Proudly Filipina

Please watch QTV 11's Proudly Filipina, hosted by Ms. Charlene Gonzales-Muhlach, this Friday, Oct. 17, 2008 at 8.30 pm. Re-run on Saturday (NOT sunday - sorry) 2.30 pm.It's about a day in the life of a doctor to the barrios - me.

By the way, pardon the hibernation of this blog. I am currently in a 'big' transition stage. Will update the blog once I get a breather.

Send me an e-mail at merricherri@gmail.com if you need to contact me. Read more!

Barrio 101

Perfect way to end my stint as a doctor to the barrio. Read on....

Youngblood
Barrio 101
By Che Zablan
Philippine Daily Inquirer
First Posted 01:38:00 08/12/2008

You would feel the same way if you were me 20 months ago. I was a Manila-educated, Tagalog-speaking, newly licensed physician sent to a remote, fifth-class municipality in Ilocos Sur province as a doctor to the barrio. I couldn’t help but feel important and all-knowing.

However, I wasn’t even in the barrio when it started teaching me lesson No. 1: Be patient.

To get to this upland community takes about eight hours by bus from Manila, three hours from the provincial capital and another 45 minutes from the main highway. You either enjoy the bumpy ride and take in the view of mountain on one side and cliff and valley on the other, or kill yourself with boredom.

Since Filipino is the national language, you would think you wouldn’t have much difficulty communicating anywhere in the Philippines as long as you speak it. During my very first week, this barrio taught me lesson No. 2: Filipino may be our national language, but it is not understood, much less is it spoken, by all Filipinos.

This is true of the patients I see here, especially those who grew up in upland villages. What’s even more striking is that some older folks speak better English than Filipino. So much for knowing the national language. I thought I could survive without having to learn the Ilocano language, but if I wanted to serve them well, I needed at the very least to understand it. And I did.

It was harvest time when I came to this barrio, and almost immediately I learned lesson No. 3: Rice does not grow in grocery stands. Real, hard-working people quite literally break their backs to plant, grow and harvest it. No wonder, during the harvest season we get the highest number of patients complaining of muscle or back pain. If we could learn to value the effort a farmer puts into growing rice, we might not have the crisis we have right now.

A doctor to the barrio is not only a healer but also a manager of the community’s health. I thought I was cut out for the job. After leading student organizations in school, two months’ training in community medicine and with “MD” after my name, how hard could it be? Four months after arriving in this barrio, I learned lesson No. 4: Leadership is earned and learned.

Education and a title can make one an instant leader, but only for a very short time. Effective leadership takes time to learn. One may be named leader because of one’s stature or education, but true leadership requires respect and trust from the followers.

I joined the Doctors to the Barrios Program with the crazy idea that I could change the world. (No kidding.) But after six months, the barrio taught me lesson No. 5: If you want the world to change, change first.

I had a plan in my mind: what to do, what to change. What I forgot to consider was that I was entering a community that had its own system and values, employees who were here long before I was born and structures that took half a century to build. If I wanted to carry out the changes I had in mind, I might as well have built a new community from scratch.

I was the one who changed—with great difficulty. I changed the way I talk, the way I dress (occasionally), what I can and cannot eat. I did all these to fit in and know the community well. Then, small changes followed. I may not have changed the world, but I made a significant difference in a few lives.

The journey wasn’t easy. Most of the time, idealism wasn’t enough to get me through. Reality bumped me hard in the head. I was already in the barrio for nearly a year when I realized that sometimes doing your best is not enough. What put me through rough times was lesson No. 6: When all else fails, pray.

Imagine coming up with a million ideas, only to find out that your budget can only fund one or, if you’re lucky, two of these. Imagine coming face to face with a 70-year-old man complaining of chest pain. You know he is having a heart attack and that he needs to be given medication promptly to prevent further disabilities and then rushed to the hospital. But the reality is, you don’t have any medicine on hand and the nearest hospital is four hours away—by foot. What can you do except pray?

It took me over a year to learn and practice lesson No. 7: Live simply.

I used to consider a cup of Starbucks coffee to be essential and thought missing a blockbuster movie would kill me. This barrio taught me otherwise. It taught me to identify real necessities from the “necessities” dictated by a consumer society. Water is a necessity, but a soda is not. Knowing the latest news is a necessity but catching up with your favorite TV series is not. Weeding out the unnecessary baggage in my life does not only lighten my journey, it also gives me more opportunities to share my blessings with those who need them most.

