Reflection Paper No. 3 by Leader Dr. Suzette K. Munoz - My Passion and Advocacy

Good evening po Prof.  I know it is still quite early to submit my reflection paper no. 3, but just as well, I still opted to submit it already.  I have no intention though of adding pressure to my co-leaders. Thank you so much Prof. < It does Leader Dra.  They must do their papers early and must excel/exceed your work>

REFLECTION PAPER NO. 3 by Leader Dr. Suzette K. Munoz 4

MY PASSION AND ADVOCACY IN LIFE

Introduction:

            The miracle of birth is a fascinating event – the arrival of a new life into this world encapsulates the wonders of the human body and also captures the intricacies of how the body experiences change to accommodate the growth of another life in the womb. Moreover, the experience that a mother to be undergoes during the process is one which showcases tremendous perseverance, strength and willpower. While it is significant to appreciate and recognize the role of a mother in caring for a newborn before birth in terms of maintaining a healthy diet, exercising and sustaining her emotional wellbeing – the team of medical professions that assist the mother during this experience by being an instrument in bringing these babies to the world must also be recognized.

My Life Story as to How My Career as an Obstetrician-Gynecologist was Cultivated to Become My Passion, being an Obstetrician:

Even if at age 3, I already dreamt of being an obstetrician-gynecologist knowing that it would give me a fulfilling career so I could continue the legacy of my parents for the less fortunate, it was certainly not my passion yet, because at that early age, I did not even know what passion meant and have not even heard of that word. As I pursued with my medical schooling, it was during our clinical clerkship (4^th year of Medicine Proper) when I had my two (2) month's rotation at the Department of Obstetrics and Gynecology that I was exposed to this specialty. I was on a 24 hours duty when I was decked to this 24 y/o G1P0 pregnant woman whom I watched in labor at her bedside for practically 20 hours. I monitored the intensity of the uterine contractions with my hand on her tummy all the time and writing the frequency of the contractions and the fetal heart tones of the baby on the monitoring sheet. I felt so tired and had some sleepy episodes, but I could not rest and leave the patient as otherwise I would be reprimanded by my resident.  I was sleepless all throughout my duty. And when the time came that she became fully dilated and effaced, I rushed her to the delivery room only to find myself standing in front of her pelvis, fully scrubbed and anxious if I will be able to successfully deliver her baby without complications. The bag of water broke and with a few pushes, I saw the head of the baby descending to the pelvic outlet. I gently delivered the baby following the simultaneous maneuvers learned from our subject of Obstetrics. The baby cried, the mother cried, and I also cried signifying tears of joy on my part having been an instrument in bringing a new being into the world. I could not find the right words to explain what I felt at that very moment. There was extreme joy in my heart after I delivered the baby. All the exhaustion, the sleepless night, and the sacrifices I experienced during labor watching suddenly became insignificant and were all erased and all that mattered to me then was I delivered a baby boy! 

During my internship at the Jose B. Lingad Memorial Hospital, I was able to deliver more babies through either the vaginal or abdominal route.  What I noticed though in this government hospital was the unruly treatment of the patients in labor by the midwives. The patients in labor were laid to the delivery beds only when the babies were almost about to come out, that was on the 2^nd stage of labor. You would see these patients crying and moaning in pain along the corridors of the hospital. I learned it was a common practice as there were not enough delivery beds, delivery room staff and they don't do labor watch to monitor the progress of labor. I felt this to be disheartening and I had many what ifs, i.e. what if something bad would happen to the baby, what if the mother would suddenly develop complications during labor, what if the baby would just come out at the corridor, what if the mother or baby would die during labor? All these what ifs kept me bothered and I could not merely ignore them. Even if it was not in my job description as a postgraduate intern, I felt I had a moral obligation to correct this. I personally talked to the Chief of Clinics and proposed guidelines on improving maternal and neonatal health care with whatever resources we had at the hospital. I volunteered to give lectures to midwives and even nurses on the proper care of patients in labor and even counseled them on treating these patients with love and care even if they were only charity patients so to say.  I instilled in them that every human being, no matter what stature you have in life, should be treated as equal and to practice the Golden Rule, "Do not do to others what you don't want others to do unto you." It was a learning experience for all of us and I was amazed at the changes I noted, and it was my prayer then that even if I was no longer there after finishing my internship that they would still continue with the proper care of the parturient and that if the time comes that I would be a full-pledged Obstetrician-Gynecologist, I would continue to pursue implementation of proper and efficient maternal and neonatal health care in whatever capacity I would have.  I felt at this point, that I wanted to follow the path of being an Obstetrician-Gynecologist as a career, but I believe too that my passion for delivering healthy babies from healthy mothers stemmed from this circumstance that I witnessed in the government hospital. The mere fact that I fought for it has proven my enthusiasm to defend what was to the best interest of the patients in labor.

