Dr. Augusto P. Sarmiento was born on August 21, 1924 in Calapan, Mindoro.
While he had always envisioned himself as becoming a surgeon after graduating from Mapa High School in March 1941, he was (hell) bent in becoming a Philippine Air Force pilot. He had it all planned out. As a requirement for applying to become a flying cadet, he would have had to finish 60 university credit units (equivalent to a 2-year Pre-med course) at the College of Liberal Arts at the University of the Philippines in Padre Faura.
This, however, was thwarted by the outbreak of World War II on Dec. 7, 1941 and because of this Dr. Sarmiento decided to pursue his pre-med course at the U.P. Junior College, Manila from 1942-1943 and obtaining his Associate in Arts degree. He then proceeded to obtain his medical degree from the same university’s College of Medicine graduating on April 13, 1948.
After passing the medical examination board examinations in August 1948 he started working as a Junior Parasitologist from September 1948 to March 1949 under the Schistomiasis Control Program of the Department of Health under Dr. Trinidad Pesigan. He then became a first year resident at the UP-
PGH, Department of Obstetrics. Dr. Sarmiento used his Obstetrics residency training as his gateway to get into the Department of Surgery where he started his surgical residency in early 1950.
“My general surgery training in UP-PGH Medical Center from 1950-1954 under the watchful eyes of Dr. Januario Estrada (Head of the Department of Surgery) was a God-given opportunity,” he said. Dr. Estrada, at that time, was deemed the dean of Filipino surgeons. In addition to his very active private surgical practice he also had authored numerous scientific papers that illumined the practice of surgery and medicine as a whole. Upon completion of his surgical residence training in 1954, like many other graduates of various medical specialties, he flew to the USA to pursue more advanced surgical training. After a brief six-months’ stint at the Presbyterian Hospital (July-December 1954), he applied as resident in surgery at Memorial Center for Cancer in New York City, considered the Valhalla of Cancer Surgery. Because of his PGH resume and after a very exhilarating personal interview with the Chairman of Residency Training, he was accepted into the surgical program from January 1, 1955 and progressively until completion in early 1958. For almost four years, Dr. Sarmiento rotated through the anatomically- oriented specialty services such as Head and Neck, Breast, Gastrointestinal and Mixed Tumors, Thoracic, Genito-Urinary, and Bone and Soft Tissues. Admittedly, these programs vastly expanded the young doctor’s armamentarium to deal with all kinds of neoplastic diseases and even strengthened his skills as a general and oncologic surgeon.
Thereafter, until August 1958, he worked as Associate in private practice of Dr. Hayes Martin, widely regarded as the Father of Head and Neck Surgery. Dr. Sarmiento was offered partnerships in private practice by Dr. Martin and also by Dr. George T. Pack, another world-famous abdominal cancer surgeon, but he chose to return to Manila in October 1958. He then started private practice in general and cancer surgery at the ABM Sison Medical Group Clinic in Padre Faura St. Ermita for outpatient consultations and at Our Lady of Lourdes Hospital for his surgical and inpatient practices in November 1958.
He simultaneously also held the position of Assistant Professorship in Surgery at the UP-PGH and at UERMMMC teaching students as well as surgical residents. It was clearly evident that he encountered a very significant number of cancer cases among his many patients.
“I found myself busy helping the afflicted and feeling humbled yet pleased that I had received excellent surgical coaching/teaching both at UP-PGH and in NYC,” he shared.
It was also during this time that the approach to cure was based on the concept that cancer expands by contiguous extension (i.e. the Halsted concept), and “radical excision was the answer,” he said.
Radical mastectomy also known as the Halsted procedure was first performed by William S. Halsted, an accomplished young surgeon at Johns Hopkins, in 1882. With surgery as a breast cancer patient’s only option, a woman treated by this method not only had her entire breast removed, but also the surrounding tissues such as the axillary, lymph nodes and the pectoral muscles. According to Halsted’s belief, breast cancer grew in a slow, orderly way, spreading from the breast to the lymph nodes and finally to other parts of the body. He also believed that the more extensive the surgery, the less likely the cancer would return.
The Jerry Urban modification included the ipsilateral chest wall resection to include the mammary chain of nodes and the chest wall defect covered with the patient’s own fascia lata or from bank fascia.
Aside from Halsted radical mastectomy for breast cancer, other extensive surgeries during that time were pelvic exenteration for uterine and cervical cancers, and “commando” (combined operation for mouth, mandible and neck dissection) surgery for oral malignancies. Significantly, patients with these particular cancer types were unarguably referred to surgical oncologists like Dr. Sarmiento, radiotherapists like Dr. Lapuz, and medical oncologists like Dr. Tangco. But the outcomes, Dr. Sarmiento said, were usually depressing.
