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The case of the
mysterious diagnosis
A reputable OFW clinic facing suspension of license for alleged misdiagnosis? What could have gone wrong? Balikbayan sleuth Jun G. Garcia narrates his findings.
Ermita-based S.M. Lazo Medical Clinic is ISO-certified, proof that its medical exam services is of high quality. But this reputation is being challenged by the Department of Health (DOH), which regulates such clinics, and an OFW who underwent Hepatitis C screening at S.M. Lazo last December.
Lazo’s woes started when it released the test result of Risheema Anduhol, 30. The examinee was found positive of the Hepa C virus. Upon learning this, Anduhol no longer pursued her re-application for the job as a Medical Technologist in the Saudi embassy. Doubtful and angered by the findings, Anduhol took re-tests from January to June at the Makati Medical Center (MMC), St. Vincent Medical Clinic, Apostol Medical Clinic, Medical City in Mandaluyong City and the STD/AIDS Cooperative Central Laboratory (SACCL) in San Lazaro Hospital. The SACCL is the National Reference Laboratory of the DOH. All the results were negative, she said.
Anduhol then filed a complaint with Atty. Nicolas B. Lutero III, director of the DOH Bureau of Health Facilities and Services. On June 12, Lutero called a meeting between the contending parties. To break the impasse, he ordered a confirmatory test to be conducted on Anduhol at the SACCL. The result of the test done on June 18 was negative.
On Aug. 12, Lutero ordered S.M. Lazo’s license suspended for three months for violating Section 25.1.9 of Administrative Order No. 85-A s. 1990, which penalizes clinics found guilty of misinterpreting pre-employment medical/laboratory exam that caused non-deployment or repatriation.” He also ordered S.M. Lazo to refund Anduhol all medical exam fees paid to the clinic amounting to over P3,000. Anduhol was refunded the amount last August.
On Aug. 28, S.M. Lazo immediately wrote Health Secretary Manuel M. Dayrit protesting and contesting the suspension order. The clinic said the order is baseless, in fact and in law and that due process was not served.
Fe Bacungan, medical director of S.M. Lazo, insisted that they did not misinterpreted the laboratory result on Anduhol since it is machine generated.
She revealed that S.M. Lazo tested Anduhol five times. After the firs test on Dec. 19, 2001, she was tested again on Dec. 20, 21, 26, and on June 18, 2002. “Positive lahat even after six months. I think Anduhol knows it. She is a medical technologist so I believe she knows the process,” Bacungan said.
So why was Anduhol tested negative at the SACCL?
Dr. Dorothy May Agdamag of SACCL explained that the patient was tested positive using Abbott Murex Anti-HCV (ver 4.0), the latest solution that can detect the presence of Hepa C virus in the blood. A month later, she was tested negative by SACCL using another solution called Ortho-HCV.
The MMC and St. Vincent results are also negative but Agdamag did not know the tests used. Six months later, a repeat test by S.M. Lazo using Murex found Anduhol still positive and the repeat test by SACCL using Ortho tested her negative again.
Due to the conflicting results, Agdamag said they had to perform strip immunoblot assay (RIBA), the confirmatory test for Hepa-C. The result was negative.
Agdamag concluded that either the result from Murex might be a false positive result, which can happen in a small number of cases using such screening tests, or the patient is infected but the laboratory tests not using Murex were not able to detect the virus. The answer will be known six months after the June re-tests or by December, when the infections is expected to become full-blown.
She said it would be best to follow up the patient to definitely say that the Abbott Murex Hepa-C test indeed detected the virus or that the results obtained by the said kit was actually a false positive result.
However, Lutero said, “That’s one of our problem here. Most of these complainants ay hindi na bumabalik.”
Lutero disclosed that should S.M. Lazo prove that it is correct in its findings on Anduhol and should the Health secretary sustain its appeal, then he is willing to lift the suspension order.
Anduhol is willing to submit to another test in December but she said that the SACCL test, which is the final test, already confirmed that she is negative from the Hepa C virus. She is currently training as a caregiver and hopes to get a new job in Canada.
Whether Anduhol is positive or negative of the virus, whether S.M. Lazo’s license is suspended or not, there are still a lot of questions that need to be answered. Should medical tests that give confusing results be allowed? How will Hepa C virus screen tests be made accurate if it is imperfect? How many OFWs were given inaccurate medical tests but don’t know it? How will government help re-employ other Anduhols, who will no longer be accepted by employers even if they are really healthy? How will the public be protected against persons with Hepa C virus but believe they have none because of inaccurate tests? How can persons with Hepa C virus be cured if they believe they have no virus because of inaccurate tests? How will government compensate clinics that would be wrongly penalized?
