Vol 9, Issue No.28 July 2007 (ob29)

Transcription

Volume 9 Issue No. 29
Pasig City, Philippines
July 2007
“Nostalgia in Ilocandia Indeed!”
An Experience Like No Other
They came. They saw. They tasted. They listened. They
played. They learned. And they had one hell of a good
time! For four days last April, the Fellows of the
Philippine Orthopaedic Association and their families
and guests were treated to experiences never before
seen in its history of Midyear Conventions. This was,
in the words of the delegates, “an experience like no
other”.
The convention was held last April 23-26, 2007 at the
Fort Ilocandia Resort Hotel in Laoag City, Ilocos Norte.
This was the first time that the POA convened at the
northernmost region of the Philippines. Delegates and
guests started arriving as early as Sunday, the 21st of
April, a number of them taking the land trip along the
scenic coastal highway of the Ilocos region. The next
day, a Philippine Airlines flight specially chartered by
The Organizing Committee whoop it up as the last guests
departed at the end of “Nostalgia in Ilocandia”.
Delegates and guests lining up to savor native Ilocano snacks on their
arrival at Sitio Remedios.
the Organizing Committee arrived at the Laoag
International Airport, bringing a large portion of the
delegates. They were personally welcomed at the tarmac
by Dr. Godo Dungca, President of the North Luzon Chapter
of the POA. As they waited to collect their personal
belongings at the airport, they were serenaded by a
rondalla ensemble at the airport lobby. The delegates
and guests were then shuttled to Fort Ilocandia where
they were welcomed by the Organizing Committee led by
Dr. Paul Ruel Camina, overall chairman of the 18th
Midyear Convention. Ilocano maidens were also on hand
with garlands made of seashells to welcome the guests.
(Continued to page 2)
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Ortho Balita
Nostalgia in Ilocandia...
Volume 9, Issue No. 29
July 2007
(Continued from page 1)
The POA prexy congratulates members of the 18th Midyear Organizing Committee at the close of a very successful convention
Registration and check-in went
smoothly as this was overseen by Dr.
Jean Pierre Leung, head of the
convention secretariat. Several
activities were ongoing as the guests
came to check-in at the convention
site. Orthopaedic Research was the
theme of the morning. A Poster
Presentation featuring interesting
A rondalla ensemble serenaded the
guests as they went through
registration and check-in
Dr. Joven Cuanang, medical director of St.
Luke’s Hospital, personally welcomed the
delegates to Sitio Remedios
Dr. Kups Villaruel and Dr. Jimmy
Tamayo receive garlands of seashells from pretty Ilocano maidens
upon their arrival at Fort
Ilocandia
(Continued
to page 3)
Dr. Ed Sarrossa officially declaring the 18th
Midyear Convention open
Organizing Committee members pose with Dr. Sandra Tankeh-Torres
in colonial era costumes
July 2007
Ortho Balita
cases managed by POA Fellows in
Northern Luzon was opened at the
convention lobby – the first in a
midyear convention. A workshop on
Research Protocol Writing was also
conducted, as well as the Residents’
Research Forum in the afternoon. The
first of four lunch symposia was also
held, followed by the POA Midyear
Business Meeting. Later in the
afternoon, the members of the
Organizing Committee and the ASIN
Group of Orthopods led by Dr. Voltaire
Seares gathered everyone to the shuttle
buses and vans for the departure for
Sitio Remedios. Then, the fun started.
FIESTA ILOCANDIA
On the afternoon of Day 1, the
delegates and their guests were
brought by shuttle to Sitio Remedios.
This is a quaint seaside resort in the
town of Currimao, Ilocos Norte that
recreates the experience of living in
an Ilocano village during the years of
Spanish rule. A small chapel styled
along the lines of early churches
serves as the focal point of the resort.
A central plaza is surrounded by six
antique houses made of centuries-old
wood and tiles typical of the era. The
entire area was decorated with
bamboo trimmings and buntings
Drs. Peter Bernardo, Jay Suntay & Paul
Camina jamming with the band at the
beachfront of Sitio Remedios
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simulating a traditional town fiesta.
It was in this atmosphere of merriment
that the first of two Fellowship Nights
was held. Arriving as the sun was
setting by the bay, the delegates and
guests were welcomed by no less than
Dr. Joven Cuanang, the resort’s owner
and medical director of St. Luke’s
Hospital in Quezon City. A traditional
Ilocano band welcomed the guests as
they walked along a cobblestone path
amid gushing fountains and lotus
plants. They were also treated to
traditional Ilocano snacks which
included the popular Ilocos
empanada and pandesal halves filled
with saluyot, poki-poki (yes, you read
it right! ) and, hold you breath, ants
eggs! A children’s choir also serenaded
them with Ilocano folk songs as they
filed past the chapel towards the plaza
of the village resort.
The Opening Ceremonies were a
simple affair highlighted by the
declaration of the 18 th Midyear
Convention open by the POA President,
Dr. Edward Sarrosa. Dr. Joven Cuanang
delivered the keynote address wherein
he exhorted everyone to be proud of
our culture and to be zealous in
protecting our heritage. This was
followed by a program showcasing the
Dr. Lewy Pasion bringing the house down
with his Elvis impersonation
Dr. Edward Lim gave his talk via
videoconferencing live from his residence
in Cincinatti, USA
culture of the Ilocanos - another first
in a midyear convention. Poetry recital
accompanied by folk music, singing
of folk songs by a children’s choir, and
Ilocano folk dances were presented.
After the formal ceremonies, dinner
featuring native Ilocano cuisine was
enjoyed by the guests. Everyone also
had a grand time having their
portraits taken dressed as Senoritos,
Senoritas, Prailes and Indios in period
costumes. While everybody was busy
clicking away with their cameras at
the marvelously preserved houses and
chapel amid the light of more than a
hundred candles, a band played
contemporary pop tunes by the beach
to liven the entire atmosphere. Amid
the overflowing food and drinks, this
Fiesta was a compleat sensory
experience for everyone.
THE FIRST SCIENTIFIC SESSION
The theme Nostalgia in Ilocandia was
selected not just to highlight the
features of the convention site. It is
also subtitled “Revisiting Classic
Techniques in Today’s Contemporary
Setting”. This theme was selected by
the Scientific Committee to enhance
the delegates’ appreciation of
orthopaedic practices that have stood
the test of time and are still applicable
today despite the new toys and tools
that are available with modern
technologies. Lectures were given on
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Ortho Balita
July 2007
How to Practice
Orthopaedics
in the Philippines
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“He has no enemies but is
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intensely disliked by his
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friends.”
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Oscar
Wilde (1854-1900), Irish
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playwright and novelist
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This is a review of the usual and
accepted pathway towards practice of
orthopedics in the Philippines. To be
sure, there are exceptions but although
legal remedies abound, a “deviant”
orthopedic practitioner may one day
feel the stigma
reserved for the social pariah.
In a nutshell – finish medical school,
preferably in the Philippines; then take
and pass the Philippine medical
board exam given by the Professional
Regulatory Commission or PRC. For
orthopedic residency, take it in any of
the several hospitals with accredited
training programs in orthopedics,
preferably in the Philippines. The
Philippine Board of Orthopedics (PBO)
requires yearly assessment of training
residents in preparation for the
penultimate Qualifying Exam.
Ultimately, the graduate takes the 3stage Diplomate Exams. A bona fide
Fellow of the Philippine Orthopaedic
Association (POA), therefore, has a
license to practice medicine in the
Philippines and is certified by the
Philippine Board of Orthopedics as
having taken and passed the
diplomate exams.
Are there exceptions? Yes. And they are
arguably exceptional individuals. For
example, Dr. Ramon B. Gustilo finished
medicine at UP in 1957, passed the
Philippine medical boards but decided
to migrate to the Midwest. Dr. Edward
V.A. Lim and Dr. Rolando M. Puno also
come to mind. They all have made
names for themselves in the US. Social
responsibility mutates into many
forms and for these F ilipinoAmericans, it meant the local lecture
circuits and taking in Filipino fellows
to train with them abroad. These
actions merited goodwill and affirmed
faith in the F ilipino orthopedic
surgeon. In gratitude, the POA granted
these Fil-Am orthopedic surgeons
honorary fellow status. The POA ByLaws Sect. 3.4 thus states, as regards
the honorary fellow: “Any person who
is not otherwise eligible for
consideration as a fellow but has
contributed significantly to the
advancement of Orthopaedics in the
Philippines . . .”
Trained elsewhere, one can still
practice orthopedics in the
Philippines provided he or she has
taken and passed the Philippine
medical boards. The truth is the law
has no hold on a licensed medical
professional who has no specialist
training but decides to do specialist
work. Indeed, the “M.D.” appended
makes a lot of things possible. But
what if a doctor trained and accredited
abroad decides to practice here? Our
legal system is so studded with holes
that any formidable effort to subvert
the law succeeds. Now I don’t want to
sound like Dr/Atty Leo Olarte and I
have no business sounding like him.
