As my third year here starts, the sleepless nights are only just beginning.....

I was surprised to realise only a few weeks ago that I have been here for over two years now. So much has happened in that time, not least of which is our new arrival who is now settling in well at our house. He is still sleeping in our room and probably will until he is 6 months old. There is also, of course, the separation anxiety thing, whether we will be happy with him sleeping across the hall from us.
Oddly, Paddy sleeping in our room has brought on the realisation of a truth, our bed is not large enough. Occasionally Paddy sleeps on our bed, normally between us, we make use of an additional mattress sized for his crib, which demarks 'his space' sadly it also means that he ends up with more of it than either Kat or I (both of us have been close to falling out of bed on more than one occasion). I therefore bit the bullet and have now purchased a king size bed from our local department store, we are awaiting it being delivered, but are anticipating that happy event in a few days, and the provision of an extra 20cm or so of width and that has to be more than Paddy's armspan, doesn't it??

The passage of time also brings with it our wedding anniversary, we are due to celebrate our 2nd at a beach resort in Batangas, Pico de Loro Cove which looks rather lovely from the website. It would seem that as Kat said the other day, we are slowly exploring all of the resorts around here, I think I might need to make a list.... I love the fact that there is so much variety of places to go, I am hoping that although it is a romantic weekend away (and yes we are taking Paddy) that I will get a chance to try some photography whilst we are there, especially as we should have reduced light pollution for night shots.

With the passage of time, I am slowly adjusting to life here, I would guess that mellowing into it might be a more accurate description. I have to confess that I was quite a handful upon my arrival, being openly annoyed at the way things get done here (or don't as the case may be) and on occasion I may have been a little rude to people who didn't do things the way I wanted. I am still put out by a lot of these, a full list would be quite long, but I am now internalising my frustration by taking a deep breath or two before saying or doing anything, there are a few things that still get me going though...

• Filipino drivers, the collective delusion that they are good at it and drive defensively, they are not and  don't, not even slightly-
• I will grant that they are skillful at slotting a bike, trike, car, pickup, van or truck into a slot most people wouldn't even attempt, but their almost total lack of consideration for other road users, inconsistent and incorrect use of indicators, hazard lights and firm belief that they, whoever they are, have the right to go or be at the front of the queue never cease to amaze me. 
• Regarding the defensive driving, it is far too reactive in nature for that with little or no perception of risks or looking ahead at possible hazards.
• Timekeeping, this is probably heavily influenced by the old Spanish colonial times, I have come to find this more amusing than annoying, but it does make any form of planning difficult, I will cite some examples of the sort of thing-
• Event planning, I was invited to participate as a speaker at a training event for a multinational company's Filippino head office staff, the dates weren't confirmed until the weekend before the event, giving me only 4 days to book a driver and hotel in Manila.
• Event timing announced as starting at 6pm, no body arrives much before 7 and the event might start by 7:30
• Getting something fixed or delivered, you can't book at time for this, or at least I have not been able to, despite providing mobile phone numbers for them to call before coming, they just turn up, sometimes on the day indicated, sometimes not.....
• On the other hand, some things happen with unseemly haste, one of my sisters in law and a friend have found work overseas, both jobs were identified by an OFW agency (Overseas Filipino Worker) and whilst it was known that they would be departing soon, both had less than 2 weeks notice of actual departure date, that included work visas, tickets the whole shebang.
• Bureaucracy and paperwork, I don't quite know where to start with this one.
• We have been living in our house for 12 months now and still haven't got all the necessary permits to be doing so, and can't get onto mains electricity without them....
• Licence renewals, this can take several months, and in some cases longer than getting the original licence.
• Duplication of effort, the number of times I have needed to complete forms in duplicate or triplicate, each exactly the same as the other, doesn't NCR paper exist here, or even carbon paper? Similarly, the same organisation wants information from their clients or customers, several different forms, each asking the same questions e.g. name, address, date of birth, marital status, age (see date of birth, laziness) home and mobile phone numbers before they get to the real detail that they need, this is very common in govt agencies and oddly hospitals.
• Dumb questions on forms which are irrelevant to the matter at hand, one specific instance was when Kat applied to renew her various licences, the forms all ask for her marital status, now this may be demographically interesting to a population statistician, but what does it have to do with her ability to be a doctor or drive a car?
• The "That'll do" attitude, whilst there are many craftsmen/women and those who will go the extra yard, so many don't. When we had our house built the air con indoor units were installed, two of them were so obviously not level a blind person could have seen it, but the guy hanging them on the wall seemed all put out when I asked him to straighten them up, likewise some of the light switches and power outlets. It is sad since it is the details that people often see and it is these that spoil what is otherwise good work.
• The way the Filipinos treat potatoes, come on guys, they are like rice is to you, there are many varieties and they need to be kept out of the sunlight or they go green!!

