Impact of social media on children, adolescents and families

The harsh realities of Filipino children today include the risk of being exposed to cyberpornography and even cyberbullying.  This leads to low self-esteem that leads to dependency, which when left unaddressed make them vulnerable to sexual abuse, teenage pregnancy, illicit drug use, HIV infection and a gamut of other problems.

The advances of technology these days allow commerce to be done online with far-reaching audiences and social markets. 

Unfortunately, children in the third world countries such as the Philippines, are being exploited through this same technology.  Webcam sex tourism is a newly coined term describing how pedophiles and sex offenders virtually rape children in their own homes. 

Sweetie is a virtual 10 year old Filipina girl created by the Terre des Hommes Netherlands to trap pedophiles around the globe.

Research shows that there are 750,000 predators online at any one time.  Groups enjoin Filipinos to sign petitions to government to deliver a strong statement against Filipino children being victimized through webcam sex tourism.

A number of researches have been done to study the effect of internet use, social networking and social media on children.  Over 60% of 13-17 year olds have at least one profile on a social networking site, many spending more than 2 hours per day on social networking sites.  Majority of teenagers have cell phones.  Some use them for social media and instant messaging, and half of the population use them for texting. 

Parents are the primary protectors of their children.  They should become aware of the nature of social media sites, and provide regulation and guidance to their children when navigating the internet. 

"There are frequent online expressions of offline behaviours such as bullying, clique forming, and sexual experimentation that have introduced problems such as cyberbullying, privacy issues and sexting.”
“Cyberbullying is a potent form of strain that may be related to involvement in school problems and delinquent behaviour offline.”

Studies in the US have linked problematic internet usage with moderate to severe depression.

Looking on the bright side, although there is still a lot that the Philippine government needs to learn to be able to enforce laws and policies that protect children’s rights online, efforts have been taken to create special bodies to address these issues.  In the Central Visayas, the head of the Interagency Council against Trafficking (IACAT-7 VAWC) Senior Prosecutor Fernando Gubalane, announced that we’ve counted 16 convictions for trafficking in persons for 2015.  Many of these cases involved victims who were minors.

Last December 1 and 2, 2015, the Ako Para Sa Bata (I am for the Child) International Conference at Marco Polo Hotel in Cebu showcased best practices in advocacies to protect the Filipino child.  Nearly 1,000 delegates from government agencies, academe and non-government organizations were in attendance.  

Mulat Pinoy shared that youth advocates are given an opportunity to become journalistic writers on burning issues, and that children are given a chance to air the views in a creative way that makes a positive impact on children’s involvement in social media.  They believe that young people can learn to use social media for good.  As youth reporters, they are able to communicate with people and friends from far-away places.  The internet becomes a good source of information.  Social media creates opportunities for growth and development and with proper coordination they can achieve a lot.  This also allows transmitting youth messages to a broader audience.

The Role of Social Media in Child Participation Rights

THE ROLE OF SOCIAL MEDIA IN CHILD PARTICIPATION RIGHTS

November has been declared as National Children's Month!  The Passage of Repulic Act No. 10661, a consolidation of House Bill 1641 and Senate Bill 332, declared November of every year as National Children's Month.  It was approved by President Benigno S. Aquino III on May 29, 2015.

1. The rights.  

In 1989, governments worldwide adopted the United Nations Convention on the Rights of the Child, also known as the CRC or UNCRC.  This convention has changed the way children are treated - as human beings with a distinct set of rights.  UNICEF has published a child-friendly summary of these rights.  Article 12 reads that "Every child has the right to have a say in all matters affecting them, and to have their views taken seriously". 

In Cebu, The Share A Child Movement Inc has worked with child rights advocates on room-to-room campaigns in schools to spread awareness on the right of the child.  There are many other child-centered NGOs in the Philippines, advocating not only for child rights protection but also for child involvement in governance.

2. The real situation.  

There are a lot of stories from news articles that abound regarding violations of the inherent rights of the child. There are reports about children videotaped performing indecent acts. Some articles discuss facts on human trafficking in the Philippines.  There have been success stories about Cebu bar owners convicted for qualified trafficking of minors for sex. However, sexual abuse has moved to a different environment, as sex offenders are now online engaged in webcam sex tourism.  Sweetie, is a 10-year old virtual Filipina girl who posed on video chatrooms to entrap pedophiles and sex predators across the globe. This kind of crime "requires a new way of policing". 

