Category Archives: Medical Opinions

Patients and Patience

Yesterday I spent my only day off from work to accompany my girlfriend at the hospital, not because she’s on duty but due to the fact that her father is still currently confined at the Intensive Care Unit. She greets me with a smile and once we were permitted to do so, we came in to see how he was doing.

There was still a multitude of wires and IV tubes attached to him, monitoring his vital signs, providing nourishment, cleaning up the toxins. I told the resident on duty that day, I may be a doctor by profession but at that point in time, I was a just a another anxious visitor who wanted to know how the patient was doing, just like everybody else. The same goes for my girlfriend, her role for the past few weeks was not of a doctor on duty, but that of a daughter to her father. Even without saying, I know it is a trying time for their family right now. And contrary to what some people might think, just because a family member is a doctor, doesn’t mean he has all the answers. To paraphrase, we’re also human.

And as this story is still unfolding, kindly allow me to share an article I read about the matter, originally published in the New England Journal of Medicine by Dr. Louise Aronson.

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“Good” Patients and “Difficult” Patients — Rethinking Our Definitions

Four weeks after his quadruple bypass and valve repair, 3 weeks after the bladder infection, pharyngeal trauma, heart failure, nightly agitated confusion, and pacemaker and feeding-tube insertions, and 2 weeks after his return home, I was helping my 75-year-old father off the toilet when his blood pressure dropped out from under him. As did his legs.

I held him up. I shouted for my mother. As any doctor would, I kept a hand on my father’s pulse, which was regular: no pauses, no accelerations or decelerations.

My mother was 71 years old and, fortunately, quite fit. She had been making dinner and said she dropped the salad bowl when I yelled for her. She took the stairs two at time. Something about my tone, she said.

Together, we lowered my father to the bathroom floor. I told her to keep him talking and to call me if he stopped, and then I dialed 911.

In the emergency department, after some fluids, my father felt better. My mother held his hand. We compared this new hospital with the last one where we’d spent so many weeks but which had been diverting ambulances elsewhere that evening. The doctor came in and reported no ECG changes and no significant laboratory abnormalities, except that the INR was above the target range. The doctor guessed the trouble was a bit of dehydration. He would watch for a while, just to be safe.

My mother waited with my father. The rest of us filed in and out, not wanting to crowd the tiny room. Then my father’s blood pressure dropped again. I told the nurse and stayed out of the way. She silenced the alarm, upped the fluids, and rechecked the blood pressure. It was better. But less than half an hour later, we listened as the machine scanned for a reading, dropping from triple to double digits before it found its mark. The numbers flashed, but the silenced alarm remained quiet. I pressed the call button, and when the nurse arrived I asked her to call for the doctor. When no one came, I went to the nursing station and made my case to the assembled doctors and nurses. They were polite, but their unspoken message was that they were working hard, my father wasn’t their only patient, and they had appropriately prioritized their tasks. I wondered how many times I had made similar assumptions and offered similar assurances to patients or families.

After weeks of illness and caregiving, it can be a relief to be a daughter and leave the doctoring to others. But I had been holding a thought just beyond consciousness, and not just because I hoped to remain in my assigned role as patient’s offspring. At least as important, I didn’t want to be the sort of family member that medical teams complain about. Now that I’d apparently taken on that persona, there was no longer any point in suppressing the thought. Although the differential diagnosis for hypotension is long, my father’s heart was working well, I had adhered to the carefully calculated regimen that we’d received for his tube feeds and free water intake, and he did not have new medications or signs of infection. Those facts and his overly thin blood put internal bleeding like a neon sign at the top of the differential.

I rested my hand on my father’s arm to get his attention and said, “Dad, how much would you mind if I did a rectal?”

We doctors do many things that are otherwise unacceptable. We are trained not only in how to do such things but in how to do them almost without noticing, almost without caring, at least in the ways we might care in different circumstances or settings. A rectal exam on one’s father, of course, is exactly the same as other rectal exams — and also completely different. Luckily for me, my father was a doctor too.

When I asked my crazy question, he smiled.

