Gaea Bliss

I've always wanted to have a baby for as long as I can remember, but this is not God's will for me... so I just help other women have their babies, just like Glenda had Gaea Bliss.  As I held her sleeping form in my arms, I realize that I have missed this train.  My motto before was "habang mas regla, may pag-asa!"  But starting July 2024, I officially lost all hope of biologically having my own babies.  My womb wept for the last time for the babes left unborn.

 

ALAS PONDER

We had a reunion dinner with my pandemic executive assistant Mimi.  RJ and Gil were discussing my work schedule, that I would ontinue working until late into the nfight, sometimes extending til dawn.  ALAS PONDER means the usual time that I would stop working is until I get exhausted or energy empty batt or lights out "ponder"

So for 2025, I think I need to be more forgiving of myself as I accept that I cannot possibly do everything.  My word for 2025 would be DELEGATE.

I need to develop my staff enough to trust them to take over even important functions at work.

WORLD AIDS DAY 2024

It's the eve of WORLD AIDS DAY 2024, an event usually celebrated on December 1 every year to remember those who have died of AIDS and to continue to support those living with HIV.

T1.  After 4 decades of the HIV pandemic, why do you think the HIV infection continues to spread?

T2.  What issues and concerns do you think people living with HIV face everyday?

T3.  Knowing that stigma and discrimination against HIV still exists, how should we celebrate World AIDS Day?

I fear no death for You are at my side

 

What we have done for ourselves alone dies with us; what we have done for others and the world remains and is immortal.

- Albert Pike

Remembering one who has lived life for others.  No matter how lowly and humbly life is lived, when it is lived in the service of people, the small acts of charity will never be forgotten.

Empowering POGS Members to Maximize the Benefits of UHC

Allow me to share here the speech I gave during the Plenary Session for POGS Organization of Government Institutions and the POGS Service Delivery Network for the 2024 POGS Annual Convention and 78th Anniversary Celebration on November 15, 2024 at the PICC.

      

      I greet everyone from the queen city of the south, Cebu.  To provide context, I am a medical specialist from the regional tertiary referral hospital Vicente Sotto Memorial Medical Center.

GOVERNMENT HOSPITALS INUNDATED WITH PATIENTS
The photo shows the situation back in 2015 when our 6-bed labor room accommodated more than 60 parturients.  Imagine that the next patient would simply be offered that empty stool while in labor.  Just like other government hospitals, we were inundated with patients.

In May 2015, our training officer Dr Helen Amorin assigned me to review the maternal mortality reports for the month in preparation for the POGS Cebu quarterly maternal M&M conference.  There are 31 days of May and I was shocked to discover that we had 29 maternal deaths for that month.  Naturally, during the M&M conference, one of our POGS luminaries demanded that “since there are soooo many maternal deaths, we should investigate this hospital!” 

      This is because when patients are for emergency CS, they refer to Sotto.  When the patients have financial constraints, they refer to Sotto.  When patients are in critical condition, they refer to Sotto.  Every ambulance that transports each patient seems to shout “Sotto! Sotto! Sotto!”
This is where it all began.
 
PERINATAL STATISTICS
In 2016, our perinatologist Dr Kristina Dosdos started a joint conference between the Department of Obstetrics and Gynecology and the Department of Pediatrics called the Perinatal Statistics.  We noted that
·     more than 40% of our admissions were low risk pregnancies, which could be managed at primary and secondary level facilities.
·     One of our former residents Dr Princess Lorezo conducted a research on decision to delivery interval. Turn around time for cesarean section delivery is more than 12 hours on average!  

     MATERNAL PERINATAL STATISTICS

     In 2017, we started the Maternal Perinatal Statistics, inviting the City Health Officer and the Cebu Provincial Hospital to listen to our data presentation in the hopes of finding solutions.

    

     QUARTERLY MATERNAL PERINATAL STATISTICS

      By 2018, we started the Quarterly Maternal Perinatal Statistics where all government hospitals present their accomplishment reports, census of referrals and maternal and perinatal deaths.  We would also flash the top ten referring facilities!
 

