A List

Photo from HERE.

With everything that's going on in my life right now (everything meaning residency), the only things that I can do online, on a regular basis, are check e-mails and update my status in Facebook. I know, I know, it's a no brainer but it's a nice break when what you do all day is think, think and think.

In relation to that, FB inspired me to make lists. Lists are fun, easy to do, easy to read. So for this edition of The Blog Rounds, which Gaya is hosting, I am making a list. A list of ME. The order is random.

1. Filipino and a closet activist.
   
2. Believer.
3. Physician. I know I was born to be one.
   
4. Bookworm. Some of my favorites are The Alchemist, Velveteen Rabbit, Love Story, The Lord of the Rings, Tuesdays with Morrie. I've written about this too.
   
5. Family Man. I'd do anything for my family. That's why you will find posts about them here and here.
   
6. Movie addict. As attested by my skewed priorities, this and this. At some point, the following became my favorites: Dying Young and Rocket Gibraltar.
   
7. Traveller. I am energized by seeing new places, meeting people and knowing different cultures.
   
8. Cabalen. That's why I love food and eat frogs, crickets, among other things. It's in my blood.
   
9. Crazy in Love with Chuy. I haven't written enough about him because one blog is not enough. Cheezy ;)
10. Dreamer. There are still a lot of things that I'd want to do before I turn 50. Like teach or do underwater photography and be a wife and a mom in between.
    

By the way, I would love it if you add me up in FB. Hehe :) Pardon my craziness, I'm post duty.
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The Blog Rounds 22: The Gift (Round-up)

Fifty-seven days to go before Christmas!

One of the major tasks prior to this much-celebrated Holiday involves gifts. Of course, the are other tasks like decorating, planning parties and summing up all those annual reports (since the New Year is a few days after Christmas). But we all have to admit that gift (giving or receiving) is a big part of the celebration and with it comes a lot of work (and money!)

It is just then appropriate that 2 early birds for this round gave us priceless tips: over at Pulse, Em Dy writes on the following lists that come in handy during the season; at Practical Tips and More, Doc Joey shares some tips that she learned through the years on gift-giving. Thanks to both of you for these tips.

The next 4 entries(5 just now) coincidentally looks back on their childhood and what gifts/gift giving (or the absence of it) meant to them. In Scrubbed Out, Brian tells us why the best gifts are those not placed under the living room Christmas tree and ends with his grown-up list. I can't agree more.

Anesstajah brings us a mystery gift from rudolf the red nosed reindeer and how she discovered that she loves wrapping gifts, so much so that she can wrap all day and night, if need be. Makes me want to bring my gifts over to her, for wrapping, of course.

Doc Gi at The Last Song Syndrome tells us about a very beautiful person whom she wrongly thought the worst recipient of gifts and this person's best and last gift.

Gaya in An Adventure Called Life tells us a Santa story: Santa that is so much like his Father and how they were lucky to have had him in their lives. It was a gift beyond measure.

Our guest blogger for this round is one of my online buddy Linapuhan who wrote a tear-inducing entry, Gift-less Christmas that ends with his wish list for his nanay and tatay. I really hope you make it happen Linapuhan.

The Blogs Rounds can't go without some hint of comical sarcasm and social relevance (or at least the attempt to have it). Meloinks in The Philippine Daily Idiot enlightens us on the gift economy and how The Blog Rounds, among other things, is a good example of it.

I, on the other hand, have some wishes for our President, for family and other things. I am waiting for some entries too. :)

Gifts come in many forms. Gift giving consumes our resources -- time, money and even space. But the process of making a list, thinking of gift (even generic ones) and preparing them is what makes it fun. More often than not, those gifts that we can't see or touch are the ones that make the most mark to us.

Happy Holidays everyone!


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I Wish!

Christmas equals gifts
Gifts warrants a list
A list with wishes or names
Why not turn this into a game?

Gifts from far and near
Most you can see, some you can hear.
Wishes that are tangible,
some impossible.

4x4 to drive for my father,
My lolo and lola to live longer.
Plasma TV for my Honey,
I just wish I have the money.

My wish for our President,
a bottle of truth serum
a robe of transparency
a mile of patience.

A new President is what we need
In 2010, one which Filipino will heed.
One who won't bleed this country dry
One who won't make us cry.

I wish for higher salaries
for Pinoy MDs who stay.
I wish for health for all,
every Filipino, big or small.

I wish for The Blog Rounds
to stay inspiring and sound.
Blogger members to increase in number
and have an EB this summer.

It's free to wish and dream
especially when one is grim.
Christmas is for wishes coming true
one reason to stop being blue.

My wish for you
that your wishes do come true.
This is my Entry to TBR 22.
I wish you have one too.

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The Blog Rounds 22: The Gift

Photo from here.

It’s only 69 days before Christmas! Have you already made your Christmas list?

Christmas is the most celebrated holiday in the Philippines; time where most Balikbayans come home; longest holiday in the Filipino calendar; and definitely the most colorful and well lit season of the year.

But Christmas is always brighter when we celebrate its true meaning -- giving yourself (or part of it) to others. But since this, literally, is complicated, we give gifts instead. In fact, if there is one season that people spend aimlessly and without reason for gifts, it would be this one.

For this edition of The Blog Rounds, let’s talk about GIFTS.

What is the most priceless gift you ever got? It could be a Christmas gift, a birthday gift, or any other gift. As long as you didn’t buy it yourself, was given to you for a reason/occasion, then, we can call it a gift. Who gave it to you? Your reaction? Priceless or price less?

Just in case you don’t have, yet, that gift to rave about, what would it be? What's your wish list?