All that said, the big question is "am I happy to have moved here?" and the answer has to be a resounding yes. There are a number of reasons for this, in no particular order;-

• I have met and married my soul mate, Kat and I agree on many things and enjoy sharing these, some are music, movies and TV shows which are fairly trivial, others are our general outlook on life. Sure we disagree on some things, but so far we have not found anything we can't work around.
• We have a wonderful baby boy, I know all parents think their kid is the most amazing on the planet, so I won't disappoint, of course Paddy is!! He fills me with wonder and amazement each and every day, wonder that something so small can generate such a loud cry and volume of poop and amazes me by how much I love the little scamp despite the fact that he can drive me to distraction sometimes.
• My standard of living is better here than in the UK, and would be even better were I to have a steady income, but not too bad all the same.
• I am probably healthier here than when I was back in the UK. I used to spend hours driving around the country, often eating at odd times and not always good food. I also spent far too long in the pub drinking beer, my consumption is significantly lower now, averaging less than 4 pints (Imperial) per week (i.e. one 330 ml can or two some nights of the week), I could do that in a couple of hours back in Haslemere!!
• I am not spending quite so much on gadgets as I did back in the UK, well, this may or may not be true, I am tending to buy more expensive gadgets here since I don't have such easy access as before. A friend Tim and I were frequent purchasers from eBay from a number of resellers and refurbishing companies, even direct from Canon UK or Apple, we seemed to try and match or outdo each other for the latest or greatest iThingy. I can't do that anymore as eBay doesn't have the coverage here and sellers seem reluctant to send items to the Philippines....
• I am starting to make new friends here, mostly through Kat, but that's not a real problem.
• This is a country of 7,107 islands, tropical in nature, many of these have rather nice beaches, so we are spoiled for choice. The scuba diving here is pretty good too...

All in all, I think I made the right choice and hopefully this will remain the case as I get older and Paddy grows, I can't wait to take him to the beach in a few days time and eventually get him swimming and hopefully take him diving when he is old enough. Of course I miss my friends back in the UK and some of the things I used to be able to do and buy (sadly good old white bread, especially a bloomer loaf is something I really hanker for), but that apart life is good here and I am a very happy chappy!!

Once the initial excitement wore off, time to settle down and be a dad

So many tubes

Kat and I continued to schlep back and forth to the hospital, spending a few hours each day with Paddy whilst he slowly recovered from his surgery and pneumonia. In an attempt to get him as fit as possible before removal of the OG tube, the surgeon delayed his first feed of milk for a few days until he was able to confirm by x-ray fluoroscopy that Paddy’s oesophagus was “patent” i.e. fully repaired with no leaks. This test was carried out on Thursday afternoon which was a great relief to all of us, and meant that Paddy could try feeding later that evening. Since he still had O₂ support via nasal cannula, a central line inserted and a pulse oximeter and BP cuff, Kat wasn’t able to breastfeed him, we had to express the milk, store it in the freezer at home and bring it into the NICU. They would feed him by using a syringe or later by cupping. At first he was only allowed 5ml at a time (every 3 hours) which was obviously not enough for him, it was sadly funny to watch his delight at getting some milk and then his frustration at not being given very much. Once he was able to tolerate 5ml for 3 consecutive feedings, the neonatologist allowed the quantity to be increased, from 10ml to 15 then 30ml and after that he was allowed to feed until he was full, in her words, “like a pig!”

