By VINCENT RASALAN
(The writer, is a licensed physician, earned his degree in BS Biology from the University of the Philippines College Baguio in 1997; Doctor of Medicine at University of Northern Philippines College of Medicine, Vigan City; He finished his training in General Surgery at the James L. Gordom Memorial Hospital and currently practices in Government and Private Hospitals in Olongapo and Pampanga.
In College, he was a member of various student organizations, and later an organizer of the Alliance of Concerned Teachers – Metro Baguio before pursuing his dreams to become a Surgeon. After graduating from the College of Medicine, he volunteered with CHESTCORE. -Ed)
CHOICED CUTS, is a story board of the realities of the health sector — collage of stories, in tids and pieces, of the common Filipino facing bodily and societal ailments and struggling for a better, quality health care. These stories would be funny, sad at times it will make US feel and think while we cry or laugh, or both. J Doc Vince
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The other day, I received a message on my inbox from a fraternity brother. He was in consult with me regarding his son who had a fall during a sports activity. His right ankle was badly swollen and barely could put weight on the affected site. He couldn’t stand nor walk straight because of this. His lola, brought the poor kid to a traditional hilot in the hope of relieving him of pain. Unfortunately, it made matters worse making his condition more painful and unbearable. He was now experiencing low grade fever and irritability. Judging from the picture my brod sent me, a fracture of any of the bones on the foot and ankle is a suspect.
This is not an uncommon scenario really. Every now and then, we receive calls from acquaintances for a clinical consult. We are not in any way however, obliged to manage patients this way. As a matter of safety, any good physician should treat the actual patient – most of the time, the clinical history based from the patient’s account could very well provide us with clues leading to a working diagnosis. From there we confirm them by physical examination and diagnostics. Ninety-nine percent of the time, a good clinical history and a meticulous physical examination can provide the diagnosis and ergo the treatment for any given case. And that is where over the telephone or on-line consults fall short. We cannot see, feel, or hear our patients. Key maneuvers in diagnosis of a case cannot be done.
For the patient and their relatives of course, this is a totally different experience for them. They don’t have to wait for the long queue of patients in humid corridors of the hospital; or for the doctor/s (who is/are always late!) to arrive at their posh clinics. With a good mobile network signal or a wi-fi connection, they can bring the clinic and the doctor to the malls while they shop, to the office while they work, or just to their bedside while they rest because of their ailments. The convenience is literally in their hands. And this same convenience makes an on-line consult so temptingly feasible – and more so, because it works (and is expense-free)!
In the context of the country’s sociodemographic condition (yes that includes the entirety of the health situation), on-line and digital based medical consults deserve a second look. Imagine this same patient from the far-flung areas with no immediate access to health care. Temporizing steps can be initiated. Medications that can alleviate the patients’ symptoms can be started. Most important from the list of probable advantage is that the patient can be triaged from the site itself. This precludes unnecessary deployment of resources (ambulance, staff or manpower recalls, etc.) thus minimizing wastage of the same. An on-line consult may be life or limb-saving and can potentially save the government and the patient a significant portion of its financial burden.
Not that this concept or paradigm of medical practice is entirely new. Since the advent of communication, its different means has been heavily utilized to optimize patient care. Australia’s Royal Flying Doctors in the 1900’s were the pioneers in the field responding to trauma and varied cases of accidents and other life-threatening ailments using two-way radios. Over time, enhanced communication make education and training across regions possible. Teleconferences, live surgeries are fed to training institutions all over the world making enabling physicians compare their own practices to the best and the experts in their fields.
But while it is heavily used in the secondary (i.e., trauma and other medical emergencies) and tertiary (i.e., critical care) fields of medical practice, the world is yet to see a system or network for public health and preventive medicine in actual practice, although the University of the Philippines in Manila has introduced telemedicine in some parts of the country, and has since started a series of trainings for both physicians and rural health units for its implementation.
So apart from the usual calls from friends and relatives, we are yet to exploit and keep up with the fast evolving technologies in communication and medicine. Needless to say, the government’s primary role in providing quality health care in the rural areas most especially should still remain to be one of priority. This means, employing more doctors and health professionals to serve the marginalized and allotting more funds and even sponsorships for facilities and medicines to augment the prevailing gap between the town centers and the cities on one end, and the farthest barrios at another. Medical education and practice, should refocus and give more weight on public health and preventive medicine and less on the more specialized, hospital based/dependent practices of most of our colleagues.
So whatever happened to the my brod’s son?
Now, being 750 kms. away from my place to Samar, the most prudent advice would be to immobilize the involved foot/ankle and rush the patient to the nearest hospital for a more appropriate care. But then it was nearing midnight and the nearest district hospital is at least 2 hours from their place. At the break of the morning, they went to the hospital where an Xray of the foot was done. Luckily it was just a case of a sprained ankle. He is presently recovering from his injury. In a month’s time, he will be back on the playing court muscling it out with his peers.
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A CALL OUT to my Fraternity Brothers,
The SIGMA KAPPA PI FRATERNITY will be celebrating its 50th Founding Anniversary on September 1, 2018 at the UP Bahay ng Alumni, UP DIliman, Quezon City at 6pm. For details, you may send an email to email@example.com, or contact any member of the fraternity. # nordis.net