News On Amosup Hospital 18572s

DAILY JAPAN SHIPPING NEWS


SPECIAL ISSUE

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Kaiun Keizai Shimbunsha co.,ltd. 【Japan shipping News】　　　　　

Kyobashi-Nagaoka Bldg,3-6-1, Hacchobori,Chuo-ku,Tokyo, 104-0032 Japan ＴＥＬ（81-3）-3552-7596 ＦＡＸ（81-3）-3552-7598

AMOSUP SEAMEN’ S HOSPITAL

Enhancing medical care and promoting the health of Philippine seamen Give indirect s for safe operation of Japanese merchant shipping fleets AMOSUP Manila/Cebu/Iloilo/Davao Operating seamen’ s hospitals in 4 areas across Philippine

For further development of Philippine seamen’ s community

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Symbol of AMOSUP

70% of seamen onboard Japanese merchant fleets are a member of AMOSUP Philippine seamen are becoming indispensible for Japanese maritime transportation and economy 　“ASSOCIATED MARINE OFFICER’ S AND SEAMEN’ S UNION OF THE PHILIPPINES-PTGWO-ITF”is Philippine’ s largest seamen’ s union. 　Its current number of union is 95,000, of which more than 40% (over 40,000 ) are working for Japanese merchant fleets. Among the 60,000 seamen working on board the 3,000 ships comprising Japanese merchant fleets, 70% are of AMOSUP. Philippine seamen have become an important human infrastructure ing Japanese merchant fleets and thus the Japanese economy. If, for some reason, a situation arises that Philippine seamen could not get on board ships, not only Japan but the whole world would fall into an economic turmoil. It has become an essential requisite for the sustainable development of Japanese maritime transportation, Japanese economy and the global economy to continue stably supplying healthy and high quality Philippine seamen to Japanese merchant fleets.

It started as a small clinic with only 5 beds. After about 30 years, it has grown into an organization over 50 times in size, with more than 240,000 outpatients a year and 500 medical staff 　AMOSUP opened its first healthcare facility in Philippine for seamen and their family in June, 1978.“It was difficult for common people to get medical care on their own at that time, because social security systems were still underdeveloped in Philippine. People had to pay the entire cost for medical care, which was very expensive. Seamen were employed for fixed , and during periods that they could not get a job on board a ship, they did not have enough income to cover healthcare expenses. Deeply concerned about this situation, Captain Oca tried to improve the situation by creating a hospital in the port area for seamen and their family”said Dr. Conrad F. Oca, current President of AMOSUP and son of Captain Oca. To be healthy and fit for work is fundamental and a prerequisite to the lives of seamen. Captain Oca clearly recognized this point and embarked to build a hospital for seamen. 　It started as a small clinic in South Harbor, Manila’ s port area with only 5 to 6 beds and specializing in outpatient care. The global maritime industry was not yet aware of the huge potential of Philippine seamen. In later years, however, the international maritime community started to introduce Philippines to the center of the global seamen labor market. The rapid growth of world economy and globalization since the late 1970s gave rise to a global increase in the demand for shipping capacity, which resulted in the tightening of the maritime labor market and increased maritime labor costs. Costs for seamen surged not only in traditional maritime powers such as England and U.S., but also in newer and advanced maritime countries such as Norway, Greece and Japan, fueled by the rapid economic growth. Moreover, the 1985 Plaza Accord triggered accelerated flagging out of ships in Japan. Against this backdrop, Philippine seamen started to be spotlighted as the central player of the international maritime labor market, with their low cost labor and almost-native English speaking ability as their selling points. Along with this trend, the number of of AMOSUP expanded rapidly. 　The AMOSUP Seamen’ s Hospital, which began with only one doctor and five beds, continued to expand

as the number of grew. Today, it has expanded to operate four general hospitals across the Philippines: one each in Manila (opened in June 1978/ February 1987), Cebu (opened in April 1997), Iloilo (June 2005) and Davao (August 2008). The total number of beds across the four hospitals have reached 255 (Manila 100/ Cebu 60/Iloilo 45/Davao 50), approximately 50 times more than when the first clinic was opened. Likewise, the total number of medical staff now exceeds 500, with 230 doctors (Manila 150/Cebu 34/Iloilo 24/Davao 22) and 308 nurses (Manila 174/Cebu 55/Iloilo 35/ Davao 44). The total number of outpatients a year was approximately 240 thousand (Manila 120/Cebu 60/Iloilo 30/ Davao 30 thousand, as of December 2013). AMOSUP Seamen’ s Hospital s the health of Philippine seamen working on the seas of the world by responding to their ever-growing healthcare demand and thereby underpins the safety of the daily operations of international maritime transport by Japanese and other merchant fleets.

Aparri Santa Baguio

Dagupan

Cabanatuan

Tarlac

Angeles

Manila

Olongapo San Pablo Batangas

Legazpi

Calapan

Calbayog Tacloban

Roxas

Iloilo Cadiz Puerto Princesa

Cebu Butuan

Bacolod

Iligan Zamboanga

Cagayan de Oro

Davao

General Santos

Map of Philippines

Captain Oca’ s vision lives on All medical services provided to seamen and their family free of charge 　The biggest feature of AMOSUP Seamen’ s Hospital is that it provides all medical services to member seamen and their family free of charge. This policy has not changed since the hospital was first founded, according to the vision of Captain Oca who always placed seamen’ s welfare first before anything else. This free-of-charge medical service covers the member seaman himself, his parents and brothers/sisters aged 18 or below in the case when the member seaman is not married, and the seaman himself, his spouse and his children aged 18 or below in the case when the member seaman is married. All the four hospitals including Manila, Cebu, Iloilo and Davao adopt the same policy. This provides an important incentive for choosing seaman as a career in the Philippines where healthcare cost is expensive and the social security system is still not sufficient. However, AMOSUP’ s healthcare service goes even further.

Launch of new pilot projects to aggressively expand service Insurance coverage for healthcare provided outside of Seamen’ s Hospital / Satellite clinic system 　With the number of member seamen continuously expanding driven by the ever-increasing demand in world shipping capacity, AMOSUP has launched new projects to aggressively meet the expanding healthcare needs of seamen. Among the four Seamen’ s Hospitals, especially the one in Manila is facing the problem of not being able to catch up with the increase in healthcare demand of member seamen and their family. AMOSUP is currently working on two projects to address this problem and provide healthcare service better tailored to member needs. One is“collaboration with insurance companies for healthcare provided outside of the Seamen’ s Hospital”and the other is“building a satellite clinic

system.”The former is a mechanism to cover the expenses of healthcare provided to member seamen and their family outside of the Seamen’ s Hospital through collaboration with insurance companies. AMOSUP pays the insurance fees to the insurance company on behalf of its . This project aims to have other hospitals cover the part of the healthcare that AMOSUP Seamen’ s Hospital cannot provide by itself and to assure the costs for such treatment/healthcare up to a certain amount (20,000 peso), while also contributing to mitigate the congestion at the AMOSUP Seamen’ s Hospital. 　The latter project aims to provide healthcare to seamen and their family who have difficulty in visiting the Seamen’ s Hospital because they live in areas far away from Manila such as the northern part of Luzon Island, where there is potential demand for healthcare services to seamen. AMOSUP and existing general hospitals in these areas will form partnerships to provide healthcare for free to seamen and their family who live in these areas.“At present, the patients must travel over (to distant AMOSUP Seamen’ s Hospitals), but this project brings healthcare closer (to where the patients live)” explains President Oca. These two projects have already started. Specifically, a satellite clinic pilot project has already been launched in Dagupan City (northwest part of Luzon Island) since February 2013. After one year of pilot operation, in February 2014, AMOSUP will consider expanding this project to other areas of the Philippines based on the outcomes of the pilot project.

Promoting the health of Philippine seamen is a precondition for the safe operation of Japanese merchant fleets The trust and cooperation fostered between Japanese management and Philippine seamen in the international maritime labor market form the foundation for everything. 　Many tankers and bulk carriers comprising Japanese merchant fleets are flag-of-convenience ships, on which Philippine seamen work. The Japanese shipping industry and Philippine seamen have become so inseparably connected with each other, like an organic system, that if they are disconnected by any chance, the impact would cause economic turmoil not only in Japan but across the world. Therefore, it is indispensible that the relation between Japanese shipping industry and Philippine seamen is maintained to ensure safe and stable operation of Japanese merchant fleets. The trust and cooperation fostered between Japanese management and Philippine seamen in the international maritime labor market form the foundation for ensuring continuous and stable supply of high quality and healthy Philippine seamen at appropriate costs. 　While the AMOSUP Seamen’ s Hospital is basically a facility developed and operated by AMOSUP alone, numerous footprints of Japan-Philippine cooperation can be found in these hospitals. The following is a report on the four AMOSUP Seamen’ s Hospitals respectively located in Manila, Cebu, Iloilo and Davao.


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AMOSUP SEAMEN’ S HOSPITAL MANILA

Established in June 1978　Started out from a small clinic run by Roberto Oca, Captain Oca’s elder brother. Grew into a Government-certified general hospital in February 1980 Relocated in February 1987 to current location in Intramuros In a graceful environment surrounded by historic Roman Catholic buildings of the early modern period location for member seamen. Intramuros district is where Miguel López de Legazpi, the first Governor General of the Spanish Colony, set up a base/fort for conquering the Philippines in the late 16th century. The district is still surrounded with the fort walls built in those days. Many European Baroque style buildings including Manila Cathedral and San Agustin Church can be found in Intramuros, which was the first site in Luzon Island to be baptized by the Roman Catholic Church. Remains of batteries can still be observed at Fort Santiago, reminiscent of the colonial era. The district is the most popular tourists’spot in Manila with its unique, attractive atmosphere fusing European and Southeast Asian cultures. 　AMOSUP Seamen’ s Hospital was relocated from the port area to Intramuros in February 1987 (construction was started in June 1985). The main building and an annex stand next to each other on a

AMOSUP Seamen's Hospital Manila・Annex

　Manila is the capital of the Philippines. The Metro Manila (metropolitan area including Manila and 17 nearby cities and towns) has a population of 12 million and an area of 638 km2, both of roughly the same size as the 23 wards of Tokyo. Moreover, 21 million people inhabit the wider metropolitan area including parts of the adjacent states of Bulacan, Rizal, Laguna and Cavite, forming one of the largest cities in the world. 3,000 km south of Tokyo, Manila can be reached by a four-and-a-half hour flight from Tokyo. 　It was in June 1978 that AMOSUP, the largest seamen’ s union in the Philippines, established the first AMOSUP Seamen’ s Hospital in Manila. At first, it started off as Roberto S. Oca Workers’Clinic (RSOWC), a small outpatient clinic with 5 to 6 beds located in South Harbor, Manila’ s port area. Roberto S. Oca was an elder brother of Gregorio S. Oca who was the former president and founder of AMOSUP (late Captain Oca, father of current President, Conrad F. Oca). AMOSUP later expanded the clinic into a three-storied hospital with 50 beds and surgery, internal medicine, obstetrics and gynecology, pediatrics and dentistry departments as well as operating rooms and an intensive care unit (ICU). The hospital was certified as a Tertiary Level (rank of general hospital with specialized departments) general hospital in February 1980 by the Philippine government. This was when the former clinic set sail in earnest as AMOSUP Seamen’ s Hospital. 　AMOSUP later relocated the Seamen’ s Hospital from the port area to Intramuros in the First District at the center of Manila in February 1987 (construction started in June 1985), in order to meet the expanding healthcare needs of the rapidly increasing seamen population. The new AMOSUP Seamen’s Hospital was located at only a few minutes’walk from the AMOSUP headquarters. It had over 100 beds and ample facilities to further en-

hance the healthcare services provided to member seamen. Intramuros, meaning“within the walls,”is the oldest district and historic core of Manila where Miguel López de Legazpi, the first Governor General of the Spanish Colony, set up a base for conquering the Philippines in the late 16th century. AMOSUP Seamen’ s Hospital Manila provides medical care to member seamen in a historic environment surrounded by Manila Cathedral and San Agustin Church which are representative Roman Catholic architectures of the early modern age. 　AMOSUP Seamen’ s Hospital Manila provides healthcare to AMOSUP and family, who live on Luzon Island or temporarily called at a port in the island, which s for approximately 40% of the 95,000 AMOSUP . We visited AMOSUP Seamen’ s Hospital Manila ing the health and lives of member seamen and their family in the megacity Manila.

