurant - Kikufugi.  We approached around 5 pm and the sign said it didn't open until 5.  We asked the doorman who said "For you, I open the store!"  We walked in and surprised the Japanese sushi chefs and the waitresses who were NOT prepared for two white girls to walk in before the restaurant was even open.  However, once we pulled out cameras they got very friendly and were even posing.  The seafood we were going to eat was laid out, or swimming in the tanks, and looked amazing.  We ordered edemame, then some sashimi samples, and decided to add some rolls on later.  The sushi was super good - very smooth.  The strangest thing we got was some fish roe with what we believe was a sperm sac on top, but even that was tasty.  We got our sushi fix and then enjoyed a nice cab ride home with.....wait for it......SEATBELTS!!!!  Megan and I almost didn't know what to do with those funny strap thingys, and it was the first time since the AIRPLANE that we'd had some on.
The girls were excited to see our purchases and had played it safer (or not, ask Carol tomorrow) with McDo - the nickname for McDonald's.  We ended the night with some more card games and are looking forward to sleeping in and then heading to the Ocean Park tomorrow.

Taal

Courtesy of Heather: On Saturday, we packed ourselves into yet another rented car and headed south to Taal Lake and Volcano in Talisay. I managed to contact the head of the Taal Lake Yacht Club, who was, ironically, in the US, and he told us we could prepay and he’d give us a discount.  We got the account number for the TLYC, and deposited money right into their Bank of the Philippine Islands account – though we were a little worried that we might have just lost our deposit if the trip didn’t work out.  But, when we arrived at the Yacht Club, we showed the bank receipt and were lead right to a boat for the trip to the Volcano island, in the middle of Taal Lake =).  We even managed to all (6 of us) fit into one boat, even though we were told by the website and email that we would need 2 boats, since the limit is 5 people/boat.  Yay for saving P1,500!  The boat ride was pretty smooth, and the hike up the the volcano was hot and dusty, but the site of the crater lake from the top was worth it.  And, since Taal is an active volcano, there were numerous sulfur gas jets along the way up the mountain.  The last eruption was in 1911, so unfortunately, not much fun lava rock was around.  The scariest part was actually the trip there and back – our driver had a fondness for alternating gas and brake at short intervals, and we’re not sure he had ever tried to drive up mountain switchbacks with a clutch… and few of the girls were feeling a little queasy by the end of the ride.  But overall, it was a successful trip, and we managed to satisfy everybody’s desire to see a “real” volcano (though it is the smallest active volcano in the world).

Saturday

So the rest of the roomies left for the Taal volcano by 6 am.  I'll post one of their stories and photos when they give it to me.
My day started with a dose of Cipro for the upset stomach, and a trip to the local pharmacy.  For the cost of <$30 I was able to purchase about 2 days worth of supplies for the ED.  The residents were really happy, and put them in their "Emergency Supply".  (However, the day before we needed needles and vials, today the bigger need was face masks and Foley catheters.....you can't win here.)  I also was able to take some photos and video of the ED.
The morning started off pretty slowly, though I was able to get some IV practice and blood draw practice.  Then, all of a sudden, a woman came in limp and unconscious - she had been like that for a while.  The husband laid her on the floor and the residents told me that I'd be intubating her.  I was successful, but we were unable to revive her.  She died there on the floor, though in actuality, she was probably dead before.  The poor husband had traveled with her on a boat, then with cab from another island.   The poor man knelt beside her and was brushing her hair and kissing her face.  It was so sad, yet the business of medicine still had to take place and the residents interrupted him to sign some forms and take care of her body.  It was brutal to watch.  Luckily, he recognized me and I was able to help him out later on - and to give him my sincere condolences.  That will be a long boat ride back for him.  She was only 44 and had some sort of heart failure, not really sure.
Little did I know that was only the first of 4 codes we would have before I left at noon.  A young suicide came in tachypnic (breathing fast) after drinking lye.  He was intubated as well.  Then I had a break with codes and was told to go draw blood on a HEMOPHILIAC .  Well of course he had scarred veins and I couldn't get it so I asked the resident rather than keeping on poking him.  She, in return, punished me and made me do a rectal exam - luckily he and his dad understood English well enough to explain the procedure.  The next patient with that resident ALSO needed a rectal exam - but when we got there she didn't have a pulse.  Thus, another code began.  I attempted intubation for her but the laryngoscope light wasn't working so I tilted her head and the resident blindly intubated her.  Then I was part of the chest compression team - it's sad but I'm getting good at that.  The only problem is that I get all sweaty - it's just not right that my sweat drips down onto her, but what am I going to do?
The final code happened at about the same time, on the floor right beside this lady, and you had to literally step over the man to move around.
The final sad part was seeing a woman with extensive fungating metastatic breast cancer.  The resident wanted to teach, so we had her husband remove the large dressing over the caner.  Indescribable.  Unfortunately, she wasn't able to afford surgery when it was recommended nearly a year ago so it has literally taken over her chest, entire body, really.  I realized that it would take a lot to work in these conditions every day, and give the residents and clerks my fullest applause.  They are taking the best possible care of people in dire situations.

Thursday, February 18, 2010

Not Dead Yet

 No, nothing is wrong.  I just haven't been posting because I haven't done much fun or exciting lately.  My mom told me that she's worried when I don't write, so I'll just type up a quick synopsis of the last few days.

WEDNESDAY
Started with ACLS training in the morning.  This was pretty boring as well since we were just going over EKG basics.  (They say ECG here so it gets kinda confusing.)  We were all a little bored in the class. However, we still got the afternoon off.  Megan was more devout than the rest of us and attended Ash Wednesday Mass - she got ashed and everything.
I've been working on my tan, and my reading.  I've read 4 books already this trip and am on book #5. (Thank you to Carol and Shannon for giving me their cast-offs).  I'm excited to stop in Seoul where I'm going to let myself buy a new book for the plane ride home.
Wednesday evening we were all craving Mexican food.  We filled the fridge with beer and bought all the supplies.  Now we have to be a little creative when it comes to cooking because we've got limited pots and pans.  We made ground beef in a pot and some shrimp in a pan.  We tried to marinate the shrimp in oil, salt and pepper, but the coldness of the shrimp caused the oil to congeal - less than desirable.  We aren't used to using palm oil that has been processed and bleached - no olive oil here. (Or it's just super expensive.)  Dinner was still amazing and we got our Mexican fix.  We finished the night with a card game of "Up and Down the River".  We had a blast and it was some good roommate bonding time.
Another reason I wasn't blogging was that all the experiences people have been having lately have been bad in the hospital.  Erica and Megan won't soon forget a bad day on Labor and Delivery.  There just aren't the same patient rules here, lots of yelling and not very nice things.  No need for gory details, but it wasn't a good day.

