1) Visit to JICA Manila Office

　

　

We received a lecture on JICA's programs for public health activities in the country. Detailed report is available in Japanese text only.

　

We arrived at the UP campus nearly one and a half hours behind schedule, but we were welcomed by the beautiful smiles of the UP students.

　

We had a short lecture about the history of UP and its current system. The school system in the Philippines is like this. Compulsory education for children in the Philippines is elementary school for 6 years and high school for 4 years. After that, education at a general university (undergraduate), where they study biology, science and psychology for example, is for 4 years. In order to become a medical doctor, they must receive further education in a medical university for 5 years, 4 years of regular medical study and one-year clinical internship. It means they have to study in a university for a total of 9 years. There is a special program for students of high academic level, in which they go straight to a medica university after a high school. Many of the students who showed us around their university campus said that they study in UP for 7 years. Perhaps most of them were under this program.

　

First, we were taken to the anatomy section where 160 second year students in regular medical course studying anatomy. There were approximately 30 cadavers and other substantial materials. Anatomy is essential to understand the location of organs from outside of the body. It must be important when they don't often use CT, MRI or other graphic equipment. After the anatomy section, we visited the neurology ward. The ward started out only as a mere section of the Medicine Department. However, with the arrival and development of new technologies, an independent Department of Neurosciences was established just two years ago. The department has 2 CT scanners and it would have its own MRI in the near future. But availability of these types of equipment is rare and usually, interviews and physical examinations are given priority and doctors carefully make diagnosis by the patients' backgrounds, accompanying symptoms, their social and mental conditions and etc. They put more importance on primary medicine. I found that this hospital, the biggest public hospital in the country, is required to provide medical services with low cost especially for people with low income. Expensive and high quality medical services are available in private hospitals.

　

Next, we went to the Out Patient Department (OPD) with 140 clinics, which serves nearly 1900 patients daily. This department was founded with the help from the Japanese government. The agreement was signed in September 1987 and the department was inaugurated on the 5^th of April 1989. It seems to have become a very popular department in a few years.

　

Chapel services became available from 1947, and its construction was sponsored by funds raised by the Jesuits. These services include solicitation of funds for charity medicines in addition to regular mass, counseling, 24-hour emergency call service and campus ministry for the students. As hospital funds are not enough and many of the patients are of low income, there is a need to gather donations and charities in which the chapel has an important roll as well.

　

At the pediatrics ward, I fully recognized that they were lacking many instruments. Some babies were being warmed by the heat from a light, as there was a lack of incubators. I saw one baby in an incubator. It was a donation from three businessmen. I heard that the doctor in charge gathered the donation himself. He also went around to collect donations for his other patients. It was surprising to know that a doctor has such kind of tasks. But a UP student told me later that pediatricians are lucky because people tend to move their charity spirit to help ill children more than for adult patients. In other departments like general internal medicine, many doctors have much more difficulty in raising funds.

　

The ICU was occupied with many beds. Some patients were just laid on the bed waiting for their operation. Sometimes patients, even though they were brought in by an ambulance, they have to stay at the hospital for over one week until the operation room is ready for them. There is no gainsaying that there exists a lot of defectiveness about the system and the facility itself.

　

"Indeed, the hospital is not clean and in lack of many equipments, but each doctor here is very outstanding", a student said. It must be true, for they have to diagnose patients usually without sophisticated machinery and decide the proper treatment as well. Many of the doctors here have studied in the U.S. It is said that nearly 50 to 60 % of the UP students actually go to U.S. to practice medicine after their graduation. It is probably their medical license can also be used in the U.S. and because they have already studied medicine in English and will not have much difficulties in communication. For this reason, there is a problem of a lack doctors in the county. Another student told us, "we, ourselves have to solve the current problems and change the Philippines."

　

Recently, the hospital has achieved great technological development. And even though they have insufficient materials, they are good at making the best use of what they do have. Although we should not be too optimistic, they have a powerful weapon, their will to improve themselves.

What I regret is that we did not have enough time to talk and discuss more with the UP students. I wish we had more time to exchange and share our thought and opinions with each other.

　

　

We arrived at Jose Rodriguez Hansen's Disease Hospital after a two hours' drive from the big city, Manila. Unlike Manila, this area was surrounded by nature. The scenery was beautiful and the air was clear and nice. I liked this place. The director of the hospital, Dr. Remigio Reyes welcomed us kindly gave us an explanation about the hospital. This hospital has 2000 beds including 1800 for Hansen's disease patients and 200 for general disease patients. At present, 1010 patients are staying there. There are several departments; plastic surgery, dermatology, obstetrics and gynecology, internal medicine, ophthalmology and emergency medicine as well as the department of occupational therapy and physical therapy. They attach much importance to rehabilitation. Dr. Reyes also said that discrimination is a major problem for Hansen's disease, and we must get rid of this discrimination to enable the patients' to return back to society.

　

Next, Dr. Elvin Sanchez gave us a lecture on Hansen's disease. He gave us detailed information using many slides, from how to diagnose to how to treat the disease. He also mentioned that although it is said that the Hansen's disease has been eliminated at the national level, there still exists many patients and it is still a big health issue in the country.