This is all from Kat!

Earlier in the week, I had taken the opportunity to visit the Bureau of Immigration to get my new visa. I was anticipating the familiar run around and having hired a driver to make life a bit easier, we arrived quite early. As I mentioned in an earlier post, because the annual report for alien foreigners is still ongoing, the BoI was open before 8am, I went in and started the process at window 1, and was asked to wait for 30 minutes whilst they checked my passport. I had only just started to read the newspaper when I was called back, my passport returned and I was directed to window 2. Here I was asked to leave my passport to get the visa stamp and to return and collect it from window 3 in 2 hours. I took the opportunity to pop out and get a coffee and a Danish from Starbucks and some cash from a nearby ATM. I returned to the waiting area around 8:35, and as before picked up the newspaper, only to be called to window 3 to get my passport back and then to go to window 4 to collect my ACR-I card (Alien registration card). All this was accomplished before 9am, a little over an hour after we had arrived. All I had to do now was locate the driver and head back to the hospital.

OG and Intubation tubes out

As we moved into the third week of his life we began to hope he would be allowed home soon, tubes and support were being removed, the first of these was the nasal cannula, which was replaced by the O₂ being delivered to a small funnel. This now allowed us to try breastfeeding for the first time, which was not quite a successful as we had hoped; although Kat had plenty of milk, Paddy had become accustomed to it being poured into his mouth and was therefore unfamiliar with the whole sucking concept, this was further complicated by his having a tongue tie. Still we persevered and after having his tongue tie cut, by the Thursday he was getting the hang of it and taking as much as he wanted, although it did take a while longer than with a cup. Dra. Colasito had by this time indicated that Paddy should be discharged at the weekend. In actual fact this was brought forward, despite a slight hiccup with the surgeon (who was out of the country and wanted to see Paddy on his return before discharge, but we prevailed on him to allow a follow up the next week.) to the Friday. Paddy had by now spent 19 days in hospital after his birth and we were more than happy to be taking him home.

Yahh!!

Time to breastfeed

Discharge, however, also brought about the dreaded need to pay the bill. I had been keeping an eye on the ever increasing amount this was costing and had been making payments on my debit card to try and keep up with the amount, since my card is only permitted to pay out P70,000 at any one time, I had to make several such deposits over the two weeks, but I was now in the happy place of believing that I was ahead of the game and any additional over the past 24 hours was going to be well under the magic 70k; how wrong I was. I had forgotten that so far the bill was comprised of only the consumables and equipment usage, no doctors’ professional fees (PF) had so far been included, however, how bad could it be, after all Asian Hospital has a policy that PF is heavilly discounted for fellow doctors and their family, yeah, that’s fine in as far as it goes, but if the PF is normally a lot, even the discounted amount can be a shock. Not to put too fine a point on it, the total bill and even with the PhilHealth Insurance contribution (of P37,000 of it hah hah!) was into 7 figures. Having said that, like I mentioned previously, Asian Hospital and Medical Centre is probably one of the top two or three places in the country and definitely Luzon island that you could get the level of care Paddy needed. The fact that the 4 hour surgery had been carried out on a two day old baby and without the need for a blood transfusion was on its own worth a small fortune and the costs for similar care anywhere else in the world would have been considerably higher. It is, however times like this when you miss things like the NHS back in the UK, although had he been born there, would the doctors at the local maternity unit have diagnosed the EA and TEF so quickly and would he have needed to be transferred to Great Ormond Street Hospital for treatment and go on a waiting list, all of these questions bounced around my mind as I hoped my UK credit card would cover the remainder of the bill and they would allow us to go home. Fortunately, HSBC didn’t quibble, even when it took me 3 attempts to get the correct PIN, Doh!!

Bill paid, receipts in hand we were helped to get Paddy to the car by one of his nurses, I am not sure they are ever totally happy to see one of their patients go home, as they must, despite all their efforts, form an attachment, especially with those that are in their care for a while, we will certainly miss their care and attention.