THURSDAY
Last day of ACLS.  This was actually very useful as we went over algorithms for running codes - something we will all be responsible for in a couple of months.  It sunk in better this time - maybe because I had to concentrate so hard on their accents.  Again, we just had a half day so I resumed my suntanning and finished another book.  Heather and Shannon enjoyed mango ice cream.  Carol got to hob-knob with the elite at a Family Medicine conference in a ritzy hotel.  I'll let her tell you about it later.
Dinner was made by Megan and Erica - pancakes and a giant egg-omelet made in a pot.  It was very tasty.  The pancake mix here is "vanilla" flavored - very sweet.  It was another good home-cooked meal - we're trying to save some $$$.  Some more card games went down and we hit the hay.

FRIDAY
Returned to the ED with open arms.  I got to do a few more procedures and see some interesting patients.  We enjoyed talking to the residents and students and gave them some of our leftover gloves and masks.  We left early for lunch and now I'm going to go back to work on the tan and my 5th book.  I could go do some more sightseeing but I'm not going to lie, I'm not feeling the best. 
The rest of the room is going to go see the Taal volcano tomorrow.  I'm sure they'll have lots to tell about that.  (I don't want to be without reliable bathrooms, and I don't think my stomach will agree to another 2 1/2 hour car ride. :(  ).  I will instead go to the ED and see what I can see.
I'm seriously considering going and purchasing some basic supplies (IV's, blood vials, O2 masks, etc).  If I spent just $50 they would have supplies for a few days at least.  They really made things last - it's really sad.  They're re-using syringes, changing the needles though.  They'll label one for "Antibiotics" and another for "Lidocaine" and re-use it over and over again.  One resident told me that one syringe should last a minimum of 24 hours.  If you knew the amount of syringes we go through for one patient back in the States........ They also keep asking us to "remember them" when we're wealthy and to send them supplies.  This whole system is crazy and something here needs to change.  It's been a real eye-opener for all of us.

Other than that I've been helping Bry to pack over the phone.  He leaves in just 3 days (for me) so i'll get to see him in 4 days.  Pretty excited to show him around (and show him off!!) - this will be his first overseas experience and I hope he likes it. (I plan on making him travel a lot more in the future!)

So I'll try to be better with the blog.  Maybe you could write in questions in the **Please Comment** section if you have any and we'll try to answer them.

Tuesday, February 16, 2010

Basic Life Support

Today was day 1 of BLS and ACLS (advanced cardiac life support).  We are taking this course with other medical personnel. Nurses, doctors and recent graduates - in the US BLS is required before you are hired or while in nursing school.  The lectures were almost verbatim for one's we would have had in the US, just replace '911' with '117' and you've got it.
Luckily, we got home by noon.  Today was actually pretty sunny so a pool day was in order, after the laundry had been done. (By hand, in the sink).  I laid at the pool until 2 pm.  Then I showered and got cleaned up.
I met up with my cousin, Reuben, at the Manila Post Office.  He's studying for a Masters in Poli-Sci in Singapore.  He had a week off so he came to Manila with a friend from school.  We met up and decided to head to the illustrious Greenbelt/Ayala district.  Neither one of us could afford anything there, but it was kinda neat to see how the wealthy live in Manila.  There are about 8 malls, all interconnected with walkways.  You can buy any name brand that you want there - and some you don't know about.  We weren't really up for shopping so we decided to go to the Ayala Museum in one of the malls.  This was a nice, quiet, 3 level museum that told the history of the Philippine Islands and the Filipino people.  There were exhibits on history, ceramics, pottery, and a special exhibit on Gold.  It was pretty nicely done. (Although I decided I could never be the person who writes the description cards in museums - for example; "Brown Jug", "Brown Jug with Dragon", "Brown Jug with inlaid Pheonix", and "Ring 11", "Ring 79", etc.)
After the museum we toured the malls to find some traditional Filipino food.  We ended up eating at Masa's in Greenbelt 5 mall.  Masa was very nice, and they served my San Miguel Pale with the Sisig.  Now I've been wanting to try Sisig since I got here.  Traditionally it is left over pig parts, chopped up small (so you can't decipher exactly what it is) and fried, served with some extra crunch and a small Filipino lime-like fruit.  It was terrific, and I think it would go over well as bar food in the US if you didn't tell people what it was.  Lots of food on the menu had WAY too much for descriptions: "Squid served in its own ink" etc.   I had some pork belly and Reuben ordered the crispy squid.  Both were quite good and we enjoyed the food immensely.  We took a cab back to the area of Malate, where we're both staying.  The day could not be complete, however, without some Ube-Langka ice cream. We headed to Robinson's Mall and both got a small cone.  Ube is purple yam and Langka is cheese.  Yep, yam and cheese ice cream.  Again.  Not my fave, but it's not half bad either.
I finished the night chatting with the roomies and saying good morning to Bry.  The other girls had either stayed in for the night or returned to Greenhills mall.  Those who went to Greenhills went to the same pearl seller that I had bought from.  I forgot to tell you about my new friend, Nadjia.  Nadjia and her husband Rolan opened up a pearl booth. They have friends in Mindinao who send them the freshwater and saltwater pearls.  So when I was shopping there, Nadjia was impressed (intimidated?) by my bartering skills (and lack of knowledge about pearls) and was a real dear.  So nice, that I referred the other girls to her stall.  When I paid with credit card the process took FOREVER, so we had a nice chat.  Turns out that Rolan has a friend in Stockton, CA, married to an American.  She's a Filipina dentist and "do you know her?" No, Rolan, I am not acquainted with the Filipina dentist in Stockton, CA, but if and when I'm there I will look her up.  Nadjia gave me her card and told me she'd be happy to sell me pearls when I'm back in the US - she's got someone she ships to in France too.  Anywho, the girls (Shannon, Heather, Anna) made it back to Nadjia's stall and she totally remembered me.  Now to wait for my commission.........

Monday, February 15, 2010

Monday

Today we got up at the usual time and trudged to the ED.  We didn't see any patients on our own, and the ED was actually pretty empty.  There were a couple interesting patients - a boy with an umbrella spoke stuck in his leg, a woman from the "provinces" (other islands) who had a large cyst on top of her head that ruptured, a couple of overdoses (silver polish is popular) and one fireworks accident.

We had another lecture by the illustrious Dr. Ted Herbosa.  He went over the origins of Emergency Medicine in the world and in the Philippines.  He showed us a photo of the PGH ED from 2002 - gleaming white, monitors for every bed, beds for every patient, curtains in between.  The PGH ED today is unrecognizable from those photos.  He says this is because the government has let the public hospitals go to pot.  Quite a shock what 7 years of bad management will do.  We were informed this morning that after they ran out of normal saline and IV catheters, they also ran out of OXYGEN over the weekend.  Ouch.

