by Rene C. Vargas, M.D.

It’s been some time ago… So much muddy waters have flowed down the wide Agusan. Yet, certain memories linger on, fresh as ever…memories of life in old Butuan… memories…

I REMEMBER coming out of UST Medical School in 1962, I landed my first job as an Adjunct Resident Physician at the Butuan Hospital, the official name of the provincial hospital. I was paid PhP 32.00 a month. There was really no salary for the whole first year of service in compliance with government regulations of the time. The PhP 32.00 was the monthly laundry allowance. The sum was more symbolic than material for me; I had this feeling of fulfillment that, at long last, I was a doctor. Forgotten were the seemingly endless struggles of leafing through the pages of extra-thick books and the sleepless nights during the 2 years of premed, the 4 years of medicine proper and the one-year internship, all the while supported by my parents who were sending me a good portion of their hard-earned money. 

The following year, I was promoted, and became a Junior Resident Physician, this time with a salary of PhP240.00 a month. It was hardly enough to pay for personal expenses and transportation to and from the hospital which was then located near the present day Capitol – at that time considered as quite distant from the Butuan of my time. But it didn’t feel that far to me, now on my own, treating the sick, and assisting in surgery, and receiving remuneration, however inadequate the pay. 

People today will call it the era of frontier medicine. I REMEMBER that it was a time when disposable needles were unheard of. Needles for injection were used and re-used, repeatedly. They were sharpened again and again by rubbing them against a grinding stone. They were sterilized with a thin wire inserted into its hollow shaft to prevent sludge build up inside. Neither was there any disposable syringe. Syringes were re-used after re-sterilization, the matching syringe plunger was tied with a white cotton thread to the syringe body to prevent mismatch, because many different syringes were placed in the sterilizer at the same time.

I REMEMBER that there was no anesthesiologist then, it was a time when pioneering, yet skilled, surgeons were doing thyroidectomy, mastectomy, and even Cesarian Sections, under local anesthesia. The surgical suture needles were not disposable, they had tiny holes through which we inserted cotton or silk or gut threads that would strain the eyes of today’s surgeons accustomed to ‘ throw away ‘ ready-to-use threaded sutures. And yes, the needles were re-sterilized and re-used again and again, until they were no longer sharp enough.

I REMEMBER that we used scraped soap for washing and scrubbing our hands and arms before surgery. PhisoHex came later, Betadine even much, much later. And the brushes we used were re-used repeatedly after re-sterilization. Today’s age of throw-away paper masks, paper caps and paper boot covers is a far cry from the time when cloth was used, laundered and sterilized after each use. The hospital had a sewing department to cut, sew and fabricate all these stuff. For skin antisepsis, the use of merthiolate and mercurochrome was the vogue; both are now banned because of their mercury content.

I REMEMBER the many times when the lights went off during surgery, and those dark times were not uncommon. Yes, those were the times when the surgeon had to keep his cool, a time when the circulating nurses had to be adept at starting the Petromax fast, and at focusing the flashlight unto the depths of the surgical incision for the surgeon to see what he was doing.

I REMEMBER the nightmare of the Cholera El Tor epidemic that devastated Butuan and the entire country. It was an overwhelming experience for a green doctor fresh out of medical school. Dozens of seriously ill patients were brought to the hospital in near death from severe diarrhea and dehydration, their skin so dry and without turgor that long after being pinched the skin remained curled up, their eyeballs deeply shrunken, their voices husky and reduced to a whisper, their bodies so severely emaciated that weight loss was evident in just hours, the skin of their hands were so wrinkled, disheveled, and rumpled that they were described as ‘washerwoman’s hands’.

Intravenous fluids were dripped into veins so fast just to keep up with the huge losses of fluids from the diarrhea that, many times, we had to have one needle in each arm and leg at the same time. Blissfully, the Department of Health had a good supply of intravenous fluids. Many times we saw patients losing water and salt so fast that their kidneys refuse to put out urine.

Unable to stand, much less walk, they arrived at the hospital in makeshift stretchers, benches, hammocks, or on other’s backs. When the hospital ran out beds, patients’ families ran back home and brought their own beds. Those living in far-flung areas who were without their own beds, had to sleep on the floors. Hospital doors were unhinged and removed, and laid flat on stands to serve as beds. Plywood beds were constructed in a big hurry, a circular hole was cut at the site where the patient’s buttocks should be, and a commode was placed underneath to catch the watery stools that flowed almost endlessly from the bowels. The cause was the cholera el tor germ in contaminated food or water.

