Saturday, November 21, 2015

One Bout of "Pneumonia"

One Bout of “Pneumonia”
Viewpoint on Quality of Service
Private vs. Government Management

        It all started in September, 2015 when I had a persistent cough which I thought was only an allergic cough which persisted for weeks. I am a dialysis patient at the Regional Hospital of  Gov. Celestino  Gallares (GCGMH) for four years  now and I had one bout of Pneumonia since last 2012. I had no fever and my body is functioning normally aside from my cough so the doctor assigned at the Hemo-Dialysis Unit (HDU) finally decided to conduct a thorough listening on my lungs and said that she heard something on my left lung and prescribed me with an anti-biotic which I deliberately took as prescribed. My condition did not improve and the other HDU doctor (the former doctor was reassigned) conducted another thorough listening on my lungs and again said that my left lung is “noisy” and suggested that I should have chest X-Ray. As an obedient patient, I had a chest X-Ray on October, 2015 at the Ramiro Hospital. The result said that I had pneumonia at my left lung and my right lung is “clear”. The HDU doctor was informed and she prescribed me with more potent anti-biotic to treat the infection. I trusted the doctor more since her diagnosis is “right”, but I told her that I do not feel anything in my left lung, instead I feel something in my right lung and I also have pain at the right side of my back. The HDU doctor replied “how do you know?” I was taken aback by her authority and decided not to reply back. I could have told her that I feel that my sputum is coming from the right lung and I feel that my right lung is sore. After taking the prescribed anti-biotic, my condition improved a little bit but I still have a persistent cough so the HDU doctor advised me again to have a chest X-Ray so that she will know if she will prescribe me with a broad spectrum anti-biotic. So I had again a chest X-Ray on November, 2015 at the Ramiro Hospital and the result said that I still have Pneumonia of my left lung but it is improving and my right lung is “clear. This time my wife and I decided to consult our Pulmonary Specialist who is also our family friend. We showed the X-Ray plate and the result and upon examining the plate, he said that I have no infection on my left lung but my right lung showed some cloudiness. He said further that probably what the radiologist saw in the left lung as pneumonia is actually a “thickening” of tissues as a result of my last bout of pneumonia in 2012.  We were amazed by his findings and realized that all the time the HDU doctors have been treating my left lung which have no infection and it finally turned out that it was my right lung which need to be treated. What is most amazing is the result of the two successive  X-Rays which showed that my right lung is “clear” and have no infection. The radiologist and the HDU doctors simply failed to see the true condition of my right lung which the Pulmonologist easily saw. How come that this has happened? After having laboratory tests of my blood, our pulmonary doctor friend concluded that I have no more infection and prescribed me with anti-allergy tablets. If I did not consult a specialist, I could have been prescribed with more potent anti-biotic  which could have affected my liver. I also concluded that the patient is more sensitive of his condition and the doctors could also be mistaken with their diagnosis.

         The question now is: who should have an “eagle” eye in reading the X-Ray plate, is it the Radiologist or the Pulmonologist? It should be the Radiologist since he has specialized in reading X-Ray plates while the Pulmonologist has specialized in diseases of the lungs. I could only surmise that due to the busy schedule of the Radiologist, he is quick to decide that the interstitial infiltrates which he saw in my left lung is Pneumonia and the rest of the lung fields are “clear” and he decided to stop to carefully scrutinize the cloudiness in my right lung. He could have concluded that anyway the patient will be treated with antibiotics which will affect the left and right lung. I cannot blame the Radiologist because he does not know my medical history, but he should have been more careful with his X-Ray readings because these could result to incorrect diagnosis that could endanger the patient’s life. In my case, what if I had no lung infection and it was only an allergy; and because of incorrect diagnosis I was treated with strong antibiotics that could have affected my liver. I am a dialysis patient and it is my liver that takes care in eliminating toxins from my body. If my liver is damaged, I would die because dialysis alone is not enough to keep me alive. No wonder, even doctors in Tagbilaran City are more confident to have their medical check-ups in Cebu City rather than in Tagbilaran City to avoid incorrect diagnosis.

