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Welcome To The Freudian Slip

The Freudian Slip

The Freudian Slip is a travel-journal written by a former Doctor to the Barrio. Read his (mis)adventures here and follow how 'Doc Bien' began his exciting journey and more

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Visita Iglesia

Visita Iglesia

While traveling in Europe, I made sure to visit the churches and Cathedrals in every town or city that I visited....

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Where To Get A Tan

Where To Get A Tan

If you are looking for a nice beach to hang out, read reviews of beaches and resorts in the Philippines and around the world here

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Where To Stay

Where To Stay

Whether you are backpacking alone or travelling with a group, whether for a business meeting or for pure leisure, you might want to check out some of these hotels in the country and around the world

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Masskara Festival

Masskara Festival

After many years, I decided yesterday to brave the streets of Bacolod once again and witness the Masskara Street Dancing and see whether this "new format" for Masskara was better than...

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Where To Have Fun

Where To Have Fun

You deserve a break and there are many opportunities that will provide you with all the recreation that you need. Read some of these hang-out spots where you can relax, have fun and enjoy life to the full.

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August 8, 2017

Japanese Encephalitis

Japanese Encephalitis (JE) is the inflammation of the brain due to a the Japanese encephalitis virus (JEV). This virus is related to Dengue Virus and just like the Dengue virus it is also spread through mosquitoes. According to the World Health Organization the case-fatality rate among those with encephalitis can be as high as 30%. Permanent neurologic damage or  psychiatric sequelae can occur in 30%–50% of those with encephalitis. As of this moment, there is still no cure for this disease. So, it is better to avoid getting this disease. 


Since it is vector-borne, which means, it requires an insect or another animal (vector) to transmit the disease, the best way to avoid or even eliminate the disease is to do vector control or eradication. If communities can be helped to improve sanitation to destroy breeding places of these mosquitoes that can carry the virus or establish protective barriers against mosquitoes such as insecticide-treated mosquito nets in every home where this disease is endemic and common. Based on WHO information, 24 countries in the WHO South-East Asia and Western Pacific regions have endemic JEV transmission, exposing more than 3 billion people to risks of infection. 

According to the Outbreak News Today website: The researchers from the University of the Philippines Manila—National Institutes of Health, Institute of Child Health and Human Development, Manila, Philippines, the Philippines Department of Health, the Research Institute for Tropical Medicine (RITM) and the World Health Organization Regional Office of the Western Pacific, Manila, Philippines concluded based on the review, Japanese encephalitis virus (JEV) is an important cause of encephalitis and febrile illness in all three major island groups of the country and confirming that JE has an extensive geographic distribution in the Philippines. The majority of cases were seen in children younger than 15 years and males were more often affected than females. (March 22, 2015)
Another way to protect an individual from getting Japanese encephalitis is to have themselves vaccinated. There are vaccines available for both children and adults. And both children and adults are susceptible to getting the disease. 

According to WHO: 
There are 4 main types of JE vaccines currently in use: inactivated mouse brain-derived vaccines, inactivated Vero cell-derived vaccines, live attenuated vaccines, and live recombinant vaccines.

Over the past years, the live attenuated SA14-14-2 vaccine manufactured in China has become the most widely used vaccine in endemic countries, and it was prequalified by WHO in October 2013. Cell-culture based inactivated vaccines and the live recombinant vaccine based on the yellow fever vaccine strain have also been licensed and WHO-prequalified. In November 2013, Gavi opened a funding window to support JE vaccination campaigns in eligible countries.

All travellers to Japanese encephalitis-endemic areas should take precautions to avoid mosquito bites to reduce the risk for JE. Personal preventive measures include the use of repellents, long-sleeved clothes, coils and vaporizers. Travellers spending extensive time in JE endemic areas are recommended to get vaccinated.

Make sure to do all precautionary measures to prevent being bitten by mosquitoes that are potentially carrying the virus. Better yet, get yourself vaccinated against the virus especially if you are travelling to areas that are endemic of this disease. 


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July 30, 2017

Everyone Need Vaccines

Since its discovery when Edward Jenner made the first inoculation of cowpox in 1796, vaccines have come a long way. It has been regarded as still the cheapest most effective way of health prevention especially against "immunizable" infectious diseases. Many lives have been saved because of vaccines. However, as our understanding of medicine and health continue to evolve, production of vaccines and access to them continue to be confronted with a lot of challenges. There are still some parts of the world where we have failed to eradicate some "immunizable" diseases. And the erroneous claims that vaccines lead to development of autism did not help either. In developing countries, access to vaccines continue to be a challenge and a priority. Under the Expanded Program of Immunization of the World Health Organization, every child before he/she reaches the age of 1 year old must receive a prescribe set of vaccines that can help prevent the acquiring of common infectious diseases, most of which have debilitating effects on the child. In the Philippines alone, the country as a whole has yet to reach even its target coverage. The last report was around 80% of the target population were fully immunized in the previous years, way below its 95% target. And there are many reasons why children don't get vaccinated (even if the vaccines for children are free if you get them from a government facility). Number one is the issue of continuous supply of vaccines. There are instances when government facilities would run out of vaccines. And due to the archipelagic nature of the country, those living in remote areas are hardly reached by health workers whose numbers are not increasing. There are also issues of reliable cold chains that can store or transport vaccines to these hard-to-reach areas. And even if the vaccines are available, getting to the facility can be a challenge due to lack of transportation, lack of money to spend for transportation, lack of available time for health facility visits, lack of capability of caregiver to bring children for vaccination, etc. The list can be long and obviously cannot be addressed solely by the country's Department of Health.


