A ‘healthy’ ecosystem

DURING MY fourth year as a medical student, a local documentary was aired and caused a bit of a stir in the Philippine General Hospital. It was a short piece that depicted the hospital as one that sends away patients without having done proper clinical management. It presented case after case of patients and their struggle to receive proper healthcare service from PGH, only to be disappointed because it could not be given to them for one reason or another.

Searching for the video online, I was actually quite surprised to find comments to the same effect—disappointment and even anger for what PGH did or did not do to patients.

At the start of my internship year in PGH, during one of my duty rounds, I came across a patient with a chronic case of cervical cancer. A companion of another patient approached me so that I could attend to the woman, who was crying out in pain. In addition to her pain, she was starting to smell, and given that she had only her young son with her, no one else could see to her immediate needs.

After attending to her, I studied her chart and conducted some interviews to learn more about the woman and her situation. She was a terminal case and was already considered for palliative care. I also learned that her husband had left her and that she had no family because her siblings had abandoned her. All she had was a few thousand pesos that she thought would be enough for her treatment at PGH. But she found out that it was only sufficient for some diagnostic tests and a few medications.

The woman was initially admitted into the wards because the medical team attending to her thought that surgery could still be an option for her treatment. However, it was later found that, based on preoperative diagnostics, surgery was no longer an option because the cancer had spread to different organs.

She was supposedly going to be sent home for palliative care, except that she had no home to go to anymore. The house and all the family belongings had been sold for money for treatment. Her young son was no longer going to school because no one else could take care of his mother in the hospital. The patients beside the mother and son in the ward and their families were kind enough to give the boy some food every day and some money for water since the hospital’s food allotment is only for patients.

I explained the woman’s situation to the nurses, and they were kind enough to give her some extra time and attention despite the many other patients they had to attend to. I also spoke with the fellow in charge of her case, and he was compassionate enough to find some free medication that could be given to her. I remember talking to the fellow from palliative medicine on how to better manage her needs. He took time to attend to her and write down detailed orders for her despite the fact that he was the only palliative fellow in the hospital and had to attend to a myriad of patients.

I also remember approaching the Medical Social Services staff and discussing ways on how to aid her financially. And they were kind enough to explain to me what they had earlier done for her and how they could help regarding the new medical orders on her chart. I remember as well talking to the patients beside her and how one volunteered to take care of her son should she pass away, if no one else would take him.

It was at this time that I saw that the hospital I was in was not just an institution. It was also an intricate ecosystem of people who had adapted to the challenges and struggles they were faced with because they all wanted the same thing: to survive and to help others to do the same in the process.

Entering PGH, one does not see in plain sight what life in it is really like. It’s often masked by the antiquity of the buildings, the chaos that happens in the emergency room, the noise inside the admitting section, and the limited number of patients accommodated by the outpatient department per day. But I have been fortunate to see beyond all this while training to be a doctor. I have seen the hundreds of doctors who painstakingly give their blood, sweat and tears to PGH in order to serve the Filipino people whom they know have allowed them to train here. They give, not just their time, but sometimes even their own money for patients they know have far less than they.

I have seen the efforts of the nurses and paramedical staff who, without question, give so much of themselves and sacrifice opportunities in order to serve at PGH, when the lure of convenience and money calls them abroad. I have seen how they manage the limited resources in order to serve all the patients under their care despite the nurse-to-patient ratio being so high. And I have seen the hundreds upon hundreds of heroes we call the “bantay” of the patients, who do the work that remains to be done when the medical students, nurses, doctors and staff can no longer attend personally to each one.

Disappointment with our health situation is understandable, especially when we compare ourselves to countries with far better services than ours. In our training, we have learned the ideal medical practices from advanced countries but, more importantly, we have also learned how to apply those learnings to our setting and with our patients. I have learned to do budgeting with residents and the families of our patients as we assessed how much they had to match the costs of treatment. I have learned the value of justice and equity, as we scrupulously budgeted the available resources, to give needles and syringes and fluids to those less fortunate, the ones who needed these the most at that moment.

The Philippine health situation, reflected through our government hospitals, is not perfect. But what I have learned in my training is that while we strive and continue to try to attain the ideal, we do the best we can with what we have been given. And I believe that means a lot, especially to the thousands upon thousands of people who soldier on just trying to survive and somehow help others do the same. I am thankful that I have had the privilege to train in this setting. Call it loyalty. But at the end of the day, this was where I have been placed and through it I have been taught the wonderful privilege of what it means to be committed to serve the underserved.

Opinions aired, such as those in the documentary, or those of other people disappointed with the healthcare they have received, cannot be avoided. Everyone is entitled to their opinions based on their own experiences. But if you look a little closer, you may just be surprised to find in PGH’s old buildings, noisy ER, or crowded outpatient department, a healthy ecosystem of people wanting the same thing—to survive the struggles of life and help others do the same.

Pamela Valera, 29, a 2015 graduate of the University of the Philippines College of Medicine, completed her internship in PGH.DURING MY fourth year as a medical student, a local documentary was aired and caused a bit of a stir in the Philippine General Hospital.