Promoting a Research Environment in Medical Schools

The recent controversial issue on the dengue vaccination program in the Philippines has led me to research about such terms as “antibody-dependent enhancement” and clinical research phase studies.  Reading the news, I realize that the public will probably need a translator with all the technical terms used, but the issues boil down to questioning due diligence and social preparation, searching for evidence for safety of the vaccine, and need for further research on the proper precautions and procedures prior to administering the vaccine in a local mass vaccination program.  Not all medical doctors will understand the jargon of research and epidemiology, because not all doctors participate in research activities.  Most doctors and medical students actually tend to gravitate away from anything that sounds like research.  What would explain this common attitude?

It was Dr Ourlad Tantengco @drladstantengco who first asked the questions about the state of research and publication in UP Manila on his facebook page last December 12, 2016.  I realized when we were preparing for the PAASCU accreditation in our own medical school that there is a dirth of faculty members conducting research.  Hence, we ask the questions about strategies in promoting a research environment in our medical schools and how we can catch up with our counterparts in foreign universities where most research and publication come from medical/health colleges.

Join us on Saturday, December 17, 2016 at 9PM MLA / 9AM EST as we discuss how we can promote a research environment in medical schools.

T1. How can we promote an environment of research in medical schools?

T2. What aspects of research should be taught in medical school?

T3. In the age of evidence-based medicine, should all doctors be researchers? Why?

Independence at the Price of Depression due to Isolation

I just came from a month-long observership on HIV care in New York, USA.  I shadowed doctors, nurses, nutritionists, social workers and volunteers managing HIV-positive patients.  Many of the realizations I had were not necessarily healthcare-related.

INDEPENDENCE.  Many of the youth move out of their family home and live independently at an early age.  I am already a 38-year old professional, and I still live with my mom.  In the US, patients receive calls to remind them of their doctor’s appointments and they can come without any cash because their medical insurance would pay for the medical services and prescription medications.  In the Philippines, often doctors have to consider the cost of treatment because patients have to pay out of pocket.

ISOLATION.  Because children leave the homes early, many of the parents end up coming to appointments alone.  One taxi cab driver provided unsolicited advice that people should not build large houses because after a few years, you end up living alone anyway.  I also experienced isolation when I was housed in an expensive hotel room all by myself.

DEPRESSION.  There was a recurring commercial on television showing people telling a bald cancer patients things like “snap out of it…” or “you’re wearing me down…” or “stop with the pity part ok…” then ending with the conclusion “you don’t say this to a cancer patient, don’t say it to a person with depression.  Depression can kill…”  When people are isolated because it is the price of independence, then the ensuing depression is also a factor in the costs.  In the Philippines, you endure it when you get sad, mainly because there are a lot of people around you to talk things over with.  At one point, everyone is so snoopy they think your business is their business, hence the very active social media.  Is this better than a society that says loudly “mind your own business!” but relies heavily on professional (psychiatric) help when they feel sad or depressed?

This is also the plight of Filipinos who go abroad in search of financial independence for the sake of their families. People at risk of depression due to isolation would be overseas Filipino workers.

This is also the scenario of HIV patients who isolate themselves due to self-stigma to gain independence as a means of coping with their disease.  Often this also results in depression which necessitates additional support.

T1. How do we achieve the middle ground between independence and isolation?

T2. What strategies can be implemented to prevent depression due to isolation?

T3. How can healthcare service delivery help address mental health issues of isolation?

DOH Integrated Essential Maternal and Newborn Care

Training of Trainers on the Integrated Essential Maternal and Newborn Care (EMNC) and Lactation Management Training (LMT) for Health Care Providers in Hospitals

September 20-24, 2016

The Department of Health has a lot of programs, even for the same beneficiaries there are different programs.  For maternal and child health for example, we have the Essential Intrapartum and Newborn Care (EINC), the Kangaroo Mother Care (KMC), the Lactation Management Training (LMT) and even the Basic Emergency Obstetric and Newborn Care (BEmONC) training and Infant and Young Child Feeding (IYCF).  To make things simpler, we now have an integration of all these training programs into one broad training of trainors, much like a sampler of everything.  Hence, the Integrated Essential Maternal and Newborn Care and Lactation Management (EMNC-LM)!





