Six days of community medicine in an urban poor community

by Gideon Lasco

(Note: This is a reflection of our experience as volunteer health staff in Brgy. 143, Pasay City, as part of our medical training. I was a third year medical student then)

On our first day, we were excited to see our barangay. Ate Nene, the prominent BHW of Brgy. 143, fetched us from the LRT station. She told us that our first stop was the local health center, where we are to pay a courtesy call to the doctor. However, when we arrived there, he didn’t show up in spite of our waiting for him for over an hour. We then proceeded to the walk through the Barangay. We passed by the “Tunnel” where we saw for the first time the grim realities of the area. The tunnel’s walls and roof were patched-up shanties, stacked on top of each other; on its 1-meter wide floor the women washed their clothes, the men took their baths, the children roamed about. Everything was done in the footpath which is also the social area of the neighbors. We began to notice how politics is a significant part of the BHWs’ concerns; they introduced us to the new barangay chairman, and the outgoing Kapitan Ong, who seemed apathetic to our presences.

On our second day, we were again asked to drop by the local health center first, to pay a courtesy call to the doctor. Once again, he didn’t show up, and we insisted that we proceed to the barangay hall already. There, Dr.Portia Marcelo followed and a Barangay Health meeting was held. Foremost in the BHWs’ minds was the recently-concluded elections; they had supported the losing candidate and they were suddenly insecure about their position as BHWs. Because of these, they seem paralyzed and unmotivated. What came out of the meeting was a need to engage with the new officials, and it was agreed that they ought to make a report to present their accomplishments in the past few years. As ICCs we did virtually nothing but observe the proceedings. Only four or five BHWs were present on this day.

On our third day, we went straight to the Brgy. Hall. We checked up around 18 kids to track their health and nutrition. They are enrolled at the Supplemental Feeding Program (SFP) but due to the elections this program has been put to a halt, and it was the first time in two months that a check up took place. We found many of the kids malnourished, with dental carries, scabies infection, among others. We identified some of them for follow-up.

On our fourth day, only two BHWs were present: Ate Babes and Ate Cynthia. We were supposed to help them make their report to the new barangay officials. Perhaps their poor attendance can be related to their feeling of being ‘paralyzed’ due to, again, politics. We taught Ate Cynthia how to use a computer. Moreover, we conducted home visits to 5 kids whose special health concerns we identified the day before. Meanwhile, Kapitan Ong continued his tong-its sessions with his friends.

On our fifth day, again only two BHWs were present. Ate Babes was there, too, and we continued to help them in making their report.

On our sixth and final day, we came to help the BHWs present their final report. It was also supposedly a feedback/conclusion session. Again, very unfortunately, only Ate Babes was there.  She was disillusioned too, because she felt that she was being left alone in the struggle. It was only Ate Babes who accompanied us when we rode the jeepney and bade Brgy. 143 farewell.

From these six days, it is very apparent that the BHWs lacked motivation. Unfortunately, down to their level, political intrigue is rampant even though their positions are actually minor and petty.

Probably they are beginning to feel that their efforts are futile. However, negative attitudes are like infectious diseases, they are communicable…honestly I felt unmotivated too sometimes because we were going all the way from PGH only to meet with one or two BHWs…there wasn’t much accomplishment in that. Hopefully, when the political dust settles, the BHWs can get back to work again; there is so much that needs to be done.

It is also unfortunate that the barangay officials don’t seem to care. The Brgy. Captain just loitered around his office. How can he expect others to work if he is as lazy as that? The local health doctor exhibited a similar attitude: how can he inspire future doctors, or even his constituents, if he’s always late and doesn’t take his job seriously?

I realized also that it is not enough to see the poor from a distance, or read about their plight. Actually being there inside the tunnel and palpating the body of poverty is an experience that gives me a clearer picture of Metro Manila. There are realities within the tunnel that do not see the light of day, and these things you will never see unless you really go to these people and listen to their stories. Beneath those high-rise buildings, below those modern roads are dark tunnels. Hopefully, in the future, the people of Brgy 143’s tunnel will find their way out.

Life and the hospital: A head nurse at PGH recalls the struggles of her life

by Gideon Lasco

WHEN WE came to her one Friday morning, all eyes were on the political crisis: the president declares a ‘state of emergency’, a general gets arrested. But in the Philippine General Hospital, life goes on. No strike is possible; the men and women toil day and night, ceaselessly. The public hospital is a community of heroes, trying to heal the nation while its leaders inflict painful wounds.

Life goes on – this has been the theme of Mrs. Luningning Siarez, head nurse of the Community Medicine OPD. As her name suggests, she has a bright and ebullient personality. Approachable and talkative, like your regular ninang. She looked old for a 49-yr. old; the wrinkles of stress has weathered her face. But when we approached her, her eyes shone. As if she – head nurse of the busiest hospital in the land – had nothing else to do, she sat down and talked to us. Then her story began to unfold before our eyes.

A family of ten

Mrs. Siarez was born in Pasay City, a daughter of a driver and a housewife. Her father took the gargantuan task of breadwinning for eight children. Good thing he landed in the employ of Sen. Arturo Tolentino, but the pay wasn’t enough: to see the girls through college, the boys worked while they studied; a pig was sold and a parcel of land mortgaged.    