“Kid,” he replied, “do what you have to do.”

I found gloves and lube. I had him roll onto his side. And afterward, I took my bloody gloved finger out into the hallway to prove my point.

I realize that walking to the nurses’ station holding aloft one’s bloody, gloved hand is not an optimal tactic from a professionalism standpoint — but it worked. A nurse followed me back into my father’s room, saw my panicked mother holding a bedpan overflowing with blood and clots, and called for help. Within seconds, the room filled, and minutes later, when the ICU team showed up, I stood back, a daughter again.

In retrospect, what is most interesting is how much more comfortable I felt performing an intimate procedure on my father than demanding the attention of the professionals assigned to care for him. Abiding by the unspoken rules of medical etiquette, I had quieted my internal alarms for more than 2 hours. Instead, I had considered how doctors and nurses feel about and treat so-called pushy or “difficult” families, and as a result, I had prioritized wanting us to be seen as a “good patient” and “good family” over being a good doctor-daughter.

Although many physicians would have made different choices than I did, the impetus for my decisions lay in a trait of our medical culture. When we call patients and families “good,” or at least spare them the “difficult” label, we are noting and rewarding acquiescence. Too often, this “good” means you agree with me and you don’t bother me and you let me be in charge of what happens and when. Such a definition runs counter to what we know about truly good care as a collaborative process. From the history that so often generates the diagnosis to the treatment that is the basis of care or cure, active participation of patients and families is essential to optimal outcomes.

There will always be patients and families who are considered high maintenance, challenging, or both by health care providers. Among them are a few with evident mental illness, but most are simply trying their best to understand and manage their own or their loved ones’ illness. That we sometimes feel besieged or irritated by these advocates speaks to opportunities for improvement in both medical culture and the health care system. Culturally, we could benefit from a lens shift toward seeing more-vocal patients and families as actively engaged in their health care, presenting new, potentially important information, and expressing unmet care needs. At the systems level, we need to both count (using specially designated sections of the medical record) and reward (through diagnostic and billing codes) the time that providers spend talking to patients and families.

I’ll never know whether such changes would have altered my behavior or that of the medical staff on the night of my father’s massive intestinal bleed, and fortunately we all acted in time. I do know that 8 years later, the most vivid image I have of that night is not my father wobbling in the bathroom surrounded by cold, hard tile and angular metal structures, or a mustard yellow bedpan filling with bright red blood. The image is this, a worst-case might-have-been scenario had I not been there, had I not had medical training, had I not spoken up: my parents, sleepy because it was by then late at night, snuggled up together at the top of the gurney, my mother resting her head against my father’s chest, their eyes closed, their faces relaxed. His systolic blood pressure, usually 130, dropping to 80 and then 70. The monitors turned off or ignored. The lights dim. A short nap and they’d feel better. A little rest and maybe it would be time to go home.

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To the new Doctors…

In the now rare moments that I go online and check what is going on in, I look into my social media news feed, and I happily came across this message of a former schoolmate in medical school and her message to the newest batch of doctors who have passed licensure examination.

To the new Physicians of 2014:

By now, most of you are sitting in front of your computer clicking on the PRC website and hitting refresh relentlessly. Relax. The moment of reckoning is at hand. I was exactly where you are 6 months ago. I am familiar with the anxiety and the restlessness gnawing at you right now. If you can, try to savor the sweet torture of the anticipation. Remember the promises that you made and resolve to keep them. If you are still making promises, include this: Promise to be a physician that will serve your fellowmen. Promise to be a healer with integrity. Find your moral compass and follow it, no matter what. Promise to remember that arrogance and achievement DO NOT go hand in hand. But if you find that you cannot help yourself, keep in mind that arrogance COMES AFTER achievement and not before. Congratulations, 2014! Whatever the results may be, you have done your schools proud with your hard work and integrity.

Well said Rocky, well said.


Salvation in a Bottle

The man wearing this fancy yellow long-sleeved polo and navy blue pants was on fire. His face was drenched with his sweat as well as the excessive hair gel that failed in its duty to hold his hair together. He reached out his left fist as he shouted, “Do you want to be prosperous? Do you want to solve all your problems and worries? Do you want to be healthy and at the same time wealthy and free from the burden of your financial obligations?”

