MVAs to Chicken Pox to New Babies

It is quite interesting how a morning that starts off incredibly busy can quickly become very relaxed and almost boring by the end of the day. This morning, I walked into the clinic to see a patient being loaded up into the ambulance. The patient had been involved in a motor vehicle accident and was in critical condition. He was going to be taken via the rescue boat to the mainland, where he would hopefully make it in time to be treated. Aboard the ambulance and rescue boat, only very basic supplies are provided such as an oxygen tank and a bed. Anything beyond that, such as bloods, medications, IVS, are not available. If anything were to happen to the patient that required more supplies, he would have to wait until he reached the hospital on the mainland. I found later in the afternoon, that the patient did not survive and passed away. It was a very busy start to the morning and the consultations also proved to be interesting. We had 5 patients come in with cases of chicken pox. The chicken pox vaccine is not required here in the Philippines as it is in the US and therefore there are quite a few cases during the hotter months of chicken pox. Once one person catches it, it tends to spread quickly as it is an air-borne disease. As I have received the vaccine, I am hoping that I am protected from it. The fact that tuberculosis, chicken pox, and dengue seem to be quite common in this area worries me a little bit but hopefully in my two weeks here, I will stay in good health. Before lunch, I had the opportunity to watch a live delivery. It is a very different picture than one would find in the States. There is no comfortable bed to lay upon (in fact there is only one delivery bed for the entire community), there are no welcoming signs or pictures on the wall, there is no pain medication whatsoever, there is no AC to cool the room down, and the only people in the room are the nurses (who were not wearing any gowns or closed toed shoes). There was no coaching of the mom as she went through labor or anything given to help ease her pain. She was essentially on her own throughout the whole process and it made me really ponder about the luxuries that we have in the US that have essentially become a standard expectation in our mind. But at the end of the day, the mother delivered a healthy and beautiful baby girl. There were thankfully no complications in the delivery. It is quite a messy procedure and I think the most gruesome part was watching as one of the nurses gently yanked the placenta out of the mother. While there are medications available to mothers when they deliver if they go to the mainland or to a bigger hospital, the medication will cost them money, even if they have PhilHealth. In that sense, a natural delivery with no conveniences is the only completely free option for most mothers. In the afternoon, things slowed down quite a bit and I was able to interview 2 of the nurses and gather some of their thoughts and opinions on how the healthcare system and particularly the RHU was being run. The nurses and midwives here see and diagnose patients – something that is typically seen as a doctor’s responsibility. In fact, these nurses are not trained to diagnose patients – only to assess them, and so what they are doing is beyond the scope of their training. I was also able to learn about some of the systemic barriers that exist. Though there are promised a certain percent of the annual budget, what they actually get is sometimes less. Furthermore, they do not receive their medications on a consistent basis, forcing them to write prescriptions and patients, in turn, bear the cost of this shortage. There is also a lack of adequate supplies and equipment at the RHU which makes it very difficult to diagnose patients beyond the common cough and cold.