Lots of People wait for their turn in the courtyard

Medical inteview for outpatient

Overview of the facility

Blood test・centrifugal machine

premise of 1,200 m2. A Spanish architectural style was adopted to make the appearance of the hospital harmonize with the surrounding environment. The main building has a floor area of 4,564 ㎡ with one floor below ground and three more above. The annex has four floors above ground level and floor area of 2490㎡ , which makes the total floor area of the two buildings 7,054㎡ . The total number of beds is 100. The annex used to be a training center for seamen since it first opened in 1987 until 2000, but when the Maritime Academy of Asia and the Pacific (MAAP) was established in Kamaya Point in Mariveles, Bataan, in August 1999, the annex building was renovated as hospital space to respond to the increase in healthcare demand. [MAAP is a merchant maritime academy privately run by AMOSUP and a board of governors including organizations representing maritime employers and workers of Japan and Philippine, and the International Maritime Employers Committee Limited (IMEC) from Europe.] 　150 doctors (including 52 residents and 98 consultants) and 174 nurses work in this hospital. Besides these medical staff, there are 467 non-medical staff

150 doctors; 174 nurses Largest among AMOSUP Seamen’ s Hospitals Total floor area 7,054 ㎡ (main building and annex combined) Number of beds 100 　AMOSUP Seamen’ s Hospital Manila is located 10 km north of Ninoy Aquino International Airport, in the Intramuros district of Manila, at Cabildo Corner, San Jose Street. It’ s about a 20 minutes’drive from the airport if the roads are not jammed, but since traffic jam is normal in Manila, it usually takes about twice as much time to get to the hospital. It is only a few minutes’walk from the AMOSUP Seamen’ s Center (the headquarters), a perfectly convenient

Psychological test before boarding

such as radiology technologists, medical technologists, physical therapists, pharmacists, istrative personnel and staff in charge of maintenance work. Working days and number of doctors vary by each department. During the daytime hours (8:0017:00) , 1 surgeon, 1 physician, 5 family physicians (initial consultation/general practice), 8 obstetricians and gynecologists, 9 pediatricians see the outpatients, and during nighttime, 1 surgeon, 1 physician, 3 family physicians, 3 obstetricians and gynecologists, and 2 pediatricians work on a 24 hour shift, in rotation. Those who took a 24 hour shift take 2 to 3 days off after that. Medical examination and research related departments work during the daytime (8:00-17:00). Nurses work in 3 shifts around the clock (7:00-15:00-23:00-7:00) and rotate every 15 days. Outpatient reception is open from 8:00 to 17:00 on weekdays and 8:00 to 12:00 on Saturdays.

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Annual outpatients 120,000, inpatients 5,000, pre-boarding medical checkups 5,400 The only Seamen’ s Hospital with a MRI facility, 160 slice CT scanner Certified for Tertiary Level (highest rank) general hospital by the Philippine government Accepts internship students 　Medical departments of AMOSUP Seamen’ s Hospital Manila include internal medicine, general/ clinical surgery, pediatrics, obstetrics and gynecology, outpatient, anesthesia, ophthalmology, otorhinolaryngology, pathology, radiology, family medicine, emergency medicine, rehabilitation, nuclear medicine, dentistry, nursing, pharmacy, dietetics/nutriology, and pre- and post-boarding medical examination. One of the characteristics of Seamen’ s Hospital Manila is that it has a rehabilitation department which is a criterion for being certified as a Tertiary Level hospital by the Department of Health (DOH)

Ganma camera, donated by ITF

of the Philippine government. Among the four Seamen’ s Hospitals located across the Philippines, Manila Hospital is the only one that has a MRI scanner (since February 2010) as well as 2D ultrasound scanner and extracorporeal shock wave lithotripsy equipment (breaks gallstones using electric waves). 　Usage data of Seamen’ s Hospital Manila for 2012 was: number of inpatients 4,965 (average number of inpatients itted per day 13.6); total patient days of inpatients 21,945 (average stay of inpatients 4.4 days); bed occupancy rate 62.7%; number of outpatients 120,730 (average of 410.6 patients/day); disembarkation of sick seamen during voyage 98 (average of 0.3 patients/day); number of dentist’ s patients 54,664 (average of 224 patients/day); patients taking ultrasound scanning examination 8,794; patients taking x-ray examination 15,653 (average of 53.2 patients/day); patients itted for examination 25,739 (average of 237.4 patients/day); patients visiting the hospital for examination 338,291; seamen taking preboarding medical examination 5,404 (average of 18.4 patients/day); seamen taking post-boarding medical examination 23 (average of 0.1 patients/day); number of surgical operations 4,675; number of childbirth 618; patients receiving rehabilitation 7,417 (average of 25.2 patients/day); seamen taking pre-boarding psychological examinations 4,592 (average of 18.8 patients/day); number of deaths 51. The average number of outpatients visiting the hospital per day was 410 and those visiting the dentist were 220. Surgical operations were conducted on 8 to 9 patients per day on average. Seamen’ s Hospital Manila treats the largest number of patients among the four AMOSUP Seamen’ s Hospitals in the Philippines. 　Seamen’ s Hospital Manila can also be characterized by the number of internship students (clinical trainees) it accepts. Since it is a Tertiary Level hospital certified by DOH, it accepts more internship students compared to Seamen’ s Hospital Cebu (Secondary Level) and other hospitals. According to the medical education system in the Philippines, students must first graduate a high school, a general university (4-year science course) and a medical graduate school (4-year course specializing in medi-

Latest model of CT Scan 160 Slice

Ultrasonic crush machine for magallstone destruction. Seafarers tend to have magallstones.

cine) and then experience a 1-year“post graduate internship (PGI)”before they are qualified to take a national exam for medical practitioners. Students will become a general practitioner when they the national exam, but they will still need to undergo a 3 to 4 year residency (depending on the specializing department) and take the Board Certification Examination to become a specialist doctor. When they this exam, they finally become a specialist doctor such as a general physician, general surgeon, general podiatrist, etc. Furthermore, if they wish to further advance their specialist skills, they will undergo fellowship training for another 1 to 2 years and take the Sub-specialty Board Certification Examination. When they this exam, they will become a specialist such as a cardiovascular physician who can conduct highly specialized medical practice. 　AMOSUP Seamen’ s Hospital Manila has been accepting an average of 6 to 7 residency trainees in family medicine, obstetrics and gynecology and 1 to 2 fellowship trainees in endoscopic surgery every year since 2009. The residency period is for 4 years and fellowship is 2 years. In 2012, a total of 24 residency trainees in family medicine, obstetrics and gynecology (2 in 1st year, 6 in 2nd year, 8 in 3rd year, and 8 in 4th year) and 2 fellowship trainees in endoscopic surgery (1 each in 1st and 2nd year) were trained at Seamen’ s Hospital Manila. Seamen’ s Hospital Cebu, which is a Secondary Level DOH certified hospital, only accepts 4-year residency trainees in family medicine. 　The main building and annex of the hospital stand next to each other and are connected with a ageway. The main building has an open ceiling space at the center of the building (same as Seamen’ s Hospital Cebu). The inner courtyard is used as the patients’waiting lounge. When you walk in through the entrance on the first floor of the an-

MRI placed only in Manila Hospital

nex, you will see the nuclear medicine department and examination room on the left and the department of ophthalmology further beyond. The nuclear medicine department’s computerized tomography room is equipped with electrocardiographic testing machines, mammographic scanner, ultrasonic devices, nerve testing apparatus and a state-of-art 160 slice CT scanner that has just been delivered in June 2013. In addition, some of the equipment can only be found here at Manila Hospital among the AMOSUP Seamen’ s Hospitals such as the magnetic

Only rehabilitation institution in 4 Hospitals. Rehabilitators

Double occupancy room for senior officers

resonance imaging (MRI) scanner which was introduced in February 2010, a 2D ultrasound scanner, and a gamma camera donated by the International Transport Workers' Federation (ITF). The CT scanner has been renewed to a latest model with a processing speed three times faster than the previous one, contributing to reducing waiting time for the patients. The 64 slice CT scanner that used to be used at Seamen’ s Hospital Manila was transferred to Seamen’ s Hospital Cebu in October 2013. On the second floor of the annex are the internal medicine, general surgery and dentistry departments as well as the medical psychology and psychiatry room and chemotherapy room. The 6 dental chair units at the dentist’ s are in full operation from morning to evening every day. We saw many patients waiting in the ageway on the day we visited the hospital,

Surgery schedules. 11 surgeries from 7AM to 5PM

too. The istration office, information management room and conference rooms are located on the third floor. The fourth floor houses doctors’and nurses’offices, the library and a work out gym. 　On the other hand, on the first floor of the main building, various departments are arranged in a way to surround the waiting lounge at the center. The medical records room, pharmacy, radiology, pathology/histology laboratory, pediatrics, obstetrics and gynecology departments and the emergency room are located around the waiting lounge. On the second floor are the female surgical ward, newborn intensive care unit (NICU), operation room, labor and delivery room, sterilizing room, and stone treatment center where extracorporeal shock wave lithotripsy is conducted. Approximately 3-4 patients per day visit the hospital to receive this treatment for breaking gallstones, and many of them are seamen who want their gallstones treated before getting on board. On the third floor are the male surgical ward, isolation room, orthopedic ward, pediatric ward, intensive care unit (ICU) and the rehabilitation department. There is also a chapel on this floor. Most of the wards have around 10 beds in one room but there are special rooms with only 1 or 2 beds (each for 1 room) on third floor for senior officers such as captains and chief engineers. On the basement floor are a staff cafeteria with 60 seats, pre-boarding medical examination room, dietary consultation room, engineering maintenance room, etc.

