Posts Tagged ‘community health’

I first met Edwin (not his real name) one Saturday in September 2011.  He was around 5 feet 4 inches tall but was all skin and bones that his slight mother could actually carry him with very little effort in her arms.  Bedridden, unable to talk, and with a nasogastric tube stuck into his nose, he did not present a very comfortable sight.  Edwin has SSPE, or subacute sclerosing pancephalitis, actually been living with it for the past two years.  He was then only 11 years old.  SSPE usually occurs at around the age of 9-11 in children who have had measles before the age of 2 or before they had been vaccinated against the disease.  It is a rare sequelae of untreated measles but it happened to Edwin.  His family lives in a single-room house in one of the most impoverished and least sanitary areas in urban Metro Manila – Payatas.

The medstudent organization of which I’ve been part of for the past three years is socially- and health-oriented.  As such, it is typical for the health coordinator to impart with us some of the community’s health-related troubles from time to time.  More often than not, the problem is usually public health in nature.  However, when the health coordinator quietly asked me to go with her that particular Saturday to meet a family with a special health problem, the first thought that popped into my mind was that I was going to meet a family with a bedridden elderly patient, most probably diabetic, hypertensive, or stroked out.

According to one doctor who wanted to volunteer his services by alleviating Edwin’s pain through acupuncture, Edwin was facing a <20% chance of survival.  Despite the helpful tone of his text message, the underlying question was, “Why are you wasting your time on that?” In all honesty, I do not know but, having met Edwin, having spoken to his mother who had been crying the whole time she was talking about the difficulties that came with Edwin’s condition, it is difficult not to “waste” some time on this.

Every time my orgmates and I would return to the community once or twice every month since then, visiting Edwin and his family became a routine.  He may not know any of us, not really.  I certainly was not a lot of help since I do not have money, connections, influence, or even the adequate knowledge to truly help.  But, for families struggling with a chronic disease, emotional support means a whole lot and can go a long way in lifting morale.

How did I get to know Edwin?  I never really did.  Maybe I never will.

Yes, I want you to cry at this point.  That is exactly my intention when I started writing this piece.

Most doctors tend to remember specific diseases by the signs and symptoms presented by their patients.  These patients eventually lose their faces and individualities in these doctors’ minds by the time these doctors’ have mastered those said diseases.  Of course, it is imperative for doctors to master diseases to be able to conquer them with effective treatment plans in the future.  However, perhaps we do a disservice to ourselves and to the faces that embodied those diseases by forgetting the patients who have taught us not just to be competent doctors but how to be human as well.  Those patients were not, are not, and will never be a waste of time.

 

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My mom noticed my dad on the first day of their post-graduate medical internship program. My dad swaggered into the room and unknowingly sat on a chair with a broken leg. Because my mother was a fair woman with somewhat Caucasian features, when he looked up, he immediately saw her. Later on, he pursued my mom relentlessly. Effort could have been my dad’s middle name.

My mom has a very funny story of how my dad used to make his moves. He told her one day he was going to take her to a posh restaurant for a dinner date. However, he claimed they had to pass by the college where his sister taught so that he could introduce my mom. When they got there, he introduced her alright but, when my mom pretended to look away, he quickly whispered to my aunt that he wanted to borrow money for his date! When they were already seated down to dinner in said posh restaurant, my dad gallantly ordered an expensive plate of pasta for my mom… and water for himself. Apparently, the money my aunt gave him was only enough for one expensive meal.

My mom still laughs whenever she tells this story. They married right after they passed the Medical Boards. He was my mother’s first boyfriend.

On their third year of surgical residency, they were earning less than Php 3,000 pesos each and already had three children, delivered roughly one year apart from each other. They decided to sacrifice residency and enter government service. It was a move borne out of necessity but my dad, I think, liked it. He was a passionate man. My mom used to say, albeit not too happily, that he was a man who firmly believed he could change the world. He served as Chief of Hospital in several district hospitals in a span of nine years. My mom, on the other hand, grew up kind of well off. She was a city girl through and through. She never wanted government service and never liked going to the mountains. She stayed as Municipal Health Officer of a mountainous municipality for close to twenty years. She, who had abhorred going to rural areas, pursued a Master’s degree in Public Management and in Public Health.

