Lost in Translation

from BEYOND THE WAILING SIREN By Rogelio F Varela Jr.

As my internship at the busy city hospital progressed, I found myself in the midst of an unexpected and eye-opening incident that left a lasting impression on me. 

It was a night like any other in the labor and delivery unit when a pregnant woman, visibly in pain, was rushed to the ward.  The attending OB-GYN resident immediately took charge, her stern yet focused demeanor a testament to her experience in handling such situations.

The patient was eight months pregnant and in active labor.  She was accompanied by her worried husband who looked anxious but determined to support his wife through this challenging moment.

The OB-GYN resident displaying her typical efficiency, began asking the usual questions to assess the situation.  “Saan po kayo nag papa-pre-natal check-up?” she inquired, her tone professional yet empathetic.

The patient hesitated before responding, “Wala po akong pre-natal check-ups.”

The room fell silent for a moment. I exchanged a quick glance with the OB-GYN resident, noticing the concern in her eyes.  It was an alarming revelation, as regular pre-natal check-ups were crucial for monitoring the health of both the mother and the baby.

Attempting to emphasize the importance of prenatal care, she said, “Mostly ng patient na walang check-up namamatay.”  It was meant to be a statement of fact, a way to stress the gravity of the situation to the patient and her husband.  What transpired next was expected:  the violent reaction mixed with sheer desperation. 

The patient’s eyes welled up with tears, and her husband’s expression shifted from concern to anger.  The husband angrily retorted, “So hindi nyo kami i-admit?”

The words hung heavy in the air, and the tension in the room escalated rapidly. The OB-GYN resident clearly taken aback by the husband’s response, was at a loss for words.  It was a serious accusation, one that no healthcare professional ever wants to hear.

“Hindi ho, sinasabi ko lang ho na mostly ng mga patient na walang pre-natal check-up namamatay.  Kailangan ho kasi nagpapa-check-up para malaman kung may mga ibang sakit ba si misis habang sya ay nagbubuntis.”

She eventually ended up delivering a healthy baby girl that night.

We thought that was it and went on with our duty.  What transpired later, however, was something none of us expected. 

The following day, our office received an urgent call from the hospital’s medical director.  The husband had filed a formal complaint, alleging religious discrimination during their visit.  The OB-GYN resident was summoned to explain her side of the story, and I was asked to accompany her as a witness to the events that had unfolded.

Sitting in the medical director’s office, she recounted the entire incident, including her statement that had been misconstrued.  She explained that her intention had been to emphasize the heightened risk that pregnant women faced without proper prenatal care, regardless of their background or beliefs.

As patient’s side of the story was presented, it became evident that there had INDEED been a significant misunderstanding.  What enraged the couple was that they heard: “MUSLIM na patient na walang pre-natal check-up namamatay,” instead of the intended, “MOSTLY ng patient na walang pre-natal check-up namamatay.”  The misinterpretation triggered a chain of events that threatened to tarnish the reputation of our hospital and our dedicated medical team.

To bridge the divide and clear the air, the hospital arranged a meeting between the patient and the OB-GYN resident, where both parties could openly communicate and understand the unfortunate mistake.  It was a difficult but necessary step to resolve the misunderstanding and to rebuild the trust between the hospital and the patient.

This incident served as a poignant reminder of the importance of effective communication in the field of medicine, especially in high-stress situations like childbirth. It also highlighted the significance of cultural sensitivity and awareness among healthcare professionals.  In the end, it was a lesson for all of us on the need to choose our words carefully and to consider the impact they may have on patients from diverse backgrounds.

A Twisted Sense of Satisfaction

from Beyond The Wailing Siren By Rogelio F. Varela Jr.

The journey through medical school was a grueling marathon, a test of both intellect and endurance.  Each year seemed more demanding than the last, a crucible that pushed aspiring doctors to their limits.  The four-year odyssey was an unending battle, an incessant war waged against sleepless nights, relentless exams, and the constant fear of failure.

In those hallowed halls of medical academia, exams were a relentless adversary. They lurked around every corner, a perpetual source of stress and anxiety.  Passing was a triumph earned through sleepless nights and exhaustive study sessions.  Failing was a brutal blow, a reminder of the harsh reality that success in this field demanded nothing less than absolute dedication.

