Filipino doctors and nurses working in one of the hospitals in Jubail KSA are now despairing because salary have not yet been given for the past three months. This is also true for Doctors of other nationalities who have no salary for 4-5 months.

Employees of the said hospital are complaining of poor management. In one year not even one staff meeting had been called. The General Manager is rarely seen and when he is in, he locks himself inside his office while employees wait outside for a chance to talk to him.

More often than not the door opens so he can leave hurriedly from the hospital to wherever he is going that appears to be more important.

By MARILYNN MARCHIONE, AP Medical Writer Marilynn Marchione, Ap Medical Writer – Mon Jun 14, 10:59 am ET

We fret about airport scanners, power lines, cell phones and even microwaves. It’s true that we get too much radiation. But it’s not from those sources — it’s from too many medical tests.

Americans get the most medical radiation in the world, even more than folks in other rich countries. The U.S. accounts for half of the most advanced procedures that use radiation, and the average American’s dose has grown sixfold over the last couple of decades.

Too much radiation raises the risk of cancer. That risk is growing because people in everyday situations are getting imaging tests far too often. Like the New Hampshire teen who was about to get a CT scan to check for kidney stones until a radiologist, Dr. Steven Birnbaum, discovered he’d already had 14 of these powerful X-rays for previous episodes. Adding up the total dose, “I was horrified” at the cancer risk it posed, Birnbaum said.

After his own daughter, Molly, was given too many scans following a car accident, Birnbaum took action: He asked the two hospitals where he works to watch for any patients who had had 10 or more CT scans, or patients under 40 who had had five — clearly dangerous amounts. They found 50 people over a three-year period, including a young woman with 31 abdominal scans.

When other radiologists tell him they’ve never found such a case, Birnbaum replies: “That tells me you haven’t looked.”

Of the many ways Americans are overtested and overtreated, imaging is one of the most common and insidious. CT scans — “super X-rays” that give fast, extremely detailed images — have soared in use over the last decade, often replacing tests that don’t require radiation, such as ultrasound and MRI, or magnetic resonance imaging.

Radiation is a hidden danger — you don’t feel it when you get it, and any damage usually doesn’t show up for years. Taken individually, tests that use radiation pose little risk. Over time, though, the dose accumulates.

Doctors don’t keep track of radiation given their patients — they order a test, not a dose. Except for mammograms, there are no federal rules on radiation dose. Children and young women, who are most vulnerable to radiation harm, sometimes get too much at busy imaging centers that don’t adjust doses for each patient’s size.

That may soon change. In interviews with The Associated Press, U.S. Food and Drug Administration officials described steps in the works, including possibly requiring device makers to print the radiation dose on each X-ray or other image so patients and doctors can see how much was given.

The FDA also is pushing industry and doctors to set standard doses for common tests such as CT scans.

“We are considering requirements and guidelines for record-keeping of dose and other technical parameters of the imaging exam,” said Sean Boyd, chief of the FDA’s diagnostic devices branch.

A near-term goal: developing a “radiation medical record” to track dose from cradle to grave.

“One of the ways we could improve care is if we had a running sort of Geiger counter” that a doctor checked before ordering a test, said Dr. Prashant Kaul of Duke University.

He led an eye-opening study that found that U.S. heart attack patients get the radiation equivalent of 850 chest X-rays over the first few days they are in the hospital — much of it for repeat tests that may not have been needed.

How much radiation is risky?

It’s hard to say. The best guess is based on the 1986 Chernobyl nuclear power plant accident and studies of Japanese atomic bomb survivors who had excess cancer risk after exposures of 50 to 150 millisieverts (a measure of dose) of radiation.

A chest or abdominal CT scan involves 10 to 20 millisieverts, versus 0.01 to 0.1 for an ordinary chest X-ray, less than 1 for a mammogram, and as little as 0.005 for a dental X-ray. Natural radiation from the sun and soil accounts for about 2 millisieverts a year.

A big study last year estimated that 4 million Americans get more than 20 millisieverts a year from medical imaging. Two percent of people in the study had high exposure — 20 to 50 millisieverts.

Another study by Columbia University researchers, published in 2007, estimated that in a few decades, as many as 2 percent of all cancers in the U.S. might be due to radiation from CT scans given now. Since previous studies suggest that a third of all tests are unnecessary, 20 million adults and more than 1 million children are needlessly being put at risk, they concluded.

Just because a scan didn’t find anything wrong doesn’t mean a test wasn’t needed. Scans are useful for many diagnoses. But many studies suggest people are getting too much imaging now. For example, Mayo Clinic researchers reviewed the medical records of 251 people given heart scans in 2007 and found that only a quarter of them were clearly appropriate.

