Angelite Nurses

By Rose Eclarinal - ABS-CBN Europe News Bureau
Like Filipino nurses who leave the Philippines to find better job prospects elsewhere, UK’s home grown nurses are also leaving the country to seek opportunities abroad.

To replenish their workforce with only the best, some of UK’s National Health Service (NHS) hospitals are going further afield.

The Princess Alexandra Hospital NHS Trust confirms its recruitment in the Philippines.

“Here at Princess Alexandra, we want the best possible nursing staff that we can recruit. We can’t recruit everything we need from the locality or indeed from the UK. I’m quite excited about going to other parts of the world including the Philippines. Hopefully, lots of nurses will sign up and they will have a very warm welcome here when they arrive,” said the chairman of Princess Alexandra Hospital NHS Trust, Gerald Coteman.

Pinoy nurses as valuable assets

It is not the first time the hospital has recruited Filipino nurses to join its work force, and it very pleased so far with the nurses that have joined its work pool, especially with the quality of patient care and work ethics Filipinos have brought with them.

Executive Director of Nursing/Patient Care Yvonne Blucher said the compassion of Filipino nurses in dealing with patients also sets a good example for their colleagues. She added that Filipino nurses at the hospital are “actually valuable assets to the organization.”

“They are very thoughtful, considerate in patient care, they look at the holistic approach not just of the patients but also of the carers,” said Blucher.

“The NHS has very good experience in recruiting nurses in the past including those from the Philippines. We still have nurses here who were recruited some years ago, and that’s the case elsewhere in the NHS, so we are very pleased to be able to go back to the Philippines to see if we can get more nurses to come and work in our hospital,” said Coteman.

‘Every area would accommodate Filipino nurses’

As a growing organization, there are various opportunities in the hospital for Filipino nurses, such as vacancies in critical care, theatres, the general wards like emergency medicine, emergency trauma, surgery, and pediatrics, among others.

“Every area would actually accommodate Filipino nurses, every specialty, we could probably accommodate, currently.”

“But they have to be of a certain caliber, of a certain standard that actually fit in with our (organizational) values,” said Blucher.

Nelia Jalandoni applied for work at the Princess Alexandra Hospital in December. She is now taking the adaptation course in the hospital. She said all the processing fees, including visa application fee and airport tax, were covered by the agency.

“Masyadong mabilis, actually. Nag-apply ako sa kanila, online lang. Pinadala ko yung curriculum vitae ko, right there and then tumawag sila sa akin, nag schedule ng interview. All it took was just 2 weeks, actually,” said Jalandoni.

Jalandoni is also happy with the continuous support she’s getting both from the hospital and the agency that facilitated her application.

100 nurses needed

Jai-kin Resource has inked the contract to provide 100 nurses to the hospital. But its Operation Manager, Nancy Cunniff is apprehensive that she might not be able to deliver the number on the agreed dates. She said recent applicants in the Philippines are not meeting some of the most basic requirements of the NHS Trust. Applicants are falling short of the mandatory IELTS score, which is a score of not lower than 7 for all the areas in the test for international English language proficiency.

“Ang major na problem nila ay yung pagpasa nila ng IELTS. They should have 7 score in reading, writing, listening, speaking, and once they are qualified, they can apply for NMC kasi yan ang number one requirement,” said Cunniff.

Cunniff clarified that the average score of band 7 for all the areas will not suffice.

Apart from the IELTS, a minimum of 2 years clinical experience in a hospital setting, medical and NBI clearance are also required. If applicants have met these requirements, Jai-kin will help them apply for their Nursing and Midwifery Council (NMC) qualification in the UK.

She is looking at bringing the successful applicants to the UK in 3 installments: by the end of February, last week of April and mid July.

Interviews set for February

Louise Barnes, who is the head of Elderly Care and June Barnard, Matron of the hospital are flying to the Philippines to lead the screening process.

They said interested applicants need to sell themselves to compete for the vacancies.

“I think it’s important that they are sure with their communication skills. Communication is very important in the way that they are dealing with the public, with the family especially in the hospital environment when people are suffering from stress, etc. so it’s very important that people’s communication skills are very good,” said Barnard.

“They should have a degree of self-confidence because obviously it’s going to be daunting coming across the UK and working in a new environment,” said Barnes.

