when we are free from guilt,
we see the world with fresh eyes.

these eyes see what others do not,
people long to see what these eyes see

clear as day, the dewdrops on a petal
the stark noght cannot rob the light

but now my eyes have been clouded
i wonder what people see
when they look into my eyes
because i cannot see beyond the haze

110209

October 28, 2009

Magcocommed ba ako?  Minsan feeling ko, niloloko ko lang sarili ko.

Is community medicine really the road less traveled?  Sometimes I think it nearly always turns out to be the road not traveled well.  The least appreciated, minimal impact. Is it really for me, I wonder.

Of course there are inspiring moments.  Like during the trainer's training, I truly wondered what it would be like if I were to be doing that for the rest of my life.  However, I think that it practice it feels less remarkable. I feel as though I'm always on my toes, never good enough.  Is wanting something enough?  Is an ideal enough? How I wonder

I wonder: Are we just making ourselves feel better?

October 23, 2009

Summing up the two clinic days we have found that all the bhw's do not fill up the classification portion of the IMCI form.  In Laiya Aplaya, the IMCI forms are filled completely except for classification. in Hugom, the forms are filled only up to the cough portion.  and some of the BHW's don't even fill up the Respiratory rate portion.. 

I wonder though what prevents them from writing down. Is it confidence? Is it skill? Perhaps part of it is skill and experience. Because if it was skill then they need to learn that skill comes with experience.

But how can we tell them something like that? How can we gently ask them to fill in the classifications and manage accordingly? 

I observed that it truly is difficult to correct or to ask for something on our very first meeting with the BHWs. 
The concept of "nahihhiya" is something very unique to the Philippine psyche.  It hits me though, and it irks me a little. This is a negative thing for me, on no uncertain terms. In English, it means shame. 
Truthfully, I consider this one of the very negative portions of our culture. Because this concept, in most cases, does not stem from a respect for the other person. No. It annoys me because it stems from a difficulty of receiving correction.
Plain and simple, we, as a people, don't take correction very well. We view criticism negatively instead of as a way to improve ourselves.  From this stems the delicate balance of dealing with any strange situation.  I hate how we have to walk on eggshells around each other instead of saying what is truly on our minds, like professionals.

Much as I hate it, that is the reality.  That is my reality in the community. And though I want to change it, and I know it should be changed, I know that part of our culture cannot be changed simply by willing it to be so.

I suppose my lesson here is Stephen Covey's Emotional bank account.  It truly is difficult to give any sort of feedback in any relationship if we are not in the position to do so.  Persons who give feedback have to be in a position where he or she is responsible over the person he or she is correcting. To have responsibility over a person is not only afforded by being in the position over them, but also by taking the time out to invest in the people emotionally.  In order to be able to work with someone, you have to be emotionally involved. THere is no such thing as "just work."
In order to obtain something (like a desired learning or behaivior) from the BHW's, I in turn have to invest in them. With time, emotion, getting to know them.  Without such a relationship, I would be in no position to have influence over them enough for them to receive correction from me.

Emotional investment will take time. As will being able to correct those whom we work with.  I suppose that is one of the great hindrances to our progress in the community.  There is no consistency. Every six weeks, a new batch of interns come in, and then they have to get reaquainted. Another cycle of emotional investment before something happens. But that's the reality. We have to make the best of it.

October 22, 2009

Today was thursday, our first day of clinic in Barangay Hugom.  Yesterday's clinic was easy. We got to know the BHW's of Laiya the day before the clinic and the people were friendly and accommodating.  Also there seemed to be a steady health system in place.  This is because Laiya Aplaya was one of the first barangays in San Juan to get organized.

Hugom was very different.  The people were less warm, for lack of a better term.  It's not negative.. It's just an observation. Maybe it's cultural, maybe the Hugom BHW'se just take a little more time to warm up.  But there I was, thrown  out of my comfort zone, with people who were not responding as I expected when I reached out.  And so I realized then and there, it was so much easier to sit and wait for patients.  That I was really grateful when a patient would come for a check up because I would have reprieve from the stony silence.

Then I realized, I was glad because I was relegated back to a role I was comfortable in. Perhaps the reason why the health provider role seems to be the one being taken on by most of the interns is because this is our comfort zone.  We have been trained to talk to patients and diagnose diseases and provide remedy.  We spent four years studying and training for that role.  But when have we ever trained to be social mobilizers? to be catalysts and community organizers?  In truth we are just people and the community, they are just people as well.  We don't get to be social mobilizers enough in the community because we haven't had the training. The on the ground experience. 
I would like to think that my background would provide me some sort of advantage: we have been having community immersions since high school, I belong to an organization where part of the day to day is reaching out to people and getting them to open up.  I was president of our Medicine Student Council, so I know how to negotiate. 
But no matter how much you prepare, no matter how much you think your past   experience has prepared you for this, you fall short.
There is no formula to people.  Perhaps it would take years for me to train in interacting with people to be comfortable in a community organizer's role.  Howe can I be a social mobilizer when I am not accepted.  Becoming accepted takes both skill AND emotional investment in the community.  No amount of training will prepare you for every commmunity you will immerse in.
I think training in Community, like medicine should be day to day.  We are in the hospital everyday for 730 days straight. We live we breathe hospital. We know hospital. So when we go to community, we take a hospital mentality with us. I suppose there is no middle ground for community medicine.  Either you're in the community or you're not. And when you can't live and breathe community, you can't really be effective

So finally, here it is: reflections on my community medicine experience. Hopefully in the future they'll help me decide

(these were submitted as a requirement for the journals for the San Juan Batangas rotations)

Community Medicine Journal


October 20, 2009
Day 1 Community Medicine Immersion

It's the first day of the immersion and we just finished settling in into Ate Edith's house in Laiya Aplaya.  To be more accurate, we're getting ready to sleep in a room prepared for travelers going to the resort.  Suffice to say, this isn't at all what I expected of my physical surroundings.  We have a two bed room with air conditioning and electric fan, tiled floors and a lock on the door.  A tiled bathroom with indoor plumbing.  The shoreline is literally steps away.

I found out a few hours ago that we would be staying in this place, and as I listened to people's descriptions (beach sila everyday, may bano, change of sheets, its a resort, parang nakabakasyon) I got to wondering, would I really get the community medicine experience that I was looking for.  We wouldn't be at all 'roughing it.'  Those were my concerns, and I did not whether I should be happy or sad.

But now, I realize, that the practice of community medicine goes far beyond physical surroundings. And that the community immersion is so much more than living in a house without the conveniences you are used to.  Community medicine is about people.  We have to involve ourselves with the people who surround us. Engaging our host to treat us as one of her own is still something we have to hurdle.  I don't believe that I have been deprived of the 'full commed experience.'  In fact, I exprience the community when I speak to Ate Edith and find her slowly coming out of her shell and being more at ease with me.  I find that I learn about the community, their history and their traditions when we sit down and have conversations with the neigbors. We sit and talk, unhurriedly. And I am engaged in their stories. We share ideas andn experiences.

As of now, Ate Edith offers us a separate gas cooking range, wash area and table. This is what she offers tourists, and really, most of the interns who have previously lived with her.  And when we ate, we ate separately in spite of our repeated invitations for her and her pamangkin to join us. It is my hope that one of these days, they will feel at ease enough with us to join us for a meal. 

katz.m.d.