Certified Nursing Assistants

Today, Fiona, my boss who's an OT, and I went to do an in service for a pt who was referred by nursing for transfer training using a sit-to-stand lift.  This patient uses a Hoyer lift for transfers, meaning he is completely dependent in the transfer.  In attendance were maybe five or six CNAs (certified nursing assistants) (in the Philippines, we refer to them as caregivers) to check out the transfer technique.  After showing them how to do it, we were greeted by a straightforward response from them:  Transferring the pt through the sit-to-stand lift is cumbersome, inefficient and very time consuming.  It is not plausible, they claim, to use it on him cause it will just take too much time and there also would be a safety concern when they try to use it.

I understand what they are getting to.  They have to see many patients at a time and using the technique that we just taught is gonna take a lot more time that using a Hoyer.  In a way, I feel for them.  CNAs do the dirty job that the nurses don't do.  They are at the bottom of the pt care hierarchy: an RN is usually the unit manager and then you have the LPNs (licensed practical nurses) and then you have the CNAs.  The CNAs literally do the dirty job: clean up the pt, bathe the pt, dress the pt, change soiled clothes, feed the pt, get pt up and back in bed when needed.  They also get a measly pay, maybe several dollars more per hour than minimum wage.  What they do is physically taxing and I would not wonder why they would entertain thoughts of using the Hoyer on my patient right now because it is faster and convenient.  However, I also would want my pt to get better and that means I need him to have more active participation during the transfer which the Hoyer could not offer.

It is disappointing and sad when sometimes patients tell me that they have clicked on the nurse's call bell cause they need to go to the bathroom and nobody shows up until thirty or forty-five minutes later.  By then, they have already soiled themselves or have slid down on their wheelchairs from exhaustion.  Because of repeated instances, some of them no longer use the call bell and instead attempt to transfer themselves to the bathroom which eventually leads to falls and fractures.  They put the blame on the hapless and helpless CNAs.   Yes, like in every profession, there are good ones and bad ones.  But then again, maybe one or two CNAs are assigned for maybe up to ten beds at one time.  It is possible that while a patient turned the call bell on, the assigned CNA was helping another patient in the bathroom too.  But still they get the blame if they don't get out there and assist as soon as possible.  

It is a sad reality.  But we cannot always give the best care we want for our patients.  And, though, I would still insist on recommending the use of the sit-to-stand machine for toilet transfers with that particular patient, for now I would take time and appreciate the CNAs who were present there today.  At least they told us face front: We're not sure if we are gonna use it often with him, but let us at least try.  So for now, here is a hats off to my seldom recognized teammates in health care: the certified nursing assistants. 

The Bourne Legacy

Last year, when I learned that a new Bourne movie was coming out but Matt Damon was no longer the lead role, I didn't really care much for it.  But eventually, I wanted to watch the movie because it was shot in Manila, capital of the Philippines.  On the day it was released, I checked out rottentomatoes.com to see if it fared well with them.  It got a rating of 55%, not a really rotten tomato but not a red juicy one either.  It means that this movie seemed mediocre at best.

I just got to watch the movie today, more than a couple weeks since it was released.  For me, at least, it didn't disappoint up until the end when the conclusion of the film just came crashing like a sack of potatoes without warning.  I understand that they have to leave the movie hanging to keep the audiences expecting a sequel, but I really did wanted to have them pen a better ending. The rest of the film, though, was fast-paced, well shot and has gotten its act together so I highly recommend it.  

The new lead roles played by Jeremy Renner and Rachel Weisz were played very well.  It wasn't flawless but they did very well.  They also had the chemistry to match it with.  I did not understand why some critics say that their relationship was not established well in the movie.  I think they were able to develop the relationship at a good pace and did not seem contrived at all.

