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COME Unit

COMMUNITY ORIENTED MEDICAL EDUCATION (COME) UNIT

As an institution that derives its support from the people of the Philippines, University of the Philippines labors to fulfill its mandate of in service to the country. The UP College of Medicine is at the forefront in innovating community-oriented, i.e. relevant, medical education strategies in the country.

The World Health Organization (WHO) defined Community-Oriented Medical Education (COME) as education, which focused on population groups and individuals taking into account the health needs of the community concerned. Relevant medical education traces its beginnings to the UP Comprehensive Community Health Program (CCHP) in the 1960s spearheaded by Dr. Paulo Campos of the Department of Medicine, UPCM-PGH. It was the first serious attempt of the academe in the Philippines to address community health technologies. The CCHP was the global pioneer in modeling academic multidisciplinary involvement in community development; the first UP units involved were the colleges of medicine and agriculture.

Recognition of the unacceptable inequities in health between and within countries culminated in a collective call for development utilizing the Primary Health Care (PHC) approach in 1978. Health for All by the Year 2000 was pledged through PHC by the World Health Organization; the Philippines was among the signatories. In 1979, the Network of Community Oriented Education Institutions for the Health sciences was founded in support of this worldwide clamor for equity in health; the UP was a founding member, represented by then Dean Florentino Herrera. These global events solidified two major efforts at COME in the UP: first was the establishment of the School for Health Sciences (SHS) in Palo, Leyte, with its revolutionary step-ladder health professional development program. Second was the development, and eventual implementation, of the seven-year Integrated Arts and Medicine (INTARMED) curriculum by the University; community-orientation was enshrined as a basic value expected among medical graduates of the UP. Dean Gloria Aragon championed this through its conception and maiden years of implementation.

More progressive sectors, however, would admonish that the UP relegated it responsibility in producing the much needed community doctors to the School of Health Sciences in Leyte while leaving the UPCM INTARMED curriculum untouched. To date, SHS has consistently produced graduates who returned to serve their rural communities. The UPCM, however, could not match the performance of SHS in terms of return service by its alumni. The latter remained technology-oriented, curative and tertiary hospital-based, with the token efforts at relevance left in the realm of family and community health as well as other courses that were allotted a total of less than five percent of curricular hours, and thus considered minor courses.

Successive deans of the UPCM persisted in advocating COME thru policy directives beginning with Dean Alberto Romualdez and the Dean Marita Reyes during reorganization of the UP Manila in the late 1980s. These would eventually lead to creation of COME Unit, engagement of faculty members, and design of more relevant student learning activities and other supportive strategies to reinforce COME among faculty and students .

Dr. Froilan Inocencio, an ophthalmologist, was the COME Task Force chair in its incipient years in the mid to late 1990s. When Dr. Ramon Arcadio assumed deanship in 1998, COME was further given boost. He upgraded the Task Force into the COME Committee in 1997, then the COME Unit in 2002, steps towards its institutionalizing the body tasked to ensure the College Vision-Mission is operationalized. Five faculty positions were reserved for Community Medicine practitioners; they were also expected to help the COME Committee. The Dean and the COME Committee zeroed in on Pasay City as the urban community site for medical education. The rural community program that began in Dean Ramirez’s term moved from Laurel to Sto. Tomas then San Juan, Batangas. Other efforts at COME that came to fruition during Dean Arcadio’s six-year term were ensuring COME integration into the revision of the INTARMED curriculum, strengthening the Regionalization Program and the creation of the Social Medicine Unit. The latter was spearheaded by University Faculty Regent Marita Reyes.

A major triumph of COME in 2001 when the Dean’s Management Team adopted community-orientation became a clear criterion in the recruitment and renewal of faculty members. A major task of the COME Unit is to engage and develop commitment to the philosophy and methodology of COME among the UPCM faculty: this was done through workshops. Lasting changes in the curriculum and characteristics of graduates are expected once there is faculty buy-in into the idea; this is strategic but is among the most challenging of tasks, considering the many other difficulties facing the faculty of the UPCM. Cognates taken up in the COME Faculty Orientation Workshops, held from 1994 to 2004, are now incorporated into the Integrated Faculty Development Program beginning 2005.

