Monthly Archives: July 2014

Fernando Chua, MD (Anesthesiologist – Chinese General Hospital) RIP

Fernando

Fernando Chua, MD passed away today, July 19, 2014: his friends and proteges in the Chinese General Hospital are still in shock as we write this. He expired at 11:30AM, and from the call of his closest friend, Dr. Samuel Ang earlier, at 3:00pm, as much as he would say he expected it: Dr. Ang was obviously not yet grieving, but he was trying to take it all in, trying to understand what all this would mean to him and to the other friends of Dr. Fernando, who were seen by Dr. Fernando to be under his protection from a corrupt and corrupting world. This, we guess, summed up Fernando Chua: his large (and loud) presence and personality, and yes, his complexity, made him difficult to understand, and yet impossible to shake off. He was a loyal friend, a fierce enemy: no matter how your were classified (friend or foe? No in-betweens) in his book, he was quite a presence.

There is no way to write about this legendary anesthesiologist of Chinese General Hospital: legendary in temper, principles, likes, and dislikes. One thing for those of us who really did not know him well but could claim to at least some efforts to comprehend this incredible bundle of energy, it never failed to strike us that in his element, which was when he was in the Operating Room of the hospital he had served for over three decades with some of the best medical doctors in the country, he was usually wearing his University of Connecticut OR cap (which he is wearing in the photo we have put up above). That cap said a lot about the man, as it was the University where one of his children successfully hurdled medical internship. He loved his family, but it also said a lot about his belief that most good things emanated from the United States. It was his badge of honor to have his medical doctor-sons in the United States, making a name for themselves in medicine, having been given opportunities he had helped get, but opportunities he also never had in his life; and there is another son here in Manila who is helping manage a business concern that he was proudly involved in conceptualizing and starting. We would have friendly, even if one-sided arguments. It was one-sided because he thought, since we were younger, we really had yet to see what he had seen. Very much like Samuel Taylor Coleridge’s poem, the Ancient Mariner, he was not out to exchange ideas: he was here, in front of you, to impart wisdom, stories, and warnings about the wrath of a natural law in this world where there was a confused sense of right and wrong.

He was of the old school in many ways. He would proudly share stories of what he had been able to buy for his children. It was a contradiction of the man, to proudly declare to all the material goods he was able to give his loved ones, but to insist that most of what were important could never be quantified or even physically grasped. Maybe it was not a contradiction: just way of objectifying that parental affection. That OR cap also said to and of him, and everyone else, that he had come a long way from his days of trying to make something out of his life; it was his emblem in his world, which was really the Chinese General Hospital: it was a declaration of arrival. But no doubt he also had his share of people in this age of Facebook would be described as “unfriends”: as his ability to throw a tantrum was the stuff of stories that had been passed, retold, blown-up from one generation of Chinese General Hospital health workers and patients to another. Silence could also be his ultimate signal of contempt. His eyes and ears were sensitive to all sorts of nuances that a wrong shift of a tone, or an improper or disrespectful inflection, could provoke an immediate rebuke.

Aside from being an unforgettable character, we are writing this because he imprinted in us one lesson that he kept insisting we should learn. He said it was all we needed to be worthy of being a member of the human race: that for a man to be successful, to be respectable, to be somebody who for him was worth associating with, the basic ingredient was simple: It was to have a great sense of shame. “You have to have a great sense of shame if you want to be somebody worthy of trust and friendship. I tell that to my children. I tell that to my junior doctors. Ask them if I really say that. Ask Dr. Benito. I tell them when they do things, they should consider what their family and friends will say. They should ask: will my family and friends be embarassed by this thing I do, or will they be proud?” He was so insistent about it, as he thought there was a short supply of such a sense of embarrassment, that he had to tell you, he just must tell us people who were significantly his junior, and obviously for him, it was his way of showing his hopes and care for us, junior members of the human race. It was this passing of a man, whose affection, or even love for his family, friends, and colleagues was marked by a shout out for some sense of shame that made him so memorable. Just like the Ancient Mariner, it was figuratively the albatross around his neck, this sense that we live in a world of no shame. He was very old fashioned in this old world kind of way.