They are a little bit too shy. They have the clinical knowledge but too shy in challenging us, the medical team,” she added.

The hospital has done it in the past and it is doing it again. Its recruitment of foreign nurses, which aims to diversify its workforce and cut the shortage of staff means opportunities for work in the UK for Pinoy nurses.

But the chairman said what is imminent is not just employment for Filipino nurses but a chance to grow both personally and professionally in a culturally-diverse working environment.

“It’s a partnership. It’s not just telling our staff what they need to do to develop. It’s also asking them how they want to develop, where they see themselves in 3, in 5 year’s time. We can have that discussion and we can decide and we can support their aspiration in terms of development,” said Coteman.

This new class of caregiver is booming, and quite unregulated

When Esther Heckbert told her mother she wanted to leave the Philippines to work as a babysitter abroad, her mother was leery. “She said, ‘babysitter? You’re done university!’ ” The two were folding laundry at their home in Isabela. Esther, who has a degree in business administration, had high hopes. “I said, a babysitter abroad can make a lot of money. From there, you can upgrade yourself: you can get citizenship.” For decades, thousands with the same profile—young, female, Filipino—have come to Canada to work as babysitters. Twenty-five years since arriving, Esther has helped rear dozens of Canadian tots: first as a nanny and then as the owner of a nursery school. But a few years ago, she sensed a changing wind.

She left babysitting behind, sought retraining, and now works under a more whimsical title: granny nanny.

She joins a growing rank of babysitters-turned-eldercare workers: a nod to shifting demographics. In 2008, just under 14 per cent of the Canadian population was over 65; it will be more than 25 per cent by 2044. At the same time, seniors are increasingly shunning the option once pressed on them: nursing homes. Now, most care to frail, older adults is provided outside facilities, says Norah Keating, human ecology professor at the University of Alberta. As more seniors stay home, we’re racing to import and train professionals to care for them. That dash has created a new class of caregivers, many of whom are undertrained, unregulated and unprotected—and with this a new set of problems.

A sizable chunk of that class comes through the same provision that allows us to bring in people to care for our kids: Canada’s Live-In Caregiver Program. Unlike other temporary foreign workers, live-in caregivers are eligible for permanent resident status after meeting program requirements. More than 100,000 have come since the LCP’s inception in 1992. Most are Filipino. Most stay for good. In the early years, the LCP was effectively a babysitter-recruiting apparatus for parents. But increasingly, seniors are turning to it for 24/7 live-in care. Back in the Philippines, women are catching on. Erwin Pascual, a Filipina immigrant who runs a private career college in Toronto, says more recruiters in the Philippines are marketing eldercare courses. “The demand started going up about seven years ago,” says Pascual. And supply has risen to match. By some accounts there is a backlog of applicants in Manila, biding their time.

It can be a treacherous wait. “There are so many bad agencies out there that are exploiting and taking advantage of these girls,” says Tova Rich, who runs the Family Matters Caregiver agency in Thornhill, Ont. Many charge the women “upwards of $10,000.” (The federal government is reviewing a bill that would ban charging caregivers recruitment fees.) Then there’s the problem of what Rich calls “phantom employers.” The LCP mandates a single-employer contract, and agencies may promise a candidate, and the Canadian government, a job that doesn’t exist, says Rich. By the time the woman finds out, she’s already paid the fee—or moved here. Last year Rich was asked by a Filipino caregiver to help her relative, a woman brought over for a bogus job who, without work, was forced to live in a basement owned by the agency. “We had to rescue this girl at like 10 at night,” says Rich. “We were horrified.

We went in and there were three or four mattresses on the floor. There must have been 10 or 12 girls, all talking and cooking. We said: pack your bags.”
That’s an extreme case. But the reality of Filipinas being recruited into the homes of sick seniors and asked to function as de facto nurses is in itself a sign of a subtler kind of exploitation, says Leah Diana, who works at the Philippine Women Centre of B.C. LCP applicants, she explains, need two years of post-secondary education and relevant experience.

