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Tatlong linggo na akong clinical clerk... at sa benign kong rotation na Family and Community Medicine, pinaka-naramdaman ko ang katotohanan ng bago kong identity nung nag-duty ako sa Ambu nung first week. [Ambu--short for Ambulatory Care Unit, para sa mga emergency cases na hindi ganun ka-seryoso. Dito pinapadala ng mga tao sa ER ang mga pasyenteng pwede namang hindi i-confine, yung mga pinapauwi rin eventually]. Noong una, medyo kinakabahan at nangangapa pa, pero di nagtagal at medyo nasanay rin sa kalakaran ng pagtingin sa pasyente. Halos puro abdominal pain, hypertension, UTI ang mga cases na nakikita namin. Marami rin akong nagawang procedures tulad ng pag-inject ng pain reliever, pagkuha ng dugo at pagpasok ng foley catheter [kaya ko na mag-isa.. =)]. Syempre nakakapagod din, madalas nalilipasan din ako ng gutom. Buti na lang tig-8 hours lang ang duty dun, at limang beses lang in one week. Pabago-bago nga lang ang oras ng pag-tulog (iba-ibang shift din kasi ang na-experience namin). Hay, pano kaya pag Pedia na...

Pagdating ng second week, bagong environment naman. Tuwing umaga, sa Malibay Health Center sa Pasay ang duty namin. Nakakatuwa kasi computerized ang charts nila dun. Simple lang din ang cases ng mga pasyente kaya mabilis lang sila tingnan. Libre ang konsulta, pati ang mga gamot. Nagbibigay lang sila ng donations para patuloy na makatakbo nang maayos ang center (hindi kasi lagi on time ang dating ng funding galing sa gobyerno). Na-enjoy ko rin ang pagbakuna sa mga babies; there was a morning na naka-nine babies ako. =)

Isa pang highlight ng community rotation ay ang exposure namin sa activities ng Remedios AIDS Foundation, isang NGO na tumutulong sa pag-alaga ng kalusugan ng mga taong sangkot sa prostitution. Ibang klaseng experience din yun. Hmm.. I-upload ko na lang kaya dito ang ginawa kong paper? :)

For the last two weeks of Fam Med, sa Supportive and Palliative Hospice Care unit naman ako. Ang focus naman dito ay pag-alaga sa patients na hindi na responsive sa curative treatment (i.e. cancer patients). Meron ding patients na referred galing sa ibang wards, usually for psychosocial support. I hope this last week and a half will be meaningful..

Ayun.. so far ito ang mga nangyari sakin sa pagsimula ng clerkship.
I'll just end this abruptly for now and hope for a more coherent entry next time. Hehe. =)
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Sige... storytelling time... here's my paper about my Remedios experience. :)

Bitter Reality

It’s for real. This was what I thought when I got off from my first duty at the PGH Ambulatory Care Unit. I was taking in the fact that I really am now a clinical clerk—one step away from being an intern, two huge steps from being an M.D. It seemed that life as a medical student will be getting more serious every rotation from here on. But before plunging further into a myriad more duties and patient encounters, I got a break from the hospital environment the following week and had a different taste of reality. This time it was beyond the gates of PGH.

An objective of our Community Medicine rotation this year was to provide an opportunity to work with vulnerable sectors of society and integrate them into the health referral system. One particular vulnerable population group we focused on was the people involved in the business of prostitution. For two days, we rotated at the Remedios Aids Foundation, an NGO committed to serve the health needs of people at risk for contracting HIV/AIDS and other sexually transmitted infections (STIs). One of RAF’s main endeavors was their “Prevention Project,” where it seeks to inform, educate, and give people in prostitution (PIPs) a shot at more quality of life (albeit relatively) by reaching out to them where they can be found. So our experience consisted not only of interviewing patients in the Remedios clinic, but also of interacting with PIPs out on the streets and inside bars, a.k.a. ‘establishments’. It was an activity that was first met with a little uneasiness on my part, given my preference to avoid stepping into red light districts. But I went with an open mind still. I knew that learning experiences usually make more impact if one goes through them firsthand. Thus during the briefing at Remedios and while on the jeepney ride to Makati Avenue, I continued to psych myself up for the sights I would see, the responses I might get, and the stories I’d hear.

