I was Minding my Own Business

When…

I read of it on Facebook. My FB friend angrily asks on her status update: “(name of hospital), are you really a hospital or a financial institution?”

That made me think. Because my FB friend (and other non-medical persons) seem to believe that one is either a hospital OR a  business. Not both. The reality, though, is in my crazy country, private hospitals are BOTH  – hospital AND business. They provide medical care and services AND they also have to make a profit.

As of 2009, a majority of hospital in my country are privately owned. Personally, I don’t agree with this state of affairs. I would prefer having a system like that of UKs National Health Service (NHS) which provides socialized healthcare from cradle to the grave. But at this moment, this is MY reality.

When I was still in training I often had to shell out money for my patients’s medical expenses (which was not done out of altruism, but that’s another story). I vowed to myself that after I graduate, I will not hand out my meager resources to strangers just because they need it. Sorry, but I am not Jesus, after all.

 

download

“The triumph of Science Over Death” is a sculpture of a woman standing on top of a skull and holding a torch. It was made by Jose Rizal and seem to depict victory of medicine over infirmity, disease and death. I would disagree with perceiving medical science to have such broad powers.

Out of training, I realized that fuck! Most of medicine in MY country IS ABOUT  business. That really left a bad taste in my mouth, which is one of the reasons why I am disillusioned with private practice.

Of course, there is also public health as an alternative. And as I am currently in public health, I can honestly say that I am not impressed with the alternative.

Those in the US seem to be in a soul-searching mode as far as healthcare is concerned. And we should be too. But reading my Facebook feeds and the comments from the news article, I am left wondering if the level of discourse in my society is advanced enough for us to engage in meaningful discussions about healthcare. Of course this is a start. And perhaps I should take heart in that.

 

 

Treading Water

So today Ana was telling me of her ambivalence about having babies:

I have always been envious of good swimmers.  As someone who has been taught how to swim a number of times and has failed over and over and over again to learn, seeing someone do a breaststroke from one end of a pool to the other is kind of bittersweet. Me — I can barely keep my head above water.

What is the connection? I ask

 

tumblr_majl6hAKhh1rece9vo1_500

The problem is, Ana says, I am content having just my feet wet. I can’t go into the deep end (the one that says 6 feet) because 1.) I am afraid to drown; 2.) There doesn’t seem to be anything worthwhile about going into 6 feet; and 3.) I prefer reading my Kindle in the pool and it’s not easy to do that while trying not to drown.

 

Having a child is like driving a car or learning to swim. You have to have done it at a certain point, otherwise the energy or the desire to have one or learn one passes you by.

A lot of people in and out of cyberspace will disagree with you.

So maybe I am speaking only of myself. The inclination has passed me by. Although when I look back, I don’t think I have ever been very inclined to reproduce. When I think of babies or parenting, the impression I get is that of having a thankless job that you are doomed to do the rest of your life. Which makes it totally not worth it. 

The thing is, darling,  Christian wants to have a kid.

Yes, but it is not as if he’s pressuring me about it. As with all other things, he has a laid back attitude as far as progeny is concerned.

Or so you think.

Well, yes, there’s that.

So you think having kids is like swimming right? And now, you are what? Treading water?

Hmmm … more like wading in a knee deep pond that used to be a river.

Compassion Fatigue

I checked Wikipedia and saw that compassion is an “emotion we feel in response to suffering and which motivates our desire to help.”

A Tweet from a local reporter triggered a discussion on Facebook about the definition of compassion and whether there is compassion in a certain hospital that is supposedly one of the best in the country. Several blog posts have shown how the reporter got it right or got it wrong.

The problem with Twitter is it doesn’t give ample word space to present a dissertation on the dismal healthcare system in this country; the hospital just illustrates the brokenness of this system in all its microcospic glory.

What I didn’t like of the report which I watched on YouTube is it didn’t present a satisfying analysis on why there is a seeming lack of compassion in the hospital she mentioned.

Of course I am biased. But aren’t we all? Aren’t we more apt to give kind regard to those that are familiar?

Healthcare workers (and of course that include doctors) are human too. And yes, that is NOT an excuse to be cruel to patients. However, one should not judge unless one has not been in someone’s shoes or slippers, for that matter.

Cruelty should have gradations, I think. Sometimes one feels that being cruel is the most expedient way to be kind. In the movie/book, Sophie’s Choice, Sophie had to choose between her two children; which of them would live or die. Sophie was a Jew during the holocaust. Should I hate Sophie for choosing one of her child over the other?

In this country, in a lot of places, actually, compassion fatigue sets in because we have been given the unenviable task to choose who will live or who will die. Or who will get healthcare and who will not. Resources — which include our energy, our time, and yes, our compassion — are finite. We had to choose.

It may not have shown in our faces, in the abrupt way we turned that 100th patient away, the weary and sarcastic manner we told someone that she had to have money to rent a ventilator. It may not have been obvious to the television cameras –but doing what we did took away a part of our soul.  And we acknowledge that.

Healthcare workers are made to do a Sophie’s Choice everyday they work in the public healthcare system.  A far-from-perfect  system which does not help make the act of choosing an easy one.