And so, many are professionals: midwives, nurses, and even the occasional doctor. For Diana, that requirement, in combination with a system that makes it tough for foreign-trained nurses to get accredited, means we’ve created a flow of low-cost “unregulated nursing” into Canada. Employers seek out Filipino nurses through agencies, she insists: women who can monitor insulin levels and give injections, in addition to offering personal care. But officially the women are brought in as babysitters—and paid minimum wage. It’s why Diana’s group has launched an “End it, don’t mend it” campaign, aimed at scrapping the LCP. Playing on that slogan, Immigration Minister Jason Kenney has pledged to “mend the program, not end it.”

Deanna Santos, a lawyer of Filipino origin who advises live-in caregivers about their rights, likewise wants to do away with the LCP’s live-in requirement, as well as employer-specific contracts. Both, she says, can bind caregivers to abusive households. “Because of their desire to gain the prized permanent resident status, they endure abuses.” Allegations levelled last spring at Brampton, Ont., MP Ruby Dhalla brought some of these issues to the fore.

Caregivers working with Dhalla’s mother said they were forced to do chores like shining shoes and washing cars: tasks outside the purview of the LCP.

Dhalla has denied the charges. But lately, complaints of this sort have reached the ears of higher-ups. In December, the federal government offered proposals to revamp the LCP, including instituting an employer blacklist.

Of course, potential for abuse existed when the program focused on babysitters. But working with seniors can amplify strains. Dementia patients, for instance—a group projected to grow in numbers, according to a report released this week—are prone to violent outbursts. Albert Banerjee, a York University Ph.D. student, found 90 per cent of facility-based caregivers in Canada have experienced “physical violence.” The situation is similar in home care. Caregivers contacted for this story reported abuse ranging from racial assaults to getting punched in the face. “Many older people were raised in a generation where the Chinese were the enemy—or where blacks were seen as lesser people,” says Charmaine Spencer, a gerontologist at Simon Fraser University. “Many changed their attitude over the years.” But as they age, or develop dementia, “they lose their inhibitions.”

For all the pitfalls, Esther Heckbert found the eldercare field to be an attractive one. And so, a few years ago, as many former live-in caregivers do, she decided to advance to the next level: she enrolled as a student in a personal support worker (PSW) course. The official designation qualifies caregivers to work in nursing facilities, for one, where they provide basic care like bathing and meal preparation. Some Canadians are referred to a certified PSW by a doctor; in such cases their needs are assessed by the Canadian Association for Community Care, which allots an amount of subsidized care. Families can also approach agencies to hire one.

Thousands of Canadians get certified as PSWs each year. But even that process has its hazards, sometimes opening doors to unfit caregivers. Last year, a number of private colleges were busted for selling fake diplomas and graduating woefully unqualified PSWs. A Toronto Star story featured one school that passed students in weeks, versus the year it takes at an Ontario community college. Miranda Ferrier of the volunteer group PSW Canada says she’s had to “break the news” to PSWs that “they can no longer work [because] their certification is nothing. There’s no regulation,” she says. “None.” PSWs have no professional body, no counterpart to the College of Nurses. New trainees are not required to sit for provincial exams. The courses are not standardized, and can be taken at either community colleges or private schools. All this, Ferrier insists, leaves not only seniors, but also their caregivers, unprotected.

“The baby boomers are coming,” says Ferrier. “We need to be prepared. And we’re not close.” She started PSW Canada as a hopeful precursor to an official college. But the Health Professions Regulatory Advisory Council rejected that idea in 2006, deciding Ontario PSWs should not be regulated.

“HPRAC also concludes that the closest alternate form of regulation—a personal support worker registry—should not be implemented,” the report noted. “They said they already belong to agencies and there is a kind of oversight through that,” says SFU’s Spencer. The other view, she says, was that PSWs are too poor to support a regulatory body. “It was kind of a Catch-22. Because without a regulatory body they weren’t in a position to improve their conditions.”

On the job, PSWs are rushing to meet growing demand. Pat Irwin, an eldercare consultant, describes many agencies as “body shops of people,” where hordes of exhausted caregivers are pushed from house to house. The typical time slot for care is one hour. Kirsten Elder, an Ontario PSW, describes a shift: just enough time, if she moves speedily, to give her clients “a bath, make them something to eat, medication reminders for most. Once they’re dressed, the paperwork. That’s usually the hour.” The pay: around $13.

