“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.
