Our interview with Dr. Samuel Ang received an incredible number of hits, and the positive feedback from our readers have exceeded even our most optimistic expectations. Aside from Dr. Ang’s large following, we thought this may be due to the great interest worldwide on cancer, and so this time we decided to interview Dr. Jay Arnold Famador, a fast rising Filipino gynecologic oncologist, also known for his compassion for the patient, to get a perspective from a more junior member of the medical community. Dr. Famador was a student council president in his college-activist days at the Ateneo De Manila University, earning an undergraduate degree in economics, and soon after graduation served in Butuan, Agusan Del Sur, as an economics teacher. He came back to Manila and soon entered medical school. He is now an obstetric gynecologist and gynecologic oncologist. We are certain to hear more good things about him from the medical community in the near future. Here are excerpts of our interview conducted via email while Dr. Famador was in Vietnam:
What is getting you excited about your profession?
Radical tumor debulking cancer surgery (cytoreductive surgery) and minimally invasive surgery (laparoscopic surgery) have been quite exciting for me.
Kindly elaborate on this for the lay person.
These are surgical techniques that I have been learning recently and slowly adopting in the treatment of my patients.
Cytoreductive surgery aims to remove all visible tumors in the abdominal cavity. In the surgical treatment of advanced ovarian cancer, usually we have to be content with removing minimal amount of tumor just to make a biopsy because of the extensive spread of the cancer all over the abdomen. We then hope that chemotherapy will be able slow down the disease to allow for some extension of life. The techniques we are learning now will hopefully allow us to go after tumors that have spread, which we used to just leave behind.
Laparoscopy or minimally invasive surgery isn’t really new. It’s just new to me. The excitement derives from the learning, in improving one’s craft, and the practical benefits these may have for patients.
Why are you in Vietnam? What is unique about them?
Last month, I was with seven other Filipino doctors attended a workshop on cytoreductive surgery for ovarian cancer in the University of California Irvine. The workshop exposed us to cutting-edge surgical techniques and I hope that this learning opportunity will translate into better treatment outcomes for our patients back home.
Currently, I am back in Vietnam with a couple of colleagues continuing a training course in gynecologic laparoscopic surgery. Although training in laparoscopy is now being offered in Manila by our own local experts in an effort to pass on their knowledge and skills to fellow Filipino colleagues, the economics involved for interested individuals is still quite prohibitive. Our Vietnamese counterparts were offering a training course that was relatively much cheaper compared to ours as well as to those in other countries, the venue was geographically feasible, and indeed it was a chance to be exposed to technology that is already standard of care internationally.
What immediately struck me was that the gynecologic surgeries here are routinely done laparoscopically unless medically contraindicated. Back in the Philippines, laparoscopic surgery is reserved only for those who can afford it. In Vietnam or at least in this particular government hospital, it is the standard of care for all patients.
According to one of the doctors I asked, their “normal” patients (as opposed to private patients), would spend only around 100-200 US dollars for laparoscopic surgery in their hospital. That their government has been able to keep these costs low to benefit the people is extremely impressive to me.
How many years have you been practicing? And after all these years, what have you learned about us human beings in the practice of your profession?
I have only been in private practice for around five years. I have seen and accepted that mankind struggles endlessly in various levels and spheres of existence to overcome conflict. Some conflicts are due to “acts of God,” like cancer in the case of my patients, or Yolanda in the case of recent typhoon victims. A lot of conflicts however, whether individual or societal, I think, are also self-inflicted, caused by irrational choices, emotional instability, ignorance, or even outright psychiatric pathology.
What is the most frustrating part of your job?
What can really be frustrating is when my ability to treat a patient is limited by economic realities.
If there is something you can improve with the health care system of the Philippines, what would it be?
Number one would be to rationalize the access of indigent patients to government subsidies for public healthcare services. Patients seeking government funding for treatment have to go all the way to legislators or the Philippine Charity Sweepstakes to line up and wait for a month or more to obtain some letter of authority to present to a hospital like the Philippine General Hospital to allow the release of a meager amount. There must be a more efficient way of doing this.
How did your undergraduate years as an economics student at the Ateneo de Manila University help you as a medical doctor?
I’m not really sure, but I think being a student of economics during my undergraduate years allowed me to gain a broader perspective of the world. Unless one is in the field of public health or maybe epidemiology, the practice of specialized medicine tends to narrow one’s perspective of reality. I guess the little exposure I got in earning my undergraduate degree in economics helped me gain a more multidimensional appreciation of the world.
If you could do it all over again, would you have gone straight to pre-med, or would you still have opted for the route of going for an undergraduate degree in economics?
If I had a choice, I would still prefer the route I took.
Studying medicine mostly involves years of memorizing volumes of information and constantly preparing to be tested on how much you can recall. It kills the brain. It is intellectual torture. Intellectual curiosity and critical thought can easily be stifled over the years of driving oneself to become a doctor. Contrary to the image that studying medicine to become a doctor will make you smarter; it can actually make you dumb, or dumber.
Who influenced you the most in your formation as a medical doctor?
It would have to be my father, Dr. Benjamin Famador, Jr. who happens to also be a fellow obstetrician-gynecologist and gynecologic oncologist. My mother is a pediatrician so both my parents are doctors. During my residency training, I had the privilege to observe my father practice and to directly learn from him. His skill as a gynecologic surgeon is difficult to equal. He is an idealist who has preached and practiced ethical medicine: sometimes too dogmatically to a fault. He told me not to be content with my training as a resident and urged me to seek further subspecialty training even if it entailed additional years of sacrifice.
Please share some books or authors that have helped you and you want our readers to know about.
Most of the reading I have been doing have been limited to medical journals. Not much excitement there but a necessity to keep abreast with my field of specialization. Surgery for Ovarian Cancer by Robert Bristow and Beth Karlan is the latest medical book I got. The one and only non-medical book I read recently is Philippine Cultural Disasters: Essays on an Age of Hyper Consumption by my good friend R. Kwan Laurel. I really have to acknowledge my friend because the only authors whom I would say have helped me understand the world were those handful of thinkers I had the good fortune of reading because of him: Erich Fromm, Herbert Marcuse, Edward Said. But those readings were long ago. They were read during my university days. Having the time to read at leisure is something I greatly miss and is a privilege I no longer have.