Monday, March 10, 2008


A) Personal Digital Assistant
B) Patent Ductus Arteriosus
C) Public Display of Affection
D) Philippine Dental Association
E) None of the above

What’s your guess?

Before I give you the correct answer, let me tell you first that this post is my entry to The Blog Rounds, first edition. No, it’s not a contest. Rather, it’s something that some Filipino weblogging MDs have taken upon themselves to indulge in: writing posts pertaining to the practice of medicine and then submitting these posts to a Blog Carnival Host.

I liken it to “games webloggers do”, not for monetary gain, not for scientific education (we should still get our knowledge from Harrison, and not from, right?), but mostly for the love of writing and blogging. It’s patterned after international medical blog carnivals (ex. SurgeXperience, The Grand Rounds) but the father of The Blog Rounds (TBR), BoneMD, believes that Filipino doctors have experiences that are uniquely ours, very much unlike the experiences of doctors in other countries. And we wholeheartedly agree.

The topic for the first edition, as prescribed by the host of the first Philippine medical blog carnival, is the history of medicine in the Philippines, told with a twist of humor. Well, my tale here is not very humorous, more like horrific. To be honest, I don’t know much about the history of medicine in the Philippines but I do know the history of anesthesia (worldwide, not in the PI) and that’s what I’m going to write about.

And that brings us to the PDA, which is a landmark in the history of anesthesia in the whole wide real world. PDA means Public Demonstration of Anesthesia and this happened at the Massachusetts General Hospital in1845 when Horace Wells, a dentist who was a sophomore medical student, dared to demonstrate to a sceptical public the use of nitrous oxide, the laughing gas, for anesthesia. It was a howling success. The patient howled in pain when the surgeon made the first incision. In other words, the first PDA flopped big time and so famously that Horace Wells never fully recovered. He ended up committing suicide.

Fortunately for the rest of the populace, another daring guy named William T.G. Morton made another attempt in PDA a year later in the same place, the Mass Gen. This time he used ether as the anesthetic and this time the patient who was to undergo neck surgery, did not howl in pain. It was a success!

(Notice their outfits - they didn't know yet one can go to work in pajamas!)

And so the 1846 PDA became a milestone in the history of surgery and anesthesia. In the years pre-PDA, there were not a lot of surgeries performed because (a) not much was known about anatomy and pathophysiology anyway so the doctors did not really know what to do, other than sit by the bedside and hold the patient’s hand while patient deteriorated into oblivion (b) not much was known about asepsis and antisepsis so a lot of surgical patients succumbed to infection anyway so why bother? (3) not many surgeons could stand operating on patients who were squirming and screaming in pain and finally (4) only a handful of patients would give consent to being cut up without benefit of an anesthetic, which of course they did not know even existed then.

After 1846, anesthesia progressed in leaps and bounds and today anesthesia is so modernized you can go to the hospital before 8 am, have your surgery done and be home by 5 pm.

But what’s interesting (shocking actually) was how anesthesia was done pre-PDA. Check out this crude list:

* Hypnotism

* Acupuncture

* Drugs – alcohol, hashish, opium derivatives

* Packing limb in ice - the extreme cold temperature numbs the nerves so surgery becomes painless. Problem: what if the ice melts before surgery is finished? Ouch!

* Applying a tourniquet to the limb. (!)

* Unconsciousness by a strong blow to the head or by strangulation (tsk tsk…!!!)

And these here below are actually still being done in the Philippines, believe it or not.

“LA” - not local anesthesia but “Laway Anesthesia” with laway meaning “saliva” which is to say the surgeon uses his words only to anesthesize the patient. For example, “Gamay nga sakit ra ni, Tiyo/Tiya. Ayaw ug lihok.” (This is just a little painful, Sir/Ma’am, don’t move.”) LA is usually combined with …

“GA” - not general anesthesia but “General Agwanta” which is the Visayan for “General Pagtitiis” . The English equivalent would be “just grin and bear it”.

These may seem totally absurd even brutal to someone from a first world country but this is not rare in third world countries like the Philippines. And why is that? The answer is simple economics.

General anesthetics are imported therefore expensive. Local anesthetics are also imported actually despite the name “local”. Sometimes, a procedure that should ideally be done under general anesthesia is done under local anesthesia because of financial constraints. Thus, the procedure may not be absolutely pain-free, but the patient agrees to it because he knows that by doing so, he/she can save thousands of pesos.

Or sometimes the patient doesn’t agree to it but it happens. For example, when I was an intern rotating at one of the government hospital in Quezon City, we had several parturients who just gave birth and we interns were supposed to suture their episiotomy wounds. It so happened that the delivery room ran out of Xylocaine therefore, we had to do the episiorrhaphies sans anesthetics. I cringe and shudder now when I remember that time. One mother screamed and from her lithotomy position kicked at one of my groupmates. My stunned groupmate responded in kind, I will not mention exactly what kind.

I was a junior intern many years ago already. I hope my experience then is no longer the norm in the Philippines today.



dr_clairebear said...

i was only an intern a few years ago, and thankfully we do not run out of lidocaine anymore. i used to know of somewhat evil friends of mine at the ER back then who would stitch up lacerations of drunk men with minimal anesthesia. :P not that they would feel it - they were soooo drunk!

Ness said...

hi dr_clairebear, thanks for visiting. we sure had fun with that TBR first edition! :-)

and yeah, (+) alcoholic breath and being an ER patient is not uncommon,to say the least. :-(

Prudence said...

I was an intern a few years back and still I knew of some instances when episiorrhaphy had to be done with minimal anesthesia because the government hospital was so low in supply of lidocaine. Ugh. Nothing I could do about it then, though.


Ness said...

Doc Prudence, ganoon ba? Hay. In some places a D&C is also done under very minimal analgesia or sedation. Horrible.

You said you couldn't do anything about the lack of anesthetic then... are you perhaps in a better position now, able to do something about this kind of situation?

Thank you for visiting. Hope may maisip ako for the TBR, second edition.

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