Archive for the ‘Medicine’ Category

Filipino doctors in USA, 2nd to India among IMGs

March 23, 2009

We are quick to assert that among the international medical graduates (IMGs) in the United States, Filipinos are 2nd to doctors from India as the most represented ethnic group in the profession. This is a very good record for our country who has distinguished itself as one of the most prolific doctor suppliers of America. About ¼ of doctors in USA are IMGs.

Top Ten Countries of Medical Education for IMG Physicians

2007
India———————————— 19.99%———————-47,581
Philippines——————————8.7%————————-20,861
Mexico———————————-5.8%————————-13,929
Pakistan———————————4.8%————————-11,330
Dominican Republic——————3.3%————————–7,892
Russia———————————-2.5%————————- 6,039
Grenada———————————2.4%————————–5,708
Egypt————————————2.2%————————–5,202
Korea————————————2,1%————————–4,982
Italy————————————–2.1%————————–4,741
Source: American Medical Association (AMA) Masterfile 2007

2008
India————————————-21%————————–41,247
Philippines—————————— 9%—————————21,081
Mexico———————————- 6%—————————13,980
Pakistan———————————-5%—————————11,901
Dominican Republic——————-3.7%—————————8,618
Russia————————————2.7%—————————6,293
Grenada———————————-2.7%—————————6,299
Egypt————————————-2.2%—————————5,301
Korea————————————-2.1%—————————5,031
China————————————-2.1%—————————5,087
Source: American Medical Association (AMA) Masterfile 2008

The 2008 American Medical Association (AMA) IMG record shows the Filipino doctors rank second to India in number—-9% and 21% respectively of the total number of foreign medics who train in the United States. That’s a total of 21,081 Filipinos vs. 41,247 Indians. Because of the sharp difference (double) in numbers between the two groups, Filipino physicians in USA looks scarcer compared to the Indians.

The current distribution of Filipino doctors will probably stay for a while since the boom of the nursing profession in the Philippines has lured more doctors to come to USA as nurses. Former Sec of Health Dr. Jaime Galvez Tan confirmed this trend when he revealed in 2007, “My latest study, there are 9,000 doctors who have become nurses. Six thousand of them (6,000) have left the Philippines mainly for the U.S. to work as nurses.” Majority of these MD-nurses come from government hospitals, keeping the pool of United States Medical Licensure Examination (USMLE) takers and residency seekers from new graduates relatively intact.

A coincident fall of medical student enrollment, as much as 40% in some schools, has caused the lack of physicians in the Philippines, but not so much in USA since it remains to be a favored job destination of Filipino health professionals for more than 50 years. What is astounding is even if Filipino IMGs are second to the Indians, their number is small—less than half of the latter.(Photo Credit: Jandentonchua) =0=

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Filipino doctors in USA, 2nd to India among IMGs

March 23, 2009

We are quick to assert that among the international medical graduates (IMGs) in the United States, Filipinos are 2nd to doctors from India as the most represented ethnic group in the profession. This is a very good record for our country who has distinguished itself as one of the most prolific doctor suppliers of America. About ¼ of doctors in USA are IMGs.

Top Ten Countries of Medical Education for IMG Physicians

2007
India———————————— 19.99%———————-47,581
Philippines——————————8.7%————————-20,861
Mexico———————————-5.8%————————-13,929
Pakistan———————————4.8%————————-11,330
Dominican Republic——————3.3%————————–7,892
Russia———————————-2.5%————————- 6,039
Grenada———————————2.4%————————–5,708
Egypt————————————2.2%————————–5,202
Korea————————————2,1%————————–4,982
Italy————————————–2.1%————————–4,741
Source: American Medical Association (AMA) Masterfile 2007

2008
India————————————-21%————————–41,247
Philippines—————————— 9%—————————21,081
Mexico———————————- 6%—————————13,980
Pakistan———————————-5%—————————11,901
Dominican Republic——————-3.7%—————————8,618
Russia————————————2.7%—————————6,293
Grenada———————————-2.7%—————————6,299
Egypt————————————-2.2%—————————5,301
Korea————————————-2.1%—————————5,031
China————————————-2.1%—————————5,087
Source: American Medical Association (AMA) Masterfile 2008

The 2008 American Medical Association (AMA) IMG record shows the Filipino doctors rank second to India in number—-9% and 21% respectively of the total number of foreign medics who train in the United States. That’s a total of 21,081 Filipinos vs. 41,247 Indians. Because of the sharp difference (double) in numbers between the two groups, Filipino physicians in USA looks scarcer compared to the Indians.

