Global Health Experiential Education in the Philippines

Participating in the Philippines–Remote Island Medicine Internship with Child Family Health International (CFHI) has been personally transformative and eye-opening experience that surpassed my initial expectations.

I’ve learned opportunities of studying abroad because of the fellowships I had in my community college. As a transfer student, I spotted a UC Davis flyer promoting the Philippines–Remote Island Medicine Internship in 2022 and envisioned it as a small goal. At the end of 2022, I found there could be scholarships such as Kerr-Lacy Study Abroad and CFHI Scholarship which we can apply for as an Aggie. I chose the Remote Island Medicine internship in the Philippines to broaden my global health perspective as a dual citizen. I chose it not only because I will have a chance to see my families but reflect on what I can do today to address health disparities in rural and urban areas. I aspire to find ways to integrate professionally. But most importantly, to learn what public health means to me as a global citizen and learn together with my co-interns. The interactions we had could be a way to forge relations with students like ourselves who may someday lead their programs internationally. My internship abroad turned out to be the last class I had as an undergraduate—solidified my plans of participating in public health as an aspiring nurse midwife. The words of Dr. Joel Buenaventura's sharing on his seven years of community medicine on the island resonates deeply: 'It is not the island that’s changed, it’s me.' This sentiment echoes CFHI’s powerful slogan, 'Let the World Change You.' The immersion and interactions I had in the Philippines and their healthcare system profoundly impacted my perspectives on global health and nursing as a student, seeing essentially how our connections with one another is.
We stayed in Metro Manila (capital of the Philippines) for about 2 weeks. From here, one of the experiences that provided me insight into public/global health was walking through UP-PGH with Dr. Paulo “Lopao” Medina while talking about a part of the Philippine health system where there is more subspecialty than generalist doctors (inverted primary to tertiary). This topic has been included in the healthcare system/situation lecture at the university along with the reiteration of the disjointed healthcare system where we sat with 4th year medical students. While being mindful of the values of CFHI, another local team experience I appreciate was walking at the 'Quiapo Medical Center' (complementary/alternative medicine) tour and the National Museum of Natural History tour, where Dr. Jerry mentioned how topography (typhoons) affects healthcare distribution and the lifestyles of a culture. In a piece of information in a public health class, I read a women's health article “Why The Philippines Has So Many Teen Moms” informed me about rising teenage pregnancy, access to abortion and the need for sex education. It is a topic I yearn to know more about. One of the most significant experiences I had was learning more about it in Manila and at Tablas Island, Romblon. In Manila, Dr. Jomer led us to see the Red-light District and rotations at the HIV clinic---where CFHI opened me to see sensitive patient-doctor interaction, and how affordability could affect referrals/quality of interventions. I remember Dr. Jomer shared that he has been doing an outreach similar to HIV clinics since high school, to community college, at UC Berkeley and meeting him today at CFHI as an Aggie. Another thing that stood out to me in Manila is our Debriefing Session/Exit Conference at the University of the Philippines where we are presenting what we learned as well as being in conversations between leaders at RHU in Tablas Island and leaders in Manila—how they creatively communicate, collaborate, and value the work that they do in their respective fields in public health. I recall “How the book isn’t always what could occur in actuality and how there could be times of what is needed should be the action. Trial and Error with the importance of guidelines in Public Health. And always remember that at the center of public health are the people”. These immersive experiences reminded me of the significance of words: “pagpapakatao” (being human/importance of kindness) and kapwa– “(I) self in the other” in patient care. At CFHI Philippines, I also realized how politics and healthcare are tied together.

