Every time I attend to a dying patient, especially the ones that could have been saved if not for a more efficient healthcare delivery system, my heart aches. Four out of ten Filipino die without even seeing a doctor. In the light of the pork barrel scandal, I am awe stricken on how brilliant they are in finding ways to launder money. Maybe if we put these people in healthcare, they can help device strategies on how to make the healthcare delivery more efficient, thereby lesser people will die. – Dr. Elise Nicole B. Catalan
During my one year Post Graduate Internship (PGI) in the Philippine General Hospital (PGH) in Manila, I used to go through a mental checklist of supplies I needed to bring with me every morning before my hospital duty commences (red, purple, blue top vials check, syringes, intravenous cannula, leukoplast, pulse oximeter and apparatus and stethoscope, alcohol and cotton, and the list goes on). The PGI is a one-year pre-requisite training after medical school graduation in order to be qualified for the physician licensure exam.
If I had spent PGI year at a private hospital, I might not need to have a sling bag of ‘stash’ with me for duty to help expedite my work. Amidst the budget that the Philippine General Hospital receives annually, its funds are inadequate to supplement all the needs of the patients they serve daily. Basic medical supplies are insufficient thereby producing a challenge to the medical service providers. Although not mandated, it has become a norm and a dire necessity to bring our own supplies as part of our battle gear for every hospital duty. We voluntarily do this to facilitate a more efficient workflow. Because of this challenge, the consultants, medical residents, interns, clerks and all other medical service providers need to be more resourceful and self sufficient. To this day, I admire how the PGH community extends so much of themselves to provide service to the uninsured and underserved in our country.
The choice to do my PGI year in a public hospital was a voluntary and whole hearted one. The lack of supplies was the least of my concerns and I yearned to be in an environment of selfless service amidst adversity. Moreover, I had the strong desire to be in the epicenter of healthcare in the Philippines, to be in the forefront of where the best medical professionals cure the poorest in our country. The daily interactions I had with patients were the most valuable to me. Those experiences are etched in my mind and heart. It helped me not only in the licensure exams but more importantly it gave me moral references that I use in daily life.
All of us have experienced being physically ill at one point in time or has had a loved one who got diagnosed with an acute or chronic disease. The feelings of helplessness and impending sense of doom are a commonplace. As well as, get confused and lost in the medical jargons, worry about what happens to me and my family after this, do I get better or not, will I die, and many other concerns. Imagine it being so much worse for those who have no money, not even a peso for treatment regimens and diagnostics. I have seen on numerous occasions, family members wearing tattered clothes and worn out slippers maybe even barefoot running towards the emergency room carrying their loved ones who are unconscious or having difficulty of breathing.
I cannot even quantify how long the lines are in the free outpatient clinics and in the Philippine Charity Sweepstakes Office (PSCO) to apply for monetary support. It is not unusual to see families beg, or sell their livestock and lands. Sometimes, the caretakers themselves get sick while watching over their ill family members. It is heartbreaking to remember these images. In their eyes you see despair and desperation. Even the most stoic of my colleagues will at times choke up while hearing their histories, and their living and financial situations. What’s worse than the above stated is this statistic: Four out of ten Filipinos die without even seeing a doctor1.
Disease and poverty is the deadliest combination there is. It is the absolute worse curse and the most unfortunate demographic you will ever want to belong into. Despite the 0.9% increase in the government health expenditure from year 2000 to 20102, we are far behind from other countries. Health authorities state that the health expenditure should be at least 5% of the Gross National Product (GDP)3, the Philippines is at 4.1%4. As a mere doctor, I have very little knowledge on budget allocation and distribution. But every time I attend to a dying patient, especially the ones that could have been saved if not for a more efficient healthcare delivery system, my heart aches.
27.9% Filipinos are below the poverty line, or approximately 23million5. With more than one quarter of the population living below poverty line. These families are surviving one day at a time, with frankly little to no contribution in the productivity and advancement in the economy. Health is an inarguable and fundamental part of human resource. Albeit the existence of the public hospitals, regional heath units and barangay health centers alongside present health programs, there is an ever growing and colossal demand to meet in terms of healthcare in the country. The present health care delivery system employed by our government is functional but not optimal.
The interns bringing their own stash in public hospitals is merely the tip of the iceberg. It is one tiny telltale sign amongst a multitude of indicators we choose not to see and confront. The healthcare problems we face in the Philippines are deeply rooted. The journey to its resolution will witness many presidential administrations and it will entail more than a lifetime to fix. The core of the problem I believe is a combination of corruption, disunity and ‘walang pake’ (nonchalant/couldn’t care attitude). People do not actively think and care about healthcare until they are experiencing adversity. As with most things, we do not complain, are not vigilant, and do not have insights on improvement until we experience the problem first hand. Similarly the government, wherein the healthcare system is fully reliant on for financial budget and decision-making, has so many issues with red tape and corruption. In the light of the pork barrel scandal, I am awe stricken on how brilliant they are in finding ways to launder money. The level of intricacy and its effective outcome is astounding. Maybe if we put these people in health care, they can help device strategies on how to make the health care delivery more efficient, thereby lesser people will die.
With the magnitude of healthcare problems entailing herculean solutions, as individual citizens we may feel that we are rendered helpless. This manner of thinking is understandable but not acceptable. Cells in the body do not work as a singular unit; they work together to make the whole body function. Comparably, each of us has the power to make our healthcare system better. Stop complaining, seek to understand and help. To put it simply, care enough. Care enough to want to so do something to help. Observe good health practices (daily bathing, tooth brushing, hand hygiene, exercise, balance diet. Etc.), teach your children, family and household staff. Strive to be healthy in mind, body and spirit. Stay informed; keep up to date with the health advisories. Participate or spearhead small community health activities. Cooperate in population studies because it helps the government understand us better. Truly, we undervalue the power of small positive acts. We can lessen the burden by becoming a citizenry that cares enough to act and help. We ourselves are agents of change, one person at a time, one step at a time.
On my last duty in PGH, I remember a patient’s mother hand me this sizeable pineapple from Cavite. She generously insisted I take it and told me that was the only thing she could afford to give me for the service I provided them. I thanked her profusely and as I left the ward I couldn’t stop my eyes from welling up. Despite the healthcare problems our country faces, the underserved and the uninsured deserve to be fought for and to be helped. They cannot be forsaken. I went home that day holding the pineapple as if it were a treasured trophy. Maybe it was, the call to help was answered in my own little way, one step at a time.
(Editor’s Note: Dr. Elise Nicole Catalan is currently finishing her Master’s degree in Public Health at the Icahn School of Medicine at Mount Sinai in Manhattan’s Upper East Side. She intends to go back to the Philippines and serve in the hospital system there, where, she said, “she is needed most”.)