|How it all began...
By: Dr. Carmelita Ortigas
In 1990, Fr. William H. Kreutz, S.J. President of the Ateneo de Zamboanga, invited members of the medical profession and civic minded community leaders for a series of consultations to determine if there was a need to establish a medical school for Region IX. Or whether to accede to the recommendation of Dr. Alran Bengzon, then Secretary of Health, to simply send candidates for medical degrees to the Davao Medical School Foundation.
The latter alternative was quickly turned down by the group for the following reasons:
a. The Davao Medical School health care responsibilities did not include
Region IX which consist of Zamboanga City, Zamboanga del
Norte and Zamboanga del Sur, Basilan, Tawi-Tawi and the island
archipelago of Sulu.
b. A high majority of medical students of the region who come from low
income families would incur the unnecessary expenses of travel,
board and lodging , in addition to tuition fees and laboratory fees
of a medical school
c. Although the Davao Medical School upholds the traditional âstep ladderâ medical school curriculum, it still uses traditional teaching methodology, (assessed as inappropriate for the planned new school)
To rationalize their position of founding a medical school in Zamboanga City, this concerned group conducted a survey of health data of the Region, which led to the following conclusions:
a. Western Mindanao has one of the highest infant mortality rate in the Philippines,
b. Of the nearly 100 municipalities and 3,000 barangays in the region, more than 80% lack medical attention
c. Zamboanga City has enough practicing doctors with training in various specialty areas who can be tapped to teach in the planned medical school
This survey results and continuing consultations led to the consensus that there was indeed a need to institute a medical school for the region and this school should be in Zamboanga City. Consequently this group of civic leaders and physicians incorporated themselves as the Zamboanga Medical School Foundation (ZMSF). Fr. Kreutz was elected President and Dr. Cristobal was selected to become the pioneer dean of the Medical school once it is established.
This group then moved forward with a better vision of what was to be accomplished and how it was going to be achieved. Dr. Cristobal wrote out the vision that captured all that had gone on in the many discussions. i.e. a medical school, that will respond appropriately to medical and health needs of Region IX as well as assist the governmentâs health management programs for the area. Health activities will not be confined to the training of doctors.
Subsequently Dr. Cristobal, Fr. Kreutz and others presented the proposal to Dr. Juan Flavier, the new Secretary of Health. Dr. Flavier known for his community medicine orientation quickly said âgo!â to the plans for the Zamboanga Medical School Foundation.
When ZMSF sought approval from the Commission of Higher Education (CHED) the submitted innovative curriculum (was contrary to initial conventional curriculum submitted) met with many questions and concerns regarding its deviation from the traditional medical curriculum. But Dr. Cristobal and Fr. Kreutz were adamant : âIt was PBL or none at all!â One of the CHED panel members, Dr. Remigia Nathaniels, pulled Dr. C on the side and on closed room conference queried for more details. âTell me the truth.. what exactly are you trying to do here?â subsequently convinced on the novelty of the innovation, she subsequently championed the new approach. CHED as a body approved the curriculum in the context of âexperimental innovation, still be to closely monitoredâ. ZMSF was awarded a license to implement its curriculum on a year-to-year review basis.
The story reaches its peak â¦â¦.
What is PBL that made founders of the planned new school so resolute and so fully convinced about is appropriateness to their goals? What made them bold enough to risk the censure of the powerful Commission of Higher Education?
Dr. Cristobal had reason to be confident about his position and competence regarding PBL. By that time he had just returned from another postgraduate scholarship in Pediatrics at the University of London. In London, somewhat at a loss, on how to develop an alternative medical education curriculum, he inquired around as to who might help him, even as he was doing his postgraduate training in Pediatrics. He was referred to a Dr. Charles Engel of the University of London. Dr. Cristobal simply called him up, giving a factual story of his background, i.e.. âFilipino, from a poor country, wanting to learn about alternative types of medical education, can you take me on, but I cannot pay you.â The response was a friendly: âCome over for a cup of tea and tell me what you are doing.â
Dr. Engel must have liked the story told. He took in Dr. Cristobal, on a one-on-one, 4 hours a week for 6 months mentorship on learning the concepts, the method, helping him write a problem-based, competency- based, community-oriented medical education curriculum. An OFW friend, Mr. Oscar Pecson, an artist, drew the Spiral of Growth, which became the conceptual framework of the medical curriculum.