After a year and half in this barrio, I finally accepted lesson No. 8: Not all politicians are corrupt, but stay away from those who are.

Being educated for four years at the University of the Philippines puts your mind in default: All politicians are corrupt. However as a public health advocate, you encounter all kinds of politicians. Believe me, I have met truly honest ones. One is a village council captain who earns barely enough for his family from politics and supplements his income by farming but still manages to fix his constituents’ problems. Another is a councilor who genuinely has a calling to serve the people and you know this by just shaking his hand. Indeed there are politicians whose hearts, minds and actions speak of honesty and service.

My two years are almost up and this barrio is still teaching me lesson No. 9: Health is in the hands of every Filipino but only a few know this.

The Department of Health, together with nongovernmental organizations, has 50 or more health programs. Few people can name even just 10 of these. For instance, health centers are equipped to deal with primary cases and anti-tuberculosis drugs are given free. If half of Filipinos knew these, then they can be empowered regarding their health. If every parent knew that measles or hepatitis B vaccines are given free to infants, we could reduce the incidence of these diseases in a decade, if not eradicate them totally. If every Filipino knew that enrollment with Philippine Health Corp. can reduce their health expenses by almost half, he would know where and when to seek health care.

If there is one thing about this barrio that had the strongest impact on me, it is lesson No. 10: Humility.

No experience can be more humbling than meeting a farmer whose entire existence is driven by his dream of seeing his children earn college degrees, never mind if he misses a meal or two a day. You feel so little in the presence of teachers who walk several kilometers to mould young minds or a village health worker who earns P200 a month but never complains when she is awakened in the middle of the night to tend to a mother giving birth.

I am humbled by the experience, by the place, but most especially, by the people. You would, too, if you tried living here.

Che G. Zablan, M.D., 29, hopes to enter a residency-training program in a government hospital in two months’ time.

Read more!

At the end of the day

One month is almost over and I can’t help feeling sad. Another month ending brings me closer and closer to closing another chapter of my life. In 3 months time, my life as a doctor to the barrio will end.

As much as I could, I try to document it. Take pictures of patients who see me at least once a week (sick or well), chat longer with pedia patients or even drown my eyes with the scenery in front of the RHU.

Part of that would be picking out the 10 Lessons that I have learned these past 18 months in the barrio.

Photo from Career Hub

1. If you want the world to change, change first.
2. Live simply. Learn to weed out the real necessities, like rice, from perceived ones, like a cup of frappucino.
3. Family is your most important wealth; especially when one feels alone. So appreciate them as much as you can.
4. Whinning never helps.
5. There are things that are within your control, some that are not. Learn to know the difference.
6. Rice does not grow miraculously in grocery stands. There are people who actually break their backs to plant, grow and harvest it.
7. TV is evil and one can survive without it.
8. Not all politicians are corrupt. Stay away from those who are.
9. Count your blessings. You will feel happier.
10. When all else fails, pray.

They all sound so simple. I only had to put it in writing so that when I go back to the rat race in the city, I have this to remind me. That life can be simple and uncomplicated.

At the end of the day, the choice is within our hands.

Read more!

Learning by watching

In remote areas, health service delivery is almost always challenged by inaccessibility. And THIS barrio is not an exception. Farm to market roads takes too long to get done. Or even if they are done, they are done haphazardly that they don't last long too. But that's not what this blog is all about. It is about what an health advocate can do if faced with the same challenge.

BHWs watching an E Learning Video on Bird Flu

Tapping the skills and services of the front liners, the Barangay Health Workers (BHWs), in health service delivery has been one of my goals ever since I got here. I didn't have much choice. I either whine about rough roads and long walks to barangays or FIND a way!

Lecturing/sharing health information to them has actually been more difficult than one would think because of the language barrier. Much as I want to pass to them numerous health information, I just can't. I can't speak Ilocano! Much less converse in it!

What do you know, there are actually people/organization who makes our jobs easier.

Just two weeks ago, the UP Manila-National TeleHealth Center gave out E-Learning for Health CDs containing short films on stroke, poisoning (Iwas Lason), bird flu and tuberculosis. This was funded by the Last Mile Initiative Philippines of the USAID.