Reasons for overuse:

_Accuracy and ease of use. Scans have become a crutch for doctors afraid of using exams and judgment to make a diagnosis. Some think a picture tells more than it does. Imaging that shows arthritis in a knee or back problems doesn’t reveal how to make it better, said Dr. Richard Baron, a primary care doctor in Philadelphia.

“Physical therapy for an orthopedic injury is always the first choice,” yet doctors rush to order tests, he said. “The question you should be asking when you do sophisticated imaging is, ‘Is there something I can fix with an operation?’”

_Malpractice fear. A missed heart attack or a burst appendix could be devastating for a patient — and mean a lawsuit.

“I have great sympathy for the ER physicians because of the responsibility placed in their hands with strangers that come in off the street,” said Louis Wagner, chief physicist at the University of Texas in Houston. “They have to make a decision that could mean life or death for a patient, and the fastest way to find out is CT.”

_Patient pressure. People urge doctors to “do something” to figure out what’s wrong, and “often, doctors feel that the way to demonstrate that they’re doing something is to order tests,” said Dr. Christopher Cassady, a radiologist at Texas Childrens Hospital and the American Academy of Pediatrics‘ expert on this topic.

At his hospital, doctors first do an ultrasound on suspected appendicitis cases instead of rushing into a CT scan. Ultrasounds require no radiation.

_Health care chaos. One doctor may not know that another has ordered the same test. If a patient is referred to a specialist, “it’s often easier for him to order another study than to figure out how to get the one that was done somewhere else,” Baron said.

_Insurance issues. X-rays often are required by insurers to prove health, or for students to study abroad.

_Availability. Rural hospitals may not have an ultrasound technologist on duty in the wee hours, but imaging machines are always there.

_Treatment choice. A quick fix for chest pain — artery-opening angioplasty — requires far more imaging and radiation than bypass surgery does. The same is true of “virtual colonoscopy” instead of the standard version.

Which tests are overused? A scientific group, the International Commission on Radiological Protection, cites routine chest X-rays when people are admitted to a hospital or before surgery; imaging tests on car crash victims who don’t show signs of head or abdominal injuries; and low-back X-rays in older people with degenerative, but stable, spine conditions.

Even when tests are justified, they often include more views than needed and too much radiation. Top offender: chest CT scans looking for clogged arteries and heart problems. Cardiologists are increasingly aware of this risk and are seeking solutions.

At Columbia University, a study on dummies by Dr. Andrew Jeffrey Einstein found two dose-modifying techniques could lower the needed radiation dose by 90 percent without harming image quality.

Another cardiologist and radiation safety expert, Dr. Gilbert Raff, showed the same in real life. A study he led of nearly 5,000 patients at 15 imaging centers in Michigan found that radiation dose could be cut by two-thirds with no loss of quality.

What should patients do?

“You should question everything — what’s the dose, why am I getting it? You should be an informed consumer,” said Dr. Fred Mettler, radiology chief in the New Mexico Veterans Administration health care system. He led a study of health effects after the Chernobyl accident and is a U.S. representative to the United Nations on radiation safety.

He advised challenging “big ticket” tests like CT scans that deliver a lot of radiation to the chest and abdomen — places where cancer is likely to develop. “You shouldn’t get too excited about feet and knee X-rays,” Mettler said.

Questions to ask about radiation scans:

_Is it truly needed? How will it change my care?

_Have you or another doctor done this test on me before?

_Are there alternatives like ultrasound or MRI?

_How many scans will be done? Could one or two be enough?

_Will the dose be adjusted for my gender, age and size? Will lead shields be used to keep radiation away from places it can do harm?

_Do you have a financial stake in the machines that will be used?

_Can I have a copy of the image and information on the dose?

Mettler suggests bringing a blank CD or thumb drive with you.

“You should have all of your stuff digitally on something,” he said. “I keep mine on my laptop.”

I AM one of the 18 (or possibly more) doctors who resigned from the JR Borja General Hospital last month. I am writing to express disgust on a news item aired over ABS-CBN last Monday (July 1, 2009), in which our own mayor, Constantino Jaraula, said the physicians who tendered their resignations did so because they have higher plans for their career. I recalled Mayor Tinnex saying “Kay gusto man sila muadto sa Amerika.”

This is a blatant lie that I and my colleagues in the profession cannot allow to perpetuate. It may be good for the mayor and the general public to know that most of those who resigned had immediately taken positions in community-oriented health care services. Some of us are in small-staffed clinics that cater services to the poor with their low-priced medicines and consultation fees. Some had gone back to their private practice, as they find more peace of mind in the confines of their small, comfy clinics than suffer hell in the politically charged work environment that is our city hospital.