The current distribution of Filipino doctors will probably stay for a while since the boom of the nursing profession in the Philippines has lured more doctors to come to USA as nurses. Former Sec of Health Dr. Jaime Galvez Tan confirmed this trend when he revealed in 2007, “My latest study, there are 9,000 doctors who have become nurses. Six thousand of them (6,000) have left the Philippines mainly for the U.S. to work as nurses.” Majority of these MD-nurses come from government hospitals, keeping the pool of United States Medical Licensure Examination (USMLE) takers and residency seekers from new graduates relatively intact.

A coincident fall of medical student enrollment, as much as 40% in some schools, has caused the lack of physicians in the Philippines, but not so much in USA since it remains to be a favored job destination of Filipino health professionals for more than 50 years. What is astounding is even if Filipino IMGs are second to the Indians, their number is small—less than half of the latter.(Photo Credit: Jandentonchua) =0=

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Lucid interval in acute brain injuries: a crucial lesson on Natasha Richardson’s death

March 20, 2009

The death of Broadway star and movie actress Natasha Richardson illustrates the necessity for quick trauma management in cases of acute brain injuries. In hindsight, Richardson didn’t go to the hospital immediately after she banged her head during a ski accident in Mont Tremblant, a luxury resort in Quebec, Canada.

She had a lucid interval and a feeling of wellness not unusual in some victims of head injury. At that crucial time, blood seeped from a torn blood vessel between the brain and skull creating an epidural hematoma, an enlarging blood clot that was big enough to cause her demise. The New York medical examiner confirmed the epidural bleeding from blunt trauma that caused her death.

Richardson, the daughter of famed actress Vanessa Redgrave was conscious and well soon after the ski accident. She refused early on to be brought to the nearest hospital, hence a delay of about 4 hours before life-saving treatment was instituted. Only when she experienced headache, a sign of rising pressure within the enclosed cranium that she decided to go for the doctors’ aid.

There are questions whether an early medical intervention could have saved her life. Perhaps yes. There is a short golden period in those suffering from acute epidural bleed when doctors can still save a life. From Canada, she was flown to Lenox Hill Hospital in New York City where she passed on a day later.

The coffin bearing the remains of the talented celebrity was taken out of the Greenwich Funeral Home in Manhattan. Lights of Broadway were dimmed to pay tribute to Miss Richardson, a Tony award winner and a member of a family of distinguished movie and theatre thespians. (Photo Credit: Mickey Strikes; Reuters/ Eric Thayer)=0=

RELATED BLOG: “Broadway star Natasha Richardson died of brain injuries in a ski accident” Posted by mesiamd at 3/19/2009

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Lucid interval in acute brain injuries: a crucial lesson on Natasha Richardson’s death

March 20, 2009

The death of Broadway star and movie actress Natasha Richardson illustrates the necessity for quick trauma management in cases of acute brain injuries. In hindsight, Richardson didn’t go to the hospital immediately after she banged her head during a ski accident in Mont Tremblant, a luxury resort in Quebec, Canada.

She had a lucid interval and a feeling of wellness not unusual in some victims of head injury. At that crucial time, blood seeped from a torn blood vessel between the brain and skull creating an epidural hematoma, an enlarging blood clot that was big enough to cause her demise. The New York medical examiner confirmed the epidural bleeding from blunt trauma that caused her death.

Richardson, the daughter of famed actress Vanessa Redgrave was conscious and well soon after the ski accident. She refused early on to be brought to the nearest hospital, hence a delay of about 4 hours before life-saving treatment was instituted. Only when she experienced headache, a sign of rising pressure within the enclosed cranium that she decided to go for the doctors’ aid.

There are questions whether an early medical intervention could have saved her life. Perhaps yes. There is a short golden period in those suffering from acute epidural bleed when doctors can still save a life. From Canada, she was flown to Lenox Hill Hospital in New York City where she passed on a day later.