I came home early due to some GI complaints (I've been in a third-world country for 3 weeks, it was bound to happen) and took a rest.  The other ED girls enjoyed two more lectures (one NOT in English).  The OB Gyn girls had some more interesting tales to tell.  Let's just say that NONE of us will be delivering here.  Megan delivered a 7 lb 2 oz baby that the residents thought was "huge".  There was also liberal use of episiotomies and forceps, the practices which are fading in the US except in extreme cases.  Carol on Family Medicine did house visits with Hospice care and saw a less than appetizing case of testicular abscess. 

After a quick dip in the pool, Erica, Megan and I went to Teriyaki Dragon for some Shabu Shabu and sushi.  They didn't have a huge selection of sushi, so I'll still need to get my fix before I leave.  Shabu Shabu is basically a pot of water which boils atop a grill set in your table.  You add veggies and meat to the pot, eat them with noodles, then eat the soup that you've created.  There were some interesting sauces to try too.  We're pretty sure we made a fool of ourselves, but we got fed, didn't we?  To top it off we headed to Dairy Queen for some Asian-sized Blizzards.  The food sizes here are much more reasonable, and you can order a medium (12 oz) without feeling too guilty. 

I finished the evening writing this blog and reading my third book of the trip.  Tomorrow we start ACLS training and I'm meeting my cousin, Reuben, for dinner at Intramuros.

Bry leaves a week from today - can't wait to see him.  We've successfully booked plane tickets and a hotel room on the island of Palawan.  We'll be 'availing' of the tours to Underground River and Honda Bay, as well as a city tour of Puerto Princesa, complete with trips to the alligator farm and penal colony.  

Have a good Monday.  We look forward to reading the comments.

Chinese New Year

We all slept in late on Sunday morning since we'd done so much on Saturday.  We all kind of lounged around and scraped together the rest of the groceries into a breakfast.  We finally headed out to Binondo (Chinatown) around 12:30.  There were 8 of us total, all girls, and we once again availed the LRT.  (Avail is a word that is underused in US English and overused here in the Philippines.)  We got the map out and quickly found our way to Santa Cruz Church.  Mass was going on, but that didn't stop the firecrackers from going off.  Binondo is basically an area of about 4-5 blocks by 4-5 blocks.  It is filled with Chinese Deli's, medicinal shops, bakeries, restaurants and knick-knack shops.  Lining the street were the obligatory vendors selling fruits, good-luck charms, knick-knacks, fake jade, real jade and Tikoy. (More about Tikoy later.....)
We wandered down the streets and enjoyed the sights and sounds.  Periodically young men dressed in dragon costumes and others with drums banging and cymbals clashing would stop in front of a shop and an elaborate ceremony would take place.  Shops would put red bags full of goodies above the doors, the dragons had to retrieve the bags and the crowd would shriek.  Then, all hell would break loose and tons of firecrackers would go off, filling the air with smoke and debris and making us all deaf.  This was neat the first time, still fun the second time, but it got old around the seventh or eighth time.  We all enjoyed the festivities though, and the people were all in a good mood and it was more laid back than the Quiapo market had been.  We ate lunch at a Maxim's Tea House - a pretty realistic Chinese restaurant that we all enjoyed.  The meal came complete with soup, fish, chicken, shrimp, "cold cuts" which was warm noodles, chicken, pork and tofu, and UBE ICE CREAM.  Ube is the Tagolog for purple yam.  They put it in everything, often desserts.  We'd all been wanting to try it, and we finally got some at the end of the meal.
*** A note about eight white girls walking around Chinatown in Manila:  we became instant celebrities wherever we went.  At one point I was buying some snacks (little cakes called Hopia) and realized the girls in the next shop were taking my picture with their cell phones.  Other times mothers would come up to us, put their kids in front of us and take a picture.  Always there is pointing, laughing, chatter and commotion when we are out.  We were offered all kinds of things, including men who "loved" us and wanted to "be your Valentine".  We politely (sometimes not so politely) refused.  We were all kinda feeling like this must be what it's like to be a celebrity - and we're kinda sick of it.  It gets ridiculous, and if you see our pictures of YouTube or elsewhere on the internet please know that we did not consent to them.  Those of us with lighter hair or taller stature are even more prized as photo tokens.  To top it all off every vendor DOUBLES the price of an item when we ask, purely because we're white.  We have to explain that we're in debt 1 MILLION Pesos and are poor medical students.  Enough ranting - but we're all pretty sick of this by now!***

From Binondo we walked over to Intramuros.  This is the old part of the town that was the original fortress built by the Spanish and overtaken by the Japanese, then leveled by the Americans during WWII.  I'll talk more about it later, since I'm going there on Tuesday when my cousin, Rueben, is in town.
We continued south the the famous Rizal park which was crowded with Manilans enjoying the cool evening.  We were once again a photo-op and the talk of the town, but we strolled along the park anyways.  At one end is Manila Bay, at the other is a huge pool with a stone map of the Philippines embedded in it.  We can see the map a lot better from the LRT, and no one is allowed in the pool and it is gated off.  (This is actually for the best since I'm sure it would be TRASHED if open to the public.)  At this point it was closer to finish the walk home.  We stopped for some wine and then settled in to enjoy Valentine's Day with just us girls.
We topped off our day with a dinner of Tikoy.  Tikoy is a Chinese treat made of rice paste.  It has the consistency of dried rubber cement, is sticky, and will cling to a plate held upside down.  The texture is akin to "eating Gumby", and the flavor was ok.  We were supposed to have 3 flavors but instead we got 2 chocolates.  The other flavor was Screw Pine (Wikepedia it) which I'm actually beginning to enjoy.  We all tried some and then argued about what effect this cuisine would have on our digestive system.   When we were all assembled we cut into a giant chocolate-chocolate cake and drowned our sorrows with wine.  All in all it was a good Valentine's day and a busy weekend.

Saturday, February 13, 2010

A few more things

Shannon graciously reminded me that I forgot to mention one fact about the ER:  On FRIDAY night we came home early because they had run out of NORMAL SALINE.  (FYI, normal saline is given to EVERY patient) They were also running low on IV catheters (needles to put in IVs).  This whole idea of running short on NECESSARY supplies is foreign, and ridiculous.

Carol Goes to the Slums

This is Carol's description of her visit to the Manila slums with the Family Medicine department.  She's got pictures too, which we'll post soon.

