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Sixth Edition Blog Rounds: Philippine Healthcare, why is it far from the ideal?

{ \ Apr19 }

Philippine Healthcare: Why is it Far From Ideal?

This 6th edition Blog Rounds’ theme attempts to put forward an analysis of a problematic( is it?)healthcare system that has long been tackled, but never successfully addressed. One of the biggest stakeholders in “the solution” to such problem, the doctors may offer some valuable insights in the final analysis of the root cause for such dying health scenario- here in our land!

Join the sixth edition of TBR and be part of the lively discussions surrounding this issue! Doc Che will be hosting the sixth edition of TBR in her blog Merry Cherry. Her call for articles is already posted here. Please submit your entries to Doc Che before 5:00 PM April 21, 2008.

For those unaware yet, The Blog Rounds is a weekly compilation of the best in Philippine’s medical blogosphere, written by physician bloggers (or the medically inclined bloggers) and hosted on a participating blogger’s weblog. Archives and edition schedules ( plus the host blogger) are listed here. The next edition of TBR will be up this Tuesday, April 22, 2008 7am PST.

Physicians and medically inclined bloggers interested in joining this blog carnival, please contact me through my email kokegulper[at]yahoo[dot]com or any of the participating TBR bloggers. Guidelines and updates are posted here in my website, The Orthopedic Logbook.

Bonedoc

About Bonedoc :

As a practicing orthopedic surgeon, Bonedoc help train orthopedic residents in one institution here in South Central Mindanao, Philippines. He is into academic and clinical orthopedics but enjoy many other non medical endeavors (like blogging, computers, outdoors, sports) on his “free” time | View all posts by Bonedoc
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Baptism of fire: Blasting my way to practice last summer!

{ \ Apr14 }

Prologue: I was expecting fireworks and a band playing for a great summer homecoming last year. Indeed, I was greeted by a different kind of “fireworks” but no band of course, one that ripped thy soul and six other lives. I was just starting a provincial, orthopedic practice then. This was my christening…

“Kringg!!!!!!!!!!!!!!!”

“Heeeeeee-lo?!! Dali lang po.

Telephone call kuya! Emergency daw!” said our helper. Then my cellphone rang also as if it is angry. No. Not just my clinic cellphone, but my personal cellphone as well! Our land line and two cellphone rang almost at the same time??!! Never happened before but I have a feeling this is not something good…

It was one rainy afternoon.I just arrived from my Davao Medical Center‘s orthopedic commitment. My butt just landed on the soft comforts of our sofa. Barely 5 minutes have passed since I heared a loud thundering blast that rocked the wits out of my ears. In a moment, its gone. I was too tired to even think about it. Besides, such loud noises frequently disrupts the still atmosphere of our neighborhood. Firecrackers are being manufactured god knows where near our place. So I didn’t bother.

Kuya phone!!!!” came the second reminder from our helper. Lazily I picked the land line first. “Dr. A? Doc, kelangan po kayo dito sa hospital. Daming pasyente naputukan ng bomba!!” the ER nurse of hospital (A) told me. ” Bomba?!!!” the loud thundering blast flashed back and I froze in horror. “Ilan ang pasyente na dyan?” I asked. ” Doc di pa bilang. Puno yung ER . May pasyente na rin sa alley ng hospital tapos may on going na sa OR.!” Came the obviously panic stricken nurse. “Sige, I’d be there in five minutes. Kindly ask the ROD to triage patients based sa severity ng injury” Then I hang up the phone and hurriedly grabbed my scrubs. I almost didn’t noticed my personal cellphone is still ringing.

Doc, punta ka na dito sa hospital (B) may bombing patients dito na kelangan mo makita.” Said the ROD of another hospital. “May intra op referral din si Dr. R sau. Blast injury rin sa extremity!”.” Said another doc in another hospital. “Oh God! This bad?!” and no other ortho here?!! Then the land line rang again. I suspect it was the other hospital nearby asking for the ortho to see the blast victims. Indeed it was.“This is nuts!” My first year and my first summer here.

