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The Doctor Curricula of the University of Santo Tomas of the Faculty of Medicine and Surgery, Before the Japanese Occupation

By Dr. Artemio T. Ordinario

The Faculty of Medicine and Surgery was essentially a hospital for the wounded between 1897 to 1898, during the Philippine revolution. In 1898, the medical school was closed due to the Philippine-American war and lasted until 1901 because of legal problems.

By 1902, the medical reopened under the American regime until 1941. There was an increase in subjects from 25 to 46 to commensurate with the progress of science.

 

In 1916, the medical school was granted permission to confer to the degree of Doctor of Medicine by the Secretary of Public Education. By 1920 much of the medium of instruction and reference texts was in English; and by 1925, English became the only medium of instruction. The revolutionary medical curriculum as vigorously suggested by Abraham Flexner in the United States was likewise adopted in the Philippines in 1916. This consisted of two years in the basic sciences and two years in the clinical disciplines. However, there were still didactic sessions in the fifth year. More than anything the Flexner innovation changed pathological conference which was truly an American medicine upgrading it to European standards. The clinicopathological conference which was truly an American innovation was an intrinsic part of the curriculum. This was a weekly exercise that continued to the 1960s.

Abraham Flexner the American educator, best known for the reformation of the medical curriculum which was adopted in the Philippines by 1916.
Source: The World's Work by the University of Toronto, p. 13100

Department, as we know them today, began in 1920 with Anatomy leading the path. It is interesting that Biochemistry became a department only in 1963. On average there were 100 students per year with about 300 faculty members.

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Is this the day I catch COVID-19?

By: Dr. Romulo Babasa III

“History will remember this war. A war that was fought by doctors and nurses, not soldiers.”

March 2020 has been a particularly difficult month to wake up to. As I prepare for a shift at the Emergency Department (ED), this question always comes to mind “Is this the day I finally catch COVID?” It’s a heart-wrenching moment every single time. You think of the mortality this pandemic has produced. You are reminded of the case fatality rate of your age group and the colleagues who have fallen ill to this virus. Afterwards, there is a hesitancy to show up at work and just stay home...but quite remarkably, the sense of duty and sworn responsibility always kick in. Before, I could only imagine how a soldier must feel when he is deployed to fight in a war. Now, more than ever, I am aware of that feeling. I fear for my health. I fear for my wife and family. I fear for those who I will leave behind if ever I succumb to this disease. But inevitably and with some reluctance, I soldier on.

It is Thursday, March 12, 2020. It’s the start of my night shift wearing the ED’s new battle gear. As I tried to clear the fogging in my glasses caused by my ill-fitting N95 mask, my co-consultant gave me the first bad news of my shift during our hand-off rounds.

“We are all out of ICU beds. Pedia Crit 1 is deck 2 for a bed. 60’s male, PUI.”

Suddenly, I am hit by the irony of that statement. We have an adult male occupying a bed reserved for a critically ill pediatric patient - if ever one does arrive. And there is no telling when our PUI (Person Under Investigation) will be able to vacate that bed since he is second in line for one upstairs. We have trodden this line many times before, but tonight it seems the situation is a desperate one. In the span of a 12-hour shift at our ED, the outgoing consultant has received 5 patients who were all in respiratory failure and all intubated within minutes upon arrival. These 5 patients quickly used up our critical care complement of 3 beds and now even extended to the peds area.

Five hours into my shift, the triage nurse wheels in a 57-year-old male diabetic complaining of difficulty of breathing. From the Nurses’ Station, I could see the patient struggling to get off their car and sit on the wheelchair. The patient’s companion, his wife, was visibly worried. As I approached the critical care area where a vacant bed was being prepared, I saw the patient’s labored breathing. I quickly turned to the wife and asked what had happened.

“We ate out for lunch and he was perfectly okay, then all of a sudden he had trouble breathing. Then it got worse and worse,” the wife explained. “Until he asked to be brought here.”