Yesterday we went to a province north of Manila to a health clinic
there. It was a very poor area with people living in small homes
stacked on top of each other. The area around the clinic looked bad at
first but then we went outside the clinic area to the project area
which was worse. These were 3 to 4 story building with  families living
on each level of the structure. There were 2 building back to back with
alley's in between. It was really dirty, bars and wood on the windows,
people everywhere. On the bottom level lots of people had tables set up
selling stuff - food home made and packaged candy and such. In the
space between the backs of the buildings there was trash piled deep
with rats running around. We walked up to the second floor and visited
a patient. Surprisingly she had made her home fairly hospitable. It was
clean inside with a tv and entertainment center, couch, coffee table,
refrigerator. The resident we were with said that the  are housed about
100,000 people with as many as 3-5 families sharing one small home.
Sometimes they have to sleep in shifts because there is not enough
floor space for all of them to sleep at the same time. Then we crossed
the highway to the really poor. The first set we saw were homes made
out of wood living at the city dump. The people living there sort
through the trash for stuff they can sell at the little market down the
road called Happy Land. They also collect bottles, wood, cans and such
to sell for recycling. These were the poorest group. Then we saw people
a little better off living in an old factory. Our guide said that
surprisingly most of these people have a tv, dvd, vcr, refrigerator. It
was really interesting and made me thankful to be an American. One of
the major health problems is TB due to the tight living quarters and
non-compliance with treatment. When we went back to the clinic area I
realized how good the people in that area have it comparatively
speaking. It was fairly clean. At the clinic, they provide treatment
for TB, diabetes and other illnesses as well as health education, and
food.

Pagsanjan


We left early again this morning for Pagsanjan falls.  Part of the movie “Apocalypse Now” was filmed there.  To get to the falls we needed to get from Manila to the area around Pagsanjan, near Laguna.  We were picked up by our driver, Al, at our apartment.  Surprisingly we were all on time for the 6am departure (including Melody who had been out partying).  Al was terrific in traffic and was eager to get us to Pagsanjan in good time.  It was about a 2 hour drive down there, though not as pretty as our trip up north.  The freeway took us to about 45km from Pagsanjan and we only had to pay one toll.  The towns around Laguna were full of restaurants, hotels and roadside stands selling fruits, water toys and furniture.  We got to Pagsanjan, a smaller village whose only claim to fame is its river.  Al found us a place to catch a canoe to head to the falls.
Now, according to our guidebooks and the med students and residents we talked to, a trip should cost about P1000 or $12.00.  So this is what we planned on.  We got there and the guy started tacking on fees and charges that were just ridiculous.  And we KNEW it was only because we were white people.  We gave him a really hard time and even told him we’d leave.  He came down in price but not very much – we ended up paying more like P13,330.00 instead of P8000 for the 8 of us.  This made our money a little tight.  We even asked Al if he thought it was fair, but you can’t trust what he says since he probably gets some commission for bringing us there in the first place.
Anyways, we loaded into canoes – 3 people in 2 canoes and 2 of us in the third canoe.  Each canoe had 2 “banqueros” – guys paddling the canoes and guiding us to the falls.  They were all very pleasant and we started out into the river.  The river was super dirty, with people washing clothes, animals drinking etc, but as we got out of town it cleared up.  We were towed by motor boat for the first part, until we came to the first rapid.  The rapids are really just areas of lower water level that have been dug out for canoes to fit in.  And by fit in I mean just barely – you really had to keep your hands inside the canoes in order to keep all your fingers.  The banqueros were amazing though – they’d jump out of the canoe and push off with their bare feet on the rocks.  All of them (there’s a huge number in the town) were born in the area and are probably related – they’ve been navigating the river since they were little boys.  We had 16 rapids to go up – at times there were poles crossing the path so they could balance the canoes on them before pulling us upstream.  We got to the halfway point where there was a small waterfall – the banqueros got a rest (and Erica spent P600 to buy them all some soda and snacks). 
The river is in this deep gorge with jungle on both sides.  Because we got started so early we were the only ones on the river, which was nice.  It was raining for the first bit but soon the sun started to come out.  It took us about 1 hour to reach the real Madgapio Falls.  This giant waterfall dumps into a pool that we were told is 100ft deep.  There was one other party there when we got there.  We left the canoes and loaded onto these bamboo rafts.  Two guys pulled us via rope UNDER the falls and into the small cave just behind them.  (This part usually costs extra but we got it for free since we put up such a stink!)  We were able to swim under the falls and enjoy the sights and sounds for about 20 minutes.  Then they pulled us back over to the edge of the pool.  The water pressure was incredible – and kind of painful.  It was just an amazing experience.  The ride down the river was much faster and the banqueros enjoyed the ride too.  Sunshine came into the valley as we were leaving so we got some good pictures.  All the villagers were out now to wave to us (“Enjoy the ride, Ma’am?”) and hordes of Japanese tourists were being loaded into canoes at various spots – some were just as excited to see us as they were to go to the falls. (And they were wearing helmets, jeans and long-sleeve T-shirts? Um, you kinda get SOAKED going under the falls!!)
When we got back to the car they tried to sell us pictures they had taken, most of us refused but Carol gave them the P100 and took one home.  Al offered to take us somewhere, anywhere else (we had rented the car for the whole day but it was only 11 am) but we all just wanted to get home and shower.  The ride back to Manila was a little longer because of traffic but we made it home by 1pm. 

After a quick lunch we decided to try out Greenhills Mall.  Now, this requires some skill since one has to take the LRT1 to the MRT3 and ride a ton of stops, then walk about 2km to the actual mall.  We could have taken a cab (too expensive) or a jeepney (not too safe) but we hoofed it anyways.  Greenhills Mall is known for their amazing selection of cheap clothes, knock-off purses and super cheap PEARLS.  The pearls are imported from all over the Philippines, especially Mindinao in the south.  We all had some fun and everyone bought something (some more than others, hmmmmm Megan!).  We were getting hungry and we were all kind of sick of rice and Asian food so we broke one of my cardinal travel rules and ate at a McDonald’s.  The food tasted AMAZING though, and cost less than $2.  The McDonald’s also serves fried chicken, rice, spaghetti and Salisbury steak, just in case a Big Mac or Chicken McNuggets don’t do it for you.  We ended with an ice-cream treat and then started the long walk back to the LRT.  (FYI, cabs cost maybe a little less, but you have to bargain with the cabby, and traffic is HORRENDOUS on a Saturday so it would take just as long.)  We are, however, getting really sick of being the only white people around.  Everyone tries to get our attention to sell us things, or they stare, or point, or laugh – and it’s just weird since we’re not used to being so “popular!”   There was one point where I really thought I was going to punch the next person to shove something in my face!