But I do want to write this as the
Secretary of the POA and more
importantly as a POA Fellow who
wants fair play in his own country.
That’s not so much to wish for.
POA Congress Updates
The POA 58th Annual Convention is
nearly at hand. The Organizing
Committee, with all its subcommittees, together with the different
subspecialty societies, has put up a
comprehensive and well-balanced
scientific program for this year. Our
theme is “Back and Basics: Spine and
Lower Extremity Trauma” and it will
be held on November 22-25, 2007 at
the EDSA Shangri-la Hotel,
Mandalauyong City.
Registration starts early on the first
day which coincides with the POA &
PBO Board Elections, Orientation of
New Fellows, Annual Residents’
Research Forum, Posters/Free Paper
Presentations, the Annual Business
Meeting, the Opening Ceremonies and
start of the Trades and Exhibits. Our
very own Honorary Fellow Dr. Ramon
B. Gustilo will be the keynote speaker.
The first day would be capped by the
Fellowship Night which will highlight
the presentations prepared by the POA
Regional Chapters. Watch out for the
exclusive
and
rarely
seen
July 2007
Ortho Balita
Bone Tumors in
Filipinos
“Bone Tumors in Filipinos” is the title
of a book written by Dr. Edward H.M.
Wang, a young orthopedic surgeon
and Dr. Ariel Vergel de Dios, a
pathologist. Both of them teach and
work at the U.P. College of Medicine. A
copy of this book was personally
delivered to me by Dr. Wang at my
clinic last month, for which I am
grateful. And through this article I
also wish to extend my best wishes
and sincere prayers for the fast
recovery of Dr. Elizabeth Y.E. See, Dr.
Wang’s mother who suffered a hip
fracture. Bessy, as we used to call her,
happens to be a classmate (U.P. Class
’53) in medicine, and is one of our
brightest.
Reflecting on the past, I remember Dr.
Ambrosio Flores of the then National
Orthopedic Hospital, who was the first
qualified and who became a renowned
bone pathologist of the country. A
1945 medical graduate of the U.P.
College of Medicine, he took to bone
pathology as a ‘fish took to water’.
With a post-graduate study and
training at the State University of
Missouri, U.S.A., he became the sole
distinguished authority on bone
pathology in his time (1948-90).
But here and now, we have Dr. Edward
H.M. Wang, not only an orthopedic
oncologist who trained at the
University of Toronto-Mount Sinai
Hospital, but also a recipient of the
1998 T.O.Y.M. (Ten Outstanding Young
Men) and the 2002 Department of
Science and Technology Outstanding
Health Research Awards, in
recognition of his pioneering work and
extensive investigation into tumor
orthopedics, limb saving surgery and
reconstruction.
Bone Tumors: “This Most Interesting
Of Conditions”
Why should orthopedic surgeons be
interested in bone tumors? It is such
a rare group of diseases. Such other
conditions as trauma, sports injury,
spinal disease, and the arthritides are
more prevalent now in our lives and
occupy so much of our time.
In my mind’s eye, one reason for this
deep interest in bone tumors is that
Dr. Wang is challenged by the fact that
bone tumors are not straightforward
in character, and are capricious or
even unpredictable in their biological
behavior. Although bone tumors are
relatively rare, these tumors do create
havoc on patients and their families.
Their malignant types are very
aggressive, occur principally in the
young and are so devastating in both
their physical and socio-economic
effects.
Is There A Need For This Book? Let me
say that “Bone Tumors in Filipinos” is
a pioneering and an exceptional work.
Its repository of facts and figures
encompasses ‘the epidemiology,
clinical and radiologic presentation,
and pathologic description’ of all bone
tumors seen at the U.P.-P.G.H., a tertiary
and university teaching hospital.
Adding scientific scintilla and clinical
variety to this book are contributions
of two other young and successful
orthopedic surgeons: Dr. Cesar D.L.
Dimayuga and Dr. Albert Jerome D.
Quintos, of the New Medical City and
the U.P.-P.G.H.
Since this work is already in book
form, there is need for its wider
circulation so that it can serve as a
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vital reference for any student,
resident-trainee, or physicians
interested in the diagnosis of bone
tumors.
Is the Past A Prologue? In the field of
surging progress, the most startling
advances have occurred in the
management of bone tumors. Now we
are able to save lives and limbs of
more and more patients with these
devastating lesions. And frequently
even those patients with the tumors
that had the worst prognosis during
those days (thirty to forty years ago),
are being restored to useful and in
some cases, normal lives. This is no
mean achievement and perhaps some
keen interest and enthusiasm of these
orthopedic surgeons reflect this
growing optimism and spirit of
progress in what at one time was a
field filled with tragedy.
Quoting Dr. Wang, author of this book,
“Medical, surgical and oncologic
advantage over the past 2-3 decades
have changed the management of these
tumors drastically. Treatment is,
today, multidisciplinary and not the
monopoly of surgeons; mutilating
amputations have been replaced by
limb saving surgeries, malignant
tumors are now subjected to induction
chemotherapy: multiple adjuvants are
used for benign aggressive tumors; all
of these resulting in vastly improved
function and survival”.
As a parting statement on the subject
of “Bone Tumors in Filipinos”,
remember that the most common
problem in diagnosing and treating
bone tumors is the failure to suspect
them. Progressive or persistent
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Ortho Balita
July 2007
Solidary and Direct
Liability
This is the most recent medical malpractice case decided by the highest temple
of Justice in this Country, the Supreme Court of the Republic of the Philippines
on January 31, 2007. It was litigated for about twenty (23) years from the
lowest court, the Metropolitan Trial Court, until it reached the highest court,
the Supreme Court.
responsibility commensurate with the
undertaking to preserve and protect
the health, and indeed, the very lives
of those placed in the hospital’s
keeping.”
This recent medical jurisprudence is a public document which is printed in the
Supreme Court Reports, for public reading. This case is purely cited herein, so
that we Fellows of the Philippine Orthopedic Association can learn from it,
and avoid legal entanglements.
In summary, the culled facts of the
case are:
On April 4, 1984, Natividad Agana was
rushed to the Medical City General
Hospital, because of difficulty of
bowel movement and bloody anal
discharge. Dr. Miguel Ampil, petitioner
in G.R. No. 127590, diagnosed her to
be suffering from cancer of the
sigmoid. On April 11, 1984, Dr. Ampil,
assisted by the medical staff of the
Medical City Hospital, performed an
anterior resection surgery on
Natividad. The malignancy in her
sigmoid area had spread to her left
ovary, necessitating the removal of
certain portions of it. Thus, Dr. Ampil
obtained the consent of Natividad’s
husband, to permit Dr. Juan Fuentes,
respondent in G.R. No. 126467, to
perform hysterectomy on her. After Dr.
Fuentes had completed the
hysterectomy, Dr. Ampil took over,
completed the operation and closed
the incision. However, the operation
appeared to be flawed. In the
corresponding Record of Operation
dated April 11, 1984, the attending
nurses entered these remarks: “Sponge
count lacking, 2. Announced to
surgeon, searched done, but to no
avail, continue for closure.” After a
couple of days, Natividad complained
of excruciating pain in her anal
region. She consulted both Dr. Ampil
and Dr. Fuentes about it. They told her
that the pain was the natural
consequence of the surgery. On our
The case is:
Natividad (Substituted by her children,
Marcelino Agana III, Enrique Agana Jr.,
Emma Agana Andaya, Jesus Agana, and
Raymund and Enrique Agana,
Petitioners,
G.R. No. 126297
-versusJUAN FUENTES,
Respondent.
G.R. No. 126467
x———————————————————————x
MIGUEL AMPIL,
Petitioner,
-versusNATIVIDAD AGANA &
ENRIQUE AGANA,
Respondents.
G.R. No. 127590
X———————————————————————X
The Supreme Court said, “Once a physician undertakes the treatment and care
of a patient, the law imposes on him certain obligations. In order to escape
liability, he must possess that reasonable degree of learning, skill and
experience required by his profession. At the same time, he must apply
reasonable care and diligence in the exercise of his skills and the application
of his knowledge, and exert his best judgment.” Further it also said that,
“Hospitals, having undertaken one of mankind’s most important and delicate
endeavors, must assume the grave responsibility of pursuing it with appropriate
care. The care and service dispensed through this high trust, however technical,
complex and esoteric, its character may be, must meet standards of
July 2007
Ortho Balita
Solidary...
about September 14, 1984, patient’s
daughter who was also a doctor, found
a gauze protruding from Natividad’s
vagina. Since the pains intensified,
patient Agana was confined at the
Polymedic Hospital, where Dr. Ramon
Gutierrez extracted a foul-smelling
gauze measuring 1.5 inches in width
which badly infected her vaginal vault.
A recto-vaginal fistula had formed in
her reproductive organs which forced
stool to excrete through the vagina.
