International Child Health Section: Articles
Cagayan de Oro City, Philippines, July 1-27, 2008
Submitted by Dianne D. Lim
The air was warm and the city was bustling even in the early morning. Being a Filipino myself, I came equipped with knowledge of the people, the culture and the language. Coupled with the financial support from the Hillman International Health Grant, this gave me an edge on my international jaunt.
Cagayan de Oro City, the city of Golden Friendship, sits in the southern Philippines. It has a population of 12 million and boasts 12 hospitals. Two are run by the government: Northern Mindanao Medical Centre (NMMC), serving the province of Misamis Oriental and JR Borja General Hospital, which primarily serves the city. I was based in the former which is the main training hospital, with a full complement of paediatric subspecialties. Its catchment area included four nearby provinces.
Infectious disease accounted for the highest mortality and morbidity in the paediatric and neonatal units. Quite expectedly, malnutrition and nutritional deficiencies were common. Infection and malnutrition made treatment more challenging and the outcomes more tragic. It was interesting to see pellagra and several full-blown Kwashiorkor patients.
In the different units, I observed varying degrees of hand sanitation and safe hygiene practices. It was not common practice to wash hands and clean stethoscopes between infectious patients. There was lack of gowns, masks and gloves in the NICU as with the rest of the units. Gowns had to be returned to the bin so that they can be reused. Masks were kept by personnel for the duration of their shift.
During my rotation, I attended the inauguration of the new NICU in the NMMC. After much advocating, the department of paediatrics moved from a 3-cubicle NICU to a 3-4 room modern unit with improved ventilation and facilities. This was a great relief after seeing packed cubicles with cloth curtains separating neonatal resuscitations, ventilated babies and the septic areas.
As with anything in life, there are similarities and there are differences. There are also things that stand out. I was struck by the dedication of the staff to teach and mentor the trainees. Staff members were also quite accessible at all hours to assist and support trainees. They communicated mainly by cell phones. Information including patient updates and laboratory results were communicated by SMS messaging otherwise known as ‘text messaging’. While it effective with fewer disruptive rings, privacy and confidentiality are potential issues. It was remarkable to learn that they had phased out pagers eight years ago!
As well, I saw no lack in talent, zeal or dedication on the part of the trainees. What was quite apparent though was the feeling of futility and inadequacy in managing the sick child given their lack of resources. Technically, residents acquired great skills by virtue of the sheer volume of patients and the workload. They perform multiple IV insertions, blood extractions, lumbar punctures including intrathecal chemotherapy and bone marrow aspirations on a daily basis. I had the opportunity of doing not only IV starts and phlebotomies but also outpatient chemotherapy including IV cytarabine and vincristine.
During my stay, I reflected on issues that plague trainees both here and abroad, and there are great differences. Residents struggle with finances (salary: CDN$680/month), the workload (only 9 residents), service to education ratio, the on-call schedule (1 in 3), research requirements, interpersonal and professional relationships with patients, their families and colleagues, while trying to balance work and personal life.
In Canada, we are blessed with resources. In the Philippines, there is no formal organization that advocates for trainee work hours and benefits. They get what is dictated by the government service. Scheduling is a tightrope walk especially during sick calls. Residents are expected to put work first and value training over personal life.
However, despite these, the residents I worked with have a zest for life and a passion for their call to uphold health and life. They work hard and are grateful for the opportunity to be in the medical field. Off work, they socialize and take trips as a department. Their conferences have full course meals (even at breakfast!).
There is still a great need to advance the health of the Filipino child. The issues I saw when I left over a decade ago remain current. The decline in economy and the rising cost of living has pushed medical needs even lower in the family’s priorities. The NMMC department of paediatrics envisions itself the centre for wellness and excellence providing quality healthcare for the youngest of society. It would be an honor to be given the opportunity to return and be part of their vision.
With this experience I believe I am a better person. I am grateful for the wealth of resources we have at our disposal. This spurs me to take advantage of the multitude of opportunities to equip myself for future practice and for future collaboration with international physicians like those from the Philippines. I am interested in promoting safe medical practice for the young child.
Posted: October 2008
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