Decade Old MD

 I've been quite down these past few days, that occasional wave of sadness that comes and goes. Sometimes it clings for quite a bit. When you're immersed in that emotion, it's difficult to see the bright side. No matter how I try. 

Lately, I have been feeling unaccomplished. Trapped. Stagnant. I have a strong urge to reclaim my career. I feel that as time goes by, everything I know in the medical field will slowly fade away bringing me back to square one. I wouldn't want that.

Ten years ago today, I passed the Physicians Licensure Exam (PLE). It was the peak of joy and a feeling of success for my then 26-year old self. Today, as I reflect on the past ten years, a glimmer of gratitude came down on me. 

In the last decade, I served my hometown as a community doctor, I obtained my master's degree (MPM Major in Health Systems and Development), I finished Family Medicine residency and now a diplomate in that field, I married the best guy for me, I have housewife stints (on the second phase as of the moment), I have three beautiful daughters, I am healthy, my loved ones are healthy. Alhamdulillah.

That's more than enough to bring back the smile on my face. Allah swt is the Most Merciful. He is good, all the time. 

Re-structuring

This pandemic has disrupted our daily routine -- both in a good and bad way. For us in the residency training, it somehow slowed things down. It lifted the daily pressure of complying with residency activities and focusing only on seeing patients which is a major breather for a short while until the hypo-productivity is dragging us all down. 

I live in routines, and a slight detour of my daily activities would be difficult for me to regain the momentum. Before the pandemic, I had so little time to sleep having to wake up very early in the morning so as not to be caught in traffic and doing my home readings late at night. I was used to that albeit complaining of this unlivable metro condition. This lockdown gave me so much time that I spent most of it having extra time sleeping because I no longer worry for the traffic. 

I feel like I've wasted my two months, except for the priceless time I spent with my daughter, Amal. Other than chief-resident's stuff, I've indulged way too much Netflix, which seems to be a bad habit now (oh, please watch Ertugrul, Hospital Playlist and Reply 1988 if you haven't yet. CLOY? I'm done with that too).

Ramadhan has passed, Alhamdulillah, I feel very spiritually productive though. I only missed very few tarawih nights and finished 8/10 tahajjud prayers. It's better compared to my performance in the previous years. May Allah accept our good deeds. 

As GCQ comes to a close, I need to re-structure my daily life. There is so much that needed to be done and I am not moving any finger to finish my tasks. Subhanallah. My research is still hanging and I need to be done with it so I can finish residency and fly to Jeddah as soon as possible. There is no getting used to this LDR thing. I don't want to miss my kids' growing up years. 

I reckon this covid virus will still linger but we are slowly transitioning back to our normal lives. Although it will never be the same again. If you really think about it, this pandemic is a major game changer and you know that somehow, it brings blessings. It changed the way how we lived and yet, it made us realize what is really important in this world.

What are your realizations? 

Living In Times of COVID

It was late 2019 when the novel coronavirus broke out in Wuhan, China. The viral infection manifests with flu-like symptoms of cough, fever, colds and sore throat. These are common symptoms usually ignored and resolve spontaneously. It has a minimal fatality rate but according to statistics, elderly patients and those with co-morbidities such as hypertension and diabetes present with severe manifestations.  There's no enough study yet to prove that drugs (hydroxychloroquine + azithromycin, oseltamivir) can bring cure, but more researches are being developed. Nobody thought that like the Chinese, the virus that is unknown to the medical experts would spread all over the globe, and no cure has been identified yet. 

It has been a month since Metro Manila and some parts of the country (as well as most countries all over the world) is in lockdown. Only frontliners --- healthcare workers, policemen, supermarket staff --- are allowed to go out. This posed a huge problem especially to the daily wage earners which constitutes a major bulk of the metro dwellers. Most people have lost income, largely those in the business sector, posing a domino effect on the nation's economy.

Almost empty Taft Avenue crossing Finance Road.