Or we can talk about the 'other' side of gift giving. Do you 'recycle' gifts? Or do you feel bad when your gifts are 'recycled'? What can you say about 'generic' gifts? Do big suprises really come in small packages? What about giving cash as gifts (aside from aginaldo)?

It can be a photo blog, wish list, song, poem or whatever form. Just as long it’s something that would inspire us to give (or beg for) more.

Deadline of entries will be on October 25, 2008, 12midnight (between the 2 of us, this could extend up to the 26th or 27th). Leave a comment here or send an e-mail to the TBR e-groups.

Will wait for your gifts, err, entries.

~~~~
P.S. I will consider your entry as an early Christmas gift. :)

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Go forth and multiply... responsibly

"Iloilo Representative Janette Garin, a physician, said her bill was centered on educating the public on reproductive health and allowing couples to choose between natural and artificial family planning methods."

Now, what can be wrong with educating the public and allowing them to choose? Really.

Prudence MD invites us to share our views on The State of Reproductive Health Care in the Philippines.

Here's mine. I have nothing against those who are fighting the Bill, especially the Catholic Church. What I have against are the implications of this resistance to our nation.

1. Only 82.27% percent of Filipinos are Catholics. What about the other 17.73% who can actually make use of the artificial family planning methods?
   

2. Are Filipinos stupid that they can’t decide for themselves when given a choice between artificial and natural family planning method (NFP)?
   

3. Aren’t we shortchanging Filipinos in general when the Reproductive Health offers only NFP methods?
   

4. What happened to free will?
   

One of the many things that I have picked up from the Doctor to the Barrios Book series of Dr. Juan Flavier is his belief in INFORMED CHOICE. Meaning, offer several information/option to a patient and let him/her choose. I mean, if we limit the choices to natural methods of family planning, where is the choice in that?

5. I thought that it was eons ago when the State and the Church separated? Are we seeing a comeback of Father Damaso?
   

What ticked me off the most is the fact that our President GMA can’t even separate herself from the Church. Remember her recent State of the Nation Address where she insisted on natural methods? Was she afraid to lose the Church's support? Well, she there's not much of it to begin with. At least, the Former President Fidel Ramos had the balls to make a stand (even if it is against the Church and he could lose its support).

Where and when does the State’s independence start and Church’s influence end? In fact, Rep. Garin revised this Bill, taking into consideration the Catholic Church.

6. Natural family planning methods are the least effective of all the methods of contraception as proven by several studies. Does the Catholic Church even read these?

On a personal note, I am highly frustrated about the opposition that this Bill is getting. I see mothers in the barrio who are gravida (number of pregnancies) 14 or higher and these are not isolated cases.

Does the church even realize what 14 pregnancies can do to a woman, to the child and most especially to this country who can barely support its people?

If using a pill to prevent fertilization is sinful, let me ask you this: is it not equally sinful to bring a child to this world whom you cannot even feed, clothe much less, send to school?

~~~

Photo from here.

This is a contribution to The Blog Rounds 18 at Prudence MD: The State of Reproductive Health in the Philippines. Read more!

Sino sila?

Ano ang batayan para ang isang tao ay matawag na bayani?

Jose Rizal. Andres Bonifacio. Emilio Aguinaldo. Ninoy Aguino. Ito ang mga bayani na pinaparangalan natin taon taon. Dahil isinugal nila ang kanilang buhay para sa bayan at para sa mga Pilipino. Pero naisip ko minsan, kailangan bang mamamatay ka para ikaw ay matawag na bayani?

Ang larawang ito ay galing dito.

Tingin ko naman, hinde. Buti na lang, sa edisyon na ito ng The Blog Rounds, naisipan ni Dok Gigi sa Beyond Borders: The Lei Si Chronicles na bigyang pugay ang mga bayani sa ating buhay na di madalas mabigyan ng pansin.

Aking naisipan na bigyan pugay ang mga bayani na aking nakilala sa 2 taon kong pamamalagi sa barrio:

• Magsasaka. Hindi ko maisip minsan kung paano nila nagagawang yumuko para magtanim, buong araw, umulan or umaraw. Sa isang bansa na ang bigas ay malaking bahagi ng hapag-kainan, dapat mas bigyan natin ng pagpapahalaga ang mga nagtatanim ng ating kinakain.
• Barangay Health Worker. Hindi ko minsan mapaniwalaan na may mga tao pa na talagang likas sa kanilang puso ang pagboboluntaryo. Saan ka pa makakita ng tao na maglalakad ng ilang milya para magpurga ng bata, magbuhat ng gamot at kumalinga sa mga may sakit at makakatanggap lamang ng 200 piso bawat buwan?
• Magulang. Bawat magulang sa barrio (at kahit saan man sa Pilipinas) ay may isang pangarap sa kanilang anak: matapos ang mga ito sa pag-aaral. Kaya kahit na hindi sila kumain, magka-ulcer sa pagtatrabaho, hindi iniinda ang gutom, ok lang, basta lang may baon ang kanilang mga anak na nasa kolehiyo sa siyudad.
• Mga kabataan na naglalakad ng mga 5 hanggang 10 kilometro para lamang makapag-aral. Hindi iniinda ang sikat ng araw at sakit ng kanilang paa dahil gusto nilang matuto.
• OFW. Walang Filipino na walang kamag-anak na OFW. Wala ng hihigit pa sa pagsasakripisyo nila, pagharap sa kalungkutan at diskriminasyon sa ibang bansa, para lamang mabigyan ng magandang bukas ang pamilya na iniwan sa Pilipinas.
  

Sa bawat beses na nakakasalamuha ko ang mga taong nabanggit, nasasagot ang aking tanong. Di kailangang mamamatay para matawag na bayani. Sa katunayan, di kailanga isugal ang buhay para matawag na bayani.

