REFLECTIONS
REFLECTIONS : REALITY CHECK ! AUTHOR Teresita Bacani-Oropilla , MD heart .
Waking up to a winterland of unblemished snow and sparkling icicles on tree branches takes one ’ s breath away . Memories of kids sledding down small hills , posing with snowmen with carrot noses and frolicking pets in sweaters and snow boots inevitably bring smiles and warm the
But then , thoughts of having to maneuver to work with sudden slick spots on the road and checking for busted pipes in the basement brings us back to reality . “ I have to shovel the snow in the driveway before I can even get out !”
Having lived so long , a nonagenarian no less , I think of the past and present care of our patients through the years . On the surface , like untouched snow , we try to convince ourselves that everything is going smoothly - patients are being attended to medically , mentally , socially , financially . Then along comes a spoiler - Tornado ? Floods ? Fires ? Pandemic ? And suddenly we are caught unawares , wondering how we can remedy the situation , “ STAT .”
Our world , so diverse and yet so interconnected can no longer afford to isolate problems in one area to solve them . We need not only individually , but as a group , to pull together to help . We do , according to our capabilities , under the particular circumstances as needed .
In the late 1950s , at the Pediatric Department of the University of Louisville , medical residents , both local and foreign , were taught about immunizations ( it was post-polio epidemic ), rehydration by intravenous fluids , management of severe burns , cancer in children , etc . Isolets for premature infants were available . Antibiotics treated infections . These concepts and procedures were becoming routine in the U . S .
Back in rural Philippines after this training , full of modern ideas and dreams of implementing them , I had to improvise . Refrigeration was not widespread . Ways to transport and store vaccines , hoping that they were still potent , had to be invented .
A kindly U . S . friend at the X-ray department collected and mailed “ used ” needles to be resterilized for tiny baby veins . A steady supply of antibiotics thankfully became available . Whole milk donated by drug companies saved a lot of malnourished children with kwashiorkor .
Teaching mothers about cleanliness and food preparation prevented the spread of intestinal worms and decreased the incidence of tetanus among the newborns ; patience and innovation were requisites .
A pregnant fish vendor mother was ready to deliver triplets . Full of enthusiasm as a young U . S . -trained doctor , I ’ d thought up plans for isolating the premature babies at home , so that neighbors and family would not infect them - until I went to their home to supervise the babies ’ new quarters .
Surprise !!! I climbed the ladder to a one room bamboo house where the couple and two children under five slept on a big mat on the floor , under a huge mosquito net to ward off bites ( especially of the plasmodium variety that transmits malaria ). A clay stove with chopped firewood stood in the corner where they cooked food . Water from the town ’ s artesian well was stored in two kerosene cans . And I had dreamed of boiling separate baby bottles for formula … my dreams of isolation were kaput .
Lesson learned : know the circumstances your patients live with . Verify ! We were living in different worlds , next to each other , right then and there . Little did I know !
Could it be the same situation with our patients in the here and now ? I wonder :
Do our own pregnant mothers here really understand why their blood pressure has to be checked regularly ? Have they ever understood what preeclampsia is ? “ Too much trouble going to a prenatal clinic . I am fine ,” is what they may be thinking .
And why breastfeed ? “ Cramps my style . I don ’ t know how to pump and store breast milk . I have no time for that at work .”
Do they know that their daily beer has alcohol that can cause fetal alcohol syndrome ? Is a fat child healthier than a thin one ? Why do they have to be vaccinated ? “ So they will accept them in school ” is not the real reason . Do they really know why ?
Are we answering the questions that they don ’ t know how to ask ? Have we educated them enough ? Were they convinced ? The more they are convinced , the better they will comply with preventive and treatment plans . That spells success !
Enough of these necessary but far too numerous questions : our real task is to dig beneath the seemingly pristine snow of unreality , then patiently , practically , use our own expertise to connect and alleviate the true ills that we encounter - with the least fuss !
Great going and the best of luck ! Dr . Bacani-Oropilla is a retired pediatrician and psychiatrist .
MARCH 2022 29