Thursday, October 14, 2010

RH Bill: What you deserve.

Everytime I register for a fun-run, I usually check the beneficiary and the stuff that comes with the race pack. I make sure that everything is complete e.g. race bib, timing chip, singlet and route map. It doesn’t end there. Some seasoned runners also check if the distance they ran is exactly what they registered for. There was one running event that got so many complaints from the 10-km runners because the route was only 8.9 km. I guess it is a natural reaction for people if they did not get what they deserve or even paid for.
I remember during my clerkship year in medical school, that the residents and consultants are the “gods” in the hospital. Since we are rotating in the charity ward, patients have little choice but to listen to what the doctors have to say. As clerks, we just carry out the orders given to us. I told myself that one day I will be a consultant too and give orders for my patients.
I took my residency training in a private hospital and I thought this is my opportunity to call the shots. However, this was already the time when there is already a paradigm shift with regards patient care. The hospital was espousing a different model in patient care and that is putting the patient on center stage. I didn’t quite get the meaning at first until I gradually imbibed the culture. It is a must that we explain whatever the patient must know and lay down options for them to choose. The patient is involved in the decision making regarding their health. I also came to realize that they deserve such information and care because they paid for such services. It is the patient who is in the center of our care and not the doctors. This concept was further emphasized when the hospital applied for an international accreditation. It was my senior year in training when the accreditors came to evaluate the hospital. I was assigned to review a patient chart with the accreditor. It was random and the chart is a minor surgical case – newborn circumcision. The accreditor asked about the contents of the informed consent which we make the authorized person to sign. She asked if it contains the complications of the procedure, type of anesthetic used, etc. To my surprise, it was a general statement only. She asked me if I am in the position of the signatory, would I be satisfied with the informed consent. It was a learning experience for all of us. A dramatic change happened and the hospital has to revise all the consent forms indicating all important things that can potentially happen in any procedure no matter how trivial it is. It was even a policy that the consent forms be given to the patient days before any procedure for them to read and fully comprehend the risks involved in the procedure that they will undergo.
It did not end there. We were taught the value of explaining to the patient the possible options available and its corresponding benefits. We are discouraged to withhold information with the intention of convincing the patient to agree with our plans. Simply put, we are empowering our patients to have an informed decision. Now, the hospital espouses a new brand of patient care – making “patients as partners”. I believe every health institution has their own brand of care and it all boils down to giving what the patients rightfully deserve, whether in a private or public sector. All these advocacies are consistent with the Medicine Code of Ethics, particularly in Section 1, which bounds the physician to secure for their patients all possible benefits that may depend upon his professional skill and care.
The Reproductive Health Bill, which was tainted by so many allegations and accusations, is a non-issue for me. It is a 14-page Bill and easy to read. It speaks of the universal basic human right to reproductive health and the right to make free and informed choices – same guiding principles which I was taught in my training and consistent with the Medicine Code of Ethics. It simply highlights what each Filipino couple deserves, regardless of religion or economic status. Unfortunately, most of the people who benefit from such right are the people who can afford and has adequate understanding of and access to information. The consequence for those who lack access to reproductive health information and services, particularly the poor sector, suffer from complications of pregnancy such as bleeding, preeclampsia, unsafe abortion, etc., which is translated to 11 deaths per day. However, we still see patients who obtain incomplete and inaccurate information pertaining to reproductive health. There are discrepancies on the content of information disseminated particularly by lay people leading to more misconceptions. Family planning services are not uniformly distributed and it is banned in some areas depriving couples, particularly women, these basic services that they deserve. Despite the very slow decline in our maternal mortality rate, admittedly not reaching our MDG 5 target in 2015, we don’t have a unified approach to improve maternal health. We also have to bear in mind that the Philippines is a signatory to international treatise which addresses reproductive health and women’s rights such as the ICPD, CEDAW and recently the MDG.
Patients in private institutions have the right to demand the services that they paid for. Even as petty as being short-changed for a 10 km run, it is their right because they deserve it. Just the same, I think every Filipino deserves the right to free access of reproductive health information and services because the country is duty bound to uphold the common good of the Filipino and be faithful to our international commitments.