The virus held a tight grip to the entire world, it crippled the world economy and rendered people immobile in the safety of their homes, if they're lucky to have one. This has never occurred to the greedy beasts in the business industry, they thought nobody can stop them from gaining profits. This crisis has shown us small to large scale leadership. It has shown us who are the true leaders in the workplace, community and the nation as a whole.

Empty Rizal Park

5th week of lockdown

How's life for healthworkers like us?

Family Medicine female residents wearing a donated PPE from Quorom, a female lawyers' sorority group. 

PUI tent

My co-resident, Jhem.

Checked on Jhem at the triage.

We continue to work in spite of the risk and the anxiety of being infected. The chronic loopholes of the nation's public health is out in the open for scrutiny. I think it's too late to criticize, what we can do is to cooperate with the nation's leaders. I hope this government sees the importance of public health and gives value to it.

I know it will never be the same after this pandemic, people have lost their loved ones while some lost their jobs, I can only be grateful that I am one of those who only want this to be over so I can return to the normal daily grind of my residency training.

Right now, I enjoy the sweet calmness reigning all over the metro. I never thought I would hear the noisy streets in complete silence while I drive to almost-empty roads in Manila. It's a sad sight though seeing the homeless street dwellers, the only ones left on the streets begging food for daily survival.

 

I want our lives to return to normal again. I want to bring my baby out so we can enjoy the outdoors again --- the malls and her daycare. If there's one thing I realize, is how I lack time for my baby Amal. She's more than a year old but I haven't really seen her grow. I spend more time at work, coming home to a sleeping baby most of the time. InshaaAllah, after all these, I will spend more time with her especially during weekends, the way I was with her two older sisters.

In these trying times, we can only cling to our faith. Allah (subhaana wa ta'ala) has sent us an unseen enemy. He has shown us a sign of His might --- that He alone can stop the world, that He can topple the most powerful nation, the most powerful human being can fall into His mercy.

Dream Big

This quote immediately resonates with me as soon as I saw it. 

I was a small town girl from a lower middle-class family but I have lofty dreams. I have wanted to become a doctor as early as first grade, or even earlier I think, yet I do not know how. There's no doctor in my immediate family circle so I didn't have someone to pave the way for me or a role model except my Mom's OB-Gyn and our family pediatrician. I heard one time when I was small how costly it is to enter medical school so I wondered if my parents can even afford to send me to medschool with their meager salary as government employees. Moreover, I have five other siblings that my parents need to support. 

 In spite of our socio-economic status, my parents never discouraged me about my dreams. One time as my father and I were waiting for my mom in her office, I was scanning through an atlas sitting on my mom's table waiting to be catalogued (she's a librarian). My father, out of the blue, told me that if I study hard and get a good education then I will be able to go out and see the world. His words stuck with me and I lived by it.

 Life has way a mysterious way of putting things into its right place. Through God's grace and hardwork, my parents climbed the ladder of their professional success, hence they were able to put me through med school without selling lands and carabao. I'm just kidding, we don't have carabao. 

I am the first doctor from both sides of my family and as an advocate of dreaming big (lol at advocate), I always tell my siblings when they were younger and even my cousins to dream tall and big and work on it. It is important to work on your dreams, to act on it. You are what you think and that will eventually what you will be. 

My father was right after all. My education opened a lot of opportunities for me and yes, it brought me out to see the world. So for every country that my siblings and I go to, there is always a mandatory report to Papa about our experiences and insights. Hahaha!

 In shaa Allah, I will still continue to dream and work even harder, this time though it is no longer for myself but for my children. #Ronsiblings

Islamic Medical Association of the Philippines' (IMAN) 3rd National Conference

IMAN Philippines invites everyone to the upcoming 11th Founding Anniversary and 3rd National Conference at UP Manila on November 3, 2018. This year's theme includes timely Islamic Medicine topic updates with invited International Speakers.

Register Now! See you all in shaa Allah in this once in a lifetime get-together! 

For booth and student sponsorships, you may send us a message for inquiries.