First meeting with the family

Now came the really hard part, we had been parents for the past 19 days, but hadn’t been very hands on, in fact, we had been by necessity fairly hands off. This time we were on our own with a very delicate and small little boy in our care with peculiar demands and only one method of communication that was sure to gain our attention, crying and yes, he can cry quite loudly. We hadn’t even told Kat’s parents at this stage that he was coming home, as we wanted to actually get him there before we made the announcement, which we did shortly before posting a picture of him on FaceBook in the car seat on the couch in our living room just after we arrived. This photo has already got 300 likes and many comments from around the world. The next few hours were spent, like I am sure many more days and months shall, listening to every noise he made, and those he didn’t worrying whether he was OK or not, we jumped up to check on him several times to find him happily sleeping without a care in the world, or on occasion grizzling about a dirty diaper or needing feeding (which he seemed to want hourly or so), I guess this is the way it’s going to be for a long time…….

An unexpected turn of events

We spent the second week of February doing some things we shan't be able to do so easily once Paddy is born, we spent a week getting in a visit to a newly opened resort complex in Manila (City of Dreams) where we stayed in the Hyatt Hotel. Kat was also able to attend a pharma company sponsored event taking in lunch followed by a tour of Intramuros with Carlos Celdran (an infamous yet popular comedian/social commentator and tour guide). We followed this by attending the Philippine Infectious Diseases convention in Ortigas, which included a drive across Manila on a Tuesday morning and making me watch "50 Shades of Grey" since we had a spare afternoon before the convention.

After Kat has attended the convention we headed home via Asian Hospital where we had a scheduled Bio-Physical Scan for Paddy, this took a bit longer than anticipated as Paddy wasn't too keen on moving about as much as he should, but after a little while he moved enough to keep Dra Niza happy. She did however ask us to return for a follow up scan and consult on the Monday, as we started the 37th week.

This is pretty much when it all went wrong, or at least all of our expectations were upended and we had to respond accordingly. On the Sunday morning, Kat told me that Paddy didn't seem to be moving quite as much as previously, but we chose to wait until after lunch before we got worried since this would allow her to have something to eat and raise her blood sugar. As the afternoon wore on it was clear that Kat wasn't happy with his lack of movement, I suggested that we might want to go to Asian Hospital ER to have him checked out, she agreed.

Upon arrival at the ER, Kat was triaged and we were moved up to the Genesis Centre, which is the birthing / neonatal facility for observation. She was hooked up to a Non-Stress Test machine and the on duty OB took a look at the trace, seeing quite quickly that there was a lack of movement in the baby and his heart rate was OK but also not changing when he did move (getting faster or slower). She called Dra Niza who requested admission for further observation and to be kept informed about the ongoing monitoring. Even before we had a room organised, the trace indicated that Paddy may be in difficulty and Dra Niza decided that we need to prepare for an emergency cesarean section later that evening. This all passed Kat and I in something of a daze since it moved so quickly, I had to double check that they were planning the CS that night.

Waiting for the CS, I hadn't
shaved for a few days

It took a while, seemed forever, but was only around 3 hours before Dra Niza arrived and Kat was wheeled into the delivery room; I was given some scrubs, booties and a hair net (yeah yeah, laugh all you want) and asked to wait until they were ready for me. I was called in, no video but I could take photos and don't touch the blue draped areas. Kat was awake, having had a spinal anaesthetic, her head poking out of a sheet separating us from the surgical field. Dra Niza commented on the fact that Kat's polyhydraminous state meant that they needed to be careful with all the amniotic fluid as she cut through the last membrane, a lot of water came out, sluicing down to the floor where it wasn't caught by the drapes. Paddy, it turned out was now in a breech position, not only that, but he had also managed to wrap the umbilical cord around his neck (cord wrap); this was the reason his movement had been restricted and why it was important to get him out now. At 10:43 pm he was eased out feet first after having the cord cut to remove it from his neck.

Here he comes, ass first!!

