President’s Message

Greetings!

Christmas is the happiest season of the year. It is filled with excitement- lavish food, shopping, parties and for some, a much awaited vacation. In the heart of a child, it means a lot of gifts and surprises to be opened on Christmas Eve.

In the midst of all the merriment and festivity, let us be reminded of the deeper essence of this annual celebration -our love for God and the need to share it with others especially the less fortunate .

For the Alumni Association, it is an optimum time to reflect on the past. This year has been very fruitful for us. We had several undertakings which catered not only to the professional growth of the alumni but likewise activities geared toward humanitarian service in line with our thrust of community involvement.

I would like to take this opportunity to express my heartfelt gratitude to my team for their tireless efforts to bring this Alumni Association to the pinnacle of success. To my co- alumni, your continuous support and cooperation is greatly appreciated. This will serve as our driving force to strive harder as we carry on with our responsibilities. .

Let us continue to be one in spirit as we hurdle challenges in the days ahead.

Wishing you all a joyous and meaningful holiday.

Rosemarie V. Serrano, MD

Christmas Party Revelry!

- Dr. Benjamin Guillermo Ligot

Despite Typhoon Ruby, the annual Pediatrics Christmas Party was held last December 8 at the PCAS center. It’s theme was “Fiesta! It’s more fun in Pediatrics!” The theme celebrated the nostalgic feel of being children. Contestants from consultants to interns were tasked to play in parlor games such as Pabitin, Calamansi Relay and modern games such as “Pinoy Henyo.” The night was capped by the white elephant gift giving and a message of thanks from our outgoing chairman, Dr. Rosario Gamus – Te. It was indeed a joy-filled night for everyone.

PIONEERING A LEGACY

by Dr. John Eric Tan

Dr. Teodoro Uy Cofreros is a proud product of the second batch of the Cardinal Santos Medical Center Pediatric Residency Training Program, completing this in 1977. Graduating with a Diploma in Medicine from the UST Faculty of Medicine and Surgery, he pursued his dreams of becoming a Pediatrician in what was then one of the newer hospitals in San Juan .... known as the Cardinal Santos Memorial Hospital. He could recall that during his residency period, the Greenhills area was a vast land of undeveloped grass fields …. a far cry from the highly urbanized area that the present generation is familiar with.

After his residency, "Tito Ted", as he is fondly known to his patients efficiently juggled his time between being in full time pediatric practice in several clinics as well as being a loving and responsible father to his family. Despite being very busy in his private practice, Tito Ted always made his family his first priority. His very supportive wife, Milagros, and his 4 children, Tanya Monica, Leandro Eugenio, Carlos Jose and Tiffany Mae, were his pillars to persevere and strive for more despite the odds.

Coming from humble beginnings, Tito Ted was the 3rd of 6 siblings of an Army General and a businesswoman. The Second World War marked by the Japanese Occupation caused his family to flee from their home. This forced relocation subsequently made his mother give up her dream of becoming a doctor... a dream that years later inspired "Tito Ted" to personally fulfill. Tito Ted wanted not only to complete his mother’s ambition to be a doctor, but he himself wanted to make his mark by being the best doctor that he could be. ““Through hard work and perseverance, one can achieve anything” is one of the most valuable lessons that my parents have taught me”, said Dr. Cofreros.

During his more than 30 years in practice, Tito Ted has held various significant positions in various organizations. He was the CSMC MAB administration President in 1996-97 and still heads the Ways and Means Committee. He also Co-Chairs the Ways and Means Committee of the Philippine Pediatric Society.

Of all his achievements or positions held, the one that he is most proud of is that of being “Tatay” to his kids and “Lolo Pop” to his 3 grandkids, Luis, Matteo and Iya. His children, namely his son Carlos Jose (CJ) currently in 4th year Med school and Tiffany Mae (Mai-Mai) presently doing Pediatric residency in Amang Rodriguez Medical Center, were the ones who followed his footsteps. Tito Ted hopes to retire soon and leave his practice to his kids.