Wednesday, August 05, 2009

"Umami"

Monday, my regular clinic duty at Megaclinic. It was relatively uneventful. I even got two free meals from my patients. I only saw a handful of patients but the rest of the day I was doing annual physical exam evaluations.
Around half past eight in the evening, which is almost closing time, I was writing a laboratory request to Che, husband of my friend Lea. Everybody is preparing to go home and the nurses are already cleaning the instruments and doing final endorsements. After I bid goodbye to Lea and Che, a nurse came up to me and said there is a patient who came in at the treatment room due to ingestion of monosodium glutamate (MSG). At first, I thought it will be an easy case and I can discharge the patient in no time. As far as I know, allegations regarding MSG as a toxic substance has been disproved long time ago. Recently, I attended a post-graduate conference saying that MSG is even safe in pregnancy.
When I came to the treatment room, there was this middle-aged man wearing a blue shirt with a patch of a montessori school where my niece is going to. With him are two staff from Cabalen where he had dinner few minutes prior. He recounted what happened to him. He said he was having “palitaw” and allegedly took some seasoning on a bowl containing what looked like sugar with some pepper or beans. He poured around two teaspoons of it on his palitaw and after eating it, he noticed that it tasted different. He checked on the bowl and noticed that there were some whitish cube-like powder inside the mixture. He asked the staff what it was and eventually they admitted that one of the staff accidentally poured on MSG instead of sugar. The man suddenly felt nauseaus and vomitted in the toilet. He felt dizziness, sweating and tightness of his abdomen. It was at that time that the staff of the restaurant decided to bring the man to our clinic.
The vital signs were normal. He was ambulatory with no signs of cardiopulmonary distress, except for the anxiety. During the brief encounter, he was a bit defensive. I can see the look on the restaurant staff faces that they are also scared. I was a bit relaxed at that time and reassured the patient that MSG is not toxic. He then told me of a story of a dog that was fed with MSG and died instantly. I said that that is not backed up by medical evidence. He said that he is not really going to complain against the restaurant and that he just wants to know why he felt what he experienced after eating the alleged concoction with MSG. I reassured him that it could be something else or probably a temporary reaction to the MSG. He said he took some samples of the seasoning with him as evidence and asked the staff of Cabalen not to tamper with the original source of the seasoning. I advised the patient to seek consult to a hospital in order to have a more sophisticated test if he wants to formally file a complaint against the restaurant because our clinic is only an urgent-care facility and the clinic is about to close. I told him we cannot really do much in our facility. Surprisingly, he got upset and walked out because we were not doing anything to him. He later threatened to complain me for not doing anything and not issuing any medical form. I told him I am not issuing anything because he is clinically normal and I am advising him to transfer to a better facility. He continued his threat that if something happens to him when he transfers to a hospital it will be my fault. I told him that his case only warrants observation at this time since he is not showing any abnormal signs or symptoms during his stay at our clinic until he left. He was creating a scene in the clinic now putting the blame on me. Later on, I was able to convince him to transfer to a nearby hospital because it is much more to his advantage because he can demand that the restaurant pay for all the tests to be done to him including admission. It brought a smile to his face and agreed to go. The restaurant staff came up to me and thanked me for assisting them. I reassured the staff that it is better to bring the patient to a hospital to further disprove his allegation that he was intoxicated by the MSG.
We all felt that the patient was a bit acting weird. Although his symptoms may be valid, his reaction is way out of proportion to what actually happened. I was offering to have him stay in the clinic and take paracetamol for the headache, but he refused it. He wants an instant explanation that what he felt was due to the MSG. When he left, I just added some notes on the chart where the nurse recorded his vital signs. We didn’t even get his name and age because of his defensive approach. I went back to my room to pack up. I quickly googled on MSG and true enough all the articles confirmed what I know that it is considered SAFE. There is NO TREATMENT needed in case of excessive intake. The patient did show some rare symptoms of excessive MSG ingestion but it resolved spontaneously. Funny thing, I have been curious with the advertisement of Ajinomoto because of the word “UMAMI”. I was wondering what that meant and only because of this incident that I discovered that it refers to the “fifth tase”, meaning savoury-like taste. I guess the fifth taste doesn’t apply to the patient’s palete.

Sunday, June 21, 2009

Handover

There is a building at the corner of Julia Vargas St. and Meralco Avenue that I always pass by whenever I go to work. More than two years ago it was just an open space. Few days after that, excavation work started and they posted a perspective of the building that is going to be built. It was also around that time that my relationship with my ex ended. I was in an emotional turmoil at that time and I was shattered to bits. However, by God's grace I was able to rise up from the rubble. As I passed by the building construction, I told myself that that structure will be a testament to my healing. By the time the handover of the building takes place, I will be reconstructed beautifully as the magnificent building it will be. Months passed and I see the on-going progress of the construction running as scheduled. At the same time, I see myself and check for progress --- so far, so good. Now two years have passed and the building is almost finished with an imposing facade rising tall and strong along that avenue. Unfortunately, the construction in my heart is fairing poorly. I don't know when my handover will take place.