As is also the norm since my three (3) years of working at the Vicente Sotto Memorial Medical Center, we are tapped by the DOH as trainers and facilitators.  Rising up to the challenge of a myriad of conflicting schedules, we managed to respond.

The first batch took place on June 13-18, 2016 at Bayview Park Hotel in Manila.  

The second batch was conducted at the Cebu Business Hotel in Cebu City. For the Cebu batch, participants include Far North Luzon General Hospital, Luis Hora Memorial Regional Hospital, Novaliches District Hospital, Batangas Medical Center, Eastern Visayas Regional Medical Center, Schistosoma Research and General Hospital, Amai Pakpak Medical Center, Mayor Hilario Ramiro Sr Regional Teaching and Training Hospital, CARAGA Regional Hospital, and Vicente Sotto Memorial Medical Center. 

Aside from introducing the laws to protect breastfeeding and the support system needed to ensure continuous successful feeding, it has to start long before labor and delivery, possibly during antenatal care. This sentiment was echoed during the last session on supportive supervision.

The programs on promoting breastfeeding should consider the hospital policies, the capabilities of the healthcare works, the health education and promotion classes, as well as support groups in the community.

This training seminar included also facilitation and communication skills, in addition to promotion of breastfeeding during pregnancy, through EINC especially during non-separation of mother and child during the entire hospital stay, practices that protect breastfeeding, as well as introducing Kangaroo Mother Care for preterm babies and low birth weight babies.

The participants visited the Vicente Sotto Memorial Medical Center to interact with the mothers and to experience for themselves how a busy overcrowded government hospital implements government programs despite the challenges of inadequate space maximizing 300-400% bed capacity, undermanned service areas and limited resources.  

It warms my heart to hear that the participants appreciated the presence of the Intensive Maternal Unit, which aims to separate pregnant patients with special concerns such as hypertension, preterm labor, infections during pregnancy and antenatal bleeding.

As a case in point, when we had to move temporarily to the Trauma Center for the duration of the construction of the Perinatal Care, we only had a labor room-delivery room complex with the neonatal intensive care unit attached to it.  We had no extra space.  We really had to request for a specific space for the Intensive Maternal Unit (IMU).  Patients with high risk pregnancies complicated by hypertension, antenatal hemorrhage, preterm labor, gestational diabetes mellitus, infections in pregnancy, and other co-morbidities are admitted at the Intensive Maternal Unit, which is under the supervision of maternal health specialists like the perinatologist and the infectious disease specialist.  With cohorting as a strategy, we noted that the conditions of these patients could not be managed while they were staying at the jampacked labor room.  Patients in labor have to take turns lying down on the bed because several of them have no choice but to share on bed.  Patients in labor understandably feel discomfort and intense pain due to childbirth.  These uncomfortable circumstances would not help control the blood pressure of a hypertensive, for example. Hopefully, all government hospitals would have an intensive maternal unit, supervised by a maternal-fetal medicine/perinatology specialist so as to reduce maternal and child morbidity and mortality.

In the end, what is important is the identification of champions for the program - whether in the community, in the hospital or in the head office of the Department of Health.  These are people who truly believe that by implementing these programs, our population of mother and children will be better fed, better nourished, better cared for and healthier.  Congratulations to the team of Dr Anthony Calibo and Ms Aya Escober!

Here is the video TV commercial by the Department of Health for the promotion of breastfeeding, All for Health towards Health for All!

Voluntary Blood Donation Drive to Save our Mothers At VSMMC

Voluntary Blood Donation Drive to Save our Mothers at VSMMC 
on September 25, 2016 (Sunday) Regional Blood Center

At Vicente Sotto Memorial Medical Center, the Department of Obstetrics and Gynecology is allotted one (1) operating room and one (1) dedicated anesthesiologist. Only one. But compared to other hospitals, we operate 24 hours a day and 7 days a week, and as public servants, we accept ALL patients who come seek our help for delivery. We do emergency cesarean section because these patients are mothers and their babies who can die if we do not intervene.