It sounded like he was having a cardiac event. The patient’s oxygen saturation was worryingly low at 85%. His BP was high at 190/100. All these ultrasound findings pointed to cardiogenic pulmonary edema. But in the back of my mind, I was also suspecting COVID pneumonia. The patient’s oxygen saturation further went down. We had to act fast. I told my resident to prep the patient for rapid sequence intubation.

Our first attempt to insert the ET tube failed. At this point, the patient’s oxygen saturation dropped to 60%, his heart rate was bradycardic and his lips cyanotic. He also had frothy secretions which further complicated laryngoscopy. I had to take over the procedure and immediately realized that it was indeed a difficult airway. I could not see the glottis. I pulled on the laryngoscope handle as hard as I could but to no success. The heart rate dropped to 50…40…30…the patient was nearing peri-arrest. My goggles fogged up and I instinctively took them off and proceeded to intubating the patient. I made a calculated move and advanced the endotracheal tube blindly. It worked and his oxygen saturation as well as his vital signs improved.

I was flooded by a myriad of emotions when I learned of my results. Among them were denial, anger, helplessness and fear. Several of my co-consultants messaged me and inquired on how I was doing. One advised me to get admitted. He mentioned another EM doctor who got exposed to a COVID-19 patient in a similar way – by intubation. That doctor unfortunately developed severe pneumonia and was put on mechanical ventilation. Even though I had very mild symptoms at the time (a sore throat and beginning dysgeusia), the unpredictability of this illness coupled with my risk factors (hypertension and diabetes) made the decision to get admitted very easy.

I stayed at the hospital for 4 days, finishing a regimen of Hydroxychloroquinone and Azithromycin. I did not develop any symptoms of pneumonia, but I did lose my sense of smell and taste. My attending physician told me I should do well while at home quarantine. None of my inflammatory markers further increased, and my chest x-ray was normal. I was discharged midnight of March 30th.

What followed next was my recovery period, which also happens to be the most distressing and most miserable 2 months of my life. Early in the COVID-19 pandemic, the Centers for Disease Control recommended that healthcare workers who have recovered from COVID-19 disease should test negative in 2 successive PCR swabs before they can return to work.

I have now the unenviable task of holding stable COVID-19 patients seeking admission and diverting them to other hospitals. We are now 5 months into this pandemic, and the burnout has drawn lines upon our brows. Some have gotten sick and recovered. Some have left. But many of us are still here, resilient and seemingly tireless. Still braving the dangers of constant exposure to a now more transmissible strain of the virus. Still struggling with a far more overwhelming battle within us - to leave our families at home and serve the patients who can likely put us in harm’s way. Again, the same question comes to mind, “Is this day I catch COVID, for a second time?”

I tighten the Velcro straps of my face shield and I put on a second pair of latex gloves. The ED is now a symphony of pulse oximeter beeps and respirator alarms, punctuated by PA calls for a nursing assistant. Another patient is brought in, slumped on a wheelchair, surgical mask on with anxious relatives flanking him. I alerted my resident and motioned him to accompany me. As I walked towards this newest patient, weary but determined, I muttered these words through stifled breaths: “The war continues.”

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Licentiate in Medicine Curricula (1871-1916)

By Dr. Norberto V. Martinez

The beginning of the Licentiate Medicine Curricula in the University of Santo Tomas was adopted from the program of Spain in 1877. When the UST Faculty of Medicine and surgery opened its doors to the first batch of medical students in 1871, the graduates obtained a Licentiate in Medicine. Graduates may hold a degree of Doctor of Medicine if they wish to continue their studies exclusively in the Central University of Madrid.

 

During these times, the most popular UST student was Dr. Jose Rizal, where he pursued his medical career in Spain. He was credited for having performed the first cataract operation in the Medico Farmaceutico de Filipinas, the first medical facility established in the Philippines.