We had been asking him for an interview for this website, and that would never happen now. In spite of his age and his battle with cancer, we note the passing of Dr. Fernando Chua with sadness and disbelief. He was 68 years old.

Interview: Vicente Santos, Jr., MD (Ophthalmologist, Educator, Administrator)

Santos

Dr. Vicente Santos, Jr. is an ophthalmologist, president of Fatima Medical Center, educator and board member of Fatima University. No doubt he, together with his family, is a major force in the field of medicine in the Philippines, as a clinician, educator, and businessman.

You wear many hats in your group, which one do you enjoy the most?

First and foremost I am an ophthalmologist, but I enjoy all of them: I like teaching the undergraduates, the medical students. I enjoy doing strategic planning with our management team.

What is exciting you in your field right now?

I just got certified to do a procedure called SMILE, which is an acronym for Small Incision Lenticule Extraction, which is a technology that doesn’t, unlike Lasik, use a blade. Unlike Lasik, this procedure doesn’t need to open the corneal flap. I think there are around six of us certified, five in St. Luke’s Global, their refractive crew, and myself here in Fatima. This has been done 80,000 times already, so it is a pretty stable procedure.

Why should a layman be interested in this procedure?

20 million procedures have been done for Lasik, so it is a work horse in ophthalmology. The risk is minimal, but you also use a blade. A flap or blade complication is possible, even if remote, in Lasik, and this is not there in SMILE. But of course there is no such thing as there is no risk.

How old Fatima?

47 years.

How are you and your siblings different from your parents in managing Fatima?

We are more structured, more objective in our metrics. My parents relied on many things that were more subjective, like relationships, friendships, gut feel. We have professionalized the organization significantly, as a way not only of surviving, but of moving up and improving. We pushed the organization to go through certifications and accreditations. Although of course compared to us, our parents were much more hardworking and driven. Our family lived in the hospital for two or three years, precisely because they were that focused and dedicated, aside from the fact that it was at that time, during the construction phase our house was torn down to build the nursing school, and our ancestral home was being reconstructed.

Nursing as a college major, and the number of unemployed nurses have become problems in our country. You have seen it from both ends as a school that produces nurses, and as a hospital that employs them. What do you think should be done to solve this problem?

I think what the government did is correct: they put a moratorium on new nursing schools. During the peak of the wave of people enrolling in nursing schools, it was almost like people were putting a nursing school in their garage or anywhere they can set up one. That is happily not there anymore. Many have closed down. Enrollment fads come in waves, and there will be a next wave. There was a wave in the 1970s and 2000. There will be another surge because of the population growth, the opening again of opportunities in the First World.

Being a doctor and a hospital administrator: how do you assess Philhealth?

They are very reliable. The various complications in reimbursements are there, but I should say Philhealth is very reliable. We in ophthalmology are paid pretty well, I mean relatively well. For this reason, some have approached their practice by going for volume, while others have wanted to maintain a very high quality, disregarding the volume. But if you are a patient, Philhealth is willing to take care of your needs up to P16,000.00. That is not a small amount, and so hospitals and doctors give it importance.

What would you wish for Philippine health care if you could make a wish?

I would like to see more hospitals built outside Metro Manila. There are still many places that are underserved. Of course I also wish for the same quality that we have here in Manila to be the same all over the country. The WHO recommendation is for 15 beds per 100,000 people, we only have 5 beds for 100,000 people, so even if you double our current number, we are still far from the ideal.

Manuel V. Pangilinan’s group has been buying hospitals and many seem to be ready to put out the welcome mat to sell to them. Are you ready for them? How do you see them?

At the level of competition, of course it keeps everyone on their toes, and that is good. If your question is if we are going to sell out, the answer is no. Maybe for partnerships we are open, but definitely to sell out we are not open as we have worked very hard for years to build Fatima, we won’t just let it go. One can look at them as a threat, and of course that is true; but if we look at the vision, and if the vision of everyone is quality health care, then the threat may be overblown, because as I said, there is a shortage of hospitals and there is actually room for more, but of course we mean there is more room for quality services and quality hospitals, I don’t just mean an increase in number of beds.