My main concern about the movie is that the plot is neither cohesive nor is it novel.  It almost resembled the first three Bourne movies without a new twist into it.  In the former movies, the CIA went after the tagged-rogue agent Jason Bourne and eliminate him to shut Operation Treadstone down.  Jason Bourne escaped and caused collateral damage in his path to save himself, his lover/wife and fight back against the agency he formerly worked for while discovering his identity and trying to stay very low profile to keep the agency off his back.  In this new movie, all Bourne-like operatives have to be eliminated inorder for a new set of Bourne-like-without-the-emotional-connection-aka-drama operatives could be set in place.  Renner, of course, survives the assassination attempt, was able to discover that he had his genes mutated by a virus to have permanent physical enhancement (increased strength, reflexes etc) and with the help of Weisz, travel to Manila to have his genes mutated again-- this time to have permanent neurological enhancement ( increase nerve regeneration, sensation etc).  Now, the CIA is tracking them down, wanting to kill them but because they are the stars of the film and there is a need for a sequel (with sarcastic rolling of the eyeballs), they manage to get out of it all, kill the lone Bourne-like-without-the-drama operative and in the end were sailing smooth along the beautiful lagoons of the Hundred Islands (this I am not sure of).  ---okay, just now I've been told it is El Nido, Palawan :-)

In order to keep the movie sequel interesting, Renner should have a real meeting or even a collaboration with  the real Bourne, Matt Damon in the movie.  They called it the Bourne Legacy, but Damon didn't even make a cameo appearance in the film.  I don't think the franchise will survive without Matt Damon, the face of the Bourne franchise, in the film at all.  

The shots taken in Manila was surprisingly very good.  It really caught me off guard.  I was expecting a less than savory portrayal of the Philippines as a third world country.  The film, however, managed to showcase a picture of what Manila and the entire Philippines is all about.  It is about a nation who is rising from the clasp of poverty and is getting ready to take center stage as a booming economy that could no longer be taken for granted.  The film showed the high rise buildings along with the simple, old, tin-roofed apartments and they even have a shot of Renner losing his footing on one of those roofs.  (I was wondering at first how Renner could have run on top of those tin roofs without having one of those roofs crash down.  Well, one of them eventually did.)  The movie also showcased the people traffic along the overpasses of EDSA, which was also accurate especially if you pass there at rush hours.  The portrayal of a woman screaming magnanakaw (thief) when she discovered a stranger (Weisz) in her home is also accurate.  The same could not be said of the ensuing events that followed.  In reality, the policemen will be last to answer the call for magnanakaw and God-forbid by the time they get there, Weisz would've been beaten black and blue by the townspeople. Hahaha! It was good though, how the movie portrayed how industrious our factory workers are and even that pharmacy lady who opted to give out medicine for free to the foreigner.  That would surely have escaped the eyes of all movie-goers except the real Filipino patriots like muah.

All in all, I would rate the movie a 7.5/10.  The storyline was legit and I don't think the movie would have gotten fairly harsh criticism if only it wasn't compared to the original Bourne trilogy which is a classic.  It's like  nothing was ever as good or nearly as good as The Godfather trilogy until GoodFellas came along (and perhaps none since).  Furthermore, it was able to project my country in a new light, something full of hope this time not of despair.  It featured the Philippines and its people with vibrancy and dynamism, an economy that is growing and healthy and it did showcase the beauty of its islands for which it should be known for as it should be.  Kudos to the cast and crew of the film and I am looking forward to its next installment.

(P.S.  for the Pinoys who were in the film [I googled them, of course] we have Antonette Garcia as the landlady, John Arcilla as the security guard and comedian Lou Veloso as the fisherman/owner of the fishing boat).

Language

So here I am deliberately deciding to allot time for writing an entry into my blog.  I am laying tummy down on my bed and staring at the laptop screen with nothing to write about in particular.  I decided to type away anyway.  Random things, random thoughts, random people.

