Community Medicine Week 5: Familiar Paths

“Home isn’t a place. It’s a person.”
– Stephanie Perkins

Tita Nini, the midwife of Barangay Luksuhin Ibaba, and I were walking towards the tricycle terminal, together with one of our Barangay Health Workers, Nanay Aida, after another long Wednesday clinic day. Wednesday was our busiest clinic day, the day when most of the patients came to consult, especially the pregnant women who were to be seen by the midwife for their prenatal check-up. That said, it was quite understandable why the three of us were eager to go home and rest a bit.

We were halfway towards the Luksuhin Public Market when Tita Nini remembered she had to check something out at one of the local parlors. Parlor-parlor din ‘pag may time! Nanay Aida offered to come with her. I smiled and said that I’ll go ahead of them.
“Sigurado ka ba, dok?” asked Tita Nini, looking a bit reluctant to let me go off alone. “Kaya mo ba mag-isa?”
“Ay, oo naman po, Tita Nini! Kayang-kaya!” I laughed, reassuringly. My two companions heartily laughed along while waving good-bye and walking towards the direction of the local parlor.

As I proceeded towards the tricycle terminal on my own, I thought about the ease at which I reiterated that I was fine on my own. I also realized that it was true, that I could easily head back to Barangay Sulsugin by myself, that I no longer feared getting lost, that I knew my way back to my foster home, that a lot about Luksuhin Ibaba has become familiar.

Five weeks can never be enough to fully understand a place and a way of living, but in this very short time, I’ve grown to be fond of these paths. It is a far out cry from my first week, during which I felt like a lost wanderer most of the time. I remember being so wary of having to commute everyday just to reach my assigned barangay. I remember being so afraid of getting lost, of ending up who knows where with no idea how to get back home. But now, the paths have become familiar. The place has really grown on me.

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The barangay health workers of Luksuhin Ibaba, Dr. PJ Francisco (Family and Community Medicine resident), and I after our vital signs OSCE || It’s been a great five weeks. Thank you for making me feel right at home! :)

But more than the place, what I’ve really grown fond of are the people. Also among my fears upon starting out was feeling a bit lonely amidst all the new people. Though I’ve never been much of a shy person, there is still always that worry that there’ll be difficulty getting along with people. But everyone here has been more than welcoming. The new-found friends in my health team as well as within the other people of the community will surely never be forgotten. I’ve learned a lot from them about the simplicity of life, the dedication to work, and the importance of family. Because of them, despite being a mere visitor, I felt that I found something of a home here in Luksuhin Ibaba and in Sulsugin.

As my community medicine rotation is slowly coming to an end, I hope I was able to contribute something, no matter how little, for the betterment of the people of Luksuhin Ibaba.

Community Medicine Week 4: Recognized

” There is undoubtedly a lot of pressure that comes with recognition, which can be a good thing and a bad thing all at the same time.”

– Prabal Gurung

I had just finished another clinic duty and was walking towards the tricycle terminal found just behind the public market. I was in the middle of one of my usual daydreams when I was suddenly pulled back into reality by an eager “Hello po, doktora!”. Looking up, I saw that it was one of the tricycle drivers. He was already pulling away from the terminal, a passenger on board his vehicle, but when he saw me, he took time to greet me and even call out at his fellow drivers, informing them that I needed a ride. The man I assumed to be a foreman of sorts directed me to an empty tricycle and immediately informed the driver where I was going home to. I didn’t have to say anything. They already knew.

It felt strange to be recognized. I honestly couldn’t remember how I got acquainted with the tricycle driver, if he consulted at the barangay health station (BHS), at the rural health unit (RHU), or maybe even visited our foster home in Sulsugin as an acquaintance or relative of our foster mom. There was nothing about my appearance that may have tipped him of my identity. I wasn’t in scrubs, wasn’t wearing an ID, nor carrying any of my medical tools. The tricycle driver simply knew that I was their doctor.

