When It Rains...

I seem to have lost Girl Power Claire somewhere along the way about six months ago, and I've been struggling to find her ever since.

To be fair, I have had quite a lot to deal with these past few months. You would think that after having pulled myself up by the roots to move to an entirely new country, everything else would be a piece of cake... NOT! I don't know, maybe the pressure of a new job just doesn't agree with me. Maybe I'm just not very good at dealing with change.

Or maybe, deep down inside, I am really just a Type B kind of person playing at being a Type A lunatic.

It doesn't help that at this point, I'm still so muddled about what it is that I really want. It's hard to motivate yourself to a course of action when you're not very clear on what your motives are.

What the heck am I doing here and what am I doing it for?

I feel bad about whining when in reality I am pretty lucky to be where I am... but sometimes, being lucky is relative. All I know is that these days, it seems that all there is is rain... and it's pouring pretty darn hard.

Okay, rant over.

*sigh*



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Lunacy

Manila Traffic photo by tadzima

There is no other word to appropriately describe Manila traffic.

I'm going be the annoying, complaining, stereotypical Pinoy ex-pat just this once and not be apologetic for it... I need the stress release after just having had the most harrowing time trying to get back into the Pinoy driver every-man-for-himself mindset - easily translated as "Kill or be road kill."

Maybe cars don't go quite as fast in Manila as they do in Oz. But over there, I don't have to contend with fellow drivers who think they're either in some rally race or in Enchanted Kingdom's bumper car ring. There are no jeepneys that swerve from the middle of the road to pick up passengers on the sidewalk with absolutely no warning. There are no buses bearing down on you like huge angry monsters trying to bully you into submission by using their size.

There are no insane pedestrians that come out of nowhere and dart in front of your car just as the lights have changed. No motorcycle drivers or cyclists with death wishes who use the narrowest of spaces in between cars with no caution or heed. And it's unheard to sit in traffic for one hour covering a distance that can actually be driven in 10 minutes elsewhere.

It's utter chaos.

Try as I might, I don't think I'll ever understand the psychology of Manila traffic. Allowing one car to move ahead of you in a traffic queue seems tantamount to having one's teeth pulled. "Giving way" is a concept that seems completely foreign to us Pinoys driving in Manila - probably because any driver who practices "giving way" here will never get anywhere because other drivers will mark him as a wuss and run all over him.

I'm not sure we've realized the sheer ill logic of our behavior. We refuse to follow traffic rules because we figure no one else does so, hence not following the rules will probably get us to where we want to go in a shorter amount of time. But it's actually our refusal to follow traffic rules that increases traffic snarls exponentially - and gets all of us stuck in our cars, wasting precious time sitting in traffic jams unimaginable to anyone who's never been in one.

Driving in Manila again after just six months of driving in Perth, where traffic rules are not merely suggestions and where "rush hour congestion" means moving at 60 kph on an 80 kph road, has been akin to being thrown back into hell after experiencing a fleeting taste of paradise.

This is definitely not something that I've missed.

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I Don't Feel Like Dancing...

For most of this year, I've felt positive, energized, and empowered.

Today just hasn't been one of those days.

I should be thankful that my city by the water has made it so easy to embrace solitude. It's hard to feel lonely alone when surrounded by reminders of how beautiful the world actually is. I get worried sometimes that being here has made it so frighteningly easy to be content in my own company.

But there are days when even being close to my beloved ocean, running by the river, or lying on the grass in one of Perth's myriad open spaces staring at the bright blue sky all fail to soothe.

And those times I just feel alone - and wonder what the hell I'm doing here.

Middleton Beach, Albany early on an overcast morning, taken with my Nikon D40

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Prices Based on Twin Share

a panorama of Busselton Beach (2 hours out of Perth) by Dave Curtis

My itchy feet have been acting up again, and they, along with the unexpected gift of 4 days off coming up on my roster, have turned my thoughts to travel dreaming once more. After all, while I was in residency I couldn't stop complaining about how I never had enough time from the hospital to travel - so what kind of crazy fool would I be to pass up this opportunity?

Along those lines, I've put my OC skills to researching flight costs, bus fares, and accommodation costs - a painful reminder of the harsh reality that going places costs a pretty penny. Struggling to keep my penny-pinching side from screaming me into abandoning the idea completely, I determinedly plodded on, only to run smack-dab into another frustrating stumbling block.

In my quest to plan my first-ever solo holiday, I have come to discover that the travel industry is not at all kind to single wanderers. All the bargain holiday packages come with the following clause attached, "Prices quoted based on twin sharing."

It's almost enough to tear a single girl's hair out in frustration.

I've been having an inner debate on whether or not it would be a good idea to fly over east to Melbourne (where I've been several times before) to spend a few days with the relatives, versus traveling by myself to somewhere in the vast and beautiful state of Western Australia which I've never seen before.

Option A would definitely cost me less and be the safer and wiser choice - but where would be the adventure in that? I don't deny I'd enjoy seeing family again after six months of being totally cut off. But taking a plane ride or a long-haul bus ride to visit relatives at some far-away destination is definitely not the same as planning on a whole vacation - even a short one - entirely on my own.

On the other hand, every single girl should have at least one solo holiday under her belt. Despite my best intentions, I've never actually gone on a holiday solo. After proving I can be independent after my life-altering move to Perth, I figure it's high time I smashed through my self-imposed limits of needing a travel companion to indulge my insatiable wanderlust. And I figure there's no better time to do it but now.

Now if only the logistics would fall into place.