Thus, in October 1984, Natividad
underwent another surgery.
On November 12, 1984, Natividad and
her husband filed with the RTC, Branch
96, Quezon City a complaint for
damages against the Professional
Services, Inc. (PSI), owner of the
Medical City Hospital, Dr. Ampil, and
Dr. Fuentes, docketed as Civil Case No.
Q-43322. They alleged that the latter
are liable for negligence for leaving
two pieces of gauze inside Natividad’s
body and malpractice for concealing
their acts of negligence. Enrique Agana
also filed with the Professional
Regulation Commission (PRC) an
administrative complaint for gross
negligence and malpractice against Dr.
Ampil and Dr. Fuentes, docketed as
Administrative Case No. 1690. The PRC
Board of Medicine heard the case only
with respect to Dr. Fuentes because it
failed to acquire jurisdiction over Dr.
Ampil who was then in the United
States. On February 16, 1986, pending
the outcome of the above cases,
Natividad died. On March 17, 1993,
the Regional Trial Court rendered its
Decision in favor of the Aganas, finding
PSI, Dr. Ampil and Dr. Fuentes liable
for negligence and malpractice.
The Decision of the lower court was
brought to the Supreme Court (SC) for
review. The SC in holding Dr. Ampil
liable said that First, it is not disputed
that the surgeons used gauzes as
sponges to control the bleeding of the
patient during the surgical operation.
Second, immediately after the
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(Continued fom page 6)
operation, the nurses who assisted in
the surgery noted in their report that
the 2 sponges were lacking. A ‘search
was done but to no avail’ prompting
Dr. Ampil to continue for closure.
Third, after the operation, two (2)
gauzes were extracted from the same
spot of the body of Mrs. Agana where
the surgery was performed. An
operation requiring the placing of
sponges in the incision is not complete
until the sponges are properly
removed. To put it simply, such act is
considered so inconsistent with due
care as to raise an inference of
negligence. There are even legions of
authorities to the effect that such act
is negligence per se. Of course, the
Court is not blind to the reality that
there are times when danger to a
patient’s life precludes a surgeon from
further searching missing sponges or
foreign objects left in the body. But this
does not leave him free from any
obligation. Even if it has been shown
that a surgeon was required by the
urgent necessities of the case to leave
a sponge in his patient’s abdomen,
because of the dangers attendant upon
delay, still, it is his legal duty to so
inform his patient within a reasonable
time thereafter by advising her of what
he had been compelled to do. The
“Captain of the Ship” rule provides
that the operating surgeon is the
person in complete command.
IS THE HOSPITAL liable also?
In our shores, the nature of the
relationship between the hospital and
the physicians is an EmployerEmployee relationship, for purposes
of apportioning responsibility in
medical negligence cases. In the first
place, hospitals exercise significant
control in the hiring and firing of
consultants and in the conduct of their
work within the hospital premises.
Aside from the employer-employee
relationship test, its liability is also
anchored upon the agency principle
of apparent authority or agency by
estoppel and the doctrine of corporate
negligence which have gained
acceptance in the determination of a
hospital’s liability for negligent acts
of health professionals. Apparent
authority, or what is sometimes
referred to as the “holding out” theory,
or doctrine of ostensible agency or
agency by estoppel, has its origin from
the law of agency. It imposes liability,
not as the result of the reality of a
contractual relationship, but rather
because of the actions of a principal
or an employer in somehow
misleading the public into believing
that the relationship or the authority
exists. The concept is essentially one
of estoppel and has been explained in
this manner: The principal is bound
by the acts of his agent with the
apparent authority which he
knowingly permits the agent to
assume, or which he holds the agent
out to the public as possessing. Article
1869 of the Civil Code states that,
“Agency may be express, or implied
from the acts of the principal, from
his silence or lack of action, or his
failure to repudiate the agency,
knowing that another person is acting
on his behalf without authority.”
In this case, PSI publicly displayed in
the lobby of the Medical City Hospital
the names and specializations of the
physicians accredited by it, including
those of Dr. Ampil and Dr. Fuentes.
Indeed, PSI’s act is tantamount to
holding out to the public that Medical
City Hospital, through its accredited
physicians, offers quality health care
services.
The doctrine of corporate negligence
or corporate responsibility obliges the
hospital the duty to make reasonable
efforts to monitor and oversee the
treatment
prescribed
and
administered by the physicians
practicing in its premises. PSI’s
liability is traceable to its failure to
conduct an investigation of the matter
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Ortho Balita
July 2007
Intraosseous Fluid
Infusion
Intraosseous (IO) fluid therapy is a
safe and efficient manner of infusing
fluids and blood in pediatric critical
care patients in emergent need of
hydration and medication. This
requires the use of intraosseous
catheters, which were common in the
past, but the use of which has been
superceded by the advancements in
intravenous (IV) catheters and
alternate techniques in infusion
therapy. Lately however, intraosseous
fluid infusion has reemerged as a
popular procedure in most trauma
centers in the USA. Initially, it was
being utilized only in critically –ill
pediatric patients (below 6 years old),
but now, it is has been advocated for
use even in adult critical care patients.
The rationale for this choice is simplethe anatomic presence of thousands
of noncollapsible veins in the
medullary sinuses of the long bones
and some flat bones of the human
skeleton. By means of emissary veins,
this venous network drains directly
into the central venous circulation,
thus providing almost immediate and
rapid absorption of fluids, blood,
crystalloid
solutions
and
medications.
It was Tocantis in the 1940’s who
indoctrinated the use of intraosseous
(IO) infusion through his researches,
and then in 1984, Rosetti et al
reintroduced the IO technique after
reporting the high failure rate of
intravenous (IV) placement in
critically-ill children.
Indications
Technique
In life-threatening emergencies, when
other vascular access methods have
failed, and when time is of the essence,
the use of IO infusion is still
considered as a major and important
route of infusion and resuscitation.
The American College of Surgeons
Advanced Trauma Life Support (ATLS)
Manual in its pediatric resuscitation
guidelines recommends its use “when
venous access is impossible due to
circulatory collapse or for whom
percutaneous peripheral venous
cannulation has failed on two
attempts” in children 6 years old or
younger. Also, it is recommended for
newborns if umbilical venous access
cannot be rapidly established.
Using sterile technique, local
anesthesia and a large-bore (16- or
18- gauge needle), a landmark area
one to three centimeters below and
slightly medial to the tibial tuberosity
is chosen where the needle is
advanced in a slightly caudad
direction. After penetrating the skin
and subcutaneous tissue, make
several back and forth twist and turn
motions applying slight pressure on
the needle as it is advanced into bone.
The sensation similar to the opening
of a trap-door giving way when pushed,
will then be felt as the tip of the needle
finds its way into the intramedullary
cavity. Aspiration of bone marrow and
the easy infusion of fluid will then
confirm the correct placement of the
needle tip. The needle should not
“wobble”, and there should be very
little “play”. A fluid infusion rate of 25
ml per minute is recommended. IO
catheters are not for long-term use and
must be removed within 24 hours after
insertion.
As orthopaedic surgeons, our
extensive knowledge of the human
skeletal anatomy gives us a built-in
advantage in the application of the IO
technique. The proximal tibia is the
primary insertion choice, followed by
the distal femur in young infants,
while the sternum can be accessed in
older children and adolescents. Other
possible insertion sites include the
distal tibia, distal radius, proximal
humerus and the os calcis. We all
know that IO and other catheters must
not be inserted in an injured
extremity; where previous attempt or
placement in the same site or leg has
occurred (due to consequent
extravasation); where there is obvious
overlying infection at the insertion
site; and in patients with osteogenesis
imperfecta and chronic bone disease.
Complications are rare (less than 1%),
but have been reported, and may
include compartment syndrome,
fracture of the involved bone,
osteomyelitis, leakage at the insertion
site, and failure of infusion due to
occlusion of the catheter with bone
marrow or bending of the needle.
At present, two types of IO infusion
catheter models are in the market- the
Cook catheter (whose head looks like
an oversized thumb tacks), and the
Jamshidi sternal IO infusion needle
(which appears like a short screw
July 2007
Ortho Balita
Intraosseous...
driver). The future looks bright with
the development of disposable drills
for use not only in small children, but
in adults as well. Familiarity with
intraosseous
placement
is
recommended for trauma surgeons,
emergency medicine physicians and
nurses, emergency medical technicianparamedics and pediatric critical care
transport teams.
There have been reports in the
literature of the various uses of IO
infusion. Glaeser, et al reported in
1993 their favorable 5-year experience
involving 152 patients (ages ranging
from newborns to a 102-year old
adult) using the Jamshidi sternal IO
infusion catheter in the proximal tibia.
Goldstein (1990) reported successful
IO infusion use in severely (greater
than 70 % surface area) burned
children. McNamara (1987) reported
the use of intraosseous diazepam and
succinylcholine in critically-ill
children. Parrish (1986) reported on
HAVE YOUR ARTICLES
PRINTED!!!