Another man, with the design of his green t-shirt hidden by the dirtied white blazer bearing the logo of a government hospital, extended his arms to the air as he closed his eyes as he became emotional with his reply, “Yes, yes! I want to be prosperous! I want to be stable! Yayaman na ako!” Everyone else around him was doing the same thing – some were even jumping up and down while the others had their faces wet with their tears and sweats.

No, I was not in some Christian church that was having its fellowship.

I was at the presentation of an organization promoting its line of healthy products.

 

It was not the first time I have attended such a “presentation” – and certainly this would not be the last time. In some, I had been duped into going because I was told that my opinion as someone who has medical background would be needed, while in some I willingly went out of courtesy to the person inviting me.

I know the routine already: it would involve an audiovisual presentation of how the world is already falling apart and that the people are putting their lives at risk because of their unhealthy living. It will also show how people are getting poor because they do not know that they should be prioritizing their health, and instead of spending their hard-earned money on being healthy, they were spending it on things that would not matter in the long run. Some statistics would be cited as to how health products are only starting to be the rage and how investing on them now would mean a bigger share of the market in the future. It will be followed by a testament by the host, who would introduce a few people who were wise enough to have invested – those who belong in certain echelon of their organization because of how much they have already sold (this will include a mention of how much they were earning in a month). They will then tell the participants that they were “lucky” that one of those in the upper echelon was able to squeeze his or her time (which was supposed to be spent in talks or a vacation abroad) to give a testimony of how the product has changed his or her life.

This upper echelon person will then stand up amidst the cheer of everyone, and he would go on stage like a shining professional wrestler who was acknowledging his fans. He would introduce himself and would not fail to mention that he was a graduate of this or that course and that he did not make it in the board exams, and then say something about the hardship of his pre-health product-selling life: how he would spend countless hours in the office laboring pointlessly but never earning much to even buy himself a car, how he wanted to buy an expensive and branded gadget but he could never afford one, and how he wanted to earn enough for his family so that he could give his parents the comfort that they have always deserved but never gotten. He will then testify how much he sacrificed to start up, including what he sold or gave up to invest. Of course, it will end with a happy ending – that he was now earning almost half a million pesos a month and how miserable he is now that he does not know what else to spend on, as he already has a beautiful house, a sports car, and he could buy anything that he or his loved ones wanted.

By the way, more importantly, he was able to help make the world a healthier place. Not bad.

Of course, there is no force-selling those health products. The presentation, after all, is just to expose the invitee to the potential of earning huge money – and half a million pesos a month is not just a pretty penny even to the CEO of a small business. If you’re interested, just approach one of their “coaches” who will help you become a member, purchase their products, and maybe give you a pointer or two on the art of selling.

 

Now what is the point of all of this? The keyword was already right there – “health.” The product is about making everyone healthier and the seller prosperous. This is where physicians go in the picture.

After the presentation, I was introduced to my inviter’s other friends. They were from several different backgrounds: some were office workers who wanted to earn more, others were hardcore business people who were looking to expand their profits, and most of the rest were a mixture of eager students, bored housewives, or fresh (and not-so-fresh) graduates who were looking for work. One of my inviter’s friends left a bigger impression on me than the others.

He actually did not need to introduce himself to me, after all, his name and the capitals “M” and “D” that followed it were embroidered in dark blue above the breast pocket of his dirtied white blazer. I am not sure, however, if he were still affiliated with the hospital whose logo patch was still on his blazer, but as far as I know, residents and consultants usually have their respective fields also embroidered below their names. Seeing he has none, it was not unsafe to assume that he was a general practitioner who went to that hospital for his internship and did not bother to remove the logo anymore when he started his own practice.

Para sa atin, ‘tol. Kayang kaya natin kitain ito,” he said rather confidently. “Ang dali lang, di ba?