The coffin bearing the remains of the talented celebrity was taken out of the Greenwich Funeral Home in Manhattan. Lights of Broadway were dimmed to pay tribute to Miss Richardson, a Tony award winner and a member of a family of distinguished movie and theatre thespians. (Photo Credit: Mickey Strikes; Reuters/ Eric Thayer)=0=

RELATED BLOG: “Broadway star Natasha Richardson died of brain injuries in a ski accident” Posted by mesiamd at 3/19/2009

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Obama’s stem cell research policy: the use of embryonic cells from helpless unborn sparks religious debate

March 10, 2009

As a sign of the moral dilemma and political divide rocking the United States, Pres. Barack Obama reverses the Bush-era stem cell policy that protects the embryo from being used as a tool in finding treatments and cures for illnesses. It is one of the many secularist liberal thrusts of the new administration.

The contentious decision is a triumph for those who want effective treatments against diverse illnesses like cancer, stroke, heart attack, and Parkinson’s disease. However, it is a set-back for the outspoken anti-abortion groups and pro-lifers who believe that life starts at conception and therefore the unborn is deserving of social protection.

“Embryonic stem cells are master cells that can morph into any cell of the body. Scientists hope to harness them so they can create replacement tissues to treat a variety of diseases — such as new insulin-producing cells for diabetics, cells that could help those with Parkinson’s disease or maybe even Alzheimer’s, or new nerve connections to restore movement after spinal injury. But they come with criticism. “I believe it is unethical to use human life, even young embryonic life, to advance science,” said Tony Perkins, president of the Family Research Council, a conservative organization that opposes the move.”:—-Yahoo News/ AP (03/08/09, Eliot, J)

Obama is criticized by conservatives for approving the use of embryos in stem cell research to be funded by tax payers’ dollars. But his supporters believe curing sickness and allaying suffering take precedence over the welfare of the embryo. The advocates of the new policy are part of the rising number of Americans who believe that life without maladies is possible. They hope the words “incurable” and “terminal” may one day be banished from the vocabulary.

“This action is morally wrong because it encourages the destruction of innocent human life, treating vulnerable human beings as mere products to be harvested,” said Cardinal Justin Rigali, the Archbishop of Philadelphia and Chairman of the U.S. Conference of Catholic Bishops’ Committee on Pro-Life Activities”—-Yahoo News/ AP (03/09/09, Gorski, E)

There are those who believe that the public funding of embryonic stem research is a paradoxical prelude to setting up of a healthcare policy which will use less costly medical services to the aged and the severely ill—-a radical triage plan which favors more care for people who are young and productive over those who are old, and disabled.

Despite the advance of modern science and temptations to hasten social engineering, life must be respected at the start of conception. Having seen abortion and selective pregnancies done in the America first hand, I don’t concur with Obama’s stance to use the cells of developing embryos in research investigations.

Though I may well benefit from embyronic stem cells because of my illness and disability, on ethical and religious grounds, I believe researches must find a way to spare the embryo. Life in its early form has been redefined, used and abused to suit certain socio-political agenda. The growing embryo deserves equality, dignity, and protection from society just like any human being.

“Princeton University politics professor Robert George, a Catholic and another member of the Bush-era Council on Bioethics, said the moral argument over embryonic stem cell research is not rooted in religion but in ethics and equality. He said research shows that an embryo is a human being in its earliest form of development, so we have to ask ourselves whether all human life should be treated equally, with dignity and respect. “—-Yahoo News/ AP (03/09/09, Gorski, E)

Convenience, easing suffering, prologation of life, and escaping mortality must not be done at the expense of others in society. From the vantage of science, embyronic stem cell research is not the only way to find cures against life-threatening and debilitating illness.

It’s my belief that individuals and governments have no ethical right to use cells of helpless embryos to advance the conveniences of the strong even if the need is pressing. Though cures from stem cells may one day be realized with the use of the conceptus, humanity can’t escape the changes that go with something as natural as sickness and ageing—all that leads to dying and demise. (Photo Credits: California Institute for Regenerative Medicine x 2)=0=

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The Ebola-Reston virus scare in the Philippines

March 2, 2009

Ebola Hemorrhagic Fever

There was panic and alarm when Ebola virus first emerged as a fatal bleeding disease in Congo (Zaire) in 1978. Similar outbreaks in neighboring countries in Africa occured. Transmitted mainly by body fluids, the acute infection (aka Ebola hemorrhagic fever, EHF) of the Filoviridae family of RNA viruses presented like a typical viral infection— fever, headache, joint and muscle pain, sore throat, and weakness after an incubation of 2 to 21 days. Some manifested with a skin rash, conjunctival injection, diarrhea, vomiting, stomach pain, internal and external bleeding.

