I REMEMBER coming out of UST medical school in 1962. I landed my first job
as an Adjunct Resident Physician at the provincial hospital. I was paid
P32.00 a month. There was really no salary for the whole first year of
service per government regulations then; the P32.oo was my laundry
allowance. The sum was more symbolic than material. It was enough that, at
long last, I was now treating patients as a doctor. Forgotten were the
seemingly endless struggle of leafing through the pages of extra-thick books
and the sleepless nights during the 2 years of premed, the 4 years of proper
medicine and the one year internship, all the while supported by my parents
who were sending me a good portion of their hard-earned money.
I REMEMBER that the syringes and injection needles used at the hospital in
the mid-60s were re-sterilized and reused again and again, and not thrown
away. There were no disposable syringes, no disposable needles, no
disposable anything then. The needles had to be sharpened every so often,
with the use of a grinding stone or ba-iran, then cleansed and sterilized.
Of course, the needles couldn't be sharpened enough, so we always felt the
lagorot every time we drive the needle into the patient, and after
delivering the drug, there was another lagorot as we pulled the needle
out.
I REMEMBER also that each syringe was tied with a string, and the other end
of the string was tied to the matching plunger. This string was to make sure
that the plunger would be the proper one matching the specific syringe; kai
kung dili paris, the plunger would not fit into the syringe.
I REMEMBER the good news the following year. I was now a Junior Resident
Physician, with a salary of P240.oo a month. It was hardly enough to pay
for personal expenses and transportation to and from the hospital, which was
located near the present day Capitol. I was living with my parents in
Agao.
It was a joy that I was now treating the sick and assisting in surgery, and
receiving remuneration however inadequate the pay.
Then came the horrors of the cholera el tor epidemic that swept across
Butuan and the entire country. It was an overwhelming experience for a new
doctor. Seriously ill patients were brought to the hospital in near death
from severe diarrhea and dehydration. The patients' skin were so dry and
without turgor that long after being pinched the skin remained curled up,
their eyeballs were deeply shrunken, their voice husky and reduced to a
whisper, their body so severely emaciated that weight loss was evident in
just hours. Intravenous fluids were run into veins so fast just to keep up
with the huge losses of fluids from the diarrhea that, many times, we had to
have a needle in each arm and leg at the same time. Blissfully, the
Department of Health had a good supply of intravenous fluids. Many times we
saw patients losing water and salt so fast that their kidneys refuse to put
out urine. Unable to stand, much less walk, they arrived at the hospital on
makeshift stretchers or on hammocks. When the hospital ran out of beds,
patients' families ran back home and brought their own beds. Many patients
slept on the floors. Hospital doors were unhinged and removed, and laid flat
to serve as beds. Plywood beds were constructed in a big hurry, circular
holes were cut at the site where the patients' buttocks should be, and
commodes were placed underneath to catch the watery stools that flowed from
the bowels. The cause was the cholera el tor germ in contaminated food or water.
I REMEMBER Butuan during those difficult years when there was no potable
water supply to speak of. Water chlorination was unheard of. Drinking
water was rain water collected from roof gutters or was fetched in pails
from deep wells, or collected from the salty free-flowing artesian wells.
In the rural communities, water was fetched from streams, tobod, or dug wells.
It is a wonder that cholera did not occur during the prior years. It is a
wonder that when it did, it did not wipe out the population.
During those times, flush toilets with septic tanks were a rarity. The
Butuanon today may not fully appreciate the primitive sanitation back
then. Most households used the so-called antipolo toilets. Without the water
trap and the sealed system in use today, the antipolo toilets of those innocent
times allowed flies and vermin unhampered access to sewage in cesspools,
which in turn carried the cholera el tor germ to the kitchen and unto food
or water. It was a miracle only a few had died.
In the rural areas, some households did not have toilets at all. The soft
toilet paper was rare; commonly used were old newspapers crumpled by hand to
make them effective in wiping off the bottoms
I REMEMBER those hard times when medical practice was really frontier
medicine. There was hardly any credible laboratory test to help the doctor
in treating patients. ICU was unheard of. Doctors had to practice unaided
by the trappings of modern medicine. Today, in circumstances similar to
cholera, there will be a battery of tests done to determine the patient's
degree of dehydration, water and electrolyte balance, kidney function,
etc.,
and an array of paramedical support, like cardiac monitors, oximeters,
central venous pressure monitoring, and the like. Not then. Those years
were years of the clinical touch, the clinical eye, and even the clinical smell
- the art of bedside medicine in its purest form. There was no other choice.
I REMEMBER that even before the cholera epidemic, hospital linens seemed
to
be constantly in short supply. Many times, patients brought their own
banig. Some beds were without mattresses, so it was not unusual to see
patients sleeping on mats over the bedsprings, with pieces of cardboard in
between. The cholera epidemic was the last thing the hospital expected.
Yet the community coped, Butuanons did their best to overcome the adverse
circumstances, they did not ask what their community should be doing for
them; there were no marches or demonstrations of protests.