        It is here, that quality of service plays a vital role in medical institutions. The medical personnel are dealing with their patient’s life and they should be fully qualified or re-qualified through further trainings to perform their tasks. This is the modern world and what is applicable in the past may not be applicable today and nurses, doctors and radiologists are sent to seminars to update their skills and knowledge to be more competent in doing their duty. Of course, dedication to duty is also important. Combining all these factors, I am sure these medical personnel can sleep soundly without being bothered by their conscience.

       The Top Management also plays a vital role in keeping their medical personnel to perform in their maximum proficiency because management is all about planning, leading, organizing and control. Be loose in one of these tasks or focusing only in some will affect the performance of the organization. Not sending medical personnel to trainings and seminars will cause stagnation of their knowledge that will result to poor performance and incorrect diagnosis that will result to aggravation of the condition of the patient and the worst, it could also mean death.

       I cannot stop comparing private management of hospitals to government hospitals because I am a patient myself and I regularly enter hospitals for treatment. Top Management of private hospitals is strict in the implementation of duties of their personnel. One complain from a patient or patients means reprimand, suspension and in worst cases even dismissal of the personnel involved, while in government hospitals, lapses of medical personnel are tolerated and you would be lucky if they get a reprimand from their supervisors and Top Management. That is why the quality of service of government medical personnel is not at par with their private counterparts. Why is this so? In my opinion, government medical personnel are regular, casual or consultants. The regulars are always protecting their position so they can have a good retirement with their lump sum and monthly pensions. For this, they should have a political rapport with their co-employees. So if a patient complains, the Supervisor or even the Chief of Hospital is very careful not to put their staff in bad light because of this political bond with each other.

      My Kudos goes to the Top Management of Gov. Celestino Gallares Memorial Hospital (GCGMH) where I am a dialysis patient. Finally, the Top Management has decided to apply for ISO (International Organization for Standardization) accreditation to upgrade the level of service that will hopefully make the hospital one of the best in the Region. This act is more appropriate to remove the stigma that government service is equal to poor service because of the wrong notion that government personnel have low salaries and should only perform according to what they are receiving. I can dream of that one day when government medical personnel are proud of their institution and they can face their patients with politeness and say: “You are most welcome sir/madam to our hospital which can provide you with quality service” and not to utterly say to patients: “If you are not satisfied with our service then go to private hospitals. This is a government hospital, what do you expect from us?”

Wednesday, August 19, 2015

Invest In Your Children


     When I was in school we were told that our National Hero, Dr. Jose Rizal was quoted to have said “The youth is the hope of our nation.” With the wisdom of such a man, he can never be wrong since he must have based this on his experience in how he and his peers were raised and taught to face their obstacles and also how to handle their successes in life. Looking now on what is happening and how the youth is behaving to drugs and exhibiting mischievous practices, could these change our belief really that the youth is the hope of our nation? Maybe there is no statistics that could measure the percentage of misbehaving youth against those who are behaving properly; but I still believe that despite the various influences that the youth is subjected to, majority of the youth are properly raised and educated by their parents and teachers. Clearly, it is the family and school as well as his peers that shape the child to succeed in life.

      Training begins at a young age. Right behavior is rewarded but misbehaving is not tolerated. Failure to do a task does not mean you cannot do it right. Acceptance of the truth though is a must. Continuous practice means improving ones reflexes and thinking until it becomes automatic. With the right principles and values, a child can never run astray. Good influence and the right environment with loving people around makes a child trusting and a giver of love to another person. The world at times is a tough world to live in and the child should be supported and guided at each moments he faces the harsh world to keep him/her strong and brave. A child is like an investment that could someday prove that the youth is truly the hope of our nation.