Tito Ted always emphasized that we must work to live and not live to work. He travels with his family more than 8 times a year (Domestic or International) and is proud to have been all over the Philippines from Aparri to Jolo. During his spare time, he tends to his small farm in Antipolo where he has various fruit trees, vegetables and poultry and also takes care of his 27 dogs! He keeps his health in check by running 5 kms every morning. He also loves cooking healthy meals for his family with fresh ingredients from his organic farm.

As Tito Ted continues to be the loving and dedicated doctor to his patients both old and young, he never ceases to give the best care to all his patients. He lives by his motto: “to stand on your own but to humble yourself to others whilst helping others achieve their goals and dreams.”

CSMC-PAA ARCHERS
Dr. Veronica Cruz-Garcia

Adventurous members of our alumni group tried out one of the most anticipated sports today. At the Gandiva Archery Range & Cafe, our fun-loving , thrill-seeking alumni tested their minds and bodies as they gripped the powerful bow and focused on the targets.

In groups, our alumni headed onto the hidden sports range in the heart of Ortigas, competing against each and challenging themselves. On August 18, the pioneer group members were Drs. Rose Serrano, Tina Pangilinan, Suzette Bautista, Janet Panagsagan, Cynthia Clemente and Beverly Chua. Eagerly following on August 28 were Drs. On-On Cruz-Garcia, Doris Sta.Ines-Salvador, Angel Moral-Mendoza, Josy Venturina, and Ca Donato. The threesome Drs. Chary Gamus-Te, Arlene Samonte and Brandon Ericta went on September 4, and the final daring group went on September 8 with Drs.Loi Teodoro, Lenny Evangelista and Roy Vinuya.

As seen in the pictures, our alumni shows how fun it is to spend time with each other in new adventures, testing personal limits and reconnecting with colleagues and friends.

Community Christmas Outreach 2014

by Dr. Josy Naty Venturina. Dr. Chelsea Vicarez & Dr. Erika Joy Ng Tsai

Christmas is the most wonderful time of the year! It is during this season that we get to spend time with our loved ones, exchange gifts and most importantly celebrate the birth of our Lord Jesus Christ. It is also a perfect time for us to share our blessings. Yearly, the community committee of the department with the help of the consultant staff, alumni and residents, sponsor a Christmas party to bring a holiday cheer to the less fortunate children of our community in barangay Corazon De Jesus.

Last December 14, 2014 we celebrated the community Christmas party at Jollibee Roosevelt, Ortigas. It was warmly attended by 75 individuals. Twenty five of which were mothers, 32 kids, 3 healthcare workers, 11 residents, 1 intern and 3 consultants. The party started with an opening prayer lead by Dr. Justina Pangilinan followed by introductory remarks given by Dr. Amelia Europa. The attendees enjoyed the fun games and prizes. The residents entertained the crowd with their dance number and 6 kids likewise prepared their very own version of the dance. After which, we were graced by the sumptuous food. Special prizes were also given to healthy babies and for those who shared their talents. Everyone had a great time and were very happy to go home with their kid's loot bags and Noche Buena packages. Through this simple event, we were able bring joy to the kids and their families in our community.

EBOLA VIRUS DISEASE

Maria Tricia DV. Subido, MD, DPPS, DPIDSP

Medical Specialist III - RITM

Ebola is a highly infectious disease with five identified virus strains, four of which are known to cause disease in humans. It is transmitted from person-to-person by direct contact with infected body fluids or by contaminated fomites.

