Saturday, May 25, 2013

A disappointing return

Last week, I returned to the government hospital where I had my Med Tek internship. We transferred a relative who will undergo a possible brain surgery due to a traumatic head injury. Being back after five years or so, I could say that the hospital had a very few improvements. Not much renovations I should say. The quality of service is still far behind from that of a private hospital. It might seem unfair if I compare government and private hospitals but does it mean that our less fortunate fellow countrymen should be deprived of an excellent quality service? If I would not compare them, then it is as good as saying that the government should not improve the quality of healthcare services and hence do nothing.
Before I give my opinions to this matter, I'll share some few things that happened in the ER, in the OR, and the ward. First of all, I want to mention that the government hospital is a tertiary hospital with approximately 300 bed capacity which is located in Manila. (DAY 1) At the emergency room, we were endorsed to the neurology department but later transferred to the ER surgery department. They were evaluating our relative and after the evaluation, the doctors did not bother to tell us what's going on. We were asking nurses, and doctors as well, but we seem to be invisible to them. Of course, we got a little bit anxious and just like any hospital, they immediately respond to anxious relatives. They told us that they needed to run another set of exams, x-ray and CT scan. After these tests, they concluded that surgery is needed. They gave us a list of medicines needed for the operation. We bought it and gave it to them and they told us to wait outside the hospital until the operation was done. When the operation was done, we still could  not see our relative, even when she was transferred at the ICU. And yes, we were still outside the hospital waiting to be called in case anything was needed. (DAY 2) When she was transferred to the ward, we finally saw her. After 24 hours of staying outside the hospital and restlessly waiting if our names would be called, we were finally able to go inside the hospital. The ward was clean, as they claim it. The small cockroaches freely crawling around the ward would say otherwise. Nurses can be frequently seen, I guess the RN heals project of our government has proved its efficacy. I do hope that they are compensated justly. Ironically, the response of the nurse's station is slow. Frequent follow-up is needed.
But the slowest response became the fatal one. (DAY 3) It was around 2 a.m. when we told the nurse station that the patient seems to have difficulty in breathing. The nurse in charge claimed that she already called for the resident doctor. As we have timed it, the doctor came more than 1 hour after we reported that the patient seems to have trouble breathing. After a few minutes after the doctor came, our relative was pronounced dead due to cardiac arrest probably secondary to acute myocardial infarction (heart attack).
The doctor did not even had the courage to explain what really happened. We only found out that cause of death was cardiac arrest secondary to AMI when we had the death certificate.  
I don't know how to start and give comments about this matter. It's hard to separate your professionalism from your own personal experience as a patient's relative. I will try to be fair in choosing my words.
First, doctors or any health workers for that matter should be fair to all types of patients: rich or poor, charity patients or paying patients, indigent or not. It would also be easing for the relatives if doctors would talk them and give them an idea of what the patient is going through. Being uninformed makes the patient and the relatives restless. ICU and OR are restricted areas of the hospitals. Its sterility have to be maintained. But I have to point out that it would be decent if there is a proper waiting area for the relatives. "Cleanliness is next to godliness" as the saying goes. For crying out loud, it is a hospital. Being clean is not an option. It is a must. And get rid of your pest problems. I was actually pleased with the performance of the nurses especially the ones in the RN Heals program. I got nothing but praises. Finally, the biggest issue here is the response time. I don't know how many residents are supposed to be monitoring the wards. But all I can say is either the doctor is trying to revive another patient during that time or the doctor is simply negligent. It is your duty to save people's live. You made an oath, not the patient's relatives nor me. I have to strongly address that being late for more than one hour after being informed is unacceptable. 
Going back memory lane and meeting old friends brings smile. Losing a loved one in a hospital you used to work for bring tears. Not just ordinary tears. These are tears of sorrow, tears of anger and tears of disappointment. I was hoping for something great when I re-entered that hospital especially after seeing some  good old friends. But the story was different, there might have even been some patient negligence. It was a disappointing return indeed.
To all my fellow Med Teks and health workers, please treat every patient with utmost respect. Never mind if the patient is paying or indigent. Always remember that the patient is someone's relative, brother, sister, mother, father, best friend, family, or a loved one. To all the nurses, Med Teks, health pros and doctors to that government hospital that are giving their best everyday, thank you and job well done. To a certain Dr. G of that hospital, may you always sleep well at night.        








Dedicated to our Ate Helen... May you Rest in Peace!


Evangelina "Ate Helen" Barroso (06/06/1950 - 05/15/2013)

Friday, May 10, 2013

Pic na naman?

