I spent two weeks volunteering with Integritas: heart for detainees, in Olongapo, Philippines. This was under the invaluable supervision of Dr Rachael Pickering.

Whatever I ended up doing during the elective, I wanted to be challenged. The prison environments, hot and humid air, and general barriers to daily tasks were, therefore, a welcome experience. It was humbling and eye opening to be immersed for a short while into a completely different culture. During our time we saw extreme poverty where people were living in slums in Olongapo, but also very monied areas in Manila.

Right from landing it was clear that the country functioned somewhat haphazardly. After surrendering control of our travel situation, we arrived in Olongapo. We were encouraged to learn about the differences in hot climate cultures, and this became apparent when things were not as task oriented as we are used to. The shame/honour culture was also prominent, and altered the way we taught and interacted others. Simple tasks like getting a taxi were inhibited by the driver claiming they knew where they were going when, in fact, they did not, but did not want to admit this.

Each morning began with a team meeting. The Christian foundation of Integritas was woven into these, and I enjoyed discussing various bible passages that relate to justice and helping those in prisons. Following this, we typically visited one or two police stations or jails a day. Interwoven with medical assessments were mental health and spiritual questions. It was refreshing to be able to pray openly and discuss situations beyond physical problems. Alongside the visits was teaching with the nursing assistant students (OJTs). (And some days the plans fell through all together due to logistics that we were not familiar with. Nevertheless, there were cases to write up and reading to be done.)

There was a huge disparity in health literacy, which we encountered both with the OJTs as well as with the patients.

The OJT students were also working with Integritas as a final experience required in their training. Their main role in the police station visits was gathering patient demographics, measuring basic observations, and documenting these. This was, however, not a straightforward task. For example, we witnessed a trend of immediately taking random blood pressures before even introducing anyone. Documentation and patient confidentiality was also lax.

We formally taught BLS as well as teaching (or reprimanding!) about medical topics to the OJTs. One such topic was regarding blood pressure.

Manual blood pressure itself is a very therapeutic procedure in the Philippines, so much so that the police officers often asked for us to take theirs. The implication of the reading is grossly misunderstood, with many claiming to have ‘high blood’ when they have a headache. This is one of many misconceptions we attempted to gently challenge. Despite the love of the task, the readings were suspiciously similar, rarely veering away from a number to the nearest 10. In response, we held a teaching session with the students with the hopes of improving accuracy.

With all of this, it was tricky to find the balance between improving the quality of work by locals, while respecting their way of doing things.

Running an NGO was a whole new level. It made me think how difficult it would be to maintain the quality of work being done while not physically present. Inevitably things won’t get done perfectly. But it is costly to pay staff members and provide legal and medical assistance. I would find it stressful watching things being done not quite how I’d hoped. It’s also not a role that has have a break. There are things to be dealt with 24/7, so knowing when to tackle the problem, when to delegate, and when to let go, is a skill in itself.

The police stations themselves were stuffy, cramped, and oppressive. It was impossible not to feel empathy for the individuals on the other side of the bars, for whom this was now their home. Having learnt about the corruption within the justice system, it made it even harder to see punishment wrongly administered.

Going in, it was easy to jump straight in without a structured plan, but I enjoyed the challenge of managing multiple issues in a less than ideal circumstance. Often multiple inmates would be calling out, but they soon settled once told the plan. One thing I needed to improve was not rushing each case. With limited time and maybe 5 people with a problem, I tended to assess them all, only to realise after that I did a substandard job of them all! Thankfully, because we returned to the same stations for repeat check ups or feeding programmes, further management was able to be implemented. However, were this not the case, it would’ve been possible to have left patients falsely reassured or untreated. Beginning work in ED, I will be wary of doing a rushed and incomplete job.

The medicine itself was not dissimilar to GP, albeit through bars and via a translator. The risk of TB was much higher, dental caries were common, and wounds were often infected. Otherwise, we saw routine viral illnesses, dizziness, headaches and joint injuries as we would at home. Importantly, the aetiology of these presentations could be different. Were they injured as part of an arrest or within the cell? Have they got access to enough bottled water? Are they under a lot of stress with their legal situation? Have they had TB prior to this? Shabu (crystal meth) use was prevalent, so we learnt establish the onset of symptoms vs use of shabu.

It was good to think about equivalence of care. We performed urine dips and blood glucose monitoring, but extensive investigations were not always appropriate even if available. If the management would be the same there would be little point. Detainees were not usually allowed out the cells, but wounds could be dressed and knees could be assessed through bars without too much compromise!

It was amazing to hear about a lady helped by Integritas earlier in the year who is now being managed for breast cancer. It goes to show that more in depth medical cases could still be treated with the help of Integritas, despite their detainee status.

To add to the experience, we spent time with PREDA, and talked to Father Shay who founded the organisation. They play a vital role in helping abused women and children. Again, it was humbling to learn about the devastating impact of sex trafficking, the role of the US in this, and the now complicit society, and was a privilege to talk and play with some of the girls. It was also interesting to hear Father Shay talk about how a lot of the religion in the country is a facade, and how more often than not, is faith without action.

I did, however, have the opportunity to visit a jail with the Philippine Outreach Centre. They are church community who also look after abused children, and have a prison ministry. I had the honour of sharing my testimony to maybe 60 inmates, and joined in with their service.

Towards the end of our time, we visited both a government hospital (Rizal Medical Centre) and private high-end hospital (St Luke’s) in Manila. The government hospital was busy somewhat dilapidated, and was in fact battling a surge in sepsis cases due to poor cleanliness in one department. But I found it a comfortable and friendly environment. We also got to witness an unusual event where a very large sum of money was being gifted to the medical centre from another country. This involved many festivities and formalities, and I wouldn’t be surprised if we accidentally ended up in the news. In contrast, St Luke’s was vast, clean and undeniably posh. Whilst this is the case in many countries, I felt uncomfortable seeing the luxury of St Luke’s. The resident doctors working there took pride in the hospital, which was, unequivocally nicer. But for most Filipinos, it was not an option. I am very grateful for the NHS.

Overall, I am grateful to have learnt about a completely different culture, medicine through bars, taking leadership, the running of an NGO, and faith in action. It has left me wanting to get involved in so many areas of healthcare and faith, but of course, it is not possible to do everything. Wherever I end up, I will incorporate the integral mission and pursue justice for those I meet.