Bicol Clinic Foundation

Bicol Clinic Foundation, Inc.
Philippines, 2008

Stepping into the clinic the first day I remember thinking to myself, "How will the patients find us? We have a lot of supplies, but will we be able to help anyone?" Looking back at that first day of unpacking I remember being struck by the setting of the clinic, situated in the middle of the tropics on a cliff overlooking the bay, the view was one which could easily be captured and made into a postcard. Yet just down the road set in amongst the idyllic setting were hundreds of people living on what we in the United States would consider a very meager income. On the way to the clinic we passed by huts composed of a mixture of thatched walls, thatched roofs and cement walls, most with a small well outside to provide city water. Lines of clothing hung out to dry outside, while the children played underneath them in the dirt with sticks or tires they had found for toys.

The first day of clinic as we drove down the overgrown dirt road to the clinic, we passed patients on their way to the clinic where an already long line had begun to form. We quickly unloaded from the van and set about matching up with the doctors to start seeing patients. The next days were a blur- filled with dozens of patients each day, each with a medical condition further complicated by the situation in which they live. While there is a public hospital and free healthcare for some conditions, the medications are not always available and the public hospitals are overcrowded and lacking access to what are considered basic diagnostics like a CT scan and ultrasound. These are available at the private hospital, but the cost is exorbitant for the average citizen. In fact, for a lot of the patients we saw, simply transporting themselves to the public hospital 20 minutes away was out of reach financially. The care for chronic conditions like hypertension and diabetes in some cases was almost impossible to manage, because after speaking with several patients we learned that while they might be able to afford medicine for a month once the medicine we gave them ran out they were unable to continue treatment through no fault of their own.

While it would be easy to discuss the circumstances in which the clinic is operating, there were many successes as well. One of the first patients I saw was a mother who had just given birth to her fourth child four days prior. She showed up at the clinic tachycardic, hypotensive and pale stating that she had been having spotting since giving birth. We quickly determined that she was in hypovolemic shock, and on exam discovered her uterus had not contracted down during the hours following delivery as it should have. We were able to give her iron supplements and instruct her regarding uterine massage to stimulate contraction of the uterus. The next day her condition was much improved. Additionally, we were able to treat dozens of kids for bacterial pneumonia and numerous skin conditions and infected wounds or boils. One child we saw had insulin dependent diabetes and presented with uncontrolled blood sugar despite medication. We were able to change her dosages, provide her family funding to subsidize the cost of the medications and teach the mother how to use a glucometer so that she could regulate her daughter's blood sugar without incurring the daily cost of transportation and testing at the local hospital. My final patient on the first day was a 6 year old girl who weighed 19 pounds and came in with a fever and cough which she had had for the past five months. On physical exam she had barely audible lung sounds on the left side, which was also dull to percussion indicating consolidation. We began treatment with antibiotics while we waited for her to return with a chest x-ray. The chest x-ray showed almost a complete white-out of her left lung, which along with the history indicated tuberculosis. Unfortunately, while there are WHO clinics to oversee free DOTS (Directly Observed Therapy) programs, they are only equipped to care for adults. We then purchased and initiated a pediatric tuberculosis treatment.

These were only a handful of the patients I saw the first day of clinic, and represent a not uncommon fraction of the population of patients we saw and were able to help. This truly was a wonderful learning and personal experience for me. I was able to learn how to adapt the skills I have learnt and the protocols for medicine in the United States to treat patients in a rural tropical setting of the Philippines. Additionally, we were forced on a daily basis when evaluating a patient to consider what tests were truly necessary for diagnosis and treatment, and which would just be superfluous. On a personal level I was able to return to a region of the world which inspired me to enter medicine and devote my life taking care of people, especially those with barriers to care.

Albree Towers
University of Miami
Medical Student

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