At the end of 6 months tutorial, Dr. Engel pronounced: â You are ready to launch. You are the Dean, (of ZMSF)â¦ You are the Dean (emphatically saying it while hitting his right index finger on the chest of Dr. C). I want you to go to World Health Organization in Geneva to see Dr. Charles Bolen. I want you to command them and tell them (WHO) that your country is paying them to serve you. I want you to go to New Mexico to see Dr. Arthur Kauffman â¦ to go to this country, and go here and there.â¦ I want you to go to New Castle Australiaâ¦go and see Howard Barrows of Illinois, he is a friend of mine.â And there was Dr. C receptive to these âcommandsâ, but slowly realizing that Dr. Engel is in fact an international figure with all these network connections. But he was also silently wondering where he was going to get the money to go to all these places.
Ever resourceful , Dr. Cristobal recalled his difficult but successful treatment of the prematurely - born infant son of a Swiss national visiting in Zamboanga. (Dr. C used a crude droplight to maintain body temperature. The Swiss Embassy in Manila wanted to donate an incubator to the hospital for this effort) Dr. C wrote to tell him he was now in London for postgraduate studies. His Swiss friend delighted to hear from him offered to fund the trip to Zurich and Geneva.
In Geneva, Dr. Cristobal connected with World Health Organization (WHO) official Dr. Charles Bolen, Director of Human Resource Development for Health. Dr. C consulted him on how to put up this kind of innovative medical school in Zamboanga. Because of this meeting the Zamboanga Medical School Foundation (ZMSF) became a familiar entity to the World Health Organization. The ZMSF was quoted in the first bulletin of the WHO Towards Unity for Health Program as a model school (for developed and developing countries). Dr. C was awed by the realization that he was by now in the circle of a renowned international group of medical educators including the famous H.Barrows, considered as the PBL pioneer.
At about the same time, Fr. Kreutz in Zamboanga City met with a priest who linked him with the University of Calgary. Calgary offered an invitation to have someone from ZMSF visit Canada. Fr. K encouraged Dr. C to proceed to the University of Calgary in Canada. âThat was the start of the âCanada Connection.â âThere I absorbed all that Calgary can teach me.â (Dr. C is known to possess a photographic memory and a remarkable ability to absorb knowledge like a sponge!) In Calgary he also met Dr. Clarence A. Guenter, Director of the International Health Exchange Programs, who would later give substantial technical assistance to the Zamboanga medical school programs.
From Canada, he proceeded to the US to meet Dr. Ralph Leichner, senior associate dean of the Ateneo de Loyola in Chicago, busy at that time building a $350 M infrastructure and âhere I am trying to make do with only $500.â, recalls Dr. C. struck by their disparity of resources.
As it happened, Dr. Engel, of the University of London was also a good friend of Howard S. Barrows, M.D., Professor of the School of Medicine of the Southern Illinois University based in Chicago, the founder of the problem based-learning method (PBL). He generously and quickly gave Dr. C one-on-one tutoring on the method, asked him to speak before the University of Illinois faculty and gifted him with some of his latest published books on the subject.
Upon his return to Zamboanga, Dr. Cristobal toured the Region for six months establishing connections. Dr Reynaldo O Joson, who had taken Dr. Câs place in training the doctors and running the hospital training component in surgery was still there doing very good work. Dr. Cristobal along with Dr. Joson, started teaching the medical faculty in the use of PBL and institute the community oriented curriculum in ZMSF.
In February 1994. after one year of careful evaluation, the medical school program was approved by the Technical Panel for Medical Education of the Commission on Higher Education. With that the School of Medicine was officially established.
And the story goes onâ¦â¦.
âDeveloping an innovative medical school in pursuit of the goals of Health for More is a challenging and demanding project. However the pressing unfulfilled health needs of our communities require no less than that we focus our efforts collaborating with all sectors toward this end.â
Words from a speech of Fortunato L Cristobal, MD, MHPEd, MPH, FPPS, the Dean of Ateneo de Zamboanga University - School of Medicine (ADZU-SOM), the only medical school in Zamboanga, the only one in Region IX, surveyed as the best small medical school (for schools with less than 50 graduates annually), and overall one of the top 10 medical schools in the nation. It is only one of 4 medical schools for the entire island of Mindanao.
The above excerpt from the speech embodies in effect, the vision-mission- objectives of the medical school now realized and operational in its three distinctive features, the Three Pillars of its medical curriculum (a) use of the Problem Based Learning (PBL) as a teaching method; (b) Competency-based Evaluation and (c) Community Orientation, which includes a Masters in Public Health Education for the medical graduates in their internship stage.
These innovative features are the primary reasons why the original group of incorporators opted to establish a new type of medical school to realize its vision and mission regarding community oriented healthcare.