Fachada Sur de Sto. Tomás – Universidad de Sto. Tomás (Credits to: UST Library)

The activities were centered in the walled city, Intramuros, where the University of Santo Tomas, Colegio de San Jose, Hospital de San Juan De Dios, and Leal Hotel formerly resided.  The buildings within the walled city bustled with activities where classes were held at the University of Santo Tomas, while Hygiene, Drug, and Toxicological Analysis were performed at the chemical laboratory of Colegio de San Jose. While in Hospital de San Juan De Dios, sits the public dispensary, clinics for Medicine, Surgery, Pediatrics, Obstetrics, Gynecology, and Eye, Ear, Nose and Throat. Leal Hotel accommodated the laboratory of Histology and Bacteriology and apparatus of disinfection.

Laboratorio de Bacteriología y Parasitología de la Universidad (Credits to: UST Library)

Classes were disrupted for the first time in 1898 because of the Philippine Revolution. Two years later, a medical milestone was recorded in history, when the first laparotomy in the Philippines was performed by Dr. Juan Miciano and his team at San Juan De Dios Hospital.

In 1916, the when the Corporate Law Act (Act 1459) was passed, the University of Santo Tomas was empowered to confer the degree of Doctor of Medicine to their students who completed the five-year medical course.

The grading of the University is as follows:
Sobrasaliente (excellent)
Notable, Approvechado (very good)
Bueno (good)
Mediano (fair or poor)
Approvado (poor)
Suspenso (conditional)
Reprovado (fail)

To obtain the degree of Doctor of Medicine, the final examination for graduating students is a revalida. It was divided in to two parts: the first part included an exercise to identify materials of medical matters and the second, which was further subdivided in to two, included the history of a medical case and operation on a cadaver. Grading the first part were as follows: 3 approvados—the candidate is admitted to the second exercise; 2 approvados and 1 reprovado—additional make up time of less than 6 months is given; 1 approvado and 2 reprovado—additional time if not less than 8 months is imposed.

In 1914, a six-month course leading to a degree of Doctor in Hygiene was opened. This included lectures on Sanitary Hygiene, Statistics, Bacteriology, General and Special Hygiene. Laboratory courses and practical courses in a health station in Manila and Internship at the Hospital de San Lazaro for contagious diseases were also part of the program.

Centuries later, the UST Faculty of Medicine and Surgery improved its curricula attuned to the demands of the times. Even during its inception, the curricula were designed to pursue excellence in medical education with the guidance of Christian ethics and values.

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The Faculty of Medicine and Surgery of the University of Santo Tomas of Manila: A Parable of Inconspicuous Beginning with an Unexpected Result

By Fr. Angel Aparicio, O.P. (Regent, Faculty of Medicine and Surgery)

It was in the middle of the nineteenth century when modern or “positive medicine” started to flourish. Physicians became more pragmatic and engaged in the analysis of the origins and evolution of life, the physical and physiological

approaches to human life, the impact of the environment in the health of the individual and of the community. This systematic approach led to new discoveries and to the advancement in the different medical fields such as histology, physiology, bacteriology, surgery, etc. which were to constitute the foundations of present medical knowledge and practice.

What happened in the Philippines? Despite the precariousness of medicine and medical services in the Islands, a most auspicious event took place which would transform the traditional practices of healing of mediquillos, herbolarios and curanderas into a more rational approach to healing. This was the establishment of the first school of scientific medicine in this part of the world, the creation of the Faculties of Pharmacy and Medicine and Surgery in the University of Santo Tomas of Manila.

The University of Santo Tomas of Manila, considered as the oldest university in the east was conceived by Fr. Miguel de Benavides, O.P. the second Archbishop of Manila before his death in 1605. It started as a very modest school run by the Dominican of the Philippines under the name of Colegio de Nuestra Senora del Rosario. Classes started in 1619 with twelve (12) students and two professors. Two Chairs were

created with the classical faculties of Arts (Philosophy) and Theology for the formation of future priests.