 

Excerpt from a diary of (almost) 20 years ago

“How funny that we can’t bring ourselves to tell our children the most fundamental truth about sex, that most of the time we have sex, we have it for pleasure. ” – Alice Dreger

From the point of view of a 16 year old, sex is fascinating because it is forbidden. And it is forbidden  probably  because it feels good.

Hmmm … as good as what, I wonder? Even better than blueberry cheesecake? Or  Karen Carpenter songs? Is it  like waking up at 8 am and burrowing under your bedcovers when it’s raining outside and school is cancelled?

diary

 

I understand why grownups won’t talk about  the “S” word. My parents haven’t even said the “L” word. If they can’t bring themselves to talk about the “L” word  then S-word discussions must be like watching “The Exorcist”.

It’s like they do “it” and you are left wondering at all the fun they are having

I asked a teacher at Health Class  today why parents bother to have kids. What did I expect her to say? Because sex feels good and kids are a by-product of their parents having fun under their blankets? Of course that’s not what she said. Instead the answer was something about love and god wanting to spread love yada yada yada.

I hope  I can have the conviction to be an atheist like D. Oooops … one is not supposed to want to be an atheist. That kind of thinking can send you to hell.

***

If the Church had allowed them to grow up to be functioning adults in Irish society it would have ran the risk of demonstrating that the institution of marriage was not absolutely integral to the moral well-being of a person. – Stephanie Lord, on infanticide, unwanted pregnancies and the Catholic Church in Northern Ireland.

 

Interesting Stories

A poor patient with cervical cancer is writhing in  pain just outside the building of a big tertiary hospital. Her husband watches helplessly as she moans; all the while he was wondering when her (and his) suffering will end. They have 100 pesos with them and the wife needs at least 1500 pesos for her blood transfusion and a lot more than that for the chemotherapy.

The worst part about residency training is there came a point when the only way you can cope with all that suffering is to pretend you were a robot.

The worst part about residency training was there came a point when the only way you can cope with all that suffering is to pretend you were a robot.

 

Then comes the reporter. The reporter looks helpless and frustrated. She interviews the man and his wife. All the while, the woman was writhing in pain.

The reporter accompanies both to the heartless hospital that won’t admit them. The hospital, out of fear of negative media coverage, admits the patient and make her wait in the Admitting Section. They would still have to procure blood.

The secretary of health appears on the screen saying they are doing their best to achieve universal healthcare. A medical activist appears saying  that this is what happens when healthcare is privatized.

I haven’t heard from the doctor to whom the patient was decked.

But I imagine that this  must be his/her story:

Dr. Z has been on duty and without sleep for 48 hours. Technically, Dr. Z was on duty for 24 hours but the reality is Dr. Z has been staying in the hospital for three straight days because of complicated patients their team has to take care of. Dr. Z is  a resident-in-training and aside from taking care of the patients’s medical needs, Dr. Z has to take on the role of nurse, midwife, utility worker and social worker because the hospital lack the staff to provide adequate nursing, midwifery, janitorial and social work services to the patients. Now this cervical cancer patient comes in just as Dr.Z’s shift is about to end (the shift will end but the work will not). Dr. Z sighs and thinks, I will have to shell out the 1500 pesos for the blood, so that I can transfer her to the Oncology service, oh god 1500, I was planning to buy mommy her present, sorry mom, cervical cancer patient trumps your birthday any day, when I graduate, I am promptly going to another country, preferably first world where I don’t have to be a social worker and doctor at the same time, i am so sleepy, this day will never end .. lord please kill me now.

 

Janet’s Uterus

I have removed my share of uteruses in my career.  Hysterectomy is a pretty straightforward affair. Unlike having a brain or a heart, the presence or absence of a uterus will not be a deterrent to having a practicable human life. As readers with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome know, it is entirely possible to have a rich, meaningful, lengthy, fulfilling existence without that organ whose primary function is nurturing a fetus.

So Janet Lim Napoles (whom I have written about here and here and here and here) has thought that telling her truth would  probably set her free, so on the eve of her surgery, she went on to spill her beans at Secretary De Lima.

The story gets murkier because Janet is now waving her own list (as opposed to Benhur Luy’s and other whistleblowers’s) of pork barrel scam players among  government officials. I can imagine people in the Executive Department and Legislative Houses craning their necks and going up on their toes, itching to know if (god forbid!) their names are on this List.

Oh Janet … were you thinking of doing a St. Paul-on-the-road-to-damascus stunt, or were you just biding your time playing everyone against each other with the goal of saving your skin (and/or your loot)?  By now, nobody in this country believes that anybody in politics is untainted by corruption. So much so that any person on your list, however seemingly unlikely, will probably elicit sighs of resignation instead of surprise.

I found in the news that the reason for your profuse vaginal bleeding was myoma, adenomyosis and endometrial hyperplasia. Close call, but thank god it’s not cancer, right? Now if only prosecuting you and everyone involved in your scam is as straightforward as removing your uterus.