Significant strides in COME are observed since 2001 with the leadership of a new core of faculty members, specialists from different disciplines with strong community-oriented advocacies and experiences, who volunteered and joined the COME Unit, and enriched the COME program. Championing COME became more persistent in three arenas: (a) participation in year level academic committees; (b) departmental-level discussions on COME and efforts to look into COME in the residency program and pre-med years 1 and 2, as part of the continuum of COME campaign. COME is now part of the vocabulary of the UPCM faculty. These exciting years were steered by subsequent COME Unit chairs, Dr. Melecia Velmonte and Dr. Jaime Montoya, both infectious disease specialists, and current Chair, Dr. Ricardo Salonga (chaired the COME Committee in 2001-2002, then returned to serve as COME Unit Chief from 2005 to the present), a pulmonologist.

The concept of Community Clinical Integration Sessions (CCIS) was designed as protected time, to give the medical students the necessary cognates that provide a real opportunity to integrate their clinical knowledge with Philippine social realities. These are either community-based in Pasay City and/or in San Juan, Batangas or held within the traditional university setting. Some examples of the latter include: nutritional issues in Filipino communities (Biochemistry), voluntary blood donation law, pathology in the provinces, managing diagnostic laboratories (Pathology), patient and bantay education in the Medicine wards and PGH-OPD clinics (Medicine and Dermatology), screening for hearing and ENT defects among urban poor children, community-oriented case discussions and preceptorials (Otorhinolaryngology), etc. the course offerings of the Department of pharmacology has always been community-oriented; this can be seen in the way its faculty has woven into their learning activities their advocacies and involvement as experts in technical panels (ex. Involvement in the campaign for the rational drug use, the Generics law, environmental health especially the use of pesticides, herbal medicines, etc.). The CCIS, beginning in LU1 with the National Service Training Program, Introduction to Patient Care and throughout the medical courses in LU3 to LU7 forms the continuum of Community Oriented Medical Education.

The 7-point Criteria for COME is supposed to guide faculty in their development of CCIS throughout the 7-year INTARMED Curriculum. These are:

1. Identify the most prevalent illnesses and affected population groups in the Philippine urban and rural communities;
2. Describe the predisposing factors and psychosocial, cultural, economic, political, ecological and structural determinants of these illnesses;
3. Select relevant and evidence-based, appropriate health promotive, disease preventive and rehabilitate measures and diagnostics/ therapeutics (including complementary and alternative medicine) for these illnesses utilizing principles of high-quality, cost-effective care;
4. Where applicable, perform adequate and compassionate history taking, physical examination and primary care level management of these illnesses in the context of the Filipino family and communities;
5. Work harmoniously with other health care providers [nurses, IWs, dentists, allied medical professionals] and other multidisciplinary professionals [social workers, COs, social scientists, etc.] including BHWs and indigenous health workers;
6. Network, utilize mobilize and improve community, local, national, global resources/ programs in public and private sectors for the patients, families, community as an effective member of a team;
7. Demonstrate long-term continuing commitment serving underserved populations in the Philippines.

A special CCIS was the five-day Global Health Course, a joint project of the Social Medicine Unit, the medicine Student, the UP Manila Center for Gender and Women’s Studies and the COME Unit. Under the lead of Dr. Montoya, this special activity held in the summer months drew students from medicine and other allied health professions in the UP as well as other schools who were interested in the broader, social dimensions of health care common among vulnerable populations globally. This was among the COME Unit’s centennial offering. The COME Unit also manages the UPCM- Finnish Medical Society Duodecim partnership on global health education, where young UP medical practitioners are sent to Finland to complete a five-week diploma course on global health. Counterparts from Finland, in exchange, spend a two-week practical period in the Philippines where they get to participate in the management of health issues Filipinos face, akin to other developing countries.

Reinforcing COME concepts were done in three ways. The Senator Juan Flavier Senate Committee on Health COME Awards was given to exemplary initiatives at COME in 2003 to 2004. Dr. Jaime Galvez-Tan, former Secretary of Health, a faculty of the UPCM and a staunch advocate of COME, holds mentoring sessions for medical students who have signified interest in more socially relevant medical careers since 2001. The Regionalization Program, under successive chairs Drs. Daniel dela Paz and Jose Gonzales, also has these mentoring sessions, designed to arouse insights among students on medical practice in different regions of the country. The more structured Student Mentoring Program, launched in 2004 for all medical students, is also expected to help clarify students priorities and reinforce such values of professionalism, compassion and nationalism.