We got home and are settling in for bed.  We realized again today that we saw the entire gamut of Filipino social class – from the homeless on our block to the people living in huts on the river, to the hordes of people buying and selling at the hundreds of malls in the city.  Tomorrow is Chinese New Year so in addition to cars, horns, jeepneys, people, vendors and roosters, we're adding fireworks to the mix of our nighttime serenade! We’d also like to wish everyone back home a Happy Valentine’s Day!!!

(Bry – You are my One and Only.  I love you and miss you – can’t wait to see you and share this beautiful country with you.  –Your Abi)

Friday, February 12, 2010

Firsts

Today I had a lot of firsts at the ED.  In fact, I'm about to head back for more and I won't have time to blog before we leave for our canoe trip tomorrow at 6 am.
1. First attempt at CPR.  I always wondered what it would feel like to be doing compressions - and I knew that this pt wouldn't make it.  We ran 3 codes for a total of 21 minutes.  I loaded up Epinephrine, felt for pulses, listened to heart sounds and then I did compressions.  She died about 5-10 minutes after I was told to stop.  70 years old.
2. First ABG.  This lovely test requires you to stick a needle into the radial artery.  I got it on the first try and was pretty happy.  However, prior to that I was running around trying to find syringes, then Heparin, then cold water, then trying to figure out the pt's name.
3. First team-building exercise with Shannon.  While she skillfully extracted blood, I held the 4 vials that needed blood put in them.  She was warned that we would no longer be friends if she gave me a needle stick.
4. First status asthmaticus.
5. First electrocution.


I'm loving the activity and freedom that we have here.  I plan on getting some pictures for my files too.
The rest of the day was spent exercising, going to the mall, and purchasing tickets for Bry's and my trip to Palawan.  Now to figure out where to stay while there.......

The rest of the girls had a good day too.  Lots of OB clinic and Carol worked at the ambulatory medicine clinic (where the ED sends a lot of patients).

So we leave at 6 am with Al.  We should be back around 3 or 4 pm and we'll let you know that we survived Pagsanjan Falls.

Thursday, February 11, 2010

Not much new...

 
So today again we headed to the ER.  We went as a group (4) because we were meeting with Dr. Ted Herbosa, a legend in the field of trauma in Southeast Asia.  He has worked all over the world and done a lot of research.  Most recently he worked as a trauma surgeon in Malaysia - he even was head flight surgeon for the Formula One races held there.  He has worked at MCW and knows some of the faculty there too.  He gave us a private 1:1 session and was pretty helpful at getting our minds back into medicine mode.  He will be around the rest of our time here and has promised to help us out.
Otherwise we didn't do/see much in the ED since we were busy with Dr. Herbosa.  There was an interesting DKA+Stroke pt with some good physical exam findings.  That's one thing - here people wait FOREVER to come to the ED/hospital so their diseases are pretty advanced.  Many people are able to see things that we'll never or rarely see in the US.  The OB girls got a rude introduction to the Gyn Surgery - a woman needing a central line was subjected to opening her arm WITHOUT anesthesia to locate the vein under direct vision.  In the US we would use Ultrasound guidance and would go through a neck vein.

Carol did nothing today on family medicine (her words!).  She did, however have an interesting trip yesterday to the slums and we will be posting her description on here later.

We took off after lunch and I finally went to the pool, although there was not much sun out since our hotel blocks it and it was cloudy.  But still, I was swimming in the pool this afternoon.  We said goodbye to Dr. Kron, our course coordinator, who is heading back to the US tomorrow.  He brought us some ripe Durian - a super SMELLY food that even Andrew Zimmern of Travel Channel Bizarre Foods fame adamantly refuses to eat.  No one was brave enough to try any and I'm pretty sure the hotel staff were kinda annoyed that we stunk up the lobby.

Afterward 5 of us went to the Hobbit House, a Manila landmark for 35 years.  Anna, Carol, Shannon Megan and I walked down some dubious streets to get there and avoided ferral cats and beggars along the way.  (We realized that we like the beggars on our street a lot better.)  The place has a circular revolving door (ala J.R.R. Tolkien) and serves over 150 kinds of imported beers.  While they had a terrific selection the prices were a little steep so I stuck with my Manilan San Miguel Pale Pilsner, a new favorite.  We ordered some appetizers and enjoyed the service - all little people.  A young woman totally depressed us by singing some favorite American songs (Kiss the Rain, Bobby MacGee etc) so we got a little homesick.  

We walked through the mall on the way back (better lit, safer, no beggars) and were once again amazed at all the people in the mall on a Thursday night. 

Tomorrow Shannon and I work the 3-11 shift.  It should be filled with 1) lots of sick people 2) suicidals who don't have a Valentine's date (no joke) 3) blown up hands from people celebrating Chinese New Year with firecrackers 4) lots of stuff for us to do and 5) a LOT cooler than it is during the day.  Let you know how that goes.....

Wednesday, February 10, 2010

ER and Mall of Asia

(Photo to the left is of Steve, one of our classmates, dressed in traditional Filipino attire and dancing for us at Zambuonga)

So today started our first day of only 2 people in the ED. Shannon and I were on in the morning so we basically stuck tubes and needles into people all day long.  We enjoyed a lecture (in "Taglish" - half English half Tagalog) and noticed that the med students hung around for about 15 minutes before returning to "duty" - just like we do in the US.  I saw a pt. with a HUGE goiter and even larger parotid cyst - she was gracious enough to let me take her picture too for my medical files.  We learned about things that are very common here but rare in the US - many infectious diseases, thyroid problems, vitamin deficiencies.  It was still kind of a sad experience.

We successfully booked our 8 passenger van to take us to Pagsanjan Falls on Saturday.  The falls were made famous in the last part of the movie Apocalypse Now.  More on that when we actually go......

When we got back home Carol, Erica and Anna (not a roommate but she lives above us) took our first cab ride to  Mall of Asia, the third largest mall in the world.  Our cabby was very nice and charged us P83 (less than $2) for the ride.  The mall is huge (duh) with many rides, restaurants and stores.  We did some window shopping and got dinner at an Italian restaurant which was very nice.  We watched the sunset over Manila Bay and got some photos (to come later).  We finished shopping and found some nice items at Kultura Filipina which sells imported Filipino handmade goods.

So then, the cab ride home.  No big deal, right?  I mean, we're practically Manilan by now.  So our cabby picks us up and drives us to our neighborhood.  Traffic is super bad by our mall, so we told him to let us out early.  He wanted to charge us P400 - over 4x as much.  Well we are NOT dumb Americans so we fought with him.  He ended up getting P190, which was still too much, and we kinda just jumped out of the cab.  We were pretty confident that we shouldn't pay more than P100.  We were a bit shaken up, and realized that from now on we're going to diligently watch the meter when we get into the cab.