An improvised bomb planted by unknown persons exploded inside a jam packed billiard hall that was just in front of a pedicab terminal in Tacurong City. The bomb consists of 1 inch long concrete nails and god knows what other dreadful things. Planted in a strategic and crowded location, it was planned with an evil thing in mind- maime people. Not to kill, but sow terror.

610x Baptism of fire: Blasting my way to practice last summer!The site where the bomb exploded is chaos and terror glorified. Blood stains littered everywhere Stalls ripped apart. Glass windows blown into pieces. Panicking people where shouting, crying in pain and helplessness. A father was holding his bloodied dying son. A passerby was holding to his mangled left leg. Several injured people lay in agonizing pain just beside the sidewalk. It was hell on earth. A gory, horrific site.

Those who recovered from the trauma and passing pedestrians began loading injured people into pedicabs and tricycles. The parish priest brought his pick up and hurled all injured persons he can and brought them into the nearest hospitals.

Most people on site were in shock to even move.

I was taken aghast by the sight of patients still waiting to be seen by MDs in the hospitals. “Oh god!” Patients were coming in to no end. The ER is full, patients lay on hospital floor and benches. The nurses and hospital staff where all up and rushing IV fluids, blood samples and splints. All MDs I know are in the hospital seeing patients already. Most hospital here are secondary hospitals so beds easily filled up.”Can you give me gloves please?” I grabbed my scrubs and then went on assessing patients and triaging them based on injury severity and treatment priorities.

A 32 year old passerby driving his motorcycle was hit by shrapnel. He works as a par time driver to sustain his family of four. He had an Open 3C fx (fracture with open wound and blood vessel injury) of both his R leg and ankle. His right foot is barely recognizable. He also have an open femur, elbow and hand fractures. I have to cut his leg and put an external fixation to all his other open fractures.

Another 40 year old driver was hit by a shrapnel in his right arm and chest. Lucky for him it did not went deeper into the lungs. I debrided the wound and put external fixation on his open fracture. He had no relatives to attend to him.

I have to go to the other hospital!” I said to the ROD. I have to relegate the other more stable extremity injured patients to surgeons and MDs available in that hospital. All the patients I assessed for OR where prepared so that the we waste no waiting time. “Have to go to the other hospitals muna and see the other patients there! Please ring me when it is my turn to go to OR!” I instructed the nurse.

Then I ran to the other hospital and saw the same gory sight again.

Patients were already filling up the hospital corridor. Media men and hordes of bystanders are inside the hospital. I was passing through a maze of make shift beds and bloodied hospital floor. I saw all the extremity injured patients and prioritized who should be treated first.

A 22 ear old store helper was hit by shrapnel near the blast site. He sustained second degree burns in his lower extremity and both his feet are beyond recognition. “He is in respiratory distress already! I have to bring him first to the OR or this patients die!” I shouted at the NOD, signaling him to prioritize this one for OR. But there is an ongoing OR of another blast victim. “I hope this guy makes it to the OR.” I stabilized the patient first. Then I looked at the other patients and prioritizing treatments.

I lost count of the patients I saw. it was the longest patient triaging and stabilizing I experienced. More than what I experienced from where I trained. It was a nightmare of all sorts. Blood, pain, hysteria, crying and grief. “This is too much..”

After juggling between patients and hospitals,I started OR immediately when my turn came in. I started around 8 PM then operated on successive blast patients until 6 am. “Do we have sufficient OR needs?” Do we have blood on standby?” What about our meds?” I queried the nurses. I slept for a total of one hour 30 minutes and then started doing ORs until 2 pm. I slept for another four hours and went back for OR from 6 Pm to 2 AM. I made rounds the whole afternoon. Then for the next whole week, I was doing OR every night till 2 am next day.

It was a baptism of fire for me.

A bombing cruelty. Six dead, 32 injured, 12 ortho patients needing OR and re ors. One whole week of nightly OR till wee hours of the morning. I was taking naps in between ORs, slept in the hospital benches, OR beds and make shift tables. I rarely slept in my bed, nor eat in my home. It was like I’m some far away war front like Afghanistan or Iraq.