Sometimes, our narrator pauses – another nurse enters and reports to her. Affairs of the hospital perhaps? After all, she holds the title of ‘Chief Nurse’ and has her own office, but this, as she tells us, was hard earned. After all, she has been working at the PGH for twenty-three years!

She adds that her life back then was boring: “school, home, and church” – those three summarized her daily routine. “It’s only here in PGH that I experienced an outing – at the beach!” she exclaims.

‘My husband went to Saudi’

After surviving the hard, knock life as a youth, Mrs. Siarez was to realize that married life is even harder. Their honeymoon was still fresh in her mind when her husband had to go to Saudi to earn a living. There, he stayed for five years. “Of course it was a hard and lonely time for me,” she said. “But was there any choice for us?”

Then, from the husband’s dinars and riyals, they got themselves a small home in Calamba, Laguna, and a taxicab for her husband, but it was a hard life: as a taxi driver one has to wake up at 4 AM, and sometimes get assaulted by thugs. Instead, Mr. Siarez became an air-con technician.


Tears of a mother

It was when we asked about her family that her nostalgia turned into sadness. Mrs. Siarez told us that she earns around P18,000 as a head nurse, while his husband nets P7,000 because of so many deductions. They have a daughter enrolled as a nurse in Manila Doctors’, and the rest also studies in college and high school. All in all, the cost reaches around P80,000 per semester. “We can only afford two things – education and food. That’s all,” she sighs. “We had an insurance plan, but look at what happened. It’s all wasted,” she adds, referring to the education insurance crisis a year. “My parents give support to the kids, so does my husband’s employer”. But these, she says, are not enough. “My poor son – he may have to stop studying because we really can’t…”

She pauses and sheds some tears.

Still thankful

Countless tales, like hers, are easy to find. Just go to the streets, to the wards: the patients, doctors, nurses – everyone has a story to tell. These are tales of our people: their struggle to live in a poor country such as ours, their struggle to fulfill the needs of their loved ones. Mrs. Siarez told us that she dreamt of going abroad, but she is resigned to the fact that this is an impossible hope. “I don’t hold a grudge against life. When I see the squatters that we visit, I thank God that I am still better off. I’ve taken care of the terminally ill patients here at PGH for more than two decades, and I’m thankful that I’m still strong, that I’m able to see my kids grow. I guess that’s all.” She manages a smile.

A 49-yr. old mother, working at the hospital, struggling to give her sons and daughters a ray of hope for a bright future. There are many stories in the PGH like hers. And they are not happy ones.

Manila
January 2007

The world of DOTA: Where we can all be heroes

by Gideon Lasco

NEXT DOOR INTERNET CAFE, GUERRERO ST. - Within this computer shop a melee is unfolding between the boys of Class 2010 and Class 2011. I was too late to join the fight. If I were five minutes early, by now I would've been gearing up my thunderbolts as Zeus, the Lord of Olympia. The Greek god of gods is not supreme, however: Lucifer can be a formidable enemy.

Enter the world of DOTA, the latest successor to the LAN games throne. With almost 80 characters to chose from, each with a  unique 'personality', the possibilities are endless. It combines the mystical environment of Warcraft, the intensity of an role-playing game like Ragnarok, and the tactical excitement of Counter-Strike to create an opium for the boys – and girls too!

The phenomenon of computer gaming, like a drug-resistant virus, easily infiltrated our supposedly-immune-to-fun College of Medicine. In Class 2010 where I belong, roughly 30% of the guys play DOTA; the figures go higher for the more benign lower batches.

Interestingly, what was traditionally an all-boys activity is gradually becoming co-ed. My classmate Odelle Concepcion, who has become an avoid DOTA player, says: “There’s nothing masculine about DOTA or the other games. Girls can enjoy it too!”

While their classmates were applying for fraternities, the DOTA players in 2010 have formed a clique, which they dubbed PHI DOTA MU - perhaps this is a way of saying that in computer games, as in the fantasy worlds they bring to life - and like Greek-letter fraternities - a special bond of camaraderie exists among them.

Games like DOTA have doubtless helped to make the 21st century male more and more cerebral. Whereas the medieval crusader would take a lifetime to learn how to defeat his enemy Moor, I only have to click the mouse to kill the devil himself. And if I die, it will just take a minute for me to get back to the field again. Woe to the ladies though, who would have wished a much more glamorous male: the perspiring, muscular athlete is now the chuckling, C2-drinking guy with glasses.

Not everyone will have their names chanted at the Biochem court while an interclass basketball game goes on; not everyone will claim the distinction of a College Scholar. But in DOTA, everyone’s equal: neither muscles nor memory can give you the edge, only experience. Of course it is a non-entity when it comes to credentials: being the best DOTA player in the College won’t land me a slot in Surgery. But it will make me much happier than if I’m reading Robbins. Can you beat that?

Computer games will not replace sports and outdoor activities; I still consider it a sacrilege to exchange a hike up Mt. Ugo for two days of DOTA. But do I have two days? A med student is lucky to have two hours.

