11:08 PM - Home

To say that today was amazing is an understatement. 

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As mentioned in my last entry, I went to Pagsanjan today to meet Ellen's family. It was really something to have been received so warmly by them. Sabi nga ni Len, I was able to gain a family in Pagsanjan today. 

I'm on a high!

I love you so much dear! Thank you. 

Full circle my hime. 

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Sa susunod, falls na to definitely!

Shooting the rapids, here we come!

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Pa-siyam ni Lola ngayon and it was really great to have family and friends here at home. Nakahabol pa ako from Pagsanjan. Actually sakto lang yung alis namin ni Len dun. Pagdating ko dito sa bahay, maguumpisa pa lang yung padasal. In keeping with tradition, food and refreshments were served after. 

I think these traditions and culture of ours regarding death and dying do have their good points. I mean, these things could be a bit irritating and galling at times especially if there just seems to be too much work, inconvenience and effort involved. However, in almost all situations, these social fixtures do aid in the healing and grieving process. Wala lang. At the very least, they highlight the value of family and friends in our lives. 

Lord, I thank You for the gifts of family and friendship.

I was welcomed into a family today and I couldn't help but gush about it. 

MOA beh. Thank you talaga!

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I've been meaning to say this since the latest season of AI began but everytime I always seem to forget to put it here. 

I just think David Cook rocks and through his performances he has turned me into a fan. I think he really can win this year's AI and among the remaining finalists he definitely stands out. 

I sure hope he wins. Here's his rendition of Mariah Carey's "Always Be My Baby". When I heard this I was floored by the sheer talent with which he pulls off such a powerful, moving and amazing performance.

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Here's another great song as well as great artists. I've always liked "Alone" by Heart. From the first time I saw its music video all those years ago to the renditions my friends do during videoke sessions. 

Thanks to Youtube, I was able to watch this performance. I don't know about you, but it gave me goosebumps the first time I saw it. After n number of replays, it still does. 

Heart rocks!!! (watch niyo yung the rest of the band's performances...ang galeng talaga!!!). Go Ann and Nancy!!! (partida, they're what, at least in their 50s?)

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And finally, here's what really gave me goosebumps...

This song really means a lot to me. This was the song playing when I first knew with the utmost certainty that there is a God and that God cares for me personally and loves me so much. 

To God alone be the glory!!!

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Ayan. Will catch the replay of AI before sleeping... Hehehe. 

I miss you so much my hime! MOA MOA MOA!!!

See you tomorrow!

I love you.

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1:40 PM - a Netcafe near the UP College of Medicine

Sent part of my previous entry to Inquirer's Youngblood yesterday. I'm really crossing my fingers that it gets published. =.D

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I was extremely touched by what Ellen wrote in her blog (www.ellenlicup.blogspot.com) as her Valentine's 2008 post. I couldn't help but be moved to tears by the beauty and truth of what she wrote. Hehehe. At least now, I can say with the most heartfelt of convictions that tears of joy are definitely among the most wondrous gifts God has so generously given us.

Wow! 

Dear, I don't think I'd be able to reply to that entry as eloquently and as beautifully as you did. I don't think I'd even dare. Thank you so much dear. 

I love you my hime. 

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No matter what they may say, I am proud to be Filipino. I love my country and I will serve her and her people. 

Dugong bayani ang nananalaytay sa aking mga ugat.

Ako ay Pilipino. 

I wouldn't have it any other way.

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05:55 PM - UP College of Medicine Library

Ayos din ang LJ noh? On your homepage, it conveniently informs you of the number of weeks since you've last posted anything. My last entry was 26 weeks ago. That's more than half a year of "written silence", so to speak. 

"26 weeks", my blog seems to say accusingly. "Lopao, parang gusto ko nang magtampo. Napakarami nang nangyari sa buhay mo wala man lamang balita. Ni ha, ni ho, wala."

Fine. Here's to finally breaking half a year of "silence".