The short videos are actually in Filipino. But what makes it more interesting to the BHWs than the lecture of their Tagalog-speaking Doctor is that videos are animated. And what a person can only describe in words, a video can show it.

BHWs with their full attention ( I think) on the videos

Projects like these are priceless in many ways.

1. By just producing several copies, information on several diseases can be sent to a lot of people in just a short span of time.
2. It takes less human resource.
3. The information is retained more than conventional lectures.

The downside? It needs a computer, LCD projector and electricity. But if these are available in your areas, why not?

Dr. Alex Gavino of NThC said that these videos will be uploaded in YouTube soon. Just in case you have BHWs or just anybody who wants to learn by watching, key in the word E-learning for Health, Iwas Lason, Stroke, Tuberculosis or Bird Flu and these might come out. Just don't forget to mention the proponents of the project.

Happy watching... and learning! :)

Read more!

The way to go

In the 18 months that I have been in this barrio, I thought I've ridden it all. This barrio being an upland municipality with 2 big bodies of water in it, Amburayan and Bakun River, it's pretty easy to believe that I have tried almost every possible land or water vehicle here.

Yes, name it. I have tried the amphibian-like custom made jeepneys, jeepneys that are fully stuffed inside and out, garbage truck, the barely breathing ambulances of the RHU or on lucky days, the magarang 4-wheel drive vehicles of the politicians.

But I thought wrong. In the first week of May, before I went to Manila for a 2-week long CME, we went to the last Barangay on our list for the Garantisadong Pambata. Normally, we either cross a bamboo-made bridge or ride a banca to cross the wide Amburayan River. That day was going to be different. We were gonna try another way of getting to the other side.

That, for your information, is a balsa. A make-shift boat consisting of bamboos tied together with a string.

I asked the manong who was steering it, "Manong, pano po ako sasakay jan?"

"Ikaw doktor, pwede nakatayo or nakaupo."

What? Sit where? If I stand up, where will I hold on to? But that was only in my mind or else, manong will definitely laugh at me if I blurt that out. I opted to stand because the odds of me falling, with my height, is far greater than me keeping my ground. Besides, I'd rather get wet than fall off in that big river with those wild currents.

That's our Rural Health Midwife Manang Gladys. Watch your butt Manang.

Now, who said that the ambulance is the only way to see a patient? It could be as crazy, and as fun, as this.

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I got a free laptop!

When asked by colleagues, who are interested to get into the Doctors to the Barrios Program, if being a DTTB is ok, my answer varies. It depends on my mood, recent experience or how I know the person asking me. But my reply usually ends with, 'But it all depends on what are your intentions in joining the program.' Followed by, 'If you want to get in for the money, forget about it.' I believe that no amount of money can compensate for the the 'Filipino politics' and 'isolation' that comes with the job.

In fact, I warned my Dad that his return of investments in my medical education might come later than expected when I signed up for the program. I expected absolutely the worst possible financial compensation upon deployment. These strategies worked because in the trying times when my allowance was being held by the LGU I worked for, I was pushed even further to continue my mission and serve the constituents of that municipality despite not having financial rewards.

But God really has a special way of taking care of us when we choose to forget ourselves and serve others. As my friend aptly puts the other day when I told her about these 'unexpected blessing', bawi bawi lang yan.

In the 32nd Continuing Medical Education of the DTTB, I got an Asus Eee Pc, and an MP4 player, for free! Yey!

Both gadgets were awared because some of my colleagues and I were part of several E learning/ E Telehealth programs. The programs include studying radiology through electronic gadgets like PC and MP4 and referring patients from the barrios through different E modes like SMS, MMS, email and voice mail. Thank God for the internet because life is definitely easier for us MDs in remote areas.

I wasn't expecting to be one of the beneficiaries of the free laptops because, well, I don't think I was able to answer very well the questionnaire they gave out a week ago. One of the questions was, ' Why do you think you deserve a laptop?' I don't remember much of what I wrote but I do remember writing that 'I can't really say if I deserve one.' But I guess they think I do. Thank you.