For many granny nannies, whatever their designation, it’s a labour of love. Esther Heckbert, for instance, has a few tricks for working with dementia patients. “I sing. And while singing, I do my work.” What songs? “I have to know the person! I’ll ask them what they like. We can sing together.” Kelly McHaffie, of PSW Canada, still finds time to nickname patients: like “Chickadee,” the lady who eats like a bird. This year, one of McHaffie’s beloved patients died. She went in on her days off to care for the woman: “I got into bed with her. And she put her arms around me and we laid there together. It was comforting for her.”

But often, in the rush of one-hour time slots, the “chemistry” gets lost, says Irwin; agencies are too focused on the “great market opportunity.” Irwin’s inspiration for her career in eldercare consulting—her own father’s struggle to find care—is admirable. But it’s hard not to flinch at what she calls herself: a “rent-a-daughter.”

Recession hits a once-sure thing

When Katharine Barron enrolled in Boston College's school of nursing in 2005, everyone - family, friends, college officials - assured her hospitals would be "banging down her door" with job offers.

Because nurses were in such high demand, they said, Barron's degree was going to be like a guaranteed paycheck. Or so she thought.

Turns out Barron will be lucky to land work in Boston after she graduates later this year. The 22-year-old Newton native will be saddled with more than $100,000 in student loans and anticipates moving back to her parents' home.

"I really hope I can get a job," she said during a break from class Thursday. "It's frustrating. And it's scary to think about the future."

Because of the recession, nursing jobs are scarce for the first time in years. In Massachusetts, vacancy rates on nursing staffs have fallen to 4 percent this year, down from 5 percent in 2007, and 10 percent in 2002, when there were the most openings, according to the Massachusetts Hospital Association. As a result, many nursing students on the cusp of graduation are scrambling to find employment.

At Massachusetts General Hospital, the nursing vacancy rate is under 2 percent, grinding most hiring to a halt, said Steven Taranto, human resources director. The hospital, which has about 4,000 full- and part-time nurses, recently canceled a critical-care training program for new nurses, he said. And for the first time in memory, Taranto said, there are no nurse openings in the emergency department.

"I've worked at Mass. General for 12 years and this is the lowest vacancy [rate] I've ever had," he said.

There are 78 nurse openings posted on the hospital's website, but most require highly specialized skills or considerable experience, he said.

Beth Israel Deaconess Medical Center recently said it will lay off more than 100 employees, including nurses, and officials at two Boston nursing schools said opportunities for new nurses are nearly nonexistent at Children's Hospital.

There are two major reasons for the lack of new jobs. First, most hospitals are treating fewer patients as people put off costly elective surgery. At the same time, many experienced part-time nurses are looking for more hours, while others are coming out of retirement because a spouse was laid off.

"This steep recession has placed an unusual economic burden on a lot of households and it's driving many nurses back to the labor market," said Peter Buerhaus, a professor at Vanderbilt University who has written extensively about the nation's nursing shortage.

It is a situation nurses have not faced in a long time. For most of the last decade, nursing shortages were the rule. Hospitals frequently offered $5,000 to $10,000 sign-on bonuses, and many promised cars or generous vacation packages to attract nurses just out of school. At the same time, Buerhaus said, nursing programs at colleges proliferated to help fill the void.

In recent years, several area nursing programs have been created to train people seeking to enter the profession from other careers. Many also offer master's degree programs to help increase the number of nursing instructors. The shortage of instructors was once so severe that programs could not train nursing faculty and expand class sizes fast enough to meet demand.

Katherine McDonough, clinical care instructor at Northeastern University's nursing school, said she is advising students for the first time to network instead of simply applying for jobs online.

"It breaks my heart for them, but we go through cycles like this, and we will cycle back again," she said.

Others are less sympathetic, noting that there are still open jobs for community nurses at nursing homes, rehabilitation centers, and visiting nurse groups, though there are fewer of those, too, and they pay less.

Susan Hassmiller, a senior adviser for nursing at the Robert Wood Johnson Foundation, a private foundation that has extensively researched the nursing shortage, said many nurses could use the downturn to gain experience in the growing field of home healthcare, which is expected to explode as baby boomers age.

Many nurses will shun those jobs, she said, because the pay is lower and they offer less excitement and prestige.

