The  Hospital On Wheels
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RP Healthcraft Carrier

RP Healthcraft Carrier

The Hospital on Wheels

Dr. Jim Sanchez

RP Healthcraft Carrier
reprinted with permission from
Health & Lifestyle Magazine

By Mylene C. Orillo

Every year, approximately 80 typhoons develop above tropical waters, of which 19 enter the Philippine region and six to nine make a landfall according to the Joint Typhoon Warning Center (JTWC).

But every time major calamities and disasters happen – whether natural or man-made – we are always caught off-guard. We don’t have even ready volunteers or enough supplies, relief goods, or medical drugs.

Just like what happened in Tacloban City in November 8, 2013 when it was devastated by Typhoon Haiyan, known as Super Typhoon Yolanda. It was considered as one of the world’s strongest and deadliest tropical cyclones ever recorded, killing at least 6,300 people.
“What we need right now is immediate response that can provide temporary healthcare in the area and that can only be provided by a readily available health craft fleet that can immediately go anywhere,” says Dr. Jim Sanchez, a cosmetic surgeon who’s known to help indigent patients through his medical and surgical missions all over the country.
“It doesn’t have to go to the area of the calamity; it can go nearest to the area as much as possible,”  Dr. Sanchez says.

‘Hospital on wheels’
When an area is affected by a disaster, there is no healthcare, functioning hospitals, drugstores, or clinics for the next three months. Even health personnel like doctors, nurse, medical technologists, and pharmacists are forced to evacuate for safety reasons. 

The RP Healthcraft Carrier, the Philippines’ first ‘hospital on wheels’ is a mobile hospital that can be quickly deployed to serve as a makeshift medical facility in times of need.

It consists of a fleet of six air-conditioned buses and one support 40-foot container van that will be equipped to function as a hospital. It will contain additional water supply, gas, generator sets, and pre-fabricated tents and will be deployed simultaneously for two weeks.

The RP Healthcraft Carrier will be able to act as an emergency healthcare facility in situations such as natural disasters (typhoon, earthquake, etc.) as well as a secondary hospital to augment existing medical facilities in remote areas.
“It is like an aircraft carrier, but it’s a health craft carrier that is designed like a hospital. It is practically a hospital,” explains Dr. Sanchez.

At present, there is only one surgical van that has been in existence for the past nine years where minor and other surgeries like hernia, cleft lip, goiter, and external surgeries are being performed. It has two operating tables and six pre-fabricated operating tables folded that allow doctors to perform eight surgeries simultaneously.

The construction of additional two vans (or buses) will hopefully start this year. They are planning to launch the rest of the buses next year. These buses will have operating rooms where surgeons can perform minor and major surgeries under general or spinal anesthesia (gall bladder, gynecology surgeries, orthopedic, thoracic) depending on what is needed in the area. There will also be recovery and pre- and post-operative rooms for the patients’ preparation before and monitoring after surgery.

‘Aging warriors’
Since 1985, Dr. Sanchez has been joining medical-surgical missions. Initially, it was once or twice a year, but it became more frequent as time passed by. Soon, he realized that an operating room on wheels is needed to be able to do more surgical missions and at a much lower cost.

In September 17, 2007, with the help of the Rotary Club of San Francisco del Monte RI 3780 (Quezon City), the Mobile Surgical Unit was launched. Since its launching, it has conducted over 160 Surgical Missions all over the country (as far as Cebu, General Santos City, Catanduanes, and Aurora Province) where more than 10,000 indigent patients benefiting from it.

After joining medical-surgical missions organized by other organizations (local and international) year after year, Dr. Sanchez was humbled to find out that many have been doing these missions longer than him and on a bigger scale.
He also noticed that many of the “medical/surgical missioners” (mostly Filipino-Americans) are “aging warriors” like him, while younger volunteers are becoming less and less. If you combine all missioners’ effort, it won’t really make a big impact to the nation, considering that more than 27 million Filipinos are classified as poorest of the poor.