I read this from the net this afternoon. http://ph.news.yahoo.com/yes--some-pinoy-%E2%80%98languages%E2%80%99-are-on-the-brink-of-extinction.html

Many people I met here in the US wonder if Gemma, my friend and housemate, are related.  We tell them we are not and they would then ask from which country we came from.  When we tell them we are from the Philippines, many of them would ask as what part.  That is sorta hard to answer.  I am surprised many of the Americans actually know where the Philippines is.  When they do, it is usually because of WWII or the former US military bases here in the country.  Few of them know of our beautiful beaches and culture, fewer still know that we were once an American colony.

I have to tell them that Gemma comes from the northern island, where Manila, the capital, is located.  She is from Isabela, an 8-hour bus trip from the megacity but I don't give them the details anymore.  I also tell them I come from the middle islands.  I was even pleasantly surprised when two of my patients were able to know where Iloilo is: one used to be a navigator during the WWII and the other married an Ilongga who died from breast cancer some 30 years ago. I am amazed that my seemingly insignificant hometown is known to some people halfway across the world.

Some are taken aback if they learned that Gemma and I have been here in the US less than a year.  I personally think I speak good English.  God did not give me good skin, towering height, broad shoulders, athleticism, musical ability, a long penis, a penchant for numbers or business.  But He gave me a gift for languages.  So I would like to say that given time and adequate training I can learn a language and speak it well, at least to a level deemed acceptable with true speakers of the language.  When I tell my patients, " Pacencia, no comprende, me no habla Espanyol", some of the bilingual nurses would tell me I sounded like I did.  I wish I truly did.  I wanted to be fluent at least in these four languages: Spanish (spoken by everybody from Mexico to the entire South America except Brazil), Niponggo, Korean and Chinese.  That will be for another lifetime, though.

When I tell people that Gemma and I don't speak the same language, they are curious how we communicate with each other.  I tell them we speak the common language which is Tagalog so we can understand each other.  With more than seven thousand islands in the country, we have amazingly have developed many languages and many more dialects.  Hiligaynon, for example, is a language and Karay-a and Akeanon are dialects or sub-languages.  Karay-a is spoken by people from the western to the northwestern part of Iloilo and Antique.  Since Karay-a is mostly spoken by people from the fields and mountains, it is considered by the city-dwellers somewhat inferior compared to regular Ilonggo.  Therefore, although fiercely defending their heritage, the Karay-a speakers eventually transition to speaking the more conventional, more acceptable Ilonggo.  They would still speak Karay-a when speaking to family and friends from their hometown, but their intonation and diction transform to the more fluid and somewhat musical way of speaking Ilonggo.  That, I believe eventually leads to the death of a language/dialect.  People become socially intermingled and start losing some of their individualism.

I speak Ilonggo myself, but I can't stand listening to a Mass in vernacular.  I couldn't understand the words that the priests use.  Not being able to use many words in daily conversation eventually erode you ability to comprehend even your own language.  The loss of vocabulary will eventually be replaced by typical common words that does not reflect the distinction of your language.  I hope these endangered languages could be saved, if only for purely academic purposes.  They surely would bring light to our past as a people, united by a country of many islands and a horde  of wonderful, wonderful languages.

Yes, I am Pro RH because I am Pro-poor

We just moved to our new apartment after almost a couple months being holed up at Best Western Hotel and I just got my internet back.  I would have written more entries in the last couple months if only I got time and space to write everything down.  Today, I got both so here I go.

I am writing about the RH bill and the reasons why I am supporting it.  If you are able to read this blog entry at all, I assume you already have made a choice--you either support it or you don't.  Let me be the first to tell you that you don't have to read this to be informed.  The fact that you are reading this right now online I reckon means that you have access to the information you need on reproductive health, family planning and sex education.  If you say you don't, then your ignorance is your own fault altogether.

Let me start by saying that the RH Bill is not for you and I.  You are reading this entry, you are reading this online.  I assume you are educated.  Therefore this is not for you.  The RH Bill is for the millions of Filipinos who are poor, those without access to the right information on reproductive health and family planning, those who cannot read this entry just because they don't have access or they don't know how to turn on the computer and much less use it to be informed.  The RH Bill is for the poor and the poorly educated, not you and I.