"New grads always want to go to the hospitals first, and you can get paid a lot more in hospitals than a community setting," Hassmiller said. But "this blip . . . may not be such a bad thing," she added.

The Robert Wood Johnson Foundation did not predict the downturn and the current nursing job shortage. Just four years ago, it urged Congress and states "to act quickly to avert the crisis in patient care" and find ways to train more nurses.

Buerhaus said the glut is temporary and that research shows an overall nursing shortage nationwide through 2020. His advice to would-be nurses: "Keep your focus on the long run."

That does not console Michelle Jones, 22, who is graduating from Boston College's nursing school this year. An intern nurse at Mass. General, she planned to ease into a full-time job at the hospital after graduation.

But a professor recently told her to look elsewhere for work because there are no openings at the hospital, and some of her mentors have suggested she search for a position outside Massachusetts.

Jones said she grew up in Roxbury, where her family and fiance live, and does not want to move.

"It kind of stinks," she said. "Even now people say, 'Oh, that's great, nurses always have good jobs.' I have to tell them that it's not like that anymore."

Alexandra Wilder, 27, said she grew scared when she sent out 70 job applications in December and heard back from just three prospective employers.

After graduating from Mount Holyoke College in 2003 she worked as a paramedic and later decided to go to nursing school. She eventually borrowed $60,000 to earn a master's degree in nursing. Earlier this month, she landed a job a half-hour from her home in Boston at MetroWest Medical Center in Natick. It was not what she expected originally, but she is thrilled. Combined with her husband's income, they will be able to meet their financial obligations.

"A lot of my friends don't have spouses that work and they took out loans to go to nursing school," Wilder said. "Now they're really scraping."

Megan Woolhouse can be reached at mwoolhouse@globe.com.  

A nurse who secretly filmed for the BBC to reveal the neglect of elderly patients at a hospital has been struck off for misconduct. 

Margaret Haywood, 58, filmed at the Royal Sussex Hospital in Brighton for a BBC Panorama programme in July 2005. 

She was struck off by the Nursing and Midwifery Council which said she failed to "follow her obligations as a nurse". 

Ms Haywood, a nurse for over 20 years, said she thought she had been treated harshly and had put patients first. 

Ms Haywood, from Liverpool, said: "I am absolutely devastated and upset by it all. I think I have been treated very harshly. 
“ Panorama believes that Margaret Haywood has done the elderly population of this country a great service ” 
BBC spokesman 

"It is a serious issue and I knew it was a risk I was taking but I thought the filming was justified and it was in the public interest. 

"I always made it clear to the BBC that patients would come first at all times." 

She said she had voiced her concerns through her immediate line manager "but nothing was really taken on board" and the whole process now needed to be reviewed. 

'Patients' dignity compromised' 

A Department of Health spokesperson said: "Whistle-blowers already have full protection under the Public Interest Disclosure Act passed by this Government. 

"We expect that any member of staff who reports concerns about the safety or quality of care to be listened to by their managers and action taken to address their concerns." 

She was found guilty of misconduct on Wednesday following a fitness to practise hearing. 

The panel said she "followed the behest of the filmmakers... rather than her obligations as a nurse". 

The chair of the panel, Linda Read, said Ms Haywood had prioritised the filming, which in the view of the panel "was a major breach of the code of conduct". 

She said: "A patient should be able to trust a nurse with his/her physical condition and psychological wellbeing without that confidential information being disclosed to others. HAVE YOUR SAY How can the NMC expect respect and confidence from the public they are supposed to be serving when they react in this deplorable and protectionist manner? Graham, Canterbury 

"Although the conditions on the ward were dreadful, it was not necessary to breach confidentiality to seek to improve them by the method chosen. 

She said the misconduct was "fundamentally incompatible with being a nurse". 

"The registrant could have attempted to address shortcomings by other means. But this was never a course of action which she fully considered." 

Ms Haywood had admitted breaching patient confidentiality but denied her fitness to practise had been impaired. 
“ This makes total nonsense of all the talk about openness and transparency in the NHS. Cover-up is the order of the game ” 
Joyce Robins, Patient Concern 

Elizabeth Bloor, the BBC programme's producer, told the hearing there had been "an over-arching public interest" to produce the Undercover Nurse documentary because Panorama had received up to 5,000 complaints about conditions. 

