Friday, July 21, 2017


Two weeks back, we were talking about the challenges of referring patients with mental health issues to psychiatry service.  During the discussion, we mentioned how stigma and discrimination can lead to depression and suicidal ideations, especially among newly diagnosed people living with HIV (PLHIV).

The process of testing itself is imbedded in a private and confidential setting, with counselling to provide psychological support when one finds out about the diagnosis.  Disclosure to family and loved ones of one’s status becomes difficult, considering that one needs to open oneself up to the risk of rejection and isolation.  It is painful to realize that you may not be accepted, and that you may be shunned from polite society. 

I know of a prominent Filipino doctor who died of suffocation, refusing intubation.  He had an opportunistic fungal pneumonia, and he wanted to die because he could not accept that he had HIV/AIDS.  So he refused all interventions, and signed an advance directive to allow him to die.  Had he received psychiatric help for the depressive feelings he must have had, who knows? He might have been helping the Filipino poor today, providing health service delivery.

Last week, we had a technical meeting with the Department of Health, WHO and UNICEF on the implementation of the prevention of mother to child transmission of HIV in the Central Visayas.  During this meeting, we discussed the challenges of treating, caring and supporting pregnant women living with HIV and their families.  There is a new administrative order being drafted which integrates prevention of mother to child transmission of HIV in all levels of healthcare.  In an instant, I could imagine all the challenges we would have, so we requested that this new order be implemented with strong programs on stigma reduction and HIV awareness programs especially for healthcare providers.

During a regional forum with the Health Policy Development Program discussing the challenge of reaching the poor through a continuum of care, it was mentioned that almost 50% of people who inject drugs were HIV-positive.  These people also deal with mental health issues which drove them to use drugs in the first place.  How do we integrate HIV in all levels of healthcare without addressing first the basic mental health issues of key affected population – male who have sex with males, IV drug users, female sex workers?

Have you had an HIV test?  Until the HIV test becomes as routine as a complete blood count, it may be difficult to encourage HIV testing at the community level, and in all levels of healthcare.  We’ve got a lot of things to talk about HIV yet.

The Duke and Duchess of Cambridge and Prince Harry had a conversation about putting their HeadsTogether for mental health.  They realized that all their personal advocacies had the central point of mental health – that simply talking about things can already be therapeutic, like medicine. 

What are examples of mental health issues faced by PLHIV?
How can mental health issues affect the programmatic approach to prevent HIV/AIDS?
What strategies may help reduce stigma and discrimination among PLHIV.
How do we move forward?

We had a #HealthXPH tweetchat on this topic last Saturday.  Here are some of the inputs from those who participated:

Yenyen Delgado shares an infographic for healthcare workers. 
Roland talks about testing.

Cocoy mentions reaction to diagnosis.
Shereese talks about careers of PLHIV.

Renier talks about access to services.

Stephanie suggests screening for anxiety and depression among PLHIV.
Chin-chin talks about HIV awareness to reduce stigma.

Miko sends a positive outlook for the Philippine HIV epidemic.
...and with that, we remove the elephant in the house and continue to talk about HIV to improve awareness and attitudes towards PLHIV.

Friday, June 9, 2017

A Month of Trainings, Seminars and Meetings

I realized that there were so many activities, trainings, seminars and meetings for the month of May that I decided to document these here for future use:

Scarlet May

The month of May is dedicated for awareness of cervical cancer prevention, dubbed as Scarlet May.

May 3, 2017.  To knock out cervical cancer, we decorated our hospital lobby like a boxing ring with round 1 (HPV vaccination), round 2 (cervical cancer screening) and round 3 (cancer treatment), with our medical center chief Dr. Gerardo M. Aquino giving the "opening punch"

May 6, 2017.  Lantern Walk with a Glow at SM Seaside.  Parade from the Pedro Calungsod chapel to the Garden Wing of the SM Seaside, where there was a program with a short lecture followed by singing and zumba dancing.

May 14, 2017.  To make good on our advocacy, we trooped to Lapu-lapu City Health Department where we screened more than 800 women for cervical cancer thru visual inspection with acetic acid (VIA) and directly linked to care with cryotherapy for those VIA-positive.  With 12 women dying of cervical cancer every day, it only takes one minute to save a woman's life from cervical cancer.

Research Activities

May 3, 2017.  Research Training for Consultants.  To address a need to improve research capabilities of our consultants, we conducted a day-long training on basic research methods.

For the whole month of May, we conducted research technical reviews for our residents' research proposals.  Trained consultants review and comment to hel

June 1, 2017.  I was invited to participate in the oral defense of undergraduate students of political science at the UP Cebu College of Arts and Sciences.

June 5, 2017.  Department Resident Interesting Case Contest with guest judges Dr. Ronald Capito, Dr. Mary Girlie Veloso and Dr. Nelson Elle. 