6 Units in dentistry. Full operation


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interview− Hospital staff interview “To mitigate the continuous congestion Both the doctors and nurses are working to develop their skills, knowledge and experience to be able to mitigate the situation” 　AMOSUP Seamen’ s Hospital Manila has a much larger capacity and more sophisticated facility compared to the other seamen’ s hospitals in other areas of Philippine, but the number of both outpatients and inpatients is also exceptionally large compared to other seamen’ s hospitals, as it is situated in the capital and largest city of the country. The 95,000 AMOSUP and their family living in this area, ing for 40% of the total number of the population covered by AMOSUP’ s medical service, come flooding into the hospital every day, causing continuous congestion. 　Ms. Bridget K. Flordeliza started her career as a nurse at the AMOSUP Seamen’ s Hospital in May 1981, when the hospital used to be called by the name Roberto S. Oca Workers Clinic (RSOWC). In May 1984, she was appointed as chief nurse, the youngest (at the age of 27) chief nurse ever in the history of Philippine nurses, and for nearly 30 years since then she has been working as chief nurse at AMOSUP Seamen’ s Hospital Manila. She is a living witness of the history of the hospital. She suggests that for mitigating the congestion,“…it is important to maintain the system going. At AMOSUP Seamen’ s Hospital we have a system in place to divert people from other sections whenever a section runs short of staff. Not only the doctors but nurses too, must continue to develop their skills, knowledge and experience without getting satisfied with their present status.” 　Doctor Karen Kristine San Juan will complete her residency and become a specialist doctor in family medicine next year. She comments“It is necessary to enhance training for both doctors and nurses so that medical procedures can be carried out more quickly, which will help (mitigate the congestion).” She emphasizes that the skills improvement of each staff member is essential in enhancing medical services. Below are our interviews with three staff of the hospital, including istrative director, Elena Gysrell V. Jiloca, regarding the future and issues of the AMOSUP Seamen’ s Hospital.

What are the characteristics of AMOSUP Seamen’ s Hospital? Bridget K. Flordeliza, R.N. / Chief 　 “One clear characteristic is that President Conrad Oca wants to make sure everyone gets a chance to develop their skills. All of the medical staff, including nurses, are allowed to take a leave for participating in programs to advance their skills. Nurses can make use of scholarships, too. We also provide training via the Internet and remote education through collaboration with a partner institution (The Lyceum of the Philippines University)” 　“In addition, the hospital provides a scholarship program covering 100% of the cost for attending a medical university and 50% for a medical graduate school, for the daughter or son of hospital staff entering a medical school. This program is available

San Juan/Doctor, Flordeliza/Chief Nurse, Jiloca/ Executive Secretary

for one high-performing student per year. I, too, was granted a chance by our boss (Captain Gregorio Oca) to work for one year in Japan (received training at Tokai University and Musashino Red Cross Hospital in 1991-92).” 　“Another thing about this hospital is that the whole hospital and its staff have a feeling that we are all a member of a family. You can say the same for our patients, the seamen and their family, too. Once they visit us as a patient, they will come back again when they get sick. Although it’ s a personal episode, I about a patient, a baby I delivered who grew up and visited us (when he got sick). This patient ed me. The staff, the patients, we are all a big family.” Karen Kristine San Juan − Chi, MD/ Senior Resident Physician Department of Family and Emergency Medicine 　“This hospital can be characterized by the high level of medical care it provides. While, there are many public hospitals in Manila, most of them do not have advanced medical equipment. Another characteristic about this hospital is that its service is limited to seamen and their family. I don’ t think there are many examples like this, even for big companies.” 　“(AMOSUP ) often spend a long period at sea. When they get off the ship and return home, they usually get a health checkup, but many of these seamen are concerned about their family’ s health, too. So we provide counseling and care (to the seaman himself) and his family altogether. Another distinct point is that we have sophisticated equipment that allows for advanced surgical operations. We also conduct seamen’ s pre-boarding medical checkups. Seamen take this checkup about one month in advance of the voyage. If the checkup shows any signs of concern, then the seaman will be instructed to improve his condition through a diet program or other means, (so that he will be qualified to board the ship).” 　“In Philippine, all of the family usually gather whenever someone in the family undergoes an operation or gives birth to a child. But here, since we are a seamen’ s hospital, in many cases the husband cannot be there to witness (the childbirth or operation). Therefore we must take very good care of the family’(mental side). That’ s another aspect that is different from other hospitals.” Ma. Elena Gysrell V. Jiloca, MBA / Executive Secretary・istrative Director 　“We are continuously improving this hospital, based on the needs of member seamen. We particularly place importance on pre-boarding medical checkups. Recently, there are many seamen with high cholesterol values and blood pressure. We provide care and counseling in advance of the boarding day so that the patient can improve his health status in time (and be qualified to board the ship). We always place highest priority on responding to AMOSUP ’requests and providing services to meet their needs.”

What do you think is necessary to further improve this hospital?

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staff doesn’ t even have time to take a rest. More and more operations are being conducted and (the operation room’ s) schedule is always full. Some of our patients had to be transferred to other hospitals because there were too many people on the waiting list. These patients are sent back (to AMOSUP Seamen’ s Hospital) when anything goes wrong with them. Our outpatients also have to wait for a long time. When I think about the member seamen, who don’ t have much time to spare because of their tight boarding and training schedules, I truly wish that we could expand our capacity. We want more beds, too. We even have patients waiting to be treated in the ICU. Patients are kept waiting for their operation and ission into the hospital because there are not enough beds. I can’ t help but to hope for a larger capacity.” 　“In addition, doctors attend various conferences and academic meetings to learn about the latest therapies. I think nurses, too, need to do the same. If nurses had the ability to explain to patients (about their pathological conditions and ways to address those conditions,) like doctors do, then the patients could be relieved from their concerns sooner. Not only the doctors but nurses and istrative staff, too, must continue to develop their skills, knowledge and experience without getting satisfied with their present status. For example, we collect the latest knowledge on HIV and other issues every day. It is important to accumulate and convey such knowledge (including information such as where they can get a HIV testing etc.) to the seamen to help them hedge health risks in advance. We hope to regularly hold lectures for seamen perhaps once or twice a month.” San Juan / Senior Resident Physician 　“The most frequent surgical operation done on seamen is the surgery for gallstone removal. Currently the procedure can be performed using an endoscope, so it is of smaller burden on the patient’ s body, and they can leave the hospital in 24 hours after the operation. Unsurprisingly, the seamen’ s diet is not well balanced on board a ship, with limited intake of fresh vegetables and increased intake of meat, beer and salt, which are factors that can induce the formation of gallstones and kidney stones. (Seamen are) in need of counseling on various aspects of health including self management of physical conditions and dietary habits. We hope to increase that kind of opportunities.” 　“We always need to continuously update our facilities. The ultrasonic scanners to start with, but facilities need to be updated and upgraded in all our departments. Right now, (we don’ t have enough ultrasonic scanners and expecting mothers) are waiting to get a checkup. Some people can’ t even get treated because they have to wait for sonography. People have to make an appointment one week in advance to get an ultrasonic examination.”

Not only the AMOSUP Seamen’ s Hospital but many other public hospitals are also suffering from insufficient capacity and facilities. Are there any measures that could be taken to mitigate the situation? Flordeliza / Chief Nurse 　 “Many inpatients are here for surgical operations. We have introduced endoscopic operations 4 years ago, which has greatly contributed to reducing patients’ stay at the hospital. If (surgical operation techniques could be improved) in all departments, I think that would help a lot (in mitigating patient congestion).”

Flordeliza / Chief Nurse

San Juan / Senior Resident Physician

　“From the standpoint of a nurse, it is important to maintain the system going. There are many sick patients in Philippine and there are not enough nurses to take care of these people. In some hospitals, even though there are sufficient nurses, they go home right away when their duty is over. But here, at AMOSUP Seamen’ s Hospital, we have a system in place to divert (people) from other sections when a section runs short of staff. I think it is very important to maintain this kind of system (for facilitating the operation of the hospital).” 　 “I also hope that this hospital would become bigger in size. It wasn’ t this crowded before, but recently the number of member seamen has increased so much, the hospital is always full of patients. The

　 “The best thing we could do is to enhance training for both doctors and nurses so that medical procedures can be carried out more quickly, which will help (mitigate the congestion). Patients come from Cebu Island (to AMOSUP Seamen’ s Hospital Manila), due to various reasons including the lack of medical facilities in Cebu. It’ s always crowded during the evening hours. Some of the facilities that we have, like the MRI, is only available here (at the Manila hospital), which is another reason that we are attracting so many patients. So, it’ s really important that we speed up the procedures by upgrading our skills through training.”

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【SPECIAL ISSUE】

Key Person Interview Conrad F. Oca, President of AMOSUP

“Insurance coverage for healthcare provided outside of Seamen’ s Hospital through collaboration with insurance companies” “Partnering with existing hospitals in Dagupan City, launch of local satellite clinic pilot project”Aggressive activities to diversify and enhance services for seamen and their family 　 “If healthcare and welfare were enhanced to protect seamen’ s and their family’ s health, the seamen could commit themselves to work with peace of mind, which in turn would contribute to the development of Philippine economy.” 　Dr. Conrad F. Oca, President of AMOSUP, explained the purpose of why AMOSUP, a seamen’ s labor union, should operate hospitals for seamen and their family. Moreover, Dr. Oca doesn’ t forget to pay respect to retired seamen who have contributed to Philippine and seamen society over many years. “We also operate an action slip system to retired seamen. We issue a treatment slip for individual retired seamen upon application, so that they can receive care at the Seamen’ s Hospital. Those seamen who have worked over 20 or 30 years are eligible for this service. This is part of our efforts to enhance seamen’ s welfare.” 　President Oca’ s perspective goes even further. He aims to launch additional projects to aggressively diversify services and enhance the healthcare and welfare of seamen.

Specifically speaking: ⑴ AMOSUP plans to provide insurance coverage up to 20,000 peso per year for healthcare provided to member seamen and their family outside of the Seamen’ s Hospital through collaboration with insurance companies. AMOSUP will pay the insurance fees to the insurance company on behalf of its ; ⑵ The“satellite clinic project”aims to provide healthcare to seamen and their family who have difficulty in visiting the Seamen’ s Hospital because they live in areas far away from Manila such as the northern part of Luzon Island. AMOSUP and existing general hospitals in these areas will form partnerships to provide healthcare to seamen and their family who live in these areas. These two projects have already started. Specifically, a satellite clinic pilot project has already been launched in Dagupan City since February 2013. After one year of pilot operation, in February 2014, AMOSUP will consider expanding this project to other areas of the Philippines based on the outcomes of the pilot project. 　The following is an interview with AMOSUP

President, Dr. Conrad F. Oca, who is committed to improving the working environment and welfare of Philippine seamen, following his father’ s will to“enhance healthcare for seamen, regarding the future prospects of the Seamen’ s Hospital.”