In November the panel found no evidence that Ms Haywood broke the NHS Trust's policy on whistle-blowing by raising concerns about patient care in the documentary, or that she failed to assist colleagues when a patient was having a seizure. 

A BBC spokesman said: "There was clearly a strong public interest in revealing that some elderly people were not receiving the level of care we expect from our national health service. 

"Panorama believes that Margaret Haywood has done the elderly population of this country a great service." 

'Right and proper' 

The National Union of Journalists (NUJ) said its code of conduct stated that surreptitious means of gaining information were permissible in the public interest, and the same should apply to whistle-blowers. 

Tim Gopsill, of the NUJ, said: "Sometimes the only way to get anything done is to go to the media. No-one could possibly argue that this story was not in the public interest." 

The panel's ruling was also criticised by Joyce Robins, co-director of Patient Concern. 

She said: "This just demonstrates the priorities of the regulators - rules come before patients every time. The message that goes out to nurses is: however badly you see patients treated, keep your face shut. 

"This makes total nonsense of all the talk about openness and transparency in the NHS. Cover-up is the order of the game." 

Ms Haywood's actions were also defended by Gary Fitzgerald, chief executive of Action on Elder Abuse. 

He said: "We know that we're seeing older people suffering the most appalling care and neglect too often in our care environments. 

"In that context I believe what Margaret Haywood did and what Panorama did was right and proper." 

Story from BBC NEWS:
http://news.bbc.co.uk/go/pr/fr/-/1/hi/england/sussex/8002559.stm

Published: 2009/04/16 18:14:26 GMT

© BBC MMIX

Oncology nurse Theresa Brown is a regular contributor to Well. Today she writes about a family’s reluctance to accept the inevitable death of a loved one.


The patient being transferred to me had metastatic cancer. I was told she had a large tumor in her hip, buttock and abdomen, but that description did not prepare me for what I saw when the patient got to my floor. 

Her “large tumor” was so grotesque it is difficult to describe. She had visible growths resembling giant warts extending in a solid mass from her backside, around one hip, and covering one side of her belly from her navel to her groin. There were blackened, necrotic (dead) areas scattered throughout and other sections festered, oozed and bled. The smell was horrific.

Four of us moved her from the stretcher to the bed and, in the process, realized she was lying in layers of sheets soaked with her own secretions and bodily fluids. It was impossible to clean her up without causing her significant pain since her skin was so fragile. She was only in her early 40s, but she didn’t know where she was or what was happening. Although she had been prescribed oral pain medications, rolling and cleaning her still was physically agonizing for her.

The patient was “D.N.R./D.N.I.” — that means “do not resuscitate, do not intubate” in the case of heart failure. But she was still getting treatment because the relative who held her power of attorney said the patient could have antibiotics and blood products. An earlier scan of her chest and abdomen had shown widespread metastatic disease in her lungs and tumor growth in her groin that pressed on a main artery. She had intractable anemia that transfusions relieved but would not cure.

From my point of view she was dying, and after three of us got her rolled and changed and cleaned up, I left the room so angry I was shaking. Suffering can be part of healing, and nurses bear witness to constant suffering in the hospital, but this patient’s suffering seemed pointless and cruel. 

Nurses are supposed to be the patient’s advocate, and this situation compelled me to speak up. I called the doctor and expressed my deep misgivings with the plan of care. I thought the patient should be “C.M.O.,” or “comfort measures only,” meaning we would stop doing tests on her, stop giving her antibiotics, and start giving her enough intravenous narcotics that she wouldn’t have to live in pain. The doctor heard me out and then explained that, just the week before, the patient had been mentally intact and had insisted on continuing treatment.

Family members showed up soon after I had this conversation. I’m still a pretty new nurse, but something about this patient motivated me to bring up the issue of comfort measures with the family.

“So there’s no hope for her?” they asked, with tears in their eyes.

“We just want her to get better,” said one of her sisters.

I explained her condition to them, and then the doctor came and we all talked together. These were caring family members trying to do the right thing for someone they loved. The phrase that came up repeatedly was, “She’s not ready.” The family wanted the patient to be at peace with the decision to withdraw treatment. They, and the doctor, hoped that an infection had caused her mental status changes, and that once the infection cleared the patient would address future treatment questions herself.

