Monday, May 25, 2009

homeward bound.

“It would be good to get away for a while.”

Perhaps that statement concretized what I felt upon deciding to have an off-campus elective in Iloilo City in the summer, in lieu of taking one within the four PGH walls that had housed me for the past three years. Not that I had grown tired of the green, green grass of old, but I figured that if I were to stay within the same four walls for the next two years or so, a change of scenery might be a welcome diversion. I wanted something different, yet something relevant. Taking an off-campus elective close to home was a tempting idea: Aside from the relative convenience, it would give me the perfect break I needed right smack in the middle of clerkship year. And it would definitely be, in itself, another unique opportunity to hone skills, acquire new knowledge, and survey the health system in the province.

I was homeward bound.

I chose to pursue my inclination for the intricacies of Internal Medicine at the West Visayas State University Medical Center (WVSU-MC) – fondly called by many as the “PGH of the South”, as most of the top honchos are themselves UPCM alumni. Living up to its name, the institution aims to be a center of quality health service in Southern Philippines, catering to a diverse population with patients hailing from as far as Mindanao. The analogy is palpable: PGH patients primarily represent the urban poor; those at WVSU-MC comprise mostly the rural poor – some from the far-flung, remote regions who must have deemed themselves lucky enough to have availed health services in the nick of time. And I realized that this will be a scene repeated over and over again throughout the country – the same indigent patients, the same bleak, wearied faces yearning even for just a shot of relief from sufferance.

Unlike the two massive wards of PGH-IM that served around a hundred, there was only one Medical Ward at WVSU-MC. There were no fancy callrooms, but a workstation that served both nurses and medical students. WVSU-MC can certainly pride itself in having fairly adequate facilities, but we got to appreciate PGH facilities more in a different light, as we once again turned to plain resourcefulness and clinical acumen when suddenly left without the aid of MRIs or DEXA Scans at the click of a finger.

The atmosphere was less contrived and more informal, which I guess can be attributed to the fact that it was so much less congested at WVSU-MC, allowing for ample breathing space and interaction. Without a language barrier and armed with a home advantage, we thought we had it all – but were quickly humbled upon discovering that there were some Ilonggo words we couldn’t quite fathom out (terms for “chest tightness” and “lymphadenopathy”, for instance.) Two weeks at the OPD and two weeks at the wards – with a smattering of ICU and ER exposures – taught me that, and much more. The daily morning endorsement rounds refreshed my rusty and decidedly modest knowledge of medicine, while exposing me to my first case of tetanus. The grand rounds, on the other hand, caused me to marvel at a case of Takayasu’s arteritis and learn all about basic pacemaker technology. Of course, nothing beats witnessing your first actual pleurodesis, plus the anchovy-like consistency of an amoebic liver abscess during ultrasound-guided aspiration.

Just like PGH, there’s no escaping TB and the stigma that goes with it. The whole gamut of afflicted patients remained at the fore – from those mistakenly-diagnosed via chest X-ray to those still taking meds on their ninth month. In the wards, pneumonia and stroke claimed the upper hand with victims ranging from GCS 15-ers to those on the brink of falling into coma. For those hovering along variable levels of consciousness (and prognoses), it amazed me how effective, empathic patient-doctor-family interaction can be palliative in as much as it is informative. There were patients who appeared jovial the first day, but suddenly turned up on the mortality audit the next day. It reminded me of the extreme fragility of life and the delicate role that we doctors play, akin to a tightrope. The first time I performed CPR on a patient who underwent cardiac arrest the third time, even science could not muster the courage to summon the whys and hows that dictated the circumstances surrounding life, death, and what goes on in between.

As elective period slowly rolled by, I came to believe that everything was all about realization and reinforcement. Realization, in the sense that how things run at WVSU-MC more or less strike a similar chord back at PGH: The kindly medical resident who offered to pay the lab fees of an ailing patient. The overworked clerk. Too many patients, not enough equipment. Reinforcement came with the resolve to pursue more knowledge, better skills, richer interactions. All the while trying to keep to heart the multifaceted characteristics of a five-star physician – a practitioner, educator, researcher, leader, and social mobilizer. Four weeks proved a short time for getting to know my own backyard well enough to run the mill; nevertheless it gave me a sufficient overview of how the health system works in a medium-sized urban community, 500 miles beyond the confines of the metropolis, one called home.

Because who knows, he may just find himself homeward bound yet again – and maybe yet for good.