Isang post na walang kinalaman sa pagiging Med Tek pero napapanahon naman. Pansin ko lang... Ang daming tao na ang hilig kunan ng litrato ang sarili. Animo'y tuwang-tuwa sa mukha. Ang daming solo pic! Mahal na mahal yata ang sarili. Hindi pa nakuntento at sige ang bira sa pag-video sa sarili. Hindi pa kaya sila nagsasawa sa kanilang imahe na nakikita naman araw-araw mula sa pagising sa umaga? Syempre maghihilamos ng mukha sa harap ng salamin at sa paguwi ay magsisipilyo bago matulog sa harap ulit ng salamin. Tapos meron din syempre yung sa pagitan sa tuwing bibisita ka sa banyo o di kaya'y magrere-touch ng make-up kung kababaihan. Walang sawa na nakikita ang sarili pero kukunin pa din ang digicam o ang cellphone o tablet at walang habas na kukunan ang sarili. Gagawing wallpaper ng telepono, profile pic, ikakalat sa facebook o kaya'y mabilisang upload sa instagram. Ayos! Galing kasi ng teknolohiya e!
Dati kasi... Nung panahon ng betamax... Mahilig lang kumuha ng litrato yung tao pag kasama ang pamilya o mga kaibigan. Hindi uso ang solo pic. Maliban na lang siguro kung dalawa lang kayo. Pag may espesyal na pagsasalo-salo, handaan, pista o madalas pag birthday, dun maraming kodakan. Pwede din naman yung bakasyon o gala lang sa kung saaan. Maliban sa maiiwang magagandang memorya ng isang okasyon o handaan, nakakatuwa din na may maiiwang mga litrato para sa araw na gusto mo maalala.
Hindi naman sa naiinis pero siguro nakakairita lang. Bawas-bawasan lang ba... Maganda na din yun para makalaya ka naman sa cellphone mo paminsan-minsan. Baka kasi nagsasawa na yung gadget mo sa kaka-picture at video mo sa sarili mo. O di kaya'y sawa na din yung iba sa mukha mo. Konti lang siguro na diversity. Magsama ka ng kaibigan, ka-tropa, kapamilya, kapuso, kapatid para maiba lang. Opinyon lang naman. 





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Tuesday, May 7, 2013

ESBL producers

Extended Spectrum Beta-Lactamase (ESBL)

The picture below is a method to detect ESBL producers by using disk potentiation technique. Aztreonam (ATM 30ug) disk and Amoxicillin/Clavulanic acid or Augmentin (AMC 30ug) disk are placed 1.5 cm apart on a susceptibility plate. Incubated for 18-24 hours. Positive results can be seen as shown exhibiting a "keyhole effect" between Aztreonam disk (ATM) and Augmentin disk (AMC). *A keyhole effect can also be seen between Ticarcillin/Clavulanic acid (TIM) disk and Aztreonam (ATM) disk.

    * I will try to upload more (and better) pics of ESBL positive screening results.

ESBL are enzymes derived from mutations of TEM-1, SHV-1, capable of hydrolyzing extended spectrum cephalosporins such as cefotaxime, ceftriaxone but not cephamycins such as cefoxitin and cefotetan. These may be present and detected among enterobacteriaceae.

ESBL detection is very important in the surveillance of antimicrobial resistance. In 2007, CLSI (Clinical and Laboratory Standards Institute) recommended that all confirmed ESBL-producing strains should be interpreted and reported as resistant for all penicillins, cephalosporins (except cephamycins and Beta-Lactam/Beta-lactamase inhibitors, carbapenems) and Aztreonam regardless of in vitro results. This means that back then, an aztreonam with a zone of inhibition of 25mm, which is suppose to be susceptible, would be reported as resistant if confirmed as an ESBL-producer. But in 2010, these was changed. All results of confirmed ESBL-producers should be reported as is. This is still the recommendation up to now.  