The laptops are grants from the UP Medical Alumni Society in America (UPMASA), through the UP Manila-National TeleHealth Center. The laptop is technically still is a property of the DOH-Health Human Resource Development Bureau, the office where the DTTB program is a part of. It will only be a property of the DTTB after a year of weekly referrals and blogs from the grantee. The blog would be as easy as ABC for me, but the referrals, I have to work on.

I am a little overwhelmed right now. But let me end this by with something that I read from some forum before I became a DTTB, follow your passion, money will follow. This has been one of my mantras in the past two years and it never fails.

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A moment recalled, a blog reposted... and more

Seventeen months ago, my friends and family thought I was losing my mind. In fact, there was a brief moment when I thought of the same thing. Imagine giving up a comfortable life in the city just to be sent to a remote, unknown area in the Philippines?

How I felt that time can never be described more perfectly, or should I say more accurately, than what I wrote in October 2006 in this very same blog. Here's a repost.

Craziest Thing Ever

In two days I am going on a pre-deployment seminar with the Department of Health's Doctors to the Barrios Program. I just realized this morning that this has got to be the craziest thing that I ever did in my lifetime and I am scared.

On a personal level, I am scared that I get deployed in a really remote area without even a mobile signal and I won't be able to text my family and friends. I am not afraid of the distance, I am more afraid of being isolated or not being able to talk to anybody when I do get lonely.

Professionally, I fear that I may not know enough to serve a municipality with about 15-20 barangays. I took the boards just two months ago! I am beginning to doubt my skills. Will I be able to deliver a baby without the benefit of anesthesia or even an IV line? Can I insert a CTT, alone, when I am faced with a stabbed patient? What will I do without x-ray or urinalysis?

I also fear that I might stagnate, intellectually that is. By the time I finish this job, most of my friends will be senior residents in their chosen fields. They already have honed their skills and gained a lot of knowledge. I, on the other hand, will only be starting.

I am praying and hoping that I never get too lonely or end up stupid in this job. As one of my friends said, only I can prevent that from happening. I just have to remember that and say in the end that this is not as crazy as I thought it is.

I would like to think that no other moment in my life, crossroad at that, can top this. It was a leap of faith, a sudden turn into an unknown road, a momentary loss of sanity. But it was, and still is, the best 17 months of my life. Why?

I thought serving thousands of our countrymen is more than enough. But I didn’t realize that I would find more treasures in this road as I go along the way – got published, twice, met my one true love, traveled to numerous places, met a lot of people and made friends with most of them, and FINALLY, I knew what field to specialize in. THAT for me, is priceless.

If I come through this crossroad again, I’d still choose this same road. After all, I can always take the other roads some other time. Like what I will be doing in 6 months’ time.

Read more!

Isolated... Not

How would you feel if you were a small fish in a river thrown out into the sea, alone?

Whatever it is that came into your mind, that is how I felt 16 months ago, when I was deployed in this barrio. Name it – fear, isolation, excitement, apprehension, I felt it. But the scariest part, as a physician, was being isolated from your seniors or colleagues, whom you can turn to, if you were in the city, anytime you have doubts in your mind.

Thanks to the Internet, because despite the lack of land line and fax in this remote area, the fear of isolation was instantly gone when I realized that I can actually use my phone to connect to the Internet. Yahoo! Or should I say, Yehey?

Professionally, the Internet saved my neck a lot of times in this remote upland municipality in Ilocos Sur.

I remember that time when I was giving a seminar to BHWs (barangay health workers) and I totally forgot the exact meaning of health according to the World Health Organization. I don’t want to be accused of giving false information so with just a click of the mouse, I got the exact meaning, word by word. Or that time when I couldn't remember if MMR (maternal mortality rate) is maternal deaths per 1,000 or 100,000. WHO and CDC sites are great websites for knowing these public health information. Let's not forget our very own DOH (Department of Health), or my boss will kill me.

I had a case once of a 48 year old woman with bilateral lower limb paralysis, who has seen several doctors in Baguio, Benguet and La Union. I wanted to tell her that how in the world can I help her, me, a starting GP, when she has already seen several specialist and nothing happened? But the look of faith in the woman’s eye pushed me to find ways to help her. Thanks to UP’s National TeleHealth Center, headed by Dr. Eloy Marcelo and their BuddyWorks Team, I was able to refer this patient, through email. In two days, they helped me diagnose this patient.

