Wednesday, January 16, 2019



This was the latest question on facebook trending nowadays. The instruction being to post the first ever photo on facebook and the latest. This would be my #10yearsapart: 2009 in UP-PGH and 2019 in VSMMC. 

Basically, I am a doctor and public service has been my life. It was Senator Jovito Salonga who once addressed his critics by saying "dibale na kung matanda, basta't may pinagkatandaan..." so age we will, and hopefully we age with grace. 

This is another invitation to reflect on how we've lived our lives. "How did aging hit you?" seems to emphasize that life will keep throwing challenges our way and we just have to make sure that we hit back just as hard. 

  • More than the physical sense (camera quality matters)  this is a good reminder of how we should age by grace.

Thursday, January 10, 2019

Teachers, students and doctors awake past midnight

I messaged doc Remo that I realized it was already past midnight and we were all still awake, talking about program outcomes for Filipino doctors... He said "teachers and students do that, doctors and perpetually awake..."

Makes sense that I am perpetually Sleepless in Cebu... I spend nights doing paperworks, constructing test questions, writing letters and finishing reports, all in the hope of helping our residents and students improve their grades.

I recently celebrated my 41st birthday and realized that I am not getting any younger.  I am now hypertensive and have gained 20 lbs or so since working here.  I have been working in my hospital for five years now and begin to wonder if the efforts we've taken even made any dent.

Are all the frustrations over politics and popularity worth the reasons why I stay?

The graduation speech of Pete Davis about Netflix infinite browsing mode among millenials comes to mind:

Considering that I teach millenials and batang 90s, we need to be reminded about COMMITMENT. We need to pick a movie and see it through to the end. We need to commit to our profession, our community and to our patients.  We need to commit to making an effort to change the world, to make it a better place for our children to live in.

Targetting Enhanced Awareness and Control of HIV in Cebu #TEACHCebu

We spent weeks and months searching our brains for the right hashtag for our HIV advocacy in Cebu.  We were treatment hub staff, social hygiene clinics, government employees, medical student leaders, faculty HIV coordinators, chiefs of hospitals, community-based organizations, and patient support groups.  WHat we had in common was that we were all patient advocates.

We advocate increase HIV knowledge and awareness of HIV as a public health issue relevant enough for discussion.
We advocate normalization of HIV counseling and testing as the gateway to treatment, care, support and prevention of HIV.
We advocate reduction of stigma and discrimination against people living with HIV.

There are a lot of efforts organized to achieve all these things.  There have been a lot of organizations popping up aiming to talk about HIV.  What we need is to unify all these efforts so that we have one concentrated energy towards one health-related goal of ending HIV in Cebu and in the Philippines.

What have we achieved?
We have conducted a caravan of HIV Forums for Medical Students in the six medical schools in Cebu.

Cebu Doctors' University College of Medicine
September 4, 2018

#TOUCHMOVE Think Before You Play was an HIV Forum for Medical Students conducted at the CDU auditorium with the whole population of medical students attending from Level I to Level IV.  September 4, 2018 being a holiday, students were free to participate in the lectures during the morning with an unconference to conclude the morning session, get free HIV counseling and testing from the AIDvocates and Mandaue City Social Hygiene Clinic, then participate in parallel sessions and focused group discussions in the afternoon.  There was also signing of a wall of commitment, infomercial contest and poster-making contest with the theme of targeting enhanced awareness and control of HIV in Cebu.