There is this theory in relationship psychology, which I firmly believe to be the foundation of any healthy relationship. It’s called Matching Hypothesis. On an extremely shallow level, of course, physical attraction still rules. However, on the level below that, outsiders would say that opposite personalities attract. But, for me, sharing the same set of beliefs, principles and values on a deeper level is what truly makes any kind of relationship work. There are certain non-negotiable values that we subconsciously look for in a partner or even just a friend. Perhaps because we know that we have to have that similarity in our belief systems for us to actually agree and coexist harmoniously. Or maybe because we know that a partner’s exemplary belief system could influence us to better ourselves. Or perhaps because we want someone who knows how to have a decent deep conversation because, come on. If you enjoy talking to a person, why would you not want to spend a lot of time with him or her?

But what do I know anyway? I’m, like, the most active fellow of the medical association, FSJAI – Forever Single, Just Accept It.

 

There are people who suck at teaching and I happen to be one of them.  Thus, my college degree in Biology, which usually leads its disciples over to the academe, is useless , making it especially hard to pursue any other career path except medicine.  Thus, ever since college and just like any other medical student, I have been constantly going over and over in my brain on what medical specialty I should pursue – the specialty that will get me hooked, lined and sinkered.  I realize that the specialty a medical student chooses says a lot about who he/she is, what he/she can put up with and what he/she feels strongly about.  Hence, the idea of choosing the wrong specialty makes me want to barf… violently, as if I have the worst kind of flu virus nature ever had the vindictiveness to, uh, evolve.

Choosing and eventually deciding on something involve a lot of factors, namely what you like, what you want, what you are good at and what you need to do.  But you know what’s unfortunate?  When you have one specialty for each of those factors.  Makes life all the more interesting, doesn’t it.

  • LIKE: Neonatology.  I am of the belief that most people in the medical field have a Messianic complex – the need to take care of individuals they consider weaker than themselves.  Babies, for me, are the ultimate weak individuals (either that or my biological clock is ticking, augh).  When I am in the hospital, I would stand outside the NICU for hours just staring at babies through the viewing glass.  It makes me happy, watching them sleep or try to turn from side to side or make goo-goo noises in their cribs.  But, when I turn around, the nurses at the station would be eyeing me, probably thinking who the crazy girl was and what she’s meaning to do with the babies she’d been looking at for the past hour or so.  This specialty shows exactly how soft a person can be.
  • WANT: Nephrology and Transplant Surgery.  I grew up watching a disease related to this specialty manifest itself in its worst possible form in a loved one.  Chronic renal obstruction secondary to staghorn calculi, bilateral.  It is a very debilitating disease – physically, emotionally and financially.  Perhaps there is this want to “fix” the person that means a lot to you as well as every other person who reminds you of her.  Nephrology is the specialty I am truly most familiar with.  However, some people learn through theory but, there are some, like me, who learn through experience and hand motion.  Of all the specialties I’ve ever considered, surgery, coupled with nephrology, are what I truly want.  This specialty shows exactly how selfish a person can be.
  • GOOD AT: Psychiatry.  Paralysis by analysis for the win!  This specialty requires you to be more of a listener and an elicit-er instead of an authoritative doctor barking out orders to your patient and to exhausted nurses.  Why Psych?  I feel that I can be good at this specialty because I like knowing where people are coming from.  I like figuring out what is wrong with a person.  However, a friend once told me that I’m not really that great a listener because I tend to interrupt a talker to give one (probably unwarranted) advice or another.  Notice the kind of supportive friends I run around with.  Plus, I doubt I would want to hang out with mentally disturbed people on a daily basis.  I’m already mentally disturbed enough as it is.  This specialty shows exactly how arrogant a person can be.
  • NEED TO DO: Community and Public Health.  Remember what I said about Messianic complex?  Studying medicine is a privilege.  Thus, because we have the knowledge and the skills, we cannot just use it solely for our own financial benefit, although of course earning should still be a primary consideration in our careers.  Still, we must allow a large majority to have access to the services that we are more than capable to provide.  Community and Public Health is an advocacy and a commitment… and pursuing this as a specialty, well, kind of  scares me (to death).  I’m still thinking about it.  This specialty shows exactly how cowardly a person can be.

Some people say that medical students should wait until Clerkship Year before truly deciding on a specialty because rotating in the clinics and being immersed in different medical situations will allow you to truly weigh your options.  However, there are many others who say, no BELLOW, that we should be choosing a specialty now so that we can focus our energies on building up our knowledge and skills especially for that specialty.

What they don’t get or probably don’t remember is that deciding on a specialty is like deciding on marriage.  Heller, you’re going to have to wake up to that specialty for the rest of your life!  Does that not sound like marriage to you?  Does that not sound scary to you?  Don’t push now, dude.  Let us take our time.  We have a year until Clerkship Year.  Oh, jeez, a year sounds so freaking short.