Ang mga taong walang sawang iniaalay ang kanilang buhay, oras at panahon para sa ibang tao, un ang mga totoong bayani. Lalo na kung ang mga bayaning ito, di nila alam na kahanga-hanga sila. Ginagawa lamang nila ang mga ito dahil sa kanilang isipan, ito ang tama at ito ang dapat.

Saludo ako sa bawat taong aking nabanggit.

~~~~~

Ito ay kontribusyon sa The Blog Rounds na tungkol sa mga Bayani na tinatalakay sa Beyond Border: The Lei Si Chronicles. Read more!

Fact of life

I used to mind being called Doktora. Now, I could care less.

The transition happened when I was an intern assisting in a cholecystectomy. My very noble task: retract the liver. After a few minutes into surgery, I was asked to scrubbed out. I couldn't retract well and the surgeon was having a hard time because of me. My male group mate replaced me and he did a great job.

This incident, another few months in training and years at work actually taught me to accept one fact of life. Men and women are different.

Photo from Sweden.Se

Males have testosterone. Females have estrogen. What we do, how strong we are, our emotions are actually ruled by these two powerful hormones. That's why men are generally physically stronger than women. While women, are usually more emotionally equip to deal with different situations.

Dominance. No wonder, surgery was tagged as a male dominated field while pediatrics is women's. Not because women can't get into surgery or men into pediatrics, but because hormones dictates this. Men are naturally more aggressive, more inclined to cut up. Women, on the other hand are more geared towards taking care of the young ones. It's instinct.

What he can do, she can do. Most of times, yes. But sometimes, this is not true. There are things that men can do and women can't. Or things that women can and men can't. Being gender sensitive doesn't mean fooling ourselves and pretending female are a match for sheer male strength. But let's not use these differences to discriminate. These differences were created to complement.

Lucky for those in the field of medicine, these differences don't matter much. There is nothing in this field that a man can do that women can't (well, in my case, except retracting the liver), or vice versa.

Equal opportunity. They say that some specialties in this field don't give equal opportunities to both sexes. But these are talks. I believe that if you can prove your worth and can match up with your contemporaries, regardless of the sex, you will be given the same opportunities.

That's why male patients refusing a female examining physician throws me off. It's primarily because, the female physician was not even given the same opportunity. But this issue deserves another post.

It's habit. Now I don't mind anymore when I am being called Doktora. Because I don't think that I am being discriminated at all when people call me these. Most of the times, it's just habit. But for those who intend to discriminate by adding that extra letter A, go to hell.

~~~

This is a contribution to The Blog Rounds, hosted at Dr. Manggy's No Special Effects.


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Television and miracles

ER Generation. Doctors in our generation would definitely know ER, the TV series. It has become not only a part of our boob tube schedule in high school, like Friends, but for most of us, it has influenced our decision in becoming MDs.

Personally, it has catalyzed my dream of becoming a doctor.

Number 1 fan. Since we didn’t have cable then, I religiously watched the TV show every Tuesday on Channel 5. I watched the reruns and expectantly wait for the new season when one ends. Dr. Ross (George Clooney) has become my doctor friend A’s ultimate crush. Dr. Carter (Noah Wyle) has become mine. He actually inspired me to go into either Surgery or ER med. Only later to find out that ER Med was still non-existent when I entered med school.

The show to which I compare all. So pardon me if I say that no other medical show compares to ER. That’s why I can’t rave about shows like Chicago Hope (then) or Grey’s Anatomy (now) because they are NOT ER.

But there are other 'doctor' shows that I have come to love, but with less loyalty, after ER. One of my favorites would have to be House, MD by Hugh Laurie because of the cases and of course, his bedside manner. This, I believe, is actually similar to the old comedy series by Ted Danson who was playing an MD, also with poor bedside manner, Becker (Dr. John Becker).

Frasier is worth mentioning because the show is ultimately funny and has won several Emmys. Dr. Frasier Crane is a famous psychiatrist with a radio show played by Kelsey Grammer. Then there’s NipTuck. Uhm, need I say more about how yummy Christian Troy, played by Julian McMahon, is? Although for me, the show is sometimes bordering on 'unusual.'

Grey’s anatomy? I am not a fan because it is too EMO for me, so I leave it to my other colleagues to rave about it.

How far (or near) from reality? Watching ER before and after becoming a real doctor, I am surprised to only note ONE noticeable mistake that I remember up to this day: surgeons scrub before they put on their mask. Uhm.

My other doctor friends say that there are other parts of these shows that are way off with real practice. But come on, these are TV shows. Break from our life as doctors. Once I turn on the TV, my doctor brain shuts down (as much as it can), then I enjoy the show.

Movies and TV series are our escape from the real world. But what's amazing is, there are still some realities to it. That's why it sort of influences some of us, like me.