No Yaya, Big Problem

It's been two months since our household help/nanny left after more than a year of staying with us, right when I just started residency training. Oh well. It's so difficult to find a replacement nowadays and it's not like we live next doors to our parents or non-working relatives where we could just leave the kids while we go to work. We, technically, have no one here in the metro to help us out. The existence of the Daycare Center in Jabar's office plays a major role in our lives today. Had there been no daycare, my mind would have blown up. There's no way I'd stop residency right now.

How do we manage?

Jabar and I divide the household chores and attending to the kids' needs. If one cooks then the other does the laundry, if one gives the kids a bathe then the other one cleans up. So far, so good. But there are days when we are both sooo tired and just want to sleep and we are both so irritable. However, we have no choice but to do the tasks. Partnership has never been this meaningful for Jabar and I. Glad to have a hands-on husband who needs not to be pestered to do his tasks. He knows exactly what to do without reminding him. He makes yaya-less easy for me. Oh, credits must be given to my two daughters who are very cooperative. We give them a bath at night so as early as 6 AM, we scoop them up from the bed while they are still asleep. If they wake up while we're in transit to Jabar's office, I change their clothes in the car. Otherwise, I do it in the daycare. As soon as I drop them at the daycare, I take the UV Express to the hospital. Alhamdulillah my workplace is relatively near his office. These are the days when I wish I knew how to drive so it'd be easy for me to travel back and forth the daycare.

I wake up everyday between 3-4 AM to sterilize the bottles, boil water, cook rice for our baon, and clean up the mess from the previous night. It feels like going to the battle every morning, battle against time and traffic. We need to leave early so as not to get caught in the metro traffic, otherwise we will get late in the workplace. Punctuality has always been my mark (ahem!), I avoid being tagged as a late-comer since I am only a first year resident. So I really make sure that we leave the house before 6:30 AM.

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It is vividly clear to me now why Allah has put me in this path -- Family Medicine in Ospital ng Maynila Medical Center. The schedule just fits me perfectly even without a household help. We only have maximum of four duties in a month and we are at the OPD for the rest of the days, which means we can leave the hospital as soon as the clock strikes 5 PM. Therefore, I can do the household chores --- laundry, clean up, and cook--- as soon as I get home. These are the things I cannot do had I pursued Internal Medicine, even with the help of a nanny.

Notice my tired eyes. 

I've been looking for a nanny almost everywhere to the point that I even ask some of my patients if they know someone who wants to work for us but always to no avail. Well. I can only pray to Allah to send us a nanny whom we can entrust our kids to and will stay with us for a long time.

I have always wondered how women in Western countries, where getting household help/nannies is not the norm, do it. They can still get a full time job, reach their dreams and fight for their advocacy while raising well-balanced children into productive adults. WOW. Western doctors who are also moms are my source of inspiration right now. Gotta meet one and ask for tips!

Road To Residency

My chill life is over.

After five years of living a normal life, I have to step-up my career and proceed into residency training. I think I said this before in this blog that the medical career is very broad, one can go into public health, research, clinical medicine (IM, FM, Psychia, Pedia), surgical (general surgery, OB, ophtha, ENT) or auxiliary (patho, rehab, nuclear med).  It took me five years to really think hard about what I want---a clinical career. Based on my med school and board exam performance, I was quite inclined to Internal Medicine and yes, I love IM! So I prepared for it and made it to PGH pre-res. But in the middle of pre-residency, I did not want a life spent like that for the next three years. I am not a single woman anymore, I have a husband and children to take care of. I can’t live with a every 3-days duty** schedule. That, for me, is too morbid. I pity my children. I did not get into IM residency but I am even thankful. I found a benign but competitive clinical training---Family Medicine in Ospital ng Maynila Medical Center. Yey!

What is Family Medicine? Honestly, it is one of those med school subjects that was not quite taken seriously because it deals with basic clinical cases that students feel they’re so light they can handle it even with eyes closed. Our FM internship rotation gave us opportunity to rest during weekends. But hey, FM is not to be taken lightly. It molds physicians to become 5-star physicians: clinician, researcher, social mobilizer, leader and teacher. As an academic discipline, FM encompasses a distinct body of knowledge appropriate to the needs of a changing society. It is not disease-oriented but also health-oriented which emphasizes on the importance of disease prevention, health maintenance and curative medicine. FM manages patients holistically, we're not only dealing with the physiological aspect of the illness but we also include its psychosocial factors.