There were those who survived and spontaneously recovered, but many with severe infections showed signs of hemorrhage, fluid loss, shock, and eventual death. EHF is feared because it is highly transmissible and carries a high mortality rate.

Reported cases of EHF have been zoonotic infections (animal borne.) A potential agent of bioterrorism, Ebola can present as a nosocomial infection, a disease contracted in hospitals and medical facilities during an outbreak. The exact origin, location, and natural habitat (known as the “natural reservoir”) of Ebola virus aren’t fully known. This makes containment of the infection difficult.

The first 4 of the 5 subtypes of Ebola is known to cause disease in humans: Ebola-Zaire, Ebola-Sudan, Ebola-Ivory Coast and Ebola-Bundibugyo. The virulence and lethality of these viral strains are suggested by World Health Organizations’s (WHO) containment recommendations below. EHF has no known vaccine nor specific cure.

WHO’s containment of Ebola

•Suspected cases should be isolated from other patients and strict barrier nursing techniques implemented.
•Tracing and following up people who may have been exposed to Ebola through close contact with patients are essential.
•All hospital staff should be briefed on the nature of the disease and its transmission routes. Particular emphasis should be placed on ensuring that invasive procedures such as the placing of intravenous lines and the handling of blood, secretions, catheters and suction devices are carried out under strict barrier nursing conditions (biohazard.) Hospital staff should have individual gowns, gloves, masks and goggles. Non-disposable protective equipment must not be reused unless they have been properly disinfected.
•Infection may also spread through contact with the soiled clothing or bed linens from a patient with Ebola. Disinfection is therefore required before handling these items.
•Communities affected by Ebola should make efforts to ensure that the population is well informed, both about the nature of the disease itself and about necessary outbreak containment measures, including burial of the deceased. People who have died from Ebola should be promptly and safely buried. — World Health Organization (WHO)

WHO’s therapy and treatment of Ebola

• Severe cases require intensive supportive care, as patients are frequently dehydrated and in need of intravenous fluids or oral rehydration with solutions containing electrolytes.
• No specific treatment or vaccine is yet available for Ebola haemorrhagic fever. Several potential vaccines are being tested but it could be several years before any is available. A new drug therapy has shown some promise in laboratory studies and is currently being evaluated. But this too will take several years.
• Experimental studies using hyper-immune sera on animals have shown no protection against the disease. —World Health Organization (WHO)

Ebola Reston virus in the Philippines

“In 1989, Reston, an Ebola virus subtype, was isolated in quarantined laboratory cynomolgus monkeys (Macacca fascicularis) in Reston, Virginia, USA. From 1989 to 1996, several outbreaks caused by the Ebola Reston subtype occurred in monkeys imported from the Philippines to the USA (Reston in Virginia, Alice in Texas and Pennsylvania) and to Italy. Investigations traced the source of all Ebola Reston outbreaks to one export facility near Manila in the Philippines, but the mode of contamination of this facility was not determined. Several monkeys died, and at least four people were infected, although none of them suffered clinical illness.”—World Health Organization (WHO)

The Ebola-Reston (ERV,) the fifth subtype of the virus was first found in Philippine monkeys. It has caused disease in primates, but not in humans. Mainly because this that local health authorities seem to be “in control” over the simmering Ebola outbreak that has infected pigs in Pandi, Bulacan.

To make sure the ERV doesn’t spread to the general population, the Philippine government in coordination with the World Health Organization (WHO) is on the process of slaughtering 6,000 infected pigs. So far no person has been reported to have fallen ill of the disease, but there are 6 farm workers and butchers who turned positive for Ebola antibodies. This is surely a cause of concern.

In spite the Department of Health’s (DOH) effort to contain the disease, nobody knows the extent ERV has spread in the country at this time. It is unclear which other animal species harbor the disease agent and need isolation or killing. Philippine health authorities can only speak of what they know—that a number of pigs and some individuals were proven to be positive for antibodies— which means they encountered the virus without suffering signs of illness.

