Today, I felt the weight of being the lone medical doctor in the vicinty with a vengeance.
The resort is on Pamalican Island, one of the smaller islands in the Cuyo Islands far north of the Palawan mainland. The small archipelago is divided into two island groups. Pamalican belongs to the Quiniluban group which is even farther north. The seat of the municipality is in Cuyo Island, which is also where the nearest hospital is. It is five hours away by boat, when the sea is not choppy. The trip may be even longer when the winds are strong, as they are during these months.
For people living in the Quiniluban group of islands, the nearest available doctor is the one in Pamalican.
Having lived in an urban environment all my life, where a hospital is just a short ride away, it is hard for my mind to embrace the fact that most Filipinos are hours away from any form of medical care. It would be simple enough if distance were the only problem they have to contend with. Unfortunately, most times, they must come from places with no real roads, sometimes on foot, or travel over the sea for hours in a fisherman's boat before they can even get to a nurse or a midwife.
I cannot even begin to imagine how barrio doctors practice in areas even more remote than mine, with no access to proper medical equiment or medication, no way of asking colleagues for advice, and no means of transporting their patients to centers where they can be better helped.
Most of my off-island patients come from Manamoc, an hour's trip away by fishing boat on a rough day, who usually have relatives or acquaintances who are working at the resort. There have been rare instances when medical emergencies have prompted the doctor to leave the island by boat to attend to a patient too sick to travel. One particularly harrowing story involved a complicated birth assisted by a midwife where the placenta had not separated from the uterus properly with the mother bleeding incessantly. The doctor on duty at the time had to go by boat to Manamoc to manually extract the placenta - which, fortunately, stopped the patient from bleeding to death.
Back to present.
They brought me a baby today, 3 months old, who has been having diarrhea for 3 days. She had sunken eyeballs and a sunken fontanelle, with a slightly sluggish capillary refill time, but at least she still had tears in her eyes when she cried. Since she was a baby with moderate signs of dehydration, the ideal place to manage her would be at least a secondary hospital.
She got me and my little clinic instead.
It was not with a little irritation that I asked the parents why they had waited 3 days before they brought her to a doctor. If they had seen a doctor as soon as the diarrhea had started they could have been advised on how to replace her losses, and she would not have been so dehydrated as to need intravenous replacement. They couldn't come earlier because the waves were too high for their boat, they said. They had to travel from another small island to Manamoc then, after a night's rest, to me. They had originally planned to take the baby to Cuyo, but there would be no boat leaving for the bigger island until tomorrow morning. I was their only alternative.
As I've said several times, I've been treating only adult patients for the past three years. And while I can tell you how to choose and adjust fluids for adults with different conditions, I am a complete blank when it comes to doing the same for children. Not to mention a baby! But none of us really had a choice in the matter, not the parents, not the hapless doctor, and certainly not the baby. However, thanks to the wonders of the telephone and my pedia friends, I managed to get a line going (with great difficulty!) and regulate it accordingly. Diarrhea with dehydration seems simple enough to treat, but when you're riding point with zip recent clinical experience, it sure as hell doesn't feel that way.
It's hard to believe that she's actually better off than a lot of other children somewhere else in the country at this moment in time.
So tonight the baby and her family are staying on our island, rooming with their utility worker relative, instead of staying in a hospital ward for observation. She is being monitored by her parents, who have strict instructions to make sure that the fluids I started are running properly. I will be checking on her in a few hours just to make sure I'm not replacing the fluids too fast. And I am hoping that one of the following will be true by tomorrow: a) that she no longer has diarrhea and is properly hydrated or b) the winds and the sea will allow them to travel to Cuyo tomorrow so the baby can get the medical attention she needs.
Wish us all luck.