Fellowship in Prehospital and Disaster Medicine (PDM) is a flagship program of the Emergency in Medical and Trauma Services offered by the Universiti Teknologi MARA in Malaysia. This program is designed to empower emergency physicians through academic courses, leadership training, and networking. One of the essential elements to advance in the program is being able to do a fellowship attachment in a foreign country. I specifically chose to have my fellowship attachment in Davao City, Philippines because it has been recognized as a peaceful and orderly city that is resilient to natural and anthropogenic disasters. I was also interested to learn about the proactive stances of its leaders towards empowering communities and strengthening disaster risk reduction and disaster management capabilities. My fellowship attachment took place between March 14, 2019, and June 24, 2019. I was the first fellow in the PDM program to have my attachment in Davao City. My purpose was to identify and learn from gaps between the prehospital care and emergency medical services of Philippines and Malaysia. I also wanted to expand my clinical experience and learn more about the Emergency Medical Services in the Southern Philippines Medical Center (SPMC). Their Department of Emergency Medicine has observership arrangements with partner institutions. In SPMC, my main rotation took place in the Emergency Room - Trauma Surgery Unit. I had a comprehensive learning experience while being part of medical standby services for significant events. First, I was part of the medical standby services for the Alveo Ironman 70.3 in Azuela Cove, Davao City. The event had a month-long training and simulation for the safest race, which involved a team from various agencies such as SPMC, Central 911, Bureau of Fire Protection, Philippine National Police, Philippine Red Cross, and Philippine Coast Guard. Second, I was also involved in the medical standby services during the 2019 Palarong Pambansa, an annual multi-sport event for student athletes from all over the Philippines. I was able to participate in the emergency medical service activities of the Davao City Central 911. I had quite a few day-time, and night-time ambulance runs during my rotation, not only in the main Central 911 office, but also in the three other satellite stations in the city–Panacan, Toril, and Cabantian. Most of the patients I responded to (woman in labour, head trauma patient, medical patient in shock, pre-arrest condition, etc.) needed immediate transfers. I also had the opportunity to teach the emergency medical technicians (EMTs) and Emergency Medicine residents who were doing rotation in Central 911. During my fellowship attachment, I was also able to participate as a trainer and evaluator in an audit activity on high-quality cardiopulmonary resuscitation (CPR) using the QCPR app and a mannequin. The audit involved 60 EMTs. The pretest results of the batch revealed that about 90% of the EMTs had poor-quality CPR performance, with compression fraction percentages falling between 10% and 50% (acceptable: 80%). After the pretest, we taught the EMTs how to perform high-quality CPR and to assess the quality of their CPR through the feedback sensor attached to the mannequin's chest and the QCPR app. All of the EMTs in the batch passed the high-quality CPR feedback posttest, making them competent in performing single-rescuer, high-quality CPR. During the last month of my fellowship attachment, the Chief of the Davao City Disaster Risk Reduction and Management Office gave me the opportunity to learn about the concept and practice of disaster risk reduction in Davao City. We reviewed the data on the catastrophic events in the city during the past decade, the progressive development of disaster risk reduction efforts, and the coping mechanisms of communities that experienced disasters. I was amazed at how hard the team worked through the challenges in responding to disasters and how it managed to produce outcomes that are worthy of recognition. SPMC also gave me the opportunity to participate in its medical missions in Surigao. The missions strengthened the collaboration of SPMC with other hospitals in Mindanao for the development of the telemedicine program based in SPMC Emergency Medicine and Surgery departments. During the missions, clinicians in rural areas underwent short trainings on point-of-care ultrasonography and real-time ultrasound image transfer to enable them to participate in the telemedicine program. I was also introduced to the SPMC Diving and Hyperbaric Medicine Unit, which is located near the Emergency Room - Trauma Surgery Unit of SPMC. I learned the process of how selected patients undergo hyperbaric therapy, and I was even allowed to get into the hyperbaric chamber. I look forward to bringing back new ideas, thoughts and connections from SPMC to my institution in Malaysia. What I have witnessed and experienced firsthand during my fellowship attachment inspired me to encourage people from outside Davao City to explore the excellent development and progress of the disaster risk reduction program in Davao City. Indeed, the Philippines has many great people with compassionate character and benevolent nature. Even before leaving for my home country, I know that I will miss the Philippines and its people very much.
Emergency Medicine