Child trafficking is real in the Philippines. Many crimes go unreported because victims lack information on human trafficking, crimes are concealed by victims and violators, or families of victims accept the situation as normal.

3.  Prevention is key.  

The Church also participates in National Children's Month.  This year’s National Children’s Month focuses on child participation rights, with the theme “Bata, Kasali ka, Ikaw ay Mahalaga!" (Child, you are included, you are precious!) It aims to highlight the right of the children to express their views, to be heard, and to actively participate in matters that affect them.

4.  How do children actively participate in matters that affect them?

The major events and activities for National Children's Month Celebration include zumbata, discussion on violence against children, story books for children and talent showcase of children.

For the government, the theme for this year is “Komunidad at Pamahalaan Magkaisa, ang-aabuso sa Bata, Wakasan Na!” (Community and Government unite to end child abuse!) which highlights protection from all forms of violence, abuse, neglect, exploitation and discrimination and to encourage stakeholders to promote as well as advocate protection of children at the family, schools, community, institution, organization and other settings.

Share you own ideas on how to promote children's rights and prevent child abuse. 


In what ways can children be involved in decision-making on matters that affect them?
What challenges that hinder children from claiming their rights?
What is the role of social media in promoting child participation rights?

Public Health Policy versus Individual Patient Rights: Addressing the Philippine HIV Epidemic

According to the Department of Health (DOH) National Epidemiology Center (NEC) AIDS Registry, one Filipino is newly diagnosed with human immunodeficiency virus (HIV) infection every hour.

I was chatting face to face with Dr. Ted Herbosa and Dr. Narciso Tapia last week, and a sort of debate on how we should address the growing HIV epidemic lead me to re-thinking my perception of the problem, and to explore the different possible strategies to address the problem. One view is that of a public health policymaker, where the welfare of the public is of foremost concern.  In an epidemic, what needs to be done to control an infection is identification of cases and contact tracing.  In the Philippines, we have a number of HIV advocates whose priority is the protection of individual patient rights to privacy and confidentiality, lobbying for laws to improve counselling and testing, HIV risk reduction and stigma reduction and improvement of access to health service delivery and support.  Do these hinder control and elimination of the HIV infection in our country?

Previously described as “low and slow”, the HIV epidemic in the Philippines has now been described as “fast and furious” - and we need to do something about it!

Question 1. What public health policies do we currently have to address the HIV Epidemic in the Philippines?  In the Philippines we have the AIDS law, formally known as the Republic Act 8504, The Philippine AIDS Prevention and Control Act of 1998.

On HIV testing, the AIDS law requires that the patient to be tested for HIV give informed consent, and that this is voluntary and cannot lawfully be mandatory.  In simple terms, nobody can be forced to undergo HIV testing.

“SEC. 15. Consent as a Requisite for HIV Testing – No compulsory HIV testing shall be allowed. However, the State shall encourage voluntary testing for individuals with a high risk for contracting HIV; Provided, That written informed consent must first be obtained. Such consent shall be obtained from the person concerned if he/she is of legal age or from the parents or legal guardian in the case of a minor or a mentally incapacitated individual.”

Medical practitioners and healthcare professionals are bound to maintain confidentiality on the identity and status of persons with HIV.  This therefore prohibits the healthcare professional from disclosing to anyone (even the patient’s sexual partner) the HIV status of the patient.

“SEC. 30. Medical Confidentiality - All health professionals, medical instructors, workers, employers, recruitment agencies, insurance companies, data encoders, and other custodians of any medical record, file, data, or test results are directed to strictly observe confidentiality in the handling of all medical information, particularly the identity and status of persons with HIV.

Although healthcare professionals themselves cannot disclose the HIV status of their HIV-positive patient, the law encourages contact tracing, provided it is the patient who decides to disclose to his/her partner:

“Section 29.  Contact Tracing.  HIV/AIDS contact tracing and all other related health intelligence activities may be pursued by the Department of Health: Provided, That these do not run counter to the general purpose of this Act.”

Section 34 of Republic Act 8504 on Disclosure to Sexual Partners reads:

“Any person with HIV is obliged to disclose his/her HIV status and health condition to his/her spouse or sexual partner at the earliest opportune time.”

The DOH issued  Administrative Order 2009-0016 on Policies and Guidelines on Prevention of Mother to Child Transmission (PMTCT) of Human Immunodeficiency Virus (HIV).  Under Article VI Section 4 of this administrative order on Components of PMTCT on HIV Counseling and Testing, it reads:

“all partners of women infected with HIV shall be offered HIV counselling and testing.”