Yes, he was the same person who had his eyes closed, head bowed down, and arms extended upwards during the presentation. At that time he looked like a grave sinner whose sins had been mercifully forgiven by God and he had been delivered from eternal damnation by the speaker.

Pare, ilagay mo lang sa reseta mo yan tapos sabihin mo sa pasyente mo na hindi pa available sa Mercury iyan, pero meron ka sa clinic mo. O e di tapos!” He smiled and clapped as he said “tapos” as if it were the solution to the dilemma I was having.

It made sense though: putting it on prescription definitely makes it a “must buy” for the patient. After all, as one commercial said, “magrereseta ba si Doc ng masama sa iyo?

 

I decided to defer jumping in the bandwagon, as I prefer making my own investigations on the products. In another presentation, it was emphasized that their products were already in the latest issues of MIMS Philippines as well as Physician Desk Advisor. This, according to them, makes their products legitimate for prescription. But these publications also include milk formulas, nutritional products, vitamins and minerals, and other health supplements too – and while helpful, these do not guarantee that the health products being sold are indeed therapeutic. Unless these had been approved by the Food and Drug Administration (FDA) as treatment medications, they ought not to be advertised as treatments or health solutions. The label “No Approved Therapeutic Effects” should be emphasized. Better yet, maybe the label ought to be bilingual, and in Filipino it should state “Hindi Pa Talaga Napatutunayan Na Nakagagaling.”

The problem really is not just the labeling, but rather with the aggressive marketing that they are having. Of course, a patient who is coming in with a disease or medical condition that is bothering him or her or a loved one would expect the doctor to give something that would make them feel better – a drug or an antibiotic that will lessen if not totally remove their symptoms. What would be a better way to sell the product than by prescribing it?

I am not in the practice, but it is not unusual for me to be approached by acquaintances and friends who would ask me about their condition. Not a few of them would tell me that their medications are so expensive that they do not know how else to budget their finances. One acquaintance once told me that her child was diagnosed with a respiratory disease, and she could not bear the expenses for the treatment. I mentioned to her that medications for her child are relatively affordable, as the disease is one of the priority diseases of the government. She showed me the prescription and said that all in all, she would spend almost two thousand pesos every two weeks for her child’s treatment.

The health supplements were placed on “number one” and “number two” on the prescription, and the actual medications for the disease were numbers three, four, and five. As the two medications were more expensive outside, they would buy them from their doctor and the other meds from a pharmacy.

I do not want to make accusations, but it seemed that her prescribing doctor made sure that the health supplements would be bought first before the actual medications.

The sad part about it is that there is nothing wrong about that. Well, technically, there was nothing wrong with how the prescription was written.

 

Hippocrates once said, “primum nil nocere,” which in English means “First, do no harm.” Of course, Hippocrates is not a licensed medical practitioner and he probably did not have fancy cars, several houses, and state-of-the-art electrical gadgets as proof of a successful medical practice, and so his teachings – while important in passing worthless subjects in medical school such as “Medical Ethics” – are not really emphasized anymore once a person finishes medical school and passes the physician board exams. Maybe this is why a lot of physicians would make prescriptions of products that they do not really know about. Maybe this is why a lot of patients would go from one doctor to another to find someone who would actually help them make their lives better. Maybe this is one of the reasons why, when physicians had been subjected to an embarrassing advertisement by the government, most of the people cheered and even made exaggerations on physicians in the web.

One of the common arguments I have heard about prescribing health supplements is that it is usually covered by health maintenance organizations (HMOs) anyway. If given during their hospital stay, HMOs would be the ones paying for them anyway, so what was the big deal? In some companies, employees are given medical allowances for their medicines, and so it will be covered as well. The doctors who would prescribe the health supplements would earn extra money that they deserve, the patient will be “healthier” because of the rich components of their health supplements, and it will be carried over by people (or organizations) that are not them. Again, what was the big deal?