In our last 3 weeks at Tablas Island in the province of Romblon, we stayed at Mama Le’s home where she also takes care of her granddaughter—it made me reflect on the advantages of close-knit family ties. The “everyday” after our clinicals looks like walking near the pier with my co-interns, where we sometimes stargaze or watch lightning from a far. One of the fun aspects of the program here is having our orientation at the beach, going to Bon Bon Beach and taking boat rides, hiking near the Blue Hole, and exploring another Romblon island walking more at the Marble Capital of the Philippines with Dr. Jobin Maestro. In addition to that, I am thankful for being invited by the Municipal Health Officer (Dr. Jobin) on his Birthday joined by families and the RHU staff (forever karaoke). On the island, there are clinical observations on the dental clinic and observation of procedures done mostly by the nurses including circumcision, removal of birth control, immunization and outreach/communication on HPV vaccine (since 2023) on HS students. At the Rural Health Unit, observations of what midwives do such as newborn screening tests, assessing mother-child who gave birth at home in a remote place, and vaccines/supplementations given to pregnant women (if luckier, will witness birthing). I had the chance to observe more about: rural vs urban resources and compare it in global health, the fragmented/disjointed healthcare system, and the task shifting of their nurses and other healthcare workers. Another thing that stood out to me is visiting the Looc Marine Sanctuary with my co-interns on Tablas Island (my first time jumping, ofc with a life vest) and reflecting with Drs. Ged and Ken on the reproductive health presentation to a high school population by the RHU that had a “wasted” acronym. But most importantly, I am grateful for CFHI Philippines because it reminded me of my WHYs.

Moreover, I'm flabbergasted by meeting the CHFI Philippines director, who is part of the Department of Health International Relations (migration health), as an undergraduate. I learned how they have secured OFWs' health insurance to the country they are about to arrive. The information of fitness goes to the country of arrival or where they will migrate to. I specifically asked migration because I heard there are less studies tracing mental health for migrants and the different types of visas they hold from the Philippines to the US. In here, I perceive that there might be loss of data for analysis of health outcomes, and I speculate that transnational ties are already embedded in global health. I am grateful for Child Health Family International for the latitude of insights in global/public health and valuable experiences it provided me. I am reminded as well of the two time zones I have had since growing up. As an Aggie, I’m asked about my hometown that I’ll go home to–-here and there after the program. My internship at CFHI became a journey back home while I am at home.

I participated in Global Health in The Philippines Program. I traveled to Manila, Philippines, for one week and then was assigned to the remote island part of the program for three weeks. I was sent to a small island called Tingloy which had a population of 19,000 and was in the Batangas Province of Luzon. The first week when I was in Manila, the group I was traveling with and I were introduced to the rich culture of this country. We visited tourist spots like Rizal Park, the National Museum of the Philippines, and Intramuros. This helped introduce and contextualize what we would learn about the Philippine healthcare system. Then we had an authentic Philippine dinner and saw the national dance called the Tinkling.
Furthermore, we were introduced to the disparities of Manila as we went to a part of the city that is very underdeveloped. This opened our eyes to the inequity within Manila. The next day we went to Chinatown, and this Chinatown is considered one of the oldest Chinatowns in the world; we got to try some pretty good frog legs, and then we were taken to an area of Manila called Quiapo and visited the local street markets in vendors.

Then we were taken to a church called the minor basilica of the Black Nazarene, and this is where we learned about how Catholicism and religion play a significant role in how some policies, such as reproductive health and rights, are controlled within this country. We were also sent home later that night to watch a documentary called sicko which is about the American healthcare system, and this was going to be used to compare to what we learned about the Philippine healthcare system as we sat through six hours of lecture on the current state of the Philippine health care system. The Philippine healthcare system, in general, is run by the Department of Health, and it very much tries to veer away from an American privatized healthcare system. However, due to the existence of public and private health care, there is a vast disparity between the two, and about a little less than half of the Filipino population pays out of pocket for their medical treatment because the universal national healthcare insurance called Philhealth does not fully cover or provide basic needs. The next day we went to San Juan and Ternate Cavite; we visited the Barangay Health Station, which was pretty underfunded and had limited resources. We also got to watch a baby receive its immunizations. Then after we sat in on a lecture with medical interns who were training volunteer barangay health workers, it was exciting as many of these health workers themselves were volunteers, and two had minimal knowledge of medical-based things such as how to properly track someone's height, how to properly weigh a child, how to calculate BMI.