Question 2: How does one get HIV in the first place?

1. First, through unprotected penetrative sexual intercourse: commercial sex workers with low rates of condom use; increasing rates of casual sex among young adolescents (e.g. call center agents)

2. Transfusion of HIV-infected blood through IV drug use or blood transfusion:  The incidence of HIV infection through needle sharing in 2010 was relatively fewer in comparison to some Asian countries. A cited reason for this is the small population of people who inject drugs (PWID) in the country (Farr & Wilson, 2010), but recently an explosive rise in HIV was noted among injection drug users in Cebu.

3. From HIV-infected mother to her unborn child.  Anti-retroviral prophylaxis is a mainstay for preventing mother to child transmission.  However, there may be merits for Plan B+ also known as test-and-treat regardless of CD4 count and WHO stage of HIV infection.

Question 3: Why is there stigma and discrimination among people living with HIV?

The risk factors for acquiring HIV infection stem from high risk behaviors that are still considered taboo, such as promiscuity, casual sex or having multiple sexual partners increase the risk for acquiring HIV.  Males who have sex with males have an increased risk of HIV transmission.  Commercial sex work involves having sexual intercourse with individuals of unknown HIV status, most with low condom use. Illegal drug use is a crime punishable by law, hence re-use of needles possibly infected with HIV predispose IV drug users in acquiring the infection.

Question 4: What would be the implications of allowing HIV-positive patients confidentiality of their status which prohibits effective contact tracing?

Are there enforceable policies that can  require HIV-positive patients to change their behavior to reduce risk of transmitting the HIV infection? Counsellors and medical practitioners need to appeal to their sense of justice and benevolence.  Not allowing doctors to trace the contacts of their HIV-positive patients prevents them from advising these contacts to get tested and treated.

For instance, pregnancy is an evidence of unprotected penetrative sexual intercourse.  Many of these patients referred to us have not disclosed to the father of their child that they are HIV-positive.  The harm posed to the possibly HIV-negative sexual partner is evident since a woman can only get pregnant through unprotected penetrative sexual intercourse.  However, they fear that in disclosing to their partners, they would be thrown out on the streets with nobody to support them throughout their pregnancy.

• One such patient kept asking “kung iwanan niya ako, pano kami kakain? Saan kami titira ng mga anak ko? Saan ako kukuha ng pang-gastos ng CS ko? Paano ako bibili ng gatas ng anak ko? Anong trabaho ang pwede ko gawin eh hindi naman ako nakatapos ng pag-aaral…” (if he leaves me, how will we eat? Where will we live? Where will we get budget for my caesarean delivery? How will I buy milk formula for my baby? What work can I find when I did not finish school?)

• One HIV patient admitted that she was liberated when it came to sex, and that’s how she got infected. We were trying to convince her to disclose her HIV status to her current partner so that he could be tested as well.  She answered “bakit, sila ba naawa sa akin nung hinawahan nila ako ng HIV?” (why, did they have pity on me when they infected me with HIV?)

Non-disclosure of HIV-positive status puts people at risk for getting HIV infection.  You prevent the natural ability of the public to protect itself from acquiring the HIV infection.

Question 5: What about moves to provide needle exchange programs, condom use and pre-exposure prophylaxis?

The common view about these interventions are that these are band-aide therapies, with the risk of reinforcing high risk behaviors like IV drug use and sexual intercourse among patients already positive with HIV instead of addressing the root cause of the problem, which is drug addiction and high risk sexual behaviors.

Needle Exchange Program.  The NEP, properly understood and operated, does not contradict the goal of treatment. Research has shown that NEPs, aside from being preventive to HIV transmission, is also an effective conduit to treatment programs and other health services (Geffray, Schiray, Fabre, & Guilhem, 2002).

Pre-exposure Prophylaxis.  Just like diabetics say “I can eat cake and icecream, anyway there’s medicine to reduce my blood sugar…”  Pre-exposure prophylaxis does not address risk reduction, but allows HIV-positive patients to continue having risky sexual behaviors, after all, “there is medication for my partner anyway…”

Privilege should come with responsibility.  If HIV advocates demand that they be protected by law and afforded privacy and confidentiality regarding their status so that they can continue to be productive and self-sufficient working citizens, then they should be required to at least 1) get appropriate treatment that they need, 2) inform their own contacts to get those people tested and treated as well.