First, could you tell us about the history of AMOSUP Seamen’ s Hospital? 　 “At first, AMOSUP established a clinic, the Roberto S. Oca Workers Clinic (RSOWC) in South Harbor, Manila’ s port area, in June 1978. In honor of Roberto S. Oca, (Philippine trade union leader and elder brother of the late Captain Oca (Gregorio S. Oca, founder and former President of AMOSUP) and uncle of current AMOSUP President, Dr. Conrad F). Oca. That was the start of our Seamen’ s Hospital. At that time, RSOWC was a small outpatient clinic with only 5 to 6 beds. In February 1980, the clinic expanded into a general hospital with 50 beds. In addition to the existing internal medicine, dentistry and laboratory (for research and examination) de-


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partments, the hospital newly established surgery, obstetrics and gynecology departments and an intensive care unit (ICU). It was certified as a Tertiary Level (highest rank) general hospital by the Philippine government. 　With the increase of AMOSUP member seamen, however, the number of patients eventually increased to a point that the existing capacity became insufficient to accommodate the patients. AMOSUP constructed a new hospital with over 100 beds at Cabildo Corner, San Jose Street in Intramuros (construction was started in June 1985) and the Seamen’ s Hospital was relocated to its current location in February 1987. However, only the AMOSUP living near Manila (on Luzon Island) can come to the hospital. Therefore we decided that seamen’s hospitals need to be built on Visayan and Mindanao Islands, too, where many seamen’ s homes are. Thus additional Seamen’ s Hospitals were established in Cebu (April 1997), Iloilo (June 2005) and Davao (August 2008).

As a labor union, why did AMOSUP decide to build and operate a hospital by itself? What was the momentum behind the decision? 　“At the time (our hospital was first established 1978), the Philippines did not have an adequate social security system, although I must say it still doesn’ t. It was difficult for common people to get medical care on their own (since that time,) because people had to pay the entire cost for the care, which was very expensive. Seamen (were employed for fixed , and) during periods that they could not get a job on board a ship, any money they earned was used up for living expenses and could not afford to pay for healthcare expenses. Deeply concerned about this situation, Captain Oca (Former President of AMOSUP) tried to improve the situation by creating a hospital in the port area for seamen and their family. So that was the starting point of our hospitals.”

What is the significance or purpose for AMOSUP to build and operate the Seamen’ s Hospital by itself? 　 “One key point is that medical cost is very expensive in the Philippines. To give an example, if a person is employed by a company and that company has a health insurance policy, then the employee will be covered to a certain extent by health insurance, but if he is employed by a company without any health insurance, then he must pay for all the medical expenses by himself. While this is not a problem limited to seamen, if seamen and their family’ s health are protected with decent healthcare and welfare systems, Philippine seamen could commit themselves to work in peace of mind, which in turn would contribute to the development of Philippine economy.” 　“We also have a special action slip system to provide service to retired seamen. In principle, AMOSUP Seamen’ s Hospital only provides (free) healthcare to incumbent . However, there are cases where retired seamen are not paying for social security fees and cannot get medical care. These retired seamen may be in need of care because they have hypertension or perhaps because their family member needs operation. In such cases, we issue a treatment slip, a pink-colored slip card, upon application (and review,) to allow these people to receive treatment at AMOSUP Seamen’ s Hospital. I’ ll accept and review the applications. Those retired seamen who have contributed as AMOSUP over extended years are eligible for this system. If it is really necessary, not only incumbent AMOSUP but also other people including AMOSUP employees and their family can receive treatment by making applications. People who make use of this pink slip are increasing in recently. Those seamen who have worked over 20 or 30 years are eligible for this service. This is part of our efforts to enhance seamen’ s welfare.”

AMOSUP Seamen’ s Hospital is a wonderful endeavor and an extremely important facility for promoting the health and welfare of seamen. However, what do you think is necessary to make it an even better hospital than it is now? 　“The (four) AMOSUP Seamen’ s Hospitals are all general hospitals but not all areas of health treatment are covered in all four hospitals. For example, one of our hospitals has a gastric camera, but it doesn’ t have endoscopy equipment to remove gall stones. In such cases, that hospital has to refer its

Assumed the position of Hospital director of Manila before assuming the position of the president of AMOSUP

patients to another hospital (for endoscopic operation). In such cases, the seaman used to be required to pay by himself (for the endoscopic operation), but we now have introduced a new insurance system. AMOSUP has entered collaboration with an external insurance company to provide supplemental coverage for healthcare cost of up to 20,000 peso (approximately 46,000 yen) per seafarer and his family per year. AMOSUP has now built a nation wide network with insurance companies to cover (the expenses of healthcare provided to member seamen and their family outside of the Seamen’ s Hospitals). AMOSUP pays the insurance fees to the insurance company on behalf of its .” 　 “Another new project is being implemented right now. There are currently four AMOSUP Seamen’ s Hospitals (Manila, Cebu, Iloilo, Davao) in the Philippines. Among these four areas, Luzon Island, particularly the area around Manila, supplies the largest number of seamen. Approximately 40% of the 95,000 AMOSUP live in the area around Manila and other places of Luzon Island. Hospitals at Iloilo and Cebu cover the seamen in the Visayan Islands and the hospital at Davao covers those in Mindanao. While there are many member seamen who live in the northern parts of Luzon Island (as well as the area around Manila), it is difficult for them to visit the hospital in Manila because it’ s too distant. Therefore we have launched a pilot project for establishing a satellite clinic in Dagupan City. This is a project to form a partnership with an existing large hospital (in Dagupan City) so that seamen and their family who live in these areas can receive healthcare for free at this partner hospital. Member seamen and their family can receive surgical operations and be itted to this hospital if they wish. Depending on the outcomes of this pilot project, which has started in February 2013, we may expand it across the Philippines. After one year of pilot operation, AMOSUP will decide whether to expand it or

not, based on (’ ) needs and benefits. Dagupan City is the first site for trying out this satellite clinic system. It will make it easier for us to spread the system to other cities if it turns out to be successful in Dagupan. At present, the patients must travel over (to distant AMOSUP Seamen’ s Hospitals), but this project aims to bring healthcare closer (to where the patients live). At this point, we do not have a clear image or target as to how many (satellite clinics) will be established in the future. All I can say right now is that the target will be just as much as is necessary for AMOSUP . Right now, we have the four AMOSUP Seamen’ s Hospitals located in Manila, Cebu, Iloilo and Davao, as well as a new satellite clinic in Dagupan City. There are many more remote areas, for example Bohol Island, where a number of member seamen live. We will establish satellite clinics in areas (where many seamen live but) without sufficient access to healthcare.”

Dr. Conrad F. Oca 　Born in June 1963 and aged 50 years old. He assumed the role of AMOSUP President in November 2010, upon the death of his father, Gregorio S. Oca (Captain Oca), who was the founder and former president of AMOSUP. He himself is a licensed medical doctor who studied in the University of the East Ramon Magsaysay Memorial Medical Center (UERMMMC). He used to serve as the hospital director of AMOSUP Seamen’ s Hospital Manila prior to becoming the AMOSUP President. While he was a medical student at UERMMMC he used to be fellow students with Dr. Teodosio F. Alcantara and Dr. Richard John C. Pecson, the directors of AMOSUP Seamen’ s Hospital Cebu and Davao, respectively.

≪ Spotlight ≫ 　Among the 150 doctors that work at AMOSUP Seamen’ 　 s Hospital Manila night and day, there is one Japanese doctor. His name is Shoei Yoshida, a 37 year-old, quarter Japanese-Filipino born in August 1976. He is a true multi-lingual who speaks native Japanese, English and Tagalog because he“spent 5 years in Japan during elementary school and went to a junior high for Japanese students in Manila.” 　He is undergoing specialization training (specialized clinical training course) at AMOSUP Seamen’ s Hospital Manila to become a specialist doctor in family medicine (comparable to a“general physician”in Japan) with an aspiration to “become a doctor who s community healthcare.”He will complete his 4-year family medicine training in April 2014 and make it as a specialist doctor.“I visit the Japanese Association Manila Medical Clinic (operated by the Japan Overseas Medical Fund) in Makati 2 to 3 times a week to see Japanese patients”said Dr. Yoshida. He takes care of not only Philippine seamen but Japanese residents in Dr.Yoshida/Family Doctor the area, too.

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【SPECIAL ISSUE】

AMOSUP SEAMEN’ S HOSPITAL CEBU

The first seamen’ s hospital to be built outside of Manila (opened in April 1997) Responding to high healthcare demand in an area supplying a vast number of seamen of seamen, which stands adjacent to the hospital. The hospital stands on a premise of 2,517㎡ and has a floor area of 3,534 ㎡ (1st floor 1,504㎡, 2nd floor 1,015㎡, and 3rd floor 1,015㎡ ), a standard size among the four AMOSUP Seamen’ s Hospitals. 　The total number of staff is 166, of which 106 are medical staff and 60 are non-medical staff. Break down of the medical staff is: 19 consultant doctors, 2 resident doctors, 9 family medicine physicians, 4 dentists, 5 radiation technologists, 12 pathology researchers and technicians and 55 full time nurses. Nonmedical staff include AMOSUP Seamen's Hospital Cebu 15 staff in 　Cebu is the second largest city in the Philippines, the istrative, ing and human resource located 600 km south of Manila, the capital. It can sections, 3 pharmacists, 5 staff for medibe reached by a one-hour flight from Ninoy Aquino cal records management, 9 dietary (health manageInternational Airport. The Mactan-Cebu Internationment) managers, and 1 dental assistant. There are al Airport is located in Lapu-Lapu City on Mactan also employees in charge of the adjacent AMOSUP Island, off the coast of Cebu Island. Lapu-Lapu City Sailor’ s Home Cebu/Sports Complex, engineers and and Cebu City are connected with two bridges, so staff who do maintenance works, AMOit’ s only a 30 minutes’drive from the airport to the SUP employees managing the pension fund, etc. center of Cebu City. In the Southern Visayan region and store staff of“Slop Chest,”a mini supermarket of central Philippines, Cebu City and Lapu-Lapu located within the facility. City, together with 6 other neighboring cities includ　Outpatients are accepted from 8:00 to 17:00 on ing Mandaue, Toledo and Talisay form the Metro Monday through Friday and just during the mornCebu megacity area with a population of about 2.5 ing on Saturdays. The work hours for the ismillion, second largest to Manila. It is a beach resort trative section are the same. However, doctors are area and a popular destination for Japanese honeyon call around the clock and so are the nurses on mooners, so the name Cebu is familiar to Japanese three shifts (7:00-15:00, 15:00-23:00, 23:00-7:00). The people, too. hospital has 60 beds for inpatients. 　The area was conquered in 1565 by Miguel López de Legazpi, the first Governor General of the SpanOver 200 outpatients a day and 900 ish Colony. Cebu was the first Spanish colonial city operations a year established in the Philippines, even older than Ma(including child delivery) nila. Cebu was the capital of the Spanish colony for 64-slice CT scanner transferred from the 6 years until Manila was colonized in 1571. PerSeamen’ s Hospital Manila haps it is the legacy of the long colonial history that the people of Cebu are particularly devout Roman 　Medical departments of AMOSUP Seamen’ s Catholics among the people of the Philippines where Hospital Cebu include general internal medicine, Christians for 90% of the population. You general surgery, obstetrics and gynecology, ophthalwill find numerous Roman Catholic churches on the mology and otorhinolaryngology, pediatrics, patholstreets of Cebu, which is not only the hub of comogy/medical examination, anesthesia, radiology, outmerce, trade and industries but also the center of patients and emergency medicine, general dentistry, culture and religion in central Philippines from the pharmacy, and family medicine (first visit/general Visayan to Southern Mindanao region. practice). In addition, it also offers dietary (health 　AMOSUP established the Seamen’ s Hospital management) counseling, emergency services as a Cebu in April 1997 (construction commenced in general hospital. The average number of outpatients July 1994). It was the first seamen’ s hospital to be visiting the hospital per day is approximately 200 built outside of Manila (Seamen’ s Hospital Manila with 30/day at the dentist and 150-180/day for the was first built in 1978). The central Philippines rest of the departments. The average number of inincluding Cebu is a massive labor pool of seamen patients is about 20/week and average stay of inpasupplying approximately 15,000 AMOSUP memtients is 4.6 days/patient. Operations are in principle ber seamen and an area with extremely high deconducted twice a day and 3-4 cases per day. 613 mand for the welfare and healthcare of seamen surgical operations were conducted in 2012 and 250 and their family. We visited AMOSUP Seamen’ s child deliveries take place annually, totaling around Hospital Cebu which treats over 200 outpatients ev900 operations a year. ery day. 　Characteristic with regard to equipment and facility is that it is equipped with a CT scanner and