At this point Dra Niza handed him over to the neonatologist, Dra Colasito to check him over and clean him up a bit. This is where the world, which was already a little wobbly on its axis turned totally upside down, although Kat wasn't really aware of what was going on. After suctioning the fluid from his mouth and nose, a soft tube was pushed down his mouth, it didn't seem to go as far as expected, so the procedure was repeated through each nostril and then again the mouth, with twisting but with the same result, it didn't go in very far. Paddy had announced his presence by making a loud cry, which was a great relief, I still didn't know what was going on with him.

First chance exam in delivery room

The Neo-natologist and the on duty Paediatrician then whisked Paddy away, a quick fly past Kat to show her the baby, but it was momentary. I was asked to follow down to the NeoNatal ICU (NICU) once I had removed my scrubs, which I did. Once in there, Paddy was hooked up to oxygen support and an x-ray was ordered, repeating the tube insertion so they could see the depth it reached in his oesophagus, it was clear from the films that he had an oesophageal atresia where the tube at the back of the throat doesn't extend down to the stomach, this is often accompanied by a tracheal oesophageal fistula, where the bottom of the oesophagus joins to the wind pipe halfway up and it seemed he had both. There was one other associated anomaly, which fortunately he didn't have and that is a lack of an anal opening.

Dra Colasito examines
him some more

Once all this had been explained to me, and the need to surgically correct this quite quickly, it was clear that Paddy was going to be staying there in the NICU for several days. I was keen to get back to see Kat, upon leaving the NICU I was surprised to bump into Kat's mom and her best friend Dulcie, it was by now almost midnight. I spent the next hour or two bouncing from the delivery suite to the NICU to check up on the most important people in my life, alternately talking to Mommy and Dulcie and Dra.s Niza and Colasito as well as the nursing staff. Kat was recovering slowly and was due to be taken to her room in an hour or so, I went back to the NICU where the doctors were talking to Mommy Luz to explain to her what was going on. Shortly thereafter we got to Kat's room to try and sleep, it was hard as we both knew that our little boy was a little bit broken, although we hoped they could fix him quickly.

His nameplate

The next day dawned and Kat and I were both emotionally drained, the roller coaster of the past 14 hours had taken its toll on us. That said we had a challenge to face and a baby son to welcome to the world. I was able to go down to the NICU to see whether he had a comfortable night and what the plans were, I was told that he also had a Pattent Ductus Arterios (PDA) where a small blood vessel bypassing the lungs to allow the circulation from the heart to go to the placenta for oxygenation. This is relatively more common and often corrects itself after a few days, a second 2D echo would be needed later to confirm it had closed.

Kat's first visit with Paddy

I was also able to take some more photos of him. Kat was confined to bed until she was able to demonstrate her recovery from the CS (anyone who has been there knows what this is, I won't embarrass her by going into detail). Once she had, the OB allowed her to be taken down to the NICU in a wheelchair, this was to be the first time she had seen him properly and as you can imagine it was an intense moment and later quite hard to leave him behind to return to our room. The surgeon was due to see him again the next day with the surgery proposed for the afternoon. Some friends had also visited us that day, it was great to see them all and to feel the love for us from them.

The day of the surgery was all a bit of a blur, we had several forms to sign and a chat from the surgeon to explain what he planned to do after the diagnostic tests had provided him with the information he needed, although as he said, it all depended on what they found when they got in there, he also took us through the alternative plan if needed.....

A few hours later we were called down to the OR Suite to see him again, the surgery had been a success and plan B had not been used, everything was as hoped. Paddy should have a full recovery and lead a normal life, we saw him back to the NICU before getting back to the room for a much needed night's sleep.

On the Wednesday we went to visit Paddy for a while, he was much more relaxed than before as he was now able to breath more easily (although intubated and with a chest drain in place) and could swallow for the first time. This was also the day Kat was to be discharged, several doctors popped in throughout the day giving us updates on Paddy and also prepping Kat for going home, Dra Niza checked her dressing and when I looked at the wound site, I was amazed at the tidy sutures and almost invisible incision, this didn’t mean that Kat could be overly active, we were warned that she would take several weeks to fully recover and shouldn’t drive her car for at least 3 weeks.