What needs to be done?  Support should be provided for these patients to be able to openly disclose their status 1) to their sexual partners on whom they are fully dependent financially, emotionally and spiritually and 2) to drug addicts to be rehabilitated to prevent addictive IV drug use which predisposes to HIV transmission from use of infected needles and syringes 3) increase awareness and acceptance of HIV counselling and testing, especially among high risk groups.

Children-centered DRRM

                        Role of Technology in Children-centered Disaster Risk Reduction Management

This week, I attended a meeting with a group of NGOs involved in child rights advocacy in Cebu to talk about children and their role in disaster risk reduction management (DRRM).

In 2005 UNICEF committed to the Hyogo Framework for Action with five priority areas.  UNICEF’s DRR goals include: (1) DRR for children and women is a national and local priority, (2) different risks faced by girls, boys and women are identified and addressed, (3) safer and more resilient conditions for girls, boys and women, and (4) strengthened humanitarian preparedness, response and recovery through capacity development.  UNICEF stresses that children have an inalienable right to participate in decisions that ultimately affect them.

The scholars and child rights advocates of The Share A Child Movement Inc go room to room campaigning for children to know and protect their rights.  Imagine what they can accomplish advocating for disaster preparedness, risk reduction and mitigating climate change.

A2D’s work on inclusive DRR with UNICEF brought them to Haiyan affected areas in North Cebu where they capacitated the children with trainings, seminars and workshops.  The very first DRR youth camp in northern Cebu was conducted last May 2015. The community also participated during the Earth Hour for the very first time.

Save the Children is lobbying to support the passage of the ‘Children’s Emergency Relief & Protection Act’ House Bill 5285 and Senate Bills 2446, 2448, 2466, 2487, 2502 & 2718, which aims to increase protection for the child during emergencies when the child is most vulnerable.

Even the Cebu Provincial government seeks to support child-centered DRRM with capacity-building activities empowering children.

Many NGOs recognize the children as valuable advocates for rights.  They can be valuable advocates in caring for the environment and for the protection of vulnerable populations such as pregnant women and children, the disabled and handicapped, and the elderly as well.  They have the capacity to identify hazards and risks in their schools, homes and communities.  During times of disaster and calamities, they can be easily mobilized as leaders to ensure early evacuation as needed and proper coordination with authorities for rescue.

Children are more and more into technology and social media. How can we direct this positive energy to get the vulnerable population involved in protecting themselves and others during natural disasters and calamities so that the death toll during events like Yolanda would be brought to a minimum.

As the former Senator Nino Aquino once said “the Filipino is worth dying for…” let us hope that during times of natural disasters and calamities, we are prepared enough to be able to say “the Filipino is worth living for…”

BEDSIDE MANNERS OF E.R. DOCTORS

BEDSIDE MANNERS OF E.R. DOCTORS 

Tonight's #HealthXPH tweetchat topic drew its inspiration from an article published in MindanaoTimes which went viral on facebook because the journalist lambasted resident doctors for being fake doctors, simply because of their lack of bedside manners.

Dr. Tony Leachon reminds us to be always on our toes.  Patients nowadays don't trust as easily as before.  Doctors need to earn their patient's trust, and good bedside manners, showing empathy and and expressing compassion are ways to build rapport, alleviate anxiety, give comfort and earn patient's trust.

With patients becoming empowered, they turn to social media with their negative healthcare experiences.  This is a two-edged sword as it could destroy a healthcare professional's reputation or it could provide much needed feedback for healthcare providers to step up their performance.   This was out topic during the #HealthXPH tweetchat last week (July 18, 2015).  This reminds doctors to be vigilant on how they treat their patients regardless of whatever they are going through at that moment in time.

Emma Wilkinson offers tips on how to improve your bedside manner: 
#1 Focus.
#2 Really Listen.
#3 Ensure Privacy.
#4 Be Observant.
#5 Strike the Right Pose.
#6 Don't Judge.
#7 Use Open Questions.
#8 Offer Reassurance.
#9 Choose Words Carefully.
#10 Stay in Control.