NO ONE HOSPITAL CAN DO IT ALONE
Allow me to mention to acknowledge their contribution to the success of this endeavor the anatomy of Cebu HealthCare Provider Network

• CEBU – 1 apex DOH hospital, Vicente Sotto Memorial Medical Center
• 3 DOH hospitals - Eversley Childs Sanitarium and General Hospital, Saint Anthony Mother and Child Hospital and Cebu South Medical Center
• 4 Cebu provincial hospitals – CPH Bogo, CPH Danao, CPH Balamban and CPH Carcar
• 3 city hospitals – Lapulapu City Hospital, Mandaue City Hospital and Cebu City Medical Center
• There are also 12 district hospitals and 5 apex private hospitals.

With the key message that “NO ONE HOSPITAL CAN DO IT ALONE!”  The problem was the high maternal mortality in Cebu, most dying in VSMMC.  So the objective of the Quarterly Maternal Perinatal Statistics was to assess and develop strategies to strengthen the referral systems in order to reduce maternal and perinatal mortality in Cebu:

1.   Create technical working group that meets during quarterly maternal-perinatal statistics agreeing to a NO-BLAME culture
2.   Establish the real-time online referral system
3.   Improve functionality of peripheral hospitals to schedule elective CS at their convenient time. 
4.   Develop agreements on two-way referrals for the implementation of the Central Visayas Health Referral System

      Most of the complaints of the hospitals were difficulty contacting VSMMC telephone line to refer, lacking manpower, no computer and internet connections.  I distinctly remember that it was Dr Mona Yiu who demanded for a real time communication system between hospitals.  The hospital chiefs were convinced to find ways to decongest VSMMC in order to allow us to accommodate more of their patients needing tertiary, critical and intensive care.

      ELECTRONIC REFERRAL SYSTEM
It was the DOH Central Visayas Center for Health Development that was successful in developing a program for the electronic referral system following guidelines in the Central Visayas Health Referral System Manual. 

I am glad that Dr Joy Novero presented that this system is being used even in private hospitals like UCMED.  Dr Veloso was one of the representatives of POGS Cebu during the QMPS.
But having the technology is not enough, because we need buy in of the end users. 

Pag ayaw, may dahilan.

What did we do?  VSMMC as the tertiary referral hospital stopped tolerating.  We get what we expect.  We deserve what we tolerate.  We stopped accepting walk-in patients.  We stopped accepting patients who were not referred thru the electronic referral system.  We stopped accepting patients who were low risk. 

It needed POLITICAL WILL AND GOOD GOVERNANCE.  We were fortunate to have genuine humanistic leadership in the person of our BIG BROTHERS Dr Gerardo M Aquino Jr, our medical center chief and Dr Jaime Bernadas, our DOH Regional Director.

Gone are the patient referrals “TO HOSPITAL OF CHOICE”  For referral of patients from hospitals, we utilize the Central Visayas electronic health referral system.  For referral of patients who are at home in emergency situations who need transport to the nearest available hospital, we have the DOH 711 emergency healthline.  Currently, our DOH7 is working on developing the Telemedicine Program for electronic health records across all government health facilities with interoperability.

COVID19 PANDEMIC
This strong working relationship between our hospitals in the Service Delivery Network and HealthCare Provider Network was sorely tested during the COVID19 pandemic.  Dire need mandated compliance with the electronic referral system guidelines.  With the systems in place, we were able to provide more beds for severe and critical COVID19 patients at VSMMC.

This year, the technical working group for the healthcare provider network crafted the guidelines for referral based on functional capacity of health facilities.  The DOH Central Visayas Center for Health Development released a memorandum on the levels of care with different diagnosis and cases to guide decision-making on who to refer, when to refer, where to refer and which cases should be prioritized for referral to VSMMC as the tertiary end-referral hospital.  No matter if the doctors argue online, at least the patient is in a hospital that can provide monitoring and care.  All for patient safety.

IMPACT on BETTER HEALTH OUTCOMES, STRONGER HEALTH SYSTEM, ACCESS TO ALL LEVELS OF CARE

In 2017, Dr Dosdos reported that we had 95 maternal mortalities that year.
In 2020, we had 60 maternal mortalities.
By 2023, we were down to 31 maternal mortalities for the whole year, less than 1% of all admissions.