We do not turn away patients even if they do not have prenatal care. We do not turn away patients even if they don't have money. We do not turn away patients even if they do not have blood or blood donors. We do not turn away patients even if we don't have physical space or manpower. Because, if we start turning away patients, where will they go?

We need your help. We cannot do it alone. Mothers still die because of hemorrhage. They bleed to death when there is no available blood at the blood bank, when people do not care enough to donate their life-giving blood, when people start thinking about what they can get in return, when people keep thinking they don't have time to help.

You can help save our mothers and our babies. For a few minutes of your time, you can give your health to these patients. We need communities who care enough to take action to save our mothers and our babies. The Regional Blood Center along Jones Ave near Fuente Osmena is open to accomodate heroes who are willing to donate blood.  On September 25, 2016 (Sunday), the Department of Obstetrics and Gynecology is organizing a voluntary blood donation drive for the benefit of our patients.  We hope to see you there!

Promoting Child Rights Protection

The Republic Act 9344 known as the Juvenile Justice Welfare Act of 2006 celebrated 10 years of its existence.  This law recognizes the right of children to assistance, including proper care and nutrition, and special protection from all forms of neglect, abuse, cruelty and exploitation, and other conditions prejudicial to their development.  It further defines a child at risk and a child in conflict with the law. This law also points to the  minimum age of criminal liability: A child fifteen (15) years of age or under at the time of the commission of the offense shall be exempt from criminal liability.

Children are often used in drug trafficking nowadays because of this exemption.  Hence, some call for a lowering of this minimum age so that children committing heinous crimes can be put behind bars.  Child rights advocates insist that in these instances, children are victims too.

The Philippines signed the United Nations Convention on the Rights of the Child.

Since signing the UN CRC, the government is obliged to recognize the full spectrum of human rights for all children and strengthen efforts in enforcing the rights of children.  Different branches of government call for increasing programs that protect children's rights:

The Department of Interior and Local Government urges barangays to promote children's rights in the search for child-friendly barangays.

The Department of Education (Dep Ed) issued a memorandum on its child protection policy, policy and guidelines on protecting children in school from abuse, violence, exploitation, discrimination, bullying and other forms of abuse.  Dep Ed also strengthens protection for the reintegration of children at risk and children in conflict with the law.

The Department of Justice created a Committee for the Special Protection of Children.

The Department of Social Welfare and Development has rescued over 150 victims of webcam sex tourism and other forms of child abuse.

In the UN CRC, the guiding principles of the Convention include non-discrimination, adherence to the best interests of the child, the right to life, survival and development, and the right to participate.  In our own ways, we can also promote children's rights and help in the reintegration of children at risk and children in conflict with the law.




Questions that need to be answered:

1.  What are the different approaches to reintegrate children at risk and children in conflict with the law?
2.  Suggest ways on how we can keep children our of trouble and out of harm's way.
3.  What enabling environment can allow children to claim their own rights?

Human Trafficking: Modern Day Slavery

Human Trafficking: Modern Day Slavery

Back in highschool, I remember reading the book called the Color Purple.  The novel is about a poor and uneducated 14-year old girl who suffers rape, beatings, maltreatment and all forms of abuse, and endures through all the hardships until she is reunited with family and loved ones at the end of the story.  These stories are based on true events, and sadly these still occur until this day.

What is Human Trafficking?

Human trafficking is modern-day slavery and involves the use of force, fraud, or coercion to obtain some type of labor or commercial sex act.  People on the ground like community organizer Elaine says human trafficking is a lucrative business, and that women and children are made vulnerable by poverty and gender discrimination.  In some areas in Cebu, it has become so bad that it was once considered a cottage industry.  Children are robbed of their youth, and end up as broken, empty shells.  People on the ground report children being pimped by their own parents for sex.  Others collect payment for sexual acts performed in front of a webcam.