Also, we are sad that ABS-CBN did nothing to verify the mayor’s statement. We physicians may have limited knowledge on what constitutes a balanced news report, but this we know: A dubious claim or declaration should not be left unchallenged so as not to leave doubts in the public’s mind. The ABS-CBN report merely parroted the mayor’s statement. In fact, the report sounded too slanted to favor the mayor’s assertion.

We also decry the suggestion that our erstwhile employment at JR Borja General Hospital was aimed at gathering experience for improved employment prospects in the future. We were there because we love our profession. Some of us stuck there for years despite delayed salaries and poor working conditions. Some of us even had to shell out supplies from our private clinics because the hospital miserably lacked almost everything that patients badly need.

To suggest that we were carving our stepping stones from the hospital is twice an insult for us. By saying that, isn’t the mayor admitting that the local government can’t pay decent salaries for its doctors to be so desperate as to employ the inexperienced ones? Is this not a tacit admission that the local government is making JR Borja General Hospital a training center for newcomers in the profession simply because it can’t afford to pay doctors who are well established in the medical community?

We are not leeches. We are humans who are dedicated to the job of saving people’s lives, whether in our private practice or in government service. Contrary to what is purveyed in the media by Mayor Jaraula, we are not the butterfly type who hops from one employment to another. Please stop stereotyping us in the medical profession as a bunch of greedy people itching to go out of the country and earn big. It may be prudent to check our backgrounds from the hospital management itself to establish our credentials.

Unfortunately, it is local officials like Mayor Jaraula who are driving us out of government service. There is too much politicking and corruption going on at the hospital. The hospital suffered greatly in the last administration; it is suffering more under the present one.

We commend The Gold Star Daily and other media entities for exposing the ills at the city-run hospital. We hope for your unrelenting reportage on the issue would usher in the change we’ve been hoping for.

On behalf of the resigned physicians we remain,

Dr. R.D. (Resigned Doctor)
(PS. Please understand that I and my colleagues have decided to remain in the shadows, as we are aware how vindictive our current officials are.)

I am writing this to show my sentiments on the current issue that the Chief of Hospital of J.R. Borja General Hospital in the person of Dr. Dures Tagayuna received an order recalling her to the City Health Office.

What’s all the fuzz? Dr. Tagayuna has done more for the Hospital and it’s Personnel and Staff in the past 2 years she served as Chief of Hospital than any of her predecessors who served the same period. She was sweet-talked into running an almost dying institution probably not so much as to save it but more so in the hope of making her a political ally by the way things are going.

However, seeing that her being in her present office is not serving IT’S ORIGINAL PURPOSE but rather going in a different direction notwithstanding that direction is for the good of the institution and of it’s staff and clientele, she is being ordered to vacate her office in the pretense of being needed elsewhere for her leadership.

If the appointing office really believes in her capabilities as a leader, they will retain her in her present office and not put her at some imaginary station where she is supposed to be of better service. That reasoning may go unchallenged by the run of the mill folks whose loyalties can be easily bought by a handful of pesos but to expect the honest intelligent worker to believe that, is definitely an insult.

Dr. Tagayuna has her eye on the future of J.R. Borja General City Hospital. She hopes she can make a difference and leave a legacy for the succeeding generations of patients who will benefit from such changes. She is even willing to die for it but apparently others “entities” have set their sight on the hospital too and one can only wonder what they see.

What do they see? Do they see a leader who can bring the hospital to greater heights or do they see an obstacle to their own purposes? Do they see the health workers serving more than they are required to, under substandard condition, being exposed to communicable diseases with inadequate protection and no hazard fee? Or do they see sweatshops where they can cut down on benefits and save money for other projects? Do they see the father who is the breadwinner of the family laying sick in a worn out bed? Do they see the mother of 10 children taking care of a sick baby? Do they see a 10 year-old child wondering what he will do with the prescription in his hand because there is no medicine available in the hospital pharmacy? Or do they see that at least none of them are their fathers, neither their mothers, nor their sons nor their daughters? Do they see the sick who seek the comforts of the hospital or do they only see what the hospital can give back to the City?

Who took it upon themselves to be responsible for caring for the people? Do you? We at J.R. Borja General City Hospital do! That’s why we cannot just sit down and let anybody take away from us, a good leader who has given this hospital a direction. She boosted the staff’s morale that had been hanging low in the past several years and pulling her out means pulling everyone’s morale down.

