University of the East Ramon Magsaysay Memorial Medical Center Incorporated is a busy hospital in the middle of the bustling Quezon City, Manila. The medical center is located across the street from the University of the East where medical, nursing and physiotherapy students attend classes. The tertiary center engages in the practice of medicine, nursing, physical therapy, public health, biomedical and health services research. The Medical Center is composed of six major units namely: University Hospital, (which has both pay and teaching/clinical divisions & the University Health Service),  the four academic units, namely: Colleges of Medicine, Nursing, Physical Therapy and the Graduate School for Nursing. The sixth unit is the Research Institute (UERMMMC website).
Leah had the opportunity to work on the Critical Care ward. This is an 8 bed ward that has the capacity for 5 patients requiring critical care, 1 room that is used for hemodialysis, and 2 rooms that are used for stroke watch. The ward was not very busy during her days there with 2-3 patients during the week. The patients in the stoke bay are monitored by staff members from the neurology ward. They conduct neuro assessments hourly to ensure that the patient who has experienced a stroke does not suffer any further deficits.
The Critical Care ward is part of the pay division of the hospital. This ward is well enclosed with features including air conditioning, good lighting, and individual rooms that provide a sense of privacy for the patient and their family members. All beds on the ward are within the visual field of the nurses desk, providing for the nurses to monitor the patients at all times. The equipment found here may not be as advanced as what we have at home but it is effective and the Filipino’s use what resources they have to their best ability. For example a patient who requires feeding through a nasogastric tube does not typically use a continuous infusion pump, a resource that, at home in Canada, is utilized most of the time as we have the resources. A patients family must pay for all pumps used so typically they opt to not use them so the nurses must manually feed, which can be time consuming but is very essential that the patient receive the adequate nutrients.  The patients family must pay for everything, depending on how much oxygen therapy is required is an added cost; ie. 10L/min would cost more than 6L/min; for an IV catheter to be inserted, there is an insertion fee on top of the fee for the supplies used; every medication, feed, treatment, bandaid, linen change, diaper used, etc. is tallied and recorded on the computer system that regulates the amount the patient and their family owes. This was quite astonishing to look at and when Leah voiced her thoughts about this, the Filipino nurses were also astonished that people do not have to pay for hospital services in Canada. To them that is a norm but coming from Canada, providing equal and dignified treatment to all citizens, no matter what their income may be, is the norm.
On the pay ward all medical care is provided by the doctors; the residents are working under direct supervision of the doctors. Leah was limited in some opportunities as to what she could do as the medical students were there practicing their skills, as UERMMMCI is a teaching hospital.
The nursing care provided on critical care is one patient to one nurse. Hourly assessments are done and the type of nursing functions Leah was able to carry out included feeding via nasogastric tube, medication administration, suctioning and patient comfort measures. The nurses were helpful, many of them going the extra mile and were great teachers. They brought in a Filipino treat of banana milk, ice and tapioca, unfortunately the name has been forgotten but it was well appreciated. It was great to begin the hospital immersion on this ward, many lessons were learned when the opportunities presented themselves and were sought. It is great to see another side of health care delivery; it really makes one appreciate what the Canadian health care system can offer to those when they need it the most.
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