Thursday, February 5, 2015

The Mamasapano Incident

     On January 25, 2015, the Special Action Force (SAF) of the Philippine National Police (PNP) launched an operation in Mamasapano, Maguindanao in Mindanao called "Exodus" to arrest or kill Zulkifli ben Hir or alyas Marwan a well-known international terrorist who was involved in the Bali bombing where many tourists were killed. Another target of the operation is Basit Usman, a local terrorist and said to be an accomplice of Marwan. Reports say that around 4:00 A.M., the SAF troopers swooped down on the house where Marwan was last seen. The SAF troopers said that Marwan was awakened by the blast of booby traps set by him around the house and started firing on the raiding team who fired back and killed Marwan while Usman escaped. Proof of the death of Marwan is a photo showing him lifeless and bloodied with some missing fingers which the raiding team took for DNA analysis. Around past five in the morning, the SAF troopers were fired upon by armed men believed to be members of the Bangsamoro Islamic Freedom Fighters (BIFF), Moro Islamic Liberation Front (MILF), Moro National Liberation Front (MNLF) and private armed group operating in the area. At the same time, the blocking force of the SAF were also fired upon by armed groups

    As early as 7:00 A.M. the soldiers of the Armed Forces of the Philippines (AFP) were already in the highway of Mamasapano. Reports say that they tried to enter the encounter area but were fired upon by armed men and they were forced to retreat. The AFP said that they could not use their cannons because they do not know the exact coordinates of the SAF troopers who are fighting in the area. Later, the AFP Chief, Gen. Catapang said that they did not provide reinforcement to the SAF for fear of more casualties and could also result to an all out war that will destroy the peace agreement with the MILF and the government. It was already late in the afternoon when mediators for the cessation of hostilities finally succeeded in stopping the fire fight. The surviving SAF troops where extracted by the AFP. The following morning, the PNP and AFP returned to the encounter area to retrieve the bodies of 44 SAF troopers who died in the encounter. The SAF is an elite group of the PNP and their training is extensive and difficult, then why such a big casualty? Reports say that the area is called "the box" because it is surrounded by different armed groups who are mostly blood relatives. The area is a killing zone for the SAF soldiers and this was aggravated by their lack of familiarity of the terrain.

    The Mamasapano incident has created ripples of shock all over the country. The SAF Chief Director Getulio Napenas, was immediatedly sacked by President Aquino who made a press release saying that he knows about the operation but was not informed when it will be executed. He declared the 44 SAF men who died as heroes and said that the killing of Marwan is a priority to prevent more bombings that kill innocent people. It was also reported that the suspended PNP Chief Gen. Allan Purisima was also involved in the planning and giving of information regarding the operation whose success will give Purisima a chance to go back to his position. Initial findings indicated that Dir. Napenas did not coordinate with Pres. Aquino, DILG Sec. Mar Roxas and the AFP. The fallen soldiers were flown to the Villamor Air Base and many people were disappointed when Pres. Aquino was not able to welcome the dead soldiers because of his prior appointment with the blessing of the Mitsubishi plant in Laguna; but the next day he was able to attend the eulogy of the soldiers. The whole country is mourning the death of these 44 SAF troopers who were killed in action doing their duty to stop terrorism that affects the lives and livelihood of ordinary citizens in the country. In their effort to protect their countrymen, they have offered their life so that others will live peacefully.

     Below are questions that could also be asked by ordinary citizens who want to know the truth about the Mamasapano incident where 44 loyal SAF soldiers died. We pray that their death be not in vain and justice will be given to these courageous fallen heroes:

On the part of the MILF/MNLF/BIFF:

     Why is the MILF/BIFF/MNLF harboring terrorists like Marwan and Usman if they are sincere in the peace agreement?

     Why were  Marwan and Usman were not alerted when report was saying that as early as 10 P.M. there was already a SAF troop build-up in the area? MILF/BIFF/MNLF sympathizers or lookouts could easily have seen this troop build-up and could have sent runners to alert Marwan and Usman. At the same time the lookouts could have verified what type of troops are in the area and could have relayed this information to their commanders in the area for analysis and decision.

   Could the MILF/BIFF/MNLF have a prior knowledge of the operation to kill Marwan and this involves the US regarding the reward money of $5.0 million?

     Could Marwan be a victim of a set-up where after he (Marwan) is killed the US will give the MILF the reward money for providing information on the exact location of Marwan?

