Megan Webber, Co-Founder of KnowTheGlow, was very fortunate to capture Dr. Gary Mercado’s full attention last week as he was managing through five days of quarantine in Manila after visiting family in America. Even though struggling with jet lag and a 14 hour time change, it did not take Megan long to see how dynamic and inspiring Dr. Mercado, an ocular oncologist in Manila, Philippines, is to his patients and colleagues from around the world.
Megan was able to track down Dr. Mercado through the Philippines Retinoblastoma group page where several of the families were more than willing to connect Megan to the doctor that saved their child’s life. When Dr. Mercado learned how Megan came to connect with him, he expressed how happy he was to know that the RB parent group was gaining ground as it has always been his desire to have a parent support group, but that his clinical work has kept him so busy, he has not had the time to help direct such an initiative. He was also thrilled to hear that KnowTheGlow seeks to help build awareness around the detection of sight-robbing and potentially life-threatening conditions like retinoblastoma to the people of the Philippines. In the past, he explained, they have tried to have campaigns where they delivered posters to local barangay (village) health centers as well as give lecture caravans for pediatricians, family care physicians, and ophthalmologists. In the island of Mindanao, an increase in the early detection of RB cases was achieved due to the efforts of Dr. Mae Dolendo, a dedicated pediatric oncologist partner; similarly, those areas reached by the early detection initiatives of Dr. Mercado and Dr. Patricia Alcasabas had an increase in early-stage RB detection, but the awareness efforts were short-lived and could not always be sustained. Dr. Mercado went on to explain that in addition to increased awareness, there must also be a plan to help facilitate the logistics of getting patients and their caregivers to specialized RB treatment facilities.
Megan asked Dr. Mercado what led him to practice medicine and surprisingly, it was not because he came from a family of doctors. His mother was an educator and his father was a civil engineer, but it was a great uncle who encouraged his pursuit of medicine as he explained to him what being a medical doctor would entail. This spark was further ignited by his admiration for his pediatrician as a young boy.
Dr. Mercado seemed to have been led to do Ocular Oncology when in his senior year of ophthalmology residency in the University of Philippines – Philippine General Hospital, he was referred a lot of RB and tumor cases which unfortunately had limited options for treatment at that time. He began to think about doing oculoplastic surgery when he applied for a fellowship in the U.S. Fortunately, he was offered a clinical fellowship in Ocular Oncology with Drs. Jerry Shields and Carol Shields at Wills Eye Hospital in Philadelphia in 1996. Ocular Oncology as a subspecialty at the time was relatively new. He went on to work with the Shields Oncology Team for a short stint as a Junior Surgeon while he was also training in the Oculoplastics Section of the hospital. Thereafter, he returned to the Philippines bringing with him the lessons learned there, and continued to mold the care of Philippine RB as he continued his work in the Philippines.
In 1999, he and Dr. Eric Domingo, an ocular pathologist and ocular oncologist joined forces at their alma mater, the University of the Philippines – Philippines General Hospital, and established the ocular oncology & retinoblastoma division. Recently, the team was joined by Dr. Pamela Astudillo, a pediatric ophthalmologist with special training in retinoblastoma. Dr. Mercado feels that the success of treatment of RB relies heavily on the support and coordination with the other specialties involved in its care. For the past eight years, there have been joint monthly meetings to discuss all the cases as a team. The partnership with the Pediatric Oncology team headed by Dr. Patricia Alcasabas among many others is the key to the improvement in RB care. Dr. Mercado also mentioned that one of their greatest assets in the care plan was the participation of a nurse navigator, Rico. The nurse navigator has been able to bridge the gap between concerned parents and their doctors. Parents often feel that they have difficulty in opening up to the doctors as easily as they can with the nurse and the building of this trust has led to a dramatic reduction in treatment abandonment. Dr. Mercado confided in Megan that he would love to have two or three additional nurse navigators as he sees how stretched thin the current nurse navigator is.
Dr. Mercado explained that the Philippines is different from other countries in many ways. Geographically, the archipelagic nature of the country poses major difficulties in specialized health care delivery. There are many ophthalmologists in the country but most are located in the urban areas. Very few are trained in retinoblastoma care. The health care system is divided into state-funded facilities and privately run hospitals. With his work at the Philippine General Hospital as well as at his three private clinics (The Medical City on Ortigas Avenue, Pasig; Manila Doctors’ Hospital, and Makati Medical Center), he sees the full socio-economic spectrum of patients. He is thankful when they can identify cases early, catch them in the intraocular stage, and can attempt globe salvage, but laments that sometimes (especially in times like during this pandemic) he sees more extraocular RB where the tumors have grown beyond the orb of the eye. He told Megan that his patients in the private sector are more reflective of what he saw at Wills Eye Hospital – more intraocular and manageable RB while his cases at the Philippine General Hospital are generally more far-advanced. The University of the Philippines – Philippines General Hospital, a state-funded and university-affiliated hospital, is a tertiary referral center for retinoblastoma with facilities that are at par with most RB centers worldwide. Dr. Mercado along with his teammates continues to devise ways in being able to provide the appropriate care due to the Filipino children with RB. For one, the pandemic has opened the option of telemedicine which, he says, may help bridge the gap of providing know-how and expertise to the far-flung islands in the Philippines. In addition, discussions and collaborations with RB experts overseas have become more doable.
It is usually a parent who notices the glow and takes their child to a pediatrician. If and only if the pediatrician or primary care physician is aware of what the white pupil may signify, will he or she then give the proper referral to an ophthalmologist. Unfortunately, it does not get detected as easily or as early as it should be. In their campaigns, they have tried to include red reflex screening in well-child check-ups but sadly, it is not routinely performed. It is not just a problem in the Philippines as the situation is similar in most countries. Dr. Mercado asked pediatric colleagues in America regarding their well-baby checkup protocols and they admitted that it was neither part of their actual routine. Detecting a white pupil in the 0-5-year-old age group is critical. Increasing awareness of the glow and its consequent eye conditions improves the potential for early detection and proper referrals.
Megan is eager for the KTG community to learn of Dr. Mercado’s selfless and far-reaching work and looks forward to seeing all the positive potential opportunities that are opening up in this amazing country. We are proud to highlight the work of Dr. Mercado and his team and the quality and access to the care he is providing for the children of the Philippines.