All in all a pretty good day.  The rest of the girls had fun too - Carol got to drive out to the Manila slums (literally - she has pictures) with the Family Medicine people.  Erica and Megan did NOT run into any rats (in fact, one was dead!) and only had a half day.  Heather is still at the ED for the night shift and is having a pretty exciting evening.

Tomorrow we're thinking about a trip to Intramuros - the old Manila from 1500's.  We're also trying to plot out the evenings for next week. 

Tuesday, February 9, 2010

Eye Opener

Well I think we were all not sure what to expect, and nothing would have prepared us for the reality of a third world "charity" hospital.  People are lined up on bare metal cots, or on cardboard on the floor, with no privacy, no ventilation, no medications and limited resources.  No one wears gloves (except for us!) and all of us will seroconvert for TB by the end of the month, unless we already have (me and Heather).  Our job will include obtaining all blood, intubating, inserting catheters, some interview and improving our physical exam skills.  Family of the patients are expected to do things like help move the patient, hold tubes of blood, run the blood down to the lab, hold the IV fluids and even VENTILATE - meaning pump the balloon that is helping the patient breathe.  This would NEVER fly in the US.

Already we've seen some interesting patients.  A lady with a goiter the size of a softball, multiple injuries from falls, a man with liver failure NOT from alcohol but likely from TB, schistosomiasis or other infectious disease - these things would not even make my top 5 list back in the states. Today I was successful at inserting an IV, drawing blood, and almost successful at intubating a fully awake patient.  I will get my share of attempts though.

The other wards had just as much excitement.  OB deliveries, vaginal checks, D&Cs and surgical post-op all take place in the same room with no curtains, not even beds for everyone.  The girls had one patient code on them - not a pretty picture.  Then Megan had a run-in with the infamous HUGE rat that lives where the OB students and residents keep their bags - she will not be bringing snacks along with her for the rest of the month. (Nor going in that room alone!!!)  Erica thought they would get to do more, but only 1 delivery occured and it was a C-Section of a "large baby" - 8lbs 1 oz!  We are all going to develop body insecurities this month with all these tiny people around.

The medical students are called "clerks" and they have been super helpful and nice.  The ER ones had lunch with us and took us to a Chinese restaurant in the nearby mall.  The food was good, but was not traditional Chinese more of Asian Fusion. 

For dinner we went as a group to Zambounga, a traditional Filipino restaurant.  The food was amazing - tons of seafood and very tasty.  Lots of prawns, crab, squid, oysters and mussels.  We really enjoyed the fruit dessert too.  But by far the highlight of the evening was seeing some of our classmates dance the traditional Filipino dances - complete with 2 guys (Nathan and Steve) dancing in HULA OUTFITS. (Photos to come and they are priceless!)  The official dancers put on a great show too.

Monday, February 8, 2010

Questions

To answer some questions....
I don't know what kind of TV stations we get - we've only had it on for about 5 minutes.
We could tell what most things are at the market place, and most people speak some English so we could ask.
Beth - yes, we are happy to be here, but we miss you and your name (and shoes and clothes) has come up a lot when we've been shopping.  What do you want us to bring you?

Day One PGH

This morning we woke up just as the Super Bowl pregame was beginning.  We we all a little nervous for our first day - especially those of us who have been on vacation for a while.......  We headed over to University of Philippines as a group and met with the Dean of students.  Then began a long, drawn out application process that took over 3 hours!  We filled out forms, had to go get new pictures taken, had to go get our passports, had to wait around again....and  on and on.
Then we got our first glimpse of our rotation sites.  Let me tell you, HIPAA does not exist in this country.  Neither does free ER care, gloves, machines, curtains or private rooms.  The ER is open air, yet the smell of urine, blood, sweat, infection and feces manages to linger in the air.  We met some nice senior residents, interns (5th year med students) and clerks (4th year med students) - although it will take a while to get to know their names.  They speak English very well and will be able to help us with translation.  It was their first day too so we won't be too far behind.
We will be working 8 hour shifts, I think.  It may change.  It sounds like we can kinda set our schedule and make it what we want.  We will also probably get to do a lot of procedures - phlebotomy, intubation, suturing and it should be interesting.
Patients here have to pay UP FRONT.  There is a "menu" of how much it costs for certain things, including drugs.  It costs P 2100 ~ about $50 per day for a room.  With the cost of living here that is an exhorbitant amount.  (Most people make between P200 and P300 per day - only about $6).  We will also be restricted in the drugs and machines we can use for patients based on what they can pay.
We passed the anti-rabies unit on our way to noon conference (same as in the US).  We got a free meal, which was delicious and proudly presented by 2 drug companies.  We also heard 2 case presentations that kind of jogged our memory about what medicine is all about.  I think this month is going to be a great experience.
The other girls had good days too - I realize my blog is being read by all the girls' families so I'll try include their activities too. (Hi to all the moms! We LOVE to read your comments!)
The OB/Gyn floor is also open air with no curtains.  We're not sure if people actually deliver there or if they go to a different room but they labor in the general room along with all the Gyn surgical patients.  The Family Medicine gets to start at 9am (all the rest start at 7) and we're not sure what that all includes.

After we left around 2PM we still had some things to finish up, like getting pictures and a badge for the campus.  Heather, Shannon and I (amazingly, Abigail is the simplest of the names for the Filipinos to pronounce!!! We now have "Heater" and "Shan-shan-shon-shon-........"!) broke the ice for everyone else and waited over 1 hour to accomplish the whole badge thing - too complicated.  We rewarded ourselves with some smoothies at the mall.  We finished the day with pizza on the roof with the rest of the group.  Tomorrow the real work begins.....

Quiapo Market

So on Sunday morning we decided to try a couple of things 1) the elevated train 2) marketplaces 3) navigating Manila.  We were successful in all.  We headed for Quiapo Church and marketplace - 3 train stations away.  The trains were even air-conditioned, and there was a female-only section we could ride in.  The ride cost < $2 for 7 of us - not too shabby.  The market was RIDICULOUS - there were hundreds of vendors and THOUSANDS of people.  We attracted quite a bit of attention too - being the ONLY white people there.  Everyone was trying to get us to look at their goods.  Speaking of goods - you could buy anything from DVDs (House Season 6 even!!!), sun glasses and clothes to dried fish and vegetables.  We enjoyed going down the aisles, although Erica was not used to all the commotion (nothing like it in North Dakota!).  We looked around and also visited the famous Quiapo church which has a black crucifix which was brought over by Spanish priests during the 1600's.  Mass was going on (for 4 hours) so we didn't get farther than the narthex inside, but there was a jumbo screen in the marketplace so you could see the priest.  We all bought some trinkets - Chinese lucky charms, flying airplanes, T-shirts ("We have BIG sizes, Ma'am") and some veggies.  A word about this Ma'am thing - EVERYONE calls you Ma'am or Sir, except that Ma'am sounds like "Mum".  It's so common that we've even started saying it back!  We are also the largest people in most company, and by large I mean we can't wear child's-sized clothes.  It's part of the culture here to point out that they know we can't fit in their clothing, but nonetheless my ego has taken quite a hit and I will be joining Weight Watchers when I get back to the States! 
After the market we bought some questionable street food (shaomai - basically a bun with some pork inside) that we re-heated at home and ate for lunch.  Some of us went to the pool for the rest of the day and the others just stayed in and enjoyed the activity-free afternoon.