Today, if you need to be admitted, you don’t need to know anyone to have access.  You might need to wait, but eventually you will be accommodated.  The DOH 711 emergency healthline and the electronic health referral system will help make sure that THE RIGHT PATIENT IS AT THE RIGHT FACILITY AT THE RIGHT TIME ALL THE TIME.

Kay kami sa Sotto, kalidad nga serbisyo among garbo. 
Quality service is our pride.

Lavander and Mint

I miss Dr Helen Amorin.  She was my mentor, ally and biggest fan/supporter.  We would spend 30 minutes over the phone discussing strategies and she would give me advice like an older sister.

Ever since I joined VSMMC in 2013, she had been providing me with strength to DARE institute changes for reform in the Department of Obstetrics and Gynecology. 

We started with changing the admission guidelines to the 12-hour obstetrician-on-duty, adopting the system from PGH with residents assigned to the OB Admitting Section, ER Gynecology, Labor Room, Delivery Room, and Operating Room. This provided additional accountability to the consultants and residents in charge.

Then we scheduled additional conferences like the staff conference, sonologic surgico-pathologic conference, mortality conference, grand rounds, pre-op/post-op conference.  We also had quarterly trophoblastic conferences, perinatal statistics, joint OBGYN-IM conference and mutli-disciplinary conferences as needed.

I was happy to know that there was somebody who was as passionate and hard-working as I am, probably even more... so that the busyness of daily operations didn't seem too overwhelming.  My main concern then was difficulty waking up early for these conferences, but mam Helen would always give me an early wake up call when I was needed for those special events.

We also had time to disconnect and have a social dinner or coffee with blueberry cheesecake.  She always knew my favorite!  When shd ventured into soap-making, she gifted me with peppermint-scented bath soap which brought me a lot of comfort.  Mam Helen preferred LAVANDER and I would remember to pick up small stuff for her when I would see Lavander.  Lavander-scented showers refresh her and make her happy.

Together, we were the dynamic duo.  When we had a series of three (3) non-puerperal uterine inversion, she would operate abdominally and I would be her vagina girl.  We were Helen A and Helen M.  She was the early one and I would be the night duty.

Yesterday, I was part of a plenary panel discussion for the POGS Organization of Government Institutions, telling the story of the Central Visayas Electronic Health Referral System.  I couldn't tell the story without starting from where it all began... and I just had to mention Dr Helen Amorin, who asked me to review the 29 maternal mortalities for the month of May in 2015.

I had to explain that most ambulances transported patients to Vicente Sotto Memorial Medical Center (VSMMC) which was most often the hospital of choice.  The audience laughed when I told them that to me the ambulance sirens sounded like "Sotto, Sotto, Sotto!"

More importantly, the audience seemed to be attentive to the unfolding of OUR STORY.  The realization that "no hospital can do it alone" and that it is actually the strong working relationship between hospital healthworkers that make sure THE RIGHT PATIENT is at the RIGHT FACILITY at the RIGHT TIME ALL THE TIME.

I miss mam Helen.  She was proud of me when I described the Program for Young Parents before the DOH National Staff Meeting in 2014.  I'm sure she would have been proud of OUR STORY when I narrated it to the POGS Annual Convention in 2024.

Layo pa 'ta pero layo na 'ta.

This one's for you, mam Helen!  Helen A and Helen M, lavander and mint!

The Growth Journey

I found this illustration on my facebook feed.  I realize that in order to grow, we need to get out of our comfort zone and do it.  Do it scared! Do it even if you're not sure what you're doing!

While we continue to learn as lifelong learners, we continue to face challenges by acquiring new skill sets.  The willingness to learn is one of the most important characteristics of a growing person.

Take courage!

Blind man:  Have mercy on me, I beg you!  I want to see!

Jesus:  Stand up, your faith has healed you!

Often we are preoccupied with our worries and struggles that we cannot be disturbed to help those blind people sitting along the roadside asking for help.

Kuya Gil is an example of how we can truly be instruments of God's healing despite our own poverty and handicaps.

On the anniversary and project leaders meeting of the Enfantes Du Mekong, the message of the Bamboos to the scholars are "Take courage and get up.  Jesus is calling you!"