I still haven't booked where to go - a must given that it's the height of summer here and school holidays are in full swing - because I haven't quite made up my mind where to take my itchy feet. I'd love to drive my car over because in Australia a car is an absolute necessity when exploring the overwhelmingly huge countryside, but I'm not sure I'm quite ready for that yet. I can always take a bus from here to the country towns, but I won't have wheels to get from one attraction to another when I get there.

Then there's that irritating, totally discriminatory twin-share rate.

Obviously, at this point, I'm still in the process of trying to figure things out. I just know that one those four days off, I will not be in Perth and be off having an adventure somewhere - on my first-ever solo travel holiday. I'm open to suggestions... does anyone have any? Click here to read the rest of this post.

The More Things Change...

In the few weeks I have been here, one question that's often asked of me is, "What made you come here?"

I find that it's easier to tell them about the dismal working conditions, the laughable salary, and the feeling that I am getting nowhere fast on my career track and let them draw their own conclusions about me (i.e. "what kind of mercenary so-and-so is she?"). It would be more complicated to explain to them about my compulsive need to turn my life upside down in an effort to get unstuck and maybe get my life going. Which, to be honest, it has done.

Still, one thing I am quickly beginning to realize is that one brave thing does not necessarily lead to another. And the overused cliche, "The more things change, the more they stay the same," is obviously a cliche for a reason.

My friends have all sung to me about the benefits of living abroad - even temporarily. It's supposed to be my fresh start, my chance to get out of my shell, to learn to be confident in my own skin, maybe to even reinvent myself into the person I've always wanted people to see me as but was too entrenched in my own pattern to do so.

The truth is, reinventing myself may be a good idea in theory, but apparently I am simply incapable of doing so. I would love to be able to channel the vibe of my friend, Y, who is sassy and mysterious and uber-confident, or, E, who is sweet, adorable, and exudes a "let's-take-care-of-her" air. Instead I can only be me, equal parts ditzy and capable, gung ho, no-nonsense, snarky and easy to get a rise from, chicken and self-conscious, and very what-you-see-is-what-you-get.

Still, maybe it's only early days yet. Then again, that's part of what worries me. Just a few weeks into my big move, I'm already sliding (kicking and screaming on the inside, believe me) into the same role and persona I have tried in vain to shed every time I have moved from one stage of my life (and one group of friends) to the next. And all I can think is, "WTF am I doing wrong?"

Obviously, they can take the girl out of the Philippines, but they can't take the Philippines out of the girl.

So, does anyone want to give me tips on how to claw myself out of this potential rut before I'm actually stuck in it again?

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R.I.P.

For some weird reason, all of my gadgets have started acting up on me ever since I flew them over here. Just last week, my CD drive suddenly disappeared from my laptop... my Palm PDA refuses to hot sync with my computer at the worst possible time... now, to top it off, a traveler's worst gadget nightmare has happened.

My digital camera has apparently kicked the bucket.

I got my Cybershot as a medical school graduation gift from my parents, and it's been a constant travel companion eversince. It's been with me through far and wide, high seas and mountains (not a lot of these, though), good and bad weather, drunk and sober times (yes, this is relevant). I've never had much trouble with it over the past three years and change I've had it - so its demise has come as a complete shocker.

Well, maybe not a complete shocker. It's been doing that flickering LCD thing ever since Aman - which I initially put down to overexposure from the blinding white sands of the beach. I thought it had had it when we were in Anawangin after it got caught in the rain - after my last sunset shot, it flickered and died. Thankfully, it came back to life after I charged it back home, so I thought it was probably just the battery.

I've been going around my adopted city these past two weeks with it in tow, but being a traveler alone makes it tricky to take too many pictures. It seemed alright the few times I brought it out - I was even able to get a picture of me and my landlady at the bed and breakfast I was staying at last week. So imagine my dismay when I tried it out right before I left for a day exploring King's Park the other day (more on that another time).

When I turned it on, I was treated to a laser light show complete with hissing sound effects instead of a functioning LCD and zoom lens. I took out the battery and put it back in, then turned it on - and the retractable lens just peeked at me, moved out halfway, then died. I plugged it into the wall, in an attempt to charge it, but when I turned it on, the anti-red eye orange light blinked several times, the flash went off once - then it died.

It has since then refused to switch on since. Not even for a flicker.

Given labor and repair costs here - which are atrocious - it may be cheaper to throw it out and get a new one. You can imagine just how distressing this is for me - I'm living in a foreign country and just itching to take photos as I explore it for posterity, I am trying to save up and my first paycheck is already accounted for by expenses even before I get it... and this happens! I wasn't planning on a new camera until after a year... only then, I was planning on getting an SLR. So much for that!

Besides that, it feels like I'm saying goodbye to a really good friend. *sigh* (Now you have an idea why I am such a pack rat.)

So long, my little Cybershot! :(

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You're Putting WHAT in my Mouth?!

photo by megnicol

Acting on the wise advice of everyone who's gone an a long trip away from home, I've been spending the past few days (apart from fixing my papers and embracing my new role as an OFW) catching up on my dental work.

Much as I like my dentist as a person, I am one of those who considers a session in the "hot seat" akin to a stint in purgatory regardless of what form of pain she chooses to inflict on me at the time. The less I see of her the better. Now that I've experienced getting a tooth extracted, I have revised my opinion - a visit to the dentist is not a trip to purgatory but a trip straight to hell.

One of my molars has been undergoing intensive root canal treatments for a while - probably another legacy of too much sweets as a child. A few weeks ago, after an x-ray, my dentist gave me the devastating verdict that the tooth was beyond saving. If I didn't want to suddenly wake up with the mother of all toothaches when I'm stuck in a place where all health-related services are notoriously expensive unless you're covered by Medicare, the molar had to go ASAP.