On its centenary, the UPCM has resolved further to live out its vision- mission: leadership and excellence in community-oriented medical education, research and service directed to the underserved. The UPCM College Council, under the leadership of Dean Cecilia Tomas, approved the return service contract for students admitted under the College Regionalization Program, legally binding them to serve in the country the equivalent number of years of their UP medical education. She likewise spearheaded the creation of task Force Pagsasabuhay, to solidify UPCM programs towards this end as we entered a new centennary. Chaired also by COME Unit Chief Dr. Salonga, members of the Task Force were former UPCM denas, DOH Secretaries who are UPCM alumni and current heads of UPCM Units of socially oriented health disciplines. When Dean Alberto Roxas took office in 2006, he took up a major recommendation of the Task Force Pagsasabuhay, created the Return Service Committee which designed policy, the UP return service policy for all graduates of the College to serve the underserved Filipinos for at least 3 years. This was offered overwhelmingly by the College Council in 2007, College of Allied Medical Professions, College of Nursing, College of Pharmacy, College of Public Health, School of Health Sciences in Palo Leyte and College of Dentistry followed suit; The BOR thus approved the Return Service policy for UP Manila in 2008 that would call for medical graduates of the UP to serve the Philippines for a specified period. He also directed academic coordinators to design learning courses in ambulatory medicine to be held in more appropriate primary care settings outside of the PGH—tertiary hospital. The campaign for COME has been long-drawn. The first evaluation research was conducted in 2007. A compendium of experiences documenting outcomes of community-based learning activities is published. While COME has been included in other evaluation efforts by the College, more research on educational outcomes are expected in the next two years.

The health challenges facing the Philippines are great; the consequences of the diaspora of health professionals are being felt more sharply in underserved communities in the country. Development of community oriented education programs is part of the solution; UPCM Faculty research has to deepen our understanding of the basic and clinical sciences, find connection with the social sciences in order to find better, more cost-effective ways of ministering to our patients, addressing unnecessary illness and deaths among the filipino, especially the poor. The UP is continually challenged to develop good clinicians who would find their niche amongst Filipino communities; physicians influencing policies towards equity is expected of the UPCM alumni positioned in strategic government and private sector posts. Ultimately yet, UP physicians who understand, are capable of managing these health issues and find their vocations posted in marginalized communities is even a step closer to solving a major part of the problem. As a state-subsidized university, the UP must systemize and scale-up its efforts in eliminating disparities in health.

Our Memorandum of Agreement (MOA) with Pasay City officials ended June 2012. We are now in the process of transferring our COME activity to the city of Manila where we have a new MOA signed by Mayor Alfredo Lim and Chancellor Manuel B. Agulto. Our LU5 and LU1 NSTP has been transferred to a new venue, ERDA Tech Secondary and Vocational School, Pandacan, Manila. Our program of activities were identified after a workshop with participation of all stakeholders;LU5 class officers, ERDA Tech faculty and student leaders and COME Faculty and staff.

In addition, we also are now in the process of developing new areas/barangays for two-weeks LU5 urban Community Medicine rotation and for COME activity under the direction of Dr. Edelina P. Dela Paz.


FACULTY

SALONGA, Ricardo M., Professor
Chief
MD, UPCM 1973
Internal Medicine-Pulmonolgy

SANTIAGO, Darby E., Clinical Associate Professor
Vice Chief
MD,UPCM 1996
Ophthalmology

AGUILAR, Angela S., Associate Professor
MD, UPCM 1991
Obstetrics and Gynecology; Reproductive Endocrinology and Infertility

BAUTISTA, Resti Ma. M.
MD, UPCM 1998
Pediatrics

CONICONDE, LINDA L., Associate Professor
BS Home Tech, UPLB 1975
MCN, University of Queensland 1989
Community Medicine, Community Nutrition

DELA PAZ, Edelina P., Associate Professor
MD, UPCM 1980
Community Medicine/Social Medicine

GAERLAN, Faith Joan M., Clinical Associate Professor
MD,UPCM 1998

GALVEZ TAN, Jaime Z., Professor
MD,UPCM
Community Medicine

LLANETA, April B., Clinical Associate Professor
MD, UPCM 1974
Emergency Medicine

LAPEÑA, Jose Florencio F., Professor
MD, UPCM 1994
Pediatric Otolaryngology, Craniofacial & Cleft Surgery

MARCELO, Portia Grace F., Associate Professor
MD, UPCM 1993
MPH, JHU 2001
Community Medicine/Local Health Program Management and Development

PASCO,Paul Matthew D., Associate Professor
MD,UPCM 1992
Nueroscience

PATERNO, Elizabeth R., Associate Professor
MD, UPCM 1977
MPH, UP Open University 2005
Diplomate Philippine Pediatric Society 1995
Community Medicine, Pediatrics

PATERNO, Ramon Pedro P., Clinical Associate Professor
MD, UPCM 1976
MPH, UP Open University 2005
Community Medicine

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