But no, this is not Iraq nor Afghanistan. This is my place. And when you see dead or injured people because of so called altruistic principles, I can’t help but curse at their bullshit war. People get killed, some maimed and families lost love ones. And these are civilians with no business whatsoever in their so called war to freedom.“You call this fight for freedom?” I have a better adjective for this type of people who sow terror in the guise of “freedom”- cowards!

One year now, that summer, I still vividly recall the gory that baptized me into my practice. I can still remember the crying people losing their loved ones, of dying people under my care. Lost limbs, lost souls, all because of that “bomb” for freedom. I still have bombing patients under my care now, recovering from the trauma they sustained one year ago. Most of them became my friends. Some, lost on follow up.

I hope this summer would not be the same summer as last year. Not again. Please?!!!

(This is my supposed to be entry to TBR5 but just didn’t make it to the deadline. I had a last minute change of heart from the usual posts of outdoor adventures that summer. I have a whole web blog for these kind of escapades here, in my other travel blog, Talakudong Mountaineer)

Bonedoc

About Bonedoc :

As a practicing orthopedic surgeon, Bonedoc help train orthopedic residents in one institution here in South Central Mindanao, Philippines. He is into academic and clinical orthopedics but enjoy many other non medical endeavors (like blogging, computers, outdoors, sports) on his “free” time | View all posts by Bonedoc
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The Blog Rounds goes summer experience hopping!

{ \ Apr13 }
Summer+jump%21 The Blog Rounds goes summer experience hopping!
Summer fun?

Check out what MDs do come summer time! Watch out for the upcoming fifth edition of The Blog Rounds, themed “I Know What You Did Last Summer!” to be chronicled by Doc Ness in her blog, At Random Ness!

Deadline for submission of blog entries will be on April 15, 2008! Guidelines for submission can be read here. Visit Doc Ness blog for the edition’s theme and additional guidelines.

Bonedoc

About Bonedoc :

As a practicing orthopedic surgeon, Bonedoc help train orthopedic residents in one institution here in South Central Mindanao, Philippines. He is into academic and clinical orthopedics but enjoy many other non medical endeavors (like blogging, computers, outdoors, sports) on his “free” time | View all posts by Bonedoc
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Our marvel for survivorship!

{ \ Apr6 }

tumor Our marvel for survivorship!“What??!!” was my bewildered reply to the nervous voice on the phone line. I stood silent for a full minute holding tightly to the phone on my ears and staring blankly on the corridors of ward 8. Feeling the cold sweat engulfing my consciousness, the world around me suddenly turning into a gyroscope of blurred images. Then the universe went dark.

Doc? okey ka lang?” came the ward nurse’s faint voice. “I need you to sign this” handing me a patient chart needing an RIC’s signature. I cleared my throat and mustered enough energy to sign the chart with my hands shaking. “Sigurado ka okey ka lang doc?” She asked again. “Thank you” I said, motioning her to go away and making a gesture I’m answering a call.

I haven’t turned off the phone yet.

I vividly remembered her face. She has a short, gray hair that was always kept tidy by constant rearrangements. Her face look cheerful but is wittingly sharp, beaconing years of endless struggle to survive a harsh but arguably defiant world. Lately, wrinkles appeared in her forehead and no matter how she ‘tucked” those with her scant make up, age seem to catch up with her indomitable spirit. She use to wake me up in the morning with “kain na!!!!“and then bang my door.

She was just fifty and I just finished med school.

She went into the provincial hospital without informing anyone about it. Not even us. I only found out when she called after the operation.” My sister’s nervous voice collapsed into sobs of frustration. Dumbfounded of the events unfolding, I can neither summon enough energy to console my sister nor think clearly about the situation we were in. It was a chaotic tug of war between uncertainty and frustration. I am totally dazed.The mixed emotions of grief, fear, anger and love all brought affront.

What if we lost her? Are we prepared for this? Is she prepared for this?I shiver at these possibilities.

A marvel of parental control and survivorship, she lost her husband while in her early forties. She took the cudgels of single handedly supporting their four children, sending them to through college and produced four top caliber professionals in their fields. For the longest time she was the family’s beacon, the passion, the inspiration. And now the danger of suddenly “losing her” lurks just around the corner.