Going into this rotation, I knew that it was going to be a challenge being the sole doctor at the barangay health station. With Luksuhin Ibaba being the largest and most populated barangay in Alfonso, I had the additional challenge of having slightly more patients than my co-interns. That said, maybe it was inevitable that people would start actively seeking out this sole doctor. For some of them, you’re the only doctor they’ll ever get to see.

It really is such a different world here in the community, compared to what I know in UP-PGH. Back in the hospital, my patience would repeatedly get tested after being called “Nurse! Nurse!”, “Ate! Ate”, or worse “Ineng! Ineng!” by patients and their watchers. All these, even after all these years and after finally earning the right to wear my Intern’s coat. I’d all but grown tired of correcting them about my confusing position as ‘almost a doctor’. But here in the community, even without the coat, people recognize me as their doctor. And though this initially brought me delight, thinking that, at last, I’ve sort of arrived! I actually talk knowledgeably and act skillfully enough to be seen as a physician!, the recognition now brings a little bit of panic in me. For I once again realize that to be called and recognized as a doctor is more than just a title, it is really such a big responsibility. Being a doctor makes people put their utmost trust in you. There will be moments when you’ll literally have lives on your hands.

“…to be called and recognized as a doctor is more than just a title, it is really such a big responsibility.”

Two more weeks remain of my stay as the intern-in-charge of Barangay Luksuhin Ibaba, and I’m planning to make the most of every moment. I’ll do my best to prove worthy of my patients’ trust and their everyday greetings of “Hello, doktora!”.

Community Medicine Week 3: In Good Company

“People are always good company when they are doing what they really enjoy.” 

– Samuel Butler

A big part of Barangay Luksuhin Ibaba is found along the major highway of Alfonso, the long road that stretches from its welcome arc and passes through several barangays before arriving at the town proper. However, a part of Luksuhin Ibaba’s Purok 3, the largest and most populated of the three, is a bit more secluded. Nasa looban, as the locals would say. It is a part that can only be reached after passing through several small passageways, zigzagging this way and that. That said, the residents of this part of the barangay find it a bit difficult to reach the barangay health station (BHS), which is located along the highway. It is quite the walk towards the Sulsugin-Luksuhin road, where they will be able to ride a tricycleon the way to the BHS.

And so, the barangay health team [that is, the barangay health workers (BHWs) and I] decided to hold a satellite clinic day last Thursday, February 2, 2017, at this part of Purok 3, so as to reach out to those unable to go to the BHS. Nanay Linda, one of our BHWs, generously offered the use of her house as the host of this satellite clinic. We converted the dining area into a clinic of some sorts, bringing along even the height chart from the BHS.


The most memorable patient encounter I had at our Purok 3 satellite clinic would have to be Lola L.M., who I wouldn’t have thought was already 94-years-old. Still strong for her age, she had a smile on her face as she entered Nanay Linda’s dining room, albeit with some difficulty due to her aching legs. Lola  L.M. was a known hypertensive, but she admitted having difficulty complying with her medications. Through the efforts of our BHW, she would have her BP monitored, sharing that the highest reading reached up to 200/100 mmHg. Lola L.M. had a bit of difficulty hearing as well, so she had one of her neighbors, Nanay A.C. (also the one who accompanied her there at the satellite clinic), help her understand my questions as I continued history-taking. I tried to probe as to reasons why she was poorly compliant to her medications. It was then that Lola L.M. began to tear up as she related how she was already living alone, how all her children already had their own families and had moved out of Alfonso, how she couldn’t commute, much less walk to the main road, all the way to the BHS.

 I couldn’t imagine how a 94-year-old lady, even if she was as strong as Lola L.M. was,  could live alone. It was truly saddening. I thought perhaps that beyond her uncontrolled hypertension, beyond her muscle pains, what Lola L.M. was really suffering from was loneliness. Thank God for neighbors and friends like Nanay A.C., who take time to help her with whatever she may need. At the end of the day, I was really happy to have been able to come see Lola L.M. and the other patients who found it difficult to reach the BHS. 
In the true spirit of Filipino hospitality, Nanay Linda, assisted by the other BHWs, prepared a feast of sorts, food that wasn’t just limited for us, the health team, but offered to every patient who came to consult at the clinic. My tummy had a hard time keeping up with all the food they prepared, but of course, I gamely tried all the dishes.