Ebola first emerged in the form of two nearly simultaneous outbreaks in 1976, caused by 2 different strains: Sudan ebolavirus and Zaire ebolavirus. The first outbreak occurred in Sudan, near the border with the Democratic Republic of the Congo (DRC) and was due to the strain Sudan ebolavirus. Since then, outbreaks have appeared sporadically in Africa. Outbreaks occur when the virus is introduced into humans from a wild animal reservoir, with subsequent human-to-human transmission, often fueled by nosocomial amplification in resource-poor settings. On March 21, 2014, the World Health Organization (WHO) was formally notified of a rapidly evolving outbreak of Ebola Virus Disease. To date, countries with widespread transmission include Guinea, Sierra Leone and Liberia and those with localized transmission include Mali, DRC, Spain and USA. Case fatality rates for severely affected people range from 25% to 90% (approximately 70% in the 2014 outbreak).

The most common manifestations of the disease are fever, fatigue, gastrointestinal symptoms (e.g. abdominal pain, vomiting and diarrhea), severe headache, muscle pain anorexia and related volume depletion requiring the administration of intravenous fluids and electrolyte therapy. Symptoms may appear anywhere from 2 to 21 days after exposure to Ebola virus, but the average is 8 to 10 days.

When an infection occurs in humans, the virus can be spread to others through direct contact (through broken skin or mucous membranes in, for example, the eyes, nose, or mouth) with blood or body fluids (including but not limited to urine, saliva, sweat, feces, vomit, breast milk, and semen) of a person who is sick with Ebola as well as objects (like needles and syringes) that have been contaminated with the virus and infected fruit bats or primates (apes and monkeys). The degree of viremia appears to correlate with the clinical state. People are most infectious late in the course of severe disease, especially when copious vomiting, diarrhea, and/or bleeding are present. Transmission during the incubation period, when the person is asymptomatic, is not believed to occur.

The diagnosis of Ebola virus infection should be considered in a person who develops a fever within 21 days of travel to an endemic area (particularly Sierra Leone, Liberia, and Guinea in the 2014 outbreak). Confirmation of diagnosis may be done using antigen-capture enzyme-linked immunosorbent assay (ELISA) testing, IgM ELISA - Polymerase chain reaction (PCR) and virus isolation within a few days after symptoms begin.

Symptoms of Ebola are treated as they appear. Basic interventions, when used early, can significantly improve the chances of survival. This includes providing intravenous fluids and balancing electrolytes, maintaining oxygenation status and blood pressure, treating other co-existing infections.

As healthcare providers, we are at high risk of getting sick with this virus because we may come in contact with infected blood and body fluids of possibly infected patients. During outbreaks of Ebola, the disease can spread quickly within healthcare settings (such as a clinic or hospital). When in close contact (within 1 meter) of patients with Ebola virus, health-care workers should wear complete Personal Protective Equipment (PPEs). Dedicated medical equipment (preferably disposable, when possible) should be used to provide patient care. Proper cleaning and disposal of instruments, such as needles and syringes, is also important. If instruments are not disposable, they must be sterilized before being used again. Without adequate sterilization of the instruments, virus transmission can continue and amplify an outbreak.

The Research Institute for Tropical Medicine (RITM) was designated by the Department of Health (DOH) as the primary referral center for Emerging and Re-emerging Infectious Diseases in the Philippines. It houses the National Reference Laboratory capable of performing the currently recommended diagnostic tests for EBOLA such as Polymerase Chain Reaction and ELISA for antigen and antibody detection.

As part of the DOH’s preparation for the possible entry of Ebola virus disease (EVD) in the country, RITM has developed standard procedures for screening and diagnosing patients suspected to have EVD. RITM, in coordination with the DOH and the World Health Organization developed a comprehensive 3-day training course for healthcare professionals whose objective is to provide participants with the knowledge and skills to diagnose and treat patients with EVD following proper infection control procedures. The training course includes guidelines on clinical management, laboratory diagnosis and infection prevention and control. Emphasis on donning and doffing of PPEs. The trainings were held last October 28-30, 2014 for DOH retained hospitals, November 4-6, 2014 for private hospitals and November 11-13, 2014 for local government units.

