Making his mark by championing others Juan Fuentes Jr., MD
By Sunly Coo, Contributing Writer
It wasn't long ago when midwives were treated by the medical community with anything from condescension to disdain. They were known in some provinces as hilots, women who presided over childbearing with barely enough scientific knowledge and experience to cope with emergency cases. "What they did was hilot, watch, wait for the baby to come out, and catch," says Dr Juan Fuentes, Jr., the founder and once 30-year chair of The Medical City's obstetric and gynecology department. That slowly changed when he became the chairman of the Board of Midwifery, a position he held for two terms under the appointments of former Presidents Corazon Aquino and Fidel Ramos. By revising the Midwifery Law in 1992, he upgraded and legitimated the profession, allowing duly trained and licensed midwives to perform functions that were once reserved to physicians. Instead of letting nature take its course when a baby's head or shoulders are lodged in the vulva, or when fetal distress occurs in the birth canal, midwives are allowed to do episiotomy, a perineum incision to expedite the delivery, minimize vaginal tearing, and prevent vaginal prolapse in the woman's advanced years. It also became legal for midwives to conduct internal examination, administer oxytocin orally or parenterally after delivery of the placenta to induce uterine contractions and avert hemorrhaging, suture perineal lacerations to stanch bleeding, dispense intravenous solutions during obstetrical emergencies, and inject vitamin K to the newborn. The revolutionary change in responsibilities demanded that the current curriculum for midwifery be expanded to equip these primary health-care practitioners with the necessary competencies for providing adequate care to mothers before, during, and after the baby is delivered. It paved the way for the establishment of the Continuing Education Program (CPE), which would ensure registered midwives are kept abreast of the latest developments, including updates on family planning, neonatal care, disease prevention, and hygiene practices. To bring the licensure exams into the 20th century, Fuentes attended workshops in Singapore before implementing a fully computerized system affecting 900 or so schools of midwifery. He supplanted the old essay test with the more objective and empirical multiple-choice exam, where the questions were selected randomly by a computer. Automated checking and scoring shortened the waiting period for results to two days. For Fuentes, the only Filipino ever to sit in the executive board of the International Federation of Obstetrics and Gynecology (FIGO), his efforts went beyond legitimating an ancient profession; it was about saving lives. "Midwives are the first line of defense in barangays," especially in depressed and rural communities, he explains. When they are properly trained, they can significantly reduce maternal and perinatal mortality. Fuentes also made a vital contribution to posterity with his book The History of Midwifery, Modern Obstetrics and Gynecology in the Philippines, a seminal work that traces the subject matter's evolution from the 16th century to 1995. Even if his achievements in the field of midwifery continue to benefit millions of lives, the doctor, who turns 82 in December, will always cherish the simple, undiluted joy of being an obstetrician. He recalls: "Once, I rode a jeep from [the Philippine General Hospital] to Quiapo. The driver told me I did not have to pay because he remembered I was the one who delivered his wife's baby." Smiling, he says, "That is the essence of my practice." M
Glecy Gamboa, Contributing Writer
Dr. Carmela Lapitan is the first female practising urologist in the Philippines, but she would like to play down this fact, saying she's just the right person at the right time. "Medicine is a hard career to be in," she says. "So much is expected from a person. It is not just a job, it is not just a career. Look at it as your life. It is not a matter of working skills or professional skills. It is more a dedication of yourself to your work. Take care of your patients, even the relatives of your patients." She adds: "Medicine is no place for a half-hearted desire. It has to be a whole-hearted dedication to one's work. It is difficult, yes, but there is fulfilment. You are not just in the office. But you save lives. And that makes you feel better." And she also has a few people to look up to so she could push herself to give more. Two of the people Lapitan considers her role models are Dr. Eduardo Gatchalian, president of the Philippine College of Surgeons, and Dr. Josefina Almonte, the first female pediatric surgeon in the country. She also says that to be successful, "you have to give what is expected of you. At times you have to give what is better than the best. What is most important is that you give service to your patients, service to the institution and to your students." And what she has done so far can be a good example of what's "better than the best." Lapitan's research on urinary incontinence in the country as well as in Asia is well recognized. She was one of the lead researchers that had conducted a survey on the prevalence of urinary incontinence in 11 Asia-Pacific countries. The study involved 10,000 subjects from across Asia, with 1,000 patients coming from the Philippines. Urinary continence is a significant health problem and not just an embarrassing problem, with as much as 10 percent of all women worldwide believed to have this problem. More than 50 million men and women around the world suffer from this problem, and they often suffer in silence. To Lapitan, who is a part of the World Health Organization consultation on incontinence, this problem deserves much more medical attention and public education. Lapitan is one of the editors of the Incontinence Review Group of the Cochrane Collaboration, an international not-for-profit organization, which produces the Cochrane Database of Systematic Reviews. The Cochrane Systematic Reviews, meanwhile, is part of The Cochrane Library, the definitive resource for evidence-based health care. The editorial base of the group is at the University of Aberdeen, United Kingdom. Lapitan is one of the active research fellows of the University of the Philippines Manila-National Institutes of Health, and teaches at the UP College of Medicine, and is involved with training at the Philippine General Hospital. She is currently a fellow of the