She is Helen. Helen is my mom.

Well differentiated uterine adenocarcinoma,” came the histopath. I went into silent panic. The sudden gush of adrenaline made my heart thump louder I could hear them between my breaths. The phone almost slipped my hands while I froze in disbelief. Now, losing my mom is a grim possibility. What now?What shall I do? What shall we do? Med school had trained me for situations like this. But not if your mom (or any other close person) is the patient.

Med school even made it more painful for us doctors. We often have an idea how disease progress and how it eventually ends.

Sir can I file a leave starting tomorrow?” I told my team captain and chief resident. “My mom have uterine CA and will undergo surgery in our province“. My chief resident looked at me for a while and said “Ok. You can file your leave and go home a soon as you endorsed all your patients. But come back and don’t quit this program! ” He too can sense the frustration and hopelessness in me. That events like this may have a ripple effect on my training program. I might go berserk in reckless decision making. “I won’t sir” I answered in lip service. I was busy thinking about my mom.

I’m still lost in grief.

Arriving early in the airport next day, I went directly to the hospital and into my mom’s room. She was lying on the sickbed, asleep with IV lines jutting out of her forearm. She looked pale from the blood loss of prolonged menstrual bleeding before. She is cachectic and visibly weakened . “She lost this much…” I whispered. I looked at her teary eyed and hugged her tightly. I was unaware of the four other people inside the room. Her sunken, gray rimmed eyes suddenly opened. She was surprised to see me there and hugging her. My mom is not used to this hugging thing and she hates being pitied upon. “Bakit?” was all she said. I didn’t answer. I just hugged her.

We’d be doing a Total Hysterectomy tomorrow. She won’t need her ovaries too so we’d take it as well. Problem is she has diabetes.” Her OB Gyn told me. “Diabetes???” I remembered my mom siblings got diabetes too, so it is really possible my mom has diabetes but she was mum about it. My heart melt in pity for my mom. She couldn’t just take all these diseases in one single hospitalization! If she is lucky enough to survive the CA, she has to contend with another equally debilitating chronic disease!

After all she had done for us?? This is all she will get??! It’s not only unfair but entirely painful!

I sprang into a robotic action, called all the MDs I know, asked for advices and called a family meeting. That family meeting seem like eternity. I could feel the tons of weight that stood on our shoulders. “I am the doc and I know what to do.” That’s what is expected of me and that what I’m hypnotizing myself with. Hopefully it will work out.

My brother and sisters all waited silently, visibly grief- stricken. We abruptly “lost” our dad before too. Such sudden turn of events not only traumatized our poor souls but made us grappling for lifelines too. The fact that none of them has had any medical background added more to their uncertainty. The burden is so heavy. “You decide because you are the doctor and you know what to do” said our eldest. I always dread this phrase. It makes me feel like dying too.

We will all suffer and grieve, If we will all just cry here and do nothing ” I said in a crackling obviously pretending voice. But we’re ready to strike a deal with fate just to extend my mom’s life. She was our lifeline.

Hiding the panic in me, I went organizing a support group for my mom. “We have to adapt to the current situation or we will suffer. “ I made roles and schedules for each of my siblings- preparing food, relieving hospital watch, even informing contacts. I was busy arranging for the OR, finding the necessary meds, medical needs and preparations. I pretended to be the “in charge guy” but deep inside I’m cracking up in panic and fear.

I’ll advised” said my friend.

I decided to scrubbed in the OR next day. My mom’s surgeons let me in and used my “surgical” hands too. It was an all star surgery for a routine hysterectomy. An OB gyne doing the surgery, a general surgeon assisting and an orthopod on the second assist and another MD on third assist. We have an internist watching over my moms medical condition the whole OR There two anesthesiologist working behind the bags and machines. Outside the operating theater were hordes of close friends watching the show.

