By: Jose Miguel Medrano, MD, FPNA; Joanne Robles, MD, FPNA; Isabelita Rogado, RN, MAAN; Geraldine Siena Mariano, MD, FPNA, FPCP, FNCS, FPSCCM
COVID-19 has put a spotlight on the importance of excellent, holistic, multidisciplinary critical care; despite this pandemic, there remains a steady influx of patients with cerebrovascular disease, traumatic brain injury and other severe neurological diseases. It is during this era that neurocritical care continues to adapt, grow and evolve, addressing the ever more complex needs of these most critical patients, especially in a resource limited country like the Philippines.
The Philippines is a low-to-middle income country in Southeast Asia, an archipelago with 7107 islands and a growing percentage of the population living in urban areas. Our health system is still dealing with the burden of infectious diseases and now emerging illnesses, while simultaneously experiencing a significant rise in lifestyle-related illnesses. Health care expenditure is primarily individual out-of-pocket spending, only partially subsidized, if at all, by private and national health insurance programs.
The Philippine Neurocritical Care Society (PNCS) is a non-profit organization with a dedicated team of physicians, nurses, pharmacists, therapists and other allied medical professionals that strive to elevate the level of neurocritical care in the Philippines despite all these healthcare challenges. The PNCS was founded on May 10, 2017 at St. Luke’s Medical Center in Quezon City, Philippines which marked the first meeting presided by Dr. Geraldine Siena Mariano, Dr. Lina Laxamana and Dr. Abdias Aquino. The society soon became an affiliate of the Neurocritical Care Society (NCS) International Affiliates Program, reflecting the mission statement of the NCS.
Local collaboration is one of the key strengths of the PNCS, having formed a tight partnership with the Critical Care Nurses Association of the Philippines, Inc. (CCNAPI). One of the flagship programs borne out of this union is a unique adaptation of the ENLS that includes simulation workshops, small group discussions, and checklist-based evaluations of multidisciplinary teams consisting of physicians, nurses, and pharmacists. The first implementation of this pioneer project was held at the Asian Hospital and Medical Center on October 12 and 13, 2018 with guest speaker and ENLS ambassador Dr. Romergryko Geocadin from the Neurocritical Care Society. This 2-day ENLS certification course focused on the theme “Save the Brain, Save a Life!” with the 77 participants during the face to face session and about 25 participants attending the simulation workshop. In the months that followed a series of workshop-lectures were carried out, also in partnership with CCNAPI, in the provincial urban and regional medical centers entitled Neurocritical Care 101.
The PNCS continues to strengthen its relationships with international partners and forges new ones by reaching out to our ASEAN neighbors through the active participation and advocacies of its members. In 2019, Dr. Joanne Robles, the secretary of the PNCS, served as NCS ambassadors in the first 3 ENLS live courses conducted in Jakarta, Indonesia, initiated by various local medical groups and institutions. Dr. Mariano was an invited speaker during the KNCS Winder Symposium in 2018, discussing “Severe Brain Injury - ICP lowering strategies”. Various PNCS members have attended regional meetings in Korea (2018) and Japan (2019).
The efforts of the different members of the PNCS have also been recognized by the NCS, with President Geraldine Siena Mariano becoming the first Philippine-based physician to be recognized as a full fellow of the Neurocritical Care Society and Vice-President Ma. Isabelita Rogado has also received a presidential citation award from the NCS.
The PNCS conducted its first Congress from April 30 to May 2, 2019. Dr. Romergryko Geocadin, Dr. Gene Sung, Dr. Kiwon Lee and Dawai Olsen were among the notable speakers during the convention, aptly themed “AGE of Neurocritical care - Adapt, Grow and Evolve”, a recurring mantra for the society. Members of the Asian Chapter (especially Southeast Asian countries) flew to Manila to participate in the 3-day event, sharing their experiences in navigating the difficulties of neurocritical care in resource limited settings. The 2nd PNCS congress was originally set in August 2020, however, the COVID-19 pandemic challenged us to forge new ways to continue our mission.
Innovation is indeed borne of need, and amidst the restrictions of the pandemic, where some saw a challenge, we saw opportunity. Leveraging the ever growing connectivity within the Philippines, the PNCS in partnership with Pfizer Philippines, conducted a webinar entitled “Liberation: Managing Pain, Delirium and Immobility.” The webinar was conducted on September 5, 2020 with the theme on ICU Liberation, a quality improvement program geared towards optimizing strategies to improve patient outcomes by addressing pain, agitation, delirium, immobility and sleep interruption in the ICU., especially in the ICU patients with COVID-19 infections. The speakers during this virtual activity were Kathleen Vollman, Treasurer of the World Federation of Critical Care Nurses, Dr. Joanne Robles, Dr. Miguel Medrano, Dr. Manolo Kristoffer Flores and Mr. Edward Tolentino of the PNCS, The activity was attended by 1,076 participants from multiple specialties, exemplifying the PNCS advocacy of multidisciplinary neurocritical care.
This however, is merely the beginning. The society is slated to launch another webinar this September 2021 entitled “Neurocritical Care at the End of the Line”, with the objective to provide an understanding of the ethical dilemma existent in neurocritical care, the art of prognostication, and the diagnosis of brain death and its many nuances. In addition, 2022 marks a significant milestone in PNCS history as the society hosts the 2022 Meeting for the Asian Chapter of the Neurocritical Care Society, with a planned focus on neurocritical care in low-resource settings.
Since the last months of 2019, the paradigm of critical care, and continuing health professional education has changed, but the Philippine Neurocritical Care Society is poised and eager to thrive in this new age - by adapting, growing, and evolving.