Philosophical meanderings aside, DOTA is a great game, a great detox activity. We may desire to climb mountains or play ball, but a ward summons or a sudden rain can ruin everything. There's always DOTA, though. It’s just next door, within the Ladymed’s sight.

As Iskolars ng Bayan, we are perpetually asked to be heroes of the nation and act like adults, healers, five-star physicians. Tall order for someone like me, who remains nostalgic over high schools days when we skipped classes in order to play Starcraft. Sure, I may turn out to be somewhat heroic. But for the time being I can shrug off these weighty challenges for a while and go to our virtual playground, where we can all be heroes and forget about the next Pathology exam.

I could write more. But I’ll have to wrap this up. The next game is about to begin!

Manila
November 2006

Fight or flight? A medical student weighs between staying in PH or going abroad

by Gideon Lasco

Fight-or-flight response: n. a physiological reaction that occurs in response to a perceived harmful event, attack, or threat to survival.

Sometimes, I feel that we medical students are the most abused breed in the country. Before, our all-white uniforms carried an aura of dignity and prestige. When people find out I'm a medical student, they will express admiration and wish that I'd give them a free consultation as soon as I pass the board exams.

"That's still too far from now, I would always say," adding, jokingly: "If I give free consults all the time, how will I raise a family?!"

Of course those exchanges are light-hearted, but nowadays there are tougher questions we always have to prepare for. Not just the quotidian "What are you planning to specialize in?", but questions that speak of the times we live in.

First: "Are you planning to take up Nursing?"
Second: "You're just end up working abroad, won't you?"

Oftentimes I am tempted to give a vehement "No of course not!" to the first - and an annoyed look at the second, but I try to be polite. Yet should I say no, they would sometimes follow up, "You're just saying that because you're young and idealistic. Let''s see what will happen in the future." Many people expect us to be heroes, but sadly, they judge our profession even there are many things they do not understand.

Coming from a middle class family, my parents work hard so that I can study medicine. The expenses include tuition fees, dorm rentals, books, medical tools like stethoscopes, and of course, my allowance; what makes it heavy for many breadwinners is the fact that it has to be sustained for several years. Indeed, I would likely be still toiling in the hospital long after my high school classmates have graduated and landed on good jobs.

Daily we study, nightly we review. For a single exam, we have to read hundreds of pages, memorize hundreds of terms, and pay hundreds to photocopy lecture transcripts and handouts. It takes a week to do all of those, and there's an exam almost every week. It's been a month since I was last able to go home to my family in Laguna, because I don't want to fail a subject.

We have to bear the foul stench of cadavers and dissect them, inside-out, in the name of learning. Daily, we medical students take the risk of having all sorts of diseases in PGH ranging from tuberculosis to the common cold; from Hepatitis B to flu.

All these for five years. And to specialize, at least three more. Only then can you begin your practice. It will still take some time before patients will fall in line in your clinic.

Yet, I want to become a doctor. I want to learn about the human body and mind, and enter a profession that is both challenging and fulfilling. Being in medical school, I am well on my way in achieving my goal, but the question is: where do I practice medicine?

If being a medical student in the Philippines is hard, being a doctor is even harder. There will always be sick people in need of care, but many of them cannot afford to pay the cost of medicines and medical services. Doctors also have to make a living, and they cannot always render their services pro bono. Patients can go to public hospitals, but with government budget on health being sliced yearly, government doctors feel that their meager salary - after all those years in training - not worth it.

As for choosing private practice, that too comes with its own challenges: If you want to have a clinic or practice in private hospitals, you have to buy bonds or stocks that sometimes amount to millions.

Who then can blame doctors for leaving the country? Or for taking up Nursing?

Flight from the country is a viable option to those who have experienced the difficulties of Medicine. After years of labor, they expect to be rewarded. And in pursuing an opportunity abroad, one can ensure the future of their family.

On the other hand, fighting for the country is also a choice. The fight I speak of is the battle against diseases that plague the nation; both medical and social ills. Having visited communities all over the country, from the Cordilleras to Southern Mindanao, I realize that just one doctor can make a lot of difference. The satisfaction of seeing lives saved, and people uplifted, can make the financial sacrifice worth it.

A less dramatic example of fighting for the country is staying in hospitals that need physicians badly. These hospitals are scattered all over the Philippines, and if doctors choose to stay in their provinces where they were born, it will mean a lot to their people. Finally, highly-specialized doctors who train abroad would also do well by bringing their skills to the country.

It largely depends on the individual. Any profession is a struggle, and one must choose a path in which he will be satisfied. We cannot demand every doctor to make sacrifices, but we have to appreciate those who do. It is unfortunate that the few doctors who remain in the barrios receive death threats, and are sometimes even killed, by powers-that-be who do not wish our people to progress.

Personally, I remain undecided. As I hurdle challenge after challenge in med school, I learn a lot of things: the vastness of human knowledge; the importance of empathy; and the fragility of human life. In time, maybe the path ahead will be made clear.

Fight or flight? With four more years before I graduate, I will wait before making my decision. Surely, it won't be an easy one.

Gideon Lasco
LU IV (2nd year Medicine)
June 13, 2006