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Medical Missions
Wednesday, February 28, 2007

It is again the season of medical missions. Especially now that the national election is forthcoming, we doctors expect medical missions here and there. In fact it has already started in the month of February. In the photo is a medical mission that took place in Lingayen, Pangasinan. It was attended by thousands of people. It was a four day medical and dental mission with free laboratory work-ups, x-rays of all sorts, electrocardiogram (ECG), and other diagnostic methods, and of course free medicine.

For over a month now, a mobile X-ray machine and ECG sponsored by one famous candidate roams around the entire town of San Fabian, Pangasinan. The mobile together with its staff composed doctors, dentists, nurses, rad tech, etc. stay for 1 day per baranggay giving out the said diagnostic methods together with free medicine and free T-shirt printed with the name of the candidate.

Are these medical missions really helping the people? Considering the high cost of medicine here in the Philippines, maybe everyone will say that it is beneficial to all Filipinos. But if we really look into it, most of the medicines used in these projects are the low cost generics made by unheard of pharmaceutical companies. And when given to people, only the starting dose good only for 2 to 3 days and not the entire course of treatment is given. This way of giving medicine may induce resistance of the patient to the medication.

In most of the medical missions that I attended, physician samples were used and not the stock medicine. These samples are usually solicited from different pharmaceutical companies. Again these are very few when given to the recipient and good only for 1 to 2 doses. They need to buy the rest of the medication in order to get well.

On the other side of the coin, are we really sure that these people who frequent medical missions are really sick or are they just after the free medicine and keep them for future use? Yes, most of these people are not actually sick. Most of the medicines they gathered are kept and shared with other family members. This often results to under dosage or over dosage depending on who gets to use the free medicines.
posted by Amelyn R. Rafael,MD @ 5:30 PM   0 comments
Rehab of the Stroke Patient (Part II)
Friday, February 16, 2007

IV. Lying on the non-affected side:
The head must be comfortably stabilized and in line with the trunk which is slightly leaning forwards together with the paralyzed shoulder. The paralyzed arm and hand must be rested on a pillow in 100 degrees forward flexion. The paralyzed leg and foot must also be stabilized by a pillow with the hip and knee slightly bent. The normal arm in a comfortable position with the normal hip and knee extended.

V. Transfer sideways in bed:
The patient lies with knees bent, the heels close to his bottom. Facilitation: the knees of the patients are guided downwards and over the heels. The other hand guides the pelvis upwards and sideways. The shoulders are then moved sideways using the pillow until the trunk is in straight line.

VI. Rolling towards the sound side:
Bend the paralyzed knee, clasp the hands of the patient together, then assist the patient while rolling by holding the hip and the shoulder.

VII. Rolling towards the paralyzed side:
With the cargiver assisting the paralyzed shoulder and knee, the patient must bring the normal leg and arm over to the other side.

VII. Sitting in bed:
Sit the patient in bed with a pillow on the lower back. The trunk must be straight and the head is free to move. The hip must be in 90 degrees flexion with the weight distributed over both buttocks. The arm is positioned forwards with the elbows supported on an adjustable table with a pillow on top

VIII. From lying to sitting:
The patient is rolled over to the paralyzed side with the knees bent. He leans with the good hand on the edge of the bed.

IX. Walking on the bottom:
The patient walks forwards on his bottom by shifting his weight from one side to the other.The caregiver helps him by supporting the hips. The patient keeps the paralyzed hand forwards.

Those are the steps that you can do while taking care of a stroke patient on his road to recovery.
posted by Amelyn R. Rafael,MD @ 10:16 AM   0 comments
Valentines's Day
Wednesday, February 14, 2007

Happy Valentine's Day to all my readers! I hope that you will all enjoy the day with your loved ones. It's nice celebrating the day with the entire family not just with boyfriends or girlfriends. Here in the Philippines, celebration starts with watching a movie in the afternoon after the day's work then having a dinner in the evening. A stroll in the park or along the beach during sunset can also be very romantic. See you around!
posted by Amelyn R. Rafael,MD @ 9:50 AM   0 comments
Rehab of the Stroke Patient (Part I)
Wednesday, February 07, 2007

Stroke is a common condition here in the Philippines. My grandmother for one had been bedridden after her second stroke until she finally died more than a year after. Fortunately, my mom is a retired nurse. She was the one who took care of my grandma from the time half of her body became paralyzed until the time she finally rested.