Ospital ng Maynila Medical Center is the home base of Pamantasan ng Lungsod ng Maynila (PLM) College of Medicine, one of the top medical schools in the Philippines. Needless to say, OMMC is dominated by PLM grads (the same way PGH is dominated by UPCM grads) so I was hesitant to blend in at first. But during pre-res, my co-residents are very accommodating as well as the consultants! It is only here where we can speak to the consultants as friends, not as god-like creatures who’d make us feel like we know nothing.

One month into residency, I am eternally grateful that Allah led me to this path. We only go on duty once a week, and on an 8-5 sched during weekdays. So if I’m lucky and I’m not on duty during weekend, I have all my time for the little tots. The husband and I can still do stuff together---groceries, market and do jogging once in a while. I can even do other stuff because I have plenty of time! Alhamdulillah..

**duty means 24-48 hours attending to patients in the hospital, either in the wards, ER or OPD. Outside the duty schedule is either pre-duty or post-duty, that still warrants being in the hospital for 12 hours. A regular resident knows only 3 kinds of days: pre-duty, duty and post-duty. Then repeat. There are no weekends or holidays.

Reflections of a Doctor Mom

My youngest, Amreen, had high-grade fever four days ago accompanied by few maculopapular rashes on her upper extremities and anorexia. She wasn't vomiting nor having a diarrhea but I noticed her stools were soft and mucoid. I only gave her paracetamol and a tepid sponge bath while closely monitoring her fever. On the 2nd day, I brought her to the nearest ER to get her labs done. Her CBC showed plain viral infection which can resolve on its own and be managed at home. She started to throw up her milk and her medications. I hate seeing her weak and irritable and refusing to eat. It tears my heart apart and I feel so anxious thinking it might be something else overlooked by her CBC. So at 2:00 AM yesterday, Jabar and I rushed her to the hospital (the hospital where I gave birth to her, where everyone was nice and calm. Love it here.) after an episode of vomiting and spiking fever. 

Being a doctor who knows every step in the ER, the labs and the rationale of the management, I was supposed to be calm. Yes I was, but part of me gets anxious and uneasy every time my daughter cries and I can't tame her. She was dehydrated with poor skin turgor and crying without tears. I can't stand seeing her this way. Her initial CBC in the ER is still a viral picture, so the resident asked me if I will still admit the patient. I opted to admit her for rehydration and to lessen my anxiety and worry. 

                                                   

Here are my reflections while we were at the ER yesterday morning:

1.) There's a valid reason for a mom who brought her child to the ER at 2 in the morning. She's not nag-iinarte lang. Every inquiry of an anxious mom must be addressed properly. Do not judge.

2.) Every single staff in a hospital contributes to the entire hospital experience of a patient, from the security guard who opens the ER door to the nurse manning the triage area and the housekeeping staff. Being courteous and nice is valuable beyond estimation. Kindness must be the universal trait.

                                                   

3.) Stellar clerks who have lots of repeating questions are annoying. Hahaha! Especially when you were asked the same question by the nurses and residents already. I appreciate the detailed history taking though. Good job, kid! 

4.) Pedia residents and clerks should not be doing rounds to non-toxic patients especially during midnight when the baby is fast asleep. Hirap na hirap ako magpatulog nyan tapos gigisingin nyo lang! Hahaha! Really. I'm sure they'd opt to sleep either. Been there done that, 1:00 am rounds to pedia patients during clerkship. Inis na inis pala ang mga nanay sa amin! Why do we do that again?? Lol!


                                                   

Alhamdulillah Amreen's fever abated now and her appetite is returning. But her body is covered with rashes, she looks so pitiful. Breaks my heart. The attending just had her rounds and her final diagnosis is Roseola infantum and we're bound for discharge today. Yay!

P.S.