Isn’t that amazing? I didn’t have to go out of this barrio, I probably only spent about 10 pesos for the Internet connection, and the patient didn’t even have to go out of her house to be diagnosed. That is something priceless for the people in remote areas like this because going to a hospital is costly. The nearest primary hospital is 11 kms away and tertiary hospital is about 50 kms away. Did I say nearest? :)

These are only 2 of the many stories I have on how Internet saved my life, or other people's lives, for that matter. There are more.

As a newbie physician deployed in place where I don't know a single soul and don’t even speak the dialect, I was worried that I might go insane with just a few days of being here. Luckily, it didn't go that far because of Yahoo Messenger, Chikka and those community sites like Friendster, Facebook, Multiply, etc. These connected me to my family and friends and even to strangers. I can go online, buzz someone, refer, chat or just simply vent out my frustrations either through forums (Pinoy MD) or blogging.

I cannot overemphasize how being connected with people helped me get through my rough and lonely times here. In fact, just knowing that I can buzz anyone anytime or that someone is reading my experiences here gives me confidence to cure and save lives. That alone makes me a better person, if not a better clinician.

Has Internet saved lives for me? Definitely. Has it made my life easier as a doctor to the barrio? No doubt. I am still just a small fish swimming in this wide ocean. Thanks to the World Wide Web though, I have learned to navigate through it and come out alive and clicking, err, kicking.

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Hanging Bridge

I can compare my stint as a doctor to the barrio to my first experience of crossing a hanging bridge.

Growing up in the plains of Central Luzon, then maturing in the busy streets of Manila doesn't leave much room for crossing a hanging bridge. The closest encounter I had with crossing one was in Subic, 6 years ago. And that was a fake hanging bridge. Meaning, it was built only for fun but not as necessity.

I didn't realize that being assigned in a mountainous municipality would include crossing hanging bridges, and when I say bridgeS, I meant, a lot. On my 2nd month, I have already crossed 3 of them and on my 4th bridge, I stopped counting.

I came to the barrio with all the idealism and gusto of a newly-licensed physician. I thought, I could change the world, or the barrio that I was assigned in, for that matter.

Much like the first time I had to cross a hanging bridge, I was excited and went ahead of everybody. I wasn't even halfway through when I realized that I was holding everybody up because I was really slow. I wasn't used to the height and the mobility of the bridge, not to mention that it was really loong.

I then asked all of my staff to go in front of me and lead the way. After all, they can cross the bridge without even holding on the the sides. I might as well learn from them.

Applying this in my everyday life here, I realized that the best way to incorporate change is to know the people first. Start with what they have, what they know and where they are.

It has been over a year and a half since I crossed my first hanging bridge in Alilem. I can cross without fear of falling now. But I still can't cross without holding on the sides. Hopefully, before my term ends, I will be able to do that.

There are a million things that I learned from this bridges, and I will definitely share them with you on my succeeding blogs.

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Damo at iba pa

There are patients who are just remarkable enough that every physician remembers them, either for good or not so good reason.

In my case, my RHD (that would be rheumatic heart disease) patients are unforgettable because they are only 2 and they come to the clinic monthly, for Penicillin injections. Not to mention that they are both boys in high school, what a coincidence.

These two patients both had unfortunate accidents before Christmas, both sustaining laceration and punctured wound.

The younger one came to me last Friday, for penicillin injection, and I was really touched because he brought me gulay, well, more of edible plant. I forgot what the midwives called it but it was the first time I saw that plant.

In the past 14 months that I have been in the area, this are the kind of things that really touches my heart. So much so that I brought this home to my Dad.

My Dad was surprised because he didn't know what the plant was (considering my dad is into all kinds of edible grass and plants or anything exotic for that matter). We sauteed the leaves and some young stalk, as per my midwives' direction. Well, it tasted like any other leafy vegetable.

What made it remarkable was that it was given to me, as a sign of a patients' appreciation of my work. And that taste better than anything in this world.

---

My next topic would come as a surprise after reading the above blog.

I am bored.

After 14 months in the barrio, I feel like I am growing roots or something. It's not really the work, well, partly it's because of the work. Mostly though, it's because of my personality. I get easily bored.