Monday, May 25, 2009

Ode to Mama

Long-suffering & unconditional love are the best words that will describe how Mama lived her life. She has endured several loss in her family starting with her husband (Papa) many years ago, more than a year ago with her youngest son, Tito Boyet, and last month her sister, Lola Digna. I know I cannot fully comprehend the pain she has experienced with the passing away of her loved ones. I know that she even fears the possibility that she might even lose her two remaining children --- my Dad and my aunt, Tita Mary Anne --- because of their health conditions. Above all that, she is fully aware that anytime it would be her time to close the chapter of her life. Honestly, I am not even brave enough to see through what she is feeling because I know I am not that strong to endure it. Amazingly enough, Mama Nitang persevered and lived through her life standing tall.

Well, that’s just the tip of the iceberg. I think another ordeal that she has faced was the feeling of rejection. Old as she is, definitely she is at the mercy of the rest of us. All of us have our own plans in life, and I guess most of the time it doesn’t include her. I know she is not ignorant of the fact that she might be a burden to the family where she is living with. She stayed at several homes for a certain duration of time dealing with different personalities. I think it was truly hard to fit in and be less of a burden. I am a witness to that when finally we took her in. Most of the time she is alone in her room. Despite her severe osteoporotic condition, she manages to sit herself up, walk and go around the house. Honestly, that feat is accompanied by severe joint pain. Her will to endure the pain worked for good in terms of her health. She never developed any bed sores nor pneumonia for prolonged lying down. There was no major medical complication that arose while she was here. She was never confined to a hospital. Sometimes she manages to go to the kitchen and find herself food to eat. She does this because she doesn’t want to be a burden to all of us. But I guess she doesn’t have to because she has all the right to be cared for.

Despite the loneliness, feelings of rejection and the physical pain, she never blamed anybody nor said a hurting word. She suffered in silence and was ever clinging to God. In fact, she could have pointed a finger at all of us demanding to be cared for after all that she did. Such an irony that we who are able-bodied and strong are easy to blame others for their shortcomings, but Mama has all the right to be helped but never raised a voice at us.

With the life the she lived and showed to us, truly she remained to be a good and faithful servant. Her life served as a testament that there is no trial that is difficult. I guess whatever shortcomings we have or any hint of bitterness should also be buried now. Honestly, I am happy that Mama has committed her life to the Lord. It is a time to rejoice because we know that Mama is eternally enjoying the presence of God.

Monday, May 04, 2009

Spelunking Faith

Truth is, I didn’t know what spelunking meant when I first heard it last year from a friend. I googled it and it simply meant, cave trekking. I had a taste of a mini-spelunking back in Hinagdanan Cave, Bohol last month. But when I got to Sagada, that word came to life.

I thought it would be a brady-bunch kinda tour with all the lights, stop-overs, guided walks, etc. At the entrance of Lumiang Cave, we were welcomed with centuries-old pine coffins hanging from the cave wall. We were given a brief orientation by Gareth, the cave-guide, on certain maneuvers to assume when inside the cave. Bottom-line is, to trust the guides.

First encounter was a small crevise leading to a small cave, followed by another crack with a rope leading to some 15 to 20 feet drop. Everyone was a bit scared and apprehensive. It was both a battle of the mind and body. When I took my turn, I tried recalling what the guide told us --- trust the guide. I slipped my body into that tiny crack without seeing where my feet will land. But as promised, a guide was at the bottom telling me where to put my feet and how I must turn. I followed without a doubt and true enough, the descent was easy. We encountered several rock formations, more crevices, cliffs, water falls, flow stones, etc. We even walked on cold pools of chest-deep water. In all these obstacles, the guide was always present showing and lighting the way. It also during that time that I appreciated the power of both darkness and light. When the gas-lamp was advancing too far, you can see the darkness engulfing the path infront of you as if was alive. But when you shout to the guide that you need the light, the burst of light immediately dissolves the darkness in an instant and gives you a relaxing feeling. The path that we are taking is always forward. There is no sense in looking back because it is already filled with darkness. Sometimes, you get off balance and acrophobic because of you realize the height you are in. But then, you hear the guide behind your back telling you to move on.

Suddenly, my life came flashing in my mind. I have been spelunking way before this trip --- the cave that is called Life. I believe that I started my life inside that cave of utter darkness not knowing where to go and what my purpose is. I have been groping in the dark, tripping on stones and rocks and plunging in cold waters. Then I saw the Guide carrying the light and followed. He said he is the Way and all I have to do is trust Him completely. On the first part of the journey, I obeyed like a child and clinged to Him tight. However, as I was getting the hang of it, I was slowly drifting away until I was covered in darkness. It reminded me of the time when we were almost half way through the cave that I was trying to wander ahead of the guide. There was even a funny and embarrassing incident wherein I was on top of the lead and the guide was far behind me. He told us to climb up the rocks because above it is the path to the exit. I was very confident because I’m the only one with the head lamp. I heard from behind that the guide was telling me to stop for awhile and wait for the others. I disobeyed and still moved on. The next thing that happened was, my hand landed on a pile of bat droppings. At that moment, the guide was already behind me and told me to go down because I was heading the wrong way. It was a humbling experience. The path he led us was a totally different way apart from what I thought was the most logical way out. When I thought of what happened, I realized that if I have no guide, I will be lost forever.