Southwestern University-PHINMA College of Medicine
September 28, 2018

University of the Visayas Gullas College of Medicine 
September 29, 2018

Cebu Institute of Medicine
October 6, 2018

Matias H Aznar Memorial College of Medicine
October 20, 2018

University of Cebu School of Medicine
October 27, 2018

We are KAAMBAG: together we TEACH... #TEACHCEBU

Tuesday, November 20, 2018

Building Partnerships for Health

What keeps me busy these days is connecting, organizing, and collaborating.  It's not easy to be a people person.  You have to cultivate your patience, tolerance and the skill to make people comfortable.  It's a habit you develop and improve everyday you meet new people.  #HealthXPH has taught me how to be kind to strangers and how to connect with people who are different from you.  Based on the connectivist theory, you learn in the digital age not just within the individual but within and across networks.  Connectivism sees knowledge as a network and learning as a process of pattern recognition.  Every Saturday, we learn how to be gracious and as the participants how their week was, and to introduce yourself and be conscious of one another's mental health.  Through this process, we build communities.
This process of building communities online has taught me how to effectively build communities offline.  You see, I am a government employee and working in a patient-congested tertiary government hospital with a lot of maternal deaths motivated me to organize periodic meetings with stakeholders from referring institutions like provincial and city hospitals.  Initially, we presented our needs and solicited suggestions for improvement and how the stakeholders could help us improve our health service delivery.  From there we proceeded to lay down our cards to become accountable for our performance, where each hospital presented their own accomplishment reports and best practices.  No blaming, no name-calling, but with constructive criticism to help each other improve to reduce maternal mortality.  We all agreed that the apex hospital cannot do it alone, we each should contribute to achieving the same goal of reducing maternal mortality.  Here was a prime example of building partnerships toward one common goal: to reduce maternal mortality.

Last May 2018, the Association of Medical Colleges of the Philippines (APMC) urged each medical school to develop its own HIV program.  This spurred a move to coordinate with HIV coordinators of each medical school to link them to the HIV treatment hubs and social hygiene clinics as well as community-based organizations, to unify the efforts for HIV advocacy campaigns.  This lead to the development of the informal group called #TEACHCebu which stands for "Targeting Enhanced Awareness and Control of HIV in Cebu".

We were able to organize an HIV Forum with free HIV counseling and testing for medical students for each of the six (6) medical schools in Cebu.   By December 1, 2018, we will be launching "KAAMBAG (meaning partnership): together we TEACH..." an HIV Congress for Healthcare Professionals on December 1, 2018 at the Cebu Doctors' University auditorium.  We hope that this is the first of many successful unified efforts to increase HIV awareness among service providers to reduce stigma and discrimination against people living with HIV.

These are just some personal experiences in building partnerships to achieve health-related goals. 

Share experiences of building partnerships and collaborating with other groups for health-related goals.  What are the benefits and challenges of working together toward one health-related goal? What is the role of social media in building partnerships for health?

Monday, September 10, 2018

Enhanced Awareness and Control Program for HIV

It all started in May 2018 when Dr Gruet invited me to attend the AMPC Seminar Workshop on Setting Up HIV Programs for Medical Schools.  The model unit was that of UP PGH system where the UP College of Medicine, their base hospital Philippine General Hospital and the SAGIP HIV treatment hub were all in one geographic location. However, the set up is not the same in Cebu.

In Cebu, there are six (6) medical schools, namely Cebu Doctors' University College of Medicine, Cebu Institute of Medicine, Matias H. Aznar Memorial College of Medicine, Southwestern University-PHINMA College of Medicine, UV Gullas College of Medicine and University of Cebu School of Medicine. We may even expand our reach to the Silliman University Medical School in Dumaguete. The base hospitals are also located separately, and the main HIV treatment hub in the Visayas is located in the Vicente Sotto Memorial Medical Center.

Looking at our strengths, we have highly motivated HIV advocates and a well-connected group of social hygiene clinics.  Hence, our strategy to have all medical students tested for HIV was to conduct a caravan of HIV fora for awareness raising coupled with free HIV counselling and testing. Learning from my experiences with #HealthXPH in engaging stakeholders thru social media, we formed a facebook chat group where one by one passionate faculty HIV coordinators and dynamic student leaders representing each medical school started expressing their ideas and giving suggestions. We all committed to organizing HIV fora for medical students in our respective schools.