"Trafficking in Persons" is legally defined in the Republic Act 9208 (Anti-Trafficking in Persons Act of 2003) as:

the recruitment, transportation, transfer or harboring, or receipt of persons with or without the victim’s consent or knowledge, within or across national borders by means of threat or use of force, or other forms of coercion, abduction, fraud, deception, abuse of power or of position, taking advantage of the vulnerability of the person, or, the giving or receiving of payments or benefits to achieve the consent of a person having control over another person for the purpose of exploitation which includes at a minimum, the exploitation or the prostitution of others or other forms of sexual exploitation, forced labor or services, slavery, servitude or the removal or sale of organs.

Hence, the main elements of human trafficking would include movement, means and motivation.

Where is Human Trafficking?

The Global Slavery Index estimates that in 2016 there are 45.8 million people are in some form of modern slavery in 167 countries.

CNN US Trafficking in Persons Report discusses that on the same day that the new President Rodrigo Duterte assumed power, the Philippines moved up to become a Tier 1 nation. During his State of the Nation Address, President Rodrigo Duterte declared war against human trafficking.

According to the Trafficking in Persons (TIP) Report

• Tier 1 means that governments fully comply with the Trafficking Victims Protection Act's (TVPA) minimum standards.
• Tier 2 means that governments do not fully comply, but are making significant efforts to bring themselves into compliance.
• Tier 3 means that governments do not fully comply and are not making significant efforts to do so. Myanmar, Sudan and Haiti are currently among the worst offenders for human trafficking.

In Cebu Philippines, the Inter-agency Council against Trafficking (IACAT-7-ACP-VAWC) celebrates World Day against Traffiking in Persons (WDAT) with a multi-sectoral conference at the Mandaue City Sports Complex with all government agencies, non-government organizations and even private sectors involved in efforts towards stopping human trafficking.

The Share A Child Movement Inc works at the level of the barangay, organizing community-based child protection networks and youth advocate groups to report, refer and monitor cases of child abuse in the barangay.  We also conduct information-education campaigns to increase awareness on the rights of the child and the laws protecting children and women.

Other organizations focus on the transportation and tourism sectors, empowering the service providers to detect suspicious movements and report potential cases of human trafficking.  Other organizations specialize in protection of victims and prosecution of perpetuators.

As we celebrate the Philippines' upgrading to TIP Tier 1 especially on World Day against Trafficking in Persons, we continue our efforts to stop all forms of human trafficking in our society, to protect our children and strengthen our families.

When your facebook newsfeed speaks to you

When your FB newsfeed speaks to you

Have you ever experienced that feeling when the universe seems to speak to you?  When everything seems to fall into place?

My life now might be super jampacked with activities left and right, sleepless night, adrenaline rush to meet deadlines... but scrolling down on my FB newsfeed, Angelina Jolie says "let us do the best we can with this life!" and Robin Williams says "make your life spectacular!"

Simply amazing!

Daily Logs

Daily Logs

Since I've been assigned as training officer of our department, I've focused on my role as teacher and trainer, and I embody this role in all my other responsibilities whether in the medical schools where I teach, at the hospital where we have resident physician trainees, or even with my staff in our NGO The Share A Child Movement Inc.  I aim for other people to learn from me, a little something everyday.  The more proper perspective is for me to assist THEM in their self-directed learning.

So one suggestion by the training office is to have a daily diary or a daily log of things you have achieved for that day, or things you have learned.  Back in UST med school days, a favorite surgery consultant introduced me to the "one-fourth sheet of paper a day" addition in knowledge.  I should not be content until I am able to fill up one fourth sheet of paper with new learning.  Regardless of the source, we do learn something new everyday.

Hence, here is my "notebook" for everyone to see.  I realize that my blogs need not be long academic articles that is publish-worthy.  I can publish even simple thoughts that might induce other people to start thinking as well.

I have learned about the outcome-based education, same as the output impact orientation in social development.  They all point to the same thing:  the end measurement of success is the final product!

Doctors as Patients: who takes care of healthcare providers?