I REMEMBER Butuan during those difficult years. There was no potable water supply to speak of. Water chlorination was unheard of. Drinking water was rain water collected from roof gutters or was fetched in pails from deep wells, or collected from the salty free-flowing artesian wells. In the rural communities, water was fetched from streams.

I REMEMBER old Butuan where flush toilets with septic tanks were a rarity. Today, sanitation and public health are many multiples better, but back then the so-called Antipolo toilets were in use. Without the water trap and the sealed system in use today, the Antipolo toilets of those innocent times allowed flies and vermin unhampered access to cesspools, carrying the vibrio cholera el tor germ and other microbes to the kitchen and unto food or water. It was a miracle so few had died.

I REMEMBER that, as the epidemic was raging, hospital resources and staff were severely strained. The usual stab wounds, fractures, pneumonias, malaria, infectious diseases, gunshot wounds, falls from fruit trees, pregnant women in labor, injuries from brawls, all of them had to be attended to as well. It was a time when there was only one “public” hospital, there was no city hospital. People seemed much, much poorer then than now. Patients from all over the then undivided province of Agusan favored the provincial hospital over the smaller private hospitals for economic and other reasons.

I REMEMBER the great flood, the heavy downpour, the Agusan River swollen and overflowing, dumping its brown waters unto the community. The river dike we have now was not yet conceived in the early to mid-60s. The deluge lasted an unbelievable 3 months. The whole city was underwater. Whatever vegetables, fish, or meat there was, were sold on the roof of the market building, or at the kiosko at the Rizal Park (it was called Guingona Park then), others were peddled from floating barotos.

The ground floor of the hospital was submerged deep under flood waters. Patients were transferred to the second storey, crowding even the hallways. Due to lack of space, patients were now packed like sardines, lying next to each other. The Lord must be kind to Butuanons because there was hardly any cross infection. Doctors had difficulty making patient rounds because there was hardly any space between patients. From their homes, the hospital staff had great difficulty coming to work, riding on barotos without outriggers. Many came late for work, others simply did not show up. Many were the nights and days I stayed on duty in the hospital, sometimes for a stretch of 2 or 3 days, because the reliever, himself a flood victim, couldn’t make it through the flood waters. But there were light moments too. Our chief of hospital had fun hunting wild ducks and snipes from the hospital window with his .22 caliber rifle. Yes, ‘them were those days’ indeed.

I REMEMBER the Obstetrics practitioner at the public hospital sending hospital utility workers into the nearby swamps to catch frogs. A “frog test” was the pregnancy test at that time. While today the test is done so simply and conveniently by the patient herself at home without sacrificing those poor amphibians, at that time it was not that simple. So, off went the aides to the marshes to gather the frogs.

I REMEMBER the x-rays taken during those years. One x-ray plate was used for several patients. Each patient’s radiograph took up space of only just over an inch square of the whole plate. One plate contained exposures of several patients. Radiologists today would think of it as a big joke. But that was the practice at the Chest Center in the 60s when the economy was still so bad just 20 years after the Second World War.

The “micrograph”, as it was called, saved on the cost of x-ray plates. But of course, the films were not developed until the entire plate had been used up by many patients. Patients just had to wait for the results else the rest of the plate would be wasted. The Radiologist at that time would cut the plate to separate each patient’s micrograph, mount the tiny square piece of the plate under a huge magnifying lens the size of present day viewers, and lo and behold, the image becomes big enough for diagnosis to be made. The service was free of charge to patients, part of the country’s program to control tuberculosis then so rampant in the Philippines. Today of course, with the advent of digital imaging, there is no more use of plates and no developing the films as there simply are no more films used.

I REMEMBER patients waiting to have their x-rays taken. The city’s electric utility was unreliable then and they had to wait for the availability of electric power. While the Chest Center had its own generating unit, there were many times when the machine broke down. People today take many things for granted, but those of us who lived through those lean years appreciate more the conveniences we experience today. 

I REMEMBER the Butuan we left in 1965… the tartanilya… lamao… lambog… Manapa…Tinago…Then, I had my residency in General Surgery at the Hospital of the Medical College of Ohio and Affiliated Hospitals…Was extremely excited to be back home in 1971…then, Marcos promptly declared Martial Law the next year… militarization… violence… night curfews… check points… Being stopped at night on the way to the hospital to answer an emergency…Bright lights flashed on my face by black uniformed military men in a military jeep… A different Philippines emerged…Left my home country in 1983… practiced my profession in Ohio… Returned soon after EDSA to serve my fellow Agusanons again… But that’s for the next chapter in the book of my life.

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