In the photo above is a booklet given to doctors by a pharmaceutical company. We use these booklets to explain to patients how to take care of stroke patients outside the hospital. The booklet serves as guide to cargivers of stroke patients on the proper handling of these patients. Since not all caregivers are given this, I would like to share the contents of this booklet to my readers in the hope that it can be of assistance.

I. Arrangement of the patient's room:
The bed of the patient must be arranged in such a way that the normal half of his body is near the wall and all activities take place on the paralyzed side. This is so that the patient will receive maximum stimuli on the paralyzed side.

II. Lying on the paralyzed side:
The bed must be completely flat. The head must be comfortably stabilized. The trunk is slightly backwards and is stabilized by a pillow in the back and the bottom. The paralyzed shoulder must be brought forward and externally rotated. The paralyzed arm is on 90 degrees flexion, completely supported on an arm table next to the patient's bed, and the elbow as straight as possible and the palm upwards. The paralyzed hip must be in extension with the knee slightly bent. The normal arm must be lying on the trunk or on a pillow. The normal leg and foot must be in stepping position on a pillow with the knee and hip slightly bent.

III. Lying supine:
With the bed completely flat, the head must be on a pillow, not in flexion. Both shoulders must be stabilized by a pillow. The paralyzed arm must be lying on a pillow slightly away from the trunk with the elbow and fingers straight, wrist extended. The paralyzed hip must be in extension and stabilized by the pillow where the arm rests. (To be continued)
posted by Amelyn R. Rafael,MD @ 8:21 AM   0 comments
La Marea Academy Field Trip 2007
Monday, February 05, 2007
My sons' school conducted a field trip for Preparatory up to High School students. It took place on February 1. I accompanied my elder son who never failed to join field trips conducted by his school.

There were several destinations on our itinerary. The first was in Sugarland located in the Makati area. We were able to enter Sugarland, the maker of Jelly Ace, their most famous product. Our coordinator told us before we arrived there that we will be able to see how these products are made. Unfortunately, because of commercial reasons, we were only allowed to view machines used for pasteurization, drying, and packaging. Even picture taking was prohibited. Its totally a waste of time considering that we came from a four hour ride (from Pangasinan to Makati) for this trip. I didn't see anything educational on that part of our field trip. The only thing good (especially for those who patronize Sugarland products) was being able to purchase their goods at factory price.

From Sugarland we proceeded to Go Nuts Donuts in Cubao. Beside this donut store is a mini factory with glass wall 9photos above) where one can view donuts being transferred from one machine to another, or being dipped from one coating to another. Our coordinator told the kids before we arrived there that they will be able to make or assemble their own donuts. But this part of the story again did not come true. All they did was watch the machines from a distance as they listened to somebody explain how the machines do the work. The parents were given 10% discounts for every dozen of donuts purchased. Well, quite acceptable.

It was the 3rd destination - a stage play of Snow White and the Seven Dwarfs - which the kids enjoyed the most. The actors and actresses were great. The play was interrupted at certain parts to give way to interactions with the kids. During interactions, the seven dwarfs took turns asking questions and they give out goodies to the children who were able to answer the questions. The kids, especially the preschoolers, enjoyed watching the play. Photo sessions were done after the play (photo above).

Later in the afternoon we toured to Intramuros then to Fort Santiago. Here we saw the cell of Jose Rizal, our national hero. We also saw several barracks where prisoners stayed, three dungeons where prisoners during Rizal's time were tortured, the ground where hundreds of Filipinos were buried, and Rizal's footsteps before he was shot by the soldiers that ended his life (photos below).

From Fort Santiago we proceeded to the Mall of Asia where we had dinner and a little shopping. I was so exhausted by this time that I had no more energy to take pictures. Mall of Asia is such a big big place one cannot tour it in just a few hours of stay.
posted by Amelyn R. Rafael,MD @ 8:51 PM   0 comments
About Me

Name: Amelyn R. Rafael,MD
Home: San Fabian, Pangasinan, Philippines
About Me: Family Physician, and Associate Professor (Clinical Anatomy and Medical Physiology)
See my complete profile
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