Scholars of CSMC PAA

Dr. Josy Naty Venturina, Dr. Angel Andrea M. Moral-Mendoza & Dr. Odette Nebre-Lising

The Scholarship Committee of CSMC Pediatric Alumni Association since it was established in 2011, has sponsored 2 of our alumni namely, Dr. Edwin Rodriguez (ER) and Dr. Ma. Naval Rivas (MNR). Dr. Edwin pursued his masteral degree in Health Professions Education and Dr. Navs her Masteral in Developmental Psychology.

Year you graduated from the CSMC pediatrics residency program? Fellowship training?

ER: I finished my pediatric residency training in CSMC in 1998 serving as Assistant Chief Resident during my senior year. I pursued my fellowship in pediatric hematology at the UST Hospital from 2000-2002. I took my written examinations for diplomate in 1999 and passed my oral examinations in 2001. I am currently a fellow of the Philippine Pediatric Society, Philippine Society of Hematology and Blood Transfusion, Philippine Society of Pediatric Hematology and a regular member of the Philippine Society of Experimental and Clinical Pharmacology.

MNR : December 2000. No fellowship training.

How many years have you been in practice?

ER: I have been in pediatric practice since 2002 and pediatric hematology practice since 2003. So that makes it 12-13 years of clinical practice.

MNR: I think I started getting patients in 2000.

Current affiliations and teaching positions and in what university?

ER: I am currently Associate Professor II at the Departments of Pharmacology and Pediatrics at the UST Faculty of Medicine and Surgery rising from the ranks of Instructor IV from 2006-2009, Assistant Professor II from 2009-2012 and my present academic rank since 2012. I was also appointed Faculty Secretary of the UST Faculty of Medicine and Surgery in 2012.

MNR: Clinical Instructor, Ateneo School of Medicine and Public Health

Name of postgrad course taken and where?

ER: I completed my masteral degree in health professions education (MHPEd) magna cum laude at the UST Graduate School from 2010-2013. It was the best place for me to undergo further training as it was very conveniently located within the university and was scheduled from 6-9pm after my classes and clinic hours in UST.

MNR: Masteral in Developmental Psychology, Ateneo De Manila University

What inspired you to pursue a master's degree in this particular field?

ER: Being methodical is something inherent about me and in the way I think, talk and act. I have always observed and practiced a strategy which I thought will be both useful and appropriate. I always dissect problematic situations requiring judgment and decision-making by first, breaking them down into pieces (analysis), carefully noting how I went through the process. Then I look closely at every part and see how it contributes to both the problem and its solution. Finally, I piece back a solution using some, all or none of the dissected pieces and come up with something new and distinctly mine (synthesis). Having been introduced to medical education in 2005, it took me five years to finally start acquiring the methods I believe I must equip myself with to be an effective educator. Guided by the same mental framework, I then embarked on a formal track to become a qualified and competent medical educator, armed with both the experience and the empirical foundation to be credible and competent. I think being an educator is intrinsic to every physician as we are confronted with countless opportunities to teach, demonstrate, show and share whatever knowledge and facts we know or have accumulated through the years. So with the end of being a “highly effective and methodical educator” in mind, I decided to work back from the outcome I envisioned to the steps I needed to take successfully to make it a reality. From the very beginning, I never realized I was “outcome-based”.

MNR: I have always been interested in human Psychology, it was actually my pre-medicine course.

Even as I was finishing my medical degree, I always found the opportunity to practice what I learned

from my undergraduate degree and counsel friends and classmates. However, in private practice, I

realized a wider need for the practice of psychology in general pediatrics.

Children nowadays are raised differently by competitive parents. The culture of early schooling, wide use of technological gadgets and dependence on tutorials have implications on the psychological well-being, academic performance and social functioning of children. Difficulties in these areas I mentioned may be developmentally rooted and may sometimes express as somatic complaints. Again I found myself meddling with the family’s dynamics when I sense that there are psychosocial factors involved in a child’s persistent complaint, for example an on and off abdominal pain. Actually this attitude towards managing every patient of mine nurtured in me an advocacy on parenting. It became a passion to advice parents during well child visits on how to also take care of the socioemotional development of their children. Then there came a point that I decided to enrich my knowledge through going back to school hence, graduate school!