After going through all the stages in the dying process - denial ("Are you sure nothing can be done?"), anger ("I've been getting a root canal for months, what do you mean I have to get my tooth taken out?"), bargaining ("Maybe we can try for a few more treatments and I can have it taken out when I get back?"), depression ("I can't believe I am actually going to have a permanent tooth taken out at 31. At this rate I'll have a mouthful of false teeth by the time I'm 60."), and finally acceptance ("Fine, let's get this sucker out once and for all.") - I finally had my tooth taken out a few hours ago. The trauma is so fresh that I have yet to feel sensation return to my lips and tongue even as I type.

With all due respect to my dentist and all the other dentists in the world -- I really don't know how they can do what they do. I can't even imagine how they grow up wanting to do what they eventually do! How does one grow up wanting to become a dentist? I'm not saying it's not good honest work and a much needed skilled profession. It's just that that someone who actually wants to do this because he enjoys it must have an unacknowledged sadistic streak lurking somewhere. They definitely have it in spades over surgeons - who at least cut and inflict pain on patients asleep and wear the mantle of the but-I'm-saving-his-life syndrome to justify it.

Dentists do their work on a fully awake patient who can feel every twist, scrape, wiggle, and tug as they do it. Despite the advent of anesthetics and modern instruments, the prodding and the pulling that modern dentists do still eerily calls to mind untrained barbers doing the same thing a century or two ago.

At the sight of my dentist laying out the things she was going to need to pull out my one measly tooth, it was all I could do not to squawk in panic at the array of vicious looking sticks, picks, and pliers - not to mention that evil-looking hypodermic needle. The only way I could think of to get through the experience without being scarred for life was to keep my eyes closed. That way I didn't have to give into the urge to screech, "You're going to put THAT in my mouth!" every time my dentist picked up another instrument from her tray and approached my open mouth with it.

The extraction procedure was, quite thankfully, a textbook one despite my fleeting urge to go into hysterics.

An empty stomach did not deter me from popping two different kinds of analgesic right after the procedure to counter the sucker punch of pain that's bound to come once the effect of the lidocaine has completely faded out. The anesthetic is beginning to wear off, so I'm going to go get an ice cream now. Not being able to eat solid foods is a good excuse as anything to get a sundae without guilt.

Frankly, I hope I never, never have to go through anything like that ever again. Or should the occasion ever arise, I'm going to insist on a general anesthetic so I can sleep through every tug and pull.

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Laid to Waste

So Sick of This by aperfectfailure

Due to incredibly bad luck, the three hectic days I spent attending my specialty society's annual convention - full days of lectures by day and living out of various hotel rooms at night - was capped with a serious bout of acute gastroenterititis.

It sucks big time to be sick.

My troubles started yesterday afternoon, a few hours after lunch, when my stomach suddenly started doing some serious acrobatics. I'm not going to go into detail about the unsavory bodily functions that went horribly awry after that, but suffice it to say that by the evening, I had lost a LOT of water - and my intestines weren't through making me miserable. I felt weak and dehydrated, but I couldn't bring myself to drink to replace my losses because every time I did, my gut would tumble in protest.

I woke up a few times in the course of the night to go to the bathroom, and by this morning, I was not only dehydrated but also fuzzy from the lack of sleep. Thankfully, my tummy had settled down enough for me to take some soup and more liquids this morning, but my entire body screamed in protest every time I moved. Using the last of my energy, I hauled my backpack heavy with dirty clothes and another heavier bag of freebies to catch a cab home.

As a doctor who knows her stuff, I knew this would be self-limiting and nothing to worry about too much. But as a patient in abject misery, I thought it would never end and wished for a bit more sympathy from my friends apart from being told I just needed to hydrate and wait it out. The problem with understanding what's going on with yourself when you're sick and being surrounded by people who also know what's what is that you don't get to milk this period of vulnerability for what it's worth.

After spending the afternoon in bed despite the sweltering heat, trying to recover from one of the worst bouts of diarrhea I've had in years, I feel marginally human again. Maybe after a few more bottles of Gatorade, I'll finally stop feeling like someone stole my brain and replaced it with cotton.

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Lost in Makati-land

My visa sponsorship finally came in Wednesday. I've been busy putting together my papers to send off to Australia - and I finally got to do it yesterday afternoon. Looks like I may make my deadline after all.

But that's not really what this post is about.

This morning, as part of my visa requirements, I had to go into the heart of the Makati central business district to get a medical exam done. Not being a bona fide Makati yuppie, I haven't really had any chance to wander the CBD. Apart from my occasional visits to the malls, Makati is a foreign to me as another country.

After today, I have come to realize that it is as confusing to me as Wonderland must have been to Alice.

Murphy was certainly working overtime on me today. For one thing, my alarm didn't go off, and I left the house late - which considerably complicated my plans. I couldn't get an FX that would go directly to Ayala Avenue, where I could get off across the street from the clinic. After almost an hour of waiting along Ortigas for a ride, I hoofed it back home to get my car and drive to Makati - smack at the height of rush hour traffic.

Being of a practical bent, I wasn't about to take the car directly into the heart of the CBD, where parking rates were atrocious. I chose to park the car at Glorietta, the biggest mall complex there, and was planning on taking a bus or a cab to the clinic instead.

Easier said than done, given the confusing maze of underpasses and lack of pedestrian crossings along Ayala Avenue.

I emerged from the parking complex in front of Rustan's and found the underpass that let me cross the road to the side where I mean to catch the bus. At the stop, I was refused a ride by the driver, who told me it was only an unloading zone. I needed to walk further down Ayala to get to the loading zone.