Dr. Edgar Lerma shared this article where Leonard Feldman of Johns Hopkins University School of Medicine pointed out that basic things make a difference in patient outcomes. Etiquette-based communication include: introducing oneself, explaining one's role in the patient's care, touching the patient, asking open-ended questions such as "How are you feeling today?" and sitting down with the patient.  Maybe I should see if my own residents and interns also fail to do these things, because we don't do these during our grand bedside rounds.  Learning something new everyday, this should also be a reminder to me, to extend compassion to our patients while teaching our students  the science of medicine, we should not forget the art of medicine as well.

My take is on how we were trained in Basic Life Support (BLS), that the very first step would always to tap the patient on the should and ask "hey hey hey are you okay?" - this written and memorized script shows that the priority is ascertaining first of all if the patient is stable enough to respond, and second, to determine how the patient is doing.  In all patient encounters, simply asking a patient whether he or she is okay focuses on the patient and expresses the healthcare provider's concern over the patient's welfare.  At the emergency room where the situation is quite chaotic, simple supportive touches, attentive focused listening and sincere reassurance that everything will be done for the patient are enough to alleviate anxiety and comfort.

And now, the next project for me is to learn about Storify from Marie Ennis-Conner @JBBC like she did for our latest tweetchat.  Thanks for sharing!  Join our next #HealthXPH tweetchat Saturday 9PM Mla / 9AM EST!


Dr Helen V. Madamba, working on my bedside manners

THE SHARE A CHILD MOVEMENT INC: a legacy of child empowerment

THE SHARE A CHILD MOVEMENT INC: a legacy of child empowerment

The Share A Child Movement Inc is a Cebu-based non-government organization started by my grandmother Atty Esperanza "Lola Sising" Valenzona back in the 80s.  

At that time, she visited the juvenile delinquents at the Bagong Buhay Rehabilitation Center (BBRC) city jail where she and other lady lawyers would conduct literacy classes for the youths.  They instituted a lot of reforms including separation of adult inmates from juvenile delinquents so that there may be true rehabilitation. Wanting to find a way to prevent children from ending up in jail in the first place, Atty. Valenzona solicited funds from her friends, co-workers and benefactors to provide financial assistance to keep poor but deserving children in school.  This was where The Share A Child Movement Inc was born.

The Share A Child Movement Inc (TSACMI) has been in existence for the past 33 years and has gone a long way from the one-woman operation by our founder Atty. Esperanza G. Valenzona to a 20-employee organization, with most staff doing advocacy and community development work. 

Our advocacy work aims to empower communities to prevent child trafficking, the worst kind of child sexual abuse. With projects supported by the Caritas Switzerland and Terre des Hommes, the strategy of training, advocacy and organizing (TAO) is done in partnership with the local government units at the barangay levels in the municipality of Consolacion, Mandaue City, Cebu City and Talisay City.  Community-based children protection networks were organized into proactive engaged groups to identify, reeport and refer suspicious cases to authorities.

Cebu was identified as a hotspot for child traffickers and pedophilia.  

The Share A Child Movement Inc was mentioned in local news dailies today as one of the partners of the international organization Terre des Hommes fighting to protect Filipino children from sexual abuse.

TSACMI aims to empower children and youth to become productive citizens of the world primarily by providing educational assistance to poor but deserving children to help them break the cycle of poverty.

Based on available records since 1993, TSACMI has helped keep 1051 scholars in school, many of them now successful professionals.  In 2014, a year of transition and necessary changes for our organization, we provided educational assistance for 110 existing scholars from poor barangays of Cebu City. During our recognition ceremonies last April 6, 2015, we had 5 graduates from college and vocational school, 19 graduates from high school and elementary school, 5 of them with honors. We also had fifty two (52) children moving up from our Balay Bata Daycare Center, ready to be mainstreamed into formal educational system.

SCARLET MAY 2015 in Cebu, Philippines

SCARLET MAY 2015

Lantern walk to help promote awareness on cervical cancer prevention last May 2, 2015. 

This activity was spearheaded by the Department of Obstetrics and Gynecology of the Vicente Sotto Memorial Medical Center under the able leadership of Dr Belinda Panares and Dr Helen Amorin, participated in by VSMMC employees, POGS Cebu Chapter members, the provincial health office, the city health office and by several Cebu-based non-government organizations (NGOs), foundations and people's organizations.

The walk from Fuente Osmena circle to the Provincial Capitol was followed by the symbolic lighting of the Provincial Capitol building which would be "red" for the whole month to signify support to the cervical cancer prevention cause.

The program ended with Zumba-all-you-can where our OBGYN consultants danced to the beat of face-paced and energetic music.

