Sunday, April 27, 2008

A Stay at Silliman Medical Center

From an expat point of view, medical care in Dumaguete has been both praised and maligned. When you talk to other expats at social gatherings you will no doubt hear so called horror stories about everything from misdiagnosis to incompetent physicians. If you participate on local internet forums, the discussions run the gamut from caution to praise. I had the recent opportunity to, by quite serendipitous and unpleasant circumstances, to become involved first hand in the quality of care at Silliman Medical Center.

When a member of your family becomes gravely ill, sometimes you have no choice but to avail yourself of the first line defenses available in the community. I’ll leave out the personal details in this narrative out of courtesy to my family, suffice to say, all came out extremely well. What follows is a “foreigners” perspective on local hospital care.

Silliman University Medical center is well respected in the local community. A teaching institution, there are always plenty of student nurses, interns, and medical students running about. The physical infrastructure is old, no other way to put it. Most of the beds look like they date back to the 1940’s. The wards are small crowded, and worn. We were forced to use the general facilities for three days as there were no available private rooms.

In the Philippines the first difference a typical foreign visitor will notice, is that there are no restrictions on family visits. The wards are literally jammed with mothers, fathers, and anyone one else who would like to come in. It is common practice to stay with your sick family member often sleeping in the same bed around the clock. I became part of this. I chose to sleep at home, but spent my entire day at the bedside. Food is supplied three times a day, but most often we went outside for food, an unusual practice by my standards, but no one objects as long as the restrictions are complied with. In fact all manner of food drinks and personal supplies are brought in by families.

If you are in a ward the problem is that all these people are crammed into one very small room housing up to six patients, all eating all manner of sometimes odiferous food brought in from the outside. Banana Q’s, lechon, fish, whatever is allowed on the patients diet comes in from outside. We were fortunate to transfer to a private room in a few days as one became available.

Despite the shabby surroundings, the medical care was good. The Doctor we had was astute, conscientious and managed to correctly diagnose two complicating infections. Doctor patient communication is not as well developed as a rule, as most Filipinos tend to let the doctors do their thing and ask few questions. I am used to talking to doctors and getting specific information about the diagnosis and care of the patient. The nurses and doctors were forthcoming and informative when asked, and would go into great detail. But you must ask.

There were never fewer than 15 nurses at the nurses station on our floor, sometimes there were 30 or more. I am assuming many of these were students. One thing they could not seem to do was check the IV in our patient. We had to summon the nurse every time the Dextrose solution ran low.

Another unusual practice is the dispensing of the medications prescribed. The patient is presented a list daily of all the meds the patient will require. The family can go outside the hospital and buy the medications. I tried in vain to have the hospital supply the meds, but they don’t have many of the medications in stock at the hospital pharmacy. So every day we went out to buy antibiotics, Dextrose solution, and a variety of other medications. This is unlike anything I have experienced before, and I found it unbelievable that the hospital did not have medications on hand. It was explained to me that this practice is to allow local families to buy medicines at lower prices outside the hospital. Nearly everyone takes advantage of this opportunity to by cheaper medications when possible. Perhaps this is why the hospital does not bother to stock some drugs.

Since I was going outside several times a day, I became very familiar with the two elevators at the hospital. It looked as if they were never inspected. One always stopped 3-6 inches above or below the floor level; the other would sometimes fail to open right away, causing some concern. On occasion the smaller of the two elevators would deliver you to the basement unannounced (the morgue). After a day or two I got used to this, never got stuck between floors, and just kicked the door to get it open.

Our family Doctor had the demeanor of a politician, rushing into the room, trailed by several student doctors furtively taking notes; she was loud, cheerful, took no questions and left as suddenly as she had entered. Her assistant, a young Korean med student would visit alternatively. She was very forthcoming and was the source for the answers to most of our questions.

Despite the unusual protocols and rundown infrastructure, I was very pleased with the overall care, both nurses and doctors were attentive (except the IV checking), and provided care indistinguishable from a hospital in the U.S. From our experience I can’t fault the level of care at Silliman University Medical Center. Some people might be taken aback by the old equipment and shabby paint, but the bottom line is the care you receive, and in this instance it was first rate.

1 comment:

Angel Castillo said...

Hello there!

I'm Angel from Dumaguete City and a nurse at the OB-SURGERY and Pediatrics Ward of Silliman Medical Center. I was quite pleased and even had a laugh reading at your take on the hospital and the service it delivers. I agree with most of what you said except for the 15 nurses. Silliman Medical Center is quite understaffed and that probably explains the inefficient IV checking. Your adventure in the elevator is quite funny to read. Some people purposely push the Basement button (i'm guilty myself). Those who enter next will get the unexpected surprise of descending to the "former morgue territory"