Obedient commuter that I am, I followed his instructions and walked a couple of blocks to the intersection of Ayala and Makati Avenue. I could see the bus stop in the distance, a few meters away - only to have my way barred by a fence that screamed, "No pedestrian crossing!"

What the fudge? How was I supposed to get to the other side?

Incensed, I walked back the way I came, looking for an underpass that would possibly allow me to emerge on the other side once more... but I couldn't find any until I came to the first underpass I used. Left with no other choice, I crossed back to my starting point and walked the same couple of blocks back towards Makati Avenue until I finally came to another underpass that finally led me to the loading zone.

What should have been a simple walk a couple of blocks long in a straight line turned out to be one confusing zig-zagging among the underpasses. Anyone who plans to go around Makati on foot should arm himself with a map of the underpass network rather than a street map!

I appreciate the efforts of Makati to keep their pedestrians safe and maybe to improve the traffic situation, but is it too much to ask them to make the underpasses less confusing and allow pedestrians to cross at street level on intersections not provided with an underpass?

It was an incredibly confusing and tiring day overall. And that's not even taking into consideration how I had to take two and a half liters of fluid in the span of 30 minutes for my medical exam... but that's another story!

It's a good thing I have the prospect of another new summer travel adventure to brighten my day. Tomorrow... destination: Anawangin!


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It's Out of My Hands - and I'm Going Nuts

Now that I've more or less made my immediate future plans more public, everyone has been asking me when I am leaving for Perth.

My standard response used to be, "Probably some time in May to early June." After a few weeks of the apparent inactivity of my employers' visa sponsorship papers in the DIMC, it became, "When the visa comes through - and, oh by the way, I haven't lodged my application yet."

These days, when asked the same question, I no longer attest when the visa comes through - I say, "If the visa ever comes through."

The waiting is obviously eroding into my optimism big time and undermining what little hard-earned courage I have to do this.

While patience has never been my strong suit, there is something else that makes my leaving within the next three months crucial. Due to the evolving rules regarding practicing medicine in Australia with a temporary registration, all who apply for a temporary license after June 30 are required to have passed the Australian Medical Council's written exam when they apply.

At the moment, all they require of foreign medical graduates to work in Western Australia is for an application to take the AMC exam to already be underway, authenticated credentials from your training institution, an acceptable score on the academic IELTS (for medical practitioners, 7 and above), and an initial application by your employer for temporary registration.

Scheduling the AMC written exam is no easy feat. At this point, the earliest schedule I can get would be in July 1, which I can take here in Manila. The rest of the scheduled test dates are off-shore in Australia. Which I cannot enter regardless because I do not have a visa.

*sigh* Maybe it's a sign.

The usual processing time for the visa once it is lodged (something I have YET to do) is roughly 4-8 weeks. If I don't lodge it soon, I'm not going to make deadline. Frankly, I have no idea what will happen if I don't make deadline. Will my employer withdraw my job offer? Will they give me the next few months to study and take the exam? (And taking the exam is a whole other cesspool of anxiety waiting to happen.)

One wonders why I am subjecting myself to this anxiety in the first place. If I had just taken the fellowship exam and gone straight into fellowship, I wouldn't be tearing my hair out in frustration right about now. I could have a well-charted life here. I would be doing a job that is suited to my level of training (a status which I have earned through a lot of hard work, I might add) rather than going down a step and taking on the challenge of being a general practitioner all over again - albeit, hospital based.

Sometimes, it really boggles my mind, too.

It's not so much that I am unpatriotic, and that I can't wait to take the next plane out of here. I won't deny that the better compensation is one of the reasons why I have decided to take a hiatus from training by getting a job abroad. While I have no long-term plans at the moment, I also won't deny that while I am there, I will be taking steps to allow me to eventually apply for a permanent residency should I wish to do so. I hope to come back, but I also believe in keeping options open. Everything at this point is up in the air.

Truth is, I really just want to get out of my staid old box, drive off the paved road, and experience something totally new. Does this make me a selfish, ungrateful person to put my needs first? The guilt hanging over my head says it does, but on another level, I also know I am just doing what I need to do to stay sane.

I've committed myself to this, and I am determined to see everything through regardless of outcome. If, in the end, I don't get to fly out at all, it's not because I didn't make a real go of it.

But it's all out of my hands, and it is driving me nuts.

****

Post Scripts:

* I am interrupting regular programming for the next few days while I shed my anxieties and drink in the beauty of the Caramoan Peninsula with friends. Let's hope our trip to Bicol will not be as cursed by weather as the last time we went. I promise to take lots and lots of pictures this time!

* The Middle of Nowhere visited two medical blog carnivals this week - both very, very interesting reads. Our weekly all-Pinoy Blog Rounds, with the theme "The Doctor as Patient" is up at Dr. Tes's site. One of my posts was also included in this week's Grand Rounds at Dr. Wes's site. Medical-minded readers might want to take a look at those while I'm away. Great weekend reading!

Okay - I'm off to pack for my two days in the summer sun.

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A Night in the Bitter Barn

this photo uploaded by Carhan on Flickr

You know that your family is desperate for you to get off the road to spinsterhood (a.k.a. matandang dalaga in Filipino) when you're told the following in the same mortifying conversation -

"Dapat naman kasi mag-ayos-ayos ka na, para naman mapansin ka. Papayat ka na kasi!" (You really should fix yourself up so that men will notice you. Lose weight!) - my mother.