However, they are essential for the Philippine healthcare system as many people within the town will go to these volunteers when they are sick and will only visit the primary healthcare center if there are concerns that do not alleviate or go away. These volunteers are the front-line workers of the structure of the primary health care system. We took some photos with them, which was fun, and they did get to practice all these skills with us. Then we headed to Ternate, Cavite, where we saw the Municipal Health Officer, Dr. Gina. She showed us her facility, which was more underfunded than San Juan. However, a dentist did exist but mainly only for extractions. She also talked about how the DOH does not pay her enough and that she's not provided enough money to deal with Ternate's number one program that they have in place, which is the drug rehabilitation program. The next day, we visited the Philippines General Hospital, the largest public hospital in Manila and the country.
As I walked through the facility, it was very crowded, and our local preceptors told us that some people might be sitting there for two to three days to see a doctor. However, they did have a wide range of specialties, and we got to see the ER. It was interesting to see that people were sprawled out in the lobby in beds and that medical interns, so medical students that had just graduated, were doing the job of doctors as there was not enough staff to be spread. They were allowed full diagnosing abilities also. Then we visited BCG, one of the wealthiest parts of Manila, and we got to see St. Luke's Hospital, a private hospital. It was a night and day change as St. Luke's looked like an upscale mall that had restaurants and cafes in very fancy accommodations to come with it. Many upper-class business people and foreigners in general visit St. Luke's. This showed the difference between what money could get you in Manila and the disparities between public and private healthcare. Some experience I had in Manila was I went to Robinsons Mall, which is this massive mall within Eremite. I could get everything there, and I tried Jollibee, the national fast-food chain of the Philippines. I liked it because it was chicken and rice.

I also got to ride in a Jeepney, an old war machine/tank turned into a bus-looking thing, you pay for seven kilometers, and they're very hard to navigate, but they were still fun. We also visited a souvenir shop, and there were these cute fish wallets. Also, the night we stayed at BCG, our local preceptors got dinner with us, and we went to a fun karaoke room. I wish they would have them in the US. On the last day of Manila, we just had a lecture about a video that explained how a small child died. We had to analyze the video and develop a web chain to explain what happened. The point of the lecture was to see that public health plays a huge role in someone's well-being and that a lot of outside environmental factors affected the death of this child, and it wasn't just the disease that took her. They wanted us to use this perspective when we were sent to the remote islands as necessary, as many outside factors affect the type of healthcare these populations receive. We got in a car and traveled to Talaga port; we would take a 35-to-40-minute ferry to Tingloy. There we got on a trike, the only mode of transportation on the island except for walking or taking an ATV. Then we went to the rural health unit and met Doc Patt, which was funny because everybody on the island knew who doc pat was, so we just had to say that name, and they knew where to send us. We were the second batch of students on Tingloy, so many of the locals were not used to having foreigners. The homestay we stayed at was excellent, and our host mom Ate Czen was lovely and kind; she introduced us to her kids and cousins, and the word about us on the island spread very quickly. The rural health unit in Tingloy is nice and set up like a hospital due to the last mayor wanting to make this RHU a hospital. However, when the new mayor came in, plans changed, and the local doctor taught us the importance of relationships and how maintaining these good relationships will get you the resources you need when it is not provided initially. We learned that the two main programs on Tingloy are TB and immunizations. We also got to learn the ins and outs of how the Tingloy RHU has explicitly set up its staff.