On May 4, 2015 after the flag ceremony, the Scarlet May celebrations were officially opened with Ribbon-Cutting of the Exhibit at the lobby of the Vicente Sotto Memorial Medical Center with the Medical Center Chief Dr Gerardo Aquino Jr and Chief of Clinics Dr. Roque Antonio Paradela, doing the honors.

Guiness Book of World Records Mass Screening for Cervical Cancer at the Cebu City Central Elementary School last May 9, 2015.

We were able to beat the existing record for the most number of women screened for cervical cancer, set by India.  We were able to successfully screen 808 Filipino women for cervical cancer through visual inspection with acetic acid (VIA).

Daily "pulong" health education classes at the VSMMC outpatient department on cervical cancer prevention, screening and treatment.

Month-long free papsmear and visual inspection with acetic acid (VIA) at the Vicente Sotto Memorial Medical Center and Community-based papsmear missions sponsored by the Ramon Aboitiz Foundation Inc.

Residents of the Department of Obstetrics and Gynecology offered daily free papsmear for the first week and free visual inspection with acetic acid linked with treatment with cryotherapy - known as the single visit approach for the rest of the month of May to patients from all walks of life.

Continuing Medical Education (CME) Workshop on Cryotherapy was conducted at the VSMMC Auditorium last May 27, 2015, sponsored by the Philippine Society of Cervical Pathology and Colposcopy (PSCPC) with Dr. Jericho Thaddeus Luna, Dr. Ana Dy Echo and Dr. Renee Sicam.

Dr. Luna in a photo opportunity with the training officer and the residents of the VSMMC Department of Obstetrics and Gynecology.

On May 28, 2015, the Vicente Sotto Memorial Medical Center Department of Obstetrics and Gynecology Staff Conference on Fertility Sparing Surgery for Early Stage Cervical Cancer was presented by Dr. Christine Rose Nonan and discussed by Dr. Sola Viste.  Invited special guest reactors include our supporter and advocate Mr. Ronaldo Delos Reyes from the Ramon Aboitiz Foundation Inc and our idol, champion and mentor Dr. Cecilia Llave, the chair of the Cervical Cancer Prevention Network (CECAP) and the first lady chair of the Cancer Institute at UP Manila.

Active staff of the department attended.

Consultants and residents of the VSMMC Department of OBGYN

Insights include that the patient was one lucky lady because the cervical cancer was detected early enough to preserve her fertility, not just to extend her life but to give forth life.  It was also stressed that no woman should die from cervical cancer, and that it only takes one minute to save a woman's life for cervical cancer. 

The month-long celebrations of the Scarlet May 2015 for Cervical Cancer Prevention was culminated with a lecture on Cervical Cancer by Dr. Cecilia Llave at the CIM auditorium, organized by the Philippine Obstetrical and Gynecological Society Inc (POGS) Cebu Chapter.

Congratulations to the VSMMC Department of Obstetrics and Gynecology particularly to Dr Helen Amorin, to the POGS, to our friends from the EJACC (Ramon Aboitiz Foundation), She Matters and the Cebu City government and the Provincial Health Office for a very successful Scarlet May celebration!

DOCTORS SHARE BOTH THEIR PATIENT'S JOYS AND PAINS

DOCTORS SHARE BOTH THEIR PATIENT'S JOYS AND PAINS

I was called to scrub in to the OR of a difficult infected case - to evaluate whether we could save a uterus or proceed with pelvic clean up.  With both fallopian tubes removed due to a previous ectopic pregnancy and now due to a tubo-ovarian abscess, we conserved the uterus so that our patient might still try to get pregnant through in-vitro fertilization (IVF), an artificial reproductive technique. Highly desirous of pregnancy, definitely, post-operatively we will have to deal with issues of infertility.  A lot of psychological and emotional issues go with infertility.

As I passed by our jampacked PACU, I met a guy lovingly holding a baby in his arms. Obviously his newborn baby, I joked that he should remove his shirt for skin to skin contact, to comply to the essential intrapartum and newborn care program. The nurses informed me that the mother is being prepared for transfer to the wards, and the baby was entrusted to the father for safety reasons.  He couldn't keep his smile from his face, pure joy reflected in his eyes.  Even the mother seemed happy despite her obviously tired state.

Such is the life of a doctor. We share in our patients' pain of loss and grief. We try our best to comfort those who suffer. We sacrifice sleep, rest and physical comforts to make sure our patients live. It is when we see our patients smiling that we feel affirmed in our work. It is when our patients pray for us that we know we are doing the right thing.