"Pinagdadasal ko na nga sana naman makahanap na ng boyfriend." (I've been praying that you would finally find a boyfriend.) - a meddling aunt.

"Wag ka mag-alala, pag pumunta ka doon amin yung pinsan mo madami mga kaibigang lalaki, sasabihan na namin ipakilala na sa iyo." (Don't worry, if you come to visit us, your cousin has a lot of male friends, we'll tell her to introduce you.) - a sympathetic, if tactless, uncle.

All this is punctuated by an exchange of worried glances, the meaning of which they might as well have screamed, Poor child. What the heck is WRONG with her? There must be something we can do!

It's bad enough that I know they talk about the barren wasteland that is my love life behind my back. That they have now begun expressing their unsolicited opinion about my singlehood to my face underscores the depth of their concern. And the fact that my mother is encouraging any and all of her relatives to please find her eldest, aging daughter a date is enough to make me want to sink through the floor.

It doesn't seem that long ago when my well-meaning relatives - most specially my mother - were telling me to put any thoughts of a love life in the backseat. Be a good girl and concentrate on my studies first, they said. You'll have time for romantic pursuits when you're older, they said. Concentrate on the more important things first. Yeah, right.

Don't get me wrong, I'm not blaming them for my state of singleness - the reasons for this particular state of my life is multi-factorial. I just find it painfully funny that they are now desperately seeking my Mr. Right after all those years of praying I wouldn't find him just yet. You know, because of all the things I had to take care of first (i.e. getting my medical degree, finishing residency).

Now they think that just because I've finally gotten everything else out of the way, it's high time I started looking for a - you guessed it! - potential husband. News flash, folks - most of the men in my age group are already married, are soon-to-be-married, or are wonderful and gay. Men do not grow on trees, and, even if they did, I am not the kind of woman who could happily pick them up and go my merry way. If only it were that easy...

Apparently, my family has never heard of the saying, "Be careful what you wish for."

Remember when I said that my degree of optimism about being a quirkyalone waxes and wanes? Well, today it's definitely on the wane. I can't lie and say I've never wanted all those things they want for me for myself - because I have. And, believe me, I've whipped myself about it and guessed and second-guessed some more about what I did or what I didn't do to end up alone like this. I guess love just comes hard for some people. Or it just doesn't come at all.

It's hard enough to battle with the demons of self-doubt and the fear of never finding anyone to share my life with without having to add their voices to the mix. I love them and I know they mean well, but sometimes I really wish they would just leave me alone.

Looks like I'm sleeping in the bitter barn tonight. Someone please throw me a rope and help me get out of here.


* * * *

"Oh the fear I've known -
That I might reap the praise of strangers
And end up on my own
All I've sown was a song
But maybe I was wrong...

... I'm working through the grammar of my fears
oh mercy,to have the things that mean the most
Not to mean the things I miss..."

- Language or the Kiss - Indigo Girls



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New POEA Policy on Direct Hiring - How Will This Affect Us Doctors?

I posted this message on the Pinoy MD forum last night, in the hopes that more fellow doctors will be made aware of this new policy on Direct Hiring. I know that most of my contacts and most of those in my extended network are young doctors like myself, who are considering going overseas for training and employment opportunities.

As doctors, most of us who seek work abroad do not go through recruitment agencies but rather apply on our own and are hired directly by hospitals we are matched to (in the US) or are accepted into (in other countries). Since I see no provisos in the copy of the memorandum (you can get to read the full document over here) for doctors, this will definitely affect our own bids to leave the country through direct hiring. This will be particularly problematic for colleagues who have been given H1b visas to the US. The rest of us who are to be sponsored on temporary employment visa will be greatly affected as well.

How it will ultimately affect us (and our chances for being matched and hired by hospitals abroad), I don't know. But its effects will likely be detrimental rather than benificial given the recent economic slowdown and the fierce atmosphere of competition in the world at large. The POEA has just given foreign hospitals one more good reason not to hire Filipino.

Here is the content of my post on the Pinoy MD forum:

Hello, everyone! I hope people will not be angry with me for cross-posting this in the Health Issues Thread and the Career Opportunities thread, but I feel that our community should be made aware of this new policy. Surprisingly enough, it was a doctor friend of mine already working in Australia who picked this story up and posted it on his blog for the rest of us.

http://www.gmanews.tv/story/77354/Warning-aired-vs-new-hiring-policy-for-OFWs

This is very much a topic of concern for doctors because most of the jobs and training programs we secure from abroad are a result of "direct hiring." We do not go through any of the recruitment agencies when we are matched, or when we apply directly to hospitals abroad for RMO positions and the like. I have already been to the POEA site, and you can download the guidelines in PDF form from the home page.

Among the new changes in the policy is the requirement of USD 11,000 as bond for repatriation and the like for every employee that a company hires through direct hiring. Given the extremely competitive atmosphere in the global market, what company would choose to hire a Pinoy worker directly for that much extra cost when he can shell out a lot less to hire some equally qualified worked through a recruitment agency or from another country all together?

Admittedly, this is all allegedly being done in the guise of "protecting" OFWs from being preyed upon by opportunistic direct-hiring companies abroad.

However, given our government's track record, I can't help but question their motives. I can't help but wonder which recruitment agencies managed to lobby hard enough and shell out enough money to have this change implemented. All the more fishy is how a change in policy this significant has not even generated a buzz in the OFW community - is the POEA keeping this under wraps? How could something with huge repercussions for the hundreds of Filipino workers trying to find work abroad and do not want to go through a recruitment agency (that will only get a huge chunk of their cash and process their applications at the same rate or even slower) have been enacted without a peep of protest?