The sudden downpour of rain that came in the afternoon, a few minutes after I saw the last patient, paved the way for lively chatter among our barangay health team. This, of course, could not be complete without more food – we had coffee/hot choco + pan de sal during the long conversation. It was stimulating to be among such people, whose friendship and bond were apparent for all to see. They talked about their work. They talked about recent events happening within the barangay and beyond. They talked about their families. They talked about their past interns. They shared all sorts of stories that I happily listened to. I could tell that despite it being a volunteer job,  despite there being some problems along the way, these women, when it comes right down to it, enjoyed what they were doing. After the sky cleared up a bit, I went home that day with my stomach full and my heart happy to have spent a day in good company.

Community Medicine Week 2: Breathless

“Life is measured not by the number of breaths we take, but by the moments that take our breath away.”  

                                                                                                                                             – Author Unknown (Uncertain Origins)

When a patient comes to you, complaining of difficulty of breathing, a long list of differentials come to mind, ranging from the apparent pulmonary etiology to the more complicated renal pathology. But in the case of A.D., 23/F, it is highly probable that her shortness of breath is caused by an exacerbation of her bronchial asthma, most likely exercise-induced. It is probably her own fault, knowing that her lungs can’t handle prolonged walks, much less keep up with her healthy, non-asthmatic friends when it comes to physical activity, yet still attempting to assert herself. Ayan tuloy, hingal na hingal…  To think I’d have an uncontrolled asthma week here in the community. Sigh…

It is ironic that an aspiring doctor such as myself would have several co-morbidities, yet it is proof that physicians, no matter how much they are sometimes revered as mortals attempting to combat death, one disease entity as a time, are still quite human when it comes right down to it. A beloved Family Medicine consultant once told me that I should look at my illnesses as a sort of blessing in that they help me empathize more with my patients. I know first hand what pain is, and not just physical pain, and I know first hand how difficult and extremely debilitating it can all get. I know what it’s like to feel so hopeless, when you feel so, so weak that it’s hard to even feed yourself. I know what it’s like to gasp for air, to literally be breathless. 

when the doctor becomes the patient…. || 23-year-old female presents with shortness of breath and slight chest tightness; Tx: Salbutamol 2mg/tab q6 for now || Never take breathing for granted. Some of us find it so difficult to do.

So, even more so now that I’m in a way running my own clinic at the Luksuhin Ibaba Barangay Health Station (BHS), I make it a point to listen to my patients’ stories, to believe in pain scores, to take note of all complaints. If it is something they deemed important enough to warrant a consult, then by all means, let me do my best to address all concerns. I’ve heard all sorts of complaints during my clinic duties at the BHS. There was a young mother who brought her 2-month-old baby for ‘loss of appetite’ when in fact, the baby was well and healthy, just a little bloated and  needed a little burping. I simply taught the mother about feeding cues and to not force feed her baby. I also had a variety of ‘headache’ complaints, the history-taking of which was almost enough to induce a headache of my own. Di ko po alam, doc. Basta po masakit! goes on, while another insists, Ay, 10 out of 10 po talaga, doc! Ganun kasakit! Still, pain is subjective. 

My determination to hold clinic today despite my breathlessness seems to bear little as I only saw three patients today. But maybe, for the three of them, my efforts were a big deal. They were able to see a doctor (well, almost a doctor) today. They were able to get free medicines today. They were able to be advised today. And as always, I am comforted by their grateful smiles. 

I remain constantly appreciative of the little moments, those quiet patient times when you can just converse freely with patients. A welcome change from hospital life (UP-PGH life, in particular) where everything seems to be in fast forward and just the mere thought of taking your time is seemingly punishable by demerit. It is these quiet moments that frequently go unnoticed, frequently taken for granted. We are sometimes so overcome with excitement, with adventure, with twists and turns, that we fail to appreciate the quiet times. 

But they are, in fact, what we live for. They are the very moments that make every breath we make worth making.