Philippine College of Surgeons and the Philippine Urological Association, and an active member of the Continence Foundation of the Philippines, the Asian Society for Female Urology, the Asia-Pacific Continence Advisory Board, and the International Continence Society's Continence Promotion Committee. As a result of her dedication and passion for her work, Lapitan was named international guest scholar by the American College of Surgeons. And in 2004, she scored two awards-as one of the outstanding young scientists, as given by the National Academy of Science and Technology, and one of Ten Outstanding Young Men (TOYM). But to Lapitan, the greatest award isn't a trophy or a certificate. "I have that sense of fulfilment at the end of the day when patients get well," she says. "I feel good that there is a new resident being trained well; when I teach urology to a new student; when my research paper is published; and others get something from my work. " She also sees no point in resting on her laurels. She says: "There are a lot of things to be done. I will continue to be busy with the Philippine Urologic Society. I am working on a project now-the National Registry of Urologic Diseases in 11 major hospitals. It is going to be an electronic data system. It is not pure research, though. It is a project, the results of which will generate research work in urology for the country." But it's not all work for this young achiever. Lapitan admits to being interested in crafts. "I make scrapbooks, beadworks, accessories," she says. "I gave these accessories once to my relatives in Australia as token for the donation they gave for an institution. I also like reading children's books like Harry Potter, C. S. Lewis [books], and Peter Pan. And of course, I play with my 10-year-old Pomeranian dog. " And when she needs to buckle down to work once more, she does so willingly for this simple reason: "It is not just work, it is your life." M
Glecy Gamboa, Contributing Writer
"The eyes are the window to the empirical world. The reality, the visual images contribute to the pool of experiences that link us to the past, anchor us to the present, and allow us to glimpse the future." So says Dr. Salvador Salceda, an eminent ophthalmologist and professor emeritus at the University of the Philippines College of Medicine. "Eighty percent of our learning and working process occur with the help of our sight and the other senses," he adds. "We don't know much about the eyes. Every day there is a new discovery." And over the years, his desire to discover something new every day has just kept him going. One of the discoveries that Salceda currently finds fascinating is a paper by Swedish psychologist Mats Larsson that suggests that patterns in the iris of the eye can give an indication of personality-that the eyes, in a manner of speaking, may really be the windows to the soul. The study looks at relationship between measures of personality and the "crypts, pigment dots, and contraction furrows" of the iris. Larsson has found that "crypts" are significantly associated with five personality characteristics (feelings, tenderness, warmth, trust, and positive emotions), whereas "contraction furrows" are associated with impulsiveness. His lifelong dedication to new discoveries in ophthalmology has made him one of the leading forces of ophthalmic research in the country. He gives credit to his parents for encouraging him to become a doctor. He acknowledges that his becoming a doctor. His decision to become an ophthalmologist, meanwhile, was influenced by no less than the father of Philippine ophthalmology himself, Dr. Geminiano de Ocampo. "I discovered what I wanted in Dr. de Ocampo's work and dedication as an ophthalmologist," explains Salceda. While de Ocampo's influence of Salceda was significant, Salceda himself has worked hard to earn the admiration and respect of his colleagues and the younger generation of doctors. He had the distinction of being named an international postdoctoral research fellow at the National Institutes of Health in Bethesda, Maryland, something that might have opened a lucrative career in the United States. Instead, Salceda returned to the country and joined his mentor as assistant director of the Philippine Eye Research Institute (PERI) from 1967 to 1972, during with he coauthored with de Ocampo several research papers published both in the country and abroad. Salceda also served as director of the UP Institute of Ophthalmology, the leading center for eye research in the country. He also organized the Eye Referral Center of the Philippines in 1981. For his work as a clinician, researcher, and educator, Salceda has received several distinctions, including the Outstanding Ophthalmic Educator Award and the Geminiano de Ocampo Outstanding Researcher in Ophthalmology Award during the 60th Anniversary of the Philippine Academy of Ophthalmology. But this other distinction that Salceda holds is just as important-that of a role model. He says: "We have to be an example to the young. They discover what they want in what they see in other people." Dr. Minguita Padilla, a student of Salceda at the UPCM, is proud to admit that he is an important influence on her. Of the things Salceda told her, this she says really made an impression: "You are not here to do just the ordinary." Now 75, Salceda shares his thoughts on ageing: "My mind is not old, my feeling is not old, but my body is." But ever the research enthusiast, he adds: "We the senior doctors have the duty to impress among young doctors the idea of writing papers for scientific conventions." He urges doctors to consistently maintain full professional knowledge and skills, and to safeguard the public and the professionals from those who are deficient in competence and moral character. He says: "Give [the people] the highest quality of service. Do not only be concerned about income. Treat those who are not financially able. God will take care of that." And even at 75, Salceda sees room for growth. He says: "As you grow older, you realize that the world is expanding. You begin to partake of what the world will offer. Being a master of something is not enough. The responsibilities and positions I had were mostly an unraveling of the human spirit because a person is a multidimensional-physical, social, emotional, spiritual-being." Salceda shares his wisdom. Indeed, the eye is the lamp of the body. If the eye is working properly, the whole body is full of light. Because light illumines the heart and soul. M |
