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.

where running gets you fish slapped

running in the philippines: just say it keeps you on your toes. while filipinos generally leave you alone when you’re walking down the street, for some reason they enter a whole new mode of interest when they see a white man running down their street. one is suddenly peppered with questions including “whats your name?” “where are you going?” or “why are you running?” also, comments such as “you’re so handsome," and the classic “f—k you” and “fight me”. for some reason some shout with the intention of startling you, even when you are two feet from them, usually “whoa," “hey” or “uhhhhghh”. i don’t really know what to make of it. sometimes people will intentionally stand in your way. in terms of the ladies – some giggle, some wave, and many cover their faces like stefan on saturday night live. but most of the time one is met with just incredulous stares, as everyone completely stops whatever they were doing and watches you pass. virtually no one ever acted normally when i ran by.

even the drivers of cars and buses stare. one time, i was very slowly passed by a brand new beamer. you would think the driver of a new $50 000 car would probably be worldly and educated enough to know what a running caucasian looks like, right? well, all the black-tinted windows got rolled down. they turned around and slowly drove past me again, all staring as if i was the most exotic specimen they had ever seen. 200 meters down the road they turned around yet again for yet another pass. another time an oncoming bus pulled over in front of me, and stopped. bus driver was staring. it was right on the edge of the shoulder, and i thought he was going to start driving again, so i was forced to run through the tall reeds along the side of the road. well, turns out no one was getting on or off the bus – he had just stopped so he could have more time to stare at me running.

drivers in the philippines don’t know how to deal with runners either. i run opposite to traffic, and they hug the shoulder to the inch without budging, forcing me into the ditch on numerous occasions. i have no clue as to why they love being within an inch of the shoulder so much. some even swerve to hit. and they always honk.

my favorite responders are the kids. usually they get super happy, yelling “hi!”, and often running alongside for a few seconds, sometimes even for considerable distances. always good for a hi-five. but even some encounters with kids are less than joyous. one boy about ten years old was carrying a bunch of fresh fish hanging from a metal hook. as i ran by, he abruptly slapped the dozen or so large, raw fish against my back! not cool! then he chased me for a good kilometer attempting to do it again. lets just say it was one of the fastest kilometers i’ve run recently.

there are many things i love about the philippines, but the human obstacles to running aren’t one of them. but at least its always warm!

spelunking in asia's second largest cave!

our last weekend in tacloban we went spelunking! the langun-gobinob-lurodpun cave in samar is the second largest in asia! upon arriving at the meetup point, we realized that about ten of the local interns we had been working with over the last weeks were joining us, which was really special! to go into the cave, one needs a special permit. the office was closed, but one of the intern’s family members was the district boss of tourism, and gave us special permission. without the family connection it wouldn’t have been possible.

from the main road we hired some motorcycle drivers to take us up into the rainforested hills. we were stopped and checked at a checkpoint of the philippine army – a communist rebel group has used the cave as a base in the past so security is high. then we hiked for 2 hours to the entrance.

inside the cave quickly became pitch black. we stumbled over rugged, sharp rocks and crystals; blood was shed. stalactites and stalagmites were very impressive. often the ceiling of the cave was so high we could not see it with our flashlights. we went through some narrow passageways and across large muddy cesspools. eventually we made it as far as we could go without diving – an underground river connected the cave we were in to the rest of the cave system. one can spend a week down there without exploring it all. there were fascinating creatures like translucent crabs and massive insects running around. rumor has it there is a species of one-eyed “cyclops” fish living in the cave's waterways. a completely mesmerizing subterranean world!