Doctors as Patients: who takes care of healthcare providers?

Sometimes we tend to forget that doctors are humans too, and doctors can get sick if they don't take care of our health. Most doctors are busy people - preoccupied with keeping patients healthy.

According to a 2008 systematic review on DOCTORS AS PATIENTS: doctors' health access and the barriers they experience by Kay et. al., doctors have the same preventive health needs as the general community.  Barriers to seeking health care may include embarrassment, time, cost and the personality of the doctor as a patient. However, systematic barriers to health access (long hours of duty and cultural issues) are more significant than individual barriers.

Doctors tend to be selfless, often endure sleepless nights caring for their patients, skipping meals (and baths), often neglecting their own health. We complain about patients seeking medical consult late, but it is much the same with doctors - we tend to ignore our aches and pains until our conditions get too difficult to handle.

Do you agree that doctors are the worst kind of patients?  Wessely and Gerada (2013) explains the concept of doctors creating a medical self with characteristics of being perfectionists, narcissists, compulsives, denigrators of vulnerability, and martyrs.  These characteristics make them good doctors, but also distort doctors’ ability to seek help and adopt the role of patient.  When doctors relinquish their medical self and become patients, there is a better chance of reduced distress and global improvement.

Join us tonight at 9PM MLA time for our ‪#‎HealthXPH‬ tweetchat to discuss healing of healers... who takes care of healthcare providers?

T1. What are the challenges for doctors to take care of their health?
T2. Suggest ways on how healthcare professionals can take care of their own health.
T3. How can patients take care of their doctors?

The Role of Research in Academe

During the Global Forum 2015, there was a plenary session that pointed out the disconnect between researchers who don't teach and teachers who don't do research. Research faculty are separated from academic faculty.  Many programs attempt to marry research industry and academic institutions through research grants. Still the question is left unanswered: what is the role of research in academe?

One website says "the purpose of research is to inform action" and main problem is the "slow translation of research into practice".  Here again it is mentioned that there is a disconnect between those who create the evidence base (the researchers) and those who are positioned to implement the research findings (teachers).

I teach research to first year medical students.  Many of my students find the class difficult, with so many steps to go through; but since it's a requirement, they plod on.  I also supervise the research projects of my residents in obstetrics and gynecology.  You would think that since they went through research in medical school, they'd fair better.  In reality, if medical students find research difficult, imagine that residents have fourfold difficulty juggling clinical patient care with cudgels of research work.  One resident complained "why are we required to do research? Why not limit it to those who actually like research?".  The main advantage of actually conducting research is knowing the actual process and understanding how to interpret data globally available and to translate it into policy and practice.  Hence, we are left with the question:  How do we bridge the disconnect between teachers who don't do research and researchers who don't teach?

Republic Act 10532, an act institutionalizing the Philippine National Health Research System (PNHRS), aims to improve the quality of life of every Filipino through health research and development activities.  Medical schools are mandated to prepare research agendas to which students align their research projects.  Areas for research are identified in the National Unified Health Research Agenda (NUHRA), Regional Unified Health Research Agenda (RUHRA) and the National Higher Education Research Agenda (NHERA).  One challenge is the rigorous process of technical and ethical reviews of research protocols prior to actual implementation to ensure that health research adheres to universal ethical principles.  Another challenge for researchers is how to tap funding for research. Medical schools offer grants to encourage faculty to do research. The Philippine Council for Health Research and Development (PCHRD) accepts research proposals for funding.  Aside from this, how do we help researchers tap funding for research?

Teachers on twitter.  Pezaro (2015) shares that a small but growing group of teachers flock to social media to share their resources, experiences and ideas. Because formal research is hard and technical, teachers seek what they need through networks, and events, instead.  Social media is a platform where formal research may be shared and presented and translated into simpler more easily understandable language.  Still, there needs to be those people who will create the evidence base, people who will translate the evidence for consumption, and people who are positioned to implement the findings.  Data is there on social media, then researchers need to be able to organize this data into formal research for publication.  However, how do we ensure that research based on data from social media adheres to universal ethical principles?  What ethical issues arise when doing research on social media platforms?