The big deal perhaps is not really the coverage – after all, HMOs are huge evil corporations ought to screw people from their hard-earned cash – but rather it’s about missing the point of Medicine – that of making people’s lives better. More so, it involves doing no harm in the first place. It is good if these health supplements are useless and would just be passed out as urine or fecal material, but more often than not, they are not. Health supplements are health supplements and not medicines for a reason, and it is not because of the conspiracy of huge pharmaceutical industries that want to keep healthcare exclusive to themselves. Rather, it is because health supplements are not yet fully proven to be effective and their side effects are not completely known at the time.

Of course, who will stop them? There are no laws stating that health supplements should be prescribed on a limited bulk. There is no memo among specialty societies saying that health supplements ought to be prescribed on a separate prescription pad and the patient instructed that these should take a backseat to medicines and antibiotics prescribed to actually treat their conditions. There is very few if any healthy discussion of these health supplements during medical conventions. Maybe because health supplements can afford to sponsor the conventions in cool venues such as Boracay and Camarines Sur?

The image of the doctor with the closed eyes, bowed head, and outstretched hand saying “yayaman na ako” will forever stay in my mind – much worse, his not uncommon or unusual solution of prescribing the health supplement to his every patient will haunt me and hurt me not just as a medical professional but as a human being who is genuinely concerned about his fellow human beings. I don’t know where he is now, but I have directly and indirectly encountered quite a number of doctors who use the same strategy and who try to convince me to do the same.

Forget Hippocrates and his ethics, there is salvation in a bottle.


April Fools and Medical Tools

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Earlier today, I was reading a blog… It had reasons why you shouldn’t become a doctor. Natawa ako. I understood and mostly, I felt what the author was trying to say about the medical field. In summary, he said that you shouldn’t delve into studying medicine if you are not ready to sacrifice your friends before Medical School, your relationships and pretty much your own health and sanity.

Doctors are not the healthiest people on the planet, they are sleep deprived, eat irregularly and do whatever it takes to survive the stress. Maslow’s hierarchy of needs is evident when you’ve been on duty and you had to choose between sleep or quality time with a significant other. Sleep wins. Physiologic needs trump the need for love and belonging, for security. You need to find either a partner who is in the same field or a SAINT who would willingly put up with the craziness you’re going through. However there is ONE reason why you should take up Medicine. If it is your calling, if it is the one thing you see yourself doing FOR THE REST OF YOUR LIFE then by all means, GO FOR IT.

Tomorrow is April 1. What’s special? Wala naman because I don’t have any summer vacation picture to post in my page nor a “mouthwatering” body to display in the beach. Sa totoo lang, wala pa ako maayos na tulog. Hindi dahil nag-inuman kami hangga mag umaga, nagpagulong-gulong sa beach, sumayaw buong gabi ng “Feel this Moment”. Nasa hospital ako, naka duty. Habang pinagmamasdan ko ang pasyente ko pinapa nebulize, sumagi sa isip ko na mag ta-tatlong taon na pala ako nung unang sinabak kami sa hospital bilang doktor. Oo, April 1, trending na naman nyan ang mga hastags #clerkship, #juniorinternship , #lowestformofanimal ,#ninjaintern , #boyatgirltakas , #anakngdiyoskayapullout at kung sosyal ka,#shetwhitelacosteshoeskomayblood

Mahabang pasensya ang kailangan sa #clerkship. You have to survive this step in your medical career even if it means hardly seeing your family whom you live with, even though you won’t be able to see your best friends that much, even though you’re in a group different from your friends, even though you would be seeing your ex’s girlfriend/boyfriend in the hospital every single day, even though another ex is dating your group mate, even though you would miss a lot of events including weddings of friends and christening of their kids birthdays and everything else, even though you would end up not watching your favorite shows or get to watch movies you’ve been dying to see, even though you are going to lose the guy/girl that made your heart skip a beat again (whom you just met a couple of weeks before clerkship), You just got to deal with it. Everything would fall into place if it is in His will.

But before you can go further, you need to be able to fulfill your basic responsibility. As a medical student, that responsibility is to study well. The pervasive nature of mediocrity is such that medical students who get by with “Pwede na,” “Ayos lang iyan,” and “Bakit ko ba pahihirapan ang sarili ko?” later on become the doctors who deprive their patients the opportunity to receive the best possible medical care at the soonest possible time. Remember that every minute of delay translates, not just to inconvenience at your patient’s end, but to another minute of unnecessary pain, or anxiety, or hopelessness.

