Adventures of the Country bumpkin

Parols at the balcony of the 2nd floor of the Silliman Medical Center. December 20, 2010.

So far, it’s been a slow day at work (thankfully enough). Like I was joking to one of the nurses on duty earlier, “It’s Christmas, people should stay in their houses…and behave.” He laughed at this (but he ended his shift without having to do a lot of paperwork aside from the usual charting jobs anyway.)

Oh, but it’s not a perfect duty schedule, of course…there have been a couple of vehicular accident victims who have had a little too much party alcohol and crashed their mopeds. No serious injuries, but still, I’m making them stay overnight for observation (when I asked one where if he knew where he was, he said he was in X City, which was, funnily enough, an hour away from our hospital in the opposite direction, hence the stay.)

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It’s not always like this, so I really “cherish” the downtime. For a sleepy town, you’d be surprised at the number of cases that I get to see and treat. There is an occasional “medical marvel”, but mostly, it’s your usual, run-of-the-mill common aches and pains, urinary tract infections, minor surgical infections, normal spontaneous deliveries…all mostly handled at the primary care level. If there is a need for further evaluation and diagnostics, the cases are referred to a tertiary hospital.

What we doctors do here is very far from what you would call cutting-edge medicine, but for most of the people here (a majority of them indigent), it is the most accessible and the best primary care facility for miles around.

I won’t lie. My initial reaction to this place was that there was such a profound lack of the things I was used to. Why, I even laughed a little to myself before when I found out that if I stood at one spot, I could see the whole hospital from where I was standing. Oh, and the mangroves…they were everywhere. And, the sea water would rise and edge its way to the hospital walls during high tide (the beach was a quarter of a kilometer away). And there was only one private room…and the only other rooms that had air-conditioning were the quarters and the offices.

:-) 

But that was in the past. Somehow, the place endears itself to you. The people, in their own simple ways make you feel that there is a lot you can contribute. There is a lot to love, really. I never thought I’d say this, but I did love how the air was crisp and clear in the mornings, why, bird chirping was even commonplace. Everywhere it was green, green…an occasional house, and then lots of mountains in the distance (but not that far off, because you can still see the detail on the huts that dot the sides).  The people were a different sort as well. 

They have such an openness, a naivete that I find utterly endearing, because I know that they’ll follow my instructions to the letter and do what they could to scrape together funds…as opposed to how some people would doctor-shop and just take the medications only for a time…or worse, not take them at all.

Things I think I like about practicing Medicine in the rural area:

1.       My patients don’t have a lot, so I have to be “creative” in treatment

2.       Not a lot of exposure, so I don’t always have to resort to high-end antibiotics for their infections.

3.       They’re fairly nice people who are open to medical advice.

4.       They’re simple, and funny, and generally good-natured.

5.       When they say thank you, they really mean it…and bring you fruit, or the native delicacy, or whatever they can afford to give you. (One of my favorite perks.)

6.       They’re good at networking.

7.       I do almost everything…it’s all hands-on. All the decisions are mine, and apart from the referring as needed, I get to assert myself. (And form balls of steel in the process on a daily basis.:-))

8.       I learned more of the practical work on my own than I ever did while I was a clerk (when you’re all supposed to do the scut work).

9.       I learned that it’s pretty lousy to always make up excuses for why you can or cannot do something.

10.   I learned to be patient…well, I already am most times, but I really mean that I can stretch more now.

Things that I don’t like about it:

1.       It’s far from a tertiary hospital (most of them are in Dumaguete City, and being referred there costs the patients a lot).

2.       We don’t have any anti-psychotic on hand. ß geesh.

3.       The hospital (as most primary government hospitals are), doesn’t have its own ambulance. When a patient needs an ambulance, his folks (his relatives) have to approach the personnel in charge of the ambulance registration, usually a clerk at the municipal hall. (More often than not, it has political leanings, even going to the extent of a patient not being allowed to use the ambulance because he or she is a supporter of a different political party.) It’s sad, really.

4.       Drunk drivers who get into an accident come in more often than I’d prefer.

5.       Pulmonary Tuberculosis cases abound.

6.       Many kids are malnourished.

7.       A number of pregnant women have not had good and very thorough prenatal check-ups (it’s almost appalling, but you can’t blame them that much because not all of them have reached a high level of education, they live quite a distance from the health facility…which corresponds to them not using any type of birth control (“withdrawal” doesn’t count, in my book.)

8.       Sometimes they go to the hilot first when they have fractures.

9.       The diagnostics are quite lacking. Very basic, at most. (No sodium-potassium.)

10.   Paperwork. Haha.

It takes me an hour and half, or maybe 2 hours, depending on the kind of public transport I’m taking (I don’t drive.).That’s about 4 hours of sitting in a bus, or a rented van ( a V-hire), if you count it as a single trip back and forth…which totally gets my goat, because I don’t like being inactive and not being able to do anything.

Funnily enough, I learned how to calm and pace myself and to be creative on these trips. I’ve also read books while in transit, listened to a whole bunch of music downloads, composed emails and blog entries, and plan things. It was almost meditative…when I wouldn’t be obsessing about any single topic, of course. :-p

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For about a 7 months, our arrangement had been to man the OPD from 9AM up to 4PM (while being on-call for ward referrals), with us doing everything from suturing, to administering certain medications, and delivering babies. On top of that, if anything ever happened, and someone went bad in the ward, we’d have to drop everything and deal with that too. On a regular day, that’d be like, 40 patients (50 if it was really busy) at the OPD.

Sure it’s just talking, you say…but if that’s what you did the whole day, it can get pretty draining, believe me.( After a while, I’d bring a canteen of water to last me through.)

Three months ago, another doctor joined our roster, and so now, it’s a lighter workload. There’s always a doctor for the out-patient department, and we stay in the wards and take care of admissions.

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I didn’t get to read a lot…I’d be too tired at the end of my shift, and then, before I know it, I’d be back on duty again. (LOL.)

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I love delivering babies, and little kid patients.

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Meals are almost always fat free. Haha. (Very non-fattening.)

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Patients-wise, I suppose I’ve had my heart broken so many times here than I’ve ever had in any other hospital. Because of many factors such as low levels of education, a prevalent “alternative medicine” culture, and just plain economic lack, I’ve had patients who died on me…because they were brought to the hospital too late.

There were two cases that I remembered of incredibly septic babies who came in pale, either very warm to the touch (or very cool), malnourished…who gasped their last a few minutes upon arriving. Actually, I was more worked up about the baby that I didn’t even mind that his mother was ranting about how she should never have brought her baby to the hospital, it died in it anyway.

(I try my best to educate patients, but what’s one or two vs. the innocent many?)

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It was a year well-spent, of course. People would often ask why I decided to take  year off the academics of my medical career, and I find myself saying that I wanted to give back (and “serve humanity”) for my cheaper, government-subsidized medical education…and more practically, because I wanted to save up for training in Manila (it’s not cheap to live there, mind you).

I don’t have any regrets. It was a good job…and there are benefits to working for the government. It’s got a higher-paying salary than most private institutions. I hope I’ve saved enough to last me the three months without a salary in my new institution. J

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:-)

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All in all, even though I joke about how much of a country bumpkin I’m getting…that’s all that is, I’m just poking fun at it. In reality, being a “country bumpkin” has been good for me to help me have a more comfortable life as a “city girl”.

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Love, 

S.