Now came the time of soul searching where I had to decide whether to follow the path going to Obstetrics & Gynecology knowing the hazardous trail I would have to go through in this journey. Obstetrics & Gynecology, especially Obstetrics, is not for everyone.  You must have utmost patience, dedication, strong will, love, commitment and courage to be an Obstetrician. You must be willing to sacrifice your time, and make yourself available anytime you are called for a patient in labor. Gone would be those out of town and out of the country trips for the sake of your patients who would really trust that you would be the one to deliver their babies after having put their confidence and trust in you for 9 months during the regular prenatal check-ups. While much of an obstetrician's work with pregnant women happens prior to the birth of a baby, the thrill of helping bring new life into the world is the hook for some. During residency, obstetricians often get their first opportunities to help deliver a child. Though intense -- and sometimes risky -- the miracle of birth often affects the doctor as much as it does the family of the baby. Obstetrics is a medical specialty that focuses solely on women. Providing topnotch medical care for women during pregnancy and in reproductive health situations is appealing to some. If you have a personal desire to care for women and be a part of their journey through pregnancy, this may be your calling. Passion is often what gets obstetricians excited about late-night calls to a birthing room. Keeping in mind all these, I believed I was determined to be an Obstetrician-Gynecologist and so I pursued with my residency training in Obstetrics & Gynecology at the United States Air Force Regional Medical Center Clark.  It were a rigorous three (3) year residency training and I was so blessed to have had my training in this institution with top of the line equipment/s and with the best training in all aspects of maternal and reproductive health care. I was exposed to several techniques of external and internal fetal monitoring using gadgets not even available yet even in big institutions in Manila at that time. Also, it was during residency training where we would have wanted to experience most of the varied complications of pregnancy, parturition and postpartum so that we could learn to best manage them so that we would be more confident in managing these complications when we would be exposed to them in our own private practice.

My career as an Obstetrician-Gynecologist for the past 25 years has been very fulfilling.  And this part of my career, being an Obstetrician, has become my passion without a doubt.  Even up to my age of 60 years old, I never lost the drive to wake up during the wee hours of the morning when called for a delivery. I never complain about having sleepless nights and never complained that I could not do as I pleased because I have to make myself available for my patients in labor anytime.  I had to miss and sacrifice a lot in my life for my patients in labor. And all of these are worth sacrificing for because the extreme joy of bringing a new life into this world will make the difference.

The Fullness of My Passion as an Obstetrician:

My passion in life is being an obstetrician because I believe this path in the medical field presents immense challenges but is also fulfilling for an individual on an intrinsic and emotional level. The role of obstetrical care in childbirth is fundamental because the healthcare offered to a pregnant woman by an obstetrician encompasses all aspects of labor from the birth of the child to post-partum care in the period which follows. The most important role that is to be played by an obstetrician is to gauge the current situation and factors before and during the patient goes into labor and assessing those elements to conduct effective decision-making. These critical decisions include understanding when labor has begun or when it is expected based on the imminent signs. This allows the obstetrician to recommend the procedure for ensuring that the health of the mother and the baby is never compromised.

While career considerations especially in the field of healthcare are highly significant when making decisions about the path that an individual wishes to choose, the intrinsic reward of being an instrument in bringing a life into this world is unmatchable. As an obstetrician I will be able to establish a positive association with my patients by being a part of one of the most memorable and momentous moments in their life. The personal satisfaction, intrinsic motivation and self-actualization that this could possibly bring may not be possible to attain in any other area of medicinal practice. Also, an obstetrician's responsibility towards a mother does not finish at the delivery of the child but only begins at that moment because an OB/GYN serves as a guide to the health of women throughout different stages of their life.

Therefore, the patient-doctor relationship in this area of medicine is something which I highly value as it is pivotal in designing a care plan for the patient that meets their requirements and expectations. I believe that by fulfilling my lifelong passion of serving as an obstetrician, I would be able to be a part of a very special moment in the lives of families that have been looking forward to it for so long. This career path has a degree of personal connection with the patients, which I understand would equip me in understanding their needs and assessing them accordingly. Thus, by establishing this personal connection and patient rapport I hope I can make a difference in the lives of patients and offer them support during this critical stage in their lives.

My Advocacy that Goes With My Passion:

It has been recorded that in economically underdeveloped countries, including our country where the standard of living of citizens is not up to a standard to ensure the successful provision of medical facilities, the health of a mother and a child may be at risk because of inadequate support. This notion asserts that under circumstances when a pregnant woman is unable to secure obstetrical care, the unavailability of these facilities puts the child at risk of serious health consequences. Thus, the significance of obstetrical care during the period defines the challenges that are faced by an obstetrician and overcoming these challenges to offer the optimum care to the patient and the child is immensely rewarding.

As my advocacy to help reduce maternal morbidity and mortality, I am actively supporting and participating in the advocacy programs of our mother society, The Philippine Obstetrical & Gynecological Society among which are:

·                      POGS Millennium Development Goals (MDGs) – This is a program in line with one of the United Nation's MDGs, that of improving maternal health by lowering maternal mortality rates by the year 2015, the POGS is embarking on a program to train and equip the midwives with the needed skills and knowledge to properly manage uncomplicated pregnancies and refer problematic cases to appropriate centers and physicians. Sufficient funding is paramount for the success of this endeavor.

·                       

·                      Advanced Labor and Risk Management (ALARM) – The program includes a module for normal newborn care, including newborn resuscitation in a health care facility and in the community; on preventive care; and on recognition and management of problems following resuscitation or in the first week of life.  The Society also accredits hospital obstetric services.

Conclusion:

In the Summary of Thoughts, my answer to all the ten (10) questions in the "The Passion Test" is a perfect 10!  There is no doubt whatsoever that my passion is my career, being an obstetrician.

And two quotes that describe my passion, " It's not how much money you make that ultimately makes you happy.  It's whether or not your work fulfills you.  The best feeling in the world is getting paid to do what you love." And "Neglecting passion blocks creative flow. When you're passionate, you're energized. Likewise, when you lack passion, your energy is low and unproductive. Energy is everything when it comes to being successful.  When passion and skill work together, the end result is often a masterpiece."

The joy of bringing a healthy new life from a healthy mother into the world is my masterpiece……….hence, it will remain my passion till my last breath.

<God puts you on where you are needed most - where needs are deepest, and that match your talents.  Congratulations Leader Dra.  Munoz.  Carry this light, ie of reducing maternal mortality and morbidity (as well as the infants) further into this world in this country in this time. and even beyond your time>