san lazaro...

This week (and future weeks), a good chunk of my time will be spent at the Extended Child Care Center (ECCC) at San Lazaro Hospital. On my first day at ECCC, I was given a tour of the grounds with Lorrie:

San Lazaro is part of a health-care compound, which also houses Jose Reyes Hospital and the Philippines Department of Health. San Lazaro is the national hospital for infectious diseases, and also functions as a teaching hospital; it deals with cases of rabies, TB, AIDS, dengue, measles, etc etc. Jose Reyes is a public hospital that treats, as Lorrie said, “the poorest of the poor” in Manila. (I’m told residents of Manila are classified A, B, C or D, according to income – Jose Reyes treats C and D category patients.) The Department of Health is exactly what it sounds like – administrative buildings, the under-secretary and secretary both have offices here, as does the WHO.

PJM’s main role on the property is at the Extended Child Care Center – initially designed to help accommodate children of patients in the infectious disease wards (who were essentially living at the hospital, sometimes sleeping outside the wards, because their parents were inpatients), it’s been expanded to families in the local community and their children, and has become a catch-all for a variety of programs and office work.

San Lazaro Hospital (named after St. Lazarus) is around 400 years old, dating back to the period of Spanish colonial rule in the Philippines. 2 Spanish brothers, I am told, were called to set up a hospital in the core of the city, dedicated to spreading the light of Christ amidst disease and death.

Historically, this place became quite dark as the 20th century arrived. Because of the kinds of cases San Lazaro deals with, it became a place that represented death – families in the community would ask that they or their children not be admitted, because it was known as the hospital where patients went to die. There was, for many years, a crematorium on-site (which, I’m told, was used during the day – Lorrie said “it was like Auschwitz”). The morgue at the time was also seriously problematic, and bodies were consistently improperly stored and being openly wheeled around the property, in plain view of the children.

While there is a new morgue and the crematorium has been destroyed, the legacy of this place is a dark one. PJM’s presence on the grounds, its daily devotions and prayer walks, and its presence in the wards and events for staff all contribute to this place moving in a positive direction – but inevitably, there remains much work to be done, “much death to be driven back.”
The compound is fairly large, with 30+ buildings of varying sizes. It is walled/barbed wire on all sides (the property borders on Tondo, an area of Metro Manila dominated by squatter communities), and the entrances/exits are guarded. Nevertheless, there are always lots of people. The hospital wards range in size – there are a few 4-5 story buildings that look like fairly standard (albeit third-world) hospital buildings. There are several separated smaller 1-story buildings that house specific infectious disease patients – the TB ward, for example, houses between 150 and 200 end-stage TB patients (who will die of a curable disease) in poorly ventilated buildings which, to be honest, look more like barracks.

In all the wards in this hospital, I am told it is not uncommon to have 2 patients to a bed. We went for a short tour through the Pediatric Ward in San Lazaro; a glance into a room dedicated to pneumonia reveals 10 cribs (of the very institutional, rusting, steel-painted-white variety), each with a child and a parent (who is sometimes sitting on/in the crib as well). The size of the room would house 2 patients in a hospital in Victoria, and in this room, there are easily 12 children and 10 adults; there is little ventilation to speak of. In the Philippines, “you don’t go to the hospital by yourself.” The phenomenon of “watchers” is an institution here – every inpatient has a family member or companion that stays with them.

There are multiple rooms with varying degrees of capacity – each is labelled: pneumonia, measles, dengue, ICU etc. The floors are badly chipped, gouged and worn down to varying levels of concrete (which makes me wonder, with all the divots etc., how tricky it would be to move a stretcher), and everything feels dingy and dirty. The nurses bustle around behind the nursing station; the walls are painted with friendly scenes of woodland creatures (think Bambi) and bright colors.

I have never been in a hospital in the third world. (When we went to the hospital following the car accident last week, we were taken to a private hospital – Medical City – whose facilities were comparable to brand-new hospitals in Victoria (think the newly-renovated parts of the Jubilee in Victoria). Otherwise, my only reference point is various photos, touching World Vision commercials, church presentations on mission trips.

Seeing it in person is pretty surreal. Somewhat unfathomable, really, to think about how nurses and hospital staff provide healthcare in the environment I witnessed, to be honest. The sheer volume of people makes the logistics more than difficult. And, even more, to think about the types of diseases they are dealing with – measles, which has a vaccine; TB, which is curable with meds.

The PJM staff does regular ward visits with patients at San Lazaro. Because of the nature of the patients (e.g. those with infectious diseases), these wards have largely been neglected by organizations/ministries that work within the hospital.

The rest of the property includes research and development buildings, local education centers (e.g. AIDS and STI education), lab facilities, some minimal staff housing, and the admin structures for the Department of Health – these are non-descript administrative buildings, but they are, again, inescapably third world...they are somewhat reminiscent of abandoned buildings in Victoria in appearance: peeling paint, layers of dirt and grime, cloudy windows with bars and air-con units in disrepair, various drips and leaks.

There is a chapel on the property; surrounded by crumbling stone walls and several courtyards. This is the part of the property where you can truly see its history; the walls are old, covered in vines, and immediately upon entering the space, it is quiet. Lorrie said that since PJM has been here, they’re positive that “these walls have heard hundreds of years of prayer.” It is inescapably a sacred place, that courtyard. I anticipate I will be going back there often.