What you don't know about the goings-on in our public hospitals... 10/26/2010 12:21:00 AM

Let me add some of my impressions in the midst of the big issue on the RH Bill...
While I was a medical student five years ago, I rotated at the local regional government hospital for a total of 15 days. Though I was there for only a short period of time, I came to the conclusion that there is no need for any further legislation (i.e. the Reproductive Health Bill) regarding the use of contraception or sterilization. The mechanism is already in place right at this level. 
As soon as an indigent patient is brought to the delivery room,and subsequently advised to undergo a second caesarian section (or succeeding thereof), one is immediately advised to have a bilateral tubal ligation as well and then wife and husband are asked to sign a consent form. I observed this to be the standard operating procedure. No further explanations are made to help the patient in labor pains to come to an informed decision. I guess the few staff around were too busy attending to more patients coming in that giving said patient all the information she needs such as explanations of what to expect, pros and cons, including possible side effects (i.e. ectopic pregnancies in the blocked fallopian tube) would take too much of their time.
I was completely appalled when one mother about to have a third caesarian section was berated and bad-mouthed by resident physicians, nurses and midwives for deciding not to have a bilateral tubal ligation at the same time, what is known as C/S + BTL in medical parlance. The said patient was already crying (from the emotional barrage and the pains of labor) but firmly stuck to her decision. The husband was also unwilling to sign the consent. I decided to whisper to her to be strong and stick to her choice. The residents gave as reason that there are usually a lot of adhesions (Aren't there surgical SOP's done to prevent this from happening?) and when the the next caesarian section is done, the procedure becomes technically difficult. A good enough argument, yet are not doctors supposed to honor the patient's decision (without coercing her to change it by emotional abuse) and render their expertise with competence? If the uterus thus becomes so scarred after having been cut open several times as to render it diseased, hysterectomy thus may be performed without violating the bioethical principle of bodily integrity. I know of several persons who have had multiple caesarian sections (one had at least 7) and may have had difficult deliveries but mother and children come out fine, thanks to medical advances and the proficiency of attending OB-GYNE's.
My personal experience with conscientious objection to assisting the OB-GYNE resident in performing a bilateral tubal ligation after doing a caesarian section was met with rolling of eyeballs and snide remarks in the operating room. In other circumstances, it might also mean a few more days rotation within that department (serving an extension, as we call it) or other such sanctions. With the passage of this bill, I pity the young aspiring doctors who want to be consistent with their faith and ethics who would now be faced with large fines and/or imprisonment for such actions. 
At the out-patient services department, mothers who have at least two children are at once instructed on the different methods they can avail of during their first post-natal check-up. There is bias for artificial contraceptives, of course as all manufactured products have shelf lives and need to be disposed of as soon as possible (not a few of these contraceptive devices are surpluses from elsewhere). Anyway, in medical school there is little mention of natural family planning (NFP) which is always mentioned while dismissing it as "highly unreliable". I wish they also gave us time to learn how to teach these methods to couples as part of our medical curriculum, in the same manner that they teach us to write prescriptions for artificial chemical contraceptives or show us how to insert IUD's in medical school. In that way, there would be absolutely no bias for those wanting to go in this specialized field of medicine to just write down a prescription rather than take time to explain a method.
It also seems that government hospitals may also have a certain quota for sterilization procedures as one friend of mine noted that during an endorsement, the chairperson of the department of obstetrics and gynecology queried her residents regarding the fact that their census for said procedures had gone down for the month. They did not know that it was thanks to the way my friend tactfully and slowly explained to the mothers in the delivery room NFP and the value of openness to welcome another life even in the midst of poverty: Not another mouth to feed but two more hands to help.
As you may have well guessed, I am totally pro-life and uncompromising with regards to my Catholic Faith.

Wala Na ang Narra! 10/24/2010 02:50:00 PM

Ang karaan nga kahoy
Dinha sa among eskina
Kahugnu-on na
Mao nga
Gi-putol-putol na
Ang mga kara-ang sanga
Dili na mag-silbi
Nga padayung mag-tubo pa
Wala na ang narra.