You’ve already invested so much into this, your parents gave so much for this. Sweat, blood and tears went into your career path and it’s not over yet… There’s nothing else you can do but survive. Let’s take it one day at a time. Matatapos din yan  As I’ve always been saying, by choosing to become a doctor, you make a commitment to pursue excellence, to go above and beyond expectations whenever possible. That commitment starts, not during #clerkship, not when you pass the licensure exam, but on the day you turn page one of your Anatomy book

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About the author:

Francis Xavier “FX” Apostol, MD is a graduate of the Angeles University Foundation Medical Center School of Medicine Class of 2012. Aside from being a highly respected and dedicated doctor, is also a loving father and husband, a mentor, educator and lifelong learner. He also describes himself as pogi.

NB: this first appeared on the author’s social media account, accompanying pictures and words by Dr. FX Apostol. No copyright infringement intended.


Called to Serve

The following is a written narrative of the events that transpired during our stint as medical volunteers for Mission Tacloban some time last year..

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The MedCentral Team 5: Mica Veloso, Allen Mallari, Vince Alimurong, Ginggay Hontiveros, Gary Yu, & Anna Javelosa

Day 1:  Getting Ready (November 21, 2013)

It’s been barely a week since our last medical mission at Ormoc City, Leyte when I was once again called to serve. The meeting place was at MedCentral HQ at BCLI in Makati, meaning I had to commute from Pampanga to Makati. Designated time was at 4 AM, but since I went early was already in the Makati area 2 hours ahead of schedule. I killed time at the nearest convenience store then at a 24 hour Jollibee store before hailing a cab to the Universal RE Building where I was instructed by the guard on duty to proceed to the 6th floor where I was greeted by the guard on duty. I was the first to arrive and I was required to log my name among the roster of other volunteers. The records showed that we were the 5th batch to be deployed, a 5 man team delegation. I scanned and noted the names of my other fellow volunteers: Dr. Vince Alimurong, Dr. Ana Javelosa, Dr. Mica Veloso and Dr. Gary Yu, who I was just with last week on the Ormoc mission. After the customary greetings and group photo, we went to the airport for our hour long flight. Upon arriving at the airport, or what was left of it at least, Vince commented that this was probably one of the few times when so many necks craned to either side of the plane at one time to see firsthand the level of destruction. We were definitely going to have our hands full. Transportation was already been arranged for us, a run-down but working and functional van brought us through what would seem to be a war torn city had we not known what happened here just the week before. We arrived at our destination, RTR or Remedios Trinidad Romualdez Hospital which was to be our base of operation. Since we came in at mid morning, most of the other teams have already been deployed and so we were tasked to take over and assist at the makeshift out-patient clinic where people were waiting patiently in line for treatment and free medicines. The lines were momentarily cut and the people were told to come back after an hour to give time for us to have some respite and eat lunch, which was a small block of meat and rice served in small plastic bags. No complaints here, knowing that every resource counted. We continued until late in the afternoon, only calling it a day when we could no longer see patients because the sun was beginning to set. After dinner, with nothing else to do, we settled into our room for the night, and having experienced sleeping in nothing but a concrete ledge outside of a birthing station before, having a mattress and a functional fan was a luxury. And so was sleep. And it was definitely savored.

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volunteers all

Day 2: The Work Continues (November 22, 2013)

Feeling refreshed and ready to go, we were deployed in the town of Tanaoan where we were able to cover a 3 barangays and provide much needed medical assistance at first in the scorching heat and later in the afternoon, in torrential rains. But as Dr. Ana pointed out, no patient who came in was turned away or not treated. Only the setting of the sun prompted us to head back to the operations center where it was not yet the end of the day for the team as we had to collate the data that we gathered regarding what were the prevalent diseases and what the locality actually needed. We also had to replenish our stocks of medicines and supplies that we were to bring the next day. The other blessing of the day was that the other outgoing team endorsed to us their place at the CT scan room where there was a fully functional and always on air conditioning unit. Needless to say, we were asleep in no time.

