Global Health in the Philippines

I recently completed the Global Health in the Philippines program offered by Child Family Health International (CFHI), and it was an incredible experience. Our first week was spent in Manila, where we explored the historical and cultural factors that continue to shape the country’s healthcare system. Dr. Katrina Narcida, our local coordinator, was an engaging and supportive guide who not only answered our questions but also immersed us in Filipino culture. We visited both publicly and privately funded health centers, as well as local markets offering traditional remedies—giving us insight into the wide range of healthcare practices in the Philippines. In the second week, we traveled to Tingloy, a remote island in the Batangas province. Life on the island is quiet and community-centered, with no major roads or cars and only one physician serving the entire population. We worked closely with the Rural Health Unit and observed how healthcare is delivered in this unique setting. One standout experience was witnessing the monthly immunization program, where nurses travel by motorcycle to different Barangays (villages) to administer vaccines to children. Community health workers in each Barangay played an essential role in assisting the nurses, highlighting how healthcare in the Philippines is truly a community-based effort. After each round of vaccinations, the grateful communities welcomed us with delicious home-cooked meals—a touching display of hospitality that reflects the warmth and generosity so deeply rooted in Filipino culture. Whether you're a medical student like me or simply someone interested in global health, I highly recommend this program. It offers not only knowledge, but also the confidence and cultural insight needed to navigate and appreciate healthcare systems around the world. Immersing myself in Filipino culture—where community, compassion, and resilience are deeply woven into everyday life—was an experience that will stay with me both personally and professionally. This unforgettable opportunity was made possible through the support of the Friends of the Philippines Scholarship, for which I am incredibly grateful. Their generosity allowed me to learn firsthand from the communities and healthcare professionals in the Philippines, and I will carry these lessons with me throughout my global health journey.

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 possible 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 future plans of participating in public health as an aspiring nurse. 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 (Philippine General Hospital) 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 CFHI 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 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” (humaneness and the importance of narrative humility) 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 noticed that Dr. Jobin and the mayor (she’s a doctor too) have a positive relationship. We also got to visit the DOH Regional Office. I had the chance to observe more about: rural vs urban resources and compare it in global health, private vs public hospitals, 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. I was also flabbergasted by meeting the CHFI Philippines lead, who is part of the Department of Health International Relations (migration health), as an undergraduate. I learned how they have secured OFWs (Overseas Filipino Workers) 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 this 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. Moreover, I am reminded 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.