Can I Reach You? 9/12/2010 05:45:00 PM

Can I reach you

Where you are

And remind you

Of the heart

That wants to care

For only you

I want you to come back

I want you to be here

Look me in the eye

Tell me you are fine

I promise we will talk

Recover what we have lost

Tomorrow will be much better

Than yesterday or today

Tomorrow will be much better

Than yesterday or today



Turning 30 9/04/2010 05:51:00 PM

Milestone to remember
Page in my book
Turn of the road
One more
Event we can toast
One more
Reason to celebrate
Even if
Mistakes have been made
Even if
I have my ups and downs
I am
Looking forward to tomorrow
I bear much
Hope for things to come
Each day
Serves as a brand new start
I thank
The Highest Power
I thank
Those whom I love
I forgive
Those who have hurt me
I forget
All those past hurts
The day
That I turn 30

Damgo Ning Rosas 7/29/2010 01:23:00 PM




Katapusan nimong


Nagabilin nganhi kanamo


Malipayong pagpangalandom


Ni-aging panahon.



TBR v.2 Round-up: All I Needed to Know, I learned in Kindergarten (or Nursery, or Pre-School) ... 6/14/2010 03:00:00 PM

Alright, class! Place your cursors over the underlined phrases and click on the corresponding links!
Here's the latest in a cornucopia of memories in The Blog Rounds v.2's Back-to-School Edition:
Gigi gives us a few acting tips as she recalls her time to shine on stage.
Sonia reminisces on her kindergarten teacher, classmates and "accidents" way back in the second year of kindergarten.
J.A.(yours truly! ) travelled back to her days of informal schooling at the school owner's own home.
Thanks for the participation, everyone! Here's to looking forward to more entries in TBR v.2 round-ups to come!

rAdIoLoGy NoTeS 29: CODE RED! 6/14/2010 04:44:00 AM

I thought is was the beginning of another lazy Sunday duty, the only highlight of which would be installing the newer printer to the older computer in the panoramic x-ray room (which also serves as the resident's makeshift office/quarters), when we got the call:

A busload of mostly Iranian nationals headed towards Balamban had fallen off a ravine.

I braced myself for the busiest duty of my residency so far while the non-duty senior clerks, PGI's and residents were being called back to the hospital. The minor OR was opened for the patients to be accommodated. I also heard that they opened the hospital boardroom for the use of the Iranian ambassador.

The junior resident on duty with me chose to stay in general radiography, while I took on the task of generally giving preliminary readings at the CT-scan. (Our MRI is closed on Sundays, and the attending physicians decided to do CT's in the meantime because of the time element).

There were several fractures, a few suspected spine traumas, but no major brain injuries.

There was the toddler who was with a senior clerk the whole time as the mother had died, the father was still being transported and nobody could tell us the little girl's birthday (the techs decided to just estimate the age since they could not log the patient).

The surgical service thought a now unresponsive young woman had a brain injury, but with an unremarkable CT-scan of the brain as well as the visible abdomen, the diagnosis was changed to hyperventilation/hysteria vs. an electrolyte imbalance.

We heard the story of how one ophthalmology resident in another hospital had the presence of mind to remove himself from the vehicle and climb up the ravine by grabbing on to a few shrubs to finally reach the highway. He was the first patient airlifted and transported to the hospital.

We had to call the radiology resident on duty at another hospital to clarify findings on the CT-scan of a just-transferred patient (their institution and our institution now print on thermal paper which is insufficient for diagnostic purposes) as well as exchange news about the cases here and the badly injured radiology resident who was still at their institution.

The thing that struck me the most was that not a few of the people injured or dead and the relatives and friends around them were those I see from time to time in the hospital as they were also in the medical field.

Total death toll (as relayed by the surgical residents): 22 (mostly those seated at the front of the bus), including 1 who just finished residency in orthopedics at the local government hospital, 1 doing residency in nuclear medicine at our hospital, 1 doing residency in pathology at our hospital and 2 doing residency in radiology at our hospital and other sister institutions.

