We are on You Tube!

http://www.youtube.com/watch?v=Y93RXl8t5X0

More photos of the real stuff plus our reinforcements

Team 2- Anthony (Biomed) and Lee (RN) - the flowers were placed around their necks by nurses in white caps when they arrived for the dedication ceremony . The ladies had corsages pinned on,
More Team 2- Amabel (RN) and Connie (PCT) with Manny(PCT) in the background. if you ever get the chance you should hear Connie's accent- it's awesome- she is from the Philippines but has lived in North Carolina for over a decade so she has a southern drawl along with her original. It is an amazing mix of accents- I love it! This was taken at a restaurant called Enzo my last night in the country- We had a pretty large group and the musicians dedicated We Are The World to us. Of course we sang along- We are Davitans after all.

Okay- I get that I may seem a bit obsessed with the bathroom shots but really the shower was fascinating and yet so difficult to describe. I got pretty good at managing the heat and volume. If you are wondering what the red bucket on the back of the toilet is for just ask me when you see me. Poor Neil- I asked him while we were out shopping and he graciously told me but the look on his face was priceless (how did I end up being the one she asked said his face?)

Taxi Cabs Philippine style

This belongs to the husband of one our patients. He drove her to treatment in it and then gave a group of our teammates a ride they all seemed to enjoy. (at least it wasn't raining when they rode)

Called a Jitney- not sure of the spelling but they are all over and no two seem to be decorated the same. This one is pretty conservative comapred to the others. Fortunately no one who lives there is very tall so they don't bump their head when they board (like I would) Big city, little city- they are everywhere

San Carlos Photos

This is one of the nicer "Tricycles" They are motor scooters with sidecars and are essentially the Philippine version of taxi cabs ( as you get deeper into the country some are actually bicycles instead of motor scooters) All have umbrella tops for the sidecars in preparation for the frequent rain. No helmets at all and there appears to be no limit to the number of passengers that are allowed to pile in

Provincial Resolution NO. 320-2009

Big Finish!

I called this entry Big Finish but in fact it will not be the finish as this mission is still going on. Team 2 arrived last weekend. Kristian Lau will be the Team Leader for the second half along with RNs Lee and Amabel as well as PCTs Manny and Connie, Dietitian Merriam and Biomed Anthony. I welcomed them to the hotel on Sunday and tried my best to give them useful information about the water, showers, paper products etc...(I think they thought I was kidding about some of it but by now they know I was merely passing on useful facts with a little good humor) I'm excited for them because I know they will accomplish a lot between now and their departure on July 31. I will also lead call routine calls with the team in the Philippines for the next few months to check progress and make sure they have every thing they need to keep operating safely and efficiently. This mission can only be called a true success when the clinic is operational long after we are gone.
My final day July 21 started with a whirlwind of activity(keeping in mind since it was my travel day home the time difference caused me to experience July 21 as a 39 hour day- no wonder I still have my days and nights mixed up!). We were up early ( several of us checked out of the hotel by 7 am). When we arrived at the center there was a huge crowd of dignitaries waiting for us- lead by the Governor, his wife, the Vice Governor and her husband plus all the Board member (equal to our California assemblymen or State Senators) Nurses from the hospital in white caps presented us all with corsages and the elaborate dedication and blessing of the building began. The stage and chairs were set up outside but it had stormed the night before so it was the mix of everything we had experienced since our arrival sweltering heat while walking through a bunch of mud. I have to give the hospital crew credit. They must have arrived at the crack of dawn to put things back together after the nights previous storm- including throwing down gravel to create paths to walk on. The ceremony was great with a a few exceptional highlights- One this award winning children's choir that were just about the cutest thing I've ever seen. Two- our trainee nurse plus four of our Bridge of Life Team dressed in costumes and performed a dance that is supposed to be the favorite of the governor- I can't recall the official name but it translates to the flirtation dance- the amazing part about that is that Noni and Evelyn recruited Kristian and Manny to join the dance troupe the night they arrived - so in 48 hours of their arrival Kristian -an industrial engineer and Manny a Patient Care Technician were on stage dancing before all the Province and they were awesome! Three - there were many speeches but Ginny Mello our Bridge of Life Executive Director was outstanding- she was able to sum up everything we were feeling and express gratitude to our nurses and techs who volunteered so much time and effort to the mission and Four- the Vice Governor read a resolution and presented us all with framed copies naming us each as Sons and Daughters of the Province of Pangasinan. Very Cool- I scanned it and it posted above but I doubt you can read it. It will hang in my office as a reminder of the experience.
After the official dedication- we were able to move inside to the air conditioned clinic for a more intimate gathering with the local team. We presented them with their graduation certificates and I placed Bridge of Life bracelets on their arms (I told them that makes us BFFs) Brent from Capa productions flew over to video everything . He interviewed me and looking back I'm not sure how it will come out- I was feeling so emotional - hopefully ! gave him a few coherent answers- the video clips he takes have a way of showing up at Davita meetings and Academy's for many years to come . The one thing I do remember saying and I think I will close this post with is that I feel like all the training I've had and work I've done in my life up to now as a clinician, an operating leader, working with teammates and even my most recent coach training prepared me to do this work with Bridge of Life. As part of this team I was able to use every skill I had and some I didn't know I had every day I was here.
I am exhausted and my digestive system is still in a state of flux but nothing that happened will prevent me from going back- hopefully to open our next center with the amazing Sister Niceta. She was one of my last meetings before my exit to the Manila airport. I felt such an immediate connection with her I know I will meet her again to find ways to help her and her team of 7 nuns continue their good work. Life is good.

