Joey M.D.

When asked “What is the problem with the Philippine Healthcare System?”, I had so much to say. But I think it boils down to the fact that health care is not considered a priority. Not by the government. Not by the patients. And, sadly, public health is something most doctors don’t prioritize either. I even think mass media should prioritize health care, too, and they don’t.

Government:

Even in Metro Manila, where there are public hospitals already, the bed capacity and the number of health personnel are simply not enough for the number of people seeking relief from whatever ails them. You can see that in some public hospitals, there are 2 or 3 patients sharing one bed. There are not enough incubators for babies needing them, not enough respirators, and very little available medicines to be given to the patients.

It gets worse when you realize that the poor in Metro Manila are still lucky, because they do have the means to go to the overcrowded hospitals. Outside Metro Manila, the hospitals have even less beds and less available necessary life saving equipment. In more out-of-the-way areas, patients need to travel DAYS just to be able to reach the bayan to seek medical treatment.

On the realm of primary health care, are there enough health centers and do they reach all the people they should? I doubt it. Children remain unvaccinated, adults remain blissfully unaware of the dangers of smoking, the effective ways of birth control, the simple ways of preventing infectious illnesses.

I am not a government person nor an economist, but I do know that whatever percentage of the national budget is spent on health care is simply not enough. The devolution makes things even worse, as the budget is now taken out of the local government budget. For a small, poor community, that means that the budget for health care has been even lessened.

Patients:

For the poor who earn their wages daily, the big part of their income, if any, goes to food. If there’s any left over, they would spend it on other essentials like clothing, rent, toiletries. They would just go to see a doctor if and when they get sick. And not immediately, but when home remedies and self medicating with drugs recommended by relatives and neighbors do not seem to offer any relief. If they do, they cannot and will not buy the whole course of the antibiotics prescribed by the doctor. They will just buy a couple and if they feel better, they stop. Medications that need to be taken as maintenance? They won’t. They’ll just buy when they feel bad. They would defer important surgery unless it’s totally free because they just don’t have extra money for it. That’s because they don’t have enough money for situations like this and for them any extra spent on health care and medicine is simply “gastos” and would mean that their family would not have enough food for the next day.

However, ask them to stop their smoking, stop their drinking, and for diabetics, stop their intake of sugary foods, stop their intake of salty and fatty foods — and they ignore you. They’ll say yes to your face and do just what they want to do.

Primary health care is a bit ironic here. While 6 vaccines are available free at health centers, not everybody goes to avail of them. Sometimes it’s just due to ignorance — information dissemination may not have reached them. Others would not want to make the effort to fall in line. They’ll buy infant formula and dilute it with unboiled water (because these are expensive) when the best milk, breastmilk, is readily available and free. If and when they know about birth control, they don’t want to spend on this either and leave everything to God. That results in more kids, more mouths to feed and less budget on medicine.

Even among the well-to-do, there is still the problem of patient compliance. Even if they had the extra money, some people just won’t spend on medications. They won’t stop smoking, or drinking, or follow a diet either. They won’t follow up on the appointed date because they have better things to do and they feel better anyway…and the doctor’s fee is sooo expensive (although they would spend more on their haircut). Ah, well, they are the losers when the health deteriorates and they ultimately only have themselves to blame.

Doctors:

There is a reason, why I am in Metro Manila, in what is deemed to be “overcrowded with doctors”. I have not joined the ranks of those who have left the Philippines with a nursing degree for a paying job abroad. But neither have I joined the brave ranks of those who choose the serve the poorest of the poor in the most out-of-the-way areas.

I am no heroine. I am a doctor, but I am also a mother. This means that my priority is my son. Service to the poor, unfortunately cannot take precedence over being with my son in his formative years. Nor can I bring him to the hinterlands with me because I want him to have the best health care available, and in the Philippines, that means Metro Manila. I want him to be as close as possible to his grandparents, and that also means Metro Manila. I want him to attend the best school I can, and most of the best are still in Metro Manila. Although there are also good schools outside Metro Manila, they are not exactly in the poorest-of-the-poor areas.

My husband and I are both doctors, and we need to earn for my son’s needs. Although a private practice is not lucrative when you’re just in your first few years, it has the best potential for growth. And during the time of growth, we need to stay near our comfort zone, our parents, who can lend us some money during the times of emergency. Who’ll offer us a rent free home complete with 3 meals. Yes, it’s embarrassing but it’s true that we’re not financially independent yet and cannot even afford to live apart from our parents. Our practice is still growing. But while on our path of growing our practice, our mothers are at hand ready to help us financially, emotionally. They even help look after our son when we have to be away.

Those are my reasons. I’m sure other doctors have their own reasons for choosing not to go into public health.

Medical education is ridiculously expensive, especially if you studied in a private institution. Not only that, during the productive years of your life wherein you could have started working and investing, you were literally burning the midnight oil studying or training in the hospital. Then you get married, and raise a family. Of course, like everybody else, you need money — for your food, clothing, shelter, health care (yes, it’s not free to medical practitioners although other doctors waive their professional fees as a courtesy), children’s education, etc. Oh yeah, if you’re an ophthalmologist like me, you would have also spend a large part of your parents’ money on your clinic equipment and surgical instruments.

Then, armed with your medical license, your idealism, and whatever bravado you have, you enter the brave new world of practicing medicine.

And, find, to your dismay, that you earn less than your former high school classmates who didn’t go on to medicine and had office jobs after graduating from college. Especially if you follow your ideal of “serving the people” and go on to government service. Not only that, you get major disappointment when you find that sometimes, despite your best effort, people still don’t get well, people still die. Because they don’t have access to life saving medicines. Because they don’t have money to rent life saving equipment. Because of myriad of factors.

Is it any wonder that a lot of idealistic doctors become rather cynical? Is it any wonder that doctors leave public health? Or, ultimately, leave the country?

Mass Media

I think mass media could be better tapped for spreading correct health information. In the remote barrios, sometimes the only means of reaching them are through radio, or maybe TV. Educational health programs should do a lot to help the people with their health care. Teach them what to do to avoid dehydration during a bout of diarrhea. Teach them the benefits of vaccination and announce vaccination days so they can bring their children to the centers. Teach them how diseases can be prevented by simple measures of hand washing and boiling of drinking water.

There is so much that mass media can do. But, again, this is not a priority. On TV, telenovelas starring the hot young stars of the moment are much more profitable. Sigh!