My Perception of 2015, the VSMMC Experience

My Perception of 2015, the VSMMC Experience

My life these days has been passing by like a blur of activities, and friends have commented on this more than once.  So I should not run out of things to write about, maybe I can write about a run down of the things I've been busy with this year before I toss my very full planner into the trashcan:

My car's mileage was 20,000 kms when I bought her.  She was three years old.  My driver says a taxi cab can obtain that mileage in 3 months.  My phone is three years old.  I consume 3 fully charged battery packs in a day.  I work my phone like a taxi cab because I make a lot of calls, am a heavy texter and my mobile data is perpetually on.  Hence, it is time to replace my trusty phone.  My body however, I cannot replace as easily.  I need to reflect on what I've been doing this past year and focus on what projects to prioritize.

Year end is a good time to reflect and review how best to attack the coming year, so that I don't get burnt out and I can be efficient for a longer time.  However, like all other days, I was soooo busy at year end amuck with struggles and challenges that I havent had quiet time to sit down and write.... until now.

In 2015, there were milestones achieved:

As a medical specialist at the regional hospital Vicente Sotto Memorial Medical Center (VSMMC), I wear many hats.  

1.  EINC Program.  As the coordinator for the program on Essential Intrapartum and Newborn Care (EINC), we were able to conduct a hospital-wide orientation from January to March 2015, such that even the security guards know about EINC and endorse it to incoming patients in labor.  

In May 2015, I was among the VSMMC delegation to the DOH-sponsored Quality Improvement and Planning Workshop in Manila, where we were advised to "coach" neighboring hospitals and centers - big task!

Last July 2015, members of the DOH monitoring and support team visited VSMMC for the Care for the Small Baby (Mother-Baby Friendly Hospital Initiative, EINC and Kangaroo Mother Care).  It was this time that VSMMC was finally KMC-accredited.

Like most health programs, it feels like pushing a heavy kariton.  You need to continually push, otherwise when the fervor dies down, so does the implementation.  The multi-disciplinary weekly meetings become monthly, and now I can't even remember when we had our last meeting.  It is important, however, to continue staff orientation on the EINC policies of the hospital and to be watchdog on its implementation.

2.  Program for Young Parents.  Although the teen mom clinic in PGH is handled by maternal-fetal medicine specialists, the program on teenage pregnancies was assigned to me.  As early as 2014, as a team approach with the Department of Pediatrics, nursing and the Pink Center of VSMMC, we were able to formulate guidelines for handling teenage pregnant patients under our care.

Last June 2015, the Program for Young Parents was identified as one of the Best Practices of our institution and was presented during the 2nd DOH National Staff Meeting.  I was honored to have presented the program in behalf of our medical director Dr. Gerardo Aquino.  Shared here in our slide presentation during that event, posted with consent.

VSMMC Program for Young Parents

This program was also featured several times during the HI-5 Impact of DOH under maternal care.  I am looking forward to the time that I may pass the baton to another so that more intense attention may be given to this very relevant program.

3.  Prevention of Mother to Child Transmission of HIV.   As an HIV advocate, I had several speaking engagements, particularly on HIV Management in Pregnancy.  Considering that we are a category A area, all pregnant women are advised to have HIV counseling and testing.  We managed to increase the uptake of HIV counseling and testing among our pregnant mothers at VSMMC this year.  There were also a number of awareness-raising activities attended:

In March 2015, I presented the current POGS clinical practice recommendations on the Prevention of Mother to Child Transmission of HIV during the Philippine Society of Microbiology and Infectious Disease (PSMID) Cebu chapter 3rd Biennial Convention.

In May 2015, this was the first time that I participated in the International AIDS Candlelight Ceremony at Plaza Independencia, Cebu City, in remembrance of all the lives lost to this HIV epidemic.