Surgery for cancer treatment
In the last 20 years of the past century, a multidisciplinary approach was adopted in the management of malignant neoplasms, or new abnormal growth of tissue. The approach was complemented by “sophisticated imaging, newer cytotoxic and antiangiogenesis drugs, antibody or vaccine immunotherapy, molecular-based laboratory assessments, and minimally invasive surgical interventions for cancer.” Surgery, however, “remains to be the most frequently used therapy for cancer though outcomes are better and more often curative when non-surgical interventions are employed in combination with surgery.”
Presently, surgical, medical and radiation oncologists work closely together with nuclear medicine physicians and pathologists. “Preoperative radiotherapy and chemotherapy are sometimes used to reduce tumor size and increase the efficacy of surgical resection or cytoreduction surgery.”
Dr. Sarmiento likewise explained that cancer in the breast, prostate, head and neck, and soft tissue sarcomas can be managed today by conservative surgery because of the multimodal approach. This, he said, improves both the duration and quality of life of the patient.
Advances in cancer biology, pathology and imaging sciences have led to more limited conservative surgery with combined therapies. These therapies are designed to address the spread of small cancer cells to other organs not picked up by screening or diagnostic tests, even at the earliest stages of the disease.
“The surgeon must be technically adroit, well-versed in cancer biology and have a thorough knowledge and understanding of the range of therapies that other oncologic disciplines can offer patients in order to enhance outcomes,” he said.
Most outstanding oncology distinction
Dr. Sarmiento earned the Most Outstanding Oncology distinction from the Philippine Society of Oncology, and the Legend of the Knife of the Philippine College of Surgeons on September 10, 2012.
Affiliated with different medical groups, he is a Diplomate and Fellow of the Philippine College of Surgeons, President of the Philippine College of Surgeons in 1975, a Fellow of the American College of Surgeons, and a Diplomate and Fellow of the Philippine College of Pharmaceutical Medicine.
The TMC connection
In 1965, Dr. Sarmiento and four other bright and young doctors practicing as the ABM Sison Medical Group, named after the group’s mentor, Dr. Agerico B. M. Sison, decided to put up their own hospital to be able to accommodate their growing number of patients and enhance their practice through modern hospital facilities. They found a place along what is now the bustling San Miguel Avenue in Mandaluyong City, then an isolated, overgrown patch of land with cogonal grass.
In October 1967, the ABM Sison Hospital began operations. But only two years after it opened its doors, the hospital was on the brink of bankruptcy. Being a 93-bed hospital, it was just not economically viable because of its location in a virtually unpopulated area.
The solution that was formulated was groundbreaking for the times. Leaders from the medical and business professions would combine to create a revolutionary model of governance rather than conflict.
Under the leadership of the late Augusto M. Barcelon, an acknowledged leader in the banking industry in the country, as Chairman of the Board and Dr. Sarmiento, as President and Medical Director, operations were streamlined, costs were rationalized and internal morale was boosted. Soon, the hospital managed to raise enough funds to expand capacity to 293 beds, 200 of which were small but comfortable and adequate private rooms; the edifice was called the Roxas wing named after the board member who espoused the project. This move led to the rapid success that marked the hospital’s transformation.
In 1975, the hospital was renamed The Medical City, yet it remained focused on delivering excellent patient service through professional medical leadership and innovative management practice. Since then The Medical City has continued to grow steadily.
In 1996, Dr. Sarmiento resigned as President and Medical Director after 27 years (1969-1996) of service. He has been the Chairman of the Board of Directors of Professional Services Inc. (PSI) - The Medical City since 2004 following Mr. Barcelon’s passing. He is also the Chairman of Proser Health Services Inc.; Medical Arts Tower; PSI Healthcare Development Services Corp.; Guam Healthcare Development, Inc.; The Medical City Clark, Inc.; and Philippine Foundation for Health and Development Inc.
Next generation of surgeons
As a surgeon himself, Dr. Sarmiento has played a vital role in continuously educating and molding surgeons in TMC.
When asked what are the most important qualities a surgeon should have, he readily said: “A hallmark of a surgeon who may be considered a great one is the doctor who has gone through many years of excellent training especially at reputable medical institutions and who has dedicated himself to the specialty pursued and always in a focused manner. For having received great coaching, he himself should be a great coach. He must continue training and practicing to be able to keep up and stay on top of all new advances. He must have faith in who he is and what he does and is fully capable of. Communicating directly and connecting well with his patients and with great bedside manners lessen the burdens of a sick patient.”
As a nonagenarian, Dr. Sarmiento is still very much active and with a very sharp mind, much to the envy of his contemporaries. He attributes his longevity to good genes, not having any vices, doing and following everything that he advises his patients, and “forever trying to maintain a great shape.”
“Indeed, I feel that I still can take some 60-80 -year olds ‘for a run.’ I know that, at almost 94, I exemplify good health, owing to the fact that I still feel strong and capable at what I do best and love most,” he said.
“I do try to keep busy as much as possible by staying involved with The Medical City because I like keeping my mind working whenever possible. And lastly, I try to stay fit by indulging in the only sport I still can enjoy – golf – which additionally allows me to socialize and have lunches or dinners with close friends,” he added.