Hindi to kwento ng clerkship, well not exactly, but if you were looking for tales of IV/NGT insertions, blood extractions, pap smears, internal examinations, digital rectal exams, difficult ER cases, interesting diseases, OR stories and even liaisons ala Grey's Anatomy or House MD then this isn't one of those posts. Some other time maybe, but most likely no. I am in no mood for such trivialities. 

"Pa'no nang mga "fans" mo?"

Oo na nga. Pero hindi ganun.

Ready? 

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It's not that I have anything to hide. Di din naman ako depressed. I may still have some of my pet peeves and problems but I'm actually feeling the best I have had in years. 

Shucks. Mukhang tama nga ata si Letli (and I think nasabi ko na rin ito before or something very similar to it). I write the most when I'm hurt or down or angry or sad or mad, etc. I write the most when I'm not okay. I guess that's why I've never really been able to write my best. Because as far as I can tell, I don't think I've ever written at my best. I mean, there's so much that I want to articulate, especially now, but whenever I try to pen them down or type them up I find myself grasping for words as if these were straws or sand or whatever. 

Like many things in my life, I believe this should change. 

And change it (they) will. 

Changes are actually happening now. 

Good changes. Amazing changes. Life-defining changes.

You can go ahead and sue me for being redundant, but as I said, I have never felt this good in ages. Maybe even ever, but since I have sometimes been a man of excessive superlatives in the past I think I should say these things with a little bit of reservation. 

Pero di nga. Hehehe. Masaya ako. Masayang masayang masaya. 

Kasi MK. 

Among other things.  

Love you dear!

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The past 5 weeks have simply been amazing. 5 weeks out of the aforementioned 26, I have been experiencing the Word as I have never experienced it before. It's a bit surprising how natural everything feels. Sabi nga nung kanta, "as the deer panteth for the water so my soul longeth after Thee". For the past 5 Sundays I have been drinking in God's Word like never before. Walang kilig, Walang "Hallelujah" chorus sa background. Walang kakaibang feeling. Walang mainit na pakiramdam. 

Walang Himala.

Walang ganun. 

Ang meron lang ay ang Katotohanan. No more no less but more than enough. Definitely much much more.  

What I have received is the unshakeable certainty that I am being taught the Truth. I am learning the Truth and by the Grace of God, I will speak of and live out the Truth. 

I suppose some of you are thoughtfully biting your lips right now and wondering, "What is Lopao talking about?" Check out the book of John, chapter 3. It wouldn't take too much of your time. 

What happens after is your own story to tell. I'd be very glad to hear it.
 
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It's been nearly a year since our community medicine elective in Palawan but the lessons I learned during that brief time remain relevant and meaningful to me more so with everything I have experienced so far as a clinical clerk.
 
This may seem weird to most people but I don't think I would be doing hospital practice after I finish med school.

There. I've finally put that into writing. 

Mind you. It wasn't easy. 

Sabi nga ni Ma'am Portia, kung di daw nakasulat, hindi nangyari. I just hope what I write here doesn't come back to haunt me in the future. But anyway...  

I always tell people that things are rarely writ in stone but at this point of my life I really can't see myself as a hospital doctor. Don't get me wrong. I used to think that the white coated image of your typical physician was a really amazing thing and I think I still do. It's just that my experiences in the nearly 6 years I've already spent in medical school have altered my perceptions somewhat.

On the other hand, this doesn't mean that I would automatically be a "doctor to the barrios" or a community physician or an underpaid, overworked jaded government doctor. That would be noble indeed but I also know now that such things should never be romanticized. I know enough now to at least not make that mistake. 

Knee jerk reactions kasi eh. Pag sinasabi ko na mukhang hindi ko gustong magpractice sa hospital, nag-iiba na agad ang ihip ng hangin. It's either they're going to laugh at your apparent folly or they'd applaud you for "taking the road less travelled". It's hard to articulate but I sure would like to try. But it's not as simple as choosing one over the other. I don't think it's even an issue of one path over the other. It's not even serving the underserved or return of service or helping others or any other similar concept. It's much much bigger than all of that. 