The Cebu Doctors' University College of Medicine, led by Accentuating Lives thru Service and Advocacy (ALSA) conducted a highly successful HIV Forum with the theme #TOUCHMOVE "Think Before You Play" where more than 169 medical students underwent HIV counselling and testing. Other scheduled HIV fora include September 21 and 28 for SWU PHINMA, October 13 for CIM, October 20 for MHAM and October 27 for UCMED. We hope that by targetting our medical students, we address misconceptions by improving HIV knowledge and reducing stigna and discrimination against people living with HIV (PLHIV). These soon-to-be doctors will be our frontliners in testing, managing and supporting our PLHIV.

HIV counselling and testing is the gateway to prevention, treatment, care and support. Knowing your status is your responsibility to taking care of your own health. An HIV diagnosis is not a death sentence. HIV should not be a barrier to reaching your dreams of becoming a doctor.  So long as the viral load is undetectable, then the virus becomes untransmissible. The risk is not knowing.

Wednesday, July 11, 2018

Training Activities from January 2018 to June 2018

 Here is a summary of training activities from January to June 2018.

January 3, 2018 – Flag Ceremony sponsored by the Department of Obstetrics and Gynecology

Figure 1 shows consultants and residents prepared for the first flag ceremony for 2018 sponsored by the Department of Obstetrics and Gynecology.

Figure 2 shows picture-taking session with the Executive Committee (EXECOM) members after the flag ceremony and modern dance presentation by the consultants and residents of the Department of Obstetrics and Gynecology

January 5, 2018 – General Assembly and Presentation of Annual Statistics

Stakeholders of the VSMMC Department of Obstetrics and Gynecology were invited to attend the General Assembly and 2017 Annual Statistics Presentation.  Attendees were from the Cebu Provincial Health Office with the Chiefs of Cebu Provincial Hospitals, City Health Offices (Mandaue City, Cebu City and Talisay City) with the Chiefs of the Different City Hospitals, as well as representatives from the Department of Health Regional Office VII.

Figure 3.  Class Picture of Stakeholders attending the Department of Obstetrics and Gynecology General Assembly and Annual Statistics

Figure 4. Department Picture-Taking during the Annual General Assembly

January 18, 2018 - POGS Cebu chapter Residents’ Interesting Case Contest

Two of our residents were included as finalists in the POGS Cebu Residents’ Interesting Case Contest in Chong Hua Mandaue Hospital Conference Room:

Dr Kathleen Faye Llamera / Dr Kristina Dosdos presented a case report of obstructed labor in a Multigravid secondary to vesical calculus, which was also a finalist in the poster presentation at the 2017 DOH Research Congress.

Figure 5.  Consultant co-authors and other co-residents attended the contest to lend moral support to the resident finalists

Dr Genevieve Vista / Dr Helen Madamba presented a case of Pulmonary Aspergilloma in pregnancy, which was also a finalist in the poster presentation at the 2017 PSMID Annual Convention in PICC, Manila

 January 26, 2018 - Visit by POGS Philippine Nationwide Statistics System

According to the PNSS, VSMMC Department of Obstetrics and Gynecology reported one of the highest number of maternal mortality in the country, which warranted a visit from the society to determine ways to reduce maternal mortality and to improve statistics reporting.

Figure 6.  Welcoming Committee for the representatives of the POGS PNSS

February 2, 2018 – Annual Trophoblastic Disease Census

There are several patients admitted under the Department with Gestational Trophoblastic Diseases – from hydatidiform moles to gestational trophoblastic neoplasia, a type of cancer which is highly responsive to chemotherapy.

Figure 7.  Dr Thalia Tubungbanua and Dr Donnah Laizabeth Dones present the 2017 Annual Trophoblastic Diseases Census

February 21, 2018 - POGS Cebu Interesting Case Writing Workshop

To improve research skills of residents in writing case reports and/or case series, POGS Cebu tapped an expert to conduct a workshop on writing interesting case reports and case series at Southwestern University.  First year residents from the Department of Obstetrics and Gynecology participate in the workshop.

Figure 8.  Residents of Different Training Hospitals attend POGS Cebu Interesting Case Writing Workshop

February 26, 2018 – POGS Mock Exams

To simulate the oral diplomate examinations, the POGS Cebu chapter organized unified residents mock oral examinations for senior residents.  Dr Karen Kris Balbosa, Dr Gladys Hojas, Dr Michelle Alcantara and Dr Mhea Lasola participated in these mock oral exams.