As if the academic rigors weren’t enough, the fourth year of medical school brought forth an entirely new battlefield.  We were called medical clerks, assigned to different hospitals for specialty rotations.  We were thrusted into a world where they expected us to adapt quickly, absorbing knowledge and honing skills under the stern gaze of seasoned professionals.

It was a tumultuous journey.  The nurses sometimes treated the fledgling medical students as if they were the lowest form of life in the hospital hierarchy.  Perhaps it was a rite of passage, a way to toughen the aspiring doctors for the harsh realities that lay ahead.  But the humiliation and the derogatory remarks often felt like an extra burden to bear.

Mental health, an aspect often overlooked in the medical world, struggled to find a fair footing amidst this relentless academic and clinical pressure.  The stress was palpable, a heavy cloud that hung over the corridors of medical school.  Many students grappled with anxiety and depression, dealing with the immense expectations and the ever-present fear of disappointing not only themselves but also their families and mentors.

The residents, perched on a slightly higher rung of the ladder, sometimes viewed the medical students as personal assistants, assigning menial tasks such as fetching food and drinks.  The hierarchy was clear, and the demands were relentless. It was a trial by fire, a test of humility and obedience.

One day, a group of beautiful young medical representatives ventured into the surgery office at Quezon City General Hospital, where I was on my surgery rotation.  They were aiming to present their pharmaceutical products.  The surgery residents, ever eager to seize a moment of respite, decided to flirt with these representatives, indulging in casual banter.

In the midst of their exchanges, the surgical residents requested that I purchase canned sodas for them.  It wasn’t an uncommon request, but on this particular day, I felt a surge of defiance.  The audacity of the representatives to also ask me to fetch their drinks fueled my annoyance.  So, with a sly smile, I shook the soda cans with great vigor, silently vowing to unleash a small act of rebellion.

As the unsuspecting representatives popped open their cans, the carbonated contents exploded, dousing their blouses.  Their startled cries echoed through the room as I watched with a twisted sense of satisfaction.  It was a fleeting moment of triumph, a small act of defiance in a world that often seemed to demand too much.

Reflecting on that incident later, I couldn’t help but chuckle to myself.  It was a memory that reminded me of the need to stand up, even in the smallest of ways, when faced with circumstances that tested my limits.  In the harsh world of medical education, sometimes, a bit of mischief was necessary to preserve one’s sanity.

The Field Trip

The hospital corridors echoed with an eerie silence on that tranquil Saturday morning—a stark contrast to the chaos that usually unfolds in the East Avenue Medical Center’s emergency room.  Several empty gurneys lined the room, awaiting their next occupant.  On the outside, they appeared spotless, even pristine; but a closer look would reveal random traces of sweat, blood, and vomit.  These gurneys held tales of countless souls.  If these gurneys could only talk, they could have whispered, “Lay down and rest now, my friend.  If only I could shield you from pain, I would; but all I can offer is reprieve.”

The ever-present scent of disinfectant clung to the air like a persistent memory. Manong, the grizzled hospital orderly, dragged a pail of water mixed with Chlorox*, erasing the remnants of human agony from the cold hospital floor.

At the station, nurses received endorsements from their night-shift counterparts.  Medical clerks and interns, fueled by coffee, raced to complete the 24-hour ER Census.  In the wards, resident doctors engaged in grand rounds with consultants, their minds already focused on the day’s challenges.

Saturday mornings in the ER are usually quiet, the calm following the tempest of Friday nights.  The calm hardly does justice to describe the pandemonium that ensued the night prior.

As a surgery resident with years of experience, from the days of medical clerkship to moonlighting as an intern and now proudly serving at a public hospital, I developed an uncanny ability to anticipate emergencies based solely on the vehicle bringing in the patient.  A tricycle filled with shirtless men was most likely carrying a stabbing or gunshot victim.  A lone man in a tricycle with a large bag hinted at an imminent childbirth. Private vehicles with passengers frantically shouting a patient’s name typically indicated cardiac arrest or stroke.  When an ambulance arrives, it most likely bore the aftermath of a motor vehicular accident.