If the goal is to make everyone subservient to the whims of a self-seeking power then the hope for change will be crushed. How long can one keep on banging his head against the wall if the wall does not give in? Until he finds another way to survive without banging his head on the wall.

I have worked in the hospital for almost three years now. With my training, I thought I could make a difference. On my own I found out I could not. It took the presence of a passionate leader to help realize some of those hopes. Suddenly, going to work is not so much of a burden anymore knowing what we are doing is not going to waste. While we still lack equipment to give the most basic of services, while we are still short on supplies, while some of our basic benefits are still not given to us, we can work thinking, all those problems are workable and someday the solutions will be found by the right person/s with the right attitude.

Health should be a priority that is not affected by biases, pride, and powerplay. Dr. Dures Tagayuna is the man for the job as Chief of the J.R. Borja General City Hospital. Remove her from the helm and the hospital will be like a ship without a Captain, driven wherever the wind fancies it to go. If you want to save the hospital put Dr. Tagayuna at the helm.

DR. RICHEL BACOT
Medical Officer IV
J.R. Borja General Hospital
Cagayan de Oro City
Mindanao

WELCOME TO PGH, THE NATIONAL UNIVERSITY HOSPITAL
(by virtue of Republic Act 9500, or the UP Charter of 2008)

Mabuhay from PGH, the Philippines’ 102-year old national tertiary referral center and teaching hospital of UP Manila (The Health Sciences Center) that includes the UP College of Medicine, UP College of Nursing, UP College of Dentistry and allied colleges. It is the largest government hospital administered by the UP System (not by the Department of Health); occupies 10 hectares of prime Manila real estate, 45 interconnected and stand-alone buildings, and 125,000 square meters of floor area; consists of 19 clinical departments distributed in the in- and outpatient sections, 1500 patient beds (1000 charity, 500 pay and special units); and includes modernized and upgraded service, training and research facilities, the latest of which are emergency and radiodiagnostic complexes, the National Eye Referral Center (Sentro Oftalmologico Jose Rizal) and the soon-to-operate Faculty Medical Arts Building (FMAB), among others.

Since its creation by Philippine Commission Act 1688 on August 17, 1907 and subsequent opening to the public on September 1, 1910 with 300 beds, PGH stood by s — its noble purpose of providing quality health care to the Filipino people especially to the underserved. From 1985 to 1991, PGH underwent a major renovation and expansion program, necessitating a dramatic increase in manpower, hospital services and equipment. Today, PGH boasts of about 4000 medical and non-medical employees, a wide array of general, subspecialty and cutting-edge services, and complete support programs and facilities that enable it to render comprehensive quality care to both healthy and sick Filipinos, in particular the indigent and marginalized.

Our shared vision for 2004-2009 says it all: “We are a community of first-rate, highly-energized, socially-responsible healthcare professionals and workers collectively enhancing the national and international image of UP-PGH as the national university hospital showcasing excellence and leadership in client service, training, research and governance”. We go by the battlecry “Tatak PGH Plus” and the simple objectives of (1) delivering what is core in our abovecited four areas of engagement, (2) raising the bar, and (3) setting and achieving leadership targets. We are guided by core values/initiatives which are expressed as slogans: excellence, leadership, basic courtesy and professionalism in the workplace (“magaling na, magalang pa”, “bagong anyo”), along with thriftiness, resourcefulness and loyalty (“iwas waldas”, “dagdag kita”, “magmalasakit, PGH muna”), and patient and environment safety (“malinis at ligtas tayo sa PGH”). We celebrated our Centennial Year from August 17, 2006 to August 17, 2007, and beyond that pledged to (1) sustain, enhance and share PGH’s best practices and successful initiatives; (2) pursue priority project – human resource enrichment, personnel welfare and incentives, quality management systems improvement and modernization/rehabilitation; and (3) benchmark PGH with the best national university hospitals in Asia and the world. On our shoulders fall the daunting tasks of preparing PGH for the second 100 years of its glorious existence. This includes massive rehabilitation of existing physical plant, a multi-storey building housing new facilities, top-of-the-line hospital equipment, fully-computerized systems, a markedly improved human resource management program and a sustainable ISO certification. With the wellspring of support from the National Government, the university, our philanthropic pool of governmental, non-governmental and private groups and individuals here and abroad, and most of all the Filipino public, PGH will be able to celebrate a meaningful and momentous centenary.

On to the next “100 Years of Excellence and Leadership in Quality Healthcare for the Filipino”!
Carmelo A. Alfiler, MD Director, Philippine General Hospital