I feel like I have been the area for ages and I am actually looking for new challenges. I miss the consultant's wrath, sleepless duty in the hospital, numerous patients, etc.

But more importantly, I miss the city. The accessibility of EVERYTHING in the city.

Get me out of here... in October. Hahaha :) Read more!

Half Full

In the past weeks, my spirit is really down because of some problems I had regarding my benefits from the LGU where i worked. For sometime, i felt like every working moment is hell. I've never felt this way since internship and i hate that feeling -- that you are only working just to work.

But since I've always had high standards especially in my profession, even though it's taking me so much effort to still give my best, i decided that I will. I will still work like I'm paid a million bucks, get through my contract here and make myself proud in the end.

Last Tuesday, I went o Candon City to file the Phil Health accreditation of the RHU. But before doing that, I had to have some papers notarized so I passed by a notary public. Surprises of all surprises, Atty. Tudayan, a board member in Candon City, didn't charge me a single peso when he learned that I am a doctor to the barrio. Especially when he learned that I am filing papers for a health program.

I went out of his office feeling glad that I am a doctor to the barrio. At this time when I am doubting if I my work is appreciated, I needed that to reassure me that people do appreciate my efforts and the rest of my colleagues in DTTB.

I remember at that moment what i always tell my friends, 'It's just a matter of looking at the glass as half empty or half full.'

I just realized then that sometimes, it's easier said than done. But after what happened, I know I should start seeing the glass as half full. After all, I have a lot to be thankful for. But that deserves another blog.

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Perks

If there is one experience that I will never forget from the studying at the state university, it is falling in line. Every iskolar ng bayan, especially from Diliman, will totally agree with me when I say nothing, and I mean nothing, can beat the long registration lines in UP.

So I was really disappointed when I was asking people how to go about getting a passport from DFA. Everybody replied, " Go early. Mahaba ang pila."

"What? I thought I was over that already!"

So with a much apprehension, I did go to DFA. A little late cause I couldn't make myself to get up early. I thought I was already in trouble cause I was running really late and they said there's a cut-off. But God is so good. Know why? There is a special lane for government employees.

Yipee! This is one of those moments when I am so glad I work for the government. Can you believe it when i say I finished my application in 30 minutes, waiting, seated in an air-conditioned room?

I couldn't help but smile and think, "Ang babaw ko talaga." Read more!

Faker

When i was starting med school, one of our professors in Ethics said that what doctors must learn to have is EMPATHY, NOT sympathy. Then she went on the explain that the difference between the two is point of view. Empathy is putting yourself in the patient's shoes. It's like seeing the world in his point of view. I thought, easy enough. I just realized now that's where the easy part ended.

My empathizing skills are usually put to test every time I go on duty at the DR-LR (delivery and slabor room). I am single and I think this is my greatest limiting attribute. How can I tell a mother in labor or a mother who's about to go undergo CS that everything will be all right when I haven't even experience like a quarter of their pain? When a mother in labor tells me, "doktor, ang sakit", I am actually at lost for words. I mean, will I say, "OK lang yan mommy" even though I can see that she is really in pain. If I try to appease her, I know that I don't have any idea what I'm talking about.

When I started to work in the barrio, my staff asked me if I can start giving PMC. I asked, "What's PMC?"

My entire staff laughed because for starters, I don't even know what PMC meant. It means premarital counselling. Then they realized that I am single, don't have kids, and don't speak a word of Ilocano. So really, how will counsel marrying couples about family planning?

I realized that I may know the physiology of every family planning method there is, but that's where it ends. In fact, I feel like an hypocrite every time I lecture mothers about family planning or breastfeeding.

Once, I asked a mother in our barrio why she had 8 kids and 1 on the way, she answered, " Mag asawa ka na doktor. Malalaman mo bakit walo ang anak ko."

Well said.

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Quasi-OC

I am a quasi-OC. Meaning, i can be extremely organized in some aspects of my life, but a total mess on some. Like, when it comes to out of town trips, parties or get together, you can trust me to organize it, be it in a day or in a month. I can organize a weekend dinner or a baby shower for a friend from anywhere in the Philippines. So it was not surprising that I actually had our Vigan-Pagudopod-Ilocos Tour organized 1 month prior. In fact, I even sent an email to Yaya and Kat about the specifics of the tour a week prior that I was so proud of my organizational skills.