As I was crawling up that pile of boulders, it reminded me of the futility of looking back to the past. I tried turning my head to see where the others are and I felt my knees shake when I saw the height I was in. I regained my perspective and focused on what lies infront of me and what is ahead. It made me realize that truly there is no use lingering on past hurts because it will get you off balance. The here-and-now is what matters, most especially, the instruction of the Guide. I have to admit I got lost for awhile sometime ago and I was running around in circles. I can see the light but I kept on heading the other direction. What it brought me was more obstacles, more bruises and more pain. The Guide was calling me out of the darkness and His light was ever present. He never stopped pursuing me until I walk with Him again. I’m glad that I did.

The cave of my life is not yet over. All I need is a “spelunking faith” to complete it and come out to a place of rest that my Guide prepared for me. Despite the bruises I got from the journey, He will heal them one by one. At the end of the cave, an Everlasting Light welcomes me with springs of living water to refresh me and give me renewed strength. The reward is just but simple --- eternity with the Guide.

Monday, April 13, 2009

Paving the way

I just don’t understand why God has allowed me to be alone until this time of my life. I have been living a good life. I became a doctor. I got recognized for my hard work on some occassions. My colleagues admire me for what I do. I never heard a very derogatory remark against me. It was all praises. I did my job well and even did extra. I walk the extra mile for anybody, especially my friends. Some would even say that I am good catch. But why, why on earth has anyone found me yet and would bravely say to my face that they want to spend the rest of their lives with me. Why am I still tangled up with the past relationship I had? What has he done or have I done that keeps me feeling so hurt and wasted? I have to admit, I really can’t move on. Maybe because I gave so much and loved someone so deep I almost forgot who I am, until now. I don’t know what else to do. I don’t even know what I want to happen to make this pain stop. I guess it’s still so hard to accept the fact that someone you loved so much had the guts to fall out of love for you. It would have been better that no one has made me fall in love with them in the first place. I prayed earnestly day in and day out that God would intervene and somehow made him feel the pain that I am feeling. Or to cut the story short, make him love me again. I did almost everything so that he will have no reasons to look for another or need another. But I failed to see that it made him lose the excitement and eventually his love. I have read the signals way before he left, but I tried to ignore it and just decided to love him more. It didn’t seem to work. I guess I just need to find a reason to open my eyes that it is not worth crying over.
God has been good though. My sister was able to finish building her new house and she transfered in a few months. Later on they were able to sell it and now lives in Greenhills. The apartment in QC was being renovated and it was a total overhaul. An unexpected delay occured which left me living alone in a condo here in Pasig. Looking back, it was probably God’s way of ironing out my past to help eradicate any bit of memory I have with my ex-friend. Now either such place will never be seen or had a complete change from the past, so that new memories can be lived. I can also see it the other way, that maybe it is paving a way for something new.
I have every bit of my prayers and dreams answered. My becoming a doctor was never a passion, it seemed like an accident that happened. When it did happen, I just rode with it. It was a bit difficult but I survived. I made the best out of it and now I can’t imagine that I am now a specialist in a subject that I flunked in med school. Later on, when everything seems to have fallen in place, I slowly retreat and I don’t want to dare to dream. My aspirations are not very risky, instead, they are more realistic and low key. I just dream to be a teacher, no less. With such twists of coincidences, that too became a reality. However, one thing remained unrealized --- a partner in life who will learn to love me fully and stay.

Sunday, January 18, 2009

Time of My Life

I've been waiting for my dreams to turn into something
I could believe in and looking for that magic rainbow on the horizon.
I couldn't see it until I let go.
Gave into love and watched all the bitterness burn.
Now I'm coming alive, body and soul, and feeling my world start to turn.

And I'll taste every moment and live it out loud.
I know this is the time.
This is the time to be more than a name, or a face in the crowd.
I know this is the time.
This is the time of my life.
The time of my life.

Holding onto things that vanished into the air, left me in pieces.
But now I'm rising from the ashes, finding my wings
And all that I needed was there all along within my reach
As close as the beat of my heart.

And I'm out on the edge of forever.
Ready to run.
I'm keeping my feet on the ground.
Arms open wide.
My face to the sun.