–A flower that blooms in adversity is the rarest of them all – Emperor, (Mulan)-

it is without doubt that in the rules of causality that a cause will often times lead to multiple effects and it is in this concept that we look at the current pandemic. It has become a prime mover of change within the last years. This pandemic has ushered a new era. It has changed trajectories of many lives, it has changed the priorities of many, and it has even forced us to scrutinize the very essence of our existence and the values which we hold dear. 

The plague which has been afflicting the global community has been devastating and its hand has reached into every little nook and cranny of our lives. In fact, this pestilence has even taken some of the people we hold dear. 

Devastating as it is, life will always find a way; and as Sir David Attenburough put it, “mankind is the greatest species of problem solvers”. 

Our lives may have been curtailed by the different restrictions which have been put in place by the initiatives in order to stem the pandemic but it is without doubt that the common theme of prevailing through the odds are still at play. This basic theme is reflected by the resilience of the people and as such it can also be seen and reflected in how we proceed despite of what is currently happening. 

Physicians are among the forefront warriors in this fight along with our frontline brothers and sisters. We have devoted ourselves when we took up the profession to help in the time of need and together with this devotion, we also uphold our oath to prosper ourselves through learning and training. 

The pandemic has ravaged all aspects of life as we know it and it is without doubt that that training programs for residency have not been in exception. 

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I cannot speak for residents for other institutions from other programs however I do believe it is safe to say that the feelings and opinions which I present here are of the common theme. I present to you the experiences with regards to my learning and my training. I present the experience of a resident in training during the surge of the pandemic in the Southern part of the Philippines in Vicente Sotto Memorial Medical Center in Cebu. 

When all of these started at the late part of 2019,  it was but an idea; it never really occurred to me that this would go full on pandemic. Life has been placed on alert, however no restrictions were in place until the first COVID related death was recorded in Cebu City; a lady who traveled from China died and everything changed. Restrictions were put in place and the lockdown was initiated. Cases surged and rose to levels whereby even us surgeons were placed along side our internal medicine colleagues to man the COVID wards. We ceased operations and conferences. We became general physicians. 

It was in this moment that I realized that the dream of becoming a urologist was now also becoming a victim of COVID. There was a standstill in its progress. It was at this moment that I wondered in how we will progress and if we can continue with the training program. 

The greatest gift of man is that imagination has no limits and necessity is the father of invention. It is in this darkness that the dynamic Philippine Urological Association had the inception of the idea to move forward despite of; using advances in technology and with a little bit of imagination and an enormous amount of tenacity, the PUA found ways in order to push learning forward. It is in this seemingly bleak moment that a spark of hope was born.

In a consolidated effort by imaginative and dedicated personnel, the PUA has been able to initiate and conduct internet based conferences and meetings which were fruitful and safe. The PUA was able to hold an Annual PUA Convention online. This has never been done before and no one knew how it would result into however it was a success nevertheless. This act has then paved way to the plethora of web based learnings which followed suite. 

This has been the inspiration whereby the Department of Urology of the Vicente Sotto Memorial Medical Center pushed forward; in order to maintain the requirements and to progress learning, web based conferences, web based reporting were put in place. The consultant staff has made incredible efforts in order to continue with our training and to assure our safety as much as they can. 

Information access was at all time high despite of the pandemic induced restrictions; As a resident in the Visayas, never in my mind would I dream of learning the basics of Urodynamics from Dr David Bolong. Never would I have imagined hearing lectures from Japan, Korea and the US with the amount of ease. Inter-hospital case conferences would have been different, never would have I imagined a corroboration of different Manila based institutions to have a case conference with our institutions for the south. 

It is within the restrictions set forth by the pandemic that we have actually extended our reach. We have been able to do more even with the handicap.

Furthermore, it is without doubt that the imagination of the PUA and the Philippine Board of Urology has exceeded expectation when it  was announced that the resident’s in service training exam was to be held online; this was another first on the books and it was successful and thereby created a standard on its own. It was with this that the Philippine Urology Residents Association and the PUA also held its online in service examination review and this was very helpful. 

The pandemic has affected everything. It has reached into the very essence of what we are and forced us to question the very essence of what we are; and that we did. Each among us has reacted on a very personal level on a problem with a global encompass, we have had our share or ups and downs but we prevail nevertheless. 

The PUA is a reminder that when a group of dedicated people share a common goal and tenaciously work towards this goal, with a little bit of luck and a whole lot of hard work, anything can be achieved and dreams can be a reality. 

Ray Raphael Tan de Guzman

Urology Resident IV 

Vicente Sotto Memorial Medical Center

Cebu City , Philippines