All this has accomplished is to greatly diminish a Filipino OFWs chance of being hired at all - thus forcing him to resort to paying these so-called "legitimate" and "registered" recruitment agencies to help them find a job. In the end, who really has benefited from this policy? Is it the really the Filipino workers? Or the opportunistic recruitment agencies that prey on their desperation? Frankly, the fact that our own countrymen are preying on their own is even more disgusting and difficult to stomach. We continue to become our own enemy.

I know that a good number of people who frequent this board are taking the MLEs and other foreign licensing exams or have been matched already. Since this policy change was implemented January 17, this will all affect you as well.

I really hope that some form of collective action can be initiated and done on this manner. At the very least, the POEA and the DOLE must explain the rationale for this move to the public. It should be our choice to make to stay here rather than to have to unlock shackles of our government's making in order to exercise our right to seek employment in the way we see fit and work abroad.

I hope we all do our part in letting your classmates and friends (especially those with plans to go to the US and have already spent so much of their hard-earned money in the process) know about this new development.

The sooner we can generate enough noise to publicize this and its implications on our future, perhaps it will also be the sooner the government will take action on it. Thank you very much!

As a post-script, I would like to share with you the post of another member of the Pinoy MD forum, which he posted in this thread.

I just happen (sic) to inquire from an Australian recruitment agency. Nakakalungkot but I don't know if this is true for us filipino doctors. I just want to share his reply to me.

Dear Doctor

Thank you for your application, opportunities in Australia have somewhat narrowed for Filipinos. Filipino's (sic) if any are accepted and it is unlikely that they will be are now subject to a 10 000 USD bond refunded on completion of a 2 year contract.

We recommend you try America

Thanks

Doctors Recruitment

Thank you very much, POEA and DOLE, for shutting down the few windows of opportunity our desperate people already have.

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Salt in the Wound

I promised myself I wouldn't post another entry until after my exams on Sunday, but after reading this article ("Estrada: God is punishing the country"), I just couldn't help myself.

Apparently, the ousted ex-President insists on being akin to a Bad Joke on our country that simply refuses to go away.


He not only insists he is innocent in the face of overwhelming evidence to the contrary. He now has the nerve to thumb his nose at the people whose courage and conviction took them to the streets in the revolution that threw him out of Malacanang. He is now saying that the Filipino people are getting their "just desserts" because they refused to keep him, a blatantly amoral president, in power any longer than they had to.

It is a testament to the man's maturity and wisdom - or, rather, his lack thereof - that he continues to rub salt in an already festering wound. How can this man continue to style himself as "para sa masa" (for the masses) if he can throw their suffering in their face with impunity as he sticks out his tongue at them and says, "Beh, buti nga sa inyo, kasalanan nyo yan" (serves all of you right, it's all your fault)?

At the expense of repeating myself, I can only shake my head as I say, "Only in the Philippines."
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Second Guessing

My dad is in the next room, and I think he has pneumonia.

I listened to his lungs, and it sounds like a pneumonia. He was coughing like there's no tomorrow, but the anti-cough medicines I've given him seem to have calmed him down. His respiratory rate is less than 30, and he says he's not having a hard time breathing. I've already started him on oral antibiotics with good coverage for a wide range of possible bugs.

So why am I still awake at 2:30 AM trying to decide whether I should bring him to the ER or not?

You'd think that after 3 years of training in Internal Medicine, I'd be sure of what to do next. After all, I've seen already so many cases of pneumonia, seen patients falling into the full range of the disease. As part of my training, I've evaluated these patients in the ER and in the out-patient clinic and have made quick rational clinical decisions about who can be treated at home and who should be admitted.

I've just finished reading the chapter on pneumonia as part of my review, and I don't think Dad needs to be admitted. Sure, he's a diabetic and hypertensive, but those two conditions are stable anyway. I guess he'll be okay here at home. I haven't even confirmed it's really pneumonia. Maybe I didn't really hear anything.

Or maybe I'm just in denial.

I'm bringing my dad to his doctor as soon as the sun is up. His doctor can decide whether to admit him or treat him out-patient basis.

This plan of action is sure to get my parents' goat yet again. We've had this argument too many times to count. They will play the "what's-the-point-of-your-medical-degree-
if-you-can't-treat-us-anyway" card. I will come out looking like their useless child but I will drag them to a doctor's office anyway.

What most people, especially my parents, cannot understand is that once you're dealing with diagnosing and managing your close family members, all that medical training goes out the window.

Objectivity, an essential element in the clinical decision-making process, is all but impossible. It's easy enough to make treatment decisions for people who you can hold at a certain distance, thinking in terms of likelihoods and probabilities. When you're this close to the ones you are treating, this second guessing simply cannot be helped. It doesn't matter that you're supposed to know better - in that moment, you don't.

So while I think my dad doesn't need to go to the ER right now, I still won't be able to sleep - because I could be wrong.

These are the moments when I have to say it really sucks to be the only doctor in my family.
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Steal Big, Steal Little

These past few days have blurred into one another for their sameness as I continue my frantic cramming for the make or break exam coming at the end of the month. The only difference is which Starbucks branch I choose to park the heavy backpack I use to lug my two volumes of Harrison's around Manila.

This hectic schedule has, ironically, made my world even smaller than it was while I was still working at the hospital. I haven't been watching any TV, nor have I been listening to anything other than my iPod as a means to drown out the noise. Fortunately, thanks to my parents' and Starbucks' newspaper subscriptions, I have been able to keep updated about what's going on.

Not that there's been a lot of good news going around.

After all, the last thing we need at the start of a hopeful new year is to hear that a convicted plunderer is planning to run for president for 2010.