All POA Chapters, POA
Subspecialties, PBO-Accredited
Training Institutions, PBO Residents and POA Fellows are enjoined to submit articles for upcoming Ortho Balita Issues...
Significant events like CME/scientific meetings, outreach programs and other important
meetings that would be of
much interest to the orthopedic community are most welcome.
To submit your articles, please
email to mikee@philortho.org
together with the pictures, with
a resolution of 300 dpi, and its
captions.
its use in the emergency department.
Guy (1993) reported their
institution’s experience on 27
critically-ill and injured patients
(age range- 3 months to ten years).
Florito (2005) reported 47 patients
undergoing pediatric critical care
transport, with a 78% success rate
out of 58 intraosseous placements.
Anderson (1994) reported the
success of a standardized regional
training program for 154 prehospital
advanced life support providers,
some of whom performed IO
intervention in 15 patients, all in less
than 2 minutes.
The University Medical Center of
Southern Nevada (UMC) Trauma
Center is one of the US trauma
centers that has advocated IO
infusion use in critically–ill and
severely
injured
patients.
Strategically located in fabulous Las
Vegas, it is the first and only hospital
in Nevada to achieve a Level I Trauma
designation, and is among the top 10
trauma centers in the USA. Its Medical
Director is John Fildes, MD, FACS,
presently and the American College
of Surgeons (ACS) Trauma Committee
chairman. A 1982 meritisimus
medical alumnus of the UST, he has
lectured in the PCS annual
convention, and is happily married
to a Filipina from Masbate. It is the
training facility of the University of
Nevada School of Medicine
(UNSOM). In 2006, the UMC Trauma
Center cared for 11,630 patients and
had 2,763 admissions. Its staff
includes 15 orthopaedic surgeons, 9
trauma surgeons, 8 neurosurgeons,
12 anesthesiologists, among others.
It services almost 2 million Clark
County residents and about 40
million Las Vegas visitors every year.
(The author is a past POA president,
the founding chairman of the POAFI,
former associate editor of the POA
Journal and founding Editor (19982004) of the Ortho Balita. He can be
reached at rodnitollama@yahoo.com)
Page
9
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JOSE
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LOURDES A. VERGARA
MA.
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FRANCISCO
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Ortho Balita
Page 10
Ortho Balita
July 2007
2007 AOA-Zimmer TF
The Fellows
Dr. Lauro R. Bonifacio is this year’s
American Orthopaedic Association ASEAN Orthopaedic Association
Zimmer traveling fellow representing
the Philippines. The fellowship started
last May 22 and ended on June 16,
2007. Each of the ASEAN member
countries
had
their
own
representatives: Dr Pham Dang Ninh
(Vietnam); Dr Agus Hadian Rahim
(Indonesia); Dr Nayyer Naveed Wazir
(Malaysia); Dr Sunton Wongsiri
(Thailand); and Dr Lingaraj Krishna
(Singapore). Dr. Bonifacio, POA’s
present treasurer, was designated by
AOA Secretary General Dr. Ong leong
Boon, through the recommendation of
AOA president Dr. Bambang Tiksnadi,
as the leader of the group. As soon as
Dr. Bonifacio obtained the final travel
itinerary from the American
Orthopedic Association secretary, Ms
Lesley
Coussis,
he
started
coordinating the travel plans of the
group easily through emails and text
messages. Dr Lingaraj Krishna of
Singapore wasn’t able to join us for
the rest of the tour for personal
reasons. Some minor glitches
encountered were mainly through
Visa problems like Dr Wazir, a
Pakistani practicing in Malaysia and
Dr Pham Dang Ninh, a military
physician from North Vietnam. But
still their Visas were released on time.
All the flights were coordinated well
in such a way that everybody would
arrive in Detroit, Michigan in the
afternoon of May 22, 2007. The tour
concluded at the American
Orthopedic Association meeting at
Grove Park Inn, Asheville, North
Carolina.
The Sites
The American Orthopedic Association
selected eight excellent sites for the
tour, each having a distinct charm and
unique brand of hospitality that were
beyond their expectation. Each site had
its own itinerary, but was similar in
many ways. The tour included the
following:
Tuesday, May 22 to Thursday May, 24
- PennState University Milton S.
Hershey Medical Center
Friday, June 1 to Monday, June 4 –
George Washington University,
Washington DC
Monday, June 4 to Thursday, June 7 –
University of Florida at Gainesville,
Gainesville, Florida.
Thursday, June 7 to Sunday, June 10 –
Medical University of South Carolina,
Charleston, South Carolina
Sunday, June 10 to Thursday, June 13 –
Wake Forest University, Winston
Salem, North Carolina
Thursday, June 13 to Sunday, June 16 –
Asheville, North Carolina American
Orthopedic Association Meeting
Thursday, May
24 to Monday,
May
28
Columbia
University, New
York City.
Monday, May
28
to
Wednesday
May 30 –
Zimmer Plant,
W a r s a w ,
Indiana
W e d n e s d a y,
May 30 to
Friday, June 1 –
University of
Cincinnati,
C i n c i n n a t i , During a cocktail reception with the Department of Orthopedics Staff,
Wake Forest University with Dr Andrew Kowman (second from left),
Ohio..
Chair Orthopedics Department.
The fellows with American Orthopedic Association President Dr. Terry Light (with bowtie)
July 2007
Ortho Balita
Solidary...
reported in the nota bene of the count
nurse. Such failure established PSI’s
part in the dark conspiracy of silence
and concealment about the gauzes.
Ethical considerations, if not also
legal, dictated the holding of an
immediate inquiry into the events, if
not for the benefit of the patient to
whom the duty is primarily owed, then
in the interest of arriving at the truth.
The Court cannot accept that the
medical and the healing professions
can callously turn their backs on and
disregard even a mere probability of
mistake or negligence by refusing or
failing to investigate a report of such
seriousness. The emerging trend is to
hold the hospital responsible where
the hospital has failed to monitor and
review medical services being
provided within its walls.
PSI, apart from a general denial of its
responsibility, failed to adduce
evidence showing that it exercised the
diligence of a good father of a family
in the accreditation and supervision
of the latter. In neglecting to offer such
proof, PSI failed to discharge its burden
under the last paragraph of Article
2180 of the Civil Code. And therefore,
must be held solidarily liable with Dr.
Ampil. Moreover, as we have
discussed, PSI is also directly liable to
the Aganas.
Anent the corollary issue of whether
PSI is solidarily liable with Dr. Ampil
for damages, let it be emphasized that
Dr. Leo Olarte’s email address is:
attydrolarte@yahoo.com.ph
Thus, Colleagues in the Medical
profession and fellows of the
Philippine Orthopedic Association,
Medical Malpractice today has again
been placed in the limelight. Let us be
more careful in the practice of our
beloved medical profession.
Page
11
Bone
Tumors
unexplained pain of the trunk or
extremities, particularly associated
with a mass, must be considered to be
a tumor until proven otherwise.
Pinoy Odd Signs and Quotes (from the
files of VJA Rosales, MD, CM - UST)
Posted outside a house in Jaro, Iloilo
– HOUSE FOR RENT, FULLY FURNACED
(Boy, it must be hot in there!)
On a glass window of a photography
shop in Cabanatuan City – WE SHOOT
YOU WHILE YOU WAIT
Posted at a construction site in
Mandaluyong City – BAWAL OMEHI
DITO, ANG MAHOLI BOG-BOG!
AOAZ TF - A Learning Experience
The AOA – ASEAN Traveling fellowship
is a unique and gratifying experience.
It is the general feeling of our group
that this prestigious undertaking must
be sustained. There is a lot of sharing
which include clinical experiences,
orthopedic health practices in each
locality and how the ASEAN can initiate
regional orthopedic research projects.
Some observations are worth
mentioning to make this activity even
more worthwhile. The preparation
time was insufficient for us to carry
out the necessary planning. The
economics of the tour has also become
an issue, particularly to those who do
not want to make advance airfare
payments from their own pockets. An
early release of stipend will be more
helpful to the fellows. Overall, it is
undeniable that all of us have enjoyed
the tour and immensely benefited from
this ASEAN-honored activity.
Let
me
extend my
f u l l
appreciation
a
n
d
gratitude to
t
h
e
American
Orthopedic
Association,
A S E A N
Orthopedic
Association
a
n
d
Philippine
Orthopedic
Association
for
the
g r e a t
With Ms Tammi Parker(standing at middle ), at the Zimmer Plant Tour,
Warsaw, Indiana.
opportunity given to me as a
representative to the 2007 AOA Zimmer
Traveling Fellowship. I am also
grateful to Zimmer, USA for their
continued support to this AOA – ASEAN
fellowship program.
- Lauro R Bonifacio, MD, FPOA
Page 12
Ortho Balita
July 2007
Even the Ilocano band that welcomed guests to the Fiesta Ilocandia Fellowship Night was antique!