With the potential to mutate and acquire virulence, Ebola-Reston can be transmitted to susceptible hosts and become infective to more animals and humans. Though ERV doesn’t cause disease in healthy individuals, it’s unclear what happens if the virus infects people with weak immunity or those sick of debilitating illnesses. That’s why to avoid epidemics, isolation or euthanasia of infected animals (like in the Avian Flu infection) are high in the list of priorities.

Awareness of the disease is enhanced through step-up public health education. Cleanliness is important. There is heightened watch over the sale of “double-dead” meat that may carry the disease agent. As a precaution, testing for ERV is expanded and export of porcine meat to other countries has been halted.

The strategies to combat ERV is complex and tedious. Despite DOH’s monitoring and vigilance, medical workers have to deal with the challenges of a serious health threat whose outcome is just starting to unravel. The danger of Ebola doesn’t only rest on the Philippines, but on the entire world as well. It’s a global effort that this disease is nipped on the bud. (Photo Credit: [][][][][]/ http://www.bio.davidson.edu /KeeAun)=0=

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Medicine & Religion: Is confession a potent balm against major diseases in RP?

February 16, 2009

Dr. Francisco Duque III, the secretary of the Department of Health (DOH) reportedly said a staggering 80% of Filipinos are suffering from non-communicable diseases (NCDs) “due to unhealthy lifestyle.” The doctor goes on to say that to combat cardiovascular illnesses, cancers, and diabetes, people have to go to church and make regular “confession.” I find his religious recommendation oddly misleading. It needs clarification.

“Among those considered as NCDs are cardiovascular diseases, cancer, and diabetes. Duque said the three are now among the major health problems in the country. Duque said one way to address this problem is for the people to go on regular confession.” I suggest that they go to church to pray and confess their sins because its one way of managing”—-GMANewTV.net (02/16/09)

It isn’t unusual to blame stress as a cause of sickness. Though stress goes with almost all diseases, its role is often indirect, sometimes obscure, in many organic diseases. As far as science is concerned, most illnesses have underlying pathogenetic bases whose roles are generally far-reaching than the effects of stress.

Heart diseases are related to high fat diet, sedentary lifestyle, and smoking. Diabetes mellitus may have an autoimmune basis but can come with risk factors like obesity, lack of exercise, and genetics. Certain cancers are triggered by stepwise mutations (alterations in the DNA) that generate clones of abnormal cells that invade, metastasize, and eventually kill the body. In all these, stress plays a role, albeit less strongly than what is suggested by Dr. Duque.

The act of confession (reconciliation) taught by certain religions is not shared by all believers. Confessing sins to a priest by the Catholics has markedly dwindled in recent years. Dr. Duque may encounter criticism and opposition in recommending the holy sacrament to prevent non-communicable diseases. There are non-faith based treatments in medicine which are more predictable and efficacious.

Stress is part of the normal challenges of daily living. Not all people who go through significant emotionally disruptive situations get ill in the process. Sick and healthy individuals, suffer from harrowing conditions in varying degrees. As such the roles of stress in every illness are hard to quantify; their effects on the body aren’t uniformly the same.

I believe emotion plus the working of the mind, and the entire body equilibrium are influenced by stress more than it affects specific organs of the body. It is probably the reason why religion, spirituality, a belief in the supernatural, exercise, meditation, and relaxation regimens have some roles to play in disease management. The mechanisms behind their healing properties aren’t fully understood.

Yet, medical science offers credible explanations in disease causation and treatment. Illnesses can be attributed to causes like direct physical injuries, infections, cancers, immunologic conditions, hormonal swings, metabolic derangements, nutritional deficiencies, hereditary disorders, chemical, drug and radiation exposures, poisonings, among others.

Stress is only one among the long list. Therefore, “confession” as Dr. Duque suggested may help in being healthy, preventing sickness, and going through an illness and subsequent recuperation. But surely, we need to account for greater ways to fight diseases more than what have been recommended by the standard and complementary approaches of medicine. This is important in the holistic way of maintaining the health of the nation.(Photo Credits: denislpaul; sacerdotal) =0=

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Medicine & Religion: Is confession a potent balm against major diseases in RP?