Bartimeus was important to Jesus because he said "Call him" asking the people to bring Bartimeus instead of just ordering Bartimeus to "Come here".  In the same way, the children matter not only to EDM but also to God.  Volunteers are the instruments that God use to bring the children closer to Him and closer to restoration of their sight and the restoration of their faith in humankind.  People are gifts.  People live for other people.  That faith in humankind can save lives!

Padayon, ninong Gil!

Post-tweetchat on the Art of Negotiation

 

One of the main illustrations during the chat is from Dr Remo Aguilar @bonedoc on the Principled Negotiation.

The Art of NEGOTIATION

 

I saw this post of Dr Tony Leachon on my feed, knowing that those personalities engaging in a friendly handshake have been political opponents in the past election.  The caption tells us to never fear to negotiate.

This is an inspiring photo of how people have the capacity to agree to disagree, and to set aside their differences to cooperate towards the same goal.  I also wonder why our politicians find it difficult to negotiate for continuity of good programs.  The common practice is to stop all programs of the previous administration in favor of new projects that bear the new administration's stamp of approval and branding.

Negotiation is defined as a discussion aimed at reaching an agreement.  The United Nations discuss negotiation as a way of coping with disagreement, with varying views and with different objectives.  Harvard Business School Online lists the following skills needed to negotiate professionally: (1) communication; (2) emotional intelligence; (3) planning; (4) value creation; (5) strategy and (6) reflection.  Sometimes, at work we don't need to be friends, but we need to be negotiate professionally to reach an agreed strategy or way to move forward.

Join us tonight at 9PM MLA time on #HealthXPH to discuss the Art of NEGOTIATION:

T1.  What is your understanding and/or definition of a good negotiation?

T2.  What factors, in your experience, contribute to a successful negotiation?

T3.  Can you tell us a story of a negotiation that you had done in the past?  What went right/wrong?

Boundaries

A lack of boundaries invite a lack of respect.  

You get what you expect.

You deserve what you tolerate.

I saw this video on my feed and it aptly illustrates that nobody can disrespect you if you do not allow it.  Maybe it's a part of our culture that we were raised to be hospitable, to be welcoming of people, to be caring even to a point where we get uncomfortable just to address the needs of others.  There should be a point where we say NO.  This is as far as I go.  Your rights should not step on my rights.  I have rights too.  I have a boundary.  I deserve respect.

FOCUS

in the hustle and bustle of everyday grind, we can take a break to breathe and pause to smell the coffee.

then i realize that life is a matter of FOCUS.  I may be sitting quietly contemplating on life with my cup of coffee, but I am still focusing on the traffic below.  time to shift my focus on my cup of coffee and me.  just for a moment.  just to pause and breathe.  just to shut out the noise outside and give myself a moment of peace.

HEALING

There are a lot of factors in healing, but definitely healing takes time, effort and understanding.  One needs to reflect on the root cause of one's suffering and trauma to directly address and cut off the triggers, no matter how painful.  Sometimes we make things complicated for ourselves, so we also need to analyze our own role in our own problems.

Habang may buhay, may pag-asa.

Para kanino ka gumigising

There are mornings when it is challenging to simply get out of bed.

EMPLOYEE MERITOCRACY

The PRAISE Awards is the rewards and recognition part of the Civil Service Commission Program to Institutionalize Meritocracy and Excellence in Human Resource (PRIME-HR).  

We recognized employees who have served 10, 15, 20, 30 and 40 years.  We also recognize employees with perfect attendance and with professional achievement, as well as those with innovations for improvement.

Writing a thank you card or an email appreciating the work of an employee and an acknowledgemenf of their professional growth shows the extra effort you put in which makes the recognition more meaningful.

Join us tonight August 31, 2024 (Saturday) at 9PM MLA to discuss employee meritocracy:

T1.  What qualities and achievements would you recognize and reward among your employees if you were an employer?

T2.  Can you share a memorable experience with an employee or co-worker that you are thankful for?

T3.  How would you celebrate small wins and rewards meritocracy and excellent performance?

Trust Your Doctors

This is an appreciation post for the doctors who are helping me take care of my health.

The weight loss part is the most difficult about getting to a healthy place.  I am noisy about it because aiming to achieve goals with a partner or with a support group is more effective than going at it alone.

Whatever the diagnosis, trust your doctors.  They have your best interests at heart.