Kunstcher Nailing, the SIGN Nail,
Femoral Plating, Exchange Nailing for
Open Fractures and Femoral Fractures
in Children. The highlight of the
morning session was the interactive
lecture on Irrigating Solutions for
Open Fractures which featured a
collaborative talk given by Dr. Albert
Dy in Laoag and Dr. Edward Lim from
Cincinatti, USA. This was the first time
that videoconferencing was employed
in a POA convention. Dr. Lim was seen
and heard live (from his kitchen, in
his scrubs / pajamas!) using DSL
technology, and the participants also
had the opportunity to ask him
questions even though he was not
physically present at the convention
site. In the words of Dr. Ramon Gustilo,
it was a feature of the convention that
he thoroughly enjoyed. This
groundbreaking session using the
Internet is sure to become a fixture of
upcoming POA conventions.
ALTERNATIVE PROGRAM
Accompanying persons of the
delegates had a treat in Sitio Remedios
as the scientific meeting was ongoing
at Fort Ilocandia. The children were
gathered under an umbrella tree by the
beach and were given brushes and
paint. These little masters were then
taught the basics of painting on
canvas. While this was going on, adult
participants were brought to the Paoay
Public Market to shop for fresh
vegetables that they would use in the
Ilocano Cooking Class. The
preparation and cooking of dishes
such as Inabraw, Poquipoqui, Pinakbet, Crispy
Dinuguan, and Ilocos
Empanada were taught to
the participants. Everyone
had a good time during the
session as jokes were
cracked along with eggs
and heartfelt laughter was
shared along with greattasting viands. Lunchtime
consisted of the dishes
prepared
by
each
participant. It was such a
unique experience that
more people came back
the next day.
Orthopedic residents as irreverent Prailes during the picture taking
POA Fellows and their families enjoying the trip to Baluarte
in Vigan, Ilocos Sur
VIVA VIGAN!
After another sumptuous
lunch symposium, the
shuttle buses and vans
brought everyone to
Vigan, Ilocos Sur. Formerly
known
as
Ciudad
Fernandina, this was the
premiere
Spanish
settlement outside of
Europe during the colonial The POA President and his family enjoying the free calesa
era. Its well-preserved tour of Vigan
streets, houses and churches from the
Spanish times have earned for the
place the title of “World Heritage Site”
from the UNESCO. As the guests
arrived, they were able to visit the
Baluarte, a private compound owned
by Ilocos Sur Governor Chavit Singson
that featured exotic animals such as
Bengal tigers, albino pythons,
miniature horses among others. They
were then brought around the city by
horse-drawn calesas to give them a
feel of life in the 1800s. They also
walked along Crisologo Street, the
cobblestone road of the heritage
village which featured old houses that
have been converted into stores that
sell antique wares as well as Ilocano
products. Guests had a field day
July 2007
Ortho Balita
shopping for bagnet, longganisa,
chichacorn and Inabel blankets, all the
while snapping pictures along the
way. It was at this point that the
Organizing Committee announced that
a Photo Contest would be held to
capture the entire POA Ilocandia
Experience. This was the first time that
such a contest was held during a
midyear convention.
After the tour and shopping, another
first for the convention awaited the
guests. Plaza Burgos beside the Vigan
Cathedral was closed off just for the
POA for the staging of a second
fellowship night. Ilocano food and
drinks were again overflowing as the
POA held the search for the “First POA
Idol” Singing Contest. Contestants
representing each of the six POA
Chapters sang with a live band amid
the cheers and jeers of the Fellows.
They were critiqued by the Board of
Judges led by no less than 1969 Miss
Universe Gloria Diaz and World
Bowling Champion Bong Coo. While
most of the judges opined that the
contestants were better off mending
broken bones than singing, Dr. Gee Asis
from Manila was unanimously named
the First POA Idol for his heartfelt
song rendition. But what really brought
the house down was the performance
of Lewy “Elvis the Pelvis” Pasion. His
songs and dancing brought the
audience to their feet, so much so that
Miss Gloria Diaz personally requested
for an encore performance later in the
show! Guests left Vigan that night
truly energized by the entire cultural
overload!
THE SECOND SCIENTIFIC SESSION
The realities of orthopaedic practice,
especially in the provinces of the
Philippines, were what welcomed the
Fellows on Day 3 of the convention.
Economic realities facing a majority
of the population meant that fractures
and dislocations are neglected,
making the management of these
conditions very difficult. Thus lectures
on neglected elbow and shoulder
Page
dislocation were given in order to
show the options for these conditions.
This was followed by a timely review
by Dr. Ramon Gustilo on the reasons
why Total Hip Replacement fails in
some patients. Since majority of
patients could not afford expensive
implants, a discussion on Austin
M o o r e
prosthesis
was
also
done, with
speakers on
opposing
s i d e s
highlighting
t
h
e
advantages
a
n
d
disadvantages
of cementing
t h i s
orthopedic
appliance. For
the delegates,
this was an
enlightening
session
as
they usually
encounter a
number of
these issues in
their
own
practices.
13
and billiards in Laoag City, and tennis
at Fort Ilocandia. One of the highlights
of the day was the staging of the first
ever Dr. Ramon B. Gustilo Cup Golf
Tournament at the Fort Ilocandia Golf
Plaza Burgos beside the Vigan Cathedral was reserved for the POA for
the Second Fellowship Night and The 1st POA Idol Search
A children’s choir serenaded the guests with Ilocano folk songs during
the cultural program
THE MIDYEAR
SPORTSFEST
AND ALUMNI
NIGHT
The afternoon Children of POA Fellows having a grand time with the parlor games by
of Day 3 was the poolside
reserved the
M i d y e a r
Sportsfest.
POA Fellows
braved the
heat of the
I l o c o s
s u m m e r
afternoon to
win trophies
and friends in
b a d m i n t o n Even the Ilocano band that welcomed guests to the Fiesta Ilocandia
Fellowship Night was antique!
Page 14
Ortho Balita
Course. Designed by golfing legend
Gary Player, this course was the
playground of former President
Ferdinand Marcos. Everyone who
played that afternoon found the course
really breathtaking in more ways than
one. The layout of the course against
the background of Paoay Lake was a
picturesque sight, but the searing heat
of the Ilocos summer really took their
breath away - literally!
While POA Fellows battled it out in
golf, badminton, billiards and tennis,
a free City Tour of Laoag City, Paoay
Dr. Ivan Concepcion posing beside his Case
Presentation Poster at the convention lobby
Souvenir shopping included the popular
Vigan longganisa
July 2007
and Batac was organized for the
accompanying persons. History was
in the air as guests wondered at the
massive and awe-inspiring Paoay
Church, the majesty of the Sinking
Belltower and St. Williams Cathedral,
and the pomp and pageantry of the
Marcoses at the Malacanang of the
North and the Marcos Museum in
Batac. This sense of awe was evident
as the guests filed past the remains of
the former president at his
mausoleum.
The sportsfest was not just for the
grown-ups. The children of the
Cooking class participants looking at fresh
vegetables at the Paoay Public Market
delegates also had a grand time by the
poolside of Fort Ilocandia. For the first
time ever, parlor games were set-up
by the Organizing Committee for POA
children. The little ones and their
parents had a great time scavenging
the grounds for treats in a Treasure
Hunt. And each participant went home
with toys as they won in games such
as sack race, water scooping, tug-ofwar, and others.
And as the sun set on another
enjoyable day, the POA Fellows went
to different venues to reunite with the
colleagues in training for the Alumni
Night of the respective training
institutions.
THE LAST DAY AND FAREWELL
While most conventions wind down
their activities on the last day, this one
was still full of activities up to the last
minute. The Spine Society conducted a
symposium on Low Back Pain, Spine
Injuries,
Osteoporosis
and
Vesselplasty along with a Workshop
on Spinal Instrumentation. A lecture
on financial literacy and management
was also given during the brunch
symposium. This was followed by the
Awarding Ceremonies to winners of the
Sportsfest, Raffle and Photo Contest.
The baton for staging the next midyear
convention was then passed to the
Northen Mindanao Chapter. And as Dr.
Godo Dungca thanked everyone and
wished them a
safe
journey
home, a video of
the highlights of
the entire event
was presented,
giving everyone
present a final
glimpse of a
convention that
was truly, an
experience like no
other! - Daniel V.
Dungca, M.D.,
“Mashers” getting together at Sitio Remedios enjoy mixing the FPOA
dough for the famous Ilocos Empanada
July 2007
Ortho Balita
Page
15
Norberto R. Agcaoili His Unfulfilled Dream
Born on the 6th of December, 1944, an
Atenean by his primary and secondary
education, a medical degree from the
University of the East Ramon
Magsaysay Memorial Medical Center,
orthopedic residency from the UP-PGH,
a fellowship from the Nuffield
Orthopaedic Center, Oxford University
and a Professor from both Colleges of
Medicine, UP and UERMMMC – that is
Norberto R. Agcaoili.