Overview of the facility Over 100 medical staff including doctors, nurses and medical employees Total floor area 3,500 ㎡　 Number of beds 60　 Round-the-clock operation 　AMOSUP Seamen’ s Hospital Cebu is located on Camino Vicinal Street, Umapad in Mandaue City which is north-east to Cebu City in Southern Visayan Region of central Philippines. It is 4 km, a 10 minutes drive from Mactan-Cebu Airport. It was opened in April 1997 (construction commenced in July 1994), second oldest to AMOSUP Seamen’ s Hospital Manila, and the first seamen’ s hospital built outside of Manila. The total floor area is 9,051㎡ when combined with AMOSUP Sailor’ s Home Cebu, AMOSUP’ s accommodation facility for the welfare

Opened in April, 1997

a mammography device that are not introduced at the Seamen’ s Hospitals in Davao and Iloilo. The single slice CT scanner that was introduced in 2005 was replaced in October 2013 with a Japanesemade 64-slice scanner that had been used at AMOSUP Seamen’ s Hospital Manila. However, Seamen’ s Hospital Cebu does not have a magnetic resonance imaging (MRI) scanner, (which can only be found at Seamen’ s Hospital Manila). 　AMOSUP Seamen’ s Hospital Cebu has been certified as the Secondary Level general hospital (as it includes all departments except rehabilitation) by (the Department of Health (DOH) of) the Philippine government, and therefore is qualified to accept internship students. Graduates of medical graduate schools (4-year graduate course specializing in medicine after finishing a regular four-year college) must undergo a“post graduate internship (PGI)” before they can take the national exam for medical practitioners. Since three years ago, Seamen’ s Hospital Cebu has been accepting 3 to 4 trainees a year (mainly in family medicine), including PGI trainees as well as specialist residency trainees who are being trained to become a specialist doctor through a 3 to 4 year residency after acquiring a medical license (the period depends on the specializing department). 　Like the other AMOSUP Seamen’ s Hospitals, Seamen’ s Hospital Cebu, in principle, offers care to only AMOSUP and their family . Emergency patients, however, are accepted 24 hours 365 days. Care provided to emergency patients that are not an AMOSUP member is limited to emergency treatment, and they will be transferred to a nearby private or public hospital when their conditions become stable. All AMOSUP and their family can receive all treatment for free including the prescribed drugs. This free-of-charge healthcare service covers the member seaman himself, his parents and brothers/sisters aged 18 or below and unmarried in the case when the member seaman is not married, and the seaman himself, his spouse and his children aged 18 or below in the case when the member seaman is married. Patients are required to show their AMOSUP

Cebu

ID card and seamen’ s booklet for member seamen himself, and a dependent’ s ID and latest payment slip for family , in order to receive healthcare for free. 　The hospital is a three-story building with an open ceiling space at the center of the building. The outpatient departments are arranged on the first floor. Upon entering the entrance, you see in anti-clockwise order from the right, the pharmacy, pay desk, pediatrics, surgery, internal medicine, emergency room, laboratory, ophthalmology and otorhinolaryngology, radiology, obstetrics and gynecology, dietary (physical condition) counseling room, and then the staff cafeteria and istration office. The radiology department is equipped with a Japanese-made 64-slice CT scanner, which was transferred from the Seamen’ s Hospital Manila in October 2013, X-ray scanner, portable X-ray scanner, mammography scanner and ultrasonic devices. On the second floor are the operation room, labor and delivery rooms, recovery room (for post-operation recovery) and a nurse station as well as the female ward. The family medicine (general practice) department, pediatrics ward, male ward, isolation rooms, a conference room, intensive care unit (ICU) and a chapel are arranged on the third floor. The elevator used within the hospital has been donated by a Dutch maritime transport operator, Stolt-Nielsen Limited.


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interview−

Hospital staff interview

“The important thing is that each member of the hospital staff from top to bottom thinks what needs to be done” 　Ms. Lingaro, the ward supervisor at AMOSUP Seamen’ s Hospital Cebu, who manages the nurses

and other hospital staff, pointed out that, in addition to upgrading the medical facilities of the hospital, “each member (of the hospital staff) from the top management to ordinary workers should think what needs to be done to make (the hospital) better.”She thinks that it is important that everyone working at the medical front maintains their motivation to continue to improve in their own area of assignment. Below are our interviews with two nurse leaders of AMOSUP Seamen’ s Hospital Cebu. Jubeth Palmas S. Lingaro, RN, MAN / ICU − Ward Supervisor 　“I ed this hospital in November 1999, ever since, I have worked here for over 14 years. (The biggest characteristic of this hospital is that) all the doctors and staff are such nice people, not to mention that many of them are specialists with sophisticated expertise in their own field. Among the many hospitals in the Philippines, Seamen’ s Hospital Cebu is equipped with a variety of good facilities. The nurses are committed to training and improving skills. (I’ m in a position) to manage (nurses), and I think that the nurses and other staff are all capable

Lingaro/Supervisor, Agustin/Head Nurse

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of taking good communication with the patients. Whenever a problem arises, we discuss it among the staff to find a solution. That’ s one of the main roles (as a ward supervisor.)” 　“(In order to make this hospital even better) in addition to upgrading the medical facilities of the hospital, each member (of the hospital staff) from top to bottom should think what needs to be done for improvement.” Jussary C. Agustin / OPD-ER Head Nurse 　 “(My responsibilities are) to ensure that the nurses and the equipment that they use are all in good condition. It includes both desk work and (on-site) supervision. I prepare documents at the istrative office and also go round all the sections of the hospital to make sure that everything is operating smoothly.” 　“(The good thing about this hospital is) that it provides such valuable benefit to seamen and their family. I think it’ s a really good thing that seamen and their family can receive healthcare free of charge.” 　 “(To make this hospital even better…,) we already have quite a solid lineup of facilities, but I think we could do better, for example, (if we had) a MRI scanner (like the one they have in Manila).”

AMOSUP Seamen’ s Hospital Cebu Medical Director / Interview TEODOSIO F. ALCANTRA MD, MBA, FPPS

“Maintains an advanced management system that has been certified by the Philippine government and ISO by Det Norske Veritas (a Norwegian classification society)” LEE JOSEPH Y. GONZALES　MAHAd　

“Our ultimate goal is to reduce the number of our patients by making everyone healthy” 　Dr. Alcantra was born in Manila in January 1966 and aged 47. He also serves as the manager of the AMOSUP Sailor’ s Home Cebu, an accommodation facility for the welfare of seamen, adjacent to the hospital. He studied in the University of the East Ramon M　agsaysay Memorial Medical Center (UERMMMC) during 1987 to 1992, where he was a fellow student and a good friend of the current AMOSUP President, Dr, Conrad F. Oca. In 2002, he came to Cebu as a pediatric doctor. He became a doctor because he“wanted to save the lives of small children.”Not only Dr. Alcantra but Dr. Richard C. Pecson, Director of AMOSUP Seamen’ s Hospital Davao, was also President Oca’ s fellow student at UERMMMC. 　Mr. Gonzales, Hospital , was born in March 1972 and aged 41. He was born and raised in Cebu, and he has been working as istrative staff at AMOSUP Seamen’ s Hospital Cebu since the preparation stage before it opened. He is also the of AMOSUP Sports Complex and Co of the Sailor’ s Home. 　Dr. Alcantra pointed out as one of the characteristics of AMOSUP Seamen’ s Hospital Cebu, that“it maintains an advanced management system that has been accredited by the Philippine government

Placed Maria on hospital property

(PhilHealth) and Det Norske Veritas (a Norwegian classification society).”Meanwhile, Mr. Gonzales commented that“we want to enhance health programs for member seamen and their family through collaboration between the hospital and its adjacent Sports Complex, because after all, our ultimate goal is to reduce the number of our patients by making everyone healthy.” 　Below are our interviews with these two men

who watch over of the health of Philippine seamen ing the safe operation of Japanese merchant fleets, through the operation of the hospital in central Philippine Cebu.

