we spent half our time in tacloban at the regional tertiary care hospital – i spent the time in the pediatrics ward. interestingly, pediatrics in the philippines is the most challenging and draining rotation for medical students and residents, with malignantly harsh professors and the strictest of expectations. this is in sharp contrast to the general culture of pediatrics in the west. we had to sign in and out every day to make sure we were there for all of the required hours. the interns work 32 hour shifts every third day (q3 call) without any weekends or breaks, which is insane. we did these overnights sometimes but thankfully they didn’t make us do them every three days. then, in the morning, the young doctor’s verbal presentations were picked apart and absolutely destroyed by the attending physicians and director of the department, often with unveiled and unnecessary personal insults.
and this was one of the least sad things about the pediatrics ward. the place was grossly underesourced. not a single person used gloves the entire time i was there. there were often 10 or 20 patients and their families in a room, and privacy was nonexistent. when a patient died the family would be told and left to mourn in a room full of onlookers. while technically there is a government payment scheme that most in the area belong to since being struck by the typhoon, not much was covered. little things like caps for intravenous catheters or bigger things like certain drugs had to be purchased by the parents in the streets outside the hospital. in the pediatric intensive care unit when babies went into respiratory distress (which happened on a daily basis) they asked the parent if they could intubate, using the english term without any explanation of what that meant. sometimes the parent refused, nothing was done, and the baby promptly died. the parent almost certainly said no out of ignorance or misunderstanding. in the west, lifesaving interventions for children are done even if the parent does not give permission. in tacloban, even when the patient was intubated, there were sadly no ventilators. so the parent was expected to manually ventilate their child with a bag. no one from the hospital staff had the time to relieve the parent, and often there was no support to bring them food or water. so what would typically happen is that the parent would bag nonstop for 24 or 36 hours without food or water, and then give up, and the child would die. completely preventable deaths. and this happened almost every day. it is terrible.
one interesting program at the hospital was for rehabilitation of malnourished children. the program was funded by unicef. one mother brought in her infant who was obviously starving to death, and told us that she had been feeding him exclusively watered-down rice water since birth. the program pays for children like this to stay in the hospital until they are deemed rehabilitated enough to return home. the problem is, the issue will undoubtedly recur when the patient does go home. the family only earns one dollar or so a day and has 11 other children to feed. even the parents were subsisting off just rice. it’s a rough world when you don’t have resources. i suppose that is the moral of this story.