“Of course, it’s not easy, but at least there’s an initiative, and how can we find out if this is effective or fitted for our situation not until you launch it. For me, let’s launch it. If it’s not working well, then let’s not reproduce it. If it’s working well, then let’s multiply it,” he says with passion and conviction.

Funding and manpower
Dr. Sanchez reveals that they get funds and donations from Doctors’ Offering Care Service Foundation, which is tax-exempt. They also rely on different grants from the Rotary Club as the latter finds their projects very worthwhile and meaningful to the sectors of society they serve.

As to volunteers, they get residents, interns from medical centers that don’t have service patients. They are, of course, under the supervision of junior consultants.
Soon, they are planning to maximize “telemedicine” where senior consultants can view the case via internet, and supervise their junior consultants wherever they are.
Telemedicine, according to the American Telemedicine Association, is the “use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status”. It comes from two words: Tele-, meaning “to or at a distance”, and -medicine.

It includes “formulating diagnosis and decision on treatment based on the data and health information transmitted via telecommunications system. A growing variety of applications and services are being used nowadays such as SMS, smart phones, two-way video conferencing, and email.”

“If the doctor is away, let’s say he’s in Manila or in the US, the resident can do the X-ray, ultrasound, 2D echo, CT scan and will send (the tests) via email. The senior consultant will then do the reading and interpretation,” explains Dr. Sanchez.
“Whether you like it or not, these (senior) specialists won’t stay in remote, rural hospitals. With this mobile hospital, they can go on rotation. So we get junior consultants or new graduates in their idealistic and early stage but who are already capable,” he says.

Dr. Sanchez shares that many specialists are having a hard time in their early practice as they have to put up their own clinic, look for a place and patients and it would cost them a lot.

“Later on, these residents or interns will be busy so you get another set of graduates. This is the most practical. They will get a stipend from grants, donations, fundraisings, and tie-up with the media,” explains Dr. Sanchez.

Perfect training ground
According to Dr. Sanchez, the medical-surgical missions are perfect training grounds for residents and interns from private medical centers that don’t have access to charity patients or ‘service’ patients.

This is a guided program where there will be junior consultants that are also guided by senior consultants thru telemedicine.

But he clarifies that “telemedicine” will only be applicable to certain conditions, procedures, and specialties. Telemedicine can be a potential research or study on how efficient it is and its applicability to other specialties.

“If there are studies like that, there’s a research grant. We can tie up with centers or institutions abroad.”

Dr. Sanchez also sees the possibility of other countries sending their residents to train in our country, but they have to pay. They can also have a joint study on whatever research can be implemented here thru study or research grants.
He also plans to maintain good and reliable documentation or records, or EMR (electronic medical records) of patients, which is a recurring problem in the Philippines.

“We don’t have good documentation. We don’t even have statistics. I’m looking at one health craft fleet per region in the next five years. So there are 17 regions, can you imagine if we have proper documentation and statistics?”

Lack of specialists and infrastructures
Despite the growing number of population, Dr. Sanchez notes that there are no ongoing construction of government hospitals these days. Even if there is one, it cannot fully operate due to lack of funds, no plantilla for the staffs, no budget to maintain it, no machines, and no specialists to man it.

In order to build a structure like a hospital, the government needs at least PhP 500 million, and the infrastructure is static and immovable, according to Dr. Sanchez.
He gives a good analogy: “We need to cope with the modernization and technology as well. If we have fast foods with 24-hour service, drive thru and delivery, why can’t you do that with health?”

Many patients don’t have access to quality healthcare for many reasons. Some remote areas don’t even have hospitals so that they will need to go to Manila for a check-up. But with the bulk of patients arriving in tertiary hospitals like the Philippine General Hospital, East Avenue Medical Hospital, Quirino, it would be impossible to handle all of them and give them proper quality care, says Dr. Sanchez. 
“The purpose of mobile hospitals is to bring the healthcare to the people instead of people going to hospitals. The hospitals will go to the patient, and that’s my purpose – to help the government reduce the load of patients,” stresses the noted cosmetic surgeon.