I don’t know, but whenever I went into the surgical room, my panic temporarily stops. I feel as cold as any steel as the scalpel I’m holding, perhaps a result of years of training. The team went into robotic precision the entire surgery. I distracted myself not to think about the patient on the OR table, so I don’t clutter or be jerky assisting. The surgeons were meticulously well oiled and systematic. After swiftly removing the uterine and ovaries, we inspected all the nodes and noted for gross metastases. We did the routine inspection three times. None were suspicious. My mom’s appendix is “inflamed” so the surgeon removed it also. I was totally engrossed in the procedure I didn’t notice we were already an hour into the surgery. “Wash!” Woke me up and made me realized the surgery will soon end. After final last minute check of organs, bowels, instruments and sponges, we closed the incision. It was an uneventful procedure and we were all happy the team is through these emotion filled surgery. I made a little speech to the OR team thanking them for helping my family all out and making this surgery safe and succesfull for my mom. I was surprised by the round of applause the team gave each other.

Two days after, my mom was already walking and taking her bath alone. She was visibly rejuvenated but is still weak to walk unassisted. Her blood sugar stabilized and she was eating quite well. There is this smile on her face already. My pamangkins were all around her playfully tagging their lola. Helen is all smiles facing and talking to all those visitors she had like nothing happened.

We were happy too. She went to live another lifetime we believed. Perhaps several years more who knows For once we were suddenly reminded of our moms loving presence. That in the process of us growing, we never had noticed she was getting old also. And as me and my siblings looked at each other, we knew right then we’d be better off showering our mom with love or we won’t have time for that at all!

Epilogue:
The tumor margins were negative for mets. The review of slides were the same adeno CA initially diagnosed in our provincial. I brought my mom to a well known gyne-oncologist in Manila for another follow up check up. He said that my mom luckily survived the ordeal. He advised yearly abdominal CT Scan. For 8 years now, my mom has been symptom free. She had her swings of glucose intolerance but this can be adequately controlled medically. She still hates being pitied upon or being thought of as weak. My mom is a marvel of survivorship.

Bonedoc

About Bonedoc :

As a practicing orthopedic surgeon, Bonedoc help train orthopedic residents in one institution here in South Central Mindanao, Philippines. He is into academic and clinical orthopedics but enjoy many other non medical endeavors (like blogging, computers, outdoors, sports) on his “free” time | View all posts by Bonedoc
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At A Crossroad: The Blog Rounds 3rd ed is up at In the Middle of Nowhere

{ \ Apr2 }
(The original picture in this post is owned by Kenny Gulley, entitled The Storms of Life, was removed upon the owners request, depicts a man at a “crossroad”)

The thousands crossroads we face in our daily lives. Who makes these crossroads? Who serves us the options? Why do we have to face it? What makes us choose the road less traveled? How do we feel about our decisions now? Are we happy about it?

These are some of the questions physicians have dissected, researched and the answers, blogged in The Blog Rounds 3rd ed. Themed “At a crossroad“, the third edition of The Blog Rounds is up at Doc Claires blog In the Middle of Nowhere. In this edition, you will see a growing community of Filipino doctors who blogged about their personal and medical life! What they wrote, will actually fill my whole week of reading and pondering!
I am very thankful Doc Claire accepted and run a well thought of third edition of TBR. I am very much excited also of the growing number of Filipino MD blogger who joined TBR! My hat’s off to all of you!
The Blog Rounds is a weekly compilation of the best in Philippine’s medical blogosphere, written by physician bloggers (or the medically inclined bloggers) and hosted on a participating blogger’s weblog. Archives and edition schedules ( plus the host blogger) are listed here. The next edition of TBR will be up this Tuesday, April 8,2008 7am PST and will be hosted by Doc Tess of An Eye Doctor in a Third World Country.

For physicians and medically inclined bloggers interested in joining this blog carnival, please contact me through my email kokegulper[at]yahoo[dot]com or any of the participating TBR bloggers. Guidelines and updates are posted here in my website, The Orthopedic Logbook.

Bonedoc

About Bonedoc :

As a practicing orthopedic surgeon, Bonedoc help train orthopedic residents in one institution here in South Central Mindanao, Philippines. He is into academic and clinical orthopedics but enjoy many other non medical endeavors (like blogging, computers, outdoors, sports) on his “free” time | View all posts by Bonedoc
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