Preparing For Re Entry!

So...you may have noticed a gap in my postings. The Internet connection was just not there the last 48 hours. I am now sitting in the business class lounge in Manila waiting for my 10:30 pm flight to San Francisco and hooray they appear to have a big city server somewhere so this will be the last post before hitting American soil. (Have I mentioned lately how lucky I feel to live in the United States of America?) You know I've always been a patriot but my goodness what 16 days away from the simple things like clean running water can do to remind you how blessed we are.
Another blessing I always remind myself of is family and good ol brother Doug called and offered to pick me up in San Francisco and chauffeur me home to the comfort of my own bed sparing me another night in a hotel and the Amtrak ride home on Wednesday. He called and said he was concnerned that I might not enjoy the train ride considering the fragile state of my digestive system. I happily accepted his offer. What a guy! In spite of knowing this was a life changing trip and an 90% chance I will return to the Philippines in the next 6 months for another project, right now I am like the horse who can smell home and there's no getting me to turn around and come back. I have no idea what will happen with my internal clock as I switch back but I do think Doug's act of kindness will help me adjust sooner. Having cool brothers's just rocks!
One clarification of my previous post I did say I danced with most every Dr in the room - just blogging with a free flow of thought, I guess I should mention since we were the guests of honor I suspect either the Governor or simply their custom required they take turns with us on the dance floor. ALL of the females on the Bridge of Life Team danced with the Dr's and dignitaries not just me. That voice in my head (Mother) mentioned it sounded a bit odd , hence my feeble attempt at clarification.
I have so many thoughts running through my head regarding this trip, Bridge of Life and how I will contribute to the mission going forward I think I will let it settle bit before putting it all to paper. I can tell you am personally committed to supporting the center in San Carlos City for many years to come. I am a part of that team and they are a part of me.
I met with Sister Niceta, Sister Pinkie and their group at our dedication ceremony this morning and it appears likely they will be our next project. Just really wonderful women doing really good work. It will be very different from our project with the government as our partner but I think an amazingly fulfilling experience. More on that later.
Health wise things aren't great but I have the medications to keep things under control for the long flight home and my goal in these next months will be to bolster my system and research all possible ways of avoiding a recurrence of the gastric nightmare my next time out. And no matter what - totally worth it. Hard to imagine I know . I wish you could all have the experience.
See you all very soon- I can't wait to see Jacob and Jack. I'll meet you both at the swimming pool!