Dr. Sanchez clarifies that the RP Health Craft Carrier is just a prototype. If the government thinks it’s working, they can reproduce it using the DOH budget.

“I think this is more practical. We have specialists on rotation. But if you tell me the specialists have to live in remote areas—they won’t live there! But if they go on schedule like two weeks, that’s possible, on rotation basis,” he explains.

Coordination with LGUs
As to the schedules and venues of medical-surgical missions, the team of Dr. Sanchez coordinates with the local governments and rotary clubs or by invitations from private citizens and religious organizations as to which areas are underserved and needs priority.

“Almost all regions in the Philippines even in Metro Manila are underserved. Try going to the emergency rooms of government hospitals, that’s where the patients are. Go to the outpatient, it’s full of patients who can’t be admitted because it’s full already.”

As responsible private citizens, Dr. Sanchez believes that we have to initiate this worthy endeavor to help the government and countrymen.

“We need to initiate and show them that this works. For a PhP 70-million budget only or let’s say PhP 100 million as compared to building a PhP 500-million to PhP 1 billion-worth of hospital. With that amount, you can already have five to 10 health craft mobile fleet. This is healthcare in action.”

Call to service
Dr. Sanchez believes that it’s high time for Filipinos to unite instead of complaining or criticizing the government.

“Every Filipinos should think how he can help his fellowmen and our country. That’s the goal of the RP Healthcraft Carrier – educational and service at the same time,” says Dr. Sanchez. 

 “Hospital on wheels” is projected to conduct medical-surgical missions once a week, or one to four times a month. On the average, it can accommodate 50-70 surgical cases per trip; but if needed, it can expand operations up to 250 cases, depending on the number of days.

Dr. Sanchez’ parting words were poignant: “Let us join hands and make this happen. This is for our country and for our people. Kasi masama ang combination ng mahirap na, wala pang pera; maysakit ka tapos wala kang pera, ni wala kang pamasahe; may pagkain di mo alam kung kakain ka bukas tapos magpapahospital ka ba; mag-pa-pa-hospital ka, i-co-compromise mo yung pagkain ng pamilya mo.”
(The worst combination is you’re poor and have no money, sick and have no money. You have food but you don’t know if you’ll still eat tomorrow then you still have to go to the hospital. If you go to the hospital, you worry that you might compromise the food of your family.)
We wish this vision for the RP Health Craft Carrier Godspeed.
Dr. Jim Sanchez, a cosmetic surgeon  known to help indigent patients through his medical and surgical missions in underserved areas all over the country, shares his vision on how a virtual ‘hospital on wheels’ can help fill in the healthcare gap in remote areas, especially during times of natural calamity
Email  of Dr. Jim Sanchez on Father's Day, June 19, 2016

Dear Kababayan and Friends,

First of all, I would like thank you for your help, trust and concern.
I am not a religious person, but I believe that God has brought us together for this rare opportunity to be united in putting up the Hospital On Wheels (HOW) which we have named the RP Healthcraft Carrier to help our government address the severe lack of quality healthcare in our country. The HOW will also serve as a makeshift medical facility during times of calamities. At least 10 major disasters affects our country every year!
An average of 500 local and foreign organized medical missions is held in the Philippines every year, expecting a reduction in the future due to many reasons; logistics, manpower (missioners unable to join due to busy schedule or due to physical, mental or financial disability), objections from local/national medical societies, restrictions/requirements from government agencies, etc. Despite this large number of medical missions, it has only served a small fraction of the target population (30% of the population or the 27 million poorest of the poor). Aside from this, most of the foreign organized medical missions are held in the months of January and February and in “handpicked” areas and not according to the needs of the country. In other words, we lack systems and coordination.  