 Magulo na ba? Mukha nga eh. Nahihirapan akong isulat to. Parang gustong sumabog ng dibdib ko. Mukhang di ko ata maipapaliwanag nang husto. Basta. Hindi issue ang kung ano bang klaseng duktor ako magiging. Mababaw lang yun kung tutuusin. Ewan ko kung naiintindihan mo. Ewan ko kung maisusulat ko ba ng maayos. Bahala na. Tao lang. Kung may tanong ka, tanong ka lang. Itanong mo lang.
 
Watch Michael Moore's documentary "Sicko". I think it will help you to understand me more. I think.   

The issue is, I want to change the Philippine Health Care System. I am calling for Universal Health Care for the Filipino NOW, without exceptions. I am calling for equity in terms of health care. Our country's health care system is pathetic and it has to change. Matagal na natin tong alam. Madami na ring nagsabi nito at madami na ring nagtankang ayusin ang mga mali sa sistema. Hindi na to bago. 

Hindi na nga ba bago? Nag let's DOH it na tayo. May doctors to the barrios at leaders for health. Mahigit isang dekada nang may decentralization of health care. May educational campaigns for disease eradication, vaccination, herbal medicines, etc.  Wala pang dalawang taon ang Pinoy MD program. At siempre. May Philippine General Hospital. May UP College of Medicine.

Maybe everyone's been trying to address all of these problems the wrong way. Well meaning luminaries of the Health Care field have come up with all sorts of programs to reinvent, rejuvenate and even resurrect Philippine Health Care to no avail. I think I know why. 

Fine. Mayabang na kung mayabang. Kung mali man ako, feel free to bring me down. Besides, I don't think something like this is an original idea. Di pa naman ganun kakapal ang mukha ko. If there are people out there with similar views or even dissenting ones, let's talk. At the very least, I think such conversations would be very interesting indeed. 

Anyway, I digress. Back to my previous statement:

I think I know why. 

Little has resulted from our efforts to overhaul our health care system because we've tried to attack the problem as if it existed in a vacuum. We've failed to realize that to transform such a corrupted and pathetic system we need to address ALL of our country's other problems. Poverty, poor governance, lack of education, corruption, crime, degradation of morality, graft, unemployment, etc, etc, etc. You name it. All of these whether individually, in tandem, or collectively impact health care and health care delivery. Indirectly or directly they affect our nation's health and health care. Sa madaling salita, para matugunan ang ating mga problemang pangkalusugan, kailangan nating matugunan ang mga prublema natin bilang bansa. 

Alas, it is when I get to this particular point that I get the feeling of being overwhelmed by the immensity of the problem. Madali na lang na balewalain eh. Madali na lang na sabihin na "ang galing ko naman. Naisip ko to!" Ayan. I have my conclusions. I could already write an interesting enough essay on the topic. I suppose I could even maybe write a policy paper on it. Pero hanggang ganun na lang ba?

One lesson I got from the 3rd UP Global Health Course is that by identifying a problem, one is now empowered to understand it. Once one understands a problem (or in my case, I think I understand the problem) one is now placed in a position to be able to do something about it. However, one still has to take the most important step, without which one would never be able to do anything about a problem. 

One has to own the problem.

Problema ko ito. Itong pagkakaroon natin ng bulok at buktot na sistemang pangkalusugan? Problema ko ito.
 
Problema ko ito. Oo. Bulok at buktot ang kabuuan ng sistema ng ating bansa. Problema ko ito. 

I think I've gone on long enough for this entry. Pagod ka na siguro sa kababasa (kung nagbasa ka nga). One last question for you:

Being Filipino/Filipina, don't you think these things are your problem too?

I think I have mentioned this before, somewhere or somewhen... If we start to take action and do something about all of these, it is most likely that our efforts wouldn't be bearing fruit in our lifetimes. But still. Are you willing to own these problems? And if you are, then what can we do?