My Last Sunday in the Phillipines

This is the weekend of the handoff from Team 1 to Team 2. Four teammates headed out yesterday morning and the rest of Team 1 will leave Tuesday afternoon after the official dedication of the building. Remember it's a five hour drive back to Manila and about 4 hours at the airport since seats are not pre assigned- then a 13 hour flight to San Francisco where I will land at 8:00 pm.I pick up that day I lost when I left. I'll spend the night at a hotel in SF and then take Amtrak home again on Wednesday. Six team members from Team 2 arrived this afternoon. The rest of our group went on another excursion but I stayed behind to relax a bit and welcome the newcomers. It's great to feel their energy. Unfortunately one of them is missing luggage. She came from North Carolina so there were a few transfer opportunities for error.
What a trip. I don't recall ever seeing this much rain in my life. The sky just opens ups for hours at a time and days at a time. Everything here is soggy and muddy right now. My overall impression is that it is such a naturally beautiful place - but the lack of infrastructure and overall poverty presents so many challenges to the people. So much of the kidney disease here could be prevented if they could just have access to basic blood pressure medicine. You don't really see any obesity so it's a the high salt (and I do mean high salt) foods . plus the water quality is so poor it's just an infection waiting to happen - and then when it does it's antibiotics on a cash basis so you only get it if you have money. The safety net here is the public hospital that I expect to tour tomorrow but my understanding is that it's not much of a safety net. Imagine 2 patients per bed. They only have so many beds and do the best they can.
I'm so proud of the water system Bridge of Life has installed in the center. I'm going to attach a couple of photos. It may not mean much to you non dialysis folks but trust me when I tell you it's a beauty.
I've started refilling my duffel bag in preparation for my departure on Tuesday. Big lesson- I brought way too many clothes..way too many. The next couple of days will be very busy. Tomorrow Ginny Mello and I are traveling to another Village where they would like us to come for a mission. I hope the rain lets up for a bit. My poncho works fine but I worry a bit about the roads we will need to pass to get there. It's all an adventure.
On the health front I'm still pretty much existing on rice and soup. My system suffered a pretty big assault last week and is still a tad fragile. I am CRAVING a big ol wedge salad when I get home. Nice crisp iceberg lettuce with blue cheese dressing..ahhh a girl can dream!

Big Night

We were honored last night at a party hosted by the Governor. There was a ceremony of Thanksgiving where they placed flowers on our heads and gave us lovey gifts. Then we learned than no one likes to sing and dance like the Philippino people- and the good news is they had a band that played all the songs from high school. When the Governor tells you its your turn to sing you take the mike and go. I belted out "Yesterday Once More" ( you remember the Carpenters) It was so loud I could barely hear myself sing but they were surprised I could carry a tune. It turns out my teammate Neil is quite the singer himself. He did a beautiful rendition of the Beatles "Yesterday" I think I danced with every Dr in the room but my favorite part was introducing our young nurses to all dancing in a circle. Hey we have plenty of practice at nationwide with a 70/30 female to male dance floor.... hence the circle dance.
I have to say I am just in love with all of our trainees. They are so bright and fresh and they will all be highly competent dialysis nurses.
I'm about to lose my battery but I will try to upload a photo. FYI- I'm healthier

Health Update

First lets get it straight whatever the date on this blog says up top it is actually Thursday July 16 here in the Philipinnes. When I started the day by tossing my cookies AGAIN ( Day 3) I knew I needed something else. Neill our team leader offered to run to the clinic to pick up some supplies and come back to start an IV on me. I quickly agreed so that gives you some idea of my level of desperation. Within minutes the Governor sent over 2 Drs and I had an iv of lactate ringers in me before I knew it. They added in some Raglan (for nausea) and a follow up bag of normal saline and I feel almost human. While lying on my bed waiting for the last bag to drip in Ginny Mello our Bridge of Life Executive Director and Dr John Ball walked in. Now I really felt like a wimp. They were all very nice and very concerned. Dr Ball sat with me for awhile and gave me lots of good advice, I've managed to keep down a bottle of Gatorade and a I really feel like I'm on the road to recovery. Not to worry, especially with Dr Ball here I am in very good hands. I'm just anxious to get back to work at the center

Cafe Davita!

We thought it was ironic that this was the coffee they served at lunch at Kevin's, I didn't have any so I know it wasn't the culprit.

