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.