Because I believe that there are a lot of things that we can do. I also know that I cannot  solve this problem on my own. 

I suppose that's why I've written this...whatever this is. 

Are you with me?

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Kinikilabutan ako sa mga sinasabi ko.
 
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I love you MK.         

  

 

Living the Adventure: Medicine in the Philippines

 The 2007 Palawan Community Medicine Elective

Paolo Victor N. Medina

UP College of Medicine Class 2009

            As part of the Intarmed – Organ systems Integration curriculum of the UPCM, incoming clinical clerks (LU 6) are given the option to take a summer off-campus elective course for their academic as well as personal edification. For the summer of 2007, one such course was a community medicine elective in the island province of Palawan. Looking back at the experience, I can’t help but feel so privileged and blessed to have been one of the ten then incoming clerks who took the elective.

            The elective was a brainchild of Dr. Jaime Galvez-Tan who wanted to offer a different off-campus elective for LU 6 students. The 21 day course was basically of the community immersion/exposure type under the field preceptorship of Dr. Jose Antonio Socrates of UPCM Class 1974. Doc Soc as we fondly came to call him, is an orthopedic surgeon by training, a community medicine advocate and practitioner by calling and also served as Provincial Health Officer of Palawan a few years ago. Doc Soc was also conferred the 2007 Sasakawa Award by the WHO in recognition of his work in community medicine.

We were based at the Bahatala (Bahay, Hawak, Tayo, Lakad) Rehabilitation Center for the first nine days of the elective. Bahatala is the community based physical rehabilitation facility under the management and leadership of Doc Soc and his wife Ma’am Cecille. The facility mainly caters to the physical therapy and physical rehabilitation needs of the underserved and underprivileged of Palawan. It offers free consultations, limb prostheses, physical therapy/rehabilitation sessions, fracture treatment, etc. The center’s services aren’t only limited to orthopedic and rehabilitation cases. It has its fair share of medical consults for other diseases in which thorough assessments and prompt referrals would be made as part of exhaustive efforts to help its mostly poor and marginalized patients.

In Bahatala, the ten of us “shadowed” Doc Soc as he ministered to patients who would come from all over Palawan just to avail of its free medical and social services. What was striking about our patient encounters in Bahatala was that patient empowerment and rational (i.e. conservative) treatment formed the main framework of Dr. Socrates’ healing philosophy. Patient education was central to the treatment regimens that Doc Soc would come up with since most of them had the patient and his/her family as the main players in his/her healing and recovery. Home treatment/recuperation was also preferred over hospitalization keeping in mind the comfort and limited resources of available to the patients. Much importance was also placed on addressing the effects of the social determinants of health such as poverty, education or the lack thereof, etc. on the patient and his/her family. Dr Socrates’ methods served to highlight the fact that these things have such an impact on a person’s illness more so for the underserved and marginalized sectors of society. “Shadowing” also meant that we were with Dr. Socrates a he made his “clinical rounds” around Puerto Princesa city and its outskirts. These were in essence home visits in which medicine was brought to the people in their respective communities effectively alleviating the cost to limited resources as well as lost livelihood opportunities that invariably come with prolonged hospitalizations. Such a practice by Dr. Socrates also encouraged and enabled patients and their families to play a larger and more active role in their treatment and recovery. Patient empowerment was clearly manifest and evident. Patients with fractures were undergoing traction in the relative comfort of their own homes. Casts were adjusted or removed by the patient or his/her family under the supervision and instruction of Dr. Socrates. Rehabilitation methods and techniques that were initially taught to the patients and their families by the Bahatala staff were also monitored and followed up during these visits.

During our stay in Puerto Princesa we also worked with Dr. Edith Miguel, who is also an alumna of the UPCM and herself a WHO Sasakawa awardee for 2006. We were part of her field medical team for her community based health programs on a couple of occasions, serving in the municipality of Roxas as well as in Barangay Mangingisda, a marginalized coastal community in the outskirts of Puerto Princesa.

