filipino birfday baby!

my life will never be the same again! one of the pediatrics residents in the hospital invited tim and i to her son aaron’s first birthday party! it was held on the top/10th floor of the nicest hotel in tacloban. there were even signs outside indicating “this way to the best party ever!”. inside the elevator was what seemed like a plastic robot, which was impressive. but then we realized he was a person painted like a robot, being paid to act and dance like a robot in the elevator! by about floor six on the ride up we could start hearing the bass pounding. upon reaching the top, we were greeted by a room filled with streamers, person-sized mickey mouse balloons, and memorabilia from aaron’s first year of life, along with dozens of rambunctious toddlers and children and their parents. the highest concentration of morbidly obese, spoiled kids i’ve ever seen - like maybe this is what they are doing every night is going to these parties. they’re definitely not walking the streets of the tacloban i thought i knew. aaron was dressed in a tuxedo, wearing a red bowtie, completely ambivalent to anything occurring around him.

the festivities began of course with a prayer, quickly followed and perfectly juxtaposed by two clowns gyrating sexually to “talk dirty to me”, which obviously had to be loud enough that they could hear it in manila. the clowns continued gettin it down to a few more r&b songs themed around bootys; toddlers clearly in awe. then, some hired musicians came out to take it down a notch with some popular valentines-themed pop songs aimed more at the adults. parents could jump in kareoke style if they’d like. then, it was food time: a lavish buffet with three types of pork including the necessity at every filipino party: lechon - crispy-skinned spit fired suckling piglet. waiters brought around soft drinks on gold-plated platters that were guzzled by the morbidly obese young partiers. a chortling metrosexual wearing a wizard’s hat and a suit who was clearly hired for his infectiously incessant machine-gun-style laugh took the stage for jokes, and to referee a bunch of games for the kids. also ones for the adults, including one for tim and i, who, as the visible minority “guests”, raced to drink large baby bottles full of grape soda while wearing bibs. they brought around cupcakes. there was a magic show that lasted for over an hour. it involved fire. they brought around more desserts. there was confetti falling from the ceiling. multiple types of chocolate things on sticks were coming from somewhere. kids were drinking sugared juice from special-produced bottles with aaron’s likeness on them, with an ingredient list that read “cute: 100%, precious: 100%”, etc. the round kids were helping themselves to more chunks of dripping fat off the roast pig. there was a game where the parents got to jump in a free for all to reach expensive toys that their children wanted that were hanging above them just out of reach. everyone got huge plastic 3-d mickey-mouse heads that were filled with candies.

aaron, your parents got a new mortgage for this party; sure hope you enjoyed it!

pediatric inpatient medicine – eastern visayas regional medical center

we spent half our time in tacloban at the regional tertiary care hospital – i spent the time in the pediatrics ward. interestingly, pediatrics in the philippines is the most challenging and draining rotation for medical students and residents, with malignantly harsh professors and the strictest of expectations. this is in sharp contrast to the general culture of pediatrics in the west. we had to sign in and out every day to make sure we were there for all of the required hours. the interns work 32 hour shifts every third day (q3 call) without any weekends or breaks, which is insane. we did these overnights sometimes but thankfully they didn’t make us do them every three days. then, in the morning, the young doctor’s verbal presentations were picked apart and absolutely destroyed by the attending physicians and director of the department, often with unveiled and unnecessary personal insults.

and this was one of the least sad things about the pediatrics ward. the place was grossly underesourced. not a single person used gloves the entire time i was there. there were often 10 or 20 patients and their families in a room, and privacy was nonexistent. when a patient died the family would be told and left to mourn in a room full of onlookers. while technically there is a government payment scheme that most in the area belong to since being struck by the typhoon, not evrything was covered. little things like caps for intravenous catheters or bigger things like certain drugs had to be purchased by the parents outside the hospital. in the pediatric intensive care unit when babies went into respiratory distress (which happened on a daily basis) they asked the parent if they could intubate. sometimes the parent refused, and the baby promptly died. the parent almost certainly said no out of ignorance or misunderstanding. in the west, lifesaving interventions for children are done even if the parent does not give permission. in tacloban when the parent did give permission the patient was intubated, but there were no ventilators. so the parent was expected to manually ventilate their child with a bag. no one from the hospital staff had the time to relieve the parent, and often there was no support to bring them food or water. so what would typically happen is that the parent would bag nonstop for 24 or 36 hours without food or water, and then give up, and the child would die. completely preventable deaths. and this happened almost every day. it is terrible.

one interesting program at the hospital was for rehabilitation of malnourished children. the program was funded by unicef. one mother brought in her infant who was obviously starving to death, and told us that she had been feeding him exclusively watered-down rice water since birth. the program pays for children like this to stay in the hospital until they are deemed rehabilitated enough to return home. the problem is, the issue will undoubtedly recur when the patient does go home. the family only earns a dollar or so a day and has 11 other children to feed. even the parents were subsisting off just rice. it’s a rough world when you don’t have resources. i suppose that is the moral of this story.