Around lunchtime, a distant rumble was heard and grew steadily louder, vibrating through the hospital’s foundations.  Uncertainty shrouded my instincts as I questioned whether the source of the sound was indeed drawing nearer to the ER entrance.

Then, as if to validate my apprehension, a massive tourist bus appeared into view. Three buses in total, each numbered from 1 to 3, carrying young souls from Molino Elementary School.  A chilling clarity settled in as I realized the severity of the situation—they had experienced a tragic accident during what should have been an exciting field trip.

The ER’s tranquility was shattered as we all hurried outside to get a clearer picture of what transpired.  The first bus bore the scars of the incident, with a cracked windshield and damaged front bumper.  The loud cries of young children emanated from within.

Nurses and orderlies rushed forward, wheelchairs at the ready, anticipating the injured children.  The cries grew as the children disembarked, while their teachers and field trip coordinators engaged in heated discussions with the bus driver and conductor.

The serene halls of East Avenue Medical Center transformed into a whirlwind of activity. All I could think to myself was, “Just another day as a surgery resident.”

In the midst of the commotion, I learned that these three buses transported students from Molino Elementary School, and a total of 31 people, including 21 elementary students, had been injured.  They were all brought to East Avenue Medical Center for treatment.

The scene was nothing short of chaotic.  Injured children, parents, and teachers filled the ER, their expressions a tapestry of pain, fear, and confusion.  The young students, who embarked on an educational field trip to Luneta Park, were now facing a different kind of lesson—one of resilience and courage.

I saw the eyes of these young patients, brimming with tears, and my medical instincts surged to the forefront.  Together with our dedicated team of nurses and fellow residents, we sprang into action, assessing their injuries.  Most suffered from cuts, bruises, and minor fractures, but one case gripped our attention—a six-year-old boy with a lacerated eyelid, a delicate injury demanding immediate attention.

As we worked tirelessly to stabilize the young boy and care for the other injured patients, I couldn’t help but think about the parents waiting anxiously for news of their children.  The weight of their concern hung palpably in the air.  My duty extended beyond medical care.  At that moment I felt the shift from being a surgeon bent on diagnosing and treating, to a healer, trying to be a source of comfort and reassurance to these worried families.

Time seemed to fly by in a blur as we treated the young patients, the minutes slipping through our fingers like grains of sand.  Outside the ER, investigation into the accident already commenced.  Conflicting accounts from witnesses and drivers complicated the situation, reminding us that in the medical field, we were not just healers of the physical body but also navigators of intricate human stories and emotions.

As the sun dipped below the horizon, a sense of relief washed over the hospital. The injured children were on the path to recovery, and their families expressed gratitude for the care they had received.  The following day, there it was – my name printed in the news: “Dr. Rogelio F. Varela Jr., who attended to the injured passengers, said…” It was a moment of pride, a reminder of the profound impact we can make as doctors.

The lessons of that challenging day would forever shape my journey as a physician. The young students from Molino Elementary School had left an indelible mark on my heart, reaffirming that our role extended beyond medical expertise, embracing the profound importance of compassion in medicine.

Invaluable Lessons from Marrakesh: Charting a Path Forward for the Philippines

By Rogelio F Varela Jr

In the heart of North Africa, where tradition seamlessly intertwines with modernity, lies Marrakesh, Morocco—a city that casts a spell of enchantment with its rich tapestry of culture and hospitality. Recently, I had the privilege of embarking on a transformative journey to this captivating city, a journey made even more extraordinary by its coincidence with the 2nd African Health Harm Reduction Summit.
Marrakesh had an element of surprise in store for me upon my arrival. Mere weeks prior, the city had experienced a seismic event that left many questioning the readiness of the summit. To my astonishment, I found an event that was exceptionally well-prepared and meticulously organized, a testament to the resilience and determination of the Moroccan people.

Yet, what truly left an indelible mark on my heart was the genuine warmth and kindness of the local inhabitants. The Moroccan people extended a warm welcome, making me feel at home in a foreign land. Their hospitality was boundless, a reminder that the true beauty of a place resides not only in its physical wonders but in the hearts of its people.

Marrakesh, a city that defies easy description, is a testament to centuries of history and culture. Its labyrinthine medina, bustling souks, and breathtaking architecture tell tales of an ageless past. The vibrant colors, intricate designs, and tantalizing aromas of local cuisine create an immersive experience beyond imagination.