After our sojourn in Puerto Princesa we backpacked to 4 other municipalities in the northern region of Palawan. First stop was Dumaran, an island municipality which was 5 hours from the mainland municipality of Roxas by pump boat. Riding the waves for such an extended period of time on that seemingly too frail pump boat was an unforgettable experience in itself which only added to the adventure undertone for our whole Palawan stay. We stayed in Dumaran for 4 days and 3 nights, gaining much insight from its Municipal Health Officer, Dr, Juan Mabutas, a veteran of the “doctors to the barrios” program of the DOH. From him, we learned about the oftentimes delicate idiosyncrasies and fickle nature of working as an MHO. We heard from him firsthand, the difficulties and challenges he’s had to endure to become an effective public health practitioner and advocate in the context of devolution brought about by the local government code. We helped out at the Rural Health Unit in Dumaran by seeing some patients and were impressed at some of Dr. Mabutas’ imaginative programs such as the “Beat Watch”, an incentives and rewards project for the Dumaran Barangays to come up with programs at the barangay level for the betterment of the community. Such projects were designed to encourage more community involvement from the Dumaran folk in terms of their health care and overall community development. We were also able to interview known “hilots” in the island who gamely answered our questions and shared their insights on health care in their own communities. One of them even agreed to demonstrate his technique of using patients’ pulses to diagnose their ills and let two of the group experience his massage method of healing.

From Dumaran, we returned to the mainland and stayed in the municipality of Roxas for 3 days and 2 nights. We were billeted at the Roxas Medicare Hospital through the generosity of Dr. Cagape, the hospital’s lone doctor. Our stay here served as a reality check since the idyllic sights and experiences of the previous 2 municipalities somehow attenuated the realities that constitute the Philippine Health Care System. Dra. Cagape was the only doctor in the Medicare Hospital serving as its attending physician/surgeon on duty/obstetrician on duty/hospital administrator. The rest of the hospital staff consisting of a midwife and nurses had to undergo additional training in attending to patients by necessity in an attempt to offset the facility’s lack of doctors. Manpower was only one of the many issues of the hospital. Among other concerns, there was also that constant lack of equipment and resources to contend with as well as the sad fact that the hospital did not have running water whatsoever. I could only imagine the superhuman effort that running such a facility on a daily basis requires from Dra. Cagape.

In Roxas, we were also able to interview its Municipal Health Officer, Dr. Leo Salvino. He quite candidly shared with us his frustrations at the challenges of working as an MHO but was also quite animated as he told us about the methods which he came up with to circumvent at least some of these difficulties. One particular project which he was evidently proud of was the Roxas Social Health Insurance Program. Funded by NGO’s the program is a socialized health insurance scheme designed to benefit the people of Roxas. The management team for the program consisted of Dr. Salvino as chairperson, Dra. Cagape as vice chairperson and officials of the LGU serving as members. He cited it as an example of how cooperation among the officials of the LGU and its health care practitioners can be of great benefit to the community especially within the context of devolution. We were also able to hold a Focus Group Discussion with the Barangay Health Committee of Barangay Minarra, Roxas where we were able to determine the interplay among the RHU, municipal authorities and the community in terms of health care as a consequence of community development.

We left Roxas for El Nido where we stayed for a couple of days for some rest and recreation. We were supposed to interview the resort town’s municipal health officer but were counseled against it by Dr. Soc and Ma’am Cecille. El Nido’s MHO was apparently preparing to take the nursing board examinations and for all intents and purposes was just biding his time and awaiting his chance to leave the country. For me, the realization of the implications of this on the state of our health care system was quite saddening. It was a nagging and persistent thought, one that even the breathtaking beauty of El Nido failed to dispel.