What were the difficulties you encountered along the way? How did you overcome them?

ER: I prefer to use “challenges” in place of the word “difficulties” and “sacrifices” instead of “sufferings” to describe the many ups and downs, twists and turns I have ever encountered in any endeavor I have decided to undertake. Taking a masteral degree is sheer hard work. I was a full time academician and clinician with administrative responsibilities. My schedule was deadly. One whole day as either educator and/or administrator then at night a struggling graduate school learner. I was assuming the role of educator and learner every single day during my graduate school education. My usual routine is I will go home around 9 pm very hungry, still needing to make rounds to admitted patients, rushing to complete my lesson plans, checking papers in between and answering my assignments for submission the next meeting. I walked around the campus during Christmas time for three years, teary eyed and tired, sometimes asking myself why I even considered pushing myself that far. I had to re-enter the library again and re-learn the index medicus for rare books, browse through the web for medical education journals, cue during enrollment and line up for photocopying services. I had a tough time but to my surprise I enjoyed every single minute of it.

How did I survive? Let me count the ways. (1) Time management was key. (2) Open mindedness and maturity were essential to fully embrace the workload and appreciate the benefits my efforts brought me. (3) Faith in God, in oneself and in one’s capabilities were essential to convince myself I can make the cut. (4) I never tried to compete with anyone except myself. My own success is my own benchmark so I never end up vain or bitter.(5) I likewise am not fond of comparing myself with others. I know who I am and what I am capable of doing so I don’t end up with envy or despise of another. (6) Creativity was an indispensable tool and the freedom to express your thoughts through knowledge built on what exists and new knowledge generated by deep learning from what never existed were incomparable sources of bliss I cherished in graduate school.

The scholarly environment of the graduate school both inspires you to be up to par and compels you to prove yourself vis-à-vis young, energetic and zealous classmates. I enjoyed the counsel of the young as they have a different version of the same story. I marveled at the gifts of the young as they can do what is beyond description both with their imagination and the technology at hand. Knowing why you are in graduate school, pursuing almost spirally an aspect of knowledge and bringing it to a higher level of mastery is what sets a graduate school survivor apart.

MNR: Time management is the primary difficulty. I had to divide my time between private practice, part-time teaching loads, night time school of 3hours 3x a week, tutoring my grade 3 child and paperwork deadlines of school. It is an understatement to say that it was indeed challenging! My goal to get the degree and the motivation that I get from the quality learning that I acquired just kept me going. Every year that I finish, made the task easier. It really became tougher by the end of each semester, all I had to do was extend my working/studying .hours, cut some leisure time and add some cups of coffee.

How are you able to apply the course you took to your profession as a clinician and/or educator?

ER: In a formal sense, my MHPEd was essential in the better understanding of my role as a medical educator and equipped me with firmer grasp of the influence I can impart to better the lives of future medical learners. My masteral degree gave me a solid foundation on how to view medical education from the perspective of all stakeholders – learners, educators and schools of higher learning – justly and correctly. My masteral degree made me a kinder, more considerate, more sensitive mentor. Putting my learners in the center of what I do and what I hope to do has changed my appreciation of my responsibilities and duties as an educator. My masteral degree allowed me to view myself as an important conduit of constructive and collaborative learning by designing and engineering changes in the curriculum and its attendant learning outcomes, teaching-learning activities and assessment tasks. I learned that feedback and the productive outcomes emanating from such practice are pivotal in the process of improvement and near perfection. But this positive impact goes well beyond the medical school. The tenets and principles of sound medical education is never limited by the boundaries of physical learning environments nor is it caged by traditional mindsets. In fact, it is even better appreciated in the clinical environment where all of us were once immersed. Even in our own pediatric residency training program, I have incorporated both in my personal and professional encounters with resident-trainees approaches to assess their cognitive, affective and psychomotor learning domains. I have pushed for a portfolio-based assessment which combines pencil-an-paper tests with performance-based evaluation to adequately and accurately evaluate residency performance.