First Place: Dr. Maria Floribeth Daraman/Helen Amorin - Basal cell carcinoma of the vulva
Second Place: Dr. Diorelle Malaque/Helen Amorin - A Rare Case of Ovarian Gonadoblastoma
Third Place: Dr. Kristina Plaza/Marilou Viray - A Case of Papillary Serous Cystadenofibroma
Fourth Place: Dr. Justine Galdo/Kristina Dosdos - Intramural pregnancy
Fifth Place: Dr. Genevieve Vista/Helen Madamba - Aspergilloma in Pregnancy

Maternal Death Reviews

May 4, 2017.  POGS Quarterly Morbidity and Mortality Conference and Continuing Medical Education on Asthma in Pregnancy

May 10-11, 2017.  Cebu City Health Department Maternal Death Review at Montebello Villa Hotel

May 19, 2017.  Department of Health Regional Office VII Maternal Death Surveillance Response  at Crowne Regency Guadalupe, Cebu City

May 24, 2017.  The Department of Obstetrics and Gynecology conducts its own monthly Morbidity and Mortality Conference, inviting our friendly consultants and residents from the Department of Internal Medicine to help us with the verbal autopsy of our maternal mortalities.

Advocacy Lectures on HIV/AIDS

May 17, 2017.  Department of Health Regional Office VII Technical Updates on HIV/AIDS and Prevention of Mother to Child Transmission of HIV in Bohol

May 20, 2017.  The Cebu Velez General Hospital conducted a lactation management education training (LMET) and I talked about the issue of prevention of mother to child transmission of HIV in relation to breastfeeding.  Some issues that still need to be addressed is the safety of wet nursing when the donor mother is not tested for HIV.

May 31, 2017.  The VSMMC HACT conducted an HIV Awareness Seminar for VSMMC hospital staff, and I shared about prevention of mother to child transmission of HIV.  My main message that "HIV will end with me" opines the ABCDE to prevent HIV transmission: 

A - abstinence 
B - be faithful 
C - check your HIV status
D - don't do drugs 
E - educate yourself and others about HIV

...and here a bit more of a month worth of a peek into my life as a trainor, mentor, advocate...

Monday, May 29, 2017

Residency Training in a Millenial World

According to the Department of Health Hospital Levels, a level 4 hospital is a teaching and training hospital with clinical services in general medicine, pediatrics, surgery, anesthesia, obstetrics and gynecology, specialized forms of treatment, intensive care and surgical procedures, tertiary clinical laboratory and third level radiology, pharmacy, nursing care for patients needing continuous and specialized critical care.  Our hospital is one such hospital where most district and provincial hospitals, and even local birthing clinics, refer their patients for emergency cesarean deliveries, blood transfusion and/or intensive care.

It is a recurring refrain among district and provincial hospitals that the reason why they continue to refer patients to our tertiary government hospital (level 4) is because of the dirge of specialists like obstetricians and anesthesiologists e.g. to conduct emergency cesarean deliveries.

I recently attended the graduation of medical students at a medical college where I teach.  More than 100 smiling graduates all dressed up with their proud parents and guardians looking on... They will all proceed to internship and take the physician licensure examination (board exams).  Last March 2017, PRC announced that 813 examinees passed the physician licensure examination and are now full-pledged physicians.  Where do these new medical doctors go after passing the board exams?

Some take on the grueling 3-5 years of residency training to become a specialist.  Many apply for jobs abroad. Others prefer the laid back lifestyle of a hospitalist, junior consultant "moonlighting" at different private hospitals. Others work for corporate institutions, occupational doctor for companies and their employees. Others work as cruise ship doctors to enjoy travel while earning a good salary.  A chosen few go into research instead of clinical work.  A handful volunteer as "Doctors to the Barrios" program, serving difficult to reach geographical locations.
During a bi-annual trainors meeting of our specialty society, the problem about dwindling applicants to residency training was raised as an urgent issue.  One consultant gave the explanation that "millenials" nowadays have the YOLO mentality, meaning "you only live once..." hence they opt for career paths other than residency training.  However, for a super-congested level 4 referral tertiary government hospital in the Philippines, the complement of resident physician trainees is the lifeblood of hospital operations.  Without this, patient care and safety will be compromised.
  1. What are the different career paths for new medical doctors?
  2. How does a 3-5 year residency training program appeal to millenials today?
  3. How can we convince new doctors to proceed to residency training?

Saturday, May 6, 2017


If I weren't a doctor, I would have been a social worker.


I am a government employee and proud of it.  My motives for medical training has always been to minister to the sick and the poor, and to maximize application of all the training I have received.

If I were not a doctor, I would have joined a religious order to become a missionary nun, but God led me to a different path, to a different vocation.  