We also visited Masasa Beach, which is a beautiful beach. We also visited the blue lagoon, walked around town, and got invited to a couple of enjoyable celebrations, such as a fiesta hosted by the mayor. Many children on the island like to play Latto which is a game with these two balls that clink next to each other, and sometimes it gets a bit aggravating. However, it was still a wonderful toy and an experience to learn about. They serenaded us when we walked down the streets, which was pretty funny. Every month they go out into the branches or have specific days for certain barangays to come and get their children vaccinated. The parents are handed a vaccination book indicating which vaccine their child is supposed to get at what age and always bring them in their blue. The local doctor said he doesn't see an issue with many against vaccinations, as many people want their children to be vaccinated. We watched many of these vaccination days, and I did notice that they explained this in Manila. Also, families always come in with a companion; if one family member has to leave, another family member comes to replace so that the patient's not alone. I also noticed that HIPAA itself is very wonky, as many patients sit beside each other; the intake form is a desk with two chairs, so patients sit across from each other and hear the nurses talking about their intake information.

Lastly, the nurses always work in pairs of two, so one fills out the forms because they are handwritten and filed while the other nurse takes the vitals. I participated in a blood drive and got to shadow and see many other things, this is a once in a lifetime trip, and I would recommend it as I have learned so much in the past month, and it was worth the 30 hours of travel back home, lol. If you are considering it, this is a great program, and CFHI does a great job with cultural competency and integration with local preceptors. I made good friends with them, and they said we should catch up and meet when we visit them.

I participated in the Remote Island Medicine program in Quezon, Philippines. The entire process leading up to the trip was smooth and informative. I also appreciated that my capstone project topic was selected by the local hosts themselves and not by CFHI.

My experience in the Philippines went just as smoothly as the trip preparation. The hosts I was working with were excellent mentors, super ambitious and successful in their fields, and well connected as well. This meant that besides the rich knowledge and context they provided us, they were also able to provide additional experiences, like a visit to the WHO HQ. The experience helped me to begin to build an international professional network.

Besides the professional connections I made, I continue to cherish the personal ones I made even 2 years later. My host "family" and neighborhood friends, as well as the medical student traveling with me, enriched my experience and really helped push me into the culture. The time we had off to explore our surroundings and connect with the community provided just as much growth as our time working.

I went to the Philippines in Jan ' 20 before the whole Covid lockdown went into full effect. I was assigned to one of the small islands to work on a rural health community medicine project. It was one of the most amazing things I have ever done. Not only was the teaching incredible, the experience was everything that I could have asked for. As a senior medical student, I saw how community workers cared for rural communities, worked with medical centers both on the coast, and all the way up into the mountains and assisted in public health initiatives like family planning, and vaccinations.

I can honestly say that I have a little Filipino family on the island of Marinduque. So much love, and care is shown by both the community, healthcare workers and professors. I want to return back as a resident, hoping to be working in ER medicine/Disaster Medicine someday.

The CFHI Remote Island Medicine program in the Philippines is an amazing way to get hands on knowledge and experience in the global and public health field. Much of the program is focused on clinical exposure, shadowing, and learning about health inequities. For me, I had learned about global and public health in the classroom but never had any real exposure to the field. This program was a way for me to understand the field through valuable experience.

The cool thing about CFHI is that they really are a vehicle for you to connect to the local community. I really wanted a program that was working with local organizations, not just an American organization going into a community and doing “good work”. CFHI makes the connection to the local community, and then the rest is up to the local directors in the Philippines. So when it comes to ethical standards and ethical service, CFHI did a great job.

Another great factor in this program is its connection to small, tight knit communities in the Philippines. While you will spend some time in Manila, the bulk of your time will be on smaller islands and living in small communities with host families. Living within the community was my favorite part of the internship, as I made friends with my host families, with nurses in the Rural Health Unit, and with other local personalities. I'm still in contact with my friends from the Philippines today!

This program will not only expose you to the global health field and medicine, but it will also challenge you to think ethically and critically about community engagement, it will challenge you to become involved in the community, it will challenge you to learn about a new culture and attempt to learn a new language! The community partnerships you make in the Philippines will be long lasting if you put in the effort, as I'm already planning to spend a year there following graduation!