What are the characteristics of AMOSUP Seamen’ s Hospital Cebu? Dr. Alcantra / Hospital Director

Gonzales/Executive Secretary, Alcantra/Hospital Director

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Newborn Intensive Care Unit

　“We have been certified as a Secondary Level hospital by the Philippine government (Department of Health). In addition, we have also been certified to ISO’ s management system standards (ISO9001: 2008) by Det Norske Veritas AS (a Norwegian classification society). These can be pointed out as our characteristics. We obtained certification from DNV in July 2010, not just for Seamen’ s Hospital Cebu, but for the whole AMOSUP Seamen’ s Hospital organization including Manila, Iloilo and

Wait for their initial consultation

Cebu. This means that if there is one hospital that does not meet the standards, all the rest of the hospitals could not be qualified for the certification. So we’ re always (managing the hospital) with a sense of tension. All the four AMOSUP Seamen’ s Hospitals (including Manila, Cebu, Iloilo and Davao) use the same management system. DNV certified us based on the recognition that the Seamen’ s Hospital is a maritime organization, too.” 　“Needless to say, we are subject to PhilHealth (national health insurance system of the Philippines). But PhilHealth only covers 25-30% of the medical costs and the remaining 70% or more must be borne by the patients. At the Seamen’ s Hospital, however, all member seamen and their family can receive healthcare for free. That’ s another distinct characteristic. (The costs) covered by PhilHealth can be appropriated to doctor fees, so we can enhance hospital operations.” 　“Government certification for PhilHealth is renewed every year, so we must undergo screening

Built in open ceiling structure

and review each year (to check whether we meet certain standards as a facility subject to PhilHealth). Seamen’ s Hospital Cebu is classified as a Secondary Level hospital (among the three-tiered government classification system). (One of the key criteria to become a Secondary Level) hospital is whether there is an intensive Care Unit (or not). (And Cebu has it.) To become a Tertiary Level (highest rank) hospital, you must have a rehabilitation department, but at present, only Manila has this department among the four AMOSUP Seamen’ s Hospitals, and that’ s why Manila is the only one classified as Tertiary Level. While DNV certifies all (the d AMOSUP Seamen’ s Hospitals) as one organization, (government certification for) PhilHealth is obtained on an individual hospital basis.” This hospital is playing an important role in enhancing the welfare and healthcare of seamen. What do you think is necessary to further improve this hospital? Mr. Gonzales / istrative Director 　“Medical technologies are constantly advancing. A 64 slice CT scanner arrived at this hospital in October (2013). Before this scanner arrived, which had been used at Seamen’ s Hospital Manila since 2007, we have been using a rather conventional single slice scanner since 2005. It is essential to continue upgrading our medical facilities in order to provide high quality care. For example, the video scope that we currently use for surgical operations is a digital device with good resolution. There are 3D equipments available for surgical operations now. Technology is constantly evolving and we would like to keep up with that progress, but obviously, we have (budgetary) constraints.” 　“We are running family health programs in collaboration with the Sailors’Home Cebu and Sports Complex, including programs for children, wives and the seamen himself. We provide basketball classes (capacity of 80 participants) and swimming classes (capacity of 180 participants) (at the Sports Complex). We also have cooking classes for housewives and seminars for healthy cooking instructed by the hospital’ s dietician. These programs are designed to

CT Scan 64 Slice, transferred from Hospital Manila

Nurse station

3 Units in dentistry

Pediatric ward

promote health communication within the family. If the whole family including the children can attend our programs together, (family ) would become more aware of each other’ s health conditions, which would be most effective in promoting health. We are advantageous in that we have the Seamen’ s Hospital, the Sports Complex, kids’room, and accommodation facility (Sailors’Home) all together on one premise, as well as a variety of health building facilities and equipment. We want to further enhance health programs so that everyone in the family can become healthy. After all, our ultimate goal is to reduce the number of our patients by making everyone healthy.”

DNV Business Assurance Management System Certificate

PhilHealth Certificate for Philippines health insurance


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AMOSUP SEAMEN’ S HOSPITAL ILOILO AMOSUP Seamen's Hospital Iloilo

Opened in June 2005, to the health and healthcare of seamen and their family in the Western Visayan region of central Philippines, the second largest supply area of Philippine seamen 　500 km south, about an hour’ s flight from the capital Manila, Iloilo is located on the southern coast of Panay Island in the West Visayan region of central Philippines. Its state capital, Iloilo City has a population of approximately 420 thousand (as of 2007), the 9th largest city in the Philippines. More of the lush green is left unspoiled in this city compared to larger cities like Manila, Cebu and Davao. The local government unit for providing public services is based in Metro Iloilo encoming five surrounding towns (Leganes, Oton, Pavia, Santa Barbara, and San Miguel as well as Iloilo City,) which together has a population of 650 thousand. The state of Iloilo has a population of 1,560 thousand. Metro Iloilo is positioned as the political and economic center of the Western Visayan region of central Philippines. It is also known as a center of education and culture, with a branch campus of University of the Philippines (UP), the top ranking University in the Philippines, and five other prestige universities. The people in this area are said to be well educated and have a relevantly higher command of English compared to other areas of the Philippines. This may be one of the reasons why this area provides abundant seamen who are qualified to work in the international arena. This area has achieved significant economic growth in recent years driven by the rapidly growing construction demand in the Philippines. High-rise buildings are gradually increasing in this area, too. 　Iloilo is an important supply base of international seamen and home to the second largest number of AMOSUP next to Manila. AMOSUP Seamen’ s Hospital Iloilo is located on the site of an old private residence on Onate Street, Mandurriao, Iloilo City, a 20 minutes drive (14 km) from Iloilo Airport. It was opened in June 2005 (construction began in

February, 2004) to the health and healthcare of seamen and their family in the West Visayan region of central Philippines, covering from Iloilo, Antique, Capiz and Aklan states on Panay Island to Bacolod City on Negros Island and Guimaras Island. The hospital has an annual consultation of more than 27,600, which means an average of more than 100 consultations a day. We visited AMOSUP Seamen’ s Hospital Iloilo striving to respond to a sharp increase in healthcare demand.

Overview of the facility Purchased and rebuilt an old private residence into a hospital Total site area 2,750 ㎡ Compact in size compared to other AMOSUP Seamen’s Hospitals 24 doctors; 35 nurses; 45 beds 　AMOSUP Seamen’ s Hospital Iloilo is located on Onate Street, Mandurriao, Iloilo City, the state capital of Iloilo on the southern coast of Panay Island in the Western Visayan region of central Philippines. It is about a 20 minutes drive from Iloilo Airport, which is 450km south, an hour’ s flight from Manila Airport. AMOSUP purchased a property that used to be a private residence and rebuilt the existing building into a hospital. The site area is 2,750㎡ relatively compact in size compared to other AMOSUP Seamen’ s Hospitals. The building is three stories high and has a floor area of 2,655㎡ . 　There are 9 full time doctors, 13 consultants, and 2 dentists, a total of 24 medical doctors working at the hospital. Other medical staff includes 35 nurses, 2 surgical assistants, 1 dental assistant, 8 pathological laboratory staff, 2 radiological technologists, 2 health examiners and 4 pharmacists. In addition, there are 10 istrative staff and 9 staff in charge of maintenance of the building. Outpatients visit the hospital during 8:00-17:00 on Mondays to Fridays and 8:00-12:00 on Saturdays. The total number of beds in the wards is 45, with 8 to 10 beds on each floor and some other in the intensive care unit (ICU), isolation room and operation waiting room.

Hospital Iloilo include general surgery, general pediatrics, anesthesia, internal medicine, cardiac surgery, dermatology, obstetrics and gynecology, ophthalmology and otorhinolaryngology, pathology/medical examination, general dentistry, radiology, psychological counseling, dietary (health management), pharmacy, and emergency medicine. It is the largest general hospital in the area, but it does not have a family medicine department (comparable to a“first visit department”or“general physician”in Japan). An array of medical equipment, including the treatment equipment in the general dentistry department, the X-ray machine in the radiology department, and the blood testing equipment in the pathology/medical examination department, have been donated from All Japan Seamen's Union, as with the Seamen’ s Hospital Davao. 　Usage data of Seamen’ s Hospital Iloilo for 2012 was: number of total annual outpatients 27,632 (daily average 103.63 patients/day); number of itted inpatients 1,322 (daily average of 3.63 patients/day); number of discharged inpatients 1,289; number of annual patients at the dentist’ s (including checkups) 5,498 (daily average 17.45 patients/day); number of annual patients at the radiologist’ s 3,782 (daily average 10.36 patients/day); number of annual patients at the pathological examination department 13,141 (daily average 31.57 patients/day); number of annual surgical operations 606 (surgical operations are conducted on Mondays and Thursdays); number of child delivery 236. Usage rate of the Seamen’ s Hospital is very high relative to the population of Iloilo City, suggesting that the healthcare demand is particularly high among seamen and their family. 　As with the other Seamen’ s Hospitals, Seamen’ s Hospital Iloilo offers care exclusively to AMOSUP and their family . Emergency

General hospital with 28,000 annual patients Surgical operations on Mondays and Thursdays, over 600 operations a year Dental treatment equipment, X-ray machine, blood testing equipment, etc. donated from All Japan Seamen's Union Hospital with abundant nature

　Medical departments of AMOSUP Seamen’ s

Genaral hospital in neighboring hospitals

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patients, however, are accepted 24 hours, 365 days. Care provided to emergency patients that are not an AMOSUP member is limited to emergency treatment, and they will be transferred to a nearby private or public hospital when their conditions become stable. All AMOSUP and their family can receive all treatment for free including the prescribed drugs. This free-of-charge healthcare service covers the member seaman himself, his parents and brothers/sisters aged 18 or below and unmarried in the case when the member seaman is not married, and the seaman himself, his spouse and his children aged 18 or below in the case when the member seaman is married. 　When you walk through the entrance of the hospital on the first floor, you will see a large waiting room and a reception desk on the right and a pharmacy on the left. Further left is the general outpatient section where patients are asked to measure their temperature, etc. The emergency room, pathology and blood testing laboratory, dentists’ , X-ray room and the staff dining room are allocated on the first floor. On the second floor are the female ward, obstetrics and gynecology ward, two operation rooms, labor and delivery room, recovery room, ICU, doctors’waiting room and the nurse station. On the third floor are the pediatrics department, isolation room, male ward, nurse station and the istration office. The internal structure of the hospital is very much similar to that of the Seamen’ s Hospital Davao. In addition, opinions of Dr. Ryan Ed S. Comuelo, the hospital director, have been reflected upon building the hospital. 　We happened to visit the hospital on Saturday morning, when the waiting lounge was very crowded with many outpatients. There were particularly many children from babies and infants to elementary school children waiting for their turn, which left a strong impression on my mind.

Waiting room

Blood and pathological examination machine. Donated by JSU

3 Units in dentistry, donated by JSU

X-ray tomography machine, donated by JSU

interview−

trainer there.” Nerissa T. Celiz, RN/ Supervisor (Critical Area)

Hospital staff interview 　All the nurses of AMOSUP Seamen’ s Hospital Iloilo uniformly noted insufficient capacity and the need to enhance the medical facilities of the hospital. Although the medical facilities of AMOSUP Seamen’ s Hospital Iloilo is much better than nearby public and private hospitals, further enhancement of the facilities is a pressing issue, given the surging demand for healthcare and the numerous patients that come flocking to the hospital every day. While the AMOSUP Seamen’ s Hospitals in the other areas have welfare facilities for accommodation and sports activities established on the same premise, Seamen’ s Hospital Iloilo does not have any of those adjunct facilities due to space constraints. We interviewed three nurses, the chief nursing officer, the assistant chief nurse, and the supervisor. All three of them said they were familiar with how seamen feel and think, because they have a father, husband or a brother, who is a sailor. Romelyn P. Matutina, RN. MAN/ OIC, Chief Nursing Officer 　“(I) have two elder brothers and they are both seamen. As a matter of fact, my eldest brother is an AMOSUP member. So I know a little about seamen. (I am positioned) above the supervisor to manage all the nurses. For example, I pay attention to where they are working or whether they are insufficiently allocated. It has been four and a half years since I ed this hospital. I used to work in a private hospital (as a nurse), but now I am on the manage-

ment side and my responsibilities have changed from when I was an ordinary nurse. It is hard to say which is better, but one thing I can say is that (AMOSUP Seamen’ s Hospital) provides better service to the patients, which (I am) very proud of. We sometimes ran out of medicine and other stock at the hospital I used to work for before, but that never happens here.” 　 “Ten years from now? … (I)’ d like to study about management and set up a research department (in the hospital). I’ d also like to see a training center for nurses. That would help us provide better healthcare.”