Yucky Day # 2 but getting better

I'm not pointng fingers BUT so far every meal I've had has been prepared by the hotel or the hospital. On Monday the Governor insisted on taking us to lunch at this restaurant called "Kevin's" ( now what's up with that? I haven't seen an Irish guy since I landed in Manila) anyway by late afternoon I was puking and pooping green and 48 hours later it's still having it's way with me. The drugs Emy gave me yesterday really knocked me out. I was so rested I thought I could make it in to the clinic today. No such luck- and hour into the day I was running for the bathroom ( or as they call it here the comfort room) I'm a little better this evening- the fact that I can concentrate enough to write is a good sign but I'm definitely not well. It may be a diet of crackers and sprite until I return home next week. Still totally worth the trip but I really could have done without this.The worst part is how worried they are about me. They keep checking in every hour or so to be sure I'm still breathing.

Ginny Mello and Dr John Ball are expected in San Carlos tomorrow. We are all looking forward to showing them how great the students are doing.

The Lost Day

I guess it was destined to happen though I had convinced myself I was invincible. Yesterday afternoon my head started pounding and I opted to skip the group dinner and just go back to the hotel. Good decision because I spent the night dealing with raging diarrhea and vomiting. Such fun. This morning I called Neill (our team leader ) and asked him to send Emy by my room before they left for the clinic. another good decision because she had a variety of medications that just knocked me our for HOURS. Unfortunately the Governor was in the hotel and heard I was sick so that set quite few things in motion like a phone call from the government physician (like our surgeon general) he was downstairs but I declined having him come up There were also a few knocks on the door during the day to bring me sprite and make sure I was OK and one visit from Raffy (Governors right arm) to check in. He must have been shocked to see my pasty face - messed up hair and my tshirt and sweat pants-pretty disgusting. all in all I'm in good hands though mostly it was Emys miracle drugs that saved the day. I'm going to try to go to dinner and eat a little rice. Since I'm able to write this I assume you will know I'm feeling better- weak but better
Hey Britters- my fumble fingers accidentally rejected your comment- could you plase add it again? Not sure how it happened but couldnt get it back

Sunday In Baguio

If Sunday is supposed to be a day of rest then I'm not sure what yesterday was. The tour bus picked us up at 6 am and we swung by the hospital to pick up our trainees. We traveled about two hours to the city of Baguio and it was like going to another planet. High in the mountains and very green. We went to a beautiful park and got in row boats and rowed around this pond ( for my Fresno friends it was the color of the pond at Roeding park.) It is clearly the tourist area with lots of rides and an arcade as well as little old women walking around begging for Pesos. It's a good thing we did that first because the rest of the day we experienced torrential rain. We managed to put on our ponchos and still shop at the tourist stand and then went the the Mall (a real one) and treated our team of 20 + 3 drivers to Yellow Cab pizza. It was very much like pizza you would get in the US. I was shocked when the bill was over 6,000 pesos but then realized it was $120 (including soft drinks and beer for all) not a bad price but not the dirt cheap prices we have become accustomed to.We all agreed to be back at the bus by 4:30 to head back to San Carlos City. Unfortunately a couple of our Bridge of Life nurses were an hour late getting back because they went into a quick spa in the mall and lost track of time. It was close to 9 by the time we dropped off our nurses and found our way back to the resort. I totally skipped the dining room for dinner. My sheets were barely mussed I slept so soundly. I got a bunch of souvenirs...I hope everyone likes the trinkets I will bring home. My best purchase was a blow dryer that works on 220. This morning was the first time I was able wash my hair and not just let it air dry. Good thing since I ended up participating in a couple of interviews with the Governor. More later!

Internet Woes Slow Down My Posts

I'm having quite a bit of trouble with my internet connection. I can't seem to download any photos right now. Keep your eyes open for our press realese with a picture of our team and our first patient. I know it was released in the United States yesterday. You may also want to try searching Bridge of Life on You Tube. We have Kelsey from the Casa here for a couple of days and she's been sending out a lot of stuff.
This morning we held the first of 2 community screening days. It was pretty overwhelming for the first couple of hours. People arrived early to wait to be checked. We had several stations. I manned the assessment station with Noni from Arizona and our trainees. We took blood pressures and did quick assessments and histories before sending them to the urine test station. I was blown away by the rampant hypertension. So many had crazy high blood pressures (like 200/110) . If they showed protein, blood or glucose in the urine they moved on for a finger stick. All with problems then went to the table of physicians and finished with a consult with Elaine our teams Dietitian. Overall my take away is this: Lot's of unaddressed health issues here. Our process was to place a star in the upper right hand corner of their intake form if we found something of special concern in either their BP or assessment. I estimate we placed stars on 80% of the forms.A few who came were patients who have already started dialysis but travel far and want to come here. They will return on Monday for treatment. It was hard work today but good stuff
I'll try to post some pictures in a separate post and see how it works

A Great Day!