If I were not a doctor, I would have headed west to train further in biochemistry or molecular biology to become a scientist/researcher.  There have been a number of opportunities for me to travel and to train and to work abroad, I would have chosen to work in global public health, but I chose to stay here at home where it is warm, and where I feel I am needed more.

If I were not a doctor, I would have been content to become a farmer, on a plot of land I could call my own where I could teach children in the community to learn to love their culture, their land, their heritage.

With the experience in community development through The Share A Child Movement, Inc - I realize that I when I retire from my medical career, I can be a social worker and continue to advocate for children's rights and devote my time ensuring that poor but deserving children are provided the opportunity to complete their education to break the cycle of poverty.  Maybe I would consider seriously using tri-media and social media to advocate awareness regarding issues that threaten the children's well-being: drug abuse, teenage pregnancy, HIV/AIDS.

For now, I am content being an active obstetrician-gynecologist, a medical educator, a research enthusiast and a social media activist.

Tuesday, April 25, 2017

Parents' Presence on Social Media

The 3rd Healthcare and Social Media Summit was held in Marco Polo Hotel in Cebu City organized by the #HealthXPH in coordination with the DOST-PCHRD.

"The solution to pollution is dilution."  This was the message of keynote speaker Marie O'Conner, who encouraged healthcare professionals to have a presence on social media to support patients' need for proper medical information, considering that patients are now empowered to turn to the internet for support.

In the same manner that healthcare professionals are encouraged to be online because patients are online, parents are encouraged to also have a social media presence because their children are active on social media.  The youth tend to post online their feelings and emotions, and parents should be able to identify signs of depression to determine what help their children need.

There was a post being shared a few weeks back on facebook which read "if your mother has facebook and she doesn't comment in 15 minutes, she owes you PHP1,000..."  This message proves a point that some parents create facebook account to be able to follow their children and remain connected.  Not a bad idea.  In this day and age where everything comes and goes and life passes with dizzying speed, social media is a way to be connected.

Therefore, parents should be on social media because that is where your children are.

Watch out for the next posts on pearls of wisdom about the healthcare social media summit.

Thursday, March 30, 2017

35th Anniversary of The Share A Child Movement Inc

First, I wish to thank everyone for joining us in this our celebration of thirty-five years working for the rights of children in communities.

Thirty-five years ago, my Lola Sising founded The Share A Child Movement Inc to solicit funds from friends and concerned Cebuano benefactors to help keep poor children in school.  Thirty-five years ago, I was only 4 years old.  I was fortunate enough to have a family that cherished me, and who provided me with my basic needs (food, shelter, clothes, a good education, and a little extra luxuries now and then). Unfortunately, not all children in the Philippines are as lucky as I am. Hence, it is the responsibility of those who have been abundantly blessed to share what they have and to do what they can to provide poor but deserving children with opportunities to rise above their beginnings to become morally upright and productive citizens of the world. 

The testimonies of beneficiaries and scholars of Share A Child are proof that thirty five years ago today, Share a Child was the meaningful and needed response to the needs of so many children in Cebu.  That we have changed the lives of thousands of children who have now become upright citizens of the world is a feather in the cap of our founders, and an inspiration for us to keep on doing the work that they began.

When I took over the Share a Child’s leadership three years ago, we were overcome with grief at the passing of Lola Sising, and shortly thereafter, Auntie Nina.  It was a loss that struck us at the very core of our being as an organization and which we continue to mourn today.  But there is a saying that pain refines the soul, and if we allow it to, it can make us stronger.

In a month’s time, we will be closing our ComBat project with CARITAS Switzerland.  Last Saturday, we visited the Community Based Child Protection Network (CBCPN) of San Roque in Talisay, and proudly heard the glowing reports of mothers, private citizens and barangay officials on how our interventions have changed the social landscape of their communities.  Where before there was fear and apathy, there is now vigilant awareness of the rights of children and communities working together to promote and defend it against predatory activity.

We visited the livelihood project in Sitio Panaghiusa, and heard about the neighbourhood group that produces detergents for the use of the local communities and provides retail services in procuring rice for the consumption of the neighbourhood.  With our nudging and support, our partners are going in the right direction here, providing services that will strengthen the bonds among neighbourhood groups and local communities, as well as supplementing the incomes of their members, even as we empower them with the capacity to participate in policy making of local government units.

On a shoestring budget, we accomplished our part in the Child Protect project and in fighting against Commercial Sexual Exploitation of Children (CSEC), a project funded by Terre des Homes. Community-based Child Protection Networks (CBCPNs) now initiate meaningful projects in their own barangays such as hair-cutting activities, advocacy and lobbying with their respecive local government units.