　 “My husband is a seaman. I’ ve been working here since 2007. (My responsibility is) to monitor the nurses and their working conditions. Other than that, I also manage consumables and inventory of medical supplies. I think the working environment is much better here compared to the hospital I used to work for before.” “(Ten years from now) I hope the facilities and medical equipment of this hospital will be enhanced. I truly feel it’ s necessary to provide better healthcare. Particularly, I wish there’ s a mammography scanner because it is very important (for women’ s healthcare).”

Precious Anne Sencida / OIC, Assistant Chief Nursing Officer 　“I’ ve been working in this hospital since 2007. (My) father is a seaman, so I think I know how to communicate with seamen. This kind of a system (where and their family can receive healthcare free of charge) is something that cannot be found in other hospitals, and I think it is of a huge benefit to seamen.” “(Ten years from now) I wish there was a facility for training nurses in the hospital. (I) wish I could become a

Matutina/Chief Nurse, Sencida/Chief Nurse, Celiz/Supervisor


【SPECIAL ISSUE】

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AMOSUP SEAMEN’ S HOSPITAL ILOILO Interview with the hospital director and the istrative director (also subspecialty obstetrician-gynecologist)

“Lacking capacity to meet the surging healthcare demands”

Ryan Ed S. Comuelo, MD, FPALES, FPSGS / Hospital director 　　　　　　　　 Arnold P. Liwag, FPOGS, FSGOP / 　　　　　　　　　　　　　Obstetrician-gynecologist and istrative director 　Dr. Comuelo and Dr. Liwag were both born in 1967and are aged 46. Dr. Comuelo is a surgeon and Dr. Liwag an obstetrician-gynecologist. Dr. Comuelo came to know Dr. Conrad F. Oca, AMOSUP President, when he was an intern at the Cardinals Santos Medical Center (in Metro Manila, San Juan City). Dr. Comuelo became to be so deeply trusted by Dr. Oca that he was asked to become director of Seamen’ s Hospital Iloilo. Both Dr. Comuelo and Dr. Liwag, the medical and istrative directors of the hospital, pointed out“lack of capacity”as the most important issue concerning the hospital. Seamen’ s Hospital Iloilo cannot build additional welfare facilities for accommodation or sports activities, like the other AMOSUP Seamen’ s Hospitals do, due to its limited space. The Western Visayan region is the second largest supplier of seamen next to Manila, with accordingly high healthcare demand by seamen and their family . We interviewed the two directors seeking a solution to solve the conflict between surging seamen’ s needs and spatial constraints. What are the characteristics of AMOSUP Seamen’ s Hospital Iloilo? Dr. Comuelo / Hospital director 　 “This hospital is responsible for taking care of the seamen and their family who live in the entire Western Visayan region, covering not only Iloilo but also Capiz, Antique, and Aklan states (on Panay Island) as well as Bacolod City on Negros and Guimaras Island across the strait. Moreover, (the Visayan region is) home to the second largest number of AMOSUP next to Manila. The fact that there are five famous maritime schools in this region is one of the reasons why this area is a major supplier of (seamen). Over 27,000 consultations in the hospital in a year. There used to be more than 5,000 AMOSUP in this area as of 2005, but I suspect the number has grown to exceed 15,000 by now.” 　“Cebu is also an area with many (AMOSUP ). Seamen living in Mindanao go to either Seamen’ s Hospital Davao or Cebu. ( and their family) living in Cebu don’ t come here. Dr. Liwag / istrative director 　 “This area, Iloilo, used to be a quiet countryside, with no particular economic activity except agricul-

ture and fishery, but now, the number of seamen is growing rapidly. These seamen send money from overseas to their family in Iloilo, which is driving the area’ s economic growth. Even high-rise buildings are starting to be built in Iloilo City. I guess this region may be the second fastest growing region next to Manila. The foreign money sent from seamen working on the seas of the world is significantly contributing to the area’ s economic growth. (The main characteristic) of this hospital is that it is a hospital (situated in such a socio-economic setting.)” How do the member seamen and their family think about the hospital? Dr. Comuelo / Hospital director Liwag/Execcutive Secretary, Comuelo/Hospital Director “There are two public hospitals and four private hospitals in the area, but the cost of don’ t have MRI or CT scanners here. There are healthcare at these hospitals is very expensive. Almany AMOSUP seamen and their families living in though we have a national medical insurance system this region and accordingly we take care of many (Philhealth) in the Philippines, it only covers 20% of patients. Enhancement of the facilities is a pressing (the healthcare costs) so the remaining 80% must be issue. We have already proposed about it to Presipaid (out of the pockets of the patients). In addition, dent Oca. The proposal is under consideration, but drug costs are not even covered by insurance. Seathe problem is that we can not find an (appropriate) men get a relatively higher salary (than people in site.” other occupations in the Philippines,) nevertheless, “First of all, we need land to expand, for the sake (healthcare cost would still be a heavy burden) on of the member seamen. We would also like to build them if they had to go to a private hospital. That’ s recreation facilities such as a swimming pool and why (most seamen and their family ) come basketball courts (like other Seamen’ s Hospitals). here whenever they get sick, because (they can seamen in this area are longing for that ceive healthcare here free of charge).” kind of facilities. (Recreation facilities) will help pro　 mote exchange and communication with (employers Dr. Liwag / istrative director and shipping companies) by holding tournaments 　“Regardless of whether the hospital is public or and other events.” private, only 20% of the healthcare cost is covered 　“It would also be nice to have a“Slop Chest*” by the Philippine health insurance. However, we like they do in Cebu and Manila. They have a Slop provide healthcare to all AMOSUP free of Chest within the hospital at Cebu, and one within charge, including hospital ission fees and drug the same premise at Manila. We wish we had one costs.” (at Iloilo, too,) to further enhance the welfare of sea　“AMOSUP Seamen’ s Hospital is very highly men. At Slop Chests, you can buy the same goods recognized for its service quality. For example, a at much more reasonable price than at ordinary sucaptain of a ship gets good salary. He should have permarkets. Seamen are away from their homes for enough money to go to any private hospital if he extended periods from 6 to 9 months. During their wishes. But they all come here, because they trust voyage, there are times when they can’ t transfer us for our (medical quality). We are particularly money to their family in a timely manner. If there is highly regarded for our surgical operation facilia Slop Chest, it would be of great help at such times, ties. Sometimes, non- who heard about our because AMOSUP member seamen’ s family will be reputation come here and ask us to perform operaable to buy daily goods on deferred . There is tion on them. Of course, we have to decline these a particularly strong demand for a Slop Chest from requests.” seamen’ s family (,but we don’ t have the space to 　 “AMOSUP Seamen’ s Hospital is (highly respected) build one).” because everyone concerned, including Captain Oca and Dr. Conrad Oca (current President of AMOSUP), has always been committed to improving the welfare of seamen.” Yes, I can see that this is a very nice hospital. What do you think is necessary to further improve this hospital?

Female surgery ward

Maternity room

Dr. Comuelo / Hospital director 　 “We lack space in our OPD(relative to the number of patients). Daily outpatients exceed 100, but we do not have sufficient capacity to meet this demand.” That’ s why our outpatient department sometimes becomes so crowded Dr. Liwag / istrative director 　“(The premises adjacent to the hospital) are private properties and there is no way that we can (expand) the hospital. We really need to expand (our facilities) in order to provide sufficient healthcare service to member seamen. It may be possible to transfer (part of the functions of the hospital) to another location, but operation of separate facilities in distant sites would impose too much burden on the management side. Considering this, it is best to expand our facilities to premises adjacent to our present location, but (these premises are private properties) and there is little chance (that we may be able to acquire them). However, we have not given up the idea of expanding (the facilities). In addition, we

Diagnosis by Dr.Comuelo * Slop Chest: A small supermarket or convenience store for AMOSUP that mainly sells groceries. The primary purpose is not profit but to enhance the welfare of seamen and their family, therefore, the goods are sold at nearly wholesale prices, much cheaper than retail market price. In addition, AMOSUP can purchase goods on deferred payment , which is a very well-received service among seamen families. There is a Slop Chest attached to the two seamen’s hospitals in Manila and Cebu.

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【SPECIAL ISSUE】

AMOSUP SEAMEN’S HOSPITAL DAVAO GIG OCA ROBLES SEAMEN’S HOSPITAL DAVAO

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AMOSUP Seamen's Hospital Davao

Opened in August 2008; the latest among the existing AMOSUP Seamen’ s Hospitals Located in Davao, the third largest city in the Philippines to the health of seamen and their family in southern Philippines 　Davao is the central city of Mindanao region in southern Philippines, located 1,000 km south, about one and a half hours’flight from the capital Manila. It is the third largest city in the Philippines and an economic and cultural hub of southern Philippines, as well as an important supply base of seamen. Seamen’s Hospital Davao was opened in August 2008 (construction commenced in November 2007), the latest among the four AMOSUP Seamen’ s Hospitals in the Philippines: Manila (opened in 1978, renewed in 1987); Cebu (1997); Iloilo (2005); Davao (2008). It s the health of seamen and their family in southern Philippines. After building the second seamen’s hospital in Cebu, AMOSUP was initially planning to build the next seamen’ s hospital in Davao, the central city of Mindanao region, in the early 2000’ s. However, it decided to defer the plan for a while as terrorist bombings took place sequentially in March 2003 at Davao International Airport and in April the same year at a ferry station in Davao City. Therefore, a seamen’ s hospital was built in Iloilo in 2005 before Davao. 　We visited the AMOSUP Seamen’ s Hospital Davao, where approximately 100 patients visit a day.

