My Thoughts on the Reproductive Health Bill

In government hospitals, we get to see the real state of health care in our country. I remember a particular duty when I scrubbed for a Caesarean Section, the patient, Juanita (not her real name), a 15 year old barrio lass, lay anxiously on the operating table. One can't help but feel pity for someone so young to undergo one of the most life-changing events in the life of a woman with so little knowledge or experience. Teenage pregnancies are considered high risk pregnancies, and with little to no prenatal check-ups, may contribute to statistics of maternal mortalities because of complications.

Juanita's case is only one of the many examples wherein education about sexuality and reproductive health could have helped. The recent clamor about the Reproductive Health Bill was largely centered on the Catholic Church's protest over artificial contraception as a means to control the burgeoning population. I am a Catholic myself, and have been schooled mostly in Catholic schools from Elementary, Secondary to Tertiary level, however being a nurse also means I have to be a patient advocate. It is not in my position to tell people that artificial contraception "is bad" and that natural methods "are good"- but rather provide all the information about both methods without bias and allow the patient to decide for themselves. Section 3, No.5 of House Bill 4244 states precisely that.

Note that HB 4244 also recognizes that abortion is illegal and punishable by law, however those women who are needing care post abortion (remember, there is a difference between an induced abortion and a miscarriage or spontaneous abortion- though in both cases involves the expulsion of the products of conception and the fetus before the age of viability) must be treated without judgment. Another favorable provision in the RH bill is the mention of Gender Equality- which was defined as "absence of discrimination on the basis of a person's sex, sexual orientation, and gender identity in opportunities, allocation of resources or benefits and access to services."

Going back to Juanita's case, I begin to wonder- had she been aware of the changes in her body as an adolescent- the fertility cycle, the risks of pregnancy, the enormous responsibility of being a parent, the cost of milk, diapers, and clothes, and the cost of education- had she been aware of all these, would she make the same decision? Not to pass judgment here, because there could be a number of reasons and circumstances why that pregnancy occurred, but my point is: if teenagers were aware not only of the risks but also the responsibilities, would that prompt them to be more prudent with their actions? The argument that age-appropriate sex education in school (Section 16 in HB 4244) undermines the role of parents to provide this to their children may not always be true in all families. From my own experience growing up, my parents and grandparents were so conservative that sex was an "off-limits" topic, and I would usually learn more about “the flowers and the birds" from friends and classmates. In sex education, the purpose is not to titillate or spill out lewd details, but merely to present in clinical manner, the facts about human sexuality.

The RH bill gives couples a chance to determine for themselves the size of their family, so that each child would be provided well with basic needs and education. Stating unbiased facts about both natural and artificial planning also ensures that people will make informed decisions in reproductive health. Indeed, a progressive country begins with healthy and responsible parents who plan and provide for their families- so I am personally for the RH Bill to be enacted as law.

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Beauty

We were forbidden to bring our refrigerator-sized suitcases to our summer Community Exposure, which meant provisions to be brought were down to the bare essentials. When I first caught sight of our dilapidated classroom which would turn into twenty nine student’s living quarters, I was beyond reprieve. Numbly, I sat on the Manila paper and flat sheet laid on top of the cement floor, which was to be my “bed” for the next six days. My entire first day was spent grumbling inside with a smile on the outside, silently cursing, in alternating manner, the heat, the stale air, the mosquitoes and files, and the fact that there was absolutely nothing I could do about it.

By the time the first night passed, I woke up drenched in sweat with my bones aching from the cement floor. And, as if to cap a perfect morning, I first did number two on a toilet with no indoor plumbing. That was the start of it. The rest of the day was spent eating half-cooked rice, walking in black rubber boots in Schisto-infested rice fields, and interviewing people under the blistering sun.

One day, I interviewed an old woman (or what appeared to be an old woman, since she looked weathered beyond her 53 years), which I think caused an abrupt 180 on my perspective. Her hut was about a size smaller than our living room at home, and was a kilometer’s walk on a muddy dirt road from the highway. She lived alone, and worked on the rice fields nearby. During times of harvest, she’s entitled to a ganta of palay for every ten gantas harvested- that’s her only source of food and income. Other than that, what she eats is from her own backyard garden. If the harvest is not good, then she would settle for kamote or hunger would ensue.