I passed the residency qualifying exam of the hospital where I applied and my 2-week pre-res will start tomorrow and here I am in the hospital trying to "study". I'll be starting with a 24-hour duty in the ER so wish me all the best of lucks in the world!!!! Hahahha! Bismillahir rahmaanir raheem. 

I got your back.

I share the burden. 

I share the tears.

I cry with you. 

But, I'll carry on. 

Let's carry on.

We'll get through this. 

I'll remain to keep that little spark of positivity alive. 

I can see the light.

Believe.

Have faith.

Just please, don't let me drown with you. 

Leap Of Faith

I'm currently staring at my residency application form that I will be submitting in a few days together with my other academic credentials. I prepared myself for this --- emotionally (and intellectually? Nah. I don't think I've reviewed enough. I'm actually panicking!). I'm hyperventilating by the mere thought of residency. Now the most important question to ponder on: am I ready to sacrifice precious moments with my daughters for the advancement of my career, for honing the craft I've worked hard for all my life? 

                                          

The blank application form is staring right back at me as if nodding in affirmation. Not too long ago, I made a decision that changed my life. I --- a provincial girl who never left her comfort zone --- took a big leap of faith and chose to spend a year of internship at an institution where all brilliant minds in the Philippine medical field meet. Considering I wasn't on the topmost of my class, I wasn't sure if I will get accepted. A year later, I finished my medical internship with grace and pride and eventually passed the medical board exam. 

                                            

I'm at it again. It's different now though because as I will be holed up the next three years of my life in the hospital, I will not only be sacrificing my personal social life but I have two daughters and a husband who will bear the consequences of my frequent absence in their lives. 

I ask myself this, WILL IT BE WORTH IT? 

It is difficult now, but perhaps, my family will thank me in the future for treading this path, for making this crucial decision. 

Yes, in shaa Allah, it will be worth it. 

Bismillahir rahmaanir raheem. 

Chao Phraya Abhaibhubhejhr Hospital

A part of our two-week Neuro course is a day trip to Prachinburi province to visit Chao Phraya Abhaibhubhejr Hospital (pronounced as /dzao-pya-ah-bai-bu-beh/). It is a tertiary hospital located on the eastern side of Thailand, 2 hours away via van. CPAH is on the forefront of promoting Thai traditional medicine. Patients are treated and cured with the use of Thai traditional techniques and herbs alongside modern medicine. In fact, they have a pharma lab within the institution that formulates and does scientific research on different locally known herbal medications.  They also have a museum beside the main hospital building housing intriguing medicinal displays.  

    

With Dr. Makorn Limudomporn (in dark blue polo and tie), a PNI alumnus who is now practicing at CPAH. He toured us around the hospital including the ER and Acute Stroke Unit. He also showed us the efficiency of Tele-Stroke and how it speeds up stroke management and patient recovery. 

In front of the Thai Traditional Medicine Museum

This Renaissance-style building was built as a residence for King Rama V, no wonder why most of the furniture and antiques inside are related to him. Inside is an old-style pharmacy with shelves containing different potions, herbs, and medicinal insects and reptiles. Yes, reptiles! 

 

 

Just like in PNI, Thai traditional massage and acupuncture is also incorporated in the rehabilitation program of stroke patients. They have shown us their vast massage room as well as the oils and herbal medications used. There were particular leaves and oil they apply on the skin to loosen muscles which I observe my grandmother used when a cousin accidentally sprained an ankle. More or less those leaves and the pharmacological mechanism are the same.

CPAH is the main referral center of  the secondary hospitals in the surrounding provinces. They only refer neurosurgical patients to Bangkok which happens seldom since the most ischemic stroke patients are immediately brought to the hospital and are given rT-PA with the help of the Stroke FAST Track and the Tele-Stroke program. FAST Track is an efficient process in assessing and managing stroke starting with the Emergency Medical Services (EMS) which coordinates between patient and the right hospital. EMS must have a goal of shortening the time of transporting a patient to the hospital. FAST is an acronym for Face (face fallen on one side?), Arm (can they raise both arms?), Speech (slurred speech?) and Time (call emergency hotline if any of these signs are present). An ER personnel must detect signs and symptoms of ischemic stroke for fast administration of thrombolytic therapy (rT-PA, which has a window period of <4.5 hours only).  