#HAWMC Day 12: Day of Rest

#HAWMC Day 12: Day of Rest

I have a number of blog posts piled up to be written and published, mainly because I was out of town somewhere in Dumaguete City where there was erratic internet access.  I thought it would be sort of a vacation, sight-seeing and putting my feet up to rest.  Unfortunately, work seems to catch up with me wherever I go.  

Mark, a colleague at the conference, asked me "what do you enjoy doing in your spare time?"... I stared at him, flabbergasted.  I had no answer to his question.  He laughed and added "so, do you have spare time?" and it was then that I realized that I am a workaholic.  I tend to accumulate all these activities that I want to jampack into 24 hours of a day.  There is so much I want to do in my life yet, it's like I might run out of time.  Carpe diem seems not able to capture the way I've led my life.  It's not even sufficient to suck the marrow out of life - there seems to be a restlessness in me that will not rest until some unknown goal is achieved.

Fortunately, I am able to enjoy the scenery and it is these sights that relax me the most:

Whether it is sitting on a beach, enjoying the sand, sun, wind and sky...

Or driving down country roads and exploring new places, beholding the beauty of the Philippines. Have you ever seen such blue like that?

Or cherishing the rare times I can arise with the sun, kissing the sea across the horizon... simply thanking God for a new chance at life and for giving us all these bounteous blessings.

There is beauty in a new day.  There is hope for the future.  So long as I wake with my beautiful roses blooming, I am happy.

Helen Madamba, traveller, happy with nature, pretty little rosebud.

#HAWMC Day 11: Pet Pal

#HAWMC Day 11: Pet Pal

I consider myself a dog person, and one memorable dog I had before was Trixie.  She was originally named by my auntie Annie as Patrixia Procorpia - "Trixie" for short.  She was the offspring of my auntie Nina's spaniel Lady and my auntie Rissa's Japanese spitz White Fang, so you'd imagine a short blond dog with white whiskers on her ears.  

Trixie was a faithful dog.  Throughout high school, she would sleep with me in bed.  I didn't really mind the dog hairs, but I had to be sure to bathe her before bedtime.  I was lonely in high school. Trixie kept me company.  There were times I would come home in tears, I would lock myself up in my bedroom and blast Miss Saigon on my earphones.  Trixie would lay down her paws on my chest, seemingly saying "it'll be alright, I'm here..."  Trixie was my faithful dog.

When I went off to college in Laguna, I had to leave home and board with a family.  I would come home on weekends and Trixie would be all excited to see me.  Because of the demands of college life, I would come home less and less.

I remember being the only one in our block to have a cellphone at that time - that big radio-like receiver with the long antennae.  It was using that phone that my dad called me one time.  My mom told him to be direct and to keep his message short, so he said "Helen, I need your blood!" -  what a shock that was, so I dropped everything and hurried home.  It turned out my dad was diagnosed with lung cancer and needed blood transfusion for severe anemia.  Even Trixie seemed depressed.  She was no longer trailing behind me, but was following dad wherever he went.  Nine months after diagnosis, my dad died quietly in the master bedroom of our house.  Everything seemed pretty quiet at home after that. Everybody felt at peace that dad was no longer in any pain. 

However, Trixie would not be consoled.  She kept staying in the garden outside the window of dad's room.  She kept digging among the plants until she made for herself a comfortable nook of earth.  It was about two weeks after dad's funeral that I found Trixie there, in perpetual slumber.  Trixie had found a way to follow after my dad.  Trixie had become my dad's pet dog.

Helen Madamba, dog lover.  In remembrance of Trixie.

#HAWMC Day 10: Comfort Food

#HAWMC Day 10: Comfort Food

Disclosure: I don’t cook.  I used to cook our simple inexpensive meals back in college to economize, but after that I realize that I am too absent-minded or too preoccupied to pay attention to cooking.  One time I set out to boil an egg, I left it cooking on the stove thinking that it’ll be done in 10 minutes.  So I left to do something else.  When I came back, the kitchen smelled of soot and smoke and burnt egg.  The pan looked like a dry charcoal-grill and I resolved never to cook again, for the safety of my family – both from fire hazards and from carcinogens found in burnt food.