Day 3: Signs of Hope (November 23, 2013)

With the influx of new teams coming in for relief and medical efforts, the team decided to cover more ground by splitting up: Gary with Mica, Vince with me and Ana with the other members of team PSN (Philippine Society of Nephrology). We originally, and ambitiously, wanted to serve 9 barangays, but breakdown in logistics caused some delay in our deployment and at the end of the day, we were only able to serve 5 barangays. All the new data gathered were then expertly encoded and made into usable data by the more than capable Vince. Along the way we have also noted small signs of recovery: electric poles being erected, lumber yards starting small operations to provide planks and beams for restoration and repair as well as the occasional makeshift sari-sari store on the roadside. The long and arduous road to recovery has definitely begun.

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the mission continues..

Day 3: Journey Home (November 24, 2013)

For the people back home, today would probably have been spent glued to the TV watching in anticipation for the Pacquiao fight which we would later learn he won of course. We would have also wanted to attend mass for the solemnity of Christ the King, but as Simon our Canadian born, white skinned Asian, as he’d like to describe himself told us: there is always a proactive way of sharing God’s work and we were at the moment, living it. Once again the people greeted us warmly when we arrived and again we were told that we were to be the first team, medical or otherwise to give them solace and a sense of renewed hope. There was a noted reluctance in setting up the makeshift tents and unloading of supplies as it dawned upon us, this would be for the moment, our last hurrah. And just when we thought we’d seen it all, right there on the roadside while Vince was taking the history of his young patient who had high grade fever for the past few days just suddenly went into seizures. Thankfully we were with a paramedical team who brought their own ambulance and we were able to send the child to the nearest functional hospital for further treatment. What a way to end this journey. But as we all know, we were but a small part of a big effort that just came in together. In the end although we were to ones who came in to help, we went home with a deeper understanding and respect for the power of the human spirit.


Living, Learning, Earning and Leaving

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helping the sick get better.. that’s my job

“One day I’ll be missing this place”

I read these words from a former staff nurse as a comment to a picture of the hospital where I am both a visiting consultant and a volunteer doctor. And I can’t blame them really, with the economic turmoil and the harsh reality of the nursing profession. Sometimes I myself am asked why I continue to stay despite the difficulties of medical practice and I tell them the story of one patient in particular who helped me place things in perspective.

I went to see this particular patient because she was referred to me for cardiopulmonary risk evaluation prior to a planned open cholecystectomy procedure, nothing out of the ordinary at first but when I looked briefly at her chart, I noted that she came from a far off town, at least two to three hours away. I confirmed this with the patient when I did my rounds and she told me that they even had to take a boat as part of the commute. I recall being to that town before on a medical mission at a friend’s invitation, so I know that it’s really a long way. When I asked how come they happened to be admitted at this particular hospital, she told me, and this would not be the first time, that her National Health Insurance Program (PhilHealth) payments were not up to date and hence, were not eligible for the program.

But the patient continued with her story and told me that she was not looking for a free accommodation and hospital services but rather, where the rates were lower, at least in more affordable compared to the private hospital where she first sought consult and later upon knowing the amount she had to pay, just opted to go back home despite the pain and discomfort she was feeling at that time, simply because she could not afford it. She tells me she has some money with her, but not enough she reckons for the expenses after the surgery; so that is why she will be asking for financial aid from the local politicians, a common practice I observed. She does not want to be begging for alms, but what can she do? She really wants to get well, to be relieved of the pain and suffering she told me. I finished my examination and promised her to help her in the best way that I could medically. I excused myself to make notes and place my written evaluation. The medical assessment would be the easy part; it’s all based on objective and sound scientific and medical data that’s readily available. It’s the human aspect of the healing process that’s a little tricky. The part where our mentors would say the art of medicine comes in, making that human connection and not just treating the patient as a compilation of lab results and imaging studies. In a way I’m thankful that she chose to go to this quaint hospital where it may be a little out of the way, not have the most advanced equipment, and sometimes where things just don’t go the way we plan them to be; but its doors are always open to those who seek medical aid, regardless of creed, race or stature in life. Likewise, the doctors who choose to serve here are more than willing to help out, despite the hurdles and insurmountable odds they have to face. And maybe that’s one of the reasons I choose to stay, because more than just a job, it’s a calling if you may, where I can practice my profession and give back something in return. Besides, here I can be an agent of change and there will always be something new to learn; mostly in the practice of medicine and sometimes, life in general.