I found myself telling them, “You know, sometimes people can’t be peaceful with that decision, ever, not even at the very end, and it’s heartbreaking for the families.”

Later, after the family left, the doctor and I talked again. From her point of view, and I’ve heard other medical people express this idea, physicians have an ethical obligation to address problems that can possibly be reversed, even when the patient is near death. If the patient had an infection, it could be treated with antibiotics. The patient’s anemia was also potentially treatable if the cause could be discovered.

Everyone involved had the best, even noble, motives, but nobility may be misplaced in a situation like this. The question on my mind was misery.

With her incontinence and already vulnerable skin, the patient was at risk for recurrent infections that would further debilitate her and increase her physical discomfort. As her disease grew in her lungs, her respiratory status would become more and more compromised until she was gasping for air. This patient, who was visibly suffering, who had very little real hope of living for too much longer, also was receiving very expensive health care.

The doctor was honest and empathic, the family sympathetic — there were no bad guys here. But this tableau offers a snapshot of some of the most pressing ethical issues plaguing American health care. Should patients receive expensive treatments with little hope of efficacy just because they ask for them? Should we fix problems that can be treated when those problems probably occurred because of an irreversible progression of a patient’s disease? What does it mean to be “ready” to die?

When Jan, her nurse, told me the patient finally was going home on hospice I got tears of relief in my eyes.

Americans have a hard time facing death, but we need to do better. “Do not go gentle into that good night,” Dylan Thomas wrote. The truth is, nobody needs to be told. Very few people meet death easily, and no one wants to die. But when someone’s body is wasting from disease and there is no hope, we need to bring more than good intentions to the table.

Fe Ryder shows photographs of her first encounter with Winnipeg snow 50 years ago. Ryder was one of the first four nurses from the Phillipines to come to Manitoba and stay. (KEN GIGLIOTTI / WINNIPEG FREE PRESS)


Fifty years ago, four nurses were the first "pioneers" from the Philippines to come to Manitoba and stay.

Today, just one of them is still around.

Fe Ryder is still nursing, and newcomers are still arriving from the Philippines, adding to the province's largest visible minority community.

"We showed them we're qualified to do the nursing," said Ryder, 74. "We were the stepping stone for nurses who came later to the Misericordia, St. Boniface, the Health Sciences Centre -- they were all over."

The petite dynamo nurses part-time, golfs, cross-country skis and bowls 10-pin in a league with her Canadian-born husband.

They play in the "Mabuhay" league with friends in the Filipino community, which numbers 37,790 in Manitoba, according to the 2006 census.

Ryder and three other Filipino nurses came to Winnipeg by way of Rochester, Minn. They had two-year visas to work and learn at St. Mary's Hospital there. At the end of the two years, they had to exit the U.S. but could reapply if they wanted to return. Near the end of their term, a nun who was a dietitian from Winnipeg also in Rochester told them Misericordia Hospital needed nurses.

"I didn't know much about Canada," said Ryder.

They headed north to Winnipeg, in spite of their American colleagues' warnings.

"They said 'Why Winnipeg in Manitoba? It's cold up there!,'" Ryder laughed. "That didn't scare me at all."

They arrived in Winnipeg by train at the end of November, 1959, and went to work.

"They accepted us, and I've worked there ever since," said Ryder, who retired in 1993, then went back to work part-time. A lot has changed in the burgeoning Filipino community since she arrived half a century ago. There are more professionals, more people elected to political office and more Filipino organizations, which are finalizing the details for 50th anniversary events being planned throughout the year.

What hasn't changed is the strong sense of empathy those who are already settled have for the newcomers, said Ryder.

She recalls Filipino doctors and nurses helping out the wave of garment workers who came in 1968 and others who came later.

She was the first Filipino to get married in Manitoba. Dr. Roland Guzman, the former Philippines consul and medical doctor, gave away the bride.

She thinks the adaptability of newcomers is key to their success in making Manitoba home. Ryder has been adapting since she realized nursing wasn't glamorous when she was training in Manila and told her parents she wanted to quit university.

Her father enticed her into staying in nursing school by promising her a trip to America.

The young adventurer was enamoured with Hollywood movies and magazines and went off to Rochester, Minn. for a two-year nursing stint.