　

After the lecture, Dr. Rolando Samson gave us a tour around the hospital. There were about 10 patients staying in one room in the ward. We were introduced to one of them who showed us his scars and artificial legs, like the one we saw in the slides during the lecture. In the ward, we talked with many of the patients. We all found that many of patients here were very cheerful and open, and the atmosphere in the room was very nice. One patient played a guitar for us and another was playing chess, and another drawing a picture. They were all very friendly.

　

We also leamed about what hospital does for rehabilitation from the occupational therapist. They also made moneyboxes with newspaper and received rehabilitation training just like in Japan, and they seemed enjoying doing it. They also made some equipment for themselves so as to make life easier.

　

We walked to another building, which was built by a Christian church. It was used as a working place for the patients' and their families. They made dolls and got income by these. The dolls were sold to visitors here, or exported to Europe and the USA. Everyone was merry and seemed enjoying his or her works.

　

We felt looking around the hospital that the environment seemed very comfortable to live. It was very open, bright and clean. And it was a good memory for us that we could spend time with the patients. I thought it would be wonderful if I could work in the place like here laughing together with them.

　

Dr. Marie Lorraine M. Sanchez, who is an Acting Assistant City Health Officer, gave us a talk on health administration. She put emphasis on the policy that 'from womb to tomb' that is to support the people from their birth until their death. We could tell her confidence and her strong sense of responsibility toward health administration by the way she spoke.

　

Manila is divided into 6 districts and it contains 897 barangays. We made a tour through Health District III, which holds 132 barangays. At first, we visited the Lying-in Clinic. It is a delivery facility where normal deliveries are performed. Caesarean sections are not performed here. The workers of the clinic were 1 doctor, 1 nurse and 2 midwives. There were approximately 10 beds and a delivery. When we visited the clinic, we saw 3 mother and their newborn baby; two born the day before and the other born in the morning. Usually admissions to the Lying-in Clinic are from 20 to 24 hours. It was a surprise to me because it is much shorter than that in Japan.

　

There are about 80 deliveries per month in this clinic. There are 3 other similar clinics in the area. The doctor working in the clinic must rush to the other clinics whenever a trouble happens. We were surprised to know the low number of doctors against the population. At the same time we were impressed with structure made to use the most out of limited resources.

A question occurred in my mind, 'how do mothers think in general about their pregnancy and deliveries? 'It is very common to have 5 or 6 children here. Pregnancy and deliveries may not be so special compared to that of mothers in Japan. Though they are used to deliveries, home deliveries are very few (0.1% of the birth). Because of the bad traffic circumstances in Metro Manila, sometimes they cannot reach hospitals in case of emergency. Therefore, many mothers come to Lying-in Clinics seeking safer place to give birth to babies.

　

A geriatric clinic was next to the lying-in clinic. It is intended for people over 60 years old and provides free services supported by the government. The workers there were 1 occupational therapist and 2 physical therapists. They see about 80 patients a day. Other than the beds, we saw some bicycle type exercise machines and many instruments for physical rehabilitation. We were interested in a bench called 'Negaton', which has an electric current with a healing effect for muscle aches, strokes and rheumatism.

　

Patients sit on it for about 30 minutes. When I touched it with my fingertip, I felt a weak electric shock, but I sat on it. I felt almost nothing. They also had various programs such as medical checkups and health education, which is being held once a week.

　

We next visited the Lanuza Health Center, one of the 48 Health Centers in Manila. It covers 36 barangays and a population of 45,000. Dr. Rosine de Leon explained the health service of the center. They provide pre and post-natal free vitamins, expanded program of vaccination, nutrition program for under weight children. They also had control programs for leprosy dengue fever, STD and cancer, dental and ophthalmologic primary care. She explained each program by pointing to a board, which was full of pictures. I noticed that adult disease such as cancer was a target though most programs were for young people. As an adult disease, diabetes mellitus seems to be the biggest problem here. People tend to eat rice with salty food, and no expensive vegetables.

　

That evening, we held a reception, which was postponed from yesterday due to the flood. We prepared a little performance to show at this party, and had practiced every night. Each of us put our ability and personality into our show, so we believed that we made a good one. And the time came. Although many guests from the Department of Health could not come because of the flood, we had a lot of guests at the party despite of the sudden change of the day. We all appreciated it so much.

　

The party started with a comment from our leader, Mr. Ito, to show our gratitude to the kindness and hospitality of many guests, and with a toast by Dr. Nesbit from WHO. During the party, we wanted to talk with as many people as possible, but there was not enough time. But I believe that each of us enjoyed it and got something out of the experience to keep in our minds for good. After a while, we received comments from Dr. Omi, Dr. Nesbit, Dr. Florante Trinidad from the Department of Health and Dr. Lulu C. Bravo, UP College Secretary. We were inspired by Dr. Omi's comment again. He said, "Do what you want to do, achieve the skill to communicate with international people, and find a good partner." Comments from guests also encouraged us very much.

　

And, our play that we prepared was over with a great success. Dr. Yatsuya's performance in the play was incredible, too. The UP students also showed us a beautiful performance of bamboo dance and songs. We really wanted to continue talking, but we had to close the party. We would be all happy if the guests enjoyed that party as much as we did.