Families and couples have the right to choose how large they would want their families to be. It is mostly subject to the availability of funds.  Yes, a big family is fun.  You have a lot of hands to help around the house, farm or business. You have a lot of support in times of crisis.  You will not run out of playmates and nannies to watch over the kids.  You have more people to help you with work, with projects, with assignments.  But common sense also dictates that having more people to support entails that you have to have enough resources to support them: basic necessities, education, healthcare, etc.  All of those things will put a strain on your resources unless you are enviably wealthy. A couple with a college degree for example with a combined income of thirty thousand a month would probably be able to support one child quite comfortably.  But even they would fall below poverty line if they have five or six children.  How much more a lavandera and a tricycle driver with the same number of kids? Or a saleslady and a security guard? Which is why I am saying that the RH Bill is not for you and I, the somehow okay people.  People who can get by.  This is for the poor.  When a lavandera comes to the government for help because she can no longer support the number of children she has, it is only rightful for the state to help her.  How? One way is to educate her on alternative methods of contraception.  Education is still the best way to set our people free from the chains of poverty.

The Philippines is the 12th most populous nation in the world. Now there would be studies claiming either population is or isn't what makes a country rich or poor.  I just find it so contradictory to common sense whichever says that a huge population doesn't equate to poverty.  We have a hundred million people cramped like sardines in a tiny piece of land in the Pacific ocean.  We have one-third the entire US population and one-tenth the entire Chinese population in a land of dwindling resources.  Note though, that China and the US are the third and fourth largest countries in the world respectively.  The Philippines has a hundred million mouths to feed three times a day. A hundred million mouths requiring sustenance and support pushing our land and resources to the brink of total devastation.  Add to that the fact that we are at the center of climate change with massive storms claiming lives, livestock and grain every so often.  How much more can our fragile land of diminishing resources take before we have a land left barren and unable to provide food, water and basic necessities?

Overpopulation, they say, is not the problem.  It is the corruption in the government, inequality in the distribution of  wealth and greed of the rich. They say that if they get these resolved first, then poverty will be eradicated. Yes, I admit they are problems. They are very serious problems indeed. I hope I don't sound so cocky and condescending but not even Jesus Himself, when He still walked the earth, was able to eradicate them.  Yes, they have to be addressed but as they are so deeply rooted on our beings, on our culture, on our society, they won't be resolved in a year or even ten.  That is a fact. We can stem them little by little but we can never eradicate them completely.  That, too, is a fact.

The barrage of anti-RH bill supporters finding all that is wrong and evil about contraception is now overwhelming.  They have researched thoroughly all the studies pointing to the relationship of contraception and cancer and diabetes and whatever there is they can find.  I would like to thank them for that.  Because if the RH Bill is passed into law, their information would be vital for couples to choose which one they would use, if they indeed decide to, based on their pros and cons.  I just hope that they stop implying that with the government supplying people with their chosen contraceptive, they are in effect giving them cancer. That is just so f****d up, pardon my French.

I am thinking of probably writing a second part for this entry as this is getting too long and long blog entries bore people.  Let me just explain one more thing before I finish this.  The issue of the being pro-RH or anti-RH is not just as simple as being left or right, black or white, up or down.  It is not even just about the degradation or preservation of our nation's morality.  Nor is it just about correct or incorrect management of the country.  It is more about choice.  It is all about choice.  If you think that using contraceptives is immoral and sinful, then don't use it.  If you think that it's a blessing to have many children in your family, then go ahead.  It's your choice, it's your right and it shall be rightfully respected.

However, if a couple decides they cannot support any more and they choose to use contraceptives. Respect their choice, too.  If they cannot afford to do so and asks the government for help, it should be the government's responsibility to look after them.  If you say, "but they are using my taxes to pay for their contraceptives", shall I assume that not only are you anti-freedom but also anti-poor?  Just a question to ponder.