One of the radiology residents who died was rotating with me in the ultrasound section for this month.

As one of the orthopedic surgeons said, "It becomes an entirely different story when those involved in an accident, injured or dead are people you have work with or know." The week before, he had been assisted in the OR by one of the fatalities who had just finished his training in orthopedics at the government hospital. A few consultants were at the hospital looking for the whereabouts of their Iranian residents.

The department received the last patient for imaging at around 1am. By early morning though, we still had to endorse some clarifications regarding imaging for one patient to the incoming radiology resident on duty. There is a plan to transfer all of the injured patients to our institution and have them occupy a single wing of the hospital.

In the end, I never did get to install the newer printer to the older computer... I will have to do that during my next weekend duty.

Life does have unexpected twists. We just have to be ready for any eventualities that come our way, including the end of the road at the next turn.

* In memory of the deceased, and in solidarity with those injured or in mourning.

ROUND UP DELAY! 6/13/2010 02:29:00 AM

I have so far received less than five entries to this weeks editon of TBR v.2 thus I am planning to delay posting the round-up til June14 9:00 PST (Philippine Standard Time). So what are you waiting for? Post the link to your entry as a comment here or email me: jaaraf@yahoo.com

@ the Perez's House 6/11/2010 04:46:00 PM

The house was located just inside the compound behind our parish church. My mother would drop me off in the mornings and I would be introduced to the multi-sensory wonders offered by the Montessori method of teaching. Everything about it was informal. Mdm. Perez and one or two assistants served as teachers. There were no uniforms. The living room was a makeshift classroom. There were few student, probably ten or less, including one very naughty boy who happened to be Mdm. Perez's son. This was to be expected of a school that was just starting out. At that time, the school didn't even have a name. I never received a report card either.
I can't quite remember all the lessons. I do remember my impatient self grabbing another student's work and attempting to finish it myself when I realized he wasn't quite halfway through with what we were supposed to do. At times I still have to stop myself at feeling impatient when someone I am teaching things to doesn't quite get it, and hold back the tempting thought of doing someone else's work myself.
Later on, the Montessori school transferred just behind the gasoline station nearer to our house. My next two younger siblings went there. I was always still welcome there in my early grade school days. Sometimes, when I didn't have classes, I was allowed to sit in on my younger siblings' lessons. It was there that I learned to wholeheartedly accept differently-abled children who were in my sister's class.
Whenever asked for the list of schools I attended, I would never include in the list the informal early childhood education I had in the Perez's house (which did not even have a name at the time I studied there). I believe though that earning at that informal environment enabled me to develop a lifelong love for learning and wonder at discovering new and better things each day as well as a better understanding of persons we may consider so different from us at first glance.

All I Needed to Know, I learned in Kindergarten (or Nursery, or Pre-School) ... 6/03/2010 07:04:00 PM

Here's my call (quite a few days early!) for submissions to the upcoming TBR v.2 edition I am hosting on June 12, 2010.

It's that time of the year when school-aged kids all over the country are getting ready to step into the classrooms for the very first time.
Let's give a salute to early childhood learning!

What were your experiences (or earliest memories) in pre-school/ preparatory/ nursery/ kindergarten? What do you recall of classmates and teachers at that young age? If your first forays into the academic world happened in the 1st grade, who taught you your ABC's and 1-2-3's before that? What were the serious or amusing life lessons you learned between the ages of 4 and 6?

Deadline for submission of entries in on Friday, June 11, 2010 at 11:59 PM PST (Philippine Standard Time).