He was founding member of both the
Asia Pacific Association of Surgical
Tissue Banking for which he was
president in 1994 to 1996 and Asia
Pacific Musculoskeletal Tumor
Society. He was also international
scientific adviser to the European
Tissue Bank Association. He was also
founding member of the Phil. Society
of Emergency Care Physicians, Inc. He
even attended the first organizational
meeting of the society on August 26,
1989 at the Mikimoto Restaurant,
Manila. He was consistently member
of the board of directors from its
founding period up to his demise.
In 1989 he wrote a chapter on the
Manual of Orthopaedics Emergencies
entitled “Wholistic Approach to a
Trauma Patient.” In addition he has
published about 8 scientific papers on
tumors and bone banking.
He married Amelia A. Moya on
February 20, 1971. Millie was his
classmate in medical school and a
practicing obstetrician-gynecologist
at present. They have four children:
Patricia Anne, the oldest and only
daughter is also a doctor and married
Bien Manlutac, a nephrologist.
Norberto Jr, a management graduate
is married to Alice Escalona. Andres
Eduardo is a graduate of Management
Information System from Ateneo and
Miguel, the youngest finished
Entrepreneurial Management from the
University of Asia Pacific. He has four
grand children from Tricia namely:
Macky 11 years grade 5 in La Salle
Green Hills, Marty 9 years old also
from La Salle, Sofia 4 years and
Dr. Norberto R. Agcaoili
Isabella 3 years both in nursery school
at NS Montessori.
Dr. Agcaoili was Chairman of the Dept.
of Orthopaedics, UP-PGH from 1994
to 1997. It was during his leadership
when the Orthopaedic building with
the Spine Unit was inaugurated. Dr.
Agcaoili was also past president of the
Philippine Orthopaedic Association in
1991. It was during his term of office
when he fought for the unification of
...My F Word to Boss Tong
I sometimes tell my students that to
remember what they have studied
keywords to associate with that topic
are essential.
how to extricate the whole meat of the
lobster by pushing this with your
thumb from the hind tail part.
For my Boss Tong 3 F words that I can
associate with him are: Food; Fun;
Father
2. Fun. When I ask Tricia her, daughter,
who is also a doctor what one word
can describe his father she says it is
“sit com”. Every situation they have is
fun. Just like in a comedy show.
1. Food. We have this saying that an
orthopedic surgeon must have the
following criteria. He must have an eye
of an eagle, a heart of a lion, and a
stomach of a buffalo. I would say Boss
Tong pretty much possesses the
criteria up to the last one. His stomach
always had room for good food. He
enjoyed this a lot. I learned from him
Boss Tong enjoyed life and it shows in
his everyday dealings and situations.
It was as if each day was the last day
of his life. I later learned from his
lawyer-brother that as early about
more 20 years ago, his heart was
already doomed” to fail. This was
discovered in Texas where he was
worked up after surviving a heart
attack where he was confined at St.
Luke’s Medical Center. The possibility
of a heart bypass operation was thus
abandoned. They said they had to hide
the truth to their brother. But I guess
Boss Tong had some idea of his
condition, and so he just lived one day
at a time. Each day lived with fun.
One time there was this graduate who
introduced himself to Dr. Agcaoili as
one of his students in a lecture in
splinting and he told Boss Tong that
he remembered his lecture well. And
so Boss Tong asked him bluntly, “what
did you remember in my lecture?” And
Page 16
Ortho Balita
Volume 9, Issue No.
29
July 2007
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Norberto R. Agcaoili...
the association. His principles and
values stood tall and unwavering.
He was certainly uncompromising
and he showed his true leadership
ability during those crises days of
the POA.
In 2000 he was Chairman of the Phil.
Board of Orthopaedics. During his
Chairmanship, the meetings were
described as cordial and the
discussion, were free-wheeling.
On its maiden issue in 1982 of the
Phil. Journal of Orthopaedics, he
was Managing Editor. Then in 1983
to 2006 he was designated
Circulation Manager.
He is
considered one of the pillars of the
Phil. Journal of Orthopaedics. He
was also featured in the
Orthopaedic Surgeon Profile of the
Phil. Journal of Orthopaedics in its
December, 1996 issue.
For his pioneering work in tissue
banking in the country, the Tissue Bank
Unit of the Dept. of Orthopaedics, UPPGH was named after him on July 6, 2007
during the department’s administrative
meeting... He was likewise awarded as
one of the Most Outstanding Medical
Graduate of UERMMMF last July 2007.
Tong as we fondly call him or Titong to
his family and other close friends is
indeed a silent worker, a dedicated
teacher, an assuming researcher, a true
clinician, a loving family man and a
principled Filipino.
He is a true friend and we who have been
blessed by our association with him will
surely miss him. His memories will
forever be vivid in our memory.
His unfulfilled dream of a progressive,
unified and updated orhopaedic practice
in the country was indeed bigger than
his own life.
Tony M. Montalban, MD, MHA, MPH,
MHPEd.
...My F Word to Boss Tong
the student candidly replied, “That
part where you showed a picture of
a Playboy magazine which later you
showed could be used as a splint
for the forearm”.
I remember every time Ma’am Millie
would call the clinic and just
moments before he answers the
phone we can hear him curse such
that he sounded like he was annoyed
with her call. But the moment he
talks, the sweetest sound in his
husky voice comes out of his mouth.
Dr. Agcaoili is one guy who can curse
and still not appear offensive.
3. Father. Dr. Agcaoili was a pioneer
in Bone Banking in the Philippines.
My first encounter with Dr. Agcaoili
was when I was a student in a small
group preceptorship. He was applying a
cast on a foreigner (haha I thought then
it was this Dr. Tong who innovated this
Sugar Tong cast) and what struck me was
when I gave this stupid answer the
response of this cool guy gave me a
feeling of openness and encouragement
I was not clamped down by sarcastic
comments or violent reactions like what
those older professors do who already
think students have no right to commit
mistakes. I wanted to be like him. I
learned from him then that patience in
teaching by encouraging wild or stupid
ideas have more ideas coming out of
their minds. Then learning becomes
proactive.
The second encounter with my Boss was
when I became a consultant in the
Department of Surgery. He made me feel
welcome in the Orthopedic section and
treated me as a young colleague rather
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The Philippine Board of
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Orthopaedics (PBO) held its
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annual In-Training Examinations
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(ITE) last July 14, 2007 at the
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Bayanihan
Hall,
United
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Laboratories,
United
St.,
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Mandaluyong
City.
Out
of
the
total
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examinees, 71.42% passed. Dr.
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Arnold S. Wanson of Baguio
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General Hospital and Medical
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Center topped the exams while Dr.
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Ellen Y. Lee of UP-Philippine
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General Hospital and Dr. Lendell
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John Z. Gatchalian of the East
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Avenue Medical Center bagged the
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second and third place
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respectively.
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The schedule for the PBO
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Diplomate Examination is as
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follows:
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Written Exams:
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- 07:30 AM Oct. 7, 2007
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- Westmont Pharma,
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4F Bonaventure Plaza,
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Greenhills, San Juan
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Oral Exams:
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- 08:00 AM Oct. 8, 2007
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- Westmont Pharmaceuticals,
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Practical Exams:
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- 07:00 AM Oct 9-10, 2007
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- Philippine Orthopaedic Center
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PBO
Corner
than as a new competitor. He invited
me to join in his clinic and he even
taught me how to disarticulate the
knee as swiftly and as less bloody in
an emergency. That to me was how Boss
Tong was like a father.
Dr. Agcaoili had helped a lot of
people. There was this one guy friend
who approached him because his
electric bill was long overdue and the
Bosses help made this guys life better.
- Geoffrey R. Battad, MD
July 2007
Ortho Balita
Page
17
“ATO-A ni Bay!”
ATO-A ni Bay! The Philippine
Orthopedic Association- South
Mindanao Chapter
The southern part of the country,
Mindanao has been infamously known
as the “Wild Wild West of the
Philippines”. Critics might argue that
it may not necessarily be true. Reading
stories from the papers, it seems that
moniker is gaining ground in my
senses. I hear a lot of guns blazing
just outside our village. Police sirens
keeps on bothering us at night even
beating the barks of the dog.
Having stayed and lived here, later did
I realize that Davao City is one hell of
a paradise. It is indeed one of the most
organized and disciplined metropolis
in the country. Hats off to our very
tough and no non sense type of Mayor.
The guns that we hear outside our
village were actually coming from a
shooting range just nearby. The sirens
were 911 police cars or ambulances
responding to calls from citizens in
need. The point here is that practicing
orthopedic surgeons here have a
wonderful life. Hobbies like shooting
guns, golf, scuba diving, biking, and
trekking are abundant and are just
around the corner. We have a
government that is dependable and
supportive of our needs. Overall, we
do have a very good life here that is
similar to what we see in the “Wild
Wild West” TV series of CBS played by
Robert Conrad.