But having said that, even in urban areas where access should not already be in issue, vaccination coverage is relatively low. Those who can afford to pay for their vaccines would prefer going to their pediatrician working in private facilities. Generally, most people think only children need vaccines. Adults also need vaccines. There are vaccines that can only be given to adults and to a specific group of adults who are more at risk of acquiring these diseases. 


Adults need also vaccines. Vaccines such as anti-HPV vaccine which is against the Human Papillomavirus that can cause cervical cancer. This makes it the only vaccine that can prevent cancer. It is not only for women but it is also recommended for men since men can also carry and transmit the virus especially during unprotected sex.

It is also cost-effective for companies and organizations to ensure that their employees have up-to-date vaccines especially against flu or pneumonia. Imagine to reduced sick leaves due to these illnesses. That can save the company at the same time improve productivity. Same goes with schools. Students need to be vaccinated against these illnesses so that there would be reduced absences and more time in school.

And with the world getting smaller, a lot of people are always on the move, traveling either for vacation or for work-related activities. It is important that before one goes to another place or country, he or she should consult his or her doctor if he or she would need any vaccine or prophylaxis against endemic or local diseases, especially unique to that place. It is important that a person keeps his immunization record updated.

What is more important is for governments to ensure high accessibility to these life-saving vaccines. Governments must ensure availability of these vaccines at the frontlines and that families can be able to access these vaccines with as much little cost as possible.

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May 22, 2017

A Message From the Other Side

I was told that the graduation of my alma mater College of Medicine will be this Saturday. Let me share my insights to the graduating medical students after 10 years of being a medical doctor myself, a neophyte compared to the giants of this vocation. The adventure does not stop in your graduation. This is only a step closer to the realization of a dream, a bigger dream. A dream within a dream. The diploma only marks a milestone in your life. It only certifies the end of a phase. The demand for sacrifices will still continue and the pressure and stress will still linger. Remember that the way to doctor-hood is the footprints of humility and sacrifice. Ego would have only distracted you from your journey towards becoming a doctor. You have to literally crawl on your knees to get your way to this reality: a graduate of Med School. And if you think you will now stand erect like an evolving primate to homo erectus, think again. Being a doctor, a physician, will continue to be difficult. It will be challenging. It will be frustrating. It will be disappointing. The road is sprinkled with heart aches along the way. The sacrifices will never be enough. There will always be trade-offs at every converging road you will encounter.

Underneath every cloud of gloom, there will be moments however that the sunshine will leak its way through the heavens. Treasure every beam of light, they come in the form of smiles and affirmations. Acknowledgements and compassion. They will temporarily wipe the tears you have cried alone. They will lift you for a brief moment from your weariness. Take advantage.



You can sacrifice your sleep, your time, your luxury, but never sacrifice your humanity, your soul. You can regain the lost time, the lost sleep and the unclaimed luxuries. But it will be almost impossible to reclaim your lost humanity. Guard it with your life. It is the very core of the vocation of doctor-hood.



It will be difficult just like at the beginning. Remember the trembling moments you had when you started out in medical school. They will never leave you even while you practice your profession from here on. It is the tremble in your feet that anchors you to earth, they keep you grounded. And once you are able to learn how to live with them, you would have earned Courage.



The hardships you have and will encounter prepare you how you will handle your victories. To become successful is the easy part. How to handle success is the more difficult part. And the trials you have been through. The sufferings you have to go through, they all teach you how to hold this fragile commodity called accomplishment.



Smile. Always wear that smile, especially in your heart. You cannot heal if you cannot smile. It is the mask that every physician wears. It separates you from all other professions. For you are Hope's ambassador, Comfort's representative and Hospice's spokesperson. Your language must always be the language of love. And you can only articulate love through joy. Joy even with a weary heart. Joy even with a broken soul. You are broken because in your healing others, you take a piece of yourself to replace the brokenness of the person you are healing.



Do not be afraid of failure. Failure is the shadow of every triumph. Rise with anticipation if you see the glimpse of this dark shade. Success is just around the corner.



As you step outside into the world of healing and curing, let your steps be guided by Faith. The stars in the dark sky will usher in the glorious morning that you deserve. What you are seeing now is just the breaking of dawn, it is not yet morning. But it is already beautiful.