MNR: Again as I mentioned earlier, this added education empowers me to properly meddle with the psychological development of every child I care for. This to me is an important aspect of holistic management. I feel optimum development has to be a balance between intellectual, emotional, and psychosocial milestones. Apart from maintaining wellness, I am also capable of handling children who are already affected by psychosocial factors and experiencing developmental issues. I can work closely with developmental pediatrician in the management of a developmentally challenged child.

Do you have plans to pursue other courses or get a PhD?

ER: Pursuing another masteral degree sounds interesting but obtaining a PhD seems to be the more logical option. A PhD track is something I can consider in the coming years. But at the moment, I think my masteral degree is serving me well. I would like to believe that it has prepared me satisfactorily for my tasks as administrator and medical educator. I tried to project how long I will finish a PhD degree and that would take at least 5 years more. I am andropausic by that time and my libido may not give me the kick I need, so taking this plunge is not at the moment extremely enticing for me. But if and when I decide to, you can be assured I will nail it to completion. That is one thing I consider nice about myself, I never leave what I decided to begin undone. For me, there’s got to be a closure to everything. I am taking my time on this matter.

MNR: No more PhD please.

Words of inspiration or encouragement for other alumni who have plans of taking up further studies or training.

ER: (1) Reinvention is the secret to staying on top of the game. When others see you as run of the mill, change gears and level up. When others see you as routine, shift lanes and swerve to the side. Being who you could be is much better than just being who you are. There is potential in the former and fatalism in the latter. There’s got to be a way to view, say and act things differently. That will not only get you noticed, in fact, that will get everybody guessing what’s next. In this life, what doesn’t kill you will just make you stronger. Sometimes, a different view is all that matters and sometimes that is all you need. (2) Unpredictability is power. When they expect you to react, do the opposite. When they expect you to explode, kill them with kindness. Unpredictability is power and it resides in he who has mastered the art of stirring interest. Whatever a man cannot predict makes him restless, guarded and on his toes. If you cast that effect on others, then power resides in you. (3) Resilience is a credo. It is an attribute you both pronounce and profess. Being ready to savor the tune of high notes and achieving ecstasy must also prepare you to the possibility of hitting bottom and getting bruised. Success was never narrated with the victory in the beginning. It was the twist and turns, the ups and downs the storyteller conquered that makes every story exciting, compelling and worth repeating. The ability to adapt and adopt are capabilities every successful human being must master.

On a personal note, allow me to thank the officers and members of our beloved CSMC Pediatric Alumni Association for extending 3 semesters of financial support through our educational assistance program. I am truly grateful for this concession and shall remain committed to help our department in whatever capacity I can in the areas of continuing pediatric education and professional development.

I encourage all our young graduates to consider a career in health professions education and explore the possibilities and potentials it may bring.

MNR: Going into a masteral program is a matter of desire and determination. For me, one’s heart and mind have to want it for it to happen. Once in the program, determination should make you stay and finish what you started. In my experience, it was not hard to stay motivated because I fell in love with the new learning.

TEENAGE PSYCHOLOGY

By Dr. Odette Nebre-Lising

Last August 29, 2014, our alumni lecture was given by one of our scholars, Dr. Ma. Naval Rivas, entitled “Teenage Psychology”. Dr. Rivas finished her Masteral in Developmental Psychology at Ateneo de Manila University. Presently, she is a member of the Residents Training Committee of the CSMC Department of Pediatrics and Clinical Instructor at Ateneo School of Medicine and Public Health.

She discussed about the challenges of teenage parenting with the objective of understanding the adolescent and use this as parents and physicians in helping our teens survive this stage for the complex tasks of adulthood.

An interactive session was done after the lecture where consultants and residents asked questions both from personal and clinical practice experience about teenage psychology.