I promise to post the round-ups by noon of the following day, God-willing.

rAdIoLoGy NoTeS 28: Hostia Mania 6/03/2010 07:00:00 PM

After chancing upon the on-duty radologic technologists leaving their area in order to have a meal together for the umpteenth time, the chief radiologic technologist had decided to feed his beloved staff some pieces of unleavened bread. These happened to be discards from the host-making process, given to the techs in the hope that they would be "transformed into angels" (roughly translated from-> "ma-anghelan unta"). This lead to a widespread, inevitable attack of the munchies for all the department staff (radtech interns, medical interns and radiology residents included). Variations included dipping the fine morsels in peanut butter. Discussions on the virtue of picking out the smaller melt-in-your-mouth pieces to the wider slabs worth a couple of mouthsful and the merits of some heavenly sprinkling of barbecue or cheese-flavored powder ensued. Needless, to say, the unblessed host seems to have no significant effect on the staff as demonstrated in the following photographs: There was half a plastic bag-full of stale left-over pieces left during my last hospital duty which I promptly took home for my mother to make some bread pudding from.

rAdIoLoGy NoTeS 27: On duty, plus 1 6/03/2010 06:46:00 PM

We now officially have a pre-resident who will start middle of the year, and by default, since I am the most senior resident still going on 35 hour duty, she is going on duty with me. It's an adjustment as I have been used to doing things by myself, and now I have to do my duties while teaching someone else to do my work. It takes twice the time working in a pair as opposed to working on your own. Then, there is calculating how much I should demand vis-a-vis knowing the limits of skills and knowledge I should expect of her. It helps though that I have known her personally for the past 13 years and we have been casual friends since then. No more surprises, I guess... Then again, the line between friendship and being one's senior in residency training also has to be drawn somewhere...

PDA 6/03/2010 06:44:00 PM

Note: An old poem, a cautionary tale, with a true-to-life basis, no other details to be provided.

Pero Dili Angay

Tu-ara didto
Nagtapad si Dodong ug Inday
Pa-sweetums nasad
Sa may ngit-ngit na dapit

Alas otso na ba?
Uy, mangatulog na sila
Naglatag ug banig
Nanghigda nga nagtupad

Nag-gaksanay man and duha
Nagbukot na sa habul
Maayo unta kung sila ra
Pero daghang mata man ang nagatan-aw

Si Manang, wa katingog
Bahin sa iyang nasaksi
Unsa-on man, pulos nga naghagok
Wala na gyud siya’y mahimo

Kalu-oy ni Tiyo
Nangadlawon na lang, wala pay katu’g
Gibantayan pag-ayo ang duha
Haron walay da-utang mahitabo

Maayo nga day-off sa demonyo
Walay dautang nahitabo
Siguro gitawag na ni Tiyo ang tanang santos
 Haron maluwas ang duha ka espiritu

Sus, pagkabuntag, nangamata
Mura’g wala lang sa duha
Wa’ intawon kamatnon sa “gamay’ng gubot”
Nga sila ma-oy hinungdan

Wala na lang gi-badlong ang duha
Ma-uwawan man lang gud sila
Sa atubangan sa uban pang ta’o
Busa nagpatuyang gihapon sa ilang gibati

Apan, dili g’yud angay
Ang gibuhat sa duha
Dili g’yud maayong makit-an
Ang ining-atong pagkahimutang

Siguro, maayo nga wala nay lain pang
Nasulti tungod adtong butanga
Kung naa pay gisulti si Tiyo kanila
Ay, mausab na ang akong isturya

- ju-ju -

rAdIoLoGy NoTeS 26: Seniority 1/24/2010 02:37:00 AM

I got a taste of what it's like to be the chief resident last week when our chief resident decided to take a few day's leave. I had to leave all my work and follow the most junior resident at her post.

The worst was when I had to get back to the hospital at two in the morning under the pouring rain to read an icu patient's abdominal ct-scan. It's a blessing that I live just a short 5 minute ride (or 8-minute walk) from the hospital where I work.

Going on duty is so much easier than being on call...

Kining Bao 1/24/2010 02:30:00 AM

Kining bao

Nga nagatago sa suok

Dinhi sa amoang grotto

Kontento ba kaha

Sa ginagmay nga dahon

Na iyahang pagakan-on

Salin sa utan-monggos

Na ihagis kaniya?