I REMEMBER that, as the epidemic was raging, hospital resources and staff
were severely strained. The usual stab wounds, fractures, pneumonias,
malaria, tuberculosis, measles and other infectious diseases, gunshot
wounds, falls from fruit trees, pregnant women in labor, injuries from
brawls, all of them had to be attended to as well. It was a time when
there was only the 'public' hospital. Patients from all over the then undivided
province of Agusan favored the provincial hospital over the smaller
private hospitals for economic and other reasons. People were much poorer then.
I REMEMBER also the time of the great flood. After weeks of continuous heavy
downpour, the Agusan River overflowed and dumped its brown waters unto the
community. Innocent children and adults frolicked in the muddy waters,
sometimes among the water lilies, unaware and unconcerned about the germs
and parasites swimming in those same waters. The river dike we have now
was not yet constructed then.
There were other days without rainfall, but the waters from Upper Agusan
kept coming. There were clear nights without rain and when the moon was up
and full, some romantic Butuanons lazily rode barotos in the evenings,
strumming their guitars.
Life went on. People shopped for food. Whatever vegetables, fish, or meat
there were, were sold on the roof of the market building ngadto Lawod, or
at the kiosko at the Rizal Park , or on floating barotos.
The deluge lasted an unbelievable 3 months.The ground floor of the hospital
was submerged deep under flood waters. Patients were transferred to the
second storey, ga sinardinas, crowding even the hallways. It was difficult
to make patient rounds because there was hardly any space to pass through
between patients. The Lord must have been with the Butuanons then because
we hardly noticed any incidence of cross infections.
From their homes, the hospital staff had great difficulty coming to work,
riding on barotos without outriggers. Many came late for work, others simply
did not show up. Many times I remained on duty in the hospital for 2 or 3
days, because the reliever, himself a flood victim, couldn't make it
through the flood waters.
But there were lighter moments too. Our chief of hospital, for example,
had
fun hunting wild ducks and tikling from the hospital window with his .22
caliber rifle. Those were the days indeed. Today however, the area around
the old hospital site is occupied by buildings including a shopping mall, a restaurant
specializing in goat meat, and government offices,no longer is it a hunting ground.
I REMEMBER the times before and after the flood. The Obstetrics practitioner
at the public hospital used to send hospital utility workers unto the
nearby swamps to catch frogs. "Frog test" was the pregnancy test at that
time. While today the test is done so simply and conveniently by the
patient herself at home without sacrificing those poor amphibians, at that time
there was no simple patient-friendly procedure. So, off the aides went
into the marshes to gather the frogs.
I REMEMBER those times when insulin was the only treatment for diabetes,
and the dose was titrated by a urine test. Very crude and inaccurate by
today's standards. Today, accurate blood sugar tests are done by patients
themselves at home. Today, many diabetics are on medicines taken by mouth, while
before, waai mahimo, injections ra gid. How times have changed for the
better..
I REMEMBER too that immunizations for children were not available then.
Waves of measles, chicken pox, mumps, and other outbreaks came in almost
predictable cycles. Children died. Kadakwa nga differensiya do-on.
I REMEMBER also the x-rays taken at the Chest Center during those years.
One
x-ray plate was used for several patients, each patient's radiograph took
up only just over an inch square of the entire film. One plate contained
exposures of several patients. Radiologists today would think of it as a
big joke. But that was the practice in the 60s. The 'micrograph', as it was
called, saved on the cost of x-ray plates. And of course, the films were
not developed until the entire plate was used up by many patients. Patients
just had to wait for the results in the meantime, and they understood. The
radiologist would view the micrograph under a huge magnifying lens the
size of present day viewers, and presto, the image becomes big enough for
diagnosis to be made. The service was free of charge to patients, part of
the country's program to control tuberculosis then so rampant in the
Philippines. Today, we know that, with the advent of digital imaging, xray
machines no longer use films.
Patients used to wait to have their x-rays taken kung waai electric power.
The city's electric utility was unreliable then, the generating machine
was salvaged from an old FS ship. While the Chest Center had its own
generating unit, there were many times when their machine broke down too. People
today take many things for granted, but those of us who lived through those lean
years appreciate more the conveniences we experience today.
I REMEMBER also that during those years, surgical operations were done
mostly using local anesthesia. It would be hard for today's patients to
even just think of incisions across the neck to remove goiters, or of cesarian
sections to deliver babies, or of appendectomies done with the patient
fully awake under local anesthesia. Today, Obstetricians during delivery are
assisted by an anesthesiologist to make the experience as pain-free as
possible, and a neonatologist to take care of the newborn as soon as it
comes out to this world. This is a marked contrast to the practice
before, when babies were delivered usually by general practitioners, or even
midwives. There was only one doctor in the delivery room; he took care of
the mother and the baby.
The operating rooms those times were also not as well equipped as they are
today. Some forceps had seen better days. The recurrent power failures too
made surgical operations more challenging. Petromax lamps and big
flashlights were always available in the OR.
I bid good bye to the challenges in Butuan and left the Philippines in
late 1965.
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