If these will be answered, what Anduhol have gone through will not be in vain.
Medical certificate not exclusive to agency, employer
Did a local recruitment agency ask you to take a basic pre-employment medical exam from a clinic even if you already have a valid basic PEME certificate issued by another clinic? If so, you can complain this to Atty. Nicolas B. Lutero III, director of the Bureau of Health Facilities and Services of the Department of Health (DOH-BHFS), said Nini Lanto, director of the POEA Regulation (land-base) Division.
Lanto emphasized that basic PEME certificates of OFWs are not exclusive to an agency or employer since there is no regulation stating so. "It doesn't make one unfit for work if an applicant presents his medical certificate taken from his former agency to another employer, unless it is within the 90 days validity period. That should be the practice," said Lanto.
"Modem academe na iyun for agencies to recognize the certificate and verify its authenticity so as not expose OFWs from the hazards of radiation by being re-examined and pay additional expense for the same process of medical examination," added Lutero. A basic medical examination costs P2,585.
An exception to the rule is when an employer requests for a special medical examination of an OFW.
Non-compliant OFW clinics to lose license
No Quality Standard System (QSS) or International Standard Organization (ISO) certification, no license. This is now the policy of the DOH on medical clinics serving OFWs.
The extended deadline for medical clinics to get an ISO certification from the Philippine Council of Healthcare Organization Offices (PCAHO) or Lloyds Register expired last Sept. 15. But DOH-BHFS director Atty. Nicolas B. Lutero III said there are still a number of clinics requesting another extension of the deadline. " No more extension! I cannot give them another extension. Tama na. Nakakahiya naman doon sa mga nag-comply. Tatlong taon na nga itong pinag-uusapan eh," said Lutero.
"The medical certificates or examination of OFWs from non-compliant clinics would be void," he said. But in case an OFW holds a medical certificate taken from a non-compliant clinic prior to Sept. 15, he said, "They can come to my office, I will make a certification that his medical certificate is still valid for 90 days and must be honored by any agency."
Non-compliant clinics can still apply for QSS/ISO certification without paying any fine if it still wants to cater to OFWs. Otherwise, these clinics can only conduct medical examination to local job applicants. New clinics applying for accreditation have six months to get a QSS/ISO certification.
PCAHO charges up to P30,000 fee for a QSS manual while Lloyds Register charges P100,000.
Lutero assured that the failure of some clinics to be accredited would not delay the deployment of OFWs. "We have enough certified clinics that can accommodate the growing numbers of OFWs," Lutero told Balikbayan.
New therapy removes body toxins
After 26 years of research, the Japanese medical community has found a way to flush out toxins in the human body. The health care therapy called Kinotakara has been proven to improve health and even cure diseases by eliminating toxins that the body gets from environmental pollution.
Kinotakara is a sachet that contains the essence of wood vinegar, the same substance that keeps trees strong and lush. Before sleep, the sachet is pasted to the soles of the feet, where more than 60 acupuncture points linked to organs are located. The wood vinegar works like a sponge and suck out toxins that accumulates in the soles.
The Kinotakara absorbs toxins efficiently and fast without any side effects. In turn, the blood stream is purified, circulation is improved, tissues are activated and the immune system enhanced.
With Kinotakara, health and long life is promoted.
Keeping RP’s lead in occupational and maritime medicine
While the Philippines’ economic woes continued to worsen in 1980, the country found yet another savior with the flourishing of the OFW industry. So propitious it was that a lot of enterprising individuals exploited the situation. And one particular area in which these nefarious syndicates capitalized in was the pre-employment medical examination. Though non-medical practitioners themselves, they were issuing medical certificates to aspiring migrant workers exposing the poor applicants to possible arrests and deportation back to the Philippines upon reaching their countries of destination. Aggravating the matters further, was the increase in the rate of morbidity and mortality among OFWs deployed abroad since many of them were not actually examined by competent medical practitioners. Hence, their employers were forced to shoulder whatever expenses incurred for their repatriation. However, some were less fortunate as they were left with no employers at all, totally abandoned with no direction in a foreign land. It was then that the foreign employers called the attention of the Philippine government regarding that matter.
With the distress call sounded off, we, representing about a dozen medical clinics, spearheaded a move to unite the industrial medical clinics and save the profession’s image from the repulsive activities of several erring colleagues and non-colleagues. Thus, the Associated Medical Clinics for Overseas Workers (AMCOW) was born in 1980 with the primary objective of regulating and professionalizing the issuance of pre-employment medical certificates to OFWs by only accredited medical clinics with competent staff and facilities.