Sunday, February 7, 2010

First Day of Work

We are all pretty nervous about actually going to the hospital today.  We will let you know how it goes.  The roomates are assigned as follows:

Heather, Shannon and Abigail - Emergency Medicine
Carol - Family Medicine
Megan and Erica - OB/Gyn

We start at 7:30 so we won't be able to watch the Super Bowl.  We're hoping we can catch part of it, and we also want to watch the Olympics but we'll see how that goes.

Bataan Day 2

We hardly got any sleep due to cold, roosters, dogs, monkeys and Filipinos, not to mention the hard bamboo beds that we had.  But waking up on a private beach in the South China Sea is not something I do very often so therefore I savored the moment.  There was a lot of talk, however, of Rooster Stew for breakfast........
We had a delicious Filipino breakfast (rice, etc - meal 5 straight with rice in it!) and then loaded on the bus again and headed for Morong.  We got stuck - literally - in Morong with the bus when we missed our turn.  We went to a small village called Nabylongong, home of the Pakiwan Conservation Center.  Pakiwan is Tagolog for sea turtle.  We had an educational talk about the Pakiwan (used by locals and poachers for soup, combs, eyeglasses, etc) and the efforts to preserve the creatures.  They collect the eggs over a 6 month period - each female laying 100+ eggs.  They move them to the safety of the conservation center and let them "cook" for 45-70 days before they hatch.  Temperature determines sex, so the center tries to breed more females by keeping the eggs out of the shade and at warmer temperature.
We were all given a little Pakiwan, hatched at 5 am that morning, and we took them down to the shore.  They need to complete the journey from shore to sea by themselves so they will know where to come back to in order to mate and nest. (25 years later!!!)  We had a Pakiwan Race (see photos) and enjoyed the lovely seashore.
Back at the ranch we had lunch and enjoyed the cool water while working on our tans.  We left for Manila later in the afternoon, around 3, and didn't get back until almost 8 pm because of road construction and traffic.  A late night run to the mall for some groceries completed the day and I crashed in my nice, soft, mainly rooster free bed.

Saturday, February 6, 2010

View Photos

Bataan Day 1

Bataan
2/6/10 9:22 PM
We left bright and early on Friday morning. – 6 am. We had a huge, air-conditioned bus that came with a driver, his friend, a guide, and Dr. Grace Yew, our host. She studies the shoot of the rattan plant and has found it to have anti-inflammatory, anti-bacterial and anti-cholesterol properties. She found the plant with the help of a tribe known as the Ayta.
The Ayta live in the village of Kanawan, in the hills east of Morong, Bataan. There are 411 Ayta total, with 200 children. They are known as Negritos, with short stature, dark skin and curly hair. The leader was even able to tell me how many people had curly or straight hair! They live in small huts and all the children play together.
The drive took us out of the smog and through some pretty countryside. We also got a peek at the city around us that we haven’t ventured to yet. Most of the countryside is rice paddies with handfuls of people working them and small huts scattered in the fields. We stopped for breakfast at ChowKing – a national fast food place. Now I’m a huge fan of Chinese food, and I’ve been known to eat it for breakfast, but this was a stretch even for me. The fried rice I had was good, but a little heavy for a morning on a bus. Thankfully, a Starbucks was right next to it and we all were able to get a caffeine fix. Shannon had left her swimsuit back at the hotel, so we arranged for a shopping stop in Subic. We were able to find said swimsuit, and a number of other good deals too.
The last part of the drive was a little more mountainous. Finally we turned down a private drive and got a view of our new accommodations. We were in the middle of a large inlet of Subic Bay, with only a few local fisherman living nearby. The water was gorgeous, clear and warm, and there were picturesque palms all over. Our hosts arranged for an excellent cook who made all our meals with traditional Filipino food and techniques – very good. We ate a buffet lunch and then drove to the base of the trail to get to the village.
The first part of the trail has been paved for the Ayta by the government because it becomes nearly impassable during the rainy season. We soon came to a hanging bridge which I can describe as rickety at best. The boards are barely connected to the wire infrastructure of the bridge and many have holes or are only half boards. It was an adventure – and the water buffalo laying in the river below just laughed at us.
We continued the 20 min hike to the village. Children ran up to us and were eager to wave, play tag and sing “Poker Face” by Lady Gaga for us – I guess she truly is universal! Most of the kids were still in school, so we continued up to see the jungle where the rattan shoot grows best. We were on the lookout for monkeys and lizards, as well as the ever present water buffalo. We saw mango trees and enjoyed the gorgeous views of the mountains, although there were occasional fires set by the farmers. Dr. Yew was thrilled to show us the rattan plant, and it was interesting to hear her story. She has gone so far as to grant intellectual property rights to the Aytas for their contribution to her work.
When we returned to the village there were kids everywhere! We played games with them (Apple Apple Apple Kiss, Mango Mango Mango Shake, Panda Panda Panda Ko) and taught them tag and keep away. We took blood pressures and saw a few villagers with various maladies – from a severed finger to skin lesions to high blood pressure. We left the village around 5pm and about 20 villagers rode the bus with us back to the beach.
We had another terrific buffet dinner and enjoyed a dip in the ocean while watching the amazing sunset. Then we started a bonfire and got a treat with dances by the Ayta children, songs by some amazing voices and then had our turn teaching them the Chicken Dance! Their dances were Monkey Dance, Shrimp Dance and Hunter Dance. We became fast friends with many of the kids – Abigail, Jolina, Patrick, Rico, and others. I was surprised to find out that Abigail is one of the most popular girls names in Philippines! (Abilardo is for boys.) When we said goodbye to the villagers the party continued with Karaoke and some coconut-rum drinks (in real coconuts from the nearby trees!). We slept that night on bamboo beds – it was a little chilly and we didn’t really need the mosquito netting, or the roosters, dogs, monkeys and other noises that went on all night long. It was an amazing way to spend the weekend.