The POA South Mindanao Chapter is
not just Davao City. We are a rag tag
team of fellows coming as far as
Cotabato City, General Santos, and
nearby cities. Although we are far
away from the center, which is Manila,
our chapter is very vibrant and united.
We share a common vision of
promoting camaraderie among
fellows while at the same time
uplifting each other. The chapter is
filled with a lot of activities that
promote this vision. To name a few, we
have invited guest speakers in our
monthly meetings like Dr. Edward
Sarrosa, Dr Tony San Juan, Dr.
Godofredo Dungca, Dr. Antonio Rivera
and even the world reknowned Dr.
Ramon Gustilo. They unselfishly
shared their time and expertise to all
of us.
In addition, we have organized an AO
Symposium on the Basic Principles of
Fracture Management in Davao City
last March 24, 2007. Through the
efforts of Dr. Miles dela Rosa, Dr. Lauro
Abrahan Jr., and Dr. Suthorn
Bavonratanavech, the AO Asia
Representative, the AO Philosophy was
then brought down in Mindanao.
Furthermore, the POA South Mindanao
Chapter in cooperation with the North
Mindanao has formalized the rebonding by holding the First POA
Mindanao Summit in August 17-18,
2007. This event was attended by
around 80-85% of Orthopedic
Surgeons from all over Mindanao. This
led to the realization of starting out
an annual activity that will unite
Mindanaoans and tackle issues that
are unique to us. It was indeed a very
successful convention.
We have not neglected our social
responsibilities. The POA South
Mindanao Chapter has donated newly
purchased books to the city
government to be given to our local
schools. We have also a tie up with
the Mom’s Radio and giving talks
related to musculoskeletal conditions.
The POA South Mindanao Chapter has
really gone a long way. This was made
possible because of the officers and
fellows that consistently support this
chapter. We are very proud that we
belong in this chapter. To all of us
colleagues, “ATO-A ni Bay!”
THE POA 19TH MIDYEAR CONVENTION
“WOW KATAWAN:
Cosmetic Consideration
for Application in
Orthopedic Surgery”
April 9-12, 2008,
Cagayan De Oro City
Page 18
Ortho Balita
“Walk against Osteoporosis”
May is National Osteoporosis
Awareness Month. The POA CEV
Chapter, held a “Fun Walk” on May 6,
2007. The walk started from Fuente
Osmena Park to Cebu City Sports
Center, City of Cebu led by this year
Chapter President Dr. Camilo “Butch”
Arenajo, with the theme “Walk and
Exercise against Osteoporosis and
Arthritis”. This event was sponsored
in coordination with the Golden Center
of Cebu Incorporated (GCCI), City
Government of Cebu, Office for Senior
Citizens Affairs (OSCA)
The program started out as early as
5:00 am where the participants, mostly
senior citizens, guest and members of
the Cebu City Council and staff
gathered at the park. It kicked off with
the invocation by Dr. Richard V.
Condor, welcome remarks by Dr.
Camilo Arenajo POA-CEV Chapter
president and a Message by Hon.
Roberto “Bebot” Abellanosa, Senior
Citizens Coordinator. After all the
talking, a short stretching and aerobic
exercise was initiated by coach Calixto
“Alex” Pacquiao. All participants
joined this aerobic exercise where you
can see the interest among the old
generation.
The
different
representatives from pharmaceutical
companies were also present and
joined the fun walk along Osmena
Boulevard. The event started with a
mass after the fun walk. A Lay Forum,
wherein patients had a chance to ask
questions to the consultants and
July 2007
July 2007
Ortho Balita
Page
19
JR holds 1st J.O.G.A. Cup
Last October 26, 2006, the first ever
J.O.G.A (Jose Reyes Orthopedic Golfers’
Association) Cup Golf Tournament
was successfully held at the Veterans
Golf Club, North Avenue, Quezon City.
In pursuance to the department’s
commitment in providing better health
care, this event was a brainchild of
Dr. Emiliano Tablante, current Vice
Chairman of the department, to raise
funds for the indigent patients
admitted at the Orthopedic Ward of
the institution who were in need of
orthopedic implants.
“Chipping for a Cause” was the theme
as
doctors
from
different
subspecialties and friends from the
pharmaceutical companies and
private sector came together to
participate in this endeavor. The event
culminated with the awarding
ceremonies over lunch were Dr. Robert
Pineda
(an
Ophthalmology
Consultant) who shot an unbelievable
3 under par 68, came out as the Overall Champion. Dr. Mon Villarette ruled
the Class A Group, shooting a double
bogey free round of 81, Mr. Conrad
Caraan, our golfer friend from
Batangas, was not so far behind
coming in as the 1st runner up, and Dr.
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The Central- Eastern Visayas The new set of officers is composed
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Chapter of the Philippine of Camilo “Butch” Arenajo
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Orthopaedic Association had the (president), Richard “Chad” Condor
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induction of their new set of officers (vice-president), Wilson de la
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last April 8, 2007, at the Marco Polo Calzada (secretary), Leopoldo “Leo”
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Hotel formerly Cebu Plaza Hotel. Dr. Jiao (treasurer) and Danilo “Danny”
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Edward A. Sarrosa, graced the Oligario (PRO).
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occasion as the inducting officer. He
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also gave an update on the
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management of Osteoporosis and
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the POA Current Practice Guidelines.
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POA CEVC Inducts
2007 Officers
Florencito Ylescupidez, who was
awarded 2nd runner up rounded up the
top three.
Page 20
Ortho Balita
JR holds 1st J.O.G.A. Cup
Other winners for the system 36
rule include Dr. Cesar
Ballesteros, champion in Class
B and Dr. Buencamino and Dr.
Santos were awarded 1st and 2nd
runner up respectively. Class C
winners were Dr. William Lim as
Champion and our very own Dr.
Emiliano Tablante and Dr. Joseph
Cortero (Urology Resident)
garnering 1st and 2nd runner up
respectively. Aside from the
usual appliances, prizes for the
raffle included different golf
apparel and free boarding
passes to Air Force 1 Spa as the
main prizes, compliments of our
major sponsor.
On behalf of the department, we
would like to thank our
Sponsors, Mr. Marvic Manalang,
PAGCOR, and Air Force 1 Digital
KTV, we also extend our utmost
appreciation to the people and
establishments who contributed
as Hole Sponsors, and to all
those who participated, who
found the time in their busy
schedules to play in the event, it
was because of them that our
goal was realized.
So, to all the golfers, hope we
see you again next year when
J.O.G.A. CUP II invades the golf
course once again.
- Dr. Marco Paolo G. Lasam
SRO audience at one of the scientific sessions, something rarely seen during a midyear convention
July 2007
July 2007
Ortho Balita
POA Congress Updates
Page
21
performances prepared by these
chapters! The performances of the
different chapters are in coordination
with our sponsors – the
pharmaceutical companies.
The second day will kick off with a
simultaneous Interactive Course
Lecture (ICL) handled by the Philippine
Musculoskeletal Tumor Society
(PMTS) and the Philippine Society for
the Surgery of the Hand (PSSH)
Followed by lectures that were
organized by the Philippine
Orthopaedic Trauma Society (POTS)
and the Philippine Orthopaedic Foot
and Ankle Society (POFAS). This day
ends with a free night for everybody
and may have their own Alumni
Nights.
The third day will again start with an
ICL organized by the Philippine Hip &
Knee Society (PHKS) followed by
lectures on Sports Medicine and Spine.
The Congress Banquet ends the day.
The fourth and final day will begin
with ICLs from the Pediatric
Orthopaedic Society of the
Philippines/Association for the Study
and Application of the Methods of
Ilizarov (POSP/ASAMI) and the
Philippine Orthopaedic Society for
Sports Medicine (POSSM). The Day
lectures would be on sports medicine
(knee) and pediatric orthopedics.
The Philippine Orthopaedic Society for
Sports Medicine also has their annual
convention the day before the POA
Annual Congress. Participants and
Members of the POSSM will be notified
on the specifics and details soon.
Our Foreign Speakers Include:
Dr. Arjandas Mahadev
Dr. Chang-Wug Oh
Dr. Charalampos Zalavras
Dr. Edward Lim
Dr. Hwan Tak Hee
Dr. Khong Kok Sun
Dr. S.B. Wong
Dr. Suthorn Bavonratanavech
Dr. Tan Seang Beng
Our Local Speakers Include:
Dr. Adrian Catbagan
Dr. Albert Ma. V. Molano
Dr. Antonio A. Rivera
Dr. Antonio N. Tanchuling, Jr.
Dr. Arturo C. Cañete
Dr. Dave Anthony G. Dizon
Dr. Edgar Michael T. Eufemio
Dr. Edwin Jerd T. Siatan
Dr. Emil Tablante
Dr. Francis O. Javier
Dr. Frankie Leung
Dr. Gonzalo Banuelos
Dr. Gregorio Marcelo S. Azores
Dr. Henry U. Lu
Dr. Ilustre I. Guloy, Jr.