In June 2015, we moderated a #HealthXPH tweetchat on Social Media and the Philippines HIV/AIDS Epidemic, where a lot of our HIV advocates voiced out about the conditions of HIV in our country.  Our guide questions included: How can social media reliably increase awareness on HIV?  How can social media be used to increase rates of voluntary HIV counseling and testing, specially among high-risk groups?  How can social media help improve adherence to anti-retroviral drug therapy?

In September 2015, shortly after the VSMMC HIV/AIDS Core Team (HACT) meeting, I flew to Cagayan de Oro for the POGS X Northern Mindanao chapter 4th annual postgraduate course where I spoke on HIV and TB in pregnancy.

Last October 2015 we had another #Healthxph tweetchat on HIV, this time tackling the issue on public health policy vs individual patient rights in addressing the Philippine HIV epidemic.  We discussed whether contact tracing of HIV-positive patients should be mandatory, how to find the middle ground between public health policy and individual patient rights to privacy and confidentiality and how social media can help connect public health policy and individual patient rights to privacy and confidentiality.

As we closed the year, I lent myself and my name and my photograph as endorser of the December 2015 AIDS Day Run. Personally running in the 3k Fun Run!

4.  Resident Research Coordinator.  One of my greatest frustrations is getting residents interested in research work.  Finishing their research requirements in the nick of time, our senior residents managed not only to present their research papers but to bag several awards in different research fora:

Catherine Macalos-Timbal's research on serum magnesium and preeclampsia wins first place in the 2015 CIM Research Contest.

Lorelyn Hamoy's work on the "Association of HIV Knowledge, Testing Attitudes and Risk Assessment with the Acceptance Rate of HIV Counseling and Testing among Pregnant Filipino Patients seen in a Tertiary Government Hospital" garnered first place in several research contests including the POGS Cebu Resident Research Contest, the Philippine College of Surgery Cebu and Eastern Visayas chapter.  It also won second place in the National POGS Resident Research Contest, 3rd place in the VSMMC 18th Oral Annual Presentation of Resident Research Papers, as well as Best Poster presentation during the PSMID 37th Annual Convention.

Princess Lorezo wins first place in the VSMMC 18th Oral Annual Presentation of Resident Research Papers.

Edilyn Pintac, a top 5 finalist in the oral presentation of research papers during the PSMID 37th Annual Convention, presents her poster on her research entitled "Association of Prevalence and Intensity of Soil-Transmitted Helminth Infection with the Prevalence and Severity of Anemia among Pregnant Filipino Women admitted at VSMMC"

5. Staff Conference Coordinator.  We've managed to organize monthly staff conferences on relevant topics on management of complications during pregnancy and gynecologic diseases.  For 2015, these were our topics discussed:

• Perimortem CS
• Hemorrhagic Complications in Pregnancy
• Peripartum Trauma
• Management of Preeclampsia and its Cardiac, Pulmonary and Neurologic Complications
• Cervical cancer prevention
• Abdominal Masses in Pregnancy
• Choriocarcinoma in a 16 year old
• Preterm Labor and Preterm Birth
• Surgical Site Infections
• Breast Cancer
• Violence against Women
• Prevention of Mother to Child Transmission of HIV Infection

6.  Morbidity and Mortality Conferences and the Maternal Death Review.  In an attempt to reduce maternal mortality and to improve coordination with major stakeholders in maternal health, we have our maternal morbidity and mortality conferences every month, and as much as possible, we invite resource persons to help us out with our verbal autopsy of cases, especially consultants from the Department of Internal Medicine.

In April 2015 and again in November 2015, VSMMC was represented during the Cebu City Health Department Maternal Death Review by myself, Dr Jessa Alemania and Dr Jalilah Abedin.  When the Provincial Health Office conducted their Maternal Death Reviewin December 2015, I also had to attend to react to the cases selected for presentation.  Hence, in a personal gesture of genuine help, I offered my services to assist them when coordinating transfer of real emergencies to VSMMC.  I envision one day that all pregnant patients needing tertiary care would be transferred way ahead of onset of complications, and that low risk patients can be triaged to birthing centers to decongest the end referral centers to give more attention to complicated high risk pregnancies.

