Friday, November 3, 2017

SMOKING left me DADDYless





I remember my brother hiding my dad's rim of Camel cigarettes in every nook and cranny in his innocent attempt to get him to stop smoking.

I remember being asked to light his next cigarette for him from the stove.  Other days he would simply light his next cigarette from the last one.

All his photos at work showed a cigarette between his fingers or between his lips. He added the words "Bitching about" to signs that read "SMOKING is hazardous to your health".

I was in my last year of college when he was diagnosed with stage IV lung cancer.  No surgery. No chemotherapy.  They agreed to radiotherapy due to SVC syndrome, and to alleviate his pain from hip bone mets, liver mets, and brain mets.  I watched him lose weight, unable to walk without assistance, and gnaw his teeth in pain, and have difficulty sleeping at night afraid that he might not wake up in the morning.

I took a leave of absence for a month off college to take care of him.  I would rub his back at night when he would cry out in pain.  I would coach him to breathe and pray when his bones hurt.  That one Monday morning, through his hallucinations, we prayed the rosary and bid our final farewell.  I watched his breathing become labored and his pupils start to dilate. 

It was at that moment when I decided that I never want to feel that helpless ever again.  I decided to take up medicine that year.  My dad will forever be 47 years old.  He never grew old because he died young.  Forever young.

Each milestone we have, we whisper "daddy would have enjoyed this" or "I wish daddy were here..."   I am undoubtedly daddy's girl, but it was his death that brought me and my mom together closer.


Treasure your health.  Stop smoking.  Don't even think about starting.

I started writing this post to share how tobacco changed our lives.  I ended it with tears running down my cheeks.  The pain of losing my dad is as fresh as that morning when I watched him breathe his last.

Friday, October 27, 2017

Online Tools for Teaching


I recently enrolled in a basic course in Health Professionals Education to help me improve how I teach research to medical students.  I learned that medical curriculum has evolved from the traditional classroom type of teaching to problem-based learning, and most recently to outcome-based education.  With the changes in student learning styles, so did teaching strategies evolve especially to include use of new technologies to adjust for maximum learning.
Just like what telemedicine does for healthcare service delivery, online tools can be used to aid teaching.  This will help improve intended learning outcomes through online courses.  It allows us overcome the geographic, economic and opportunity cost of education.  It ensures technical support of seasoned educators from university.  The main limitation would be the availability and accessibility to reliable internet.
Flipping the classroom involves initiating learning online by providing content outside the classroom,.  More time is freed up to reinforce the content.  Blended learning combines online provision of content with face to face classroom instruction.  These are some ways to apply online tools for teaching.  Open Education Database provides a comprehensive list of Web 2.0 Teaching Tools for a variety of functions.  At first glance, this list overwhelms, but it may be confusing as it is exciting.
Costello describes five ways to connect with online students:
  1. Forge a personal connection by providing a picture or video introduction.
  2. Enhance your lessons by integrating video clips and other types of media.
  3. Set realistic expectations for response time.
  4. Encourage your students to connect with each other through meaningful discussions.
  5. Explore interactive communication such as live chats, instant messaging, and online office hours.

Friday, September 29, 2017

Doctors Got Talent

VSMMC MEDICINE WEEK 2017



The celebration of the VSMMC Medicine Week has been one smash hit after another, beginning with the Monday morning flag ceremony and opening of exhibits of each departments' best practices.  OBGYN was assigned the color RED and we had the opportunity for a photo with the Executive Committee.

The Medicine Week 2017 coincided with the birthday celebration of our medical center chief, Dr. Gerardo M. Aquino Jr, whom we greeted with serenade and dance.  There was also a special video made in honor of our chief of ten (10) years.




Considering the importance of research in our residency training, there was a Research Oral Presentation Contest for Residents, and as the training officer of our department, I am proud that three out of ten finalists were OBGYN residents.




Dr. Jalilah Abedin presented her research on Surgical Site Infections (SSI), Dr Cindivy Rupita presented her research on Hepatitis B infection in pregnancy and Dr. Karen Kris Balbosa presented her research on Anemia in Pregnancy.



The whole week we had public health lectures on different relevant topics at the outpatient department.  The VSMMC Department of Obstetrics and Gynecology also had a voluntary blood letting activity for the benefit of the patients entitled "Save a Mother from Hemorrhage" and we thank all 28 donors who braved the rain and squeezed in time to donate despite the highly hectic schedule.

  
The next bloodletting activity will be on March 30, 2018.  

The grand finale of the Medicine Week 2017 was a showcase of the other talents of VSMMC doctors.  Much in the same theme as UP-PGH "Tao Rin Pala", the VSMMC Doctors Got Talent is a great way to show camaraderie and teamwork between consultants and residents and between different departments.



The VSMMC Department of Obstetrics and Gynecology put on a great performance themed "OBGYN Divas" considering their "one night only" practice due to the intensively hectic schedule.

 

Topping off the night was a raffle draw of the Nissan Almeera (which went to a clerk at the information desk, congratulations mam!), a Samsung Galaxy Book (which Dr. Princess Lorezo of OBGYN won) and a smart TV (which Dr. Cindivy Rupita of OBGYN won).

My take on this is that if this will become an annual event, then there must be more planning than just "one night only"



Friday, September 1, 2017

USE OF TECHNOLOGY TO IMPROVE MATERNAL HEALTH



How do we keep our mothers from dying?

Reducing maternal mortality was one of the millennium development goals (MDG) which the Philippines was not able to meet, despite all the government funds allotted for programs and intervention.  In our own local professional society, more than 90% of maternal deaths occur in the overcrowded congested government hospital.  Many of the patients present too late to prevent death. Hypertensive complications and hemorrhage is the most common causes of death. 

In response to the MDGs, the Department of Health (DOH) issued Administrative Order 2008-0029 “Implementing Health Reforms for Rapid Reduction of Maternal and Neonatal Mortality” which provides for several interventions in the Maternal, Newborn, Child Health and Nutrition (MNCHN) program including the Essential Intrapartum and Newborn Care (EINC, also known as Unang Yakap or First Embrace), Lactation Management trainings (LMET), Basic Emergency Obstetric and Neonatal Care (BEmONC) among other programs.  We wonder if any of these efforts are making a dent in improving maternal care.  Health policy groups have studied ten years of Philippine health service delivery and have shown very minimal change in health statistics across all programs.

During a regional conference on research and innovation, we came across the RxBox which contains a blood pressure apparatus, a fetal monitor, maternal tocometer and other functions all rolled into one.  This is expected to empower healthcare workers in hard to reach place with the diagnostic abilities of higher levels of care.  How has this been employed in our communities?

In this era of research, innovation, information communication technology and social media, what other technologies are available which we have not yet maximized to reduce maternal deaths and improve maternal health in your area?

What are the challenges to maternal health in your area?
What technologies are available to improve maternal health?
What is the role of social media in improving maternal health?



Friday, July 21, 2017

MENTAL HEALTH ISSUES AMONG PLHIV


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?