[Naisulat ang sanaysay na ito noong medical intern ako sa PGH taong 2011. Ibinabahagi kong muli dito.]
Six weeks ago from the hallowed, tepid womb of PGH, I was an eager medical intern waiting to be delivered to the expectant coastline community of San Juan. Six weeks ago endowed with due developmental milestones, I babbled my expectations not impishly but with the clarity of human language. Six weeks ago I along with another eleven toddlers escaped our bassinets to run down the rabbit hole leading us, not into Alice’s Wonderland, but into the no-fantasy-world but real idyllic town of San Juan. Six weeks ago we were exposed carrying with us our eight-month ripened thrill and enthusiasm to the flesh and blood of community medicine.
Sixty thousand four hundred eighty minutes flew like the monsoon wind. But how do we measure six weeks in San Juan?
Week One stomped like a racing horse, fast but not furious. My partner Greggy and I met our warm and hospitable foster family, did an ocular inspection of Buhay na Sapa and Ticalan, shook hands with the local health leaders and providers, and inquired about barangay health projects in progress. Week One was the peek-a-boo of the whole six-week rotation.
Weeks Two and Three became a two-week long holiday break granting me the rare chance of a medical intern to celebrate Yule with the family in addition to reading few good books such as Sontag’s The Benefactor, Updike’s Gertrude and Claudius, and Syjuco’s Ilustrado. Reading novels is blue moon to a hectic medical intern whose reading staples are Harrison’s, Schwartz’s and William’s.
Week Four was spent conducting clinics in health centers freshly reopened with new purchases of essential medicines shaping patient censuses to rocket-high figures. Other than seeing the sickly, kindling rapport and working with BHWs was our task of prime import. In the morning, we sat with BHWs diagnosing and advising patients using IMCI[i]. At lunchtime, we partook of their toothy fried tilapia and the squash-fruit-and-tendrils-plus-kidney-beans-in-salted-water bulanglang. The taste was excellent as their genuine company. We also got a chance to work with nursing students stationed in Buhay na Sapa. We discussed new patients for Interdisciplinary Approach referral and made three house visits. We met a two-year old with global developmental delay, his mother’s hands clasped for a miracle; a twenty-six with cerebral palsy, his family in beginning caregiver fatigue; and a five with bilateral leukocoria, her grandma responsively omnipresent for her needs. After the count of three patients we, medical interns and nursing students, synthesized our insights and experience.
Week Five was exhausted mainly for our group’s community research. We raced writing our research protocol. Brainstorming and building the instructional design for teacher’s training for BHWs was a herculean task and process. Our foster family would catch us our legs in Indian seats on the newly polished wooden floor of our sanctum using our bed as a makeshift for an instant laptop table. Fortune befell us – our arms fitted snugly in parallel to the bed mattress. We were not accosted of having sore shoulders from incessant typing in the deep nocturne. Week Five, the penultimate week of our rotation, though was not purely research. On top of our regular clinics in health centers, we facilitated a discussion regarding IMCI among BHWs. We learned about their strengths, mistakes, and fears on IMCI and appropriately acted on these. We bolstered their strengths, corrected their mistakes, and assuaged their fears. In the end, we noticed a step-up brewing empowered version of our BHWs.
Week Six, the tail end of our rotation, was hectic. Everyone was catching up. Aside from the regular clinics in health centers, we had a follow-up meeting on our IDA patients, a lecture on ovitraps (a simple invention for dengue surveillance control) and refining of our community research protocol. However hectic our schedule was, my senses were not blinded nor numbed to appreciate the beauty of San Juan. One day when we were planting the ovitraps around an elementary school, I could not help but surrender my arrested attention to the scenery directly in front of the school. There laid acres and acres of rice fields whose emerald grass blades danced and swayed with the wind. Far beyond the greeneries stood proudly Mt. Banahaw like a breast of a puerperant, her nipple touching the heavy cumulus clouds gliding in the sea of azure sky. What a simple and happy life would be to live in a place with such a view! It was a breathtaking mecca.
Unfortunately despite such a delight, Week Six spelled a mix of happiness and melancholy. Happiness that another rotation was over hence a sign of moving forward in Internship. Melancholy because everything I enjoyed in the community would suddenly stop at a halt.
As they say every start has an end. A dogmatic truth even an Einstein could not disprove. A life begins; an end consumes it. Birth and death accompany each other. Hence when I harped the first week of my Community Medicine rotation, I consented to its unavoidable end.
The day for Exit Report came inevitably, the moment we would tell our observations and experiences in San Juan pinpointing its successes and problems on its health programs. It was the last day of the last week. Inside a small room inside RHU 1, midwives and nurses comfortably sat and chat on the first four rows of monoblocs. Interns huddled at the back.
The first slide of our Exit Report flashed on the screen. The light coming out of the LCD projector temporarily blinded my vision. I got a cue from a woman in yellow. I began to report in Tagalog. In less than an hour, I was finished. After a few questions and comments, Interns were awarded certificates (of appreciation from the town of San Juan for our service) and the end was called.
As a baby slowly crosses the different planes of the maternal pelvis and passes in between the ischial spines often called station zero inching out to the light of this world, I had come for a second birth – the birthing of me from the warm womb of the community of San Juan with tepid amniotic fluid shooting in the air. After once born out of PGH to community rotation in San Juan, I was eventually reborn back to PGH. It was not a ping pong experience but a mind-opening, dynamic, practical exchange and application of theories and ideas, both medical and socio-political.
Going back to the initial question I threw – how do we measure six weeks in San Juan?
It is not measured with how many patients we saw in health centers, nor how long we spent time with the BHWs and our foster families, nor how much we paid that tricycle driver for a speedy ride from poblacion to our houses, nor how much lambanog or kapeng barako we gulped, nor how wrinkled our palms and soles were after soaking too much in Laiya. Nor how many ovitraps we planted, nor how much time we did the research, nor how much we became close to our intern buddies, nor how much often we post pictures of our blocks in Facebook.
It is in how much centripetal force those six weeks have imbibed in us convincing us to once again go back, pro-actively and voluntarily without a medical curriculum launching us, and re-experience those six weeks or even for much longer time in a place exactly or similarly San Juan. Not only a completion requirement but a self-driven passion, a personal advocacy. It may not be practically San Juan itself but another place – a well deserving place – where people only see doctors in TV dramas or where doctor is just plain word and a phantom synonym for the ubiquitous hilot. This is the real measure of gravity on how those six weeks blossomed to the genuine fruits of community medicine.
[i] Integrated Management of Childhood Illnesses (IMCI) is an easy-to-follow module for nonmedical personnel such as BHWs on managing children.