On June 11, 2020 the Diving, Hyperbaric Medicine and Difficult Wounds Fellowship was launched as a sub specialty of the Department of Emergency Medicine at the Southern Philippines Medical Center (SPMC), in Davao City. SPMC is the biggest government hospital in the country and the fellowship is the first of its kind in the Philippines. In addition to learning the management of diabetic foot ulcers and other chronic, non-healing difficult wounds, the fellowship incorporates Emergency Department (ED) rotations that include pre-hospital medical direction for injured divers and fishermen and ED procedures and interventions (e.g. resuscitation, point of care ultrasound, chest needle decompression for pneumothorax and chest tube insertion proficiencies). I am proud to say that the motivating force behind this program is my former Hyperbaric Medicine Fellow at the University of Texas Health Science Center, Houston, Jeffrey Ramos, MD. After his Fellowship at UT Houston, he returned home to the Philippines to pave the way for a new generation of hyperbaric medicine specialists.
The new fellowship program has come to fruition thanks to some visionary Filipino physician leaders. Dr. Leopoldo Vega, now Undersecretary of the Philippine Department of Health, was inspired to set up the Hyperbaric Medicine unit at SPMC after his visit to the UT Houston/Memorial Hermann Hyperbaric Medicine program in 2008. I was honored to host to Dr. Vega during his visit 12 years ago. Also instrumental in establishing the SPMC program is well-known trauma surgeon, Dr. Benedict Valdez, Chairman of Emergency Medicine at SPMC who was instrumental in establishing the SPMC Emergency Medicine Department and who recognized Hyperbaric Medicine as the department’s first sub-specialty. As a trauma surgeon, he understands the value of Hyperbaric Oxygen Therapy (HBOT) as an adjunct in certain acute trauma conditions (e.g. crush injuries, compartment syndrome, and ischemia reperfusion injury in cases of vascular re-attachment). HBOT is also included in the armamentarium for burn management in Davao (e.g. thermal and electrical burn management and wound bed preparation for complicated surgical reconstruction procedures).
The program is a one year rotation for Emergency Medicine (EM) diplomates (what we would call “Residents”) and a two-year program for non-EM trained physicians. Installation of a 12-person multi-place chamber is currently underway which will enable HBOT critical care to be performed in conjunction with critical care trained ED consultants.
The SPMC program is looking forward to hosting exchange fellows from overseas, which I think represents a beautiful cycle of learning. Dr. Ramos came to Houston to train more than a decade ago, at a time when critically ill divers were not uncommon in the USA. Now such cases are rare, so U.S. Hyperbaric Medicine Fellows may need to go to the Philippines to acquire that experience. I am proud to be a member of the Medical Advisory Board that Dr. Ramos is creating to help guide this new program.
When Jeff emailed me with the good news of the fellowship launch, he said:
“We find it important to start this specialty because the Philippines has more than 7000 islands but only two hyperbaric chambers, and we do not have enough trained hyperbaric physicians, nurses or technicians. Hopefully this training program can address the shortages we face.”
I wanted to brag about this accomplishment because I feel that I contributed to in a small way through the tireless efforts of my former Fellow and longtime friend, Dr. Ramos. I have posted a photograph of Jeff, Dr. Valdez and the first Fellow, Dr. Arthur Salvador.
Left to right in the photo are Benedict Edward Valdez, MD, Chairman of the Department of Emergency Medicine; Jeffrey Ramos, MD, Head of the Diving, Hyperbaric Medicine and Difficult Wounds Fellowship; and Arthur Salvador, MD, an Emergency Medicine junior consultant and the first Hyperbaric Medicine Fellow in the Davao program. Dr. Salvador has special interest in research.
You can read more about the new Fellowship in this local news report.