She went only as far as Grade 1, and had to stop when her mother died many years back. Her son, who only studied till Grade 2, also works in a nearby farm to support a family of his own. She’s separated from her husband. As I scrawled clumsily on my COPAR book, I had this lump in my throat that was hard to swallow. Yup, the world had bigger problems than a few mosquito bites, or a few scratches, or a darker complexion.

I gazed at her face. The skin was a dark hue of brown and sagged with lines that gave it an unusual texture. Her eyes glowed with both dignity and despair, as one who had struggles with hard times might show. And her hands were rough and calloused with work.

I thought she was the most beautiful woman I ever saw.

When I was back in Tacloban after the Community Exposure, I never quite saw things the same way. All those obsessions with fashion or hairstyles or skin care seemed too insignificant. I know now there’s more to beauty than a perfection of lines, planes, and textures. Or perfect manners and sophistication. This time, the rose-colored glasses have come off, and the stark reality seems, no less arresting or beautiful.

Blood, Needles, and Vajayjays

I acted like a complete ass (or as the British would call it, “arse”) during my first time to assist a delivery.

There I was, looking so important in my grass-green scrubs, gazing intermittently at the glass partition between the delivery room and NICU, making sure my hair was in place. The clinical preceptor was giving an orientation and final instructions, and I just nodded my head and joined murmurs of “Yes, Ma’am!” We were finally out of the classroom and laboratory, away from plastic mannequins and simulated environment. We were finally let loose into the clinical area.

“Gravida 2, 5 cm, her bag of water ruptured already!!” An orderly was wheeling in a pregnant woman in labor, her face contorted in pain.

“Vital signs and FHT now!” Barked our preceptor.

I felt like I was in the middle of Grey’s Anatomy episode (or Scrubs, more like it) as we scrambled to assist the woman to her bed in the labor room. One student took her blood pressure while we get a blanket to cover her lower extremities so we could expose her swollen belly to do Leopold’s maneuver. I could finally hear the baby’s heartbeat through the stethoscope; I counted, then marked the spot for future monitoring.

“BP 130/80 mmHg, the FHT is 130 bpm, contractions regular.” I said, wiping my brow.

“Another patient for C Section! I need two of you to scrub now!” Another patient came in a stretcher, and two students from our group scrambled for their OR gowns and start preparing.

Just as we thought it couldn’t get any worse, our preceptor screamed again. “Multipara, 10 cm already, I need you (pointing at me) and you (pointing at a friend) with me at the delivery room NOW!” The rest, stay with the other patient and monitor the progress of her labor!

“B..bb...but, Ma’am she’s not my patient, my patient is the one at the labor room.” I stammered nervously.

She just glared at me and walked hurriedly to the delivery room. I followed.

“Where’s the whiteboard marker for recording the time of delivery at the whiteboard?” She asked loudly while the patient was being assisted into the Lithotomy position.

My classmate and I looked at each other. “You didn’t tell me about any marker!” I hissed.

“Where is the Methergine ampule? Where are the sutures for the Episioraphy? Where’s your BP ap?”

“Uhmm.. ah.” I looked around in panic.

“Prepare those things NOW!”

And off we went. “Where were you during orientation?” My classmate demanded. “Oh shut up let’s just find those things.”

“Crowning!” The midwife and our clinical preceptor were instructing the mother how to push. Then the midwife did something that would take weeks to disappear from my mind: she took a sharp Mayo scissor and cut the woman’s perineum to widen the birth canal. The woman screamed in pain. Blood oozed.

I felt faint, I thought I’d collapse into the big bucket where they dumped the placentas. I wanted to slide the woman to the side so I could lie down for a while. Kidding.

The baby came out faster than I expected. No observable “internal rotation”, “extension” and all that cardinal movements we memorized in the classroom. The birth itself took no more than a few seconds. Just like that a person was born into this world.

“BP?”

“130/80mmHg.”

“Inject Methergine 1amp.”

I prepared the medication and administered it via intramuscular route. The woman was almost delirious; she did not even notice I stuck a big needle on her arm. The neonate was brought to the NICU for cord care.

We assisted the woman into her clothes and did the after care. As we watched her being wheeled away in a stretcher, my clinical preceptor asked me:

“Ok, so did you learn anything new in this exposure?”

“Yes Ma’am,” I said as I fanned myself.

“…Listen to instructions.”