One time I remember joining the summer camp in Badian, Cebu, organized by the Cebu City Taskforce on Street children.  I love soup, so I volunteered to cook one dish – to make Chinese oriental egg drop nido soup from scratch, so that the kids would know what “fine dining” tastes like.  It turned out ok since I put in my full attention so that we don’t waste the ingredients.  It was really good, if I might say so myself – one of my rare culinary achievements!  I proudly scooped up the soup into the kid’s bowls as they lined up for their share of dinner.  To my horror, they crinkled their noses, took a teeny weeny sip then poured the soup into the “lamaw” (left over scraps for pigs) bin… so that’s that.  I vowed never to volunteer to cook for streetkids again.

So we’re supposed to talk about comfort food.  My primary comfort food is sashimi and other Japanese cuisine – it’s healthy and yummy and fresh, and NOT “bawal” (prohibited) according to whatever diet I am on… I don't know technically how to prepare sashimi, but it seems easy to prepare because you can buy a slab of fresh or frozen salmon from your friendly grocery store, bring it home with wasabi and kikoman, cut into strips and enjoy! Good thing that Japanese restaurants abound also so that when I don’t feel like tinkering in the kitchen, I can just order it like fast food…

Helen Madamba, sashimi lover.

#HAWMC Day 9: Challenger

#HAWMC Day 9: Challenger

Overcoming a daunting challenge

If I had to choose among all the things I’ve gone through which I would never want to go through ever again, it would be first year residency training.

1.      

1. Blind obedience.  We were expected to behave like foot soldiers, nay slaves!  You are lower than the scum of the earth.  You are expected to follow orders with complaint and without question.  The words “wala po” (there is none) and “hindi po” (no) were erased from our vocabulary and replaced by “gagawan ko po ng paraan” (I will make a way) and “yes mam”.  If your senior issued you an order, follow it first before you ask questions.
2. Physical exhaustion.  In my eyes, first year residents must be super humans to survive extreme physical trials: functioning several days without sleep; learning to eat whatever food bites you can get your hands on in secret hiding places like even the toilet; walking around the hospital like zombies running on autopilot; being dead to the world enough not to feel it when robo-rat nibbles on your chocolate-smeared finger; learning to beg for blood at the blood bank for your patient utilizing all your God-given drama talents, or worse donating your own blood even if you’re post-duty just so your senior would agree to send you home…
3.  Emotional abuse.  Always being absent in family gatherings and having to endure the many sermons and public humiliations because you have not been able to perform to expectations.  I never got to see my mom and brothers, been out of circulation from my social life.  I would cry almost everyday because of the oppression.  You don’t eat so you lose weight.  You lose weight drastically, so much so that your parents wonder if you have tuberculosis or uncontrolled diabetes mellitus.  Suddenly, you need to buy a belt to keep your pants up and you hurry by Pedro Gil to choose from the wares of the street vendors because you never catch Robinson’s department store open. You suddenly get whiter from lack of exposure from the sun – you leave the house before the sun rises and drag yourself home long after the sun has set.  Several times you wish you could quit, but realize that your batchmates would have it so much more difficult if you leave.
4. Heirarchy of Needs.  As a first year resident, you are bottom rung.  Even if the second years are only one year ahead of you in training, you are still inferior to them hence you need to follow what they say.  The second years answer to the third years and the third years answer to the fourth years and the most senior answer to the chief resident and the consultants.  The buck stops with you though.  If there is anyone to blame, blame the first year.  You are taught to just bow down your head and accept.
5.  Forced donation.  When your patient does not have money and she needs a mechanical ventilator to breathe, automatically your batchmate collects your atm cards to withdraw money for the downpayment.  Thankful that you have salary, because a big chunk of it pays for whatever the patient needs to stay alive.  You swallow your pride and call home to ask mommy to send money.

But thankfully, first year residency is only one year long.  After this, there will be new residents to traumatize and to bully.  With less physical exertion, you start to gain back all the weight you lost and add a couple more pounds for good measure…  You realize that graduation from residency is all the more meaningful because of all the difficult experiences you had to go through, and that friendships with your batchmates run deep because you’ve been through thick and thin…When you’re going through tough times, remember this:

• Keep your head above the water and remember to keep breathing.
• Know you self-worth.  Nothing anybody can do to you will decrease your worth one bit.
• Draw strength from people who care for you the most.
• Be humble to accept the blame when you make mistakes, so that you learn from them. 
• This too shall pass.  There’s a rainbow always after the storm.

Helen Madamba, first year residency survivor.