Dr. Jose Antonio G. San Juan
Dr. Jose Fernando C. Syquia
Dr. Jose Martin S. Paiso
Dr. Juanito S. Javier
Dr. Julyn A. Aguilar
Dr. Lauro M. Abrahan, Jr
Dr. Manuel V. Pecson III
Dr. Melissa Zamuco- Mercado
Dr. Miles T. de la Rosa
Dr. Norberto A. Meriales
Dr. Orson V. Odulio
Dr. Paul Cesar N. San Pedro
Dr. Ramon Santos-Ocampo
Dr. Vicente V. Pido
Dr. William T. Lavadia
Dr. Benedict Francis D. Valdecañas
For this year, 33 PBO Diplomates
applied for POA Membership. They are:
Aguilar, Remo-Tito A.
Arandia, Edsel F.
Asedillo, Emmanuel R.
Baclig, Phillipe Y.
Bergonio Rodolfo P.
Car nero, Ryan Conrad A.
Cayvetano, Angel A. Jr
Chuasuan, William Jr, D.
Clerigo, Jeter Mendoza
Deiparine, Harem P.
Fernando, Rommel F.
Ganal-Antonio, Anne Kathleen B.
Garin, Isagani E.
Gerona, Carlos Urbano
Go, Miguel C
Grozman, Samuel Arsenio
Leonardo C. Lu
Lumawig, Jose Miguel T.
Molo, Randolph M.
Olandres, Richie A.
Panganiban, Silvino Emmanuel C.
Pidlaoan, Ronald B.
Pundavela, Victor Gerardo E.
Resubal, Jose Rafael E.
Reyes, Chad John Martin U.
Santos, Dominic D.
Sarmen, Frederick G
Sinlao, Ray Allen E.
Tan, Marseilles Renee’ P
Tan, Rommel L.
Tenorio, Ernesto, C. Jr
Trinidad, Noel G.
Valenzuela, Julius N.
Page 22
Ortho Balita
July 2007
2007 Trauma Registry Project
The POA Trauma Registry project
(POATRP), after its conception on the
late 90’s, is now again active for this
year. The first Annual report was done
last 2001and then stopped for some
years to give room for more
improvement – improve the forms,
improve data collection, get support
from every institution, get additional
funding from outside sources.
There were only four forms during the
first stages of the project, but then, by
the year 2002-2003, the POA Trauma
Registry Committee headed by Dr.
Arturo C. Cañete chaired by Dr. Mickey
Bengzon, in cooperation with the
Philippine Orthopaedic Trauma
Society, with the help from the experts
of the specialty doctors, 4 more forms
were added making it 8 in all.
The Software was then carefully
developed with the help of MSD. They
have designed a software wherein the
PBO-Accredited Training Institutions
were given terminal module database
software for them to encode their
trauma registry data and submit it as
electronic files to the POA Secretariat
Office,
which
houses
the
Administrative Software Module,
which converts all submitted data to
form one Trauma registry database as
source for reports and information
queries. The outcome for a year came
in. It was noticed that the system of
doing such kind of technique – the
administrative and terminal module,
quite didn’t seem to have worked well
enough. Some of the Institutions
experienced computer breakdowns
which resulted in a low number of data
submission. Others, though they know
how to encode them, seem not give the
proper file which is needed by the
central database. Although many had
a good number of data from the
beginning, they don’t seem to be
consistent on doing it on the
succeeding months.
All of these glitches were carefully
evaluated and considered by the
Committee together with the POTS
members and came up with a
probationary solution – Print the
forms, fill them up, hire secretaries to
collect them personally and check for
inconsistent data, and finally encode
it in the POA Office. This was a
solution that was agreed upon by the
group. Dr. David Alagar was appointed
as the Chairman of the project. The
committee then asked for support from
the POA Foundation most likely in the
financial form, the answer was –YES!
The POAFI agreed to be a part of the
this. Everything formally started out
with a series of orientation with the
residents on how to fill up the forms
and identify coding for the fractures.
The committee then had a test run
which started on October 2006. But
initially, the official start for data
encoding and collection started on
January of this year. The Philippine
Board of Orthopaedics also signified
their support and agreed to add the
POA Trauma Registry in some form or
the like to be part of their
accreditation and evaluation for each
institution. Prizes will be given to
institutions which will gain the
highest points on the criteria set by
the committee. These set of guidelines/
criteria were sent to all the different
PBO-Accredited Training Institutions.
Update: As of the first quarter report,
the count reached 50% of the POATRP
report of 2004. This was a good start,
and this second half of the year, the
total of entries has overcome that of
the 2004 annual report. This goes to
show that the combined efforts of the
POA, the POAFI, the POTRP Committee
and POTS had better results compared
with the latteer as of the moment. The
third Quarter Report might be
presented during the business
meeting of the POA 58 th Annual
Congress should there be any
July 2007
Ortho Balita
Page
23
Médecins Sans Frontières (MSF)
What is MSF?
Médecins Sans Frontières (MSF) is an
independent international medical
humanitarian organization that
delivers emergency aid to people
affected by armed conflict, epidemics,
natural or man-made disasters, or
exclusion from health care.0MSF is
founded in 1971nand currently works
in more than 70 countries.
Historical Background
MSF was founded on 20 December
1971 out of the exasperation of a group
of French doctors who worked in
desperate conditions in the Biafra
War (1967-1970). They were
determined to create a movement to
deliver independent humanitarian aid
wherever it was needed, and
particularly one that would speak out
about the plight of the victims it
helped.
As a private nonprofit association,
MSF is an international network with
sections in 19 countries. Each year,
near 3,000 volunteer doctors, nurses,
other medical professionals, logistics
experts, water/sanitation engineers
and administrators are sent to
different parts of the world to provide
medical aid. In 1999, MSF was
awarded the international Nobel
Peace Prize “in recognition of the
organization’s
pioneering
humanitarian work on several
continents.” The award honours the
work of MSF relief workers who bring
medical assistance to vulnerable
populations.
Responding to Emergencies
MSF is often one of the first
humanitarian organizations to arrive
at the scene of an emergency. Its largescale logistical capacity ensures that
MSF emergency teams hit the ground
with the specialised medical kits and
equipment they need to start saving
lives immediately.
Custom-designed by MSF for specific
field situations, geographic conditions
and climates, a kit may contain a
complete operating room, for example,
or all of the supplies needed to treat
hundreds of cholera patients. MSF kits
and medical protocols have been
replicated by relief organizations
worldwide.
MSF has proven expertise in the field
of epidemiology and is often called on
to monitor, diagnose and control
outbreaks of diseases such as
cholera, meningitis and measles.
Independent Humanitarian Action
MSF’s decision to intervene in any
country or crisis is based solely on an
independent assessment of people’s
needs, – not on political, economic, or
religious interests. MSF does not take
sides or intervene according to the
demands of governments or warring
parties.
MSF volunteers frequently work in
remote or dangerous parts of the
world. When crises unfold, they make
themselves and their skills available
on short notice, usually dedicating six
to twelve months to each assignment.
MSF teams are composed of
international volunteers and skilled
local staff. Together, they work closely
with national medical professionals
and cooperate with other aid
organisations.
Témoignage
MSF unites direct medical care with a
commitment to speaking out against
the causes of suffering and the
obstacles to providing effective
assistance. MSF volunteers raise the
concerns of their patients with
governments, the United Nations,
other international bodies, the general
public, and the media. In a wide range
of circumstances, MSF volunteers have
spoken out against violations of
international humanitarian law they
have witnessed.
Based on its field experience, MSF is
addressing obstacles preventing
people in the developing world from
obtaining affordable, effective
treatments for diseases such as HIV/
AIDS, malaria and tuberculosis.
Through its Campaign for Access to
Essential Medicines, MSF is
advocating to lower drug prices,
stimulate research and development
of new treatments, and overcome trade
and other barriers to accessing
treatments.
Financial Independence
To
ensure
its
operational
independence, an important part of
MSF’s funding for projects comes from
donations from the public. Financial
support is also given by corporations,
foundations, some governments and
international agencies. The MSF
international network collectively
strives to direct at least 80 per cent of
its expenditures to programme
activities.
2007 Trauma Registry Project
unforeseen circumstances. The group
also wishes to thank MSD for their
undying support to this project. The
POA Trauma Registry project, given the
utmost importance, and treated with
accuracy in every step and timely
submission would then contribute to
success. This would become a very
good and comprehensive source for
research or even as a good source of
demographic data to every any datahungry individual. Although not all
hospitals in the Philippines are
covered, it can still give out a
representation of significant values to
whoever might need it. Job well done
for the reseidents but still, the
committee encourages you to keep it
up, the data you give is the basis of all
the reports.

Vol 9, Issue No.28 July 2007 (ob29)

Transcription

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