Is the quality of human resources a problem? I am interested in knowing your views on this, again because you are in the education of the human resources side of health care, and with the hospital end you are employing these graduates.

Migration is of course a major problem. As soon as a person gets certified, meaning they can already do things at the level above the usual average, they leave or get pirated immediately. Then you start the retraining all over again. We are not just talking about nurses, but the whole spectrum of hospital people, medtechs, laboratory technicians, radtechs, everyone, even doctors. Happily, enrollment for medical doctors is up, there is a surge, and that is good news for medical schools, it is good news for the country, good as well for the global health industry, as it ensures continuity in the entry of doctors in the industry.

Your sub-specialization is retina. How are we in the Philippines compared to other countries?

No doubt we are at par with the best in the world.

What is your vision for Fatima?

We did announce that we hope to build a 150-bed hospital in Antipolo. We are looking for opportunities outside Metro Manila, we want a presence in South Luzon. Maybe even down in the Visayas. We hope for more expansion in the future.

Are the graduates of our high school system improving? You meet the intake of your school on a regular basis.

Yes, I think they are improving and there are a lot of efforts to improve the system. K-12 is a big move, and I think an important move. This is a very concrete move, and quite a sacrifice for colleges and universities, as our population of students would go down by as much as 50 percent for maybe four years. Information is also easily accessible now, and I think it can only help us as a nation to become better, to keep improving.

Who are the biggest influences on you as a doctor?

Dr. Mario Aquino for ophthalmology and Dr. Pearl Tamesis Villalon for retina. These were my mentors in St. Luke’s, and they were really great teachers, not just great doctors. In UERM the list is long, there is Dr. Joven Cuanang, there is Dr. Romeo Divinagracia; the names will be endless if I have to list each of them down.

What will surprise people about running a hospital?

I am not sure if there is anything that will surprise people about running a hospital: there is of course the possibility of making a decent profit, but there is also a large amount of spending to be done on a constant basis. One must be able to balance both in order to do well, and one has to manage the hospital well in order to achieve stability and income. There are a few groups getting money from doctors to put up a hospital, but some have failed to factor in the need for quality equipment, which is also very important.

What do you do outside medicine and management?

I like joining marathons and golf.

Which marathon have you joined that is most challenging?

I have joined the Lu Marathan du Medoc in the Bordeaux region of France, which is quite a challenge. This is a 42 kilometer run, and you have 21 stops where you have to drink wine and water. It was a lot of fun, but it was also very challenging, and actually very difficult.

How about as a golfer: are you good?

I cannot say I am good. But fortunately, in spite of that, I can say I have made a hole-in-one, and according to golf stats, it is quite a rare event, even among the masters. I made that hole-in-one just last March.

Do you have credible witnesses to this event, and did they sign the necessary papers as witnesses?

Yes! (Laughter)

Is this skill or luck?

(Laughter) Well, I am hoping it is partly skill. There are some people who say to increase your chances of doing a hole-in-one, you have to play golf every day for two lifetimes. Of course this doesn’t mean I am more skilled than anyone, because luck definitely had a role in it.

Is there any book you have read that you find very compelling that you would like to share with our readers?

Freakonomics: A Rogue Economist Explores the Hidden Side of Everything by Steven Levitt and Stephen Dubner. It reminds you of many things we tend to either ignore or forget. I also loved the book The Perfection Point: Sports Science Predicts the Fastest Man, the Highest Jump, and the Limits of Athletic Performance by John Breknus. This is a book that tells you what is the optimum performance possible of an athlete in a given event, assuming all conditions are right; it is very data and science driven.

I can see from your two recommended books that you are into facts, hard data, and what they mean in the science of the real world. Maybe that is why you are into marathons, you are into pushing the limits of what is said to be possible and optimum.

Yes, come to think of it, yes.