the would-be intern

an intern is someone who is almost there but not yet, a fluffy cake without the icing, a diamond in the rough. in any field, this means that the intern has the potential to be great, only he or she will need a little more time to get to an acceptable polish.

aah, this notion of being accepted, isn't this the root of discrimination? if a person does not act appropriate to social norms, whether in aspects pertaining to socio-economic background, gender, or otherwise, then will he or she not be deemed acceptable? as a thriving civilization, we humans have devised ways and means to provide structure to the wandering lifestyle of the nomads - to the benefit and detriment of human individuality. we built schools, governments, businesses & corporations, laws & constitutions, fastfood chains & malls, banks & sketchy investment funds.

this internship, then, is just but a minute construct in the grand scheme of the things, a seemingly inconsequential event in the universe, a blip in Earth's 4.5-billion-year timeline.

but for a single medical student who has finished clerkship, this thing called internship is a momentous step towards that M.D. license. so yes, it may just be a machination to provide structure to the medical profession, to obtain a certain polish before acceptance to a respected group in society. but to this wide-eyed medical apprentice, internship is the necessary process to figure out what it wants to do for the rest of his life, while being thrown into the realities of the healthcare system like a hapless child thrown into the sea by his expectant parents thinking that their child has already learned to swim after using salbabida (rubber rings) for that one year called clerkship.

welcome to reality: the smell of hot damp air of a resource-limited public hospital in summer weather. why does pgh seeminlgy get more than a thousand consults per day?  why do patients expect lab fees & medicines to be free? if the illness is that bad, then why only now? why do i get patients as far as Samar, Catandanues, or Misamis? why is this ancient-looking suction machine not even working, & why is it even here?

outside the hospital, a thousand more questions abound. where do i go from here? will i be a clinician? a teacher? an NGO worker? a researcher? a government employee? is the salary adequate? will i be able to save for my nest egg? a hospital doctor, after all, is just another blue-collared worker in a white coat that lives by the tagline: no work, no pay.

of course, one couldn't escape non-medical mysteries as well. why is it called barbers' cut? why is mcdonald's giving away free mcmuffins to rich people? why end #G2B when it has phenomenal tv ratings? where the heck is Malaysian Airlines flight 370? will i ever see snow in the Philippines?

seems like most of these questions will find their respective resolutions in time, and so for now i bid myself to commit to patience and perseverance for one more year, to claim that elusive MD title, and to get a real paid job so that i, as kuya (eldest brother), can help with my parents' finances & siblings' education.

it hasn't even started, but already i can't wait to end my internship. to my past, present, and future brave colleagues in this healthcare system, may the odds be ever in our favour.

healthy democracy

in recent months, the college of medicine that i am part of has been abuzz with two controversies, with both student welfare and patient care at stake. while there is a temporary resignation by the studentry towards the inevitable, the underlying issues remain ostensibly unresolved.

the first concerns the university-wide calendar shift from june-march to august-may, which decreases the number of medical students able to man the university hospital for several months. the second involves a directive that requires paid hospital staff to do vital signs monitoring, a responsibility that is traditionally the students' duty in the past. let me outline the two policies further.

paradigm shift

the academic calendar shift was strongly debated among higher education institutions that have declared their intention to implement it, among these the university of the philippines, ateneo de manila university, and university of sto. tomas. to be competitive globally, or at least in the ASEAN region, these universities wish to adjust their calendars supposedly to facilitate student & teacher exchanges, project partnerships, and greater curriculum parallelism, all for the goal of ASEAN integration by 2015. what surprised the students was the swiftness in which this policy change was announced.

a lot of criticism stems from the apparently minimal student involvement during the deliberations before the official memorandum has been signed. if the students were surveyed today, likely they will agree with the lack of student referendum / consensus, and majority will possibly express a contrarian view. the move is disappointing, because a school exists because of its students, which comprise the primary stakeholder in any educational system, not the administrative officers, not the security or janitorial staff, and not even the teachers. a school that does not listen to its students is like an institution with no respect for its members, or a company that does not value its customers. of course it can't be helped that this kind of stuff happens in the real world, but it is still disappointing.

i am more concerned with the fondness of school officials with the idea of globalization that this shift brings; it seems like the perfect vehicle to obtain more sabbaticals and fellowships abroad. however, i would argue that this will not bring any significant change to our ranking as a university, because all of these measures have been in place for so many years, but our local universities are still sliding in global rankings year after year.

our universities are lacking two important things: the culture of research, and publication in international journals. Do relevant research and you provide your countrymen with relevant solutions; but research should not stop there. Indulge me in saying that many of our researches stop at the most crucial point between mediocrity and greatness. We need to publish our research, and we need to submit them to internationally known journals, because sadly, that's how the competition runs. if only we can modify the standards for ranking universities to include research relevance and translatability, then our top universities will likely have stellar marks, but as of yet, international publications serve as proxy markers for many ratings agencies, and we need to be aggressive in publishing our research.

thankless job

another hospital memorandum has been circulated, with its many variations spread as rumors, that concerns with the burden of responsibility of vital signs monitoring, which arguably tops the list of tiring thankless jobs that also includes doing blood extractions, placing intravenous insertions, and writing interdepartmental referrals. traditionally monitoring has been assigned to medical students, because admittedly it is such as menial job, but is essential for two reasons: it saves patients' lives and it hones the clinical eye. medical students stand to benefit from this repetitive experience in order to gain clinical acumen as well as a sense of purpose. what makes it particularly difficult in a poorly-funded government hospital is that, many times, one medical student is assigned to monitor 20-30 patients in one ward every hour, for several hours in a span of a day, on top of other equally exhausting tasks.

the ruckus apparently started when the administrative office issued a directive requiring paid hospital staff, i.e., nurses, residents, & fellows, to be accountable for the vital signs record sheets for legal purposes. then, some nurses started to complain about doing the monitoring themselves, what with the multitude of tasks they already have in hand. some students feel that residents & fellows already had their share of monitoring during their younger days, and expressed ambivalence towards the policy change. meanwhile, residents & fellows feel that the students will be deprived of a necessary skill.

overall, this policy seemed to have left many of the staff feel disgruntled, and several have placed the blame on the students for instigating such a proposal. with no clear conclusion at hand, medical students will likely continue to do vital signs monitoring, and personally i have no qualms with it. but as part of the studentry, it hurts when senior people accuse you of complaining about monitoring, when you are not even guilty or even aware of such a complaint, and this blame game is clearly a step backward from what we dream of: harmony and cooperation in a hospital that seems to ask a lot from its members.

what is commendable in all of these, despite the negativity, is the unperturbed sense of critical thinking and freedom of expression by the medical students and hospital staff involved. strong criticisms are reflective of a healthy democracy, and despite some parties expressing disappointment, i think this entire exercise is still a good thing for both the university and the hospital because this gauges the health of democratic policy making in our institution.

let the discussions continue, and pray that the administration will truly listen to its constituents. hopefully, these debates can bring progressive resolutions to the health delivery system in our university hospital that has been weighed but found wanting.