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Pioneers of the Faculty of Medicine and Surgery

Reference from the book "First International Conference History of Medicine in the Philippines"
Editor: Rev. Fr. Angel A. Aparicio, O.P.

Photo From: UST Miguel de Benavides Library

Dr. Rafael M. Ginard

He was the first teacher and Dean of the Faculty of Medicine when it opened in 1871. Dr. Ginard taught Anatomy at the San Juan de Dios Hospital, where the clinical teaching and anatomy classes were held. During the fourteen years he spent at the University, he was always in charge of all the first-year students. He was one of Rizal's teachers. He started classes as early as 6:30 am daily, giving one hour for lecture and one hour for dissection of cadavers using texts from French translations.

He served as Secretary of a Board, which was created on August 11, 1871, by the Rector Fr. Treserra, to write the provisional Statutes including the new reform of the Decree, which incorporated the opening of the Faculties of Medicine and Pharmacy to be supported by the Corporation that committed to contributing 30,000 pesetas to sustain the new teachers. Other members of the Board were the Rectors of the University of Santo Tomas, Colegio de San Jose, Ateneo Municipal, and other delegates from the Faculty.

Dr. Ginard was later assisted by Dr. Mariano Marti in the conduct of classes in Descriptive Anatomy, General Physiology, and Exercises on Osteology and Dissection. He died in 1885 while teaching in his Anatomy class.

He wrote the Manual of Domestic Medicine and the Art to Preserve Health for all People, published by Ramirez y Giraudier Printing Press, Manila, 1858.

Photo From: UST Miguel de Benavides Library

Dr. Mariano Marti

After helping Dr. Ginard with the Exercises in Osteology and Dissection, Dr. Marti felt the need to expand the courses offered in Medicine. He proposed to the University Rector to hire more personnel, to rent a new place, to acquire more instruments and drugs, and to procure and anatomic surgery section for effective teaching.

He taught Therapeutics, Physiology, Private and Public Hygiene, Medical Matters, the Art to Prescribe, and Ophthalmology in the 2nd, 3rd, and 4th years. He was one of Trinidad Pardo de Tavera’s and Jose Rizal’s teachers.

To further improve medical education, he was one of those who suggested to have a Medical and Surgical Academy and to have a boarding school in the clinical hospital. The students would have more opportunities to practice their learning as they were asked to make rounds accompanying doctors who visited patients at any time of the day or night.

 

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On A Personal Note

By Dr. Saturnino P. Javier

In October 2019, I was appointed Medical Director of Makati Medical Center [MMC], the 600-bed tertiary care facility in the commercial district of Makati City. Then, I would still wonder occasionally why I accepted the post when I was comfortably practicing Interventional Cardiology in the same center –with no administrative headache, malpractice concerns, staff grievances, or employee complaints, among others. Four months later, the CEO, Dr. Cay Consunji expressed intent to leave for deeply personal reasons. A month after, in February 2020, I found myself beginning to confront the world’s most vicious pandemic –as interim co-CEO, along with the Chief Finance Officer. Yes, I was a four-month-old Medical Director who suddenly had to assume the position of interim co-CEO in an eight-billion peso healthcare institution facing an unprecedented medical crisis brought about by the brutal and menacing COVID-19 virus –thrown onto this predicament with a finance officer with whom I never had any working relationship before. Forward to five months later, more than 23,000 suspected COVID-19 cases, more than 2,800 COVID-19 positives, 80 deaths, and still in a state of Full Capacity for COVID-19, I am about to hand over the reins of MMC to the new CEO who will assume office in September 2020. What follows is a message of gratitude to the >700 members of the MMC Medical Community.

 

I thank the entire Makati Medical Center medical community for its support and engagement with the MMC leadership in a truly collaborative spirit during the last five months of this menacing viral pandemic. I accept and believe that your two interim CEOs [Mr. Arnold C. Ocampo and I] would not have been able to hold the fort–without the general cooperation of this group’s members.

 

The support of the MMC Medical Staff Association in handling matters that fell within or outside its domain is most valued. The assistance of the physician members of the MMC Board of Directors is most notable. The involvement of all Department Chairpersons, whose individual and collective voices always provide the much-needed rallying support, is much appreciated.

 

On a personal note, I can probably count on the fingers of just one hand the number of instances when contentious issues were lengthily discussed and argued upon in this group. As I have always mentioned before, I welcome being challenged about a policy or protocol—for as long as we adhere to what is factual, honest, true, and well-intentioned. I welcome engaging anyone in a professional and courteous manner. I always keep in mind that no one has a monopoly of good intentions and brilliant ideas - which should all be resolved in an objective and truthful manner.

 

Here, in the span of five months, a cordial and collegial atmosphere has generally prevailed in all exchanges—across all demographics, regardless of age, gender, the field of specialization, etc. I surmise that in all contentious discussions, the overarching concern for the common good is the sole and vital bond that carries all of us through. I must also say that during the peak surges of COVID-19 in March and April 2020, not one soul voiced major dissent to every policy and promulgation that was issued from my office [or from the office of the VP for Finance].  Thank you all for this. I thank you all for allowing us to do what urgently needed to be done—unchallenged and unquestioned—during the times we needed the greatest cooperation and conciliatory attitude from everyone. I am witness to the vile and vitriol that prevailed in other groups where I happened to be a part of—outside our community.

 

In April, this community has lost one of its members, Dr. Roberto V. Anastacio, from the Section of Cardiology. He, unfortunately, takes the distinction of being the lone mortality in MMC. To those who may not know it, he also takes the distinction of being like a second father to me—which definitely made his demise more painfully difficult to accept not only as a Medical Director but also as a colleague, a friend, or a son to an esteemed mentor.

 

We are still in the midst of the pandemic, but as the second wave of COVID-19 infections hits MMC and us, the indomitable spirit of the medical professionals is once again on full display.

 

As we speak, there are still challenges that we confront every day—the unrelenting droves of COVID-19 patients in our Emergency Room despite the Full Capacity announcement, the infection among our healthcare workers and trainees which fortunately are mostly asymptomatic or mildly symptomatic, community-acquired and colleague-transmitted, the increased demand for COVID-19 RT-PCR testing, the manpower capacity that keeps dwindling, the need to fully serve our non-COVID patients who have been sidelined for five months, the constant efforts to maintain adequate supplies of PPEs, anti-COVID medications, and equipment, as well as the ever-challenging PhilHealth reimbursements now saddled with corruption charges on top of its lamentable bureaucracy just to name a few.

 

We have gone through bad times, and now presumably, even worse times with COVID-19. But what keeps us all resiliently standing are the various hospital leaders and their teams from both the medical and corporate sides who have carried us through this journey. In a few weeks, Mr. Arnold C. Ocampo and I will turn over the reins of MMC to the new CEO, Atty. Pilar Nenuca P. Almira. I enjoin everyone to extend full support to the new CEO to ensure that we remain headed toward the right direction in confronting this pandemic and charting the path for MMC.

 

I urge and I plead that we stay the course - the collaborative, productive, and engaging course - as we navigate through the chaos brought about by this viral scorn. God bless.

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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.