Are we going to once more prove that when it comes to matters of justice, Filipinos' memories are notoriously short?

This man trying to play the semantics game so that he can leap through a constitutional loophole right back into Malacanang is the same man who was convicted of blatantly stealing 3.2 billion pesos from public funds while sitting as president. This convicted felon served his time in relative luxury for a few years; his peers, the hundreds of other convicted thieves, who probably cannot even conceive how much 3.2 billion pesos actually is, languished in inhuman conditions in overcrowded prisons. After a few years of token punishment, this plunderer, who has never once shown even a microcosm of remorse for what he has done and whose crime should be punishable by death, is now strutting free after being pardoned by an equally larcenous incumbent desperate to save her own hide.

Now to top it off, he is now making noise about wanting to be president again after being forcibly pried from his seat a mere few years ago.

And I thought I couldn't get more incensed about the Erap pardon than I already was. This harebrained scheme, hatched by the "forgiven" man himself, truly takes the cake.

To put it bluntly: Ang kapal talaga ng mukha.

Apparently, in the Philippines, there is a difference between stealing big and stealing little. Here's the lesson: if you're going to steal, be smart enough not to get caught. But if you're sloppy and do get caught, stealing little will only land you in jail. Stealing big, on the other hand, gets you a mere slap on the wrist and a get out of jail card for free and leaves you with enough loot to get back into a position where you can steal even bigger.

Only in the Philippines.


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Dreams for Sale

I was at Starbucks yesterday as part of my pathetic attempts to get started at studying, and, as part of my procrastination strategy, browsed through yesterday's papers. One header in particular leapt out at me from the middle of the Inquirer's opinion pages. It's a commentary by Juan Morales called, "Wedding Rings for Visas" and it explores another facet of the great Filipino Diaspora - that phenomenon of marrying to migrate.

Much has already been said about the fact that more and more Filipinos are on a steady march out of the country in search of a better life. They leave every day by the thousands, workers and migrants, pitting themselves against daunting odds in order to be able to earn for their families back home. Others, despairing that the system is no longer salvageable, leave their comfortable lives as they know it and take on jobs they are more than qualified for in order to be able to bring their children with them abroad to ensure their future. The rising desperation quotient has caused this tidal wave of emigration to be whipped up to a frenzy. Its battle cry is to get out of the Philippines by whatever means possible. But while I know that the practice of marrying for convenience for the sake of getting a visa has been around for a long while now, seeing the actual numbers is both staggering and depressing.

Forgive me, I am just trying to wrap my closet romantic's head around the concept of marrying for anything other than love. It is just hard for me to grasp the concept of a commitment that entails so much intimacy and trust and risk being undertaken for the most pragmatic of reasons. While I do not deign to question other people's choices, a part of me grieves that life for many here in our country has become so intolerable that they must to resort to this. Each one who has chosen to go by this path have reasons that are, no doubt, valid. And the closet romantic in me continues to hope that many of them, too, have found their happiness this way.

I don't mean to offend or sound patronizing. Believe me, there is no condemnation here. It is part of our being human to want to improve our condition, and I would be a hypocrite if I said thoughts of leaving for good have never entered my mind. (Part of my being in my "middle of nowhere" is the confusion about where to stake my claim and find my niche as a doctor. Commentaries about junior doctors' plight in the Philippines have been written by people with more eloquence than I, and you can read some of them here and here.) I know I am lucky because I have been given opportunities to develop skills I can barter for my ticket to go abroad. That people are actually bartering themselves in order to find their berth abroad is just reflection of the level of desperation we have ascended to. It is that that truly disturbs and makes my heart just a little bit heavier.

In truth, doesn't every overseas Filipino worker who risks his physical and emotional well-being by choosing to place his stake in the country he plans to work in do the same thing? In the end, after all is said and done, we all just do what we can to survive.

It is a sad reality that so few are able to achieve a level of comfort and security to realize that life is not just about survival, but living.
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Meet Scroogette

My mother loves Christmas. Once the "ber" months roll in, there's no stopping her rabid Christmas spirit from insinuating itself into our hapless household. She starts playing Christmas carols full blast on the living room stereo as early as September. Her Christmas shopping is done by mid-October. The tree, a mind-boggling confection of rust and orange this year, is up by early November, and the gifts are all wrapped and ready for opening by December 1.

I am the anti-thesis of my mother.

I don't know, maybe it's because my mom is such a fanatic about Christmas that she sucks all of the excitement unto herself and doesn't leave much for stragglers like me. But the truth is, I haven't been excited about Christmas since... oh, I'm not sure. Maybe it was when my mother started turning the tree into a decor showcase for Home magazine. Or when I stopped having Christmas vacations. Or maybe it was when I started to spend Christmas immersed in the misery of the patients I work with in the hospital. Having to work with people who have so little just highlights how much of what goes on during this season seems like such a waste.

Whatever the reason, I have become family Scroogette.

It's December 20, and I have yet to start shopping for Christmas presents - wait, I haven't even made my list yet! I look to the coming reunions with dread because I will be banished to the kitchen once more to cook for the posse of relatives who are coming over on Christmas day (with no hospital duty to shield me). Family reunions also mean having to parry the inevitable awkward questions that tactless relatives pose to a hopelessly single, thirty-something niece like me. Meeting up with long lost friends, while refreshing, also serve to remind me that we are no longer who we used to be and that for the most part we just have memories among us and that, under all the laughter, is just sad.