Yet, beyond the mesmerizing aesthetics of Marrakesh, I had the privilege of attending the 2nd African Health Harm Reduction Summit. This summit served as a treasure trove of knowledge and insights that transcended borders and cultures. The wisdom and insights gathered during these sessions hold immense potential for application in my homeland, the Philippines. The innovative approaches to healthcare, harm reduction strategies, and collaborative efforts showcased at the summit promise to revolutionize healthcare outcomes in my own country.

The 2nd African Health Harm Reduction Summit, held in Marrakesh, Morocco, from September 26 to 29, 2023, was a significant gathering of experts, policymakers, and stakeholders from across the globe. The summit addressed a wide range of critical topics, shedding light on innovative approaches to tackling pressing issues affecting Africa and the world. While the discussions primarily focused on the African context, the lessons and strategies presented during the summit hold valuable insights for countries like the Philippines, which also face similar challenges. Let me explores key themes discussed during the summit and highlights the lessons that the Philippines can learn from them.

Health and Environment Harm Reduction: Air Quality, Global Warming, Respiratory Diseases
One of the paramount themes at the summit was the intersection of health and environmental harm reduction. The Philippines, like Africa, grapples with air pollution, global warming, and the associated rise in respiratory diseases. Lessons from Marrakesh emphasize the importance of implementing policies to curb air pollution, transition to cleaner energy sources, and improve public health outcomes. The Philippines can draw from these insights to develop and implement strategies that mitigate the adverse health effects of environmental degradation, particularly in urban areas.

Food Security in Africa and the World: What Harm Reduction?
Food security, another crucial topic at the summit, resonates with the Philippines’ challenges of hunger and malnutrition. The country faces the compounding effects of climate change, population growth, and economic disparities on its food systems. Learning from discussions in Marrakesh, the Philippines can adopt harm reduction strategies such as sustainable agriculture practices, promoting food diversity, and enhancing food system resilience. These strategies can help improve food security while considering the global implications of such efforts.

Nutrition and Health Education: Future South-South Perspectives
The summit highlighted the pivotal role of nutrition and health education in improving public health outcomes. The Philippines shares similar concerns, with issues of undernutrition and obesity coexisting within the population. Lessons from the summit underscore the importance of fostering better nutrition practices, promoting health education, and strengthening healthcare systems. South-South collaboration, a central theme, provides the Philippines an opportunity to learn from African nations’ experiences and develop partnerships to address these health challenges collectively.

Drinking Water: Continental Investment and Capital
Access to clean drinking water remains a critical challenge in various regions of the Philippines. The summit’s discussions on continental investment and capital allocation to address water access issues can inform Philippine policymakers and stakeholders. Implementing harm reduction strategies that focus on developing water infrastructure, purification technologies, and equitable access to safe drinking water can significantly improve the health and well-being of Filipino communities.

Risk Reduction and Tomorrow’s Ecosystems: The African Equation
Lastly, the summit explored risk reduction and ecosystem preservation, issues that resonate with the Philippines’ unique ecosystems under threat from climate change, deforestation, and habitat degradation. Lessons from Marrakesh stress the importance of implementing policies to mitigate these risks, conserve biodiversity, and promote sustainable development practices. The Philippines can draw inspiration from the summit’s emphasis on local and international cooperation to safeguard its ecosystems for future generations.

The 2nd African Health Harm Reduction Summit served as an invaluable platform for addressing complex challenges facing Africa and the global community. The lessons derived from discussions on health and environment harm reduction, food security, nutrition and health education, access to clean drinking water, and ecosystem preservation offer the Philippines actionable strategies to address similar issues within its borders. As nations collaborate and share experiences, they contribute to the global effort to tackle pressing challenges, ensuring a healthier and more sustainable future for all. Marrakesh, with its cultural richness, provided the ideal backdrop for this convergence of ideas and commitment to harm reduction and shared prosperity.