Three community health outreach workers (CHOWs) accompanied us to Makati—Kuya Con, Ate Roselynn, and Kuya John (who later pulled out for his own duty at Marikina). At about half past eight, with umbrellas over our heads, the six of us set off in search of Con’s current contacts, as well as other ‘freelance workers’ that could also be potential contacts. We hadn’t gone far when he spotted Jenny, a previous contact, sitting outside a bank on the corner of Makati Ave. and Durban St. Jill went with Con to talk with her; the rest of us left them alone for a while. As we walked on, I couldn’t help but wonder if every girl we passed standing by buildings was involved in prostitution too. I had guessed that they most likely were. We reached Burgos St., where the bars were mostly concentrated. We did not enter one though, because Ate Roselynn said the managers are a little stricter in Makati. And besides, they get their own supply of condoms from the City Health Office. Nevertheless, the CHOWs are still able to schedule lectures in these establishments every now and then.

After a while Con fetched us and walked back, and then we dropped off Suzi, Chrys and Ate Roselynn at another cruising point (a.k.a. pickup point). Before heading back to Jill, who was still with Jenny, Con introduced me to Sally and Krystal, who then consented to spend some time with me. Since Sally asked about the common symptoms of STIs, I started by explaining the topic to them. Apparently, Krystal was already familiar with these symptoms, but claimed not having experienced any yet. After my first round of educating them, I asked how they were doing that day. They said they weren’t doing very well. Again, I asked: “Bakit, kapag maganda ang araw, ano ang ibig sabihin sa inyo?” To this Krystal replied, “Huwag mo na lang alamin, tama na ang kami lang ang nagtatanong sa ‘yo.” I didn’t know how to proceed after that. I wanted to ask more questions, to scratch their surface, no matter how little, but I feared they would just build a stronger wall against me. After a few silent moments, Jill and Con arrived, somewhat to my relief. Jill helped re-emphasize why we were there that evening—that we wanted to help them to be aware of the risks of their business, and to stay protected by using condoms. The visual aids we brought came in handy during our interaction; it caught their attention and facilitated some discussion (two more girls came to listen to us at this point). I also found out that Sally used to work in one of the bars there, and used have an annual check up and “cleaning” at the Social Hygiene Clinic. I got curious about this “cleaning” procedure they referred to several times, realizing later that “cleaning” was actually having a pap smear done. I wonder if the people at the Social Hygiene Clinics ever really explain the purpose of doing a pap smear. After some more chit-chat, we gave them free condoms, thanked them for their time, and then headed back to Chrys and Suzi’s spot. While waiting for them to finish with their own audience several feet away, I got to witness more typical Makati street activity late in the evening, even if it was raining. Clusters of PIPs stayed on the sidewalk, waiting for ‘guests’ or customers. Every now and then a foreigner would walk by with a Makati girl in tow, all smiles. Later, Chrys and Suzi attracted a bigger audience, all males this time. And not long after, more condoms were given out. I heard a few more stories from Ate Roselynn as well, of how these girls in prostitution are also living with the risk of getting whisked off by guests in vehicles then getting gang-raped in a hotel.

Soon, it was past 10 pm. By this time on a normal Saturday night, I would be at home sitting in front of the TV set, watching a rerun of Lost. But for countless girls in entertainment districts all over Metro Manila, a normal Saturday night would mean getting dolled up and enticing guests to sleep with them just so they could pay for bills, or tuition, or medicines, or simply be assured of a full stomach next mealtime—and the more guests, the better. We did not stay until midnight, yet even for a few hours that night I got a closer glimpse of a world that I deliberately kept to the margins of my consciousness. Quite naturally, the girls did not easily open their lives up to me, an outsider. I could only surmise how desperate they are to be going out and offering sex for money so they could get by. Sally and Krystal appeared all perky when I talked with them. But when the gaiety and nonchalance wear out, how often are they haunted by the shame of what they do?

That night showed me how valuable the painstaking work of the CHOWs was. These PIPs would not readily come to PGH or to the local health center, and many apparently still have misconceptions about reproductive health and hygiene. Thus it is really better to go and reach them where they can be found. I hope that with persistent information and education campaigns, they would be stirred to act positively about taking care of their bodies. I hope more organizations will pay attention not just to their health needs, but to their emotional and spiritual needs as well. Frustrating as it is, I wish the government would do something substantial to alleviate their condition. While it seems that this Prevention Project is all we could do for them in the meantime, I hope we don’t resign ourselves to thinking that when it comes to radically changing the system, there is nothing much we can do. This bitter reality will go on if we do nothing else.