After almost twenty years, the Sugbuanong Pundok Aron Supuon ang Child Abuse (SUPACA) is going stronger than ever.  Organized in 1997, it earned an award as one the Ten Accomplished Youth Organizations (TAYO) of the Philippines in 2004.  Today, we have a presence not only in the schools of Cebu and neighboring cities, but also in the communities that we are serving. We have infused training and capacity building into the new leadership, and the members have been active with advocacy activities in their respective schools and communities.  They say that the youth is the promise of the motherland.  The SUPACA will be at the forefront of making things happen to make this land a kinder, gentler place for the next generation.

We have been through many daunting challenges in the last three years that threatened to wipe us out.  But we have managed to survive, and with strong determination, we will persevere and strive to grow stronger.

The current social environment show that the Share a Child has many more things that need to be done.  The dangers of cyber sex and cyber pornography continues, and will thrive as long as poverty drives families to reduce children to commodities. We have to rise to the challenge of protecting the children in our communities against the menace of drug addiction and the war of extermination being waged by the current administration.  We have to rise to the challenge of encapacitating the youth to participate in planning and policy making to reduce the impact of climate change.

As we face these challenges, Share a Child itself rises to the challenge of transforming itself to a self-sustaining institution, a valuable resource in the fight to protect and promote the rights of children in Cebu.  We have painstakingly reviewed our strategic plans and policy manual, and plan to institute governance improvements in the days to come.  We will strengthen the Board of Trustees by providing for representation of the SUPACA and the Community Based Child Protection Networks, as well as other sectors such as academe, the corporate sector, and civil society. 

And so, even as we face the uncertainties of the future, we remain undaunted, because we are fully assured that we are doing the right thing, and we rely first and foremost on the Providence of a loving Father in heaven, the prayers of our founder and first Executive Director who continue to smile on us from above, and the generous support of our benefactors and partners in this imperfect world of ours.

Allow me to acknowledge the leadership of Dr. Fe Necessario, who despite her advanced age, has stepped in to fill the gap left by Lola Sising.  At the helm of the Board of Trustees, she has steered us through difficult hurdles.  Thank you also to Marlon Mendoza, who as Board Secretary, representing the alumni has so generously, contributed his time and resources to Share a Child. To my uncle,  Francisco Valenzona for his deep insights and humor that often broke the ennui at board meetings. And to the other Board members, Maricel Madamba, and SPO3 Egmedio  Felisan Jr. for their service.

I wish to acknowledge the support of the staff that has persevered with us through this most trying of times.  Thank you all and we wish you a prosperous and productive year in 2017. My God bless us all!

Community-Based Recovery Program for Drug Dependents

I attended a youth forum in our community one day.  The attendees were asked to list down the relevant issues of children and youth in society today.  Different sharing of perspectives and disclosure of personal experiences narrowed the issues to violence and drug dependency leading to sexual abuse resulting to teenage pregnancy and HIV/AIDS.

I come from Cebu, an island in the middle of the Philippine archipelago.  Cebu faces the challenge of dual epidemics of drug abuse and HIV/AIDS.  Based on a recent surveillance study, Cebu City has one of the highest concentrated epidemics of HIV in the Philippines and the main mode of transmission is via intravenous drug use.  This gives us an idea of the burden of the drug problem in our communities.  

Over 7,000 suspected drug users and drug dealers have surrendered in Cebu province since President Rodrigo Duterte was elected on May 9.  President Duterte expressed that Cebu has the highest number of drug dependency rates in the Philippines. With the current war on drugs, thousands have voluntarily surrendered to the government for rehabilitation.  Existing rehabilitation centers can no longer accommodate patients who wish to avail treatment services in public facilities.  Hence, the government turns to the private sector, the civil society organizations and the barangays to create community-based drug rehabilitation and recovery programs which consider intensive phase, relapse prevention and skills training for alternative economic opportunities.

Drug rehabilitation is a complex program that many do not understand. Patients need to be treated holistically.  Healthcare providers can determine which patients would qualify for a community-based rehabilitation program.  With community support, healthcare providers can manage and follow up patients and de-load the need to institutionalize.  There would be a combination of psychological counselling, pharmacotherapy, family development, skills training, and increased advocacy campaigns to improve awareness on drug rehabilitation.  We therefore ask the question: what can we do in our own personal capacity to help rehabilitate and reintegrate these drug dependents into our community?

On June 2017, the Central Visayas Consortium for Health Research and Development will be having its innovation conference and one of the plenary lectures will be on community-based recovery programs, and we’d like to call for collaborators on researches that need to be done on this topic to find solutions to this multi-faceted emerging health issue.  We hope that we can discuss this topic academically to find solutions to this very relevant problem.

T1.  In your view, what is the impact of drug dependence on your community’s health?
T2. What would be the components of a successful community-based drug recovery program?
T3.  What is the role of social media in solving drug dependency problems?