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!

Time management for healthcare workers

Time management for healthcare workers

Instant culture.  Today's culture is filled with technological innovations that make processes faster and make communication easier.  Food is now instant - processed to be prepared simply by adding hot water, coffee three-in-one, ready to eat home-cooked meals packaged in tetra packs or cans, fast food restaurants have replaced bed and breakfast facilities.  What used to take a whole day of doing laundry from soaping, scrubbing, rinsing, bleaching and starching, hanging and drying is now completed in one hour by a washing machine and drier.  This frees up women to pursue more loftier goals and careers.

Instant communications.  Unfortunately, with this "instant" culture, even our relationships become instant as well.  Interactions become superficial.  People often run off to do a gazillion things with so limited time.  What happened to the time that machines like washing machines saved for us?  We need to create new machines that make other work for us in an instant.

From the time when Morse code and telegraphs were the main means of communication, we went on to telephone lines and cellphones until now we have wireless web-based communication, complete with video conferencing.  Social media enables communities to interact globally at real time. It is now easier for overseas Filipino workers to communicate with their loved ones in the Philippines.

Does anybody send handwritten letters through the post office anymore?

How does this instant culture and technology impact the way we interact with each other?  A lot of material on social media show families and friends sitting at a table with noses stuck up in front of their mobile phones looking through social media.  This defeats the purpose of bringing loved ones close together when we can't even sit down and talk face to face.

Healthcare workers.  How do handheld mobile phones with internet access and social media apps affect how healthcare workers interact with patients in the clinics, in the wards and in the treatment rooms?  During the last tweetchat about barriers to physician-patient communication, time management was one of the identified barriers.  Healthcare workers are always on the run, always in a hurry, with no time to sit and really listen to patients.  I googled and found that there are a number of materials online that give tips on time management for physicians.

So how come with all the technological advance that make processes faster, and improve communication, time management is still a barrier to efficient interaction with patients?

What activities consume the time of healthcare workers?

How would healthcare workers more efficiently manage their time?

How can technology help healthcare workers manage their time more efficiently to provide more time for patient interaction?