 

 

 

 

 

Comments on the RH Law

alternate title: The Constitutionality/Unconstitutionality of the RH Law from the Perspective of a Medical Practitioner Who Had Seen the Consequences of the Lack of One for Years

I am not sure whether the recent decision of the Philippine Supreme Court (SC) regarding the Reproductive Health Law is something I can be hopeful about; or something that I should tear my hair at in frustration.

I have always thought that the idea of having a Supreme Court is to have someone clear things up when laws have become so convoluted and confusing.

Now I am even more confused. But then I am just a lowly health worker and not a lawyer.

 

When I was a little girl, I have wanted to be a lawyer. That was before my mother nagged me to take up medicine.

When I was a little girl, I have wanted to be a lawyer. That was before my mother nagged me to take up medicine.

 

The most supreme magistrates of this country said that House Bill 10354 is not unconstitutional. (I have always thought that there is something fishy going on when people  say things with a double negative.)

However (and this is where things become confusing), the SC maintained that 8 provisions of the law are unconstitutional; and here they are:

 

Section 7, Paragraph 2.  No person shall be denied information and access to family planning services, whether natural or artificial: provided, that minors will not be allowed access to modern methods of family planning without written consent from their parents or guardian/s except when the minor is already a parent or has had a miscarriage. 

Section 23 (a)(2)(ii), penalizes a health worker who requires parental consent from a minor in non-emergency cases;

In striking down these parts, is the SC saying that I  will be defying the Constitution of the Republic of the Philippines when I provide a 16 year old who had an abortion and is pregnant with baby number 2 with information on family planning without telling her parents? Holy shit! I just did that last week! Please Supreme Court, have mercy on me — the darned teenager has been living with her boyfriend for the past 2 years and is estranged from her parents. I mean she would really benefit from knowing that she can prevent future pregnancies by using the Pill. Really!

As to Section 23(a)(2)(ii), I really think that if a teenager is mature enough to ask for contraception, then she is mature enough to have one. There are some things called “the evolving capacities of a child” and “emancipated teenager.” Apparently, the SC justices have not fully digested those ideas.

 

Section 17 —  provides the grant of 48 hours free services to indigent women as a prerequisite for health care providers in securing accreditation from the Philippine Health Insurance Corp. or PhilHealth;

Last month, I went to Philhealth to have my healthcare provider accreditation renewed. It was fairly smooth sailing except for the long lines at the cashier, but it’s ok because they were quite organized. Now I wouldn’t mind granting free services to indigent women, and having that a prerequisite to securing my Philhealth accreditation. Which reminds me, I put in over 48 hours of unpaid overtime pay for my public health job last year. Would that suffice, I wonder?

 

Section 23 (a)(1). Prohibits health care service workers from withholding or disseminating information on reproductive health programs;

Section 23 (a)(3). Punishes health care providers who refuse to refer non-emergency patients to another facility regardless of religious beliefs

My sister is an Opus Dei member. For those who have read the “The Da Vinci Code,” yes they are a very conservative Catholic Church believers. I know she would hate me when I say that yes, I agree that medical workers should never withhold RH information and services. If they are uncomfortable doing so because of their religious convictions, then they should refer. The idea of referring cases we don’t want to handle to our colleagues is part of medical ethics. Which reminds me of an incident when I was in medical training. An OB Gyn Consultant was supposedly opposed to doing bilateral tubal ligation (a family planning method where a woman’s tubes are tied and cut to prevent further pregnancies) because of religious reasons. After performing the cesarean section on her patient, she told the OB Gyn resident who was assisting to carry on. The Consultant turned her back on the patient while the resident did the ligation. Of course the professional fees for the ligation went to the Consultant. Hmmm … I have been known to be guilty of hypocrisy a number of times, but at least I admit it…

 

Section 23 (a)(2)(i), Spousal consent in case of married persons: provided, that in case of disagreement, the decision of the one undergoing the procedure shall prevail;

Okay, so I am again guilty of this. With a lot of women that I have lost count. Look, Supreme Court, the thing is, when a woman comes for family planning consultation, the fact that she is married should take a back seat to the fact that she needs family planning. Last week, this 34 year old gravida 5 delivered in the clinic. After being counselled on family planning methods, she decided that she would like to have an IUD inserted. However, the partner (the baby’s father) was not around. She and her husband (the one she was married to and the father of her first 2 children) have long been separated. The dear old 34 year old lady had her IUD and may I say, dear magistrates, that her case is the norm and not the exception in the public health facility where I work.

 

Section 23 (b), which punishes a public official who refuses to support reproductive health programs regardless of religion.

O puhleeaze! For several years, the regime of former Manila Mayor Lito Atienza of Manila would not give RH services to the indigent women of Manila. That was violence against women!

 

The eighth provision which the SC said was unconstitutional had something to do with the definition of contraceptives and abortifacients. 

And  had something to do with the word “primarily”.  By the way, a friend told me that the best pre-law course should be AB English.

****

Whew … this was my longest post. Which just goes to show how emotionally invested I am in the RH Law. My mom, bless her soul, had an unwanted pregnancy and an induced abortion when she was young and stupid. I hope I would have learned from her mistakes.

****

This is one article critiquing the SC decision which is thought-provoking and well-argued. Of course it is biased towards RH but what the heck, so am I!