Dr. Makorn showing us how to use the Tele-Stroke machine and its advantage over using Facetime or other video-calling apps. 

Tele-Stroke is a technology that uses electronic communication methods such as telephone, internet and videoconferencing to provide exchange of medical information. This aims to improve patient care among stroke patients. Dr. Makorn even emphasized how Tele-Stroke is efficient and effective as he can see patients and start medical therapy while he is still at home. This is very easy to install and to adapt in our provinces in the Philippines for as long as the electricity ceases to fluctuate and the speed of our internet improves. 

Tele-stroke machine at the Stroke ER. Do you see me? Haha!

After the tour, a sumptuous lunch was waiting for us at the dining area of Abhaibhubhejr Day Spa. They have a private spa inside the hospital premises! How awesome! The dining area was enclosed in a glass room with a beautiful garden view. 

With Wai Phyo (on my right), a fellow Muslim physician from Yangon, Myanmar, sharing the table with us.

 

Our last stop was the herbal pharmacy shop inside the hospital where we were given 30% discount! Wahahaha! I bought some herbal turmeric face and body scrub, rose extract soap, and lotion. I thought about my Mom who, most of the time, prefers using traditional Meranao herbs in treating illnesses until now. I remember the bitter taste of papaya leaves extract she used to make us drink whenever we're down with a fever. Also, remember the gunda leaves extract she made me drink when I was in labor? Haha! I swear that precipitated my labor! Had she been a doctor, she'd definitely advocate the use of scientifically tested (or in her case, circumstantially tested and proven) herbal medications together with modern medicine. Nevertheless, she is a very compliant patient.

This field trip made me all the more admire the Thais. Western knowledge came to them but they didn't threw away nor resent their traditional ways and culture. Instead, they made scientific research about what they already have and use it alongside modern and new techniques. Indeed, they are the unconquered people.

International Course: Neurology for Non-Neurologists

It was a month ago when an offer to take an international course in Bangkok was posted on the page of IMAN (Islamic Medical Association of the Philippines). I inquired about it thinking that it is the best way to jump-start my slumbering brain while setting aside the question on who's to take care of the little one while I am on a 2-week course. But as Mr. Coelho put it, "And, when you want something, all the universe conspires in helping you to achieve it."  By all means, we found someone to look for our Amina while I am in class. It was a major separation anxiety on my part, but I need to deal with the reality of leaving her at times when I return to work. 

The international course was Neurology for Non-Neurologists which was conducted by Prasat Neurological Institute (PNI), a Thai government institute, which aims to train general physicians all over Southeast Asia about updates in neurology and neurosurgery, focusing mainly on stroke and epilepsy. There are five of us from the Philippines while the rest of the 20 participants are from Myanmar and Laos. They invited doctors from other Southeast Asian countries as well but only participants from the abovementioned nations turned up.  

Outside the Thai Massage and Acupuncture Unit with Dr. Tipyarat Saringcarinkul (the one in pink dress on my right) . Yes, massage and acupuncture is included in the post-stroke Rehab management as statistics proved that those procedures increase patients' recovery rate. They have a spa right inside the hospital! Unfortunately they only cater to patients. Haha! Otherwise, we would loooove to have some foot massage and try acupunture too!

Aside from the different set of lectures, we were also exposed to the facilities and the actual medical management that PNI has to offer. In the Philippines, government hospitals are synonymous to being stinky, crowded, undermanned, lacking medical amenities, with stressed, stressful and rude staff including doctors and nurses. But in PNI, we were surprised at how advanced and modern the hospital is! Sure it is crowded, like any other government hospital, but it doesn't stink and it is well-maintained! Too bad I cannot post photos taken inside their Rehab building and in the Acute Stroke Unit to prove my point. Haha! They even have a prayer room for Muslims, that made me appreciate it even more. 