The next few days were spent visiting with Paddy, his progress was agonisingly slow, or at least that is how it seemed to me, but he was visibly getting better, his breathing was much less laboured and he seemed brighter when he opened his eyes. There was only one slight problem, he is not allowed to be fed, instead he was getting his nutrition through IV, this meant that he felt hungry pretty much all of the time, and that made him very grumpy. Some tubes were removed (he was extubated on Monday), we had to consent to a central line being inserted by a cut down procedure, this would reduce the needles stuck in him to get IV access as this line is more permanent and doesn’t need to be transferred from site to site and to avoid infection.

At the time of writing this on Monday March 2nd, we received the news that Paddy's paediatrician is hoping to allow him to feed through his oral - gastric (OG) tube once the surgeon agrees and they are hoping to remove the chest drain around the same time.

I also learned that my application for permanent residency has been approved and all I need to do now is to visit the Bureau of Immigration to have my passport stamped and to get my new ACR-I card, which I am planning on doing later in the week.

Not long now, the pressure is growing as we enter the last few weeks...........

After the New Year festivities we made plans to visit the Bureau of Immigration in Manila so that we could submit our application to amend my status as a ‘Probationary Resident Alien’ into a permanent resident. Similarly to last year, we researched the requirements online using the BI website as well as ex-pat sites to get advice from those who had been through the process. There was not a lot of guidance out there, other than do it early!

It was decided that we should go up on a Wednesday, leaving early to get as much done as possible, stay overnight in an hotel in Intramuros so that we had the opportunity of Thursday to finish anything off if needed. In order to execute the plan, we rose early and skipping breakfast for now, we set off around 5:30; the journey was relatively easy, driving along SLEx and SkyWay to come off the end and turn onto Buenida and then onto Roxas Boulevard which would take us up to Intramuros. We arrived and parked the car outside the BI a little after 6:40, so we took advantage of the nearby Starbucks for breakfast.

We needed to get some documents notarised, and from previous experience we knew that there are attorneys working just behind a BDO bank branch just to the side of the BI, we walked over to find that we were the first in line for the service. For a nominal fee, we had the documents professionally formatted with the correct details and two copies of each printed (you always need duplicates and it is worth the additional cost to have notarised copies not just photocopies just in case) and notarised, next stop the BI………

At this time of year, the Philippine authorities require all registered resident aliens (i.e. people like me) to attend and complete a verification exercise that you are still here and living in the same place etc. This was the first time I would have to do this, although I had hoped the visa amendment process would cover this, but sadly no. Anyway, the point of all this is that the BI opens early in the morning for the first 60 days of the year, which allowed us to get cracking with the submission of documents. This is pretty much how it went:-

• A very helpful gentleman at the enquiries desk, who we first met last year, he quickly checked our documents, removing a number from the ‘set of copies’ I had prepared returning those to me. He then indicated that I should go to Window 18. 
• The lady at Window 18 informed me that I had incorrectly assumed that I was exempt from the annual registration and that I should go and do this; I asked whether it was a pre-requisite for this visa amendment and although it wasn’t, she wanted me to do it anyway, which meant going back outside and queueing up again.
• From looking at Annual Registration process last year and the online form, I was not overly happy with this, I would have preferred to do it later, but like the lady said, we are here now. I was now mentally prepared for a nightmare of form filling, with each box needing some form of answer even if N/A (and there are a lot of boxes). It turned out my fears were largely unfounded, as I was eligible for ‘online processing’ and with a little guidance of exactly what the system was asking for (anyone who had completed a government document knows that not all questions are easy to answer with some being ambiguous at best) I completed the registration and was then issued with a small ticket with a reference number. Thinking we were done with the proces I was happily walking away to ask where to pay, when I was informed that I needed to get a queue number, and how did I get this you ask, yes by queuing up……
• Queue number obtained, we went back inside to pay for the registration, once I had the receipt which included the mysterious “express lane” fee I was able to return to Window 18 to start the submission process again. 
• Back at Window 18, the lady I spoke to earlier informed me that there are a few boxes which I should mark N/A as I had left them blank. 
• We needed to take the documents to another window for some additional checking and then were directed to go upstairs and see an immigration lawyer, this got both of us a little excited as the interview is a key step in the process and if we could do this today, that would be great. 
• The lawyer looked through the papers, asked a few questions and then directed us to go downstairs, returning to the window we had just been at. We were then directed to go and pay at Window 23 and return with copies of the receipts, now at this point, I have to make it clear that the payments are recorded electronically, the receipts are printed on NCR paper in triplicate and they still want another copy on A4 or legal size photocopy paper, come on guys, think about the trees……
• Copies of receipts obtained we submitted these and were told that it was all done, except the interview bit, which was to be next week as indicated on the receipt, another interview, what was wrong with the one we just had? It also transpired that it was to be the same lawyer…….