     Did the death of the 44 SAF soldiers provide a "smoke screen" of the true nature of the operation to kill Marwan?

     The MILF and the military have an on-going ceasefire agreement at that time. Most of the people in the area are blood relatives and could somehow act accordingly if told by their elders or superiors even if they belong to different armed groups. There could have been a hesitation on the part of the MILF or MNLF or BIFF to engage the SAF troops in a fire-fight for fear of jeopardizing the enactment of the Bangsamoro Basic Law (BBL).

   Was the fire-fight started by a private armed group thereby confusing the MILF/MNLF/BIFF fighters who later on joined the fire-fight? If this is true, the motive of the persons who owned the private army is to sow confusion and create trouble between the MILF and military which could result to demoralization and blaming within the ranks that could also lead to political destabilization. A TV interview of a private individual who allegedly joined the fire-fight attests that a private army of an influential clan was also seen participating in the fire-fight.

On the part of the SAF/AFP:

      Why was the arrest of Marwan and Usman timed during the processing of the BBL? There was a high risk of jeopardizing the enactment of the BBL which the Aquino government does not want to happen in order not to tarnish their image as peace advocate. Why did Dir. Napeñas did not wait for a little more time to give way for the passage of the BBL where the MILF could have surrendered their firearms and political situation in the area is already stable which can give way for peaceful negotiation for the surrender of Marwan and Usman?

      Was Pres. Aquino really not informed or briefed by SAF  Dir. Napeñas on the how, when and where of the "Operation Exodus" or the Mamasapano Marwan/Usman arrest considering that this is a very sensitive operation that could result to a critical situation. If this is true, who or what really influenced Dir. Napeñas to give the go signal assuming that he or they have calculated the risk?

    What took so long for the SAF arresting team to reach the area of Marwan assuming that the start of the insertion or operation is at 10 P.M.? Reports say that the SAF troopers reached the house of Marwan at 4:00 A.M. There was a time difference of six hours. If it is true that the SAF troopers rode  non-motorized boats to ensure a stealth movement, they could have reached their target much earlier, accomplished their task and retreated the same way as they came in. Time is of the essence and it is better to move in the cover of darkness.

     If it is true that the SAF troopers were able to kill Marwan and detached one of his fingers for DNA analysis. It should be their number one priority to send back some of its men to the highway where 300 SAF troopers are waiting as soon as possible in the cover of darkness. Were the remaining SAF troopers in the target area acted as decoy to provide cover to the retreating SAF troops safeguarding Marwan's finger? Why did the blocking force did not retreat as one of their comrades was able to escape alive. They could have avoided being sitting ducks to their enemies. Could there be a notion among the engaging SAF troopers that a reinforcement from the military will prevent further escalation of hostilities and they will be saved on time?

     What took so long to contact the members or mediators for the cessation of hostilities if as early as 7:00 a.m. the AFP is already in the area?

     Reports say that the AFP was already in the area as early as 7 A.M. and also with Dir. Napeñas. Why did the AFP did not ask for the exact coordinates of Marwan's house which is near where the fire-fight happened. The AFP said that they don't know the exact place of the fire-fight and that's why they could not provide reinforcement to the beleaguered SAF troops  fighting in the area. The SAF troops have a sattelite phone, why did they fail to provide the AFP with their bearings?

     If it is true that Dir. Napeñas decided and acted on his own and did not coordinate with Pres. Aquino, Gen. Catapang and Espina and DILG Mar Roxas for secrecy to ensure the security and success of the operation, then why send almost 400 SAF troopers in Mamasapano where they are highly visible and could easily alert their target? Commandos usually penetrate an area secretly and unnoticeable as much as possible.

     Even if it is true that there was no coordination between the SAF and the AFP, there could have been an Intel information by the AFP because of the mass movement of SAF troopers a day before mobilization and the AFP could have inquired on this matter from Dir. Napeñas. Senior security officers would have known about this movement and could have decided whether to halt or give a go signal to the operation.

   What was the knowledge of the senior security officers of the Philippine government/military on who will get the reward money after Marwan is killed?

