Journey Begins in Manila

My journey of studying healthcare has officially begun in the Philippines. I spent this last week in Manila, the capital city. Some initial reactions: Manila is hot, dirty, crowded, and the traffic is horrible. The people however more than make up for this! 

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The main things of the week were:
• Met my good friend’s family
• Set up my initial meetings and visits
• Visit to Philippines General Hospital
• Worked on PESTLE analysis
• Created a rough plan of where to go

Example of typical traffic in Manila. This is about 9:00 or 10:00 PM. Usually it is about an hour to get places and you could get there just as fast by walking.

Setting up initials meetings and visits

One of the things I realized pretty early was that some places are more formal with visits and require you to submit a letter requesting a visit. This process requires a formal letter made out to a medical director that is printed out, signed, and delivered. The content of the letter consists of your purpose, some background on yourself, the times when you would like to visit and your contact information.

I was fortunate to have met a nurse who volunteered to print off my letter and deliver it to the Philippines General Hospital (this saved an hour commute there and an hour back). So far I’ve requested Philippine General Hospital (tertiary government hospital), St. Luke’s (one of the nicest private hospitals and has a partnership with the Mayo Clinic), and The Medical City which is considered centers of excellence in wellness and aesthetics, cardiovascular, cancer and regenerative medicine. I am looking for a diverse perspective so I thought I should try to see some of the nicer facilities in Manila before I go out to more rural areas.

This next week I am looking forward to meeting with an orthopedic surgeon who is Filipino but practiced in Minnesota for many years. It should be interesting hearing his perspective between the 2 countries. Along with that I plan to meet with a doctor who is heading the social innovation organization at the University of Philippines. I am really looking forward to learning about some of the initiatives going around in the Philippines and what are some of the major problem areas that have been identified. After these meetings in Manila I plan to fly down to Cebu to meet with one of my friend’s other relatives and to visit some of the clinics down there.

In between visits and setting up meetings, I’ve been working on a PESTLE analysis of the Philippines and researching health aspects of the Philippines. PESTLE is a high level view of the politics, economics, social, technological, legal, and environmental aspects of a country. When doing this you start to realize how everything is connected and how different aspects start effecting each other. A simplified example is that there is a strong catholic presence in the Philippines with 90% of people identifying as catholic. This can lead to more conservative viewpoints and judgment in relation to the use of contraceptives (Philippines has very low use of contraceptives compared to other countries). With less use of contraceptives this can lead to higher unplanned pregnancies. Other factors such as cost of the contraceptives can add to this but you can see how social culture can have an impact on family planning.

Philippines General Hospital

One of my friend’s nieces is a medical student at the University of Philippines which is paired with the Philippines General Hospital (PGH). She gave me a tour at night and then the next day I spent a half day walking around and observing everything in action.

It was shocking. There were so many people everywhere.

The Emergency Room was an open room full of people with a couple of curtains on the side for procedures. Various departments shared this space. Walking in between the beds seeing all of the patients everywhere and their conditions made me light headed. I had to harden myself to what I was seeing. This was something that I have not seen in Minnesota and have only seen pictures or read about. Seeing pictures is much different than actually being somewhere in person.

To get to this space a patient had to find an open bed. Other patients were lying on beds in the hallway being treated. Patients usually have their family travel with them to the hospital so there were family members beside the patients. Those who couldn’t fit laid on cardboard mats outside of the hospital. In the morning people would line up at 5:30AM. Usually it would take about 5 – 6 hours to be seen by somebody for the first time by a medical student. After this they would be seen by a doctor and if needed a more senior doctor. A trip to PGH is a whole day ordeal. There is a lot of waiting.

PGH is a government run tertiary hospital. The hospital treats 600,000 patients a year. The patients are referred here when the general hospitals are not able to treat them. The people treated here are some of the neediest in the Philippines and some people have to travel great distances to get here. Often the more rural patients wait until a condition is no longer bearable to make the travel. Some people do not make it in transit. If my touring request gets approved I hope to shadow some nurses and doctors to get a better feel for some of the procedures that are done in the hospital.

Lifestyle in the Philippines

My first full day in the Philippines I got to spend with my good friend’s family at one of their family gatherings. Family is very important in the Philippines so people came from all around to celebrate the host’s anniversary and birthday. I brought maple syrup and maple candies from Minnesota to give as a gift. The celebration was full of food, drinks, laughter, and singing. Filipinos love to sing! After awhile they even convinced me to go up and sing karaoke. I sang Scar Tissue by the Red Hot Chili Peppers for the very first time (I don’t sing very often). Everybody was so welcoming and it was a very great time. I am fortunate to have been invited to such a lovely gathering!

Here are some of my initial observation of Filipino culture. Filipinos are very lighthearted and love to make jokes. I’ve had many people I know and don’t know joke that I should date their daughter, sister, friend, etc. (At least I think these are jokes…). When talking with people conversation is usually pretty light but sometimes it will stray to hard hitting topics like politics. These are discussed for a little bit but then usually somebody makes a joke and the topic changes to something else. Filipinos love to sing! People sing at events, while doing chores, in the car, and whenever a song is on the radio. It seems like people tend to work a lot, at least in Manila. A number of people I talked to would say they worked 6 days a week. The people I have met are very nice and helpful and many will warn you not to trust strangers (I had a stranger on a long bus ride say this and then invited me to his family restaurant. I decided to trust him after awhile and had a great time meeting his family!) So far I haven’t run into any people trying to scam me and everybody has been great to meet. I often get stared at which I have started to get used to… my blonde hair and blue eyes definitely stand out!

The food has a range from very delicious to “what did I just eat?” My favorite dish so far has been sisig. This is pork face served on a sizzling plate with onions and veggies. The story is that the soldiers would get the good pieces of pork so the farmers were left with whatever remained inspiring this tasty dish! It is often crunchy and has a very good flavor. In general food is often served with rice but you buy it as an add on. The craziest thing I have tried was balut. (Warning if you look this up!) It was actually very delicious and it is recommended that you eat with the lights off! Luckily my friend made sure to shine a light and point out some of the more interesting parts while I was eating it… You crack one of the sides that the vendor points out and you open the egg and drink the soup that is inside. You then take off the shell and remove “the hard part”. You put a little chili vinegar and salt on it and it’s ready to eat!

Pictured below from top to bottom is kaldereta, sizzling bulalo, and sisig. This was one of the nicer meals that I have had in the Philippines!

I am writing this post in Batangas where I spent the weekend diving and getting away from the city. I am headed back to Manila in the morning for my interviews and some visitations!