Bataan Peninsula

This will just be a short post since I'm tired after the trip. We all enjoyed getting out of Manila and seeing the countryside. Briefly, we drove north of Manila and then west to the Bataan peninsula. We stopped in the town of Subic - former home of US Naval base and site of much fighting during WWII. We continued south to the area near Morong where we spent the night on a beautiful beach.

Tomorrow I will post about our visit to the Ayta tribe in the remote village of Kanawan. We've got lots of great pictures and video to share as well.

Our other activity was helping baby sea turtles, Pawikan, make the journey to the sea. Again, more details tomorrow.

Good night, Manila.

Thursday, February 4, 2010

Corrigedor Island

Corrigedor Island
2/4/10 5:09 PM
The day began early – well a little too early in fact since I woke up at 2 am, so did some of the other girls. I got back to sleep and we met in the hotel lobby at 6:15am. We walked about 2 miles to the ferry launch site. There were a ton of people jogging, walking, biking and waking up along the Manila Bay Walk which goes around Roxas Boulevard. We walked right past the Mall of Asia, third largest mall in the world which we plan on visiting in the future.
Our day tour included a hour ferry ride to the island. We had a good view of Manila except for the thick layer of smog which covered the city. The boat had a lovely prayer to start the trip out – Philippines is a Catholic country. We were able to sit inside in the AC, or venture out on deck to get some sun and see the sites of the bay. There were many people out in small outrigger canoes or small fishing boats. The trip was pretty smooth and you could buy snacks and drinks.
Approaching the island we got a view of the Bataan Peninsula, where we will be traveling tomorrow. The peninsula and the island are only 8km apart. The island is shaped like a tadpole and is part of a volcanic rim. It is steep with mountains
I had only read a little bit about the island’s history, and I can tell you that I know more about the Pacific Theater during WWII now. We were loaded onto a bus with no sides which carted us around the island.
We visited many barracks, gun batteries, Japanese and Fil-Am (Filipino-American) memorials, the Pacific War Memorial and museum, a Filipino memorial, the hospital and Malinta Tunnel - a bunker which housed General Wainright, General MacArthur's right hand man on Corrigedor. The Tour guide for us was Mr. Steve Kwiezinski whose father played a prominent role on the Bataan peninsula and on Corrigedor during 1941-1945. His point of view was therefore very moving and had many personal touches, which we all appreciated. The stories were of bravery, honor, dignity, and the horrors of war, all of which are documented nicely in the memorials and museum.
We had a buffet lunch of traditional Philippine food which was very good.

After we returned to Manila Bay some of the smog cleared and I was able to get some good pictures which I will post later.
Our dinner was scrambled eggs, toast and papaya followed by our $1 bottle of Rum and Coke Light. (Heide you'd never survive here, Coke Light does NOT taste like Diet Coke and I'm going to suffer all month long.

The weather is nice - 75-85 degrees, humid but with a nice breeze.

On the walk home we saw boys climbing the coconut trees along Roxas Blvd. They were about 8 years old.

Wednesday, February 3, 2010

US Health Embassy

US Embassy
2/3/10 7:09 PM
We toured the US Health Embassy and met with the US Foreign Medical Officer for Philippines, Japan, Micronesia and sometimes South Korea. We got special permission for a tour and he sat and talked with us for over 2 hours. He had many interesting stories to tell and gave us some advice about traveling in Philippines and places to visit.

After we got back we were all hungry and walked to a nearby restaurant. Café Adriatica is a Manila classic with lots of history. It had a pretty diverse menu with many options for everyone. We had to drink alcohol or soda since water is off limits to us here. (We boil pots of water and then fill water bottles and cool them in the fridge, it’s a pretty big event.) I had the Lola Ising Pork Belly Adobo – a traditional Philippine entrée. The other girls had omelets, Pork Rib Adobo, Linguine, and all were delicious. We made our way back to the hotel and hit the hay early.
We’ve got a 6:15am walk to the ferry pickup to catch a ride to Corrigedor Island – the US naval base during WWII. The tour will last until 3:30.
New pictures are posted on Flickr.

Manila

2/3/10 12:13 PM
Manila
We got in last night around Midnight in Manila. Our hotel provided transport from the airport and we got a taste of Manila’s traffic and night-life. For 1 am on a Tuesday night this place is hopping! There was a lot of traffic, tons of people walking around and plenty of stores open. The ride was short, yet harrowing. Traffic rules and lanes are more suggestions than RULES, Vehicles is a rather broad term here – with regulation vans and cars mixed in with bicycles, motorbikes, Jeepneys and myriad other contraptions. The best bet was to avoid watching out the window and holding on for dear life.
We got to our apartment and were very pleasantly surprised. We have a very large (bigger than our apartment) 2 bed 2 bath apartment with living room, kitchen, dining room and 3 balconies. The hotel has a pool, restaurant and work out room as well. We are located about 4 blocks from Manila Bay, 2 blocks from the hospital and 3 blocks from a humungous mall.
I got about 3 hours of sleep before we woke up and had a group breakfast. We had a terrific buffet breakfast at another nearby hotel on the 21st floor. There was an amazing view from all 4 sides and we kind of got our bearings. I think already I’m going to enjoy the many different fruits. There is a large mix of foods here, Korean, Japanese, Chinese and traditional Philippino.
Along the roads there are many peddlers, multiple money changers and of course, beggars. People are sleeping and living on the street all around us – this is definitely the most exposure I’ve had to begging and homeless children. Most of the peddlers will leave you alone if you say “no”, but the kids will walk next to you for blocks, bare, dirty feet slapping on the concrete and hands reaching into pockets or held out for money.
After breakfast we visited Manila Baywalk and saw the infamous Bay. We will go down there for sunset as it is supposed to be gorgeous. Next we hit up the large mall nearby. (Not to be confused with Mall of Asia – the size of the airport which we’ll go to later on.) There were many many shops, some familiar, dozens of restaurants and a movie theater in the 4 level mall. We stopped at a hardware store to get a 3prong-2prong adapter and then did some window shopping before going to the grocery store for some necessities.
Next up is a trip to the US Embassy which is also near our hotel.

Tuesday, February 2, 2010

Seoul

We are safely arrived in Seoul, South Korea. It was a long but tolerable flight over. We flew over Canada, Russia, and China and kept a WIDE berth around North Korean airspace! The only bummer upon landing was realizing that we had 7 MORE HOURS until we were at our final destination. We had an adorable Korean 2 1/2 year old keeping us occupied, and a bunch of us were sitting together so all in all the flight went well. And I finished half of a scarf.
We tried some strange food, walked around the airport, enjoyed the Korean cultural exhibit and are now awaiting the 4 hour flight to Manila.
So now we'll head to Manila and I'll blog later.