Community Medicine Week 1: Wandering and Wondering

“Not all those who wander are lost.” – J.R.R. Tolkien

Beginnings and endings are equally difficult to experience, but for different reasons. In the case of this week, beginning our community integration proved challenging because everything was new and different. Adjusting needed to be done as we prepared for living with our foster families, and working at our respective barangay health stations. We were to meet and converse with a lot of people, and truthfully, there was really no way of preparing oneself. That we will feel lost is an understatement. No amount of orientations or endorsements would be able to give you the exact picture of what you were to face. You only ever learn by experience, by opening yourself to discovery.

The Alfonso Municipal Hall, which doubles as the Rural Health Unit

This past week, I began my duties as the medical intern of Barangay Luksuhin Ibaba. One notable difference I had with my fellow interns was that I was the only one who didn’t reside within my assigned barangay. This made me consider two things – First, what the residents of Barangay Luksuhin Ibaba may think : could the fact that I wasn’t living in their barangay create some sort of gap?; will this make them more distant, less willing to deal with me? Or am I just overthinking things? I don’t know if it has ever been done that the Luksuhin intern be assigned a foster home in Luksuhin per se, but I wonder if it will make some sort of difference.

Second, how can I, a partially directionally-challenged person, survive daily commutes without getting myself lost? I dislike communting by myself as I tend to get off at all the wrong places. I really fear not knowing how to get home, so imagine the internal panicking that happened when I found out I was to commute daily to my assigned barangay. Still, I let myself be open to this challenge and learned the routes and fares from Sulsugin to Luksuhin (and vice versa), as well as from Alfonso Proper to Luksuhin (and vice versa). Not a lost wanderer anymore!

Ready for clinic duty at the Barangay Luksuhin Health Station!

Still, as one of my favorite authors, J.R.R. Tolkien, wrote in his famous poem, not all wanderers are lost. I certainly felt like a wanderer this first week at Alfonso, going about day-by-day without a clear direction in mind, simply aiming to get to know the ropes of things. And, so as not to get lost, I gladly opened myself up to the challenge of integration, of slowly getting to know and engaging within the community.

I had my first interaction with the Barangay Health Workers (BHW) of Luksuhin Ibaba last Wednesday. The previous interns said that Wednesday Barnagay Health Station (BHS) clinics were busy, and boy, was it really busy! I barely had the time to converse with the BHWs, aside from our short chitchat over lunch, what with the number of patients that came for consultation. I saw more than 20 patients on my first day! Wednesday’s rush got me browsing through my clinical notes, much that I was a bit more prepared for Thursday’s clinic. Truthfully, I was a bit hesitant about holding clinic duties on my own, without the familiar guidance of a resident or consultant to guide me, especially in my diagnosis and management. To make things a bit worse for my nerves, the people here have such great respect for doctors. How they smile as they greet you, Good morning doktora! How they hang on to your words as you attempt to explain their illness and treatment plan. Oh the pressure. But, I think I did alright. I certainly found talking with the patients enjoyable. One notable patient, an elderly man with hypertension, even made an effort to come back a few hours after I saw him for a consult, just to give me a small token of his appreciation – a pen. His simple effort made in complete gratitude did not fail to made me smile.

I had another interesting patient encounter during my duty at the Rural Health Unit (RHU) earlier today. It was a morning filled with consults of coughs, colds, and fevers, when come the afternoon, an 8-year-old boy came with a laceration on his forehead, brought about by a rough round of play time at school. Thank God it spared his eyelids! But the wounds was deep enough to require suturing. So suture, I did! To think that I’d still need my surgery skills during my community medicine rotation! At first, I was wondering how I was to go about it, what with the need for instruments and all, but it was good to know that the RHU was equipped with the basic suturing supplies!

After this first week of wandering and wondering, I plan to continue getting to know Barangay Luksuhin Ibaba and its people. I look forward to hearing their stories. As the new place slowly turns into a different form of home, and the stranger slowly becomes a familiar face, this wanderer will soon find direction amidst all the challenges she will face.