We left the BI, happy that we had submitted the documents and completed the annual registration, but a bit deflated that we had to come back the week after. The dates offered were the Monday or the Thursday (on which day the Pope was arriving, so most of the country would be on holiday). We returned to the car and drove round to the hotel, after all we had paid for it already, even though it was only 10:30.

The next day, having plenty of time, we decided that we could stop off and renew Kat’s driving licence (as we had failed the previous week as the office we went to didn’t have the ability to change addresses or names (Reodica to Byrne) and it was also important to change Kat’s status as she is now married (although quite what that has to do with driving ability is beyond my understanding). We had been told that we could get it all done at the LTO in Alabang Town Center, however that office can’t do name changes, so we went to the Muntinlupa office, where we met up with a former med school colleague of Kat’s. Dr James was most helpful and was able to assist us in getting all the right forms to the right windows (it’s all about windows when dealing with bureaucracy here). Although we completed the process, there are no plastic blanks on which to print new licences, so we shall have to wait, they also forgot to change her marital status, so we had to wait longer to get the new receipt, so long in fact that we had to leave and come back the next week.

Whilst we were in ATC we stopped off at an appliance store, I was looking for something for home, but had talked with Kat over dinner the night before when the topic of her parent’s old and broken down washing machine had come up (exciting conversation) and I had offered to contribute to getting a new one for them. Upon seeing what was on offer and that there was a significant discount for cash or straight card payment we made the purchase there and then, on the caveat that they could deliver the next day, before 5pm. We were assured that all would be fine and the machine would be at Kat’s parents house before 5.

The next evening, a little after 5pm we phoned Kat’s mum to ask if anything had arrived, only to be told that no, it hadn’t. Kat called the shop to ask and to get the driver to text or call to let us know what was happening. To cut a long story short, the van had broken down, so another van arrived at the house, but without the machine. Kat then called the shop back and made it very clear that she was not happy with the level of service, and we expected the machine delivered before 10am the next day. Well, it arrived a little after 10, but was delivered by the shop manager and a couple of staff; Kat’s mum told them that she was upset as the special surprise from her son-in-law had been ruined, I think they understood our point, but it made me smile, poor manager….

We had seen Kat’s OB earlier in the week, she was still not happy with the quantity of amniotic fluid that Kat has and was concerned about her going into early labour. We have been trying hard to keep Kat’s blood sugar under control but in the last trimester this is quite hard and it is this which is primarily the cause of the excess amniotic fluid. To help prepare the baby for any possible early arrival, it was recommended that he receive steroids to speed up lung maturity, the only downside is that this could elevate her blood sugar to a risky level. We could manage this at home, but it was decided to admit Kat to Asian Hospital and have any necessary care managed here. The problem with this was that we had planned it for the Monday and Tuesday with discharge on Wednesday, so we had also planned to attend the BI on the Thursday. As we got closer to this, we realised that they were likely to be shut because of the Pope’s arrival, so we were forced to take the other option, Monday morning, with the hope that the whole thing wouldn’t take too long and we could get out of Manila around lunchtime.