The two-week course expanded our horizon about the medical culture in our neighboring countries. I learned the difference in the structure of our medical education. In Thailand, as well as in Myanmar and Laos, they do not need a 4-year pre-medical course before entering medicine proper. Instead, they have a six-years medical program consisting of 3 years of pre-clinics and 3-years of clinical skills. Here in Thailand, they spend one year of internship and another two years of working in the communities before they earn their medical license. Medical licensure exam in Thailand consists of three parts: 1.) written, pre-clinics 2.) written, clinical skills and 3.) oral, Objective Structured Clinical Exam (OSCE), each part given on different times within a year. Now that we have started to adapt the K-12 program in the Philippines, I believe we also need to restructure our medical education so as not to waste those years of learning some courses which are not vital in the medical field.  

Neuroradiology Conference

They bring actual patient during grand rounds where resident extract history and perform physical exam right in front of everyone. After that, the patient is then brought to the ward and discussion continues. 

Neurology Grand Rounds 

Living here in Bangkok for more than a year now made me notice how polite and respectful the Thais are. In fact, as I always tell my friends, I have felt discrimination as a Muslim more in the capital of my own country than here in Bangkok. Truth is, the Thais never made me feel like I am different because of this piece of cloth on my head or because of my language. Generally, Thailand is a nation of respectful people. This trait is deeply embedded in their medical culture. Sure there is also a hierarchy but consultants do not insult or put down residents and interns during rounds and/or conferences. We have initially observed this during a neuroradiology conference. An intern orally presented the case, no powerpoint presentations whatsoever, and then a resident presented her clinical impression and differential diagnoses. The consultants asked a few questions or some clarifications and added their thoughts on the discussion. The atmosphere was light, there was no stress nor sense of impending doom in the air, the discussion was free flowing from all sides: the interns, residents and the consultants. It is way far from what happens during grand rounds and conferences in the Philippine setting where consultants shout, yell and insult residents and interns who cannot pop the "right" answer to their questions. We, Pinoys, primarily assumed that no boljakan happened because of our presence, the international students. But, we've also attended several grand rounds and the same thing happened! I got the chance of asking Dr. Metha, one of the young neurologists, if this is the regular set-up on a normal grand rounds. He affirmatively said yes. I asked what happens in a scenario when an intern/resident cannot answer some questions thrown at them and this is his exact answer: "Oh it's okay. This is a training hospital so we cannot expect that they know everything, we do our best to teach them the knowledge that we know. Grand rounds is an avenue for learning and should not be stressful." And he smiled. Waaaaah!!!! I wish all consultants in the Philippines think that way and I pray they realize that putting down interns/residents in front of everyone will first, hinder the learning process which will reflect on that person's performance as a physician; second, drops someone's self-esteem; and third, definitely won't make them a better person. I think most consultants in the Philippines have a problem with bloated ego. I am not generalizing as I met plenty of consultants who are so kind and are devoid of issues *winks*. Perhaps it is a consequence of the competition in the medical arena. I believe our generation of doctors condemn this practice so I hope the time comes when this will be obliterated and free flowing medical knowledge and ideas would ensue. In shaa Allah.   

With Dr. Thanaboon Worakijtharnrongchai, the one wearing a gray long-sleeved polo shirt at the center. 

Dr. Khwanrat Wangphonphattanasiri at the Epilepsy clinic.

Team Pilipinas, reprezzent! (back L-R: me, Faizar, Nash, front L-R: Marwa and Weng)

More than the medical knowledge that we gained (and weight too!) is gaining friends! It is my first time to meet my co-participants from the Philippines and it is so amazing how easily we have clicked! Learning was so much fun when you're with like-minded people. Besides, it was my pleasure playing tour guide and introducing to them my favorite halal Thai food and restos. I am sure they had enjoyed their stay while maxing out their cash for shopping! Haha! I wish to see them again in Pinas, now I have a reason to visit Zamboanga City in the future. In shaa Allah.  

I am grateful to Dr. Naheeda Mostufa who informed us about this course and to Sir Mark Santos who submitted our application for a slot. They are instrumental to the knowledge that we acquired and to the priceless experience that we had. Alhamdulillah. :)