We started the day not knowing for sure how many patients would show up. One by one they came and by 2pm we had admitted 7 patients to the only center in the Pangasinan Province. . In the end 5 full dialysis treatments were completed on day one of operations and all 7 will return on Monday. Not too shabby considering we’ve only been in the country four days and managed to get everything set and ready to go.
I’m not sure if the best part was watching the excitement on the faces of our young trainees or the emotion in the eyes of Emy, Jillia, Noni, and Eveleyn from our Bridge of Life team who used to call this place home.. When Noni addressed the team at our home room meeting- she told the nurses “this is a dream come true for me”. They are all eager to share what they’ve learned in the US to help improve the quality of care for their countrymen. When the blood hit the first dialyzer you could feel the energy in the room.
In the end our trainee nurse Aileen said it best when in the middle of the hustle of getting machines set up and patients admitted and on , she stopped for a second, looked me in the eye and said “It’s a great day” and she was right, it truly was.

A Frustrating Day

Had a small setback today. In the end we decided to delay our first treatment until tomorrow. A combination of things going on made it the right call. We are disappointed but will definitely begin our first treatment tomorrow. We actually met our first patient this afternoon. She is an employee of the hospital who started dialysis a couple of weeks ago. She’s been traveling a long distance to another town for treatment but since they require cash payment she could only pay enough for one time a week so she’s very weak. We will be able to provide treatment for her 3 times a week and should see a rapid improvement in her well being.
The rest of Team one arrived today, two more nurses and a dietitian. We continue to be served fish of various varieties (I’m not talking lobster ) I’m learning about all kinds of breeds I never knew existed. Today for breakfast we had Bangus fish. Emy tells me the common name is milk fish and they breed them out in the river. It looked kind of like a small trout and was pretty bony. Tonight they served us Bampano- It was kind of a big round thing shaped like Nemo and they served it with the head on which always freaks me out a bit. I also had ducks eggs this morning and quail eggs with tofu and spinach tonight- both considered a delicacy- the adventure continues and my digestive system is hanging in there.
We just learned that Dr Manuel the Chief of the Hospital arranged a day trip for us on Sunday. We are going by bus to a place called Baguio. Apparently it’s more tourist friendly. The local nurses oohed and ahhhh’d when they heard we were going. I suspect any souvenir buying I do will be done there.
For those of you late night television watchers I managed to do my required coaching call with the US today using the “Magic Jack”. (two of our team members brought them from home) You plug it into your computer and a basic phone and suddenly you direct dial any number in the US for free- no country code or anything. It’s pretty amazing- of course you need an internet connection and that can sometimes be a little squirrely here. The connection can be a little odd at times but I assume it depends on the internet connection. I can’t complain- technology marches on.
It’s still hot but we had several huge downpours in the middle of the day. The rain is unpredictable but either way it stays hot.
I recall I ended yesterday’s post telling you the Governor was here and he was. We spoke briefly and he thanked me for what we are doing. We have a formal meeting next week and he will attend the dedication of the center on the 21st. He was nice and surprisingly soft spoken.
Time for bed….tomorrow should be a big day

Wednesday In San Carlos City

This is the entire Bridge of Life group that's here right now plus Raffy (the gentleman to my right) We have three more clinicians arriving tomorrow and that will be it for team one. This morning we were asked to stop by the Capital on our way to the center. Raffy is the Governors top assistant and has been our primary contact since this project began over a year ago. I met with him twice in August of 2007 when he was visiting family in the Bay area. He is so committed to this project and a pleasure to work with. This morning he gave us the VIP tour of the Capital including the Governors office ( who was out today) He insisted I try out the Governors desk for size. It was cool but the best part was standing on the roof. I'm not sure if the pictures do it justice but the view of the Province was just breathtaking. You may notice my hair is clipped up in these pictures- I thought I cut it short enough before I left to just let it hang but the heat here is just sweltering - so very humid doing anything with hair is pretty much a waste of time and any hair hanging on your neck is soaked with sweat by 9 am. The hotel and clinic have air conditioning (sort of) I have a wall unit in my room that works hard all night long to keep things cool. Not quite the central air we are used to.

