Wrap up at PGH

I finished at PGH almost a week ago now and have since travelled to Cambodia and now currently in Thailand.

My last week at PGH was eventful- I had the opportunity to meet with the Secretary of Health, attend a meeting on the development of an electronic medical record for the primary care system, and wrap things up with my service team on the wards.

My list of things I've learned about healthcare at the Philippine General Hospital:

1. Patients are grateful for the most basic things we take for granted in the states- a conversation.
2. Many patients do not necessarily die directly from their disease but from the inability to pay for treatment.
3. Pulmonary tuberculosis, disseminated tuberculosis, ascariasis, and dengue fever are not uncommon here.
4. A case of intentional milk tea (Bubble tea) poisoning is possible.
5. The house staff are pay for many of their patients' diagnostic tests and medicines and do so willingly.
6. Filipinos are incredibly welcoming to all foreigners.
7. The filipino diet contributes to much of the non-communicable diseases here- heart disease, hypertension, gout, diabetes, and obesity.
8. Hilots, barangay health workers, and midwives are often the only healthcare provider in a 5 km radius.
9. As a low middle income country, there is much potential to augment the current health system via PhilHealth funding.
10. Having Dr. Antonio Dans as a mentor has reaffirmed my passion for underserved populations.

Here are a few pictures from my final days. Thanks to everyone who took the time to read :-)

Kyla <3

Weeks 2 & 3

Magandang gabi (Good evening),

I'd like to start out by giving a shoutout to the house staff at PGH- they are incredibly resourceful given the lack of manpower and medical supplies. Most of them are forced to pay out of their own pockets for their patients' lab work, imaging studies, and medications since the patients cannot afford them and the government hospital can't meet the demands. In return, many patients express their gratitude by gifting food (baked items, fruit, treats, etc) from their homes/food stands :-) The following picture was taken during rounds.

It's fun to view X-ray's old school style :P


















The past week and a half in Manila has been scorching (36 C), however I was fortunate enough to escape to Baguio City, which is a mountainous city in northern Luzon. Dr. Dans invited us here to work on the primary care white paper and also explore the city.

While working on the paper I learned a bit about the Barangay (neighborhood) health workers. These individuals volunteer from within their community to serve as the health care provider in provinces where doctors are scarce and often function as the sole provider in that area. The burden on these individuals to provide education and healthcare from only 5 weeks of basic training appears to be a tremendous task. For example, my attending on the medicine wards at PGH told us that oftentimes the Barangay workers are only equipped with UTI kits (urinary tract infection) and amoxicillin/penicillin. Because of this, many people seeking care for various ailments are not treated or managed appropriately. It is our hope that through the passing of the primary care plan, these health workers will get the management and support they desperately need.

Back at PGH, I met an elderly gentleman with end stage liver disease. He suffers from refractory ascites (build up of fluid in his abdominal cavity) that causes him to swell up, impairing his ability to breathe. Yet he was jovial and grateful to talk with me. I even asked him jokingly in Tagalog, "Meron ka po isang baby sa chan mo?" ("Do you have a baby in your stomach?), which he responded with, "oo pero hindi gusto mag lalabas pa" ("yes but it doesn't want to come out yet"). We both laughed. 

The dark areas are the result of his scratching from the intense itching that many people with liver cirrhosis develop. My observation with this particular patient was that most people seen here do not understand the extent of their disease and are oblivious to their prognosis. Ultimately, they die not because their disease isn't treatable but because they can't afford the treatment. Yet they are happy to see you and have the chance to be examined by you. My emotions are constantly in conflict between feeling happy to make them smile and sad that I can't do anything to provide an ideal solution for them.

I'd like to finish by saying W-A-R-R-I-O-R-S! The internet is terrible out here and I can't watch the highlights from last night's overtime win. But 3-0 okayyyyyyy dub nation!!!

'Till next time,

Kyla

(JB and I in the ER)

End of Week 1

Heyo,

My heart feels heavy for the people here.

A patient in his 50's suffered a heart attack (STEMI) however couldn't afford the proper treatment and instead received what he could afford- a statin and a beta blocker. In America, a trip to the cardiac cath lab for intervention would be immediate regardless of your ability to pay.

This man is one of the millions of Filipinos who don't have access to healthcare. I was shocked to realize that about 50% of the population will die from their illness without ever seeing a healthcare provider. The population as of 2010 is 92.34 million with about 70,000 registered doctors. This is equivalent to ~7 doctors for every 10,000 people (ideal ratio is 30 MDs per 10,000). The scarcity in healthcare providers is probably due to the fact that the Philippines is the largest exporter of doctors per capita (India is the highest exporter overall). Primary care doctors are especially scarce and the growing need is only getting more out of control.

I have become increasingly passionate about being a part of the primary care advocacy team headed by Dr. Antonio Dans. We will be traveling to Baguio City in a few days to meet with primary care doctors and present the blueprint. We hope to finish a proposal to present before next year's presidential election. The goal is for every Filipino to have a primary care doctor.

If this comes to pass, then Filipinos may not have advanced disease by the time they present to the hospital. Primary care and prevention can help to solve this and I'm extremely enthusiastic and humbled to be a part of this project!

On a lighter note, I visited my great-grandmother in Los Banos, which is about 2 hours outside of Manila. She is 100 years old and still has a BIG appetite and enjoys eating mangoes :-) She is under the care of my Tita Geser, who has dedicated most of her adult life to caring for her. I'm so grateful that she loves Lola Ising so much. It was really wonderful to see her and meet relatives for the first time.

As I become more comfortable with patients, I hope to be able to share more photos while in the hospital.

Thanks for reading :-)

Kyla

First Day

Good evening from Manila! Today was my first day of a 4-week rotation at the Philippines General Hospital (PGH). The hospital is the largest in the country and provides healthcare for Manila's poorest community members. Most of my day was spent meeting with my advisor, Dr. Antonio Dans, who is a trained cardiologist who decided to switch his focus to primary care 15 years ago. Talking with him was refreshing. He explained that he left his specialty after realizing the extreme lack of primary care within the Philippines. He is now a powerful advocate for primary care, medical ethics, and was also behind the sin tax, which doubled the tax on tobacco and decreased the number of smokers by a couple million. This resulted in funding for healthcare for the lowest two quintiles of Manila. I am planning to work with him in developing what he calls a "blueprint" for the implementation of a primary care plan for the presidential candidates for next year's election. Stay tuned for more on this.

I also had the opportunity to meet the residents and tour the hospital. Take a look at this shot I took with my point and shoot of a typical ward: 50 beds in an open room sans air conditioning.

I did not have the opportunity to visit with any patients today, however tomorrow is a new day.

Thanks for reading :-)

Kyla