The bad thing about being overly organized is that, sometimes, you don't leave much room for contingencies. And when it doesn't go my way, i get sorely disappointed.

Monday before our weekend tour, i was told that there was going to be a medical mission sponsored by the hydro power plant in Alilem. And that could only mean one thing -- I have to cancel our plans. OR, convince my friends that they help me in the mission.


Luckily, they agreed to help me. In exchange, we'll just have a night on the beach in La Union. I was really grateful that I had friends who are adaptable. And that there are comparable tourist attractions in Alilem. So we had a tour of the hanging bridges and the cleanest river ever.

It was so far the best week I have ever had in Alilem. I have friends to sleep with at night, to help me in the clinic during the day. It was also only then that I realize I miss Yaya and Kat so much, along with my other friends in med school. We had a great time together that going home was bittersweet.

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Going around it

Language has always been the most difficult part of my stay here in Ilocos Sur. As I’ve mentioned in my previous blogs, I don’t understand a world of Ilocano, much less use it.

I knew that I could have been more effective if I speak and understand Ilocano. Sometimes, I get really frustrated because I cannot get my message across to patients. Like how in the world could my interpreter, usually a midwife, explain to a patient, in Ilocano, that the improper use of antibiotics can give rise to resistance? Or that an aortic abdominal aneurysm is usually caused by atherosclerosis and that it can rupture anytime?

In fact, there are activities that I cannot implement in the barrio – like mother’s class, or lectures on several health programs – for very obvious reason. It would be entirely pointless because the older residents in the upland barangays barely understand Filipino, much less English, and those 2 are the only medium that I will use. It’s like speaking to a blank wall and for them, it’s like watching a Chinese movie. If I wanted to implement this, I would have to ask my staff to speak for me and that is all against my work ethics – doing thing myself.

As I was doing my consults in the first two months, I realized that the younger population in this municipality speak and understand Filipino more than the mature population – because they are more exposed to TV and they already use Filipino as medium of instructions in school. I figured, why not focus on this group? Besides, my FLCD (that would be Family Life and Child Development) degree could be put to use here.

And so I did.

Today has been one of the most fulfilling days since I got deployed here. I gave an audio visual presentation on healthy lifestyle to the elementary students of the Alilem Central School. It may be hard to imagine, but brushing of teeth and wearing of slippers is not a basic need for some kids here. For them, basic would include only food because they only earn enough for that. So my AVP included washing of hands, brushing of teeth and wearing of protective gears. And thanks to my friend Poy and her officemates, each kid was even given a set of toothpaste and toothbrush, kiddie size of course.

For the first time, it felt like my message was getting through. I kind of missed my pre-school teaching days too. But most of all, I realized that you never let one obstacle stop you from getting to your goals. If you can’t get through it, why not go around it? If I can’t be understood by mothers, then why not their kids?

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First time

They say there is a first time for everything. True and I’ve never done so many firsts in one day until I got here in Alilem.

It was the town fiesta last weekend and unlike any fiesta that I have witnessed, fiesta here is a municipality-wide affair. Every single person in this municipality participates, which includes the municipal employees, which by the way, includes me.

I vowed never to put myself in embarrassing situations when I get to a barrio. Embarrassing situations include joining a parade, dancing in front of an audience, giving speeches or even judging beauty contest. I grew up thinking that all of that is jologs. It was easy avoiding all that that when I was in the city because really, there is never an opportunity for kajologan. But here in a municipality where fiesta is such a big deal, I could say I failed miserably to detach myself from all these fears.

For the 1st time, I join a parade (right behind the municipal leaders), judged a beauty contest (it can be real confusing) and danced waltz with a Board Member (yes, he’s a good looking dad). Just thinking about it now makes me cringe but I never thought it was going to be that fun. Embarrassing but fun.

I will always remember what my friend Monsi once texted me, “If you have the choice to dance, I hope you do.” I’m glad I did because dancing with that politician was embarrassing but most enlightening. I realized a lot of things in that 5 minute waltz – that not all politicians are evil, waltz is fun and that when you are really embarrassed, just think that nobody is watching nor gives a shit about you. It works.

By the way, I am in the mountains right now, on Valentines Day with no plans at all because dining out would mean a 2-3 hour travel, one way. THIS is another first for me.

