In the Hospital Room Where it Happens: Miscarriage, Abortion, and Giving Birth in a Filipino Government Hospital

As a medical student I had an eye-opening rotation in obstetrics and gynecology at Baguio General Hospital.

This is from another international experience I had in Daet, Philippines, though the procedure room at Baguio General Hospital was similar to this

By Dr. Aldene Zeno

I worked as a sub-intern in obstetrics and gynecology at Baguio General Hospital, Baguio City, Philippines, in 2012. I was fortunate to schedule this month-long, international experience during medical school. I thought I was prepared: I was less than six months away from graduating medical school. I had already done my six-week, third-year clinical rotation in obstetrics and gynecology, a four-week family planning sub-internship at the University of Chicago, and a four-week sub-internship in maternal-child health at West Suburban Hospital in Oak Park, IL. I also spent a summer in family planning with the Midwest Access Project, and had taught sex ed at a local high school. My background in women’s health was above-average compared to most of my classmates.

When I walked into my first day of work at Baguio General Hospital, my under-preparedness was on my name-tag. I am half Filipina, but my whole life my mom has translated Filipino language and customs for me. I grew up in the U.S. and don’t speak any Filipino dialects. My badge, which I wore proudly in Chicago, said “Yo hablo español,” I speak Spanish. One of the Baguio General residents noticed it right away and laughed. She was about 3–4 years ahead of me in the hierarchy of medical training, so basically my boss. “But you don’t speak Tagalog? Ilocano? Ibaloy?” she asked. No, I didn’t know any Filipino languages. I was momentarily embarrassed, but I soon learned the running joke among the residents, that speaking English “made their nose bleed.” All formal presentations in the hospital were in English, so they would say that to express how nervous they felt presenting outside of their primary language. My embarrassment became a healthy humility with not knowing the local language, and the residents all became welcoming teachers and friends to me.

Truthfully, I didn’t do my due diligence to prepare for some of the cultural aspects of my international sub-internship. Before starting, I should have learned some basic Ilocano, the local dialect, or Tagalog, the national language. I didn’t learn about the Filipino healthcare system. I knew the country was predominantly Catholic and socially conservative, but I didn’t understand how that impacted women’s health. I didn’t know abortions were illegal, or that there was a battle in their government about sexual health education and birth control. I found out that Manny Pacquiao, the famed boxer turned congressman, was vocally against subsidized contraception care in the Philippines.

Filipina women find ways to have abortions illegally, and sometimes these patients find their way to the hospital. While I was on service there, we had several women who came bleeding with incomplete abortions. They’d taken abortion pills purchased on the black market, but without medical guidance they could only turn to the hospital room in emergencies. Unfortunately, some resident physicians seemed to deride these women and denigrate their choice to terminate a pregnancy. I remember one such case where I assisted my senior resident, and I was appalled at her negative tone towards the patient. To add insult to injury, all minor procedures, such as managing incomplete abortions, happen in the same room as the normal childbirths. In that room there were three or four surgical tables without separation. As a medical student observing this situation, I could only empathize with these patients, who I imagine were experiencing one of their worst days.

Whether it’s a woman having an abortion, or one who miscarries a desired pregnancy, I know that these women suffer emotionally. They also suffer physically. The procedure for managing an incomplete abortion, called dilation and curettage, is performed with minimal anesthesia there. Most women here in the U.S. would have it with moderate sedation, or “twilight sleep.” In that procedure room, I was heartbroken thinking about those women with incomplete miscarriages. They already know that a pregnancy they’d hoped for is ending. When their miscarriage starts but does not complete on its own, they have to have the procedure or it can causes life-threatening complications like bleeding or infection. I imagined those women scared, devastated, and feeling physically awful. I wonder how they felt being in the same room where women were giving birth.

The physicians at Baguio General Hospital work incredibly hard. As a teaching hospital, it relies heavily on the resident doctors for most of the work. The residency is four years long, similar to the U.S., but at the time their training looked more like it did 30–50 years ago in the States. The residents worked what we call, “Q2 call.” They worked 7a until evening one day, then twenty-four hours the following day. After that they were “post-call,” meaning off the rest of the day, until the next day when they did that all over again. I’m sure this easily added up to 80–100 hours per week. They cared for the most indigent patients in the area. Many of them worked this schedule while they had children, were married, or were far from their hometowns.

I often think about the woman having an abortion, the woman having a miscarriage, and the woman giving birth, all side-by-side in this procedure room. I imagine the woman giving birth without pain medicine, so beside herself with pain that she probably can’t focus on anything else. I imagine the woman having an abortion, perhaps feeling ashamed for being in the hospital when she wanted to end her pregnancy covertly. The woman with the incomplete abortion may not have even processed that this desired pregnancy is ending so suddenly. One moment she was pregnant, and now she’s being whisked into a procedure after being told her pregnancy has ended.

These women’s stories are universal. Childbirth and the loss of a pregnancy occur regularly. They’re the common stories of womanhood, and yet each story is unique. It was transformative for me to encounter all of their stories in this room, sometimes all at the same time. Just as these women left that room forever changed, I also left my time at Baguio General Hospital with an entirely new perspective. I am amazed at what women go through, with the expectation that it’s “just part of being a woman.”

As a young physician, that was the beginning of my learning to focus on the task at hand, as emotionally varied as the day’s tasks were. I learned that taking care of women requires the technical skill to do procedures, the empathy to listen to the woman in front of me, and the emotional reserve to start over with the next patient. I also saw how being a doctor in such a high-stress setting could dull one’s humanity a little bit. I was so busy running around from one procedure to the next that I didn’t truly have time to learn each woman’s story. I still consider my time at Baguio General to be a privilege. Now that I’m done with training, I look forward to giving back to that institution that helped get me started in OB/Gyn.



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Pelvic Health for Brown Girls

Pelvic Health for Brown Girls

Bill Nye taught me everyone is a shade of brown. This is a forum for all about all things female. Official blog for Dr. Aldene Zeno MD, urogynecologist.