Choosing medicine, with the years of sacrifice and hardwork it entails, is considered as a great leap into the unknown. The challenge does not end there, because after four gruelling years of medical school comes the spectrum of specializations that we have to choose from. Amid the common belief that physicians realize their growth only in the confines of the hospital, there are some who take the road less travelled and reach out to far-flung areas in order to promote public health.
Dr. Malaya Pimentel-Santos, also known by many simply as “Dr. Maya” is currently the academic head of the Department of Pathology in SLCM. She shared with us her experiences and insights from the moment she discovered her passion to how it continues to motivate her to thrive and to serve the people.
Igniting the Spark of Service for the Community
Dr. Maya first discovered her love for public health through her community service organization, UP Pagsama, back when she was still a medical student. Being a part of medical missions, health trainings and community-based programs run by non-government organizations (NGOs) has been a good avenue for her to gain perspective on the actual health situation in different communities.
“Medical students tend to be sheltered throughout elementary, high school, and college. Joining Pagsama created the perfect opportunity for me to see how different the realities are outside of my school and hospital environment. For instance, here at St. Luke’s, we have state of the art facilities and equipment, and those who have the resources can have access to the best and latest medical care. But if you just go farther and look closely at the situation outside – even more so in rural communities – you will see that despite the availability of modern forms of healthcare, there are still a lot of people who cannot afford it. Being exposed to these harsh realities was an eye opener for me, and I was active in community service throughout medical school, and even after” says Dr. Maya.
With early exposure to public health, Dr. Maya found her niche in several uncharted areas in the community as she continues to extend herself for the “last, least, and lost” of the underserved in receiving adequate medical care. After graduating from medical school, she started to work at a government hospital in Palawan, treating different kinds of patients. She cites a particular incident as an example; “I was on duty on ER and I received a call that there had been a jeepney accident near our area. There were some who had multiple injuries while some only had a few scratches and there were 30, 40, or 50 patients admitted and that made me ask ‘Ilang tao ba ang kakasya sa jeep?‘”.
Traversing the Road to Specialization
Handling a wide range of cases in Palawan was an arduous struggle. With this, she shared her experience in caring for a patient who had spontaneous abortion; her patient underwent dilatation and curettage but subsequently became hypotensive, so she was given intravenous fluids for fluid resuscitation. The same patient stabilized the next day although her eyes became swollen. “Because of that experience, I became conscious of a growing feeling of being inadequate… Working as a general practitioner, I couldn’t claim expertise in any field, and I often had to refer to the consultant specialists — so I decided I also wanted to specialize”, Dr. Maya muses.
Dr. Maya chose Dermatology as her specialization and had her residency training in Philippine General Hospital (PGH). “I wanted something both medical and procedural and during residency we managed a lot of interesting cases: deep fungal infections, leprosy, rare tumors and autoimmune conditions. During my training, the emphasis was not so much on the cosmetic aspects of dermatology.” After residency, she received the Jack Aron Scholarship at Tulane University (New Orleans, Louisiana), where Dr. Maya enrolled in a Master’s Program in Public Health and Tropical Medicine. She did several researches on different diseases such as Coccidiomycosis, STDs, Leprosy, and other cases related to Dermatology.
Planting Projects from the Grassroots Level
After finishing her post-graduate studies, Dr. Maya came back to the Philippines and worked as executive director of a non-government organization called the Philippine Center for Traditional and Asian Medicine.
“We would go out to remote communities, and help set up community based health programs. We conducted trainings on traditional medicine then we would teach basic anatomy and physiology to our participants who are mostly mothers and high school graduates. We would also train them how to take blood pressure, get the pulse rate… We would teach them tepid sponge bath for fever or steam inhalation and herbal medication for cough,”
“But why traditional medicine and herbal medications? Because once you teach them how to do it, they have something they can use, that is available in their community. Many people in far-flung areas have to walk for five hours just to get to the nearest health center and once they reach it and avail free consultation, they would usually be prescribed with medicines and if they have do money to buy the meds, they might not be able to comply… traditional and herbal medicine is something they can apply when they encounter simple illnesses and they won’t feel helpless — ‘iniiwasan natin yong pakiramdam na wala akong pera, hindi ko kaya, hindi ako makapagpatingin.”