As I reflect on my journey in Marrakesh, I am brimming with gratitude for the opportunity to explore this remarkable city, connect with extraordinary individuals, and return home with a wealth of knowledge. This knowledge has the potential to make a positive impact on the well-being of my fellow Filipinos. Marrakesh has now become a cherished chapter in my travel journal—a place where culture, resilience, and the pursuit of improved health converged to create an unforgettable experience.
As the sun sets over the bustling streets of Marrakesh, it not only marks the end of a day but also symbolizes the promise of a brighter tomorrow—a promise intertwined with the valuable lessons I’ve gained and the potential for change they hold for the Philippines.

The Doctor and the Businessman

Once upon a time in a small town, there lived a hardworking businessman named Mr. Flores. His life revolved around his sickly son, a young boy who required frequent medical attention. Every week, like clockwork, they would make the familiar journey to the clinic of the renowned Dr. Alerav. At least once every three months, their trips would escalate into anxious hospital stays. Dr. Alerav, to them, was no ordinary physician; he was their lifeline, the sole harbinger of their son’s well-being.

Years passed, and the weight of medical bills bore down on Mr. Flores. He realized that his dedication to his son’s health had drained his finances. It was during one of those late nights of worry that a brilliant idea blossomed in his mind.

Mr. Flores decided to build a hospital like no other, a medical sanctuary boasting the finest facilities and cutting-edge technology. This hospital was so sophisticated that it soon garnered the attention of other healthcare institutions in the area. They began referring and transferring their patients there, acknowledging its superior quality of care.

With the grand hospital now standing tall, Mr. Flores extended an invitation to Dr. Alerav to join their medical team. In a town that had just witnessed the birth of the most exceptional healthcare facility, the doctor couldn’t resist the offer.

But there was a catch. In order to affiliate with this hospital, Dr. Alerav had to invest Php 300,000.00 in hospital stocks and pay an additional Php 50,000.00 as a right-to-practice fee. Monthly, he had to allocate Php 2,000.00 for his clinic secretary and other clinic-related expenses.

Yet, despite the significant financial commitment, Dr. Alerav never regretted his decision. Over time, his practice flourished, and he attracted a loyal patient base. His days were filled with meaningful work and professional satisfaction, and he couldn’t help but be content.

But perhaps the happiest of them all was the astute businessman, Mr. Flores. Not only did he earn a substantial income from the doctor, but he also secured top-notch healthcare for his son without worrying about the costs.

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Only a select few doctors venture into the world of business, a realm quite different from the practice of medicine. Friends and family often question my dual pursuits, wondering why I’d choose business when I could potentially earn more by focusing solely on surgery. To them, I offer two straightforward reasons:

Firstly, I yearn for a sense of financial independence. By diversifying into business, I’ve created a passive income stream. This ensures that my financial needs don’t rely solely on the fees I earn from my surgical practice. I find solace in not praying for illness, unlike the stereotype, and this financial independence allows me to focus on my patients’ well-being without financial distractions.

Secondly, while the world perceives business as a stressful endeavor, I see it as my escape from the taxing realm of surgery. The prospect of exploring a field so different from my role as a surgeon keeps my life exciting and dynamic.

The money I make from surgery fees is wisely invested, laying the foundation for my financial future. I hope that my journey inspires other doctors to consider embracing business alongside their medical careers. I’ve witnessed numerous doctor friends who have excelled in business while still delivering exceptional medical care.

So, what about you? Are you a doctor who’s ventured into the world of business, seeking the same balance and rewards?

The Weight of Silence: A Tale of Undisclosed Diagnosis

I entered the room. It was dimly lit. He slowly opened his eyes as I got nearer. It was already 2:30 in the morning.

I was about to speak when he smiled and said, “Doc thank you sa pagdalaw”

I smiled back. I kept silent. I bent down looking at his urine bag. “Buti hindi na madugo yung ihi mo, sir.”

“I think I am feeling a little better now. Nanghihina, but a little better”

“Well that is good to hear, sir. Kung okay na and BP mo, wala kang lagnat at tuloy-tuloy na clear ang ihi mo, uwi na kayo bukas o sa makalawa.”

“Alam mo doc destiny ko tong cancer na to. Kahit na hindi agad sinabi sa akin ni commader (pertaining to his wife) na yung biopsy pala noong naoperahan mo ako dati ay cancer, accept ko na to doc. Natakot daw kasi sila sabihin sa akin kasi baka mag-alala ako da resulta ng biopsy dati. Pero tanggap ko na to doc. Ready naman na din ako, kahit hindi na mag chemotherapy”.

