Taking care of the children

Children run around, their laughter echoing around the brightly hued halls. In one room, toddlers nap on a mattress, but look up each time the door opens. They wave and giggle as strangers come and go. In a lobby, mothers patiently wait for their turn to be called and listen as young nurses give their hourly presentation on public health.

People find it hard to believe that this is a government hospital, but it is–welcome to the Philippine Children’s Medical Center (PCMC), a kid-friendly medical facility that puts pediatric medicine within reach of all sick children, rich or poor. In fact, executive director Dr. Lillian Lee points out, 60 percent of PCMC patients are charity cases ranging from general pediatic care to specialty diseases.

In addition, the hospital is a pioneer in sub-specialty treatment. "This is where the beginnings of all the sub-specialties in pediatrics originated, like child neurology, child pulmonology," Lee says of the vast hospital compound where kids with problems as simple as a tooth ache or as serious as cancer-related illnesses, kids needing pediatric rehabilitation medicine, victims of physical and sexual abuse are taken care of by a team of caring doctors, nurses and interns.

"The patients are happy because this does not really look like a hospital. The surroundings are different, and the rooms are not as expensive as those in private hospitals," Lee says. Indeed, the corridors are adorned with brightly painted decorations, rooms have beds shaped like animals or toy figures, and there are play facilities throughout the hospital.

Situated on five blocks of prime land along Quezon Avenue in Quezon City, PCMC specializes in pediatrics and tertiary care and is half-subsidized by the government. They take in an average of 300 out patients a day and 60,000 patients each year. PCMC is celebrating its 25th anniversary this week,with a growing reputation as the premiere training center for sub-specialties.

PCMC is also addressing the problem of our doctors going abroad, some to become much in-demand nurses. "So much has been heard about medical practitioners being exported, but what of those who stay? Enough recognition is not given them," laments Lee. "It’s unforto°Late that there is very little emphasis on research (in the country) and we hope to develop that atmosphere." She points out that training locally is even better as diseases vary in each country. Sub-specialists are given a freehand in training and research, not just related to pediatrics but also to other diseases.

"We have trained more than 250 pediatricians and sub-specialists who are now scattered all over the country," the PCMC chief notes, citing 19 sub-specialties including pediatric neurosurgery and pediatric epilepsy. PCMC now has about 200 consultants, some full-time but most are on a part-time basis.

"After 1986, we started certifying them and putting up specialty associations. That’s one of the biggest things the PCMC has achieved," she says.

Being the biggest tertiary care center for children of the Department of Health, PCMC has a referral system of unique and interesting cases nationwide and as such has partnerships with about 10 non-government organizations and humanitarian arms, like The Philippine STAR’s Operation Damayan, which partners with the hospital to assist needy patients. Operation Damayan were among those given special recognition at kick-off celebrations for the anniversary last Friday.

In the Philippines, infection is the No. 1 health problem among children. Pneumonia is a priority, as well as tuberculosis and dengue. Cancer related cases are among the top 10 diseases, "but not as many as infection," Lee points out.

Not surprisingly, a major concern is the lack of funds to acquire the necessary technology and equipment, like an MRI or CT-scan, says Lee. PCMC has an annual budget of P200 million. To augment this, PCMC looks to other resources, such as entering into "collaborative studies" for research in genetic diseases with Japan and the US. Doctors are also sent abroad to learn more about technology that could be brought back to PCMC, such as a machine that will allow doctors to perform surgery for Parkinson’s disease.

Another stumbling block, she says, is "political intervention", given that PCMC is a government institution. "We need political independence. That is our most difficult problem–trying to prevent the politicians from making their candidates come in not only for training but even as patients."

Dr. Lee took us on a tour of the 200-bed hospital which has the biggest intensive care units in the country. We visit an open-air therapy area where student volunteers from hospices take an active part in easing children’s anxieties over their illness. "We have activities like story telling and film showing so as to erase fears prior to chemotherapy or just seeing a doctor," she explains.

Dr. Cristan Cabanilla, a pulmonologist who heads the organizing committee for this year’s anniversary event, highlights a private facility for sexually and physically abused kids. A device called a colposcope, which Philippine hospitals rarely have, is designed to examine the genitalia of a victim and is connected to a digital camera for proper documentation. This can be used in the prosecution of such cases, according to Dr. Cecille Gan, chief of the child protection unit.

In the left wing of PCMC is the well-equipped rehabilitation center. "We have patients with cerebral palsy, deformities, those who need pulmonary rehab," explains Cabanilla. Occupational therapy students are trained here to become adept in pediatric rehabilitation. A "sound room" is available for hearing- and speaking-impaired children. Cabanilla says they have a number of psychologists and psychiatrists on staff, although he notes there is still a need to further develop the structure of their rehab program.

Inspite of having established itself as a premiere pediatric and tertiary care facility, the PCMC chief says a lot more sub-specialties need to be developed. "And that’s what we are striving to do now. But we need a lot of funds for that," she notes.

For next year, PCMC is zeroing in on specialty-driven research study programs to be launched during its week-long anniversary celebration. The top research initiatives are infectious diseases in all fields, movement related diseases and tuberculosis. Consolidate all these. "This would also be a less costly way of doing research. We will be looking at the number one cause of morbidity or mortality and second, what does a clinical practitioner need in order to better care for the patient," Cabanilla says.

Early this month, World Health Day was celebrated, stressing health priorities involving mothers and children. Statistics from the World Health Organization show that nearly 11 million children die before reaching their fifth birthday while half a million women die during pregnancy and childbirth each year. In the Philippines, child mortality risk or the probability of dying before age five is a relatively high average of 35 per 1,000 children.

With the country having a 2.3% annual population growth, the World Health Organization cites "serious challenges" in the delivery of health services, particularly those which are basic that it says need "continuous investment", which comes not only from deep pockets but producing better trained physicians spread across the country, especially in remote barrios where health services are inadequate. Perhaps giving our young doctors the opportunity to do meaningful, advance work can help convince them to stay and take care of the children.