EVOLUTION OF VASCULAR SURGERY IN THE PHILIPPINES

THE CONTINUING EVOLUTION OF VASCULAR SURGERY IN THE PHILIPPINES

By:  ELMA SANDOVAL

In the mid-90s, vascular surgery in the Philippines was roughly 25 years behind the United States. Today, thanks to medical professionals who trained as vascular surgeons abroad and chose to practice locally, the level of technology in the country is less than 7 years from what they know in the US.  And this is a source of pride for one of the surgical subspecialty’s pioneers, Dr Ricardo Quintos II. The journey to reach this level has not been without challenges, he admitted.  A further accomplishment is that the process of managing patients with vascular conditions in the country is still more advanced than other neighboring ASEAN member nations, including Singapore known for technology. It’s a team effort in the Philippines, unlike other countries where specializations take precedence.

Safer and Quicker

Being compared to a dinosaur was motivation enough for the Filipino surgeon to return and practice and teach all that he has learned about vascular surgery to bring it up to par with the United States.  Quintos is the founding chairman of the National Kidney and Transplant Institute’s Integrated Vascular Services Complex NKTI- iVASC and is enthusiastic about what he calls the ‘renaissance’ of the field. NKTI holds the distinction of starting the use of minimally invasive procedures for vascular repair in the Philippines, under Quintos.  Practicing what he learned and preaches, he is advocating to make the use of imaging -guided procedures in medical institutions mandatory, arguing it raises the level of safety in performing procedures, such as inserting central catheters, and reduces the risk of complications for patients.

In an interview with MIMS after performing an endovascular aneurysm repair (EVAR), he said while surgeons have traditionally been trained to do surgeries blind, which is dangerous, being able to visualize what is being done even before actually doing it, has greatly improved outcomes.  Besides, he added, being able to read ultrasound images themselves means vascular surgeons do not have to rely on other people reading the diagnostic test, which may not be interpreted accurately as it is needed. It helps a surgeon prepare beforehand, and the more prepared for a procedure, the less the complications.

Undaunted

Quintos recalls having to endure the taunts of his peers when he was starting as a vascular surgeon. He was called the ‘traveler’ because he used to lug around his own portable ultrasound machine while doing his rounds, for access and analysis. He often heard other doctors say, “Are you really a surgeon? Why are you doing ultrasound? Why are you doing angiogram?  But he remained undaunted, fully aware that his travel bag enabled him to perform procedures quicker and safer. Yes, there remain backward thinkers who will probably not accept that technology is now a vital component in ensuring safety for patients and doctors. But the renowned vascular surgeon believes medical professionals who do not embrace this will lose in the end.  It’s a matter of economics, he tells MIMS. Doctors who insist on doing things the old way will lose patients in the end. If you can reduce the costs of having to go through radiologists for diagnostic tests, will patients not appreciate this more, the physician pointed out. Again, he stressed that imaging-guided procedures is far safer and less costly in the end.  On spite the gains made in the field of vascular surgery at the premier government hospital, Quintos knows there is still much room for improvement.

While the Philippines still lacks support in terms of industry, it more than makes up with talent and skill, which the good doctor wishes to further harness.  The country is fortunate in that those who trained for vascular surgery have come back and decided to stay and make this subspecialty very relevant in the field of medicine. Still, he envies developed countries who have the brains, the people, and the technology, and a support system, which makes for a strong industry. He believes that in time, the Philippines will be able to build this industry as well.

For now, he is content to continue delivering service to NKTI patients primarily those afflicted with kidney diseases – through the iVASC. “Many patients with kidney diseases will have vascular diseases,” he noted training young surgeons who have expressed interest in the field has also served as motivation for Quintos as he works to uplift vascular surgery in the Philippines.

 *** This article was published at MIMS Doctors, January 2018