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December 31, 2016

Cinemedicine 2017

Every year, I ask my first year med students under my Family and Community Medicine class to come up with a mini-film that would depict a family's journey and experience when one of the family member is ill. It is part of our discussion on Family Illness trajectory. Since I've been doing it, it has been called Cinemedicine. The following are now the entries for Cinemedicine 2017: Feel free to watch and share with friends. Talk about your favorite entry on twitter using their hashtags #cinemedicine2017 #hiraya #kontak #cinco #alma #marionette

Hiraya







Kontak







Cinco







Alma







Marionette




Now, viewers can choose the best film here. A percentage of the over-all score is for the Viewer's Choice. Poll is now open. It will close on January 9, 2016 6pm Manila Time.








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March 20, 2016

Health As A Platform: What I Want the Next President to Focus On

I am currently waiting for the second Presidential debate, I am thinking of how the next Administration should address the health challenges of the country. The facts are clear, our country still has to really achieve high performance in Immunization coverage, improve services in maternal and child health and address access to safe drinking water and sanitation. So, if given the choice, based on my experience as a former Doctor to the Barrios and working with more than 72 local government units and their municipal health offices, I want the next President to focus on the following items, from the most immediate to long-term:
1. Genuine Universal Health Care - the keyword here is genuine. The Aquino administration pushed for Kalusugang Pangkahalatan and although there have been gains it is not really Universal as what the current administration would like to believe. Universal Healthcare implies basic and essential health services are made available for everyone. And I mean everyone regardless of your economic class. For example, access to essential medicines should be made available not just to the "poorest of the poor", everyone should have access to these essential medicines made available in health centers. After all the middle class also contribute to Philhealth and through other taxes. There should be no consultation/medical fees in government hospitals for everyone. Sin Tax should be enough to cover major government medical centers and provide basic services. Why not download the money directly to these medical centers? In fact, National government must review the governance and relevance of Philhealth.
2. Focus on Preventive Health Care - more emphasis on preventive and promotive health care programs and interventions. Health Program should not be "hospital-centric" or just focus on "facilities" and "infrastructure". It is a given, infrastructure in some parts of the country is badly needed especially in GIDAs (Geographically Isolated and Disadvantaged Areas), but it should not stop there. Philhealth should start covering interventions that are preventive in nature. An example would be if a patient is diagnosed as hypertensive or diabetic in a rural health unit, he or she is enrolled in a registry wherein he or she undergoes regular monitoring by the Municipal Health Officer or Primary Health Care Physician. If patient is able to maintain BP or FBS within a normal range, in other words controlled hypertension and Diabetes, patient gets incentive as well as the doctor who ensures such. A patient enrolls in a Smoking Cessation Clinic, if patient was able to stop smoking over a period of time, he gets incentives as well as the smoking cessation clinic health worker. Philhealth pays for the incentives. If a mother was able to complete the immunization of her child on time, even if she is not a CCT beneficiary, she should get an incentive from PHilhealth, including the health worker assigned to her. Dental services as well.
3. Strict Evaluation of the Department of Health - program managers both at the National and Regional Offices should be evaluated based on outcomes and not just outputs. They should be evaluated based on the impact that their programs bring to the over-all health indicators of the country or the region. If they could not hit target within a specified time period, they should be replaced. THe government could not be lenient with its people working on the health of the citizens. Make DOH accountable for outcomes and improve the overall health information system. This is to ensure that DOH makes rational decisions based on timely and relevant data. In fact, you cannot be a program manager if you didn't have appropriate experience on the ground.
4. Review Medical Curriculum - As President he or she can give a directive to CHED/PRC to review existing medical and premedical curricula and redesign it to ensure that those who finish medical school and even nursing school should have a preference for public health and primary health care where most of the patients are found. We have too many specialists serving in urban centers where not so much of the health problems are found. The health problems are found in the rural areas, in the frontlines. The pyramid has to be inverted now. Government should make Public Health practice as the most lucrative in medical practice. This should encourage doctors and nurses to stay and serve in areas where their services are needed the most. Encourage other medical and allied health careers like midwives, medical technologists, etc.
5. Anchor other National agencies on Health - the President must understand that health is a complex issue that interventions should not just be "clinical" or "exclusively health related" to address the health issues. THere are many determinants of health that the government must consider. Like in the issue of nutrition, government must ensure access and availability of stable food sources that are nutritious and affordable. Access would entail construction of roads and markets closer to the people and exemption from taxes for organic and locally grown nutritious food. The most important factor is really access to safe drinking water. This would really require securing water sources and laying out the infrastructure that would deliver water from these sources to homes and communities.
6. Making Local Governments Accountable for the Health of their People - because delivery of health services is devolved to the local government units, National Government must make sure that these LGUs deliver health services to their people and it should have impact on the health indicators of their people. National government should engage local governments more especially in the planning and implementation of the programs. LGUs look at National Government as just "downloading" programs to them for implementation, even if at times these programs are not locally relevant or designed with the local context in mind.



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