New patient consulted by doctor

Overview of the facility Total site area 10,000 ㎡ 22 doctors; 44 nurses; 50 beds

Dental treatment equipment, X-ray machine, etc. donated from All Japan Seamen’ s Union 　“AMOSUP (Gig Oca Robles) Seamen’ s Hospital Davao is located on R. Castillo St., Agdao Davao City, which is only a ten minutes’drive from the Davao International Airport on Mindanao Island, Philippines. Construction of the hospital was commenced in November 2007, with the of All Japan Seamen's Union (JSU) and International Mariners Management Association of Japan (IMMAJ). It was opened the next year, in August 2008. The dental treatment equipment, the X-ray machine and some other equipment were donated by JSU. 　The total site area is approximately 10,000 ㎡ , almost the same size as the inner field of Tokyo Dome Baseball Field. The Seamen’ s Hospital and AMOSUP-JSU Multi Purpose Center (welfare and accommodation facility for seamen) share the site, using 5000 ㎡ each. The building is a three-storied structure with floor area of 1,650 ㎡ for each story and a total floor area of about 5,000 m2. There are 6 full-time doctors and 16 part-time doctors, a total of 22 medical doctors working at the hospital. Other medical staff includes 27 full-time regular nurses, 4 assistant nurses, and 13 backup nurses (called“relievers”), a total of 44 nurses. The total number of staff including istrative staff is 122, of which 83 are full-time workers, 10 are part-time and 29 are backup staff. The hospital is operated 24 hours, 365 days and the staff work on three shifts from 7:00-15:00, 15:00-23:00, and 23:00-7:00 (the next morning). Outpatients are accepted from 8:00 to 17:00 on Monday through Friday and just during the morning on Saturdays, similar to most hospitals in Japan. There are 50 beds with 25 each in the male and female wards. Inpatients are itted up to 7 days in principle, but ission may be extended to 30 or perhaps 45 days upon a written

permission from the hospital director, depending on the condition of the patient.

Average of 100 outpatients/day (over 3,000/month), of which 30% are dentist’ s patients Emergency patients are also accepted (about 7 patients a month on average) 　Medical departments of AMOSUP Seamen’ s Hospital Davao include anesthesia, ophthalmology and otorhinolaryngology, family medicine (first consultation), internal medicine, surgery, obstetrics and gynecology, and pediatrics. Other departments include pathological laboratory, pharmacy, radiology, and dietary counseling (health management) and dentistry. The anesthesia department is capable of performing not only general anesthesia but spinal anesthesia and epidural anesthesia as well. The surgery department includes orthopedic surgery, pediatrics surgery, and urology sections. It also conducts laparoscopic surgeries. The obstetrics and gynecology department boasts the latest medical facilities including ultrasonic scanners. The pathological laboratory performs clinical microscopy, blood

General Hospital


Emergency Room and serum testing, and immunological testing. The dentist offers pharynx and mouth examination. The number of daily outpatients is approximately 100 on average, meaning more than 3,000 a month, of which 70% are general outpatients and 30% are dentist’ s patients. In addition, the hospital accepts about 7 emergency patients a month on average. 　In principle, Seamen’ s Hospital Davao offers care exclusively to AMOSUP and their family . Emergency patients, however, are accepted 24 hours, 365 days. Care provided to non AMOSUP is limited to emer-

Male surgery ward

【SPECIAL ISSUE】

gency treatment, and they will be transferred to other hospital. All AMOSUP and their family can receive all treatment for free. This free-of-charge healthcare service covers the member seaman himself, his parents and brothers/sisters aged 18 or below and unmarried in the case when the member seaman is not married, and the seaman himself, his spouse and his children aged 18 or below in the case when the member seaman is married. This means that uncles, aunts, and cousins are not covered. AMOSUP are deemed as“”for 6 months after return from a voyage. If more than 6 months without getting on a boat as a seaman, (in other words, without becoming an AMOSUP member again,) he and his family will not be subject to the healthcare service anymore, meaning that service will be terminated, in principle, even if the treatment is not completed. 　The structure of the hospital building is very similar to that of Seamen’s Hospital Iloilo. Dr. Comuelo, Director of Seamen’s Hospital Iloilo, provided some advices in deg the building. When you enter the hospital on the first floor, you will see a large waiting room (entrance room) and a reception desk on the right and a dispensing pharmacy on the left. Further inside are the general outpatient section (a consulting room and a space where the body temperature, weight, height and vital signs of the patient etc. are measured), radiology department (X-ray room), oph-

3 Units in dentistry, donated by JSU

interview− Hospital staff interview Lisette Wendelyn K. Panlilio / Human Resource Manager 　“I am responsible for human resource management. I am working on a project to enhance collaboration between doctors and nurses. I think it is important to build closer collaboration and promote information sharing.”

Operation Room

thalmology and otorhinolaryngology department, the (staff) cafeteria, istration office, and the dietary counseling room. The nurse station, obstetrics and gynecology department, operation room, labor and delivery room, intensive care unit (ICU), infant and maternal care unit (IMCU) and the female ward are arranged on the second floor. On the third floor are the surgical department, internal medicine department, male ward, pediatrics, and the dentistry department. There were many patients waiting in the lounge, maybe seamen and their family , on the day we visited the hospital.

X-ray tomography machine, donated by JSU. Bonifacio/ Radiological Technologists

“Strengthening collaboration between doctors and nurses; 　　　　　　　　delivering better care through information sharing” “Excellent work environment and medical staff 　　　　　　　　　　　　　　　　　　　　　　with professional attitude” “Experience opportunities to improve skills”

Maria Corazon V. Tan, RN, MAN / Chief Nurse 　“Nursing is a very tough job and many nurses quit their job. But this hospital offers a nice working environment and good working conditions, so there are few people who quit their job. We have a good boss and good staff, too. I think this is an excellent place to work in for my own personal development and career progress.” Bianca Mae R. Montojo, MAN, RN / Nurse Supervisor 　 “(I) used to work in a public hospital before. I get the impression that all the staff here including doctors and nurses are very professional. At a public hospital, one nurse must take care of 20 to 30 patients in most (wards), but here, you take care of just 2 to 3 patients. This environment enables us to provide sufficient care to each and all our patients. I think that’s the greatest characteristic. I wish to continue working here as a nurse even after (I) get married.” Pia Marie O. Biliran, RN / Head Nurse 　 “(I) used to be an English teacher. I studied hard to become a nurse and was lucky enough to get a job here. This is (my) first place to work as a nurse. This hospital has adequate medical facilities and staff to provide good care for the patients. AMOSUP Seamen’s Hospital offers various opportunities and experiences to further develop and improve (my) skills.”

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Panlilio/Human Resource Manager, Tan/Chief Nurse, Montojo/Supervisor, Biliran/Head Nurse

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AMOSUP (Gig Oca Robles) SEAMEN’ S HOSPITAL DAVAO Interview with the hospital director “AMOSUP member seamen and their family can receive healthcare free of charge …an invaluable advantage” “Highly recognized for doctors with advanced expertise” “Seamen are prioritized before family …don’ t want to keep the seamen waiting because they have a tight boarding schedule.”

Dr. Richard John C. Pecson, MD FPOA / Hospital Director member for over 20 years, and he has never visited an AMOSUP hospital through these years. One day he happens to fall sick for the first time in 20 years and came to our hospital, but it has been more than 6 months since he got off his last boat. In such a case, we will see the patient for free, so it’ s case by case.” 　 “In principle, we do not see non AMOSUP , but we provide first aid treatment for emergency patients. The Philippine law does not allow hospitals to refuse the acceptance of emergency patients. Once the emergency stage is over, however, non-member patients are transferred to other hospitals. Some patients say that they don’ t want to be transferred to other hospitals because the facilities and staff are much better at the AMOSUP Seamen’ s Hospital. They offer extra money and ask us to keep them here, but we cannot accept this because we are a hospital operated to serve AMOSUP .” How do the member seamen and their family think about the hospital?

Dr.Pecson/Hospital Director

　Dr. Pecson is the hospital director of Seamen’ s Hospital Davao and also serves as the manager of the AMOSUP-JSU Multi Purpose Center adjacent to the hospital. He came from Manila in August 2008 when the hospital first opened and has been directing the hospital to date. He was a fellow student of Dr. Conrad F. Oca, current AMOSUP President, at the University of the East Ramon Magsaysay Memorial Medical Center (UERMMMC) (graduated in 1991). Dr. Pecson and his wife, who is a pediatrician, are devoted to ing this hospital. Below is our interview with Dr. Pecson who indirectly s the safe operation of Japanese merchant fleets by taking care of the health of Philippine seamen. What is the greatest characteristic of AMOSUP Seamen’ s Hospital Davao?

　 “We did not have an AMOSUP Seamen’ s Hospital in the Mindanao region before. So the seamen and their family living in this area had to go all the way to either Manila or Cebu to get healthcare. This hospital was born in response to the strong requests from the seamen of Mindanao to Captain Oca (late Gregorio S. Oca, former president of AMOSUP). Seamen, who spend long periods out in the sea, are always concerned about their family back home. The health and safety of their family are of utmost importance to them. They won’ t need to worry about their family so much if there is a hospital nearby that they can rely on. Our hospital was born to respond to such needs, to the seamen and their family living in Mindanao region. That’ s one of the greatest characteristics that define the hospital.” 　“There are four AMOSUP Seamen’ s Hospital in the Philippines: Manila (opened in 1978, renewed in 1987); Cebu (1997); Iloilo (2005) and Davao (2008). The Davao hospital was supposed to be built right after Cebu and before Iloilo in the early 2000’ s. But because of the serial terrorist attacks in 2003 at Davao Airport and elsewhere, we changed the plan and decided to build the hospital in Iloilo before Davao.” 　“Above all, the most important characteristic is that we provide healthcare service to AMOSUP seamen and their family free of charge. Family who are subject to this free-ofcharge service are the member seaman himself, his parents and brothers/sisters aged 18 or below and unmarried in the case when the member seaman is not married, and the seaman himself, his spouse and his children aged 18 or below and unmarried in the case when the member seaman is married. So uncles and cousins are not included. Patients are required to show their AMOSUP ID card and seamen’s booklet for member seamen himself, or for example, a marriage certificate for the member’ s spouse, in order to receive healthcare for free. AMOSUP are deemed as“”for 6 months after return from a voyage. However, we deal with individual cases in a flexible manner. For example, let’ s say, a seaman has been an AMOSUP

　“Our patients are very much satisfied with the hospital. They say that the facilities are very clean, both doctors and nurses are good, too. We are highly recognized for doctors with advanced expertise, kind and beautiful nurses, and friendly hospital staff. If a seaman visits the hospital, he will be prioritized in the waiting list. We see the seaman first, then other family . We don’ t want to keep the seamen waiting (because they have a tight on-boarding/off-boarding schedule). That’ s another reason why we receive high reputation from busy seamen.” 　“Healthcare costs are generally expensive in the Philippines. We have high quality facility and equipment in this hospital, as a matter of fact better quality than other private hospitals, and seamen and their family can receive that high-quality healthcare free of charge. I think that gives an invaluable advantage for them.”

Diagnosis by Dr.Pecson

I can see that the facilities, the doctors and nurses are all outstanding. What do you think is necessary to further improve this hospital? 　 “It would be perfect if we could get a little more medical equipment. Specifically speaking, we want a CT scanner and some space to install it. If we could use a CT scanner, the care we provide at the intensive care unit (ICU) can be improved. Among (the four AMOSUP Seamen’s Hospitals in the Philippines), only Manila and Cebu has a CT scanner. At Manila, they also have an MRI scanner because they have much more patients than we do. I think (we can do with the existing facilities) here, since we also have to take into the budgetary constraints.”

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