Dr. Maya worked for the said NGO for five years until its operation terminated in 2009 due to funding problems. After that, she started her career track in the academe here at SLCM. She currently handles subjects such as Histology, Pathology, and Microbiology where she helps students remember topics by relating them to the actual health predicaments of our country.
“I share my public health orientation even when I teach; I try to introduce a little bit of social relevance especially with the infections given that we live in a country where diseases of poverty are still a major concern. If you go to developed countries, conditions like scabies or diarrhea are not as common, since hygiene has improved and overcrowding is not anymore a problem… I continue to share insights from my masters in Tropical Medicine about microbial diseases, helminthology and other tropical diseases.”
Empowering the Community through LEARNS
Dr. Maya is currently working on a project in partnership with the National Leprosy Control Program of the Department of Health (DOH) and the Novartis Foundation. Although leprosy is no longer a public health threat, there are still cases in our country its stigma continues to exist. The first mobile phone-based leprosy referral system called “Leprosy Alert Response Network and Surveillance” or LEARNS was created to aid in early case finding. Among the goals of this project are to identify and cure patients, prevent disability and help interrupt transmission of leprosy in the Philippines. This mobile health (mHealth) project is being done in partnership with the DOH, the regional health officers, and other key stakeholders. “When you develop a system and want it to be implemented, you need to coordinate properly; otherwise, you might end up with a technology that nobody wants to use. In consultation with other stakeholders, we chose the midwives and Barangay Health Worksers (BHWs) as the primary users, since they know their community better. In this instance, the most relevant user would be the one closest to the community,” Dr. Maya says.
“The ownership of DOH was crucial for the success of the project since we alone cannot implement it to different communities all over the country. The DOH has the resources and the personnel, and their support will help ensure its broader implementation, on a nationwide scale”.
Experiences and Challenges as a Public Health Advocate
We do not just work for the community — we work with the community. They will share a slice of their lives with you and you should share yours with them as well.
“Among doctors, relationship building is done through roundtable discussions, conferences, and sharing meals/breaking bread, often in nice restaurants. The counterpart of it in the community can include sleeping in their houses and sharing food with them. You have to be part of what they are doing regardless of what you personally feel about it otherwise you may feel like an outsider and they would not tell you their problems and the solutions they need,” Dr. Maya says.
Our current public health situation transcends mere vicarious understanding. Working at the grassroots level allows you to see and experience our chronic health problems in the community. “You may have projects to offer, but oftentimes, the challenge is finding resources and implementing the project in a way that can be sustainable. You really cannot treat health as an isolated thing; you also have to address economic development before instituting lasting changes in the health system,” she continues.
“What I’m doing here may or may not really make a difference in the long term — but I believe that one way to make a difference is through programs that successfully mobilize and engage the community such that they continue to work even after the project is officially over. Although medical missions can temporarily help, the community is still left powerless as they may not know how to manage their health. That’s why all health programs should always be coupled with proper health education and training so you could leave something to the community which they can use over and over again.”
Opportunities for Medical Students
Can medical students do something as early as now? Dr. Maya affirms that it’s definitely possible.
“There are many community service and outreach groups that work in the health sector. For instance, the Council for Health and Development (CHD) is an umbrella organization of community-based programs all over the country. They also have residency program for physicians who want to go through community medicine. For medical students, they can partner with NGOs such as the Community Medicine Development (ComMed) Foundation and participate in activities during summer vacation or semestral breaks”, she says.
In addition to this, the College also actively participates in community-based activities through our student organization, Sagip Bayan which organizes medical missions across different areas and also the Outreach Committee under the Student Council which facilitates tree planting and health education throughout the school year. Truly, a medical student shall always have an opportunity to learn and serve the people wherever his heart desires.
For those who are interested one may contact ComMed Foundation through their email address, email@example.com or at their phone number, 09178693046 for further inquiries. – Denise Joy Emmanuelle Lopez