The same is true with the Mobile Surgical Unit (MSU) which I established in partnership with the Rotary Club of SFDM RI Distr.3780. The 200+ surgical missions and 10,000+ indigent patients (cleft lip, hernia, benign and malignant “external” tumors, etc.) operated on over the past 8 & ½ years has served only a tiny fraction of the total number of patients that needed surgery. According to the Philippine College of Surgeons, there are at least two (2) million unmet surgeries in the Philippines last year. In other words, at least 2 million Filipinos who needed surgical operation did not undergo the procedure due to any of the following reasons; poverty, lack of surgeons, anesthesiologists and adequate surgical facility. Patients who avail of government hospital services have to pay for; the laboratory and diagnostic procedures, surgical supplies, anesthetic gas/medicines/supplies, pre-operative and post-operative medicine, intravenous fluids, blood, transportation, food for the watcher etc.
As I have said before, we cannot solve the whole healthcare problem of the country but we can help reduce it significantly by training more specialists, putting up more hospitals, increasing the salaries of medical specialists, focusing on prevention and not just on treatment. There are many more ways to do it but a more comprehensive, coordinated and more systematic approach by the government and the private sector is needed.
We (I and the many strong advocates of the RP Healthcraft Carrier or the Hospital on Wheels project) have already answered the; why, what, where & how of the project. We will be putting up the prototype of the project for us to see and if needed, improve it. Only then we decide to multiply it to serve the two other main islands (Visayas and Mindanao) or soon provide one for every region of our country. 

We will implement the construction of the prototype in stages; first is the 3-bus surgical unit followed by the diagnostic & pharmacy bus, then the rest of the fleet.
We will first put up the main surgical bus (with 2 separate sterile operating rooms) and one 40-footer support van (will temporarily serve as the preoperative, postoperative, dressing, scrub, sterilization and supply areas) in 1 year. Once the 2 other surgical buses are available, the 40-footer van will house the supplies, prefabricated tents, foldable furniture (bed, tables, chairs), water tank and generator.
PLEASE HELP US. Please help in whatever way you can; through donation which will not hurt your pocket, through donation of medical/surgical equipment and supplies (left overs), active support of the fund raising activities for the project, spread the word with strong endorsement to your contacts, be in our pool of Consultants who will volunteer for 3-5 days during the HOW missions or supervise the junior consultants, residents and interns through telemedicine and more.
We (our core group in the Philippines) will start the “300 Good Samaritans” (like the 300 Spartans) drive to raise Prp 9 Million pesos this year. We have “preselected names” who will be asked to be part of this noble project; relatives, friends, classmates, former patients and co-organization members (Rotary, Phil. Chamber of Commerce, Phil. Red Cross, etc.). I will also be giving prearranged talk about the RP Healthcraft Carrier project among various organizations in major cities, quite similar to what my Medicine Classmates did in the USA last May 2016.
We will also be sending letters to big private corporations to consider the HOW project as part of their CSR (Corporate Social Responsibility). I believe that many will approve it because their yearly donation will be tax deductible. Aside from this, their company (& its products or services) will be advertised directly & indirectly through our media partner, ABS CBN’s weekly TV program- Salamat Dok. The producer of Salamat Dok like the project very much and they want exclusivity in TV coverage. They called me last week and asked for a meetingtomorrow, June 20. We will study their offer and the contract.
Although I am biased, I can see the bigger picture of the project. With all the systems in place, the HOW will be able to provide quality medical service to thousands and soon to millions of indigent patients (the treatment will be therapeutic rather than symptomatic) and supervised or hands on training to medical students, interns, residents and fellows and other health professionals.
It will be the talk of the town, an inspiring and unifying project for Filipinos, Fil-Ams and other foreigners with Filipino roots.
I know that some are skeptics about the HOW project and your past system worked well in your hands. Please continue it. We wish you well. The more help our Kababayans get, the better.
For those who believe in one name with one vision and one mission- The RP Healthcraft Carrier, let us join hands to make it happen.
Marami pong salamat.
Sincerely yours,
Jim Sanchez