Zika outbreak: are we affected?

The Zika virus outbreak in Brazil has been associated with a significant rise in the number of babies born with microcephaly and neurological disorders, and has been declared a "Global Emergency" by the World Health Organization.

Let’s talk about Zika!

Zika Virus outside Africa.  Zika virus infection presents with acute onset of fever, maculopapular rash, arthralgia and conjunctivitis.  It is an Aedes mosquito-borne flavivirus  that was first discovered in 1947 in the Zika Forest of Uganda, infecting a rhesus monkey. Its serum was inoculated into mice.  Zika virus was isolated from mouse brains.  Zika was isolated from humans in Nigeria during studies conducted in 1968 and during 1971-1975.  From 1951 through 1981, serologic evidence of human ZIKV infection was reported from other African countries such as Uganda, Tanzania, Egypt, Central African Republic, Sierra Leone and Gabon, and in parts of Asia including India, Malaysia, Philippines, Thailand, Vietnam and Indonesia.

Zika Virus Infection in the Philippines.  In an active surveillance for acute febrile illness initiated in Cebu City, Philippines, in 2012, there was a report of a 15-year old boy who reported a subjective fever.  ZIKV RNA was detected in his serum sample.  The boy recovered fully by 3 weeks. Most infections are asymptomatic, and symptomatic disease generally is mild.

Between 2012-2014, the Pacific experienced a high burden of mosquito-borne disease due to concurrent epidemics of dengue, chikungunya and Zika virus infections.  Data from the French Polynesia documented a concomitant epidemic of 73 cases of Guillain-Barre syndrome and other neurologic conditions.  

Zika Virus Transmission from French Polynesia to Brazil.  There are some theories on the introduction of ZIKV to Brazil from the French Polynesia: during a World Cup soccer competition in 2014, or during the Va'a World Spirit Championship canoe race in Rio de Janeiro in 2014.   In May 2015, Zika spreads through local transmission in Brazil.  Following the spread of the Zika virus in Brazil, there has been a marked reported increase in the number of infants born with microcephaly. Until more is known, pregnant women should consider postponing travel to any area with ongoing Zika virus transmission.  Health authorities recommend that pregnant women take meticulous precautions to avoid mosquito bites and even to delay pregnancy.

LINK BETWEEN ZIKA AND MICROCEPHALY

Carlos Brito (2015) explained it well in his article Zika Virus:  New Chapter in the History of Medicine:

The increase in cases of microcephaly could be associated to Zika virus infection based on the following clinical-epidemiological aspectsand in the different diagnosis:

• the outbreak of many cases in a short space of time, occuring simultaneously in different cities and states characterizes a disease with high attack rates and rapid dispersion, a phenomenon associated with disease transmitted by arthropods;
• besides microcephaly, image exams presented some common characteristics such as: periventricular and cortical microcalcifications, vernix cerebellar hypoplasia and in some cases lisencephaly compatible with the pattern of congenital infections;
• diseases associated to TORCH, because of the transmission pattern, are not associated with large outbreaks; 
• the investigation in prenatal and perinatal were negative for TORCH infections;
• most of the mothers (70%) reported compatible features of Zika disease in the first trimester of pregnancy, the period in which the Zika V outbreak occured in the region.

Identification of zika virus in the amniotic fluid samples, brain tissue and placental tissues strengthen the link between Zika virus and microcephaly.

Alerts from the Brazil Ministry of Health, European Centre for Disease Prevention and Control, and the CDC concerning the possible association of microcephaly with the recent outbreak of Zika virus infection.  Several reports were posted as MMWR Early Release on the MMWR website, including interim guidelines on pregnant women, on infants with congential Zika virus infection, on healthcare providers caring for pregnant women and women of reproductive age, on prevention of sexual transmission.

Preventive measures would involve prevention of transmission.  Zika virus infection has been known to be transmitted through mosquito bites, through sexual transmission (proven by cases in Tahiti and USA) and through blood transfusion of blood infected with the Zika virus.

Let's talk about Zika now!  ...and do something about it!