48 hours into it I have become very accustomed to having a "Driver" at my disposal. I was uncomfortable with it at first but found I quickly came to appreciate the Governors (and Raffys) generosity. There are actually 2 drivers assigned to our group and they stay with us wherever we go. (and carry everything in and out) Today we needed a few items for the center and the driver took Neill, Peter and I to a mall (not like ours). The big store is CSI which I would liken to a Smart and Final though for some reason trash can liners could not be found. The big search was on for paper towels. Not the ones on a roll like Bounty- though we couldn't find them either but the basic paper towels we use in clinics in a dispenser. Apparently the hospital requires the nurses to dry their hands on toilet paper as a cost saving measure. After searching we found some and bought out their entire supply for a little over 2,000 pesos. I'm still working out the math ands should know for sure since I'm the one who paid but I think that's about $50. We have a huge opportunity here to improve the infection control practices of the nurses we are training . I just want to be sure we come across as helpful and not judgemental. They are all RNs but the basic hand washing technique they were taught in school pretty much went out the window when they got to the hospital and found the limited supplies. I find it ironic that the nurses in the hospital here are required to wear white crisp uniforms with the standard white hat (I am not kidding) but they don't even have anything to dry their hands on. It's all a matter of priorities I suppose. If the patients here expect to see a nurse in a white hat I guess that's' what they get. That will not be the case with the young crop of nurses we are training. They are excited to be able to wear colorful, functional scrubs in the dialysis units. I was so surprised that they are such a YOUNG group. The average age is 22 and the oldest is 28. They seem more like high school kids- lots of giggling as they practice priming machines and sticking needles in the fake arm. I suspect things will sober up a bit tomorrow when we dialyze our first 2 patients. Up to now it's all been play acting but tomorrow at 1 pm the blood will hit the first dialyzer .

One final comment about the photos of the view...that's what its like in the government compound here in the Capital city of Lingayen where we are staying. As we we exit and drive through the Town Proper (their term for downtown) and through a couple more cities to the clinic in San Carlos City- it is a very different situation. On the weekend I will get a few pictures to try to capture the reality- but though the roads are paved it is very primitive especially in the various modes of transportation...more on that later....

oh my gosh the Governor just stopped in to say hello to me...no kidding gotta go!

The Journey Begins With Lots of Hugs

Here's Jack saying good bye at the station. I took a picture of Jack, Leslie and Mark waving goodbye from inside the train- it's now my screen saver for the rest of my trip.

Here's the group who saw me off at the Amtrak station on Sunday morning. It's now Tuesday night in San Carlos City and I will have my first nights sleep in a bed since I left. (though I have to admit I slept pretty well in my Business Class seat with my noise canceling earphones and my blindfold in place) Philippine Air really treats their Business Class travelers like royalty.

The train left Fresno Amtrak station at noon and pulled into Emeryville at 4:05 pm. Two Davita FAs Stephanie and Teji met me at the station to hand off a bottle of solution the team in the Phillipines had texted me a request for. Not only did they take time out of their Sunday to go to the clinic and get what I needed, they refused to let me take a cab to SFO . Thanks Steph and Teji for taking such good care of me.

Speaking of well taken care of, we are being tretaed like royalty here. We are staying right in the government compound across from the Capital Building in a resort that is strictly for guests of the Governor. I have to be careful what I say because any comment I make can be construed as a request and three staff members will jump to attention to meet whatever they percieve my need to be. That said, no amount of service can do much about the plumbling situation. More to follow on that.

So far, every meal has been some form of fish. Tonight our first course was Fish Belly soup and yes it had a big old fish belly right in the middle.

I'm getting pretty sleepy - I'll post more as I get adjusted to the time.

Jacob came by to say goodbye and gave me this wonderful letter- Grandboys ROCK!

Here's a story that ran in the Philipinnes news this week