February 16, 2009

Dr. Francisco Duque III, the secretary of the Department of Health (DOH) reportedly said a staggering 80% of Filipinos are suffering from non-communicable diseases (NCDs) “due to unhealthy lifestyle.” The doctor goes on to say that to combat cardiovascular illnesses, cancers, and diabetes, people have to go to church and make regular “confession.” I find his religious recommendation oddly misleading. It needs clarification.

“Among those considered as NCDs are cardiovascular diseases, cancer, and diabetes. Duque said the three are now among the major health problems in the country. Duque said one way to address this problem is for the people to go on regular confession.” I suggest that they go to church to pray and confess their sins because its one way of managing”—-GMANewTV.net (02/16/09)

It isn’t unusual to blame stress as a cause of sickness. Though stress goes with almost all diseases, its role is often indirect, sometimes obscure, in many organic diseases. As far as science is concerned, most illnesses have underlying pathogenetic bases whose roles are generally far-reaching than the effects of stress.

Heart diseases are related to high fat diet, sedentary lifestyle, and smoking. Diabetes mellitus may have an autoimmune basis but can come with risk factors like obesity, lack of exercise, and genetics. Certain cancers are triggered by stepwise mutations (alterations in the DNA) that generate clones of abnormal cells that invade, metastasize, and eventually kill the body. In all these, stress plays a role, albeit less strongly than what is suggested by Dr. Duque.

The act of confession (reconciliation) taught by certain religions is not shared by all believers. Confessing sins to a priest by the Catholics has markedly dwindled in recent years. Dr. Duque may encounter criticism and opposition in recommending the holy sacrament to prevent non-communicable diseases. There are non-faith based treatments in medicine which are more predictable and efficacious.

Stress is part of the normal challenges of daily living. Not all people who go through significant emotionally disruptive situations get ill in the process. Sick and healthy individuals, suffer from harrowing conditions in varying degrees. As such the roles of stress in every illness are hard to quantify; their effects on the body aren’t uniformly the same.

I believe emotion plus the working of the mind, and the entire body equilibrium are influenced by stress more than it affects specific organs of the body. It is probably the reason why religion, spirituality, a belief in the supernatural, exercise, meditation, and relaxation regimens have some roles to play in disease management. The mechanisms behind their healing properties aren’t fully understood.

Yet, medical science offers credible explanations in disease causation and treatment. Illnesses can be attributed to causes like direct physical injuries, infections, cancers, immunologic conditions, hormonal swings, metabolic derangements, nutritional deficiencies, hereditary disorders, chemical, drug and radiation exposures, poisonings, among others.

Stress is only one among the long list. Therefore, “confession” as Dr. Duque suggested may help in being healthy, preventing sickness, and going through an illness and subsequent recuperation. But surely, we need to account for greater ways to fight diseases more than what have been recommended by the standard and complementary approaches of medicine. This is important in the holistic way of maintaining the health of the nation.(Photo Credits: denislpaul; sacerdotal) =0=

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Nepalese MD’s to train and render service in Bicol Medical Center

February 14, 2009

As a result of the drop in the number of medical school graduates and the exodus of local doctors to foreign countries, the Bicol Medical Center (BMC) in Naga City has resorted to bringing in 40 doctors from Nepal. From the remote country close to Mount Everest, Nepalese foreign medical graduates will be in the city to train and render service.

“The Bicol Medical Center (BMC) in Concepcion Pequeña, Naga City is a 500-bed government tertiary hospital under the direct supervision of Department of Health Center for Health Development – Bicol, Legazpi City. It is a non-profit institution and one of the 13 medical centers under the National Government.” http://doh.gov.ph/bmc (Photo Credit: bmc)

The presence of imported healers in Naga is expected to beef up the medical personnel of the government hospital which has suffered the lack of MDs for the last 5 years. There have been fewer applicants to fill in the 28 doctor-vacancies in BMC. Therefore, the coming of the international physicians appears to be a boon to the hospital service in the city. But is it?

Without inciting any nativist sentiment against the foreign professionals, I think it is justified to ask if the Nepalese doctors’ schooling is comparable to those of the local physicians. The adherence to standard medical training (i.e. in the tradition of Western allopathic medicine) is important before they are allowed to handle patients. Their medical background must be adequate to meet the peculiar health needs of the community. To ascertain competency and avoid compromising the health of patients, they must be tested for basic communication and clinical skills.

