Externship Experience: The Importance of Family in Filipino Healthcare

RVUCOM students who are part of the Global Medicine Track complete required externships abroad, often in areas of the world that are impoverished and critically underserved. In doing so, students receive a unique clinical experience that includes the treatment of unusual diseases and exposure to the cultural factors that can influence healthcare delivery.

For Natalie Gould, OMS III, the opportunity to provide quality healthcare while enriching her global medical education came in the form of an externship in the Philippines. The externship was set up through Work the World, an organization that customizes internships for medical students in hospitals all over the world. While the rotation was observational only, SD Gould was able to help with various procedures.

The trip began in Iloilo City, Philippines where SD Gould spent much of her time at Western Visayas Medical Center, working long hours to help the local hospital staff treat dozens of patients. She observed that the hospital was often overcrowded; at one point, she noticed 99 patients in a maternity ward designed for a capacity of 35.

At the hospital, she discovered she had to learn through observation due to the language barrier, trying to figure out as much as she could before asking the physician to translate. “There are two language lessons through Work the World so you learn the basics of Hiligaynon,” she said. “I learned how to communicate with patients with very few words and often the patients understood only a few words of English. I think it was a valuable experience to learn how to communicate despite the language barrier.”

For part of her trip, SD Gould traveled to a local village where she worked alongside nurses and midwives, underscoring the importance of these healthcare providers in remote rural areas. She helped with vaccinations, provided Vitamin A and deworming for children, and conducted a few consultations for other patients.

One case that SD Gould found interesting was a patient who experienced “chronic dislocation,” something that is very rare in the United States but is common in the Philippines. “It is likely that this patient was not able to make the journey to the hospital for various reasons: perhaps he lives in a small village that is far away; he could not afford to miss time to make the journey; perhaps he did not have the money for transport to the hospital; perhaps he did not realize that he absolutely needed medical attention; perhaps he was just tough–I saw this a lot. Maybe he saw a local healer and tried plants or herbal medicines instead.”

As she describes it, this was just one example of patients who presented with an advanced or worsened problem because of their delay in seeking treatment. “It is one of the goals of family medicine in the Philippines to educate the poor, underserved, and undereducated communities about the importance of medical care, prevention, and health maintenance…and not waiting so long to go to the doctor.”

Another case exhibited the different ways a patient’s health affects the whole family. Along with a group of interns, she went on a home visit to a severely disabled patient who was part of an ongoing case study. While interviewing the patient and her mother, they learned how the patient’s illness was impacting the health of the family itself. “[The interns] identified things that could worsen [the family’s] situation in the future and ways to avoid that. For example, the mother has hypertension and does not always prioritize refilling her medication. They discussed the importance of the mother taking care of her own health in order to care for [her daughter]. If something were to happen to [the mother], the patient would be severely impacted, as well.” As a member of a small, impoverished community, this case showed the importance of the health of the whole family and “highlighted that community service is a vital aspect to family medicine training.”

This experience and others at the hospital showed SD Gould how important family is in Filipino culture. “I never saw a patient alone in the hospital, not once. [Because] WVMC is a government-funded hospital that mostly serves the poor, they don’t have the resources that private hospitals have. This means the family is involved in patient care. The family helps with washing [them], feeding them, giving meds. I saw doctors send the family out to buy bandaging supplies.”

For students considering a similar externship experience, SD Gould offers this advice: “The most important thing is to be friendly and assertive. It was difficult at times to be with other students because…a lot of them don’t make an effort to get to know anyone and to leave as early as possible. I think this is such a shame. I worked extra hours and [got] to know the staff [which] enabled me to learn so much more. I think I had a better experience because of it. Also, try to get something out of it even if you don’t understand the language–you can still learn a lot!”