Figure 9.  Chair, training officer and senior residents of the Department of Obstetrics and Gynecology participate in the unified resident mock oral examinations

March 1, 2018 – Quarterly Maternal-Perinatal Statistics and Census of Referrals

Stakeholders of the VSMMC Department of Obstetrics and Gynecology grouped together to form the Technical Working Group which aims to reduce maternal mortality and improve the system of referrals.  Talks about a memorandum of agreement was begun, to allow two-way referral between VSMMC and Cebu Provincial Hospitals.  Each referring institution presented their accomplishment reports as well.

Figure 10.  Members of the Technical Working Group for Maternal-Perinatal Statistics during the first quarter maternal-perinatal statistics

April 22-24, 2018 – Department Team Building Activity

During the teambuilding activity, the consultants and residents were divided into four (4) teams:  yellow, pink, blue and green teams.

Figure 11.  Consultants and residents take the day off to engage in team-building activities promoting cooperation, communication and camaraderie.

May 8-9, 2018 - Central Visayas Consortium on Health Research and Development (CVCHRD) Central Visayas Research and Innovation Conference

Two of our residents, Dr Cindivy Rupita and Dr Karen Kris Balbosa represented the Department of Obstetrics and Gynecology and VSMMC during the CVCHRD Central Visayas Research and Innovation Conference last May 8-9, 2018 at the Cebu Normal University.  Dr Cindivy Rupita presented her research on the Association of Adverse Childhood Experiences with Teenage Pregnancy in the infomercial contest, while Dr. Karen Kris Balbosa presented her research on Anemia in Pregnancy as an infographic, which won the Best Infographic Award.

Figure 12.  The Department of Obstetrics and Gynecology represented VSMMC in the CVCHRD Central Visayas Research and Innovation Conference

May 23, 2018 – National VIA Day

As part of the celebration of Scarlet May for cervical cancer awareness campaign, we conducted the National Visual Inspection with Acetic Acid (VIA) Day with lectures, cervical cancer screening with VIA and human papillomavirus (HPV) vaccination of 100 patients.

Figure 13.  Prominent obstetricians grace the National VIA Day celebration of 
VSMMC Department of Obstetrics and Gynecology

May 20, 2018 – Consolacion Mass VIA Screening Activity

Figure 14. Consultants and residents of the department volunteer in the POGS Cebu chapter community outreach activity on VIA cervical cancer screening

June 22, 2018 - Urogynecology Workshop

We were blessed to have with us an expert in Urogynecology and Pelvic Surgery, Dr Geoffrey Que, a medical specialist from Southern Philippines Medical Center (SPMC) to give a lecture and to demonstrate the cystometrogram (CMG) urodynamic studies and surgical missions on patients with pelvic organ prolapse. 

Figure 15.  The consultants and residents 
with Dr Geoffrey Que 

June 29 – Pre-residency Training

The Department welcomed eight (8) applicants for residency training who underwent two weeks of pre-residency rotation at the labor room and in specified service areas.

Figure 16.  Eight (8) pre-residents presented their patients in a case conference

Department-Sponsored Voluntary Bloodletting Activity

Even Williams noted that “Obstetrics is a bloody business!” hence hemorrhage remains a top cause of maternal death.  To address the scarcity of blood units available for emergency life-saving blood transfusion, the Department of Obstetrics and Gynecology organized voluntary bloodletting activities with partners from the community.  From a bi-annual activity, we made it a quarterly activity to enhance collection of blood units for our patients.

Figure 21. Consultants, residents, post-graduate interns and medical interns donate blood to save lives.

This effort was recognized by the Department of Health Regional Office VII and the Department of Obstetrics and Gynecology was awarded the Luis Flores Awared last April 27, 2018 at the Summit Circle, Fuente Osmena, Cebu City.


Figure 22.  The Department of Obstetrics and Gynecology was awarde a certificate and a plaque of appreciation for the voluntary bloodletting activities organized.