“If you’re a doctor in the Philippines, it’s very easy not to do research,” says pediatric neurosurgeon Dr. Ronnie Baticulon. “You can just do clinical work. There’s no fault in that because when you do clinical work, you’re also serving patients.”
But there’s a small percentage of doctors who devote their time to research. They do it on top of their clinical and teaching responsibilities, without necessarily getting paid extra for it. And Dr. Baticulon of the Philippine General Hospital is one of them.
He was recently recognized as one of the country’s 11 outstanding young scientists by the National Academy of Science and Technology (NAST), in honor of his remarkable contributions to global neurosurgery, pediatric neurosurgery, and medical education.
“[Dr. Baticulon] has completed research projects in global neurosurgery that aim to estimate the burden of neurosurgical diseases and identify barriers to neurosurgical care worldwide,” says the NAST. “His aspiration to be able to provide essential neurosurgical care to all Filipinos who need it, particularly the underserved, underlies his research pursuits and clinical practice, and brings together activities to advance pediatric neurosurgery in the country.”
State of global neurosurgery
“For the longest time, when people talk about global health or providing essential healthcare, surgery has been a neglected aspect,” observes Baticulon, who has been exposed to the healthcare systems of different countries in his training as a medical student, resident, and fellow. He also undertook courses in Global Health at the University of Tampere, Finland and Global Surgery at the University of Oxford, UK.
A 2015 study by medical journal The Lancet noted that 5 billion people do not have access to safe, affordable surgical care when needed. “This means 5 billion people all over the world who need surgery don't get it, or they get it late, or the surgery that they're getting is not safe, which could lead to complications or even death.”
The same is true in the Philippines. The Universal Health Care Act (R.A. 11223) is supposed to have ensured “that all Filipinos are guaranteed equitable access to quality and affordable health care goods and services, and protected against financial risk.”
However, this is not reflected in the current state of our healthcare system, says the UP College of Medicine alumnus. “Now, if you're poor, you don't have money, you can’t get admitted in the hospital and get the medications that you need. You cannot get surgery,” he says.
This prevailing situation in many parts of the world, he says, resulted in a global neurosurgery movement. In the last few years, Dr. Baticulon has been involved in studies that try to identify the gaps in neurosurgical care.
In the Philippines, one of the gaps identified is the fact that there are only about 130 to 180 neurosurgeons. This translates to about one neurosurgeon for every 800,000 Filipinos, when the ideal ratio should be between 1 for every 67,000 to 100,000 population. Most of the neurosurgeons are found in key cities and in Metro Manila, says Dr. Baticulon.
“There are islands in the Philippines with no neurosurgeon,” he says. “So if somebody suffers from a head injury—say, he got into a car accident and there’s blood clot in the brain, it happened in an island where there's no neurosurgeon—then the patient has to travel by boat, by car, before he gets the surgery needed. By that time, the outcome may not be as good.”
Some of us may have also encountered TV commercials or social media posts requesting for donations for the surgery of children with hydrocephalus. “We still see that when in fact hydrocephalus is quite easy to treat,” he says. “If diagnosed early, [the neurosurgeon] can put in what is called a shunt, which is a device that's implanted on a patient to drain the water from the brain into the abdomen.”
If the surgery is done early enough, says Baticulon, the child can more or less live a normal life (e.g., can go to school, undergo normal development, have normal IQ). However, in many cases, patients are brought to the doctor when the heads of the kids or infants are already too big, such that when the surgeons operate on them, the outcome is no longer ideal. “Even if you put in a shunt, the patients will still be dependent on their families, they will not be able to go to school, they will not even be able to talk,” says the pediatric neurosurgeon.
Dr. Baticulon has been involved in many global neurosurgery researches, working with colleagues from the US, Africa, and Europe, gathering useful data on the number of people around the world suffering from hydrocephalus and brain tumor, the number of people who had head injuries, the number of neurosurgeons who can provide care, and so on.
One of the major projects he did in 2020 looked into the number of pediatric neurosurgeons in Asia and Australasia, the kind of training they have, the gaps in the care pathway (cultural beliefs, accessibility to information, doctors, or healthcare facilities), and how these gaps can be addressed.
Science that serves people
Dr. Baticulon is a firm believer that what the world needs is “science that serves the people.” Thus, more important than getting published in a high impact journal, improving the h-index, or the rankings in Google Scholar, is putting a premium on research that ultimately benefits the public, especially the underserved Filipinos.
In his ongoing research project, his team surveyed the neurosurgeons all over the Philippines. “We tried to find out: Where are the neurosurgeons in the country? What's the population of their patients? How many operations are they doing? Where are they doing their operations—is it in the public or private hospitals?” he says.