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Ally McBeal Moments

At 6 pm today, I almost shouted at a patient’s mother. The clinic was already close; I was writing my blog and trying to de-stress myself through writing when somebody knocked on the clinic’s door. I went to see who he was. She was a mother with her 4 year old son whom I have seen and diagnosed with Acute Respiratory Infection last Jan 29.

I asked what the problem was and she answered, “Papa-check up po.”

I couldn’t say a word and my only thought was screaming at the top of my lungs, “Are you fucking kidding me? It’s 6 pm!” But of course, it was only a thought.

What puzzles me is the fact that they live a block away from the Clinic, the boy has been coughing for past 5 days and they actually chose to go today, at 6pm? That it didn’t even cross their mind to seek consult with me at 7 am to 5 pm yesterday or even earlier today?

There are a lot of practices in the barrio that I have come to accept since I started being a doctor here last November. But this is one thing that I couldn’t deal, with grace. I don’t think I could ever. I always lose my temper with people who come at night for consultation when they’ve had all day to do just that. Their work in the farm is a priority and everything else comes second – yes, even their children’s lives.

As I have always said, I don’t mind being awakened in the middle of the night as long as it’s an emergency. It is part of our job to be on-call for emergencies. But a 5 day history of cough or 3 days history of fever doesn’t constitute an emergency and it gives enough room for consultation during decent hours. Decent meaning 8am to 5pm.

What I am asking and wishing for is some consideration of my time. That they think not only of their time, but my time too. I can’t help but feel insulted sometimes. It’s like they see their time as all important and MINE as dispensable.

I wish I could still scream my anger off. Read more!

From dusk till dawn

Dusk was my favorite time of the day. In fact, I even wrote about this in one of my blogs. Was because ever since I started working in Ilocos Sur, I started to hate it.

It was my favorite time of the day since I love night time. I am crazy about the sun set, the darkness that covers everything unpleasant or ugly and the mystery that it brings. Also, dusk signals the end of the day. End of toxic hospital duty. This is the time to sleep, eat out, watch movie, hang out with friends, or just spend quiet time at home with my family.

But when I got employed, dusk became my alone time. It signals the very same thing it does in my former life but there is only one problem. This time, I have to spend almost every dusk alone. There’s nobody to dine out with, movie house to go to, friends to hang out and family to dine with. So you can imagine how I must feel every dusk, every sun set, or every night for that matter.

I never thought I’d ever say this but I actually feel sad when it is time to go home. I feel sad not because I would like to continue working, but because 5pm means that I have to be alone again for the night.

But don’t feel sad for me. Alone doesn’t necessarily mean lonely. Or does it?

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Pictures of Alilem

Alilem, Ilocos Sur

My goal: cross all the hanging bridges. So far, nobody could tell me exactly how many are there in Alilem.

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Boob tube, Ilokano, etc.

I never thought I would survive without TV, nor internet, for over a month until I was deployed in Ilocos Sur. I couldn't believe it myself but it's true. I went for an entire month without watching House or CSI.

I realized that I could go for an entire lifetime without TV provided I still get to talk to my family.

TV, just like any material thing in my life, is dispensable. It is the intangible stuff that really matters. I have never appreciated my family or friends' text messages as much as I do now. I remember on my first day in Ilocos Sur, I cried everytime I get a call because I get so overwhelmed with being alone.

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The thing about growing up near the city and in the city is that you grow up thinking that the entire Philippines speak the pambansang wikang Filipino. When I got to Ilocos, boy, was i sorely mistaken.

I don't understand even a word of Ilocano and I soon realized that was a handicap for me. In Ilocos, it is not normal to speak Filipino so when I am not concern, they won't speak Filipino even when I am around.

If you ask how I deal with my patients who don't speak a word of Ilocano but Kankanaey, I say that that deserves an entire blog of its own.

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In relation, once when I got back from hiking to a barangay, one of my staff asked me what we ate for lunch, I answered, sitaw (string beans).

He laughed and asked, "Aluminum or plastic?" Then everybody laughed. I soon realized that sitaw in Ilocano means timba.

You wouldn't want to know what they call sitaw (string beans) in Ilocano. You'd fall off your chair from laughing. Promise. Read more!