Though the Department of Health (DOH) approves of these foreign doctors, does the government have guidelines that define the scope of medical duties and accountability? Are the professional regulations in place to protect the doctors, their patients and the hospitals where they work? Will the presence of these trainee-MDs not interfere with the training and oversight of local doctors, nurses, and other paramedical professionals? Are there enough senior MDs to supervise and teach them? Are they not in violation with the rules of the Professional Regulations Commission (PRC) which regulates physician licensure and practice? Has there been discussions on the effects of foreign doctors on the healthcare of the nation? Their presence may distract the government from pursuing the programs which will make local doctors stay and serve the community instead of going abroad.

In a blog I posted on August 27, 2008, I wrote:

According to Philippine Medical Association (PMA) president Reynaldo Santos, M.D. the arrival of these foreign medical trainees attests to the high quality of education in the country. But this is doubted in the wake of a sharp decline of the number of hospitals, a marked rise in patient load for doctors and nurses, a low passing rate of Filipinos in the United States Medical Licensure Examination (USMLE,) an over-crowding of patients and trainees, lack of budget, equipment upgrade, and medical facilities in many hospitals.

I hope Bicol Medical Center has ironed out the important issues cited above. Otherwise, sending in the Nepalese doctors will solve some of the current healthcare problems of Naga City, but it can also spawn fresh and bigger challenges that haven’t been given enough attention and consideration.=0=

RELATED BLOG: “RP’s 40% drop in med school enrollment & the foreign doctors” Posted by mesiamd at 8/27/2008

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"Chronic Fatigue Syndrome” and Sen. Miriam D. Santiago’s tiredness

February 6, 2009

I hope Sen. Juan Ponce Enrile was correct when he said that Sen. Miriam D. Santiago needed an indefinite leave from her legislative work because of chronic fatigue syndrome (CFS.) I don’t know if what he meant coincided with what we know of the disease.

Chronic Fatigue Syndrome is a nebulous medical condition with unknown cause whose manifestations run from physical to the psychological. As such CFS comes as a diagnosis only after careful and thorough health investigation which considers a plethora of possibilities—-hormonal problems (i.e. thyroid disease, diabetes,) chronic infections (TB, malaria,) exogenous drugs (substance abuse), malignancies, organ dysfunctions, nutritional, immunologic, and metabolic derangements (malnutrition, poisonings, autoimmune diseases) and psychiatric problems (bipolar disorder, depression, schizophrenia) among others.

CFS is a hard diagnosis to make because there are no specific tests or laboratory markers to pinpoint the ailment; many illnesses have fatigue as among their prominent symptoms and a good fraction of patients looks well. The manifestations of CFS vary in severity and its course is characterized by periods of remissions and exacerbations.

A CFS diagnosis should be considered in patients who present with six months or more of unexplained fatigue accompanied by other characteristic symptoms. These symptoms may include:

• cognitive dysfunction, including impaired memory or concentration
• malaise or exhaustion lasting > 24 hours after physical or mental exercise
• unrestful sleep
• joint pain without signs of inflammation
• persistent musculo-skeletal pain
• depression
• mood swings
• headaches
• tender cervical or axillary lymph nodes
• sore throat
• cardiac and respiratory symptoms

According to the Center of Disease Control (CDC) between 1 and 4 million Americans suffer from Chronic Fatigue Syndrome (CFS), an illness which presents with overrid ing tiredness. A fraction of patients are seriously impaired; at least a quarter are unemployed or on disability. About 50% of those affected come to their doctors and 40% of them have previously unrecognized medical or psychiatric condition.—Source: Center for Disease Control (CDC) at http://www.cdc.gov/ncidod/diseases/cfs

What CDC tells us is just the tip of the iceberg. From the medical perspective, one can however surmise if Sen. Miriam D. Santiago really suffers from a serious disease. Is she really sick? Does she have CFS or is she plainly tired. Let her doctor investigate so she can be treated.

The flamboyant senator who is known for her “intelligence and tartness” just wrapped up her investigation on the scandalous World Bank (WB) allegations that top-ranked officials in government colluded in rigging of project deals by contractors. She must really be tired as the Filipinos— for nothing of great significance came out of a senate probe of this nature. The investigation only broke open the unhealing wounds of corruption that has left the country mired in shame. (Photo Credits: St.ChristopherLucky; diong) =0=

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