On the part of the US Government:

     Reports say that it was the US Government who provided the location of Marwan and Usman by flying surveilance drone. If this is true, why did the US military did not bomb or strafe the house where Marwan is sleeping considering that he (Marwan) is a well known international terrorist like Bin Laden?

     Being a serious security matter, the US Government could have coordinated with Pres. Aquino and the generals of the military for consultation on how to arrest or kill Marwan and Usman?

     Who are the rightful person(s)/entity that is legible to take the $5.0 M reward? Is it some members of the MILF or the whole of MILF or part will go to the Philippine military or the whole Philippine government?

Were there any American military personnel who joined in the Mamasapano Marwan raid? Were these American personnel possibly got wounded or killed in the gun battle but covertly carried out of the battlefield?

     A lesson learned from the Mamasapano Incident is the significance of coordination in the line of command and other support government agencies like the AFP and  the PAF to prevent the loss of many lives including civilians. Simply it is not logical and it is stupid to risk the lives of your men only to kill one international terrorist considering negative factors in the terrain, timing and social complexity of the operation. Unless there is something more compelling and top secret that drove the PNP to go ahead with the mission. Why push through with a land operation if a quick air attack aided by GPS on the target will produce better result with less cost? Maybe the question on how to verify if it is really Marwan who is killed in the air attack arises; but it is better to conduct verification when the MILF/BIFF is fully aware that the NBI/FBI/PNP will enter the area where Marwan was killed to gather samples for DNA analysis. If an untoward incident happens while the verification is taking place, then this will warrant the government forces to take action without being accused of breaking the cease fire agreement.

     Regarding the BBL, the Aquino Administration has done its part to maintain peace and give chance for the passage of the BBL. It is clear that there are administrative lapses in the execution of "Operation Exodus" and it will not take long for those responsible for this blunder to be identified and penalized. The ball now is in the hands of the MILF. For the BBL to push through, the MILF should be able to show their sincerity and competence in complying with the requests of the Philippine Government regarding the Mamasapano Incident. The MILF should be able to: return the fire arms of the 44 fallen SAF troopers; identify, prosecute and bring to justice their soldiers who mercilessly killed the SAF troopers; help in the effort to arrest or kill Basit Usman; and, neutralize the insurgent activities of the BIFF and other insurgent groups operating in their area. These should be done by the MILF as a gesture of reciprocity and to ensure that previous mistakes in the past will not be repeated again before finally passing the BBL into a law.

Wednesday, January 21, 2015

A Wedding in the Family

    Months have passed by since Joshua, former boyfriend and now husband of our daughter Nadinne came to our house in Tagbilaran City, Bohol to ask for our permission to their wedding which they have set on December 14, 2014. The reason for their decision to wed soon is to facilitate the petitioning of Joshua to go to Australia. They have tried the Fiance Visa but they were discouraged by the numerous requirements. Nadinne is the second to the eldest and is a nurse working in Australia. The event is special since it is the first wedding in our family. My daughter decided to wed in Manila so we have to fly from Tagbilaran City one month before the wedding and I have to do my dialysis at Capitol Dialysis Center in Quezon City. Luckily I got a schedule even if there were many transient dialysis patients like me. A day after my first dialysis in Quezon City, me and my wife Belen was invited by Nadinne to shop in Trinoma. It was a bit hard for me to go around inside the mall due to my low Hemoglobin which is 8.7 at that time. I was prone to muscle fatigue due to the lack of oxygen in my body brought about by Anemia but I still decided to go with them. I was delighted when my daughter bought me an original Levis denim pants and a Nike Air shoes. There are a lot more walking and stopping to buy things and I forgot my facemask in our house so I have to brave breathing mall air which I know is full of viruses. It was already evening when our companions were finished shopping and they decided to watch a movie and more virus exposure. We went to the grocery after the movie to buy fruits and ingredients for their food menu.