To give us the best opportunity for a prompt 9am start, we booked into the Bayleaf Hotel in Intramuros for the Sunday night. We have stayed there before, actually at the same stage of the process last year, a nice hotel, with good facilities and nice rooms. We drove up to arrive early afternoon on the Sunday, unfortunately, on the way up I hit a small rock with the front offside wheel which blew out the tyre and buckled the alloy wheel beyond repair. This posed us with a problem on the SkyWay of needing to replace the wheel and having only the scissor jack provided with the car, and it’s a big heavy car!! Not only that, but there is only a 1m wide shoulder, not an entier lane, so you have to work on a live carriageway.  One motorist who passed by stopped to aske whether I needed any help, and although it would have been nice, I was at the ‘nuts off, wheel hanging on the studs’ stage, so didn’t need too much more help. I had wrestled the old wheel off and the replacement almost full size steel one back on by the time the tollway assistance guys turned up. At least they had a lot of strobes on the vehicle to make our predicament a little safer. That completed, we followed pretty much the same route as 5 days earlier to get to the hotel.

The interview the next day was fairly quick and despite the need to get a couple of photocopies of receipts from the annual report process and further copies of our marriage certificate (they had two of these last year) and Kat’s birth certificate we were done in less than 30 minutes. We then went down to the biometric verification office, to be told that since these were all taken last year they are not required. This meant that we were done, finished. The next step is to return once my name appears on the BI website to have the visa stamped into my passport and to get a new ID card, that is assuming the application is approved, I need to check on the BI website to see the announcement.

Departing the BI on a much more energetic note than last week, we returned to the hotel to collect our stuff and then went to Asian Hospital to get Kat admitted for her treatment. I have only had a limited experience of hospitalisation using a system not the NHS, which I miss more and more. There is a lot of paperwork to be completed as well as computer records to be updated. I can’t put my finger on the actual problem and even less so on a possible solution, but if all the players were to come to a consensus on what was needed and use common forms or a system to record patient data then we could probably reduce the time processing patients considerably. It is not helped by the mix of totally private and semi-governmental agencies providing health insurance, each requiring a form to be completed and therefore duplication of information etc..

It was during some of this form filling that I got a little annoyed with the office of PhilHealth in the hospital; most Filipinos are members of this government insurance organisation as it provides a basic level of cover for a relatively low cost. Large hospitals, such as Asian have, what is in effect, an ‘implant’ where members can transact the necessary documentation to make a claim for their hospital care. We were informed that it was necessary to get a copy of Kat’s membership data (aka MDR) and also a record of her up to date contributions, something that can’t be done by the member at home online, but needs to be done at the nearest PhilHealth accredited office. I wasn’t made aware of this at the outset, but Kat was and asked her parents to get this for her, requiring a drive of some 30km each way from Santa Rosa to Calamba as well as finding a parking spot and queueing at the office and again at the hospital to drop off the documents (parking at Asian is a nightmare if you arrive much after mid morning, I decided to use the valte parking option for the first time here). However, upon enquiring directly to PhilHealth over the phone, Kat was then informed that Asian Hospital has access via a web portal to check all of this information and shold be using it to save patients the trouble of getting it themselves. Just prior to Kat’s discharge I had to go and sort out the bill, this is how it went:-

• I entered the PhilHealth office to make the claim against Kat’s insurance
• I was asked to provide the member data and contribution record
• I refused telling them that they should be able to look it up online
• Somewhat abashed the young lady looked to her supervisior for help with this difficult foreigner
• The supervisor smiled nervously and proceded to log onto the system, where he quickly found the necessary information and informed me that I was “OK and we don’t need the records, thank you”
• I asked why they had required us to ask Kat’s elderly (sorry Lolo and Lola but it adds to the complaint) parents to make a special journey of some 80 or 100km with the attendant queueing , waiting , stress and polution when they (PhilHealth) could have moved a mouse and made a few clicks to get the same result “It’s the SOP” he replied “the portal is sometimes offline”

Those who know me well can only imagine my reaction to this, I managed to keep my voice calm although I was livid, as I infomed him that it might be time to review the SOP so that the first action would be to check whether the portal was online and to get the information that way and avoid uneccessary travel and stress on patients and their relatives. Woe betide them if they pull that stunt again when Kat is admitted for the baby’s delivery!