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Saturday, May 4, 2013

Tropang Iskrab

Hindi ko ito maitatanggi. Guilty ako dati dito. Dati ha. Sino sa inyo ang umuuwi ng naka-scrub suit? O kaya grupo-grupo na naka-iskrab papunta mall? Tapos manunuod pa ng sine o kaya e magkakape sa paboritong coffee shop. Welcome sa Tropang Iskrab!
Isang malaking pagkakamali na hindi na namamalayan. Pagkakamali na binabale-wala. Alam kung alam nyo na ang mga pwedeng maidulot pag hindi ka nagpalit ng iskrab tapos diretso uwi o mall o gala, pero bakit kaya ginagawa pa din natin? Ayan ha, sinama ko na ang sarili ko, tutal pareho-pareho naman tayong mga Med Tek di ba?
Pag hindi mo hinubad yung iskrab mo pagkatapos ng duty, pwede ka magkalat ng sakit. Yun ang pinakamabigat. Pwede mong mahawaan yung mga katabi mo sa sinehan, mga tao sa mall, kasamang pasahero sa jeep at bus, kainuman ng kape o alak at maging ang pamilya mo sa bahay. Pero kung alam naman ng lahat 'to, bakit marami pa din tayong nakikitang na-iskrab sa kung saan-saan? Tama ka, hindi lang naman kasi Med Tek ang naka-iskrab. Maging mga nars, caregiver, therapist, reflexologist, yaya, at kahit mga janitor naka-iskrab na din. Ang dami pla natin sa Tropa! All walks of life pa!
Pero balik tayo sa punto natin, madami pa din ang hindi nagpapalit ng damit o iskrab bago umalis ng ospital. Dapat kayang magkaroon ng patakaran ang bawat ospital na bawal lumabas ang empleyado na naka-iskrab? Magkaroon kaya ng sariling laundry para sa mga health professional sa loob ng hospital? Ang saya din nun noh? Araw-araw may naglalaba para sa'yo, at libre pa!
Hindi ko alam kung dapat sabihin na kasalanan ng mga propesyonal yung ginagawang pagala-gala habang naka-iskrab pero "propesyonal" nga diba? Dapat mas alam natin yung tama. Siguro mas magiging maayos kung disiplinahin nalang natin ang bawat isa. Hindi ka na kelangan sabihan ng supervisor mo, ikaw na lang sa sarili mo. Kung talagang gusto natin makatulong sa kapwa, siguro ito yung pinakamadaling gawin. Malaking responsibilidad ang maging Med Tek. Mas malaking kasalanan kung magiging pabaya. Hindi naman siguro abala yung magpalit ng damit bago umalis ng lab o ospital. E d pano yan, hindi ka na sasama sa Tropang Iskrab ha! Sabihin mo na din yung iba pa nating ka-tropa! Salamat!


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Wednesday, May 1, 2013

Para sa Med Tek

Unang post sa unang araw ng Mayo. Sakto para sa ating mga manggagawa. Araw na natin 'to. Hindi ko alam kung ano ang patutunguhan ng mga isusulat ko sa post na 'to pero dahil nga araw naman ito ng lahat ng manggagawa, may karapatan ako na sabihin ang saloobin ko.
Una, dapat siguro magkaroon na ng fixed rate ang mga propesyonal. Ibigay kay Juan ang para kay Juan. Kung halimbawa e Php 11k ang minimum sa mga empleyado, e di yun ang ibigay. Pero ibahin naman sana sa mga propesyonal. Pumasa ang mga Med Tek sa boards, respetuhin naman sana ng mga employer pati na din ng gobyerno 'to. Hindi kami dapat kabilang sa minimum wage. Bigyan ang mga Med Tek at pati na din ang iba pang propesyonal ng nauukol na minimum wage. Nakaka-degrade kasi na pareho lang kami ng salary nung fast food crew. O kaya para kunyare hindi pareho e mas mataas lang ng P10-20 per day. Tsk tsk tsk! Nagkakalokohan naman e... Malaking mga hospital yung tinutukoy ko. Bato bato sa langit, ang tamaan may bukol!
Pangalawa, kelangan namin 'tong susunod talaga. Hazard pay. Uulitin ko in all caps. HAZARD PAY. Kung ayaw nyo bigay yan, e d sila ang mag extract sa taong may HIV! Ano? Kaya ba nila yan? Mag-examine ng sputum ng taong may TB, magbulatlat ng dumi ng tao ng kung sino-sino at magpatubo ng bacteria na multi-drug resistant, may iba pa bang gagawa nyan? At hindi na din pwede yung masabi lang na nagbibigay ng hazard pay. Dapat tama! (teka pang-eleksyon yun ah) Fixed din dapat. Mukhang tama ang 20% ng gross salary.
Ikatlo, siguraduhin ang kaligtasan ng bawat Med Tek (at lahat ng empleyado ng hospital). Ang ibig kong sabihin ay PPE (Personal protective equipment), health insurance at mga gaya nito. Hindi na dapat Med Tek ang bibili ng gloves at mask para sa sarili nya. Dapat may nakalaan na mga mask, gloves, goggles at lab gown para sa mga Med Tek kapag kelangan. Kahit na nasa hospital nagtra-trabaho dapat may health insurance maliban sa Philhealth. Minsan kasi kulang yung discount sa ibang hospital para sa empleyado at pamilya nito. Uulitin ko, dapat sana fixed para lahat makikinabang.

Kung tutuusin simple lang lahat ng hinaing na 'to. Dapat nga e automatic na yan lahat. Dapat nga ay hindi na hinihingi yan. Pero sana madinig 'to. Mas maganda kung magkaroon ng batas para dito. Bakit kaya hindi ganito ang pagusapan sa PAMET? Hindi yung puro lecture at sessions. Bakit hindi pakinggan yung saloobin ng mga Med Tek at ipaglaban. Hindi yung puro pa-cute sa komersyal ng sabon at sa iba pang mga med rep.



Isang makabuluhang araw ng manggagawa sa lahat! Mabuhay tayo!




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