Once the study is published sometime early next year, it can be utilized in mapping out universal health care plans to provide essential neurosurgical care to every Filipino who needs it. He hopes that thru their research, other fields of specialties will also be encouraged to do the same. The project is supported by the Academy of Filipino Neurosurgeons, Inc.
Dr. Baticulon is currently a professor at the Department of Anatomy in the UP College of Medicine. Thus, another field of research close to his heart is medical education. Over the pandemic, he and some medical students from UP conducted a national survey that tried to determine and analyze the barriers to online learning. There were 3,000 respondents from almost all medical schools in the country who participated in the survey. Their findings showed that beyond the physical tech tools, there are actually more important barriers to online learning, among them failure of communication between the educators and learners, the students’ difficulty in adjusting to the online setup, and economic problems, among others. Since it was published, the research has already been downloaded over 200,000 times, the doctor says.
Family of geniuses
Dr. Baticulon belongs to a family of valedictorians. He’s the eldest and the only doctor among five children; his four siblings are all engineers. All five of them graduated as high school valedictorians and were UPCAT passers. A Palanca award-winning writer and book author, Baticulon once wrote an essay about his family labeled “a family of geniuses” by teachers, parents, and students.
It was in first year high school when Baticulon knew he wanted to become a physician, because while he excelled in Math and English, it was the science classes he enjoyed immensely.
“At first, I wasn't really sure [if I will be able to take up medicine] because I’m not from a rich family. We were poor,” he tells ANCX. “The only reason I was able to go to a private high school (University of Perpetual Help, Las Piñas) was because I was a scholar. I didn’t have to pay tuition.”
To maintain his high school scholarship, he studied hard and joined contests in math, science, and essay writing. He took the UPCAT in 2000 and made it to the top 50 passers, among over 60,000 examinees. This entitled him to an Oblation Scholarship.
Ronnie was admitted into the highly competitive Integrated Liberal-Arts Medicine (INTARMED) program of UP. This allowed him to finish his pre-med and med proper courses in seven years. “I never paid tuition. I only paid P60 per semester until I graduated,” he says, looking back at his years as a UP scholar.
Baticulon was drawn to neurosurgery because he’s long found the brain a most fascinating human organ. “If you can’t move your hand, or you’re not sleeping well, it could be because something is wrong with a part of your brain. It’s always like a puzzle—that's what I like about neurology,” he says.
He also realized very early on that he didn't want to be spending his whole day in a clinic, so he decided to specialize in neurosurgery. “I wanted to be doing things with my hands and have a better control of the outcome [of a patient’s treatment].”
The outstanding young scientist says he’s quite the determined type. “I usually have very clear goals. For example, when I said I want to become a doctor, I’ll be a doctor. I want to become a neurosurgeon, I’ll be a neurosurgeon,” he shares. Among his goals was to win the Palanca and to write a book. He was able to fulfill both. His piece “Some days you can’t save them all” won 2nd prize at the 2018 Carlos Palanca Memorial Awards for Literature. This was also the title of his first book published by the University of the Philippines Press in October 2019.
The book, a collection of his essays and stories from medical school and his neurosurgery training, has been consistently in UP Press’ bestsellers list. It’s also a finalist in the National Book Awards this year.
What the NAST award means to him
The recognition from NAST is an affirmation of his contribution to the field of science. But more than anything else, Dr. Baticulon says, it serves as a reminder and an encouragement that the work of researchers and clinician scientists are important.
“If we don't write about our experiences, [scholars from western countries] will be writing about it, and we don’t want that,” he says. Amid growing calls to decolonize global health movement, he says it’s important for Filipino clinician scientists to continue the work that they’re doing.
NAST also amplifies the importance of multidisciplinary work and research collaborations. “Sometimes being in the medical field, we just work on our own little space, in our own quadrant, or work with our co-physician,” he says. What's being encouraged now is for doctors to work with specialists and scientists outside their own fields of specialty.
“A good example would be the science behind COVID-19,” he points out. “It's not just the voice of the infectious disease specialists that are important. We also need to talk to physicists and aerosol specialists. We need to talk to engineers who know about airflow on how to best mitigate the spread of COVID-19.” The NAST award, he says, will greatly expand his network and open a lot of potential for collaboration.
Dr. Baticulon believes that the ultimate goal of scientists should be geared towards improving the lives of the underserved communities. “What I’ve realized is that all the letters that come after your name, the titles, they are worthless unless you use them actually to do good, to be kind, and to serve others,” he says, echoing an advice he would always tell his students. “Sa lahat ng pagkakataon, higit sa pagiging magaling ang pagiging mabuti.”
[Dr. Baticulon’s book “Some Days You Can't Save Them All” is available at UP Press bookstores and at https://shopee.ph/uppress.]