It might just happen. So when I see something 'impossible' like Meredith Grey revived after more than an hour (am I right?) of being brain dead, I tell myself (or anybody who’s watching with me) miracles do happen in TV. Just like they do in real life.

~~~

This is my contribution to The Blog Rounds 14 hosted at Em Dy's Pulse.

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(we)B Log

Why do I blog?

Because I like to document my life. I have this crazy dream that someday, I might be a little famous or die in a really 'heroic' way, that is worth covering on TV, then people will start reading about me. What a better way to chronicle everything than a journal right?

Or even if I don't become famous, I like to record the events in my life or bottle up my feelings and thoughts through writing.

But I couldn't successfully keep a conventional journal for the following reasons: my handwriting is bad, I mean, really bad; my fingers couldn't keep up with my thoughts, meaning, I usually lose my train of thought because I write so slow; and I hate hand writing.

Luckily, I type fast and accurately too (had typing lessons in High School). That's why I have been keeping my journals in the computer for a long time. So when my friend Melissa introduced me to Blogging, I was ecstatic. Finally! I can keep my journal without having to save, print and lose them!

Web Log

I remember that I learned about the word blog in med school. After convincing most of my classmates to make their Friendster account, I was convincing them to blog next. Then my classmate M.I. asked, 'Do you know where the word blog came from?'

'No.' And I thought I was the techie one here.

'Web Log. They shortened it to Blog.'

'Uhmm, nice trivia.'

Then I became addicted. It started out as an easier way, for me at least, to chronicle my life. Now, it is a habit.

What do I blog about?

I used to blog about my personal thoughts, my travel, unofficial review of movies, books or food. Now, I blog to share my more socially relevant experiences as a Doctor to the Barrios. When I stray to personal experiences, it is to update my family and friends whom I don't get to see often. It's usually an icing on the cake when a total stranger pass along and picks a few lessons or tips from this blog.

My blog was never meant to be a medical blog. I am just too much of a doctor most of the day that I want this blog to be my respite from that world.

Restrictions? I don't (or couldn't) write about the most personal thoughts or events of my life. I could only do that in my 'conventional' journal, meant for my eyes only. I am still not comfortable with the idea of strangers reading about my 'private' life, well, that is if there are strangers reading my blog. Are there?

--

This is my contribution to the 13th (Lucky 13!) ed. of The Blog Rounds being hosted by the Man of TBR, Bone MD.

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Mangan Tamu

Our province is known for it's tocino, sisig, halo-halo, Cabalen Restaurent, h-less dialect and Lito Lapid. When I tell people that I am a Kapampangan, there are only a few things that are usually asked.

No. 1. Are you related to the President. (No. Thank God for that.)

No. 2. Where in Pampanga? (It's capital.)No. 3. Do you know how to cook. (Yes.)


Nasi. Some kids learn karate or swimming during summer. But in the case of my sister and I, we learned to cook during summers in my Lola's place. The first thing that we learned to cook is rice or nasi in Kapampangan. Which they call the same thing in Bahasa Malay and Indonesia. For starters, my sister and I will cook rice UNTIL we get it right. Regardless of how many 'gantas' we burned or drown with water, we have to do it until it is perfectly right. Take note, we were never allowed to use rice cooker. We cook it in our old 'kalderos' where we have to estimate the amount of water by using the interphalangeal creases of our fingers.

Asan. Our training in cooking of viands/ulam (asan in Kapampangan) started with frying. I remember dreading this. I feel like the hot cooking oil can smell my fear and will chase me to death. I suffered several minute 2nd degree burn from my first few attempts of frying eggs. Just enough to teach me to keep away or be brave.Non-stick pans were not invented yet then. If they were, they haven't reach our barrio yet. So my Lola has a few tips to ensure that a fried fried won't stick in the pan.

• Pre heat the kawali before putting the cooking oil.
• Heat the cooking oil but not to the point it smokes and smells like soap. Then put whatever it is you need to fry.

It may have started with frying, but it didn't finish there. My passion for cooking continued and I have my family to be thankful for. Every time I cook my killer spaghetti or wrap my 'healthy' siomai, I remember that I leaned all these because I was trained early.Tradition. The Kapampangan's fame for cooking or coming up with amazing food doesn't only root from the well measured ingredients or secret spices that we put into our cuisine. I don't remember my Lola or Tita measuring anything at all when cooking or looking at printed out recipes. In fact, they laugh at me when I freak out whenever I can't find my measuring cups.

It all boils down to a tradition where food is usually associated with family. Cooking is a family affair as much as eating. Food is something that serves as a glue to most of us. Food is not just something that we biologically need. It has become a social event for most of us.

Mangan tamu. Let's eat. When we hear this, we all know it's time for a break. To stop what we are doing. May it be as trivial as a PC game or TV show or something as major as a fight or emergency call. Everything stops when we are all invited to eat. No, not because we always hungry for food. But we are hungry for the family bonding that comes with the food in the table.

We sit, eat and talk. We are all equals in the dining table. We are one family.

--

This is a contribution to The Blog Rounds 11th ed being hosted by J.A.
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He said, she said

Picture from Sandra Sunnyo Lee

This is a tale of a HE and a SHE who did things differently but ended up teaching me some of the greatest lessons in life.

She was a developmental pediatrician. He was a surgeon. They couldn't be more different than day and night.

She has a ready smile for everyone and encouraging words to students (despite your hanging off the cliff grades). When your answer is wrong, she'd make it look like, it's the right answer to the wrong question.

He, on the other hand, is known for his off-topic 'kwentong barbero' lectures, the Merry Go Rounds (this is what we call his teaching rounds during our Clerkship surgery rotation) and knack for embarrassing you in front of an entire room of patients (and relatives), with or without your consent.

She was a mentor. He was a tormentor.

She taught Ethics and Microbiology. He taught what else but surgery?

She was uber nice. He was ... indescribable.