     I felt very tired after that shopping session, my leg muscles were aching and I thought it will be gone after a day has passed but it did not. Again we were invited this time to Joshua's house to meet his parents and also watch the Pacquiao Algerri boxing fight. We ate a sumptuous lunch and drank beer while watching TV and later on sang Videoke songs. After we got home in Project 6, Quezon City, I felt more tired and now feverish. I will have my dialysis in the morning. During my dialysis I had a low fever and felt chills even with three blankets covering my body. I had low fever for three days. When I went back for dialysis, I was told by the doctor that I will be transfused with one bag of blood to elevate the level of my Hemoglobin to at least 9.0. During my dialysis and blood transfusion, I got feverish again with the usual chills. My body reacted to the foreign blood running in my veins and this went on for a week. I was afraid I will not be in top condition during the wedding but thanks to God I felt better the following week.

     The day of the wedding came and early in the morning we donned our formal clothing, me in a dark suit, the groomsmen in grey vests, the bridesmaids as well as with my wife wore long gowns in different colors that the motif which is turqouise. We stayed at the University Hotel in UP Diliman and the rooms are busy with camera men and make up artists walking around. The wedding will start at 1:30 p.m. sharp and after some finishing touches and picture taking, at last we were all ready to go to church. My daughter was very lovely in her wedding dress and it was not long enough and she was about to board the bridal car with us parents. Inside the car, the driver had set the air-conditioning to high cool and it was comfortable for us.                                                          

     We reached the church and the bride remained in the car until the wedding was about to start. The wedding entourage started walking towards the altar and my wife and I were the second to the last to walk and stop at the middle of the aisle to wait for the bride. The center door of the church opened and the bride started to enter and she was lovelier than ever with the UP Chorale at the background in the church balcony. We started walking towards the altar where the crying groom is waiting. My daughter kissed us before the groom took the bride to the altar. The wedding rites were solemn and the weather is just right (not too hot and not too cold). After the wedding rites, the usual picture taking took place. There were more photo opportunities outside the church before we finally went to the venue of the wedding reception at Blue Garden.                                           


     The reception started with the bride and groom coming down from the winding stairs of the garden with a beautiful fountain. When the newlywed were already seated at the center of the reception area, the emcee called on the relatives of the bride and groom for picture taking then their friends and officemates followed. As a surprise number the bride and groom together with the groom's nieces danced to the tune of 'Bang Bang'. Then came the part where the newlywed addressed the audience. The groom was the first but he was at a loss of words for about 3 to 5 minutes due to overwhelming emotions. At last the teary eyed groom was able to utter some words. The bride then gave her message of thankfulness. The putting of the garter on the leg of the bride came next with a different twist. The groom should enter the reception area with a sexy dance to the tune of a sexy music. The guests burst into laughter when the groom walked towards the bride like a macho dancer and slowly taking off his suit and waving it up along the way. There was a men's beer drinking contest where the winner, after imitating the groom on how to approach the bride, will have the chance to put on the leg garter to the woman who will win the contest (in lieu of the tossing of the bride's bouquet) where lady contestants were blindfolded and instructed to try looking for the safety pin in the body of the man who won the beer drinking contest. The lucky winning couple then imitate what the bride and groom is doing. If the groom kisses the bride then the couple should abide.

     Then  came the traditional bride and groom prosperity dance where anyone can pin money even checks on the bride/groom's clothing.The traditional cutting of the cake and toast were next. 

     Then the message of the principal sponsors and parents followed. I had the chance to present our surprise gift to the newlywed. I emphasized to the guests that even if our gift is of less material value, the true value and essence of our message which comes from our heart is for us priceless. Our gift is a collation of their pictures with a touching message at the back of the frame which read something like this: "Congratulations and best wishes to Nadz and Josh. Always put God in the center of your relationship so that you will be strong during your trials and will always keep the warmth of your love burning like you are feeling today when you are joined in matrimony." After the reception, more picture taking in the garden took place. The guests bade their farewell and received their wedding giveaways. We went back to the hotel where the newlywed's families and relatives gathered for an evening snack. Early in the morning, we went back to our respective homes. We felt tired but happy and fulfilled that the wedding was a successful one.