Don't get me wrong, I have nothing against Christmas per se. I do enjoy the parties, the gift giving, the taking time out to reconnect with friends and family. Like any other person, I am not proof to sight of the pretty lights around the city or the enticing smell of seasonal goodies in the air. I do appreciate that, for the first time in several years, I will not have to spend any of the major Christmas holidays on duty at the hospital.

But sometimes, even surrounded by all this happy activity, I can't help but wonder how much of this joyful energy is touched by desperation. It may be cynical, but I can't help but conclude that when it comes to celebrating Christmas, all of us are missing the point.

Whatever. I'm off to face the hopelessly snarled Manila traffic and give new meaning to the phrase panic buying.
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Arrested Development

Most doctors and doctors-in-training will agree -- committing to a career in medicine is akin to jumping voluntarily into a time warp. While our friends and contemporaries take more advanced steps into the world of responsible adulthood -- becoming financially independent, starting their own families -- those of us who chose to pursue further training in medicine are inexorably stuck in this very small but dramatic world called our training hospital. This is especially true of those among us who have chosen to take our residency training here in the Philippines.

Don't be fooled -- we may deal with life and death at work and are still able to think on our feet even after a 36 hour shift, but, for the most part, our personal lives show the emotional maturity level that is closer to adolescent than adult.

It's hard to make plans to invest in a new condo or to plan on getting married and starting a family when you barely make enough in a month to get from day to day. To be brutally honest, a good number of us are still firmly covered by our parents' financial security blanket even as we're pushing 30. It can get pretty frustrating, especially during those days when everything seems to be going wrong, you've done 48 hours straight and are still on the clock, and you can't figure out what insane impulse made you decide to make this your life. When you're pushing 30 and feel that you have nothing concrete to show for it, it seems so much easier to just give it up and be normal.

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Coming Home

It's four days to our 10-year high school reunion.

A part of me is looking forward to seeing my old friends again, some of whom I have not seen since our high school graduation. I know a good number of them have gone abroad and come home, gotten married, had children, and basically have done what they said they were going to do with their lives. I wonder if, when we see each other, we will still be able to see the same girls whom we went to school with back then behind the women we have grown up to be. And although a reunion is time for nostalgia, a part of me wonders if perhaps the past is all most of us will ever have in common.

We have, inevitably, become very different people over the past ten years.

Although biologically I am pushing thirty, I think that about 70% of me is still somewhere in between 8 and 18 years old. It's hard not to remain stuck in that limbo between true adulthood and adolescence when you've spent most of your life in school. Thanks to my parents' overwhelming support, I have yet to know what it's like to worry about where I'm going to get the next month's rent, how I'm going to pay for my utility bills, and what the heck I'm going to do once my credit card bill comes in. Compared to my classmates who have gotten married, become mothers, left home, started their own companies... it feels like I have not grown up very much. It feels like I haven't really taken my life in hand and done anything particularly brave with it.

Much as I look forward to coming home, I cannot help but dread it. Amidst the laughter and the genuine affection, there is a spectre of sadness, a dying of old dreams, because reliving the past makes you realize how different reality is from what you expected it to become when you were 18 and knew you could do anything. It's a celebration of life that is tinged by a hint of tears, a mourning for whom you used to be and whom you wish you could become again.
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Old Barbers and Young Doctors

A consultant recently gave us an inspirational talk and opened his lecture with the following quote: "Two people you cannot trust - a old barber and a young doctor."

I'm in my first two months of residency training in one of the biggest teaching hospitals in the Philippines, and in those two months, I have discovered why they call this the PRACTICE of medicine.

It's true, I've been working in this hospital for the past 3 years. I've been through the grueling 24 hour to 36 hour shifts that never seem to end. I've experienced pushing stretchers, doing the most menial tasks, taking precious catnaps on benches or simply leaning against some wall or table. I've seen patients who don't know where to get their next dose of antibiotics get worse and die, patients with neck masses as big as their heads walk in when it's too late for any doctor to do anything about it. I thought that knowing all this, I knew what I was getting into.

But being a first year resident is nothing like being in medical school.

All at once, all the things you thought you knew recedes into the background and everything you know you don't know suddenly takes up center stage. Faced with a patient who hangs on your every word and takes everything you say as gospel just because you're finally wearing that white coat, all five years of learning the science of medicine is negated by everything you didn't learn about the practice of it.

And when you need the most to deliver, you are appalled by the thought that 80% of the time, you're bluffing your way through it and praying with all your might that what you did, what you thought, what you said was right.

Our seniors tell us that everyone went through this, that we all have to start out this way... because medicine is about practice and experience, and that the mistakes we make with our patients along the way ensures that we'll be able to make a difference in more patients' lives in the future.

Still, knowing this in my mind doesn't take away that awful feeling at the pit of my stomach when I realize that I may have sent someone home that I shouldn't have or that I forgot to stop a certain medication that I should have - and I have no way of calling them to give them further instructions. It doesn't stem the should-have-dones and could-have-dones that flood my mind at the oddest moments, and all but drive me crazy.

This is at the heart of my conflict - am I cut out for this kind of life? There are joys, I admit that. I can't deny that I still love the intellectual guesswork, the analysis, and the joy of clinching the diagnosis... but when I add the actual lives that hang on the balance of my thinking process, it terrifies me so much that I don't know if I want to go on doing this at all.

I will not always be a young doctor. And doctors only get better with time. Still, I can't help but wonder if my heart can endure the seasoning it will take to make me a good doctor... or even if it's what really want to be.

In the meantime, I'm taking it one day at a time... and trying my best to do right by my patients - who don't know about old barbers and are trusting enough or desperate enough to put their lives in my young, unseasoned hands. Click here to read the rest of this post.