I stood there, and nothing came out of my mouth. What should I say?

The silence broke when his wife woke up. “Doc nandyan po pala kayo good morning po”

“OK lang maam. Daan ulit ako bukas. You get well sir”.

He smiled as he gently close his eyes.

As I walked away, I felt really bad for this man.

I did an endoscopic biopsy on him about a year ago, and it turned out to be cancer. I told his family about it, but his wife insisted on not divulging that it was cancer. She said that he will be emotionally depressed when he finds out that he has cancer.

I explained to them that it is imperative for him to know about his condition since he’ll be needing other treatment. He was not a good candidate for a radical surgical procedure, but chemotherapy can help. So I insisted that he should see an Oncologist, for him to get the proper chemotherapy program. They finally agreed.

But they never came back for follow up check-up.

Two days ago, he was brought back to the hospital and was admitted due to hip fracture. His cancer metastasized to his bones making it fragile and weak.

Yesterday, I asked his wife, “Maam bakit hindi nyo dinala kay Dra. Herdee Luna si sir? Diba ang sabi ko sa inyo dati kailangan sya makita ng Oncologist?”

“Actually doc never naman namin sinabi sa kanya yung resulta ng biopsy nya dati. Dadamdamin lang nya yun at made-depress.” she said softly.

“E ma’am tignan nyo sya ngayon kumalat na yung bukol nya. Hindi na din sya fit mag undergo ng surgery sa pelvic fracture nya sabi nung orthopedic surgeon… In fact, sobrang hina na nya mag undergo ng any form of surgery” I said.

It occurred to me: telling your patient about his condition can be difficult. They are inclined to deny that they are inflicted with it. This situation more often occurs when you are dealing with a patient with cancer.
If the patient, or his relatives are in denial and remains skeptical about the treatment options that you offer, notice that you will lose this patient. They will distance themselves from you and either look for another doctor who would conform to their idea of management or search for alternative treatment.

As in this case, his relatives were in denial that it was cancer. They took their chances, and ended up with a bad decision.

Poor patient, he had no idea that it was cancer not until his second admission. They decided on his behalf. Everyone knew about his ailment, except himself. He was deprived of the opportunity to get the proper treatment that will at least halt the progression of the disease.

It was, in my opinion, a deprivation of one’s rights to get a quality health care.

Our Faith’s Test: A Surgeon’s Journey

Faith is an enigmatic force, an ever-present challenge that can take shape in myriad forms, catching us off guard at any moment. It holds the power to shape our choices and steer our lives in directions we never anticipated. In the end, the strength of our faith is measured by whether we stand steadfast or yield to the trials.

I’m no devout believer. While I strive to attend Sunday mass, life often leads me astray. Despite my shortcomings, I carry love, trust, and unwavering faith in God.

Like all of us, I’m a sinner. Those who know me can attest to my imperfections. But even in my moments of transgression, I harbor love for God, trust in His wisdom, and unyielding faith in His plan.

Around two years ago, my medical journey introduced me to a vibrant 60-year-old patient battling prostate cancer. His spirit was infectious, brimming with hope as he embarked on a surgical journey to conquer his ailment. The procedure went well, and he left the country after his recovery.

In the months that followed, he diligently sent me his medical reports and diagnostic images, indicators of his cancer’s progression. Each result came back normal, and he credited me with the gift of a second chance at life.

But then, his messages took a different turn. He revealed that he had converted to Islam, claiming that it was this transformation that had saved him. He even mentioned that Pope Benedict himself had renounced Christianity and embraced Islam. He urged me to follow his path.

Every three months, alongside his test results, I received a stream of messages imploring me to convert. I responded to his medical inquiries but never acknowledged his invitations to change my faith.

Late last year, as his messages persisted, I felt compelled to reply. I thanked him for his gratitude regarding his recovery but politely expressed my disbelief in his assertion that his conversion was the cure. I recounted my surgical rituals, the whispered prayers for guidance, the pleas to the Lord Jesus for help. I explained that my faith in Catholicism was unshakable and that his invitation to convert to Islam could not sway me.

In the end, my faith may be tested, but it remains resolute.