My first prescription

The first phase of my clinical rotation in various departments at the Philippine General Hospital was full of doubts, angst, and frustrations. As a product of online medical school in my preclinical years, the feeling of inadequacy has been part of the duty bag I carry every day through the hallways and the wards. I also have to face the reality of the country’s health care system, and in the dusty corners of the century-old hospital, I would find myself trying to answer the question: Do we provide quality care?

For a student like me, who was robbed of opportunities because of the pandemic, the community medicine rotation at the Intramuros Health Center would be the first actual community experience. Everyone in our block was excited; we were all looking forward to writing our first prescriptions.

We held our consultations under the makeshift tents at the back of the health center, beside a golf course, which is both ironically and strategically located. Audel (not his real name), one of my first patients, came in with the chief complaint of abdominal pain. As a clinical clerk, I was expected to conduct a comprehensive history and physical examination. I had to ask about his COVID vaccination and his sexual history, even though his most pressing concern was epigastric pain. Maybe Audel felt weird about my questions because he kept on mentioning this abdominal pain of his. He then revealed that he had been admitted two weeks prior due to a syphilis infection. He broke down—it was a cry for help. Usually, silence in the middle of an interview means figuring out what to ask next, but silence this time was my way of comforting him. After a few minutes, I then proceeded to ask about his living conditions. Audel is unemployed; he lives with his brother’s family but still feels alone. He cried for the second time, this time in despair.

“Walang-wala na po ako. Gusto ko na lang pong mawala.” He expressed, having no money, lacking people who could support him, and losing the will to live. I could see the misery in his eyes amidst the background of the highly-maintained, green golf course.

After the thorough interview and examination, I wrote on my prescription pad: “Omeprazole 20 mg/tab, uminom ng dalawang tableta kada araw.” That was the first prescription I made with my signature on it. It was another milestone in my med journey. As part of the prescription process, I explained the nature of his disease and the treatment regimen. The interview ended at 11 a.m. (patient education for beginners takes a lot of time). He arrived at 7 a.m., consultations started at 8 a.m., and my interview with him started at 10 a.m. After waiting for four hours, which could be the most extended four hours of his life, he would go home empty-handed, without the treatment for the very reason he sought a consultation. The health center did not have any omeprazole.

Our community medicine rotation was a breather from the adrenaline rush in the emergency department and the countless blood extractions in the wards. However, the same question haunted me as I walked through the streets of the walled city of Intramuros. Do we provide quality care? Life outside PGH might feel less toxic and more fulfilling for me, but for most of our patients, health care experiences inside and outside the hospital do not necessarily differ. It’s the same subpar experience.

That day, I locked myself up in the room. It was all med kilig until I saw Audel throw the white piece of paper onto a black container labeled “NABUBULOK” as he exited the center. Walang-wala na nga siya, wala pang omeprazole sa center.

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Vincent Racoma, 24, is a clinical clerk at the UP-Philippine General Hospital.

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