Many of my other doctors not among these photos, but much appreciated nonetheless.

Struggling

 

100 Years of the Philippines competing in the OLYMPICS

Social media is filled with photos and videos about the 2024 Paris Olympics with images of athletes then and now.  #OlympicGames #Paris2024

The History of the Olympic Games started in 776 BC when the Greeks began measuring time in Olympiads, or the duration between each edition of the Olympic Games.  This makes the Olympic games as sort of milestones.  The Philippines first competed in the Olympic Games in 1924 in Paris, making the 2024 Paris Olympic Games a historic milestone - our centennial anniversary of competing in the Olympics.

Philippine Olympic team wore the SINAG barongs depicting the Pintados warriors for the Olympic Games Paris 2024.  Who can forget weightlifter Hidilyn Diaz, the first Filipino Olympic gold medalist? Another crowd favorite is gymnast Carlos Yulo who is aiming for a gold medal.

Join us tonight as we discuss 100 Years of the Philippines competing in the OLYMPICS:

T1.  What major changes and milestones in the past 100 years do you think have made an impact on the Olympic games?

T2.  Imagine an alternative universe where you had the strength, speed and stamina to join the 2024 Paris Olympic games, what event would you compete in?

T3.  How would you prepare to qualify for the next Olympic Games to achieve your goals?

Rejection

 

Disrespect

 

Health and Work

This was me during the Dagan para sa Kahimsugan:

Fat.

Sweaty.

Getting old.

Struggling.

Caring too much.

Still too idealistic and naive.

Still vulnerable to getting hurt.

Am I losing my spark?

Is it time to pack up and give up?

Am I a hopeless case - using work as a clutch to manage my mental and emotional health, neglecting my physical and social health, always seeking to be relevant and to be of use and helpful but always ending up as "demanding, toxic and brutal"

Kung dati ang motto ay "habang may regla, may pag-asa..." now I have to hold on to the tagline "habang may buhay, may pag-asa..."

God will help me get thru these challenges, because if He leads me to it, He will lead me thru it.

BUCAS in Primary Health Care

Last week we discussed about problems facing healthcare workers on the job.  Tonight I would like to discuss the environment that healthcare workers are in nowadays.

The DOH opened its first bagong urgent care ambulatory service, dubbed as "BUCAS" in Sto Tomas, Pampanga last March 6, 2024.  DOH Secretary Ted Herbosa shared that the goal "28 for 28 in 28" is to establish 28 primary care centers to serve the 28 million poorest Filipinos by the year 2028".

In the Visayas, the first urgent care ambulatory service was a tripartite collaboration between the Cebu Provincial government (Cebu Provincial Hospital - Carcar City), the Department of Health Central Visayas Center for Health Development (DOH 7) and the Vicente Sotto Memorial Medical Center (VSMMC), aptly called SugBUCAS.   

Hopefully, this innovation will improve the health service delivery at the peripheral areas to streamline admission to tertiary referral hospitals for patients who need critical and intensive care, and to decongest these facilities of patients that can be managed elsewhere.

Primary health care focuses on education, nutrition, preventive medicine and treatment of the most common diseases and injuries as practical means of delivering health care to populations of poor economies and areas with scarce resources.  According to the Primary Health Care strategy following the 1979 Alma Ata Declaration, the eight essential elements of primary health care effectively integrates the health and social development aspects of the health system: (a) safe water and sanitation, (b) food and nutrition, (c) maternal and child health, (d) immunization, (e) curative care, (f) essential drugs, (g) health education, (h) traditional medicine, and (i) community development.  How are we faring in the implementation of universal health care with these developments and directions?

With the barangay as the smallest unit of healthcare service delivery with the barangay health centers, would the BUCAS be sufficient to provide universal health care to the Filipinos?

Join us tonight at 9PM MLA time on #HealthXPH as we discuss BUCAS in primary health care:

T1.  What do you think will be the impact of urgent care and ambulatory services in health care service delivery?

T2.  What else do we need to provide for these BUCAS facilities to succeed?

T3.  If you were a patient, what would be the indicators of success for urgent care ambulatory service facilities?

Heal

Learning how to accept oneself and the people who do not accept me.  It's okay.

How to Handle people who mishandled you

 

Love, Kindness and Respect

 Note to self.