In the words of the Blessed Mother Teresa: “Stay where you are. Find your own Calcutta. Find the sick, the suffering and the lonely right there where you are – in your own home and in your own families, in your work places and in your schools.. You can find Calcutta all over the world if you have the eyes to see. Everywhere, wherever you go, find people who are unwanted, unloved, uncared for, just rejected by society – completely forgotten, completely left alone.”

This article uploaded in response to today’s daily prompt


accomplishing the mission

mmom

touching lives.. giving hope

It has been exactly a year ago when the small community hospital who has been in existence for just a little over two years was visited and became the base of operations of Dr. Cathy Panlilio-Arzadon’s team of dedicated medical professionals.

To most of these people, having the surgical procedure done was life changing, as they would not have had any other means to do so.

I didn’t mind playing second fiddle, working in the background and making sure that prior to surgery a medical cardiopulmonary evaluation was done and when the surgical team did their part, patient care did not end when they were wheeled from the recovery room and later discharged from the hospital as they still had lifelong illnesses and other ailments to be taken care of, long after the surgical team have taken flight, their generosity and unselfish services needed elsewhere. And all this done, free of charge and at no expense to the patients.

In hindsight, what they did were more than just mere dole outs, as what usually happens when people do medical missions just for show. 

To borrow the words of Dr. Cathy, who I believe is currently somewhere in Sorsogon doing the same thing all over again:

Our group was created in 2000 and it’s first medical mission was in Guagua, Pampanga in 2001. We have since been to towns in Zambales, Batangas, Tarlac, Bulacan, Romblon, Palawan and Pampanga.

We bring a team of 60 medical and non-medical volunteers, we pay for our own hotel, air fare and food. All funds collected are used to purchase medications and supplies in the Philippines; shipping donated surgical supplies from the USA to the Philippines; purchasing, upgrading and maintaining our medical equipment and instruments stored in our bodega in Pampanga.

We provide FREE services in the following specialties: general surgery, plastic surgery (Cleft lip/palate repairs), minor surgery, dental (extractions, cleanings, fillings), optometry (eye exams, eye glasses), health & wellness classes and rehab services; pharmacy.

We are working within a very meager 20-30K USD budget. Every year we aim to raise 50K so we can purchase additional instruments and medical equipment to make our group fully equipped for our surgeries and dental procedures but sometimes we do not reach the 50K goal and yet still manage to serve 1,500 to 2,000 patients in spite of the low budget.

We go to a hospital equipped with our own anesthesia machines, monitors, suction and cautery machines; we have dental chairs and dental units which enable us to perform procedures without having to rely on hospital equipment which are oftentimes old and unreliable.

Our website, although not that up to date (not to make excuses but all our admin staff and officers are volunteers, have full time jobs and do what they can to keep MMOM running) has photos and information about our group, please visit it if you can http://www.medmissionusa.org

We are a 501 c 3 organization comprised of kindhearted volunteers who take 7-14 days off from their busy lives to work for free…to help strangers from another land who have needs far greater than our own.
Our volunteers do the trek over and over again in the hopes of changing someone’s health therefore impacting them as a person, their family and ultimately their community. How cool is that?

Whatever help you may send our way will be greatly appreciated…prayers,well wishes, your time, talent or financial assistance has a place in the deliverance of much needed help to our kababayans…

It doesn’t take much to effect change in this world. Much like as a butterfly takes flight can cause hurricanes somewhere else in the world, these small ripples of change will somehow impact the lives of countless others.


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