After El Nido, we went back to work in the municipality of Taytay. We were there for 2 days and 2 nights and were accommodated by Bishop Teodoro Juanich at his home in the vicariate of the municipality. As luck would have it, Taytay was celebrating its annual fiesta during our stay there so we were only able to interview its municipal health officer. Dr. Dan del Rosario, the town’s MHO of only a year, was very gracious in allowing us an interview despite his busy schedule as one of the coordinators of the town festivities. Dr. del Rosario was a treasure trove of advice and wisdom as he narrated his experiences as a relatively young and inexperienced MHO still learning the steps to the delicate dance of promoting Primary Health Care to the tune of the interests of a Local Government Unit enjoying the administrative freedoms of devolution. He expressed much frustration at the way resources are allocated in the municipality. He acknowledged that the budget for health is within WHO standards, at least for the municipality of Taytay, but he struggles with the knowledge that more can be done with more rational and intelligent budget allocation. Dr. Dan was a picture of someone who knew what needed to be done but at a loss as to how these things could be done given his work environment. The circumstances under which he was working seemed to viciously attack his capability to do a lot of good in his role as MHO. Talking to him made me question the merits, few or many of them depending on which side of the fence you’re on, of our current Philippine Health Care System. For me, this was a defining insight gained from the whole Palawan experience. The health care system of our nation is indeed flawed and while there are laudable things about it, I believe that the whole system needs to undergo some serious overhauling.

After our interview with Dr. del Rosario at the RHU, he offered to show us the Taytay District Hospital. He warned us beforehand that the hospital and its lone doctor left much to be desired so to speak but I believe no amount of warning could’ve prepared us for what we saw. The hospital was severely dilapidated and has been so for quite some years already. There was only one doctor manning the facility and when we toured there, there were quite a number of patients admitted in the wards. It is quite common in our PGH setting to complain about the lack of facilities, equipment, etc but I think that after Palawan I won’t be one of those who would be complaining, at least not as much as I used to. I’ve seen worse. Much worse. In fact, the Taytay District Hospital was in such bad shape that it was necessary for cardboard bulletins to be displayed in several areas of the hospital stating: “Paunawa:Hindi na po pinapaayos ang hospital na ito dahil sa gigibain na rin para magpatayo ng panibagong gusali. Ang hospital na ito ay dapat may limang (5) doctor. Nag-iisa na lang po ang doctor dito, kaya ipagpaumanhin ninyo kung may pagkukulang dahil hindi kaya ng isang (1) doctor ang trabaho ng limang doctor.”  If I had any doubts as to what we’re being taught at the UPCM about the lack of doctors and funding for health in the Philippines in particular and the sad state of Philippine Health Care in general, I definitely do not have any doubts now.

The breathtaking beauty of Palawan only served to encourage more introspection, reflection and insight forming on my part. All of the above experiences were set against the background of the sights, sounds, tastes, culture and people that is Palawan and as such ensured that I would definitely treasure everything that I experienced and learned in the three weeks that we spent there. It really is different when one is out in the field. Behind the relative comfort of our many books and readings in med school, it is so easy to feel divorced from the realities that we have to contend with after we graduate. On the other hand, when one is out in the field, it is so easy to be overwhelmed with the apparent immensity of the problems that we would have to contend with as Filipino physicians. What to do then? I was and I still am an idealist but through my experiences of Palawan I have come to acknowledge that idealism is so fragile and that it can be so easily challenged and shattered. There is also the danger of romanticizing things but I am willing to take that risk. I am truly grateful for the opportunity to have gone on an elective in Palawan last summer.

At the very least I have become more aware of the problems of the Philippine Health Care System. Awareness is a step towards understanding and understanding is a step towards action. I have come to realize that medicine in the Philippines is not limited to community medicine but is definitely about community orientation. In the Philippines this means we are under a moral obligation to serve the underserved. It is laudable to leave the country with the intent and follow through to eventually come back and serve with the expertise, knowledge and experiences gained abroad. However, my Palawan experience has also made me realize that no matter how amazing or useful the things that we bring back to our country are they won’t have much of an impact if the current systems remain unchallenged and unchanged. I believe that as UPCM students who are purported to be the leaders in health care in this country we should be at the forefront of these efforts to improve what we currently have.

Medicine in the Philippines needs us.