During my term as AMCOW president in 1983, through the instigation mainly of the organization, a body composed of the then Labor Minister Blas Ople (now Foreign Affairs Secretary), Health Minister Jaime Azurin, the administrator of the Philippine Overseas Employment Administration and representatives from the medical clinics was formed to oversee and regulate medical clinics in accordance with the provisions of Administrative Order No. 85. Stringent measures were undertaken to ensure that only those capable of carrying out professional pre-employment medical examinations were given the accreditation to do so. Slowly but methodical as a surgeon’s knife, the illegal and incompetent practitioners were flushed out from this very sensitive area of pre-employment medical examination.
Nonetheless, our quest for competitive and professional occupational medicinal practice does not end here. The onset of globalization, while opening up broader horizons for our field of profession, has exposed us to stiffer competition on a worldwide scale. Now, we have to adapt to the standards set by internationally recognized bodies.
In 1989, in my humble capacity as the then president of the Philippine College of Occupational Medicine, I was invited to the International Symposium on Maritime Health in Hamburg, Germany, representing the Philippines and the Asia-Pacific Region. Problems and issues concerning maritime health, safety of life at sea, the increasing rate of morbidity and mortality and how to resolve them were tackled. More important, the symposium focused on how to further improve the screening of seafarers’ fitness for rigorous sea duty.
However, all efforts to come up with an organizational manifestation of the symposium proved futile as most of the participants at that time still has yet to see the need for such action. This indifference continued with the resumption of the biennial activity in 1991 in Turku, Finland; in 1993 in Antwerp, Belgium; and in 1995 in Maryland, USA. Until things took turn for the better in Oslo in Norway 1997, when the symposium finally took its organizational expression, giving birth to the International Maritime Health Association, with representations coming from all sectors concerned with maritime health including the medical practitioners, the principals, manning agencies and the P & I Clubs.
The formation of IMHA is one great leap forward for the sectors concerned in maritime health as it has adopted measures for the improvement of healthcare and medical services in the maritime industry, encourage and support scientific researches in maritime healthcare and to promote the exchange of data and results from the research project undertaken among many others.
Being an active participant in the ISMH and the IMHA since its inception helped us a lot in bringing the Philippines in the limelight of maritime health. In the 1999 edition of the biennial ISMH activity in London, I was able to convince the important personalities in the ISMH convenor’s group to bring the maritime health convention in Manila in 2001. Our dream materialized. Tapping the support of known personalities in the Philippine maritime industry like Doris Theresa Magsaysay-Ho of the Philippine Seafarers Promotion Council, Carlos Salinas of the Filipino Shipowners Association and Captain Gregorio Oca of the Associated Marine Officers and Seamen’s Union of the Philippines, ensured the success of the convention. We were able to attract hundreds of delegates from all over the world. Most important, it served to showcase the professionalism and competitiveness of the maritime health practitioners in the country. And to top it all, I was elected to the IMHA Board of Directors, the very first Asian elected to the post representing the Asia-Pacific Region.
But then, the task of professionalizing the occupational medicine in the country is not a one-man crusade. It should be a collective and concerted action among all concerned. Occupational and maritime medicine in the country has matured a lot throughout the years. We have learned to police our own rank. We have survived the threat of unscrupulous in-dividuals who tried to capitalize and exploit the fragility of maritime medical practice in our country. We have set up our own standards in collaboration with proper government agencies and in accordance with the paradigm set by international bodies. In fact, to say that occupational and maritime medicine in the country is most competitive globally would be an understatement. It is an accepted fact that we, in the Philippines, have the most stringent measure compared to other countries in getting accreditations for our clinics, making Philippine pre-employment medical examination the most policed medical field all over the world, thanks but no thanks to the ‘over’ efficient government agencies.
We are most competitive, yes. But that doesn’t mean we can simply rest on that. Competition is fast catching up. The Philippines is the largest exporter of manpower for both sea and land-based requirements. And if we are to maintain our edge over our competitor, all sectors with concern in the OFW industry, including us in the medical profession, should get our acts together to further improve our craft. We, in the medical profession, should continue to professionalize and see to it that we only send the fittest for work deployment abroad.
Then and only then, could we, Filipino occupational medical practitioners, say that our profession is truly in the pink of health.

Dr. de Guzman is the president of the Accredited Medical Clinics for the Royal Embassy of Saudi Arabia and the Accredited Medical Clinics for Taiwan Economic and Cultural Office. He is chairman of the GCC Accredited Medical Center Association, a group of medical clinics for Gulf states, and the Specialty Board of the Philippine College of Occupational Medicine. He is also the medical director of port operator International Container Terminal Services Inc. and OFW clinic Physicians’ Diagnostic Services Center.

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