Up Close and Personal with Philippine Health Care

Dr. Elisse Catalan on a Medical Mission/Free Clinic in Cebu City (Photo courtesy of Elisse Catalan)

During my one year post-graduate internship 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 commenced (red, purple, blue top vials, syringes, intravenous cannula, leukoplast, pulse oximeter and blood pressure apparatus and stethoscope, alcohol and cotton, and the list goes on).

Post Graduate Internship (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 to help expedite my work. With 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 for hospital duty as part of our battle gear. 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 itself to provide service to the uninsured and underserved in our country.

Interns bringing their own supplies in public hospitals are merely the tip of the iceberg.

The choice to do my PGI year in a public hospital was a voluntary and wholehearted one. The lack of supplies was the least of my concerns, rather, I yearned to be in an environment of selfless service amid adversity. Moreover, I had the strong desire to be in the epicenter of health care 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 important, it gave me moral references that I use in daily life.

All of