It has been a long journey of more than four centuries, beset with difficulties of all kinds, surmounted by the indomitable character of its founder and a concerted effort sustained by his successor, the Dominicans of the Holy Rosary. It struggled for one century. Already in the 18th century, the first attempts to create a school of medicine were undertaken by the Dominicans but still without success. Only in 1734 the chairs of Roman and Canon Law were added. This gave a great impulse and new life to the University. However, it would take another century before the University could boast about a new step forward by the creation of the two faculties, that of Pharmacy and Medicine.

The spirit of the Enlightenment, the ongoing scientific progress, the educational reforms undertaken in the 19th century and the increase in the population of the Islands were crying for the modernization of the public health system and services and for the establishment of medical schools in the Philippines, -writes the university historian Fr. Fidel Villarroel.
Finally, the government of the Islands in a decree signed by Governor General Rafael Izquierdo, dated May 28, 1871 approved the creation of the Faculties of Pharmacy and Medicine in the University of Santo Tomas. Thus , next year’s celebration of the Sesquicentennial of the Faculty of Medicine and Surgery of the University of Santo Tomas, the cradle of medical schools and of most health institutions in the country is most timely even in this time of pandemic.

Like in the past, our Faculty of Medicine and Surgery is confronted with tremendous hurdles. However, the example of our predecessors should inspire us in our efforts to cultivate the seed planted in this field. We cannot give in to feelings of defeat: The modernization of its facilities, the development of a cohesive community, the mending of strained partnerships, the strengthening of our alumni relations, the search for new avenues of research, the desire to be of service to the Filipino people, etc. These and other concerns should be approached with the same vision and courage of our predecessors.

The beginnings of the Faculty, as it had happened with the beginnings of the University, were very modest. But, again, it was the determination of the university authorities, the competence and commitment of the first professors, the eagerness and enthusiasm for knowledge of the first generation of students, notwithstanding the derogatory remarks of Jose Rizal, that set the firm foundations of what has been labeled by a former secretary of the Faculty, somehow triumphalistically, as the biggest, the brightest and the best school of medicine in the country.

Indeed, inconspicuous beginnings will have an unexpected result!

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The COVID Pandemic in the Eyes of a Pilgrim

The COVID Pandemic in the Eyes of a Pilgrim

by Maria Rhona M. Gatpandan-Bergantin, MD,MSc
UST Medicine Class 1995 - Infectious Diseases Specialist

A little over a year ago, my husband and two of our close friends set on a journey and followed the trail of St. James the Apostle until we were able to reach his cathedral at Santiago de Compostela, Galicia, Spain after walking 110 kilometres for 10 days.

To majority of individuals who are so used to walking long distances, what we did is nothing out of the ordinary. But for a person who had stroke-like

symptoms and was able to see things in quadruple and unable to walk for quite a while, the journey is the fulfilment of a great dream - - - one that has been anchored to the hope that things will get better after dark days.

More than the adventure, the Camino has taught us valuable lessons which I can say, has helped me as a health care worker in this time of COVID pandemic. Everything we experience in life are just fleeting and temporary – just like the picturesque and the not so picturesque scenes we pass by in our journey; any emotions we feel – grief or joy.

We are all equal – it is a fact that in our society, we put a high premium to those who have achieved more, gained material wealth more, and those who are more popular. In this pandemic, the societal and economic bridge that separate us is bridged by our common need to survive.

Live simply. In our journey, we need to identify our basic and bare essentials. Similarly, in this pandemic, we should prioritize our families, friends and loved ones.
In our weariness and anxieties during these trying times, we often forget that the loads we carry hinder us from attaining the peace and joy we truly need.

Always have a grateful heart. The food we eat and the clothes we are made to wear in this pandemic, may be quite far from the ones we used to eat or wear, pre-COVID, but we ought to realize that not everyone gets the chance to receive these provisions, thus if you are part of the luckier ones, please do not fret and complain. Simply say, thank you.

Persevere and have loads and loads of faith. With our harrowing and sorrowful experience in this era of COVID, we should persevere in our prayers, do our share in limiting the spread of the virus and take care of each other. Trust that our God Who is journeying with us in this darkness, will carry us to the light.