In Winnipeg, she worked as an operating room nurse in the Catholic Misericordia Hospital.

One of the first things she did was look for a church, taking a taxi to the cathedral in St. Boniface where she discovered everyone spoke French.

"I didn't know how to get back."

She joined St. Mary's Cathedral downtown, where she met her husband-to-be, Cecil. At the time, her family in the Philippines did not approve of her marrying an "American."

"My father sent me a ticket to get home," said Ryder.

There was a lot of resentment in the Philippines at that time towards U.S. servicemen posted there, and her parents didn't differentiate between Canadians and Americans.

Her husband's family was another story, she said.

"If I had sensed any prejudice or anything, I would not have married him. But they were so good to me," she said of Cecil's family.

In fact, in the last 50 years, pretty much everyone in her new home has been good to her, she said -- another reason she stayed.

"It was my fate."

carol.sanders@freepress.mb.ca

by phatreecio

Being an intern is a challenging experience. We have to rotate unto several wards and sections in order to be able to fully appreciate all the fields of the Nursing profession. And what really was very upsetting on my end was being assigned at the delivery room. Well, I'm a male and sometimes, pregnant women feel awkward when the "xy" chromosomed human being joins this special section. And the dreadful day came, I can still imagine that very moment when our instructor announced my name being listed as one of those who will have their duty inside the delivery room. "Mr. Stuart, you'll be reporting this Thursday at the delivery room. Ms. Smith, Ms. Jones and Ms. Roberts will join you as well!"


In order to save myself from being nervous on my first day, I went to the place ahead of time. I was wearing my scrubs but still, my hands were cold and my heart is pounding like crazy. I just can't seem to relax. My instructor called our names. "Stuart, Patrick?!". Silence. "Again?! Stuart, Patrick?!" "Oh my! Ma'am, I am very sorry, Present!" My thoughts were flying. I keep on telling myself that this feeling shall pass soon. The instructor introduced herself. “I am Ms. Cindy Periwinkle, and I will be assisting you here in the delivery room. You will be graded according to your skills, knowledge, and the application of your related learning experience. “


We were distributed all throughout the section to maximize our workforce. I was assigned at the pre-natal area. As I walked along the aisle of the reception area, I noticed a woman around her late 30’s. She was brown-skinned, with thin hair, dry lips, and bulging eyes. I looked at her tummy and I roughly estimated that she’s on her due date. She looked at me with a curious look and I sat down in front of my assigned seat. I looked at her chart. It says G4P3 and I was not wrong, she’s approaching her due date. My instructor brought here inside the examination area. While I was writing down something on the logbook, I heard my instructor calling my name. “Patrick! Wear your mask, cap, and sterile gloves!” My heart started to throb. Lub-dub. Lub-dub. I started to become nervous again. I entered the room and voila. I saw the woman on the examination table with legs spread apart revealing her privates. She looked at me again with this curious stare. My instructor called my attention and said, “I’m going to teach you how to do the internal exam to assess how many cm the cervix had dilated. You first need to spread the labia with your thumb and little finger and then slowly insert your index and middle finger.”


It felt so uncomfortable and due to my overwhelming anxiety at that moment, what I did was to immediately insert my index and middle finger and it did enter the vagina without that much trouble. My instructor told me that it was wrong and I have to do it again. So, I removed my gloves and put on a new set of sterile gloves. I slowly spread the labia but it kept on going back to its previous position. I can’t seem to perfect it. Next thing I knew was I am slowly forcing my fingers deep into the vagina to feel the cervix. My instructor told me, “You will feel something hard. It feels like touching your ears. Pretending that I felt it to end this misery as soon as possible, I said, “Yeah! It’s there. Wow. Amazing!” She then asked me, “How many cm?” And because I was upset, I shouted, “Umm. 20 cm” I can see my instructor was about to burst in laughter but she didn’t to be professional. “No, she has a 6 cm dilatation and she will be giving birth for the next 24-48 hours. I felt that I turned red that moment and said “Oh! I’m, I’m sssorry Ma’am, T-TTThanks for the information!”

I went out and rested for a while outside to relax. I saw the full-term pregnant woman and she was smiling and her eyes looked funny. I returned a smile and I believe I blushed at that moment.