Posted by Ricci Sylla, MD (a third year OBGYN resident from Kaiser Permanente, Santa Clara while…
Quirino Memorial Medical Center (QMMC) is a public hospital serving patients mostly from Quezon City. It is named after the second president of the Philippines. Over 70% of the patients are indigent. As a public hospital, several differences are immediately apparent from my experience at Kaiser Permanente Santa Clara. At Quirino, there are three triage beds separated by curtains. For patients admitted in labor, they go to the labor room which is a single room that can have up to 7 beds. For very busy days, patients may be sharing two people per bed. Patients’ families stay in the waiting area until delivery. Only 1 in 20 patients receive epidurals and those are usually the patients who bought an insurance plan through the government.
Health care in the Philippines is similar to the U.S. system where there is no nationalized health care system. Though this is a public hospital, patients are still required to pay a minimal amount for their care. For those patients who are unable to pay after their treatment and/or hospital stay, they go to a special ward. There are no beds in the ward, only chairs, and patients stay here until they are able to pay as they are not allowed to leave until their bill is paid. Patients can sometimes get their bills paid by petitioning a local politician or waiting until the social worker gets an outside donation so that they can go home.
Most of the patients labor quietly in their bed. Once they are at +2 station, they get transferred to the delivery room which contains three delivery beds next to each other. Every labor patient admitted pays
for a delivery kit containing two sterile gloves (almost always size 7 only), one suture, three bottles of normal saline 500ml, a few sponges, and other small miscellaneous items like syringes. Because resources are limited, p
atients requiring operative delivery are all delivered with forceps. Vacuums are expensiveand expendable while forceps are reusable aft er a quick autoclave. Multiparous patients are allowed to have a vaginal breech delivery depending on the clinical picture, but nulliparous patients get a Cesarean if they are found to have a breech presentation.
There are 27 Ob/Gyn residents at QMMC including four residents from Nepal who will return there after they finish their residency training. It has been very interesting to note the differences in the duty hours as there are no duty hour restrictions in the Philippines. I feel like I am experiencing residency as it used to be in the U.S. over fifteen years ago. All of the residents do a 24-hour call every three days, and residents cannot go home post-call until all the patients they took care of the day before have had their final disposition plans. For example, a patient who was admitted in the early morning who required a tumor debulking surgery got her case bumped for emergency cases so her surgery did not start until 5pm. The resident in charge of her case who was on-call the previous day and evening had to stay to do her case. So that resident did not go home until after 8pm on her post-call day, essentially working a 37-hour call day. Also, residents stay until the patients who require consults, such as from Pulmonology or Cardiology, receive their consultation. There is very little handoff for cases. It makes for great continuity of patient care though of course at the expense of resident quality of life. I look forward to working more shifts with the QMMC residents who demonstrate great temawork daily and I have appreciated how armly they have welcomed me into their fold