She taught me that being a physician starts with patient care. Do what your conscience tells you. Get your way with people by being the best person you can be. Doing what's right and what's proper will make you a great physician.

He, on the other hand, taught me that this is dog-eat-dog world. No once gets to the top by simply being nice. Watch your back. Be tough. Be ready -- be it in teaching rounds, a surgery, or life in general. Not being ready might cause you a patient's life.

She's a Yin. He's a Yang. Just the perfect combination of a mentor and a tormentor to teach me about surviving this complicated profession, and a more complicated life, outside it.

Thanks to Drs. Cielo B. Malijan and Harry Go. You might not know it, but you taught me valuable lessons in life. Thanks.

--

This is my contribution for The Blog Rounds, 9th ed, being hosted by PinayMegaMom.
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The Blog Rounds 6th Edition

Sick citizens lead to a sick nation. No doubt about that.

With the Philippines facing numerous healthcare issues, from low budget to overly expensive health care, from brain drain to underpaid and overworked health care workers, the front liners are now here to offer pieces of their minds.

photo courtesy of Lyle Lahey Editorial Cartoon

The 6th edition of The Blog Rounds tries to give light to the challenges facing the Philippine Healthcare System. Medical bloggers attempt to diagnose, explain the pathology, and even suggest management options to this barely breathing system, where they work (or used to work) for.

SHOW ME THE MONEY. Chronicles from the Middle of Nowhere talks about the painfully obvious problem of no budget for health. The patients she has seen are what see calls the The Lucky Ones because they were able to reach the hospital at all. She describes the system as that does what it can, ill-equipped, severely underfunded, but always working with the best of intentions.

The Saga Continues simplified what is wrong in A Sick System: if you have money, you can get treated. If you don't, sorry. Plain and simple, harsh but true. This very straightforward blogger ends this by saying we just have to do with we have, for now.

BRAIN DRAIN. Prudence, MD's top commented posts are mostly related on the greatest challenge our healthcare is facing -- brain drain. M.D.s on Strike discusses why doctors are and should be leaving while they can. In We are responsibie for the shortage of doctors, not the rich nations, she dwells deeply into why we should look within the country for the solutions to our problem.

The Bubbleman have several posts too. In Why Stop Me? I Am Leaving As Someone Else, he reacts to the Secretary of Health, Dr. Duque's idea of banning the deployment of doctors. In What is the real living proof of RP Doctors' skills?, he expounds on Filipino doctor's proof of skills as not based on a 64-slice Computed Tomography machine but based on his desire to serve his countrymen WITHOUT the benefit of that 64-slice thing.

IT'S COMPLICATED. Beyond Borders: The Lei Si Chronicles, sees the complexity of the system in What seems to be the problem? From “welfare state” country with outdated practices to expensive health care and unending comparison with the United States. But she believes that the most important illness that this system is going through is moral poverty.

An Eye Doctor In A Third World Country details on how the 'rotten' practices of other eye physicians in her hometown have caused undue damage to all of them, especially, starting, well-meaning ophthalmologists like her. Meron ba tayo nyan? Cheeseburger? uses humor to lighten up this very serious issue with our primary health insurance provider, PhilHealth.

Freudian Slip, a visiting blogger, cites several pathologies as to why this tricky machinery, a.k.a., healthcare system is failing. Working in a devolved setting, he has seen why the devolution of the public health system has made it even worse in Philippine Healthcare System. This entry by the way, is the first post to be submitted for this round.

Parallel Universes uses the analogy of the disease staging to illustrate the severity of the system's condition. What stage are we in? Read Diagnosing Philippine Healthcare: When Dying Becomes the Better Option when he asks several questions on long standing laws in the country, analyse the key players and ends with the more alarming reality and diagnosis is the growing apathy about the whole situation.

SKEWED PRIORITIES. Joey M.D. enumerates in Not a priority! how health is not given due importance by this government and patients, which in turn makes a doctor’s practice even more difficult. She even suggest a simple solution that maybe, just maybe, media can do their part in disseminating health information. But again, that is not their priority! Frustrating, isn't it?

Ripples from the River of My Thoughts bring us back to how it is to lose a patient, for the first time in her post Who's to Blame?. This doctor in training relates this experience in trying to figure out who’s responsible for her patient's death: the people behind the system. That would include corrupt government, patients who don't prioritize their health, anesthesized health workers.

WORLD'S APART. Anthology of Abner Hornedo, MD sarcastically posts Is there really a system? pun intended, from the Land of Down Under. His frustration is magnified in this statement, "I cannot compare the Philippine Healthcare system with Australia's Medicare. There is no point of comparing... ang layo talaga at ang laki ng kaibahan!"

On My Way Home, makes us realize that as part of the system, we must look into what we are doing: complaining and doing nothing results to nothing. Letting things as they are may be the path with least resistance but it doesn't solve anything. Philippine Healthcare System ends with these strong words: It is simpler and safer to be part of the problem.

Another visiting blogger, Nelia, compares the Emergency Room Setting of Philippines and Australia. The big difference? Accessiblity. She suggest treating the patient wholistically, and not only the disease, to at least compensate for our problems way back here.

SILVER LINING. Pinay Megamom compares going through the Philippine Health System as taking the History and physical examination of a chronically-ill patient in her post Pipti-pipti. Why the title? Read the post and she will show that things are not as hopeless as they seem.

At Random Ness contributed the most optimistic of all the posts, in the nick of time. The good, the bad and the ugly enumerates the different efforts of their provincial government to improve their health service and despite the endless list of bad and ugly things, there is, after all, something to smile about. Hopefully though, this very uplifting entry is already posted by this time.

Doralicious gives a very different but uplifting light in Philippine Healthcare System: Why is it far from the ideal? Being both a physician and a Councilor in Quezon City, she details how the government can't be solely blamed for what's happening. Or better yet, let's just all stop blaming or pointing fingers and do our part. She aptly ends this by concluding, "It is the inter-relationship of all the parties involved that cause our healthcare status to be this dismal... THERE IS HOPE." Very well said Councilor.

In case you are wondering what the host has to say about this? Health in the hands of the people suggests a simple solution to our ailing system-- focus on primary health care or preventive medicine. It may not be the ideal solution, but it is what this nation can afford and what the people can do with what we have right now.

It's a daunting task to try to figure out what ails the very system where we are parts of. But coming up with solution/s is or will be an even greater task. As we engross ourselves in these socially relevant posts, let us always keep in mind that most of us, if not all, are part of this very system we tried to diagnose.

"Knowing is not enough; we must apply. Being willing is not enough; we must do.” -- Leonardo da Vinci

Now what can we do? What will you do?

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Watch out for the next edition of The Blog Rounds in The Orthopedic Logbook. Who's hosting Bone MD? -- So Far So Good is hosting, by the way, for the 7th ed of TBR.

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Health in the hands of the people

Not your usual. No, I am not discussing the very low annual health budget (which is only 2% of our annual budget!), brain drain, overworked and underpaid health workers, the skewed priorities of our politicians, or the corruption that debilitated the healthcare in this country. For I bet my right, and even left arm, my fellow health care workers will discuss these in their own post.

In this time where the Philippine healthcare system is being challenged with the same issues, we must come up with solutions dealing with what we have, what we can do and where we are right now.

Primary Health Care. The focus on curative more than the preventive aspect of health is one of the most important but less discussed issue in a system like ours. Even in medical school, preventive medicine is not given as much as importance as the other major specialties. In return, the laymen have come to practice the same thing – depending on the damn pills for everything.

Primary care is anything that focuses on the preventive aspect of a disease. The 10 leading causes of mortality and morbidity in this country are mostly preventable and infectious. Now, if primary care is advocated and vigilantly taught to our countrymen, these data might just change. If only, half of those who smoke right now stop completely, the rate of cardiovascular disease in this country will decrease in due time.

Image from hapi naples

Health in the hands of the people. With politician like ours who don’t give a shit about the health sector, whose definition of healthcare amounts to medical missions prior to election, we have to empower the people. Make them realize that their own health is their responsibility. It is neither the government’s responsibility (even though rightfully, it should) nor their doctor’s responsibility.

Laymen should be taught, first and foremost, that their most common illness – acute gastroenteritis, pneumonia, hypertension, upper respiratory tract infection, to name a few, are all preventable. Health is reachable and it is cheaper if you start early.

Healthy Lifestyle. A doctor cannot overemphasize the importance of healthy lifestyle. Proper diet, moderate alcohol intake, no smoking, exercise. This entails little, if not zero, monetary investment at all. Every one can do this. The total return, patients have to worry less about money for hospitalization of some common but preventable diseases. In cases like hypertension, if only it is detected early, eating habits are corrected, less and less people would be needing maintenance medication.

The old adage an ounce of prevention is always better than a pound of cure won’t last for years if it wasn’t true. Healthy lifestyle will definitely lead to healthier Filipinos. Healtheir Filipinos lead to a healthy country, well, hopefully.

More importantly, hospitals will also be de-clogged of patients seeking acute care. This just might do the trick in lessening the work of our underpaid health workers.

I know, I know, most of you are thinking this is like an ideal but far-fetched solution. But it will do in a situation like ours where we always end up in dead end. It might take awhile to see it's effect, but it will do. At least in the rural areas who are most deprived of the health services.

Seek care early. Finally, in case primary care doesn’t work, especially for more acute illnesses, please, please, seek secondary care EARLY. Don’t wait for a 3 cm breast mass to grow up to 10 cms with lymph nodes to go with it. Money is not, and should not, rule you when to seek medical care. Besides, will you ever have enough if your disease is growing proportionally with your medical needs? Really. Remember, God always provides.

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This is my entry for the 6th editon of The Blog Rounds, which this blog is hosting for this week.

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Sixth Edition of The Blog Rounds: Philippine Healthcare System

A few weeks back, there was this CNN special where Dr. Sanjay Gupta discussed the health care system of the USA and how it pales in comparison to that of the other countries like France, Canada, United Kingdom, Australia and Italy. USA? Paling in comparison? What about OUR health care system? Would it look utterly anemic or deathly pale in comparison then?

France, according to the World Health Organization, have the best health care system in the world. What's WHO's criteria? That for a health care system to be considered 'ideal', each and every citizen of that country should have access to health services, or at least the basic health services. Each and every citizen includes the unemployed, those who live on the streets, in prison, retired, whomever.

The Philippines ranks 60. Yes, 60. Our neighboring countries who fared way better than us are Singapore (4), Thailand (47), and Malaysia (49). But we fared better than India (112), Indonesia (92), and China (144). But that's not any consolation because we know, we are still FAR behind. Why is this the case then?

In relation, let me introduce our theme for the 6th Edition of the The Blog Rounds.

Philippine Healthcare System: Why is it far from the ideal?

This is about the social/cultural/political (maybe even spiritual) issues (or causes) that you can think of why our health care system is far from being ideal?

Bakit hindi lahat ng Filipino na may sakit o gustong magpatingin sa doktor ay natitignan ng doktor?

Where is the GAP? Is it the health budget? Our politicians or legislators? Is this government incapacitating us to deliver basic health services to every Filipino?

Or maybe, there is also something wrong among us medical practitioners? Those physicians who treat their pockets more than they treat their patients illness? On the other end of the spectrum, do we have overworked, underpaid health care workers, who in turn, can't give ideal health service? What about the Philippine Medical Association? Yeah, what is its role in all of these?

What about our patients? Is it really just about the extreme poverty in this country that prevents our patients from seeking health services or is it MORE than that? Like skewed priorities?

For those who practise/train in other countries, we would really appreciate hearing your analysis as to why we are far behind, in comparison? Both in terms of the system and the people behind it.

Please be radicals , activist or advocates of change, if possible. No holds barred. No censorship. Just give it to us, at face value, ano ang bulok o MALI sa sistema (kung may sistema man)? Bakit marami pa ring Pilipino ang namamatay na di natitignan ng doktor? O kung natignan man ng doktor, di nabibigyan ng karampatang lunas?

So that just in case Secretary Duque or our President, or any body who is in power to do something, runs into any of our posts, they might just wake up and realized what's wrong. And start doing something, of course.

Please send the URLs or links to your posts to merricherri[at]gmail[dot]com on or before April 21, 2007 at 5:00 pm (Philippine time). Or just leave a comment in my blog and I will come visit your page.

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The topic for this edition of The Blog Rounds was originally laid back but Dr. Ness of At Random Ness did a great job of hosting the best laid back topic ever -- I know what you did last summer. Thanks to Pinoy MD though, because coming up with a new topic was an easy fit when I came across its forums. The topic for this 6th edition of TBR was inspired by the thread Grand Challenges in Philippine Medicine.

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Sun, sand and everything in between

Summer has always been my favorite time of the year. Primarily because it's hot and I can take the heat. Hahaha. No, I mean, I can really (really) take the heat. I have very low tolerance for cold, much less, for getting wet. I bring jacket/cardigans/coats anywhere, especially at nighttime, because it gets too cold for me. But I have very, very high tolerance for heat. So in summer, I don't have to worry about getting too cold while watching a movie or being rained down when I get out of the house without an umbrella.

Summer also gives us the license to wear anything casual, light, and just bask in the sun, doing nothing, in your 2-piece (1-piece bathing suit + towel = 2-piece). :) There is just something about the sun, THEN water, touching my body that gives me a rush.

In connection, I would like to summarize my top 3, no, 4, or maybe 5... OK, OK, TOP 3 favorite places I have visited during summertime. Note that most of these have bodies of water in them. I absolutely, positively, like water.

1. Boracay. Everyone who has been to Boracay would know what I mean when I say, nothing can beat this one. Oh well, OK, there are other beaches like Cabugao Beach Resort (which they say is the Boracay of the North... well), or that sand bar in Camiguin, or Laiya Beach in San Juan, Batangas (which I have yet to see). But Boracay is still Boracay. With it's laid back aura, great night life, and that powder-y sand, one cannot ask for more.

The best part about this vacation was I did it right after med school, before internship, with my GFs in the best accommodation -- Hey Jude!. And oh boy, I was so glad I did because internship in Jose Reyes MMC was a killer. And my first rotation? OB wards. Argh!

I remember that I came in late for our rotation in OB, positively glowing like a litson. My co-intern, whom I met the first time that day, suddenly asked me, "Are you from the States or something."

"Or something." It must be the tan.

2. Sagada, Banawe, Battad

I've seen this place while I was already a DTTB. Since I have batch mates in the program who are assigned in Banawe and Ifugao, they keep on telling me that I must see, at least once, the Rice Terraces, before I die. Of course, I wouldn't want to wait that long. So together with my friends J and A and A's mom, we did a tour of Sagada-Banawe-Battad. This was right after the Julia Campbell story so we were sort of curious to see Battad.

The caves in Sagada were amazing, hanging coffins were pretty extraordinary and the food (and of course, yoghurt) in Yoghurt House was superb.

Banawe, on the other hand, was too commercialized for my taste but we had to see the famous Banawe Rice Terraces, had great dining in Banaue Hotel and there were a lot of museums here.



But my favorite experience here was when we met one elderly Ifugao couple who lives behind the Banawe Hotel and they lent us their costumes for picture taking! They even showed us how they weaved the merchandise which they sell - from bags to blouses to bedsheets. Now, THIS is one of the reasons why I love traveling, when you meet people like Manang Anna and Mang Juan.


Battad, I must say, have the BEST rice terraces, once can see in a lifetime, with Tappiyah Fall as the icing on the cake. The only downside is, you have to work hard, err, walk long and hike a lot, before you will be able to appreciate the beauty of Battad.

But if you only have to see only ONE of these 3 places, I recommend Sagada, especially if you like nature/outdoor.

3. Samal Island

It was right after college graduation when our friend C invited us to her hometown, Davao City, for 2 weeks. We visited the usual tourist spots like the Crocodile farm, Malagos Garden, Eden Garden, Jack's Ridge and ate at Colasa's. But my favorite of all is the Samal Island. Again, because of the beach. What I liked most about this place is that it is quite deserted. In fact, there were only 3 groups of people, including ours, when we went there. And the water is clear. We even went snorkeling with new friends we met there.

I haven't been back to this island but my friend said that it is still the same island that I remember -- isolated. So perfect for a getaway.

These are only my TOP 3 favorite places that I have been to during summer. But I have been to comparable beaches in Subic, Olongapo, Lemery and Mabini, Batangas if you are looking for a beach near Manila. If you feel like going out of town or doing a long drive, there's Puerto Gallera's white beach, or beaches in San Juan and Bauang, La Union or Pangasinan's Bonuan and Hundred Islands.

After writing this, I just feel like I need to go to the beach tomorrow, bask in the sun and just forget that I have to be back in the barrio by Monday! Hahaha.

By the way, if you need any travel tips on any of these places, don't hesitate to contact me. No, I am not a tour guide nor do I own a traveling agency. I would just like to believe that I am a great travel advisor, but only on those places I have been to.

See you at the beach!

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On a makabayan note, I have always believed that we Filipinos must know our own country first before knowing others. So in as much as I wanted to put vacation sites I have been to outside the country, I decided to promote the best ones here, first.

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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.

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The Doctor is Sick

I have never been really sick ever since I went to medical school. Except for a few times I had trangkaso, not-so-often asthma exacerbations (which I have learned to manage well) and that minor surgery I had during internship, I could say I am pretty healthy.

Now, I think, I am sick again! I have tinnitus -- that ringing in the ear, like there is a sound playing in your head, and only you can hear it! It’s pulsatile at that, on my left ear. Texted/ called/stalked my 3 friends who are ORLs (otorhinolaryngologists) or ENTs (ear nose and throat specialist), and spent the whole holiday searching for literature online, which left me worrying more!

As my friend jokingly said, I forgot to do only one thing -- see a specialist in person and have my ears looked into!

Sometime, I wish I knew less than I do now because every time I read tinnitus being associated with vascular anomalies, atherosclerosis, tumors, etc., I become nauseous! Seriously! Despite my doctor-friends saying 'it's nothing', whenever I think about what I know, what we studied in medical school, the worst case scenario, I don't feel like it's nothing!

Last night, the pulsatile tinnitus turned into a real buzz, like there’s a mosquito in my left ear. In panic mode, I called up my friend M, a 2nd yr ENT resident. He said that for the meantime, I use an IPod to mask the tinnitus. I didn’t know if I would laugh or take him seriously!

I watched DVD instead. Buzzzzzzzzzzzzzzzzzzzzzzz. Read more!

COD

Have you ever wondered what caused the demise of some of our former Presidents? I myself never wondered until I became an MD. I mean, come on, all they ask you to remember in school is the date of death, except maybe for some who had controversial or extraordinary causes of death.

Like for example, Pres. Marcos, whom we all know, suffered from an auto-immune disease Systemic Lupus Erythematosus, or Lupus to you. Or that president who died in a helicopter crash -- Macapagal? or Magsaysay? I get totally confused because the pnemonic I used in Elementary is that this president's surname starts with M for crash in a Mountain. What I failed to note is that, we have 2 presidents whose surname starts with M!

So, as remedy, why don't I try to give you a rundown of the CODs (causes of death) of our deceased Presidents. Most from reliable sources, some, from not-so-reliable sources. So please, correct me if you find anything amiss.

Let's start with the president of the First Republic, Pres. Emilio Aguinaldo, who died of coronary thrombosis in Veteran's Memorial Hospital in February 6, 1964, at the age of 95, according to Wikipedia and Geocities. Pardon my sources please. I couldn't find more scholarly- sounding sources.

Next would be Pres. Manuel L. Quezon, where the famous Quezon City was named after, died of Tuberculosis in August 1, 1944, in Saranac Lake, New York. He was buried 3x because he was primarily buried in Washington DC then reinterred twice! His body was finally settled in Quezon Memorial Circle in Quezon City.

President Jose P. Laurel died of heart attack (I am assuming this means Myocardial Infarction) and cerebrovascular disease in Lourdes Hospital in November 6, 1959 at the age of 68. When they say heart attack, do they mean MI (myocardial infarction)? I guess.

President Sergio Osmena, our 4th President, died in October 19, 1961 in Veteran's Memorial Hospital, at the age of 83. He's the second president who died in this hospital. Cause of death: I cannot find any information on this. But as of the posting of this blog, I am still looking.

President Manuel Roxas died of heart failure in Clark, Pampanga in April 15, 1948.

Our 6th president, Pres. Elpidio Quirino died of heart attack in February 29, 1959, in Novaliches, Quezon City.

Finally, I have a chance to clear my previous confusion. It was President Ramon Magsaysay who died of plane crash in Mount Manungga, Asturias, Cebu Province in 17 March 1957, at age 49.

Our 8th president, Pres. Carlos P. Garcia died in June 14, 1971, Quezon City of heart failure at the age of 75.

Pres. Diosdado Macapagal died only recently, relative to the other former presidents, in April 21, 1997 at Makati Medical Center, due to heart failure.

President Ferdinand P. Marcos' cause of death would be the most and well known since this former President had a debilitating disease, Systemic Lupus Erythematosus. He was on dialysis for a long time and even had a kidney transplant. In fact, the first time Malacanang Palace was opened to the public after he was ousted, the dialysis machine that he used were on display. New York Times gives a full detail of his death here. He died at September 28, 1989 (Pacific time) at St. Francis Medical Center in Hawaii, due primarily to kidney failure and its complications.

It would be quite interesting to note that the later the date of death, the more specific the information are on the causes of death of our past Presidents. This would have to mean that our either our medical records are improving or the medical field in general is.

For trivia buffs out there: Only Pres. Quezon died of an infectious disease; seven died of cardiovascular causes; 1 in a plane crash (Pres. Magsaysay), 1 of autoimmune disease (Pres. Marcos) and 2 others, unknown to the author.

I guess, even for Presidents, statistics do apply. Cardiovascular diseases would still be the leading cause of mortality, even in our history.

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Blog Carnival

Here is a much-awaited event for bloggers, especially, medical Pinoy bloggers. Bone MD spearheaded it and the guidelines, etc are posted in his very interesting blog The Orthopedic Logbook.

For those of you interested, just visit the site and get to meet and join the first ever Blog Carnival of Pinoy MDs.I wish I have enough time to enumerate the other bloggers, some are even known internationally, like Tess Termulo of Prudence MD. Some I personally know like Ian of So Far So Good and then there's Bayen with his Freudian Slip and his DTTB batch's blogsite A.B.Y.A.N.KA.
The amazing thing is there are MDs that I have never met personally but got to know them through blogging like Em Dy and her famous Pulse and Dr. Claire's Chronicles from the Middle of Nowhere. I am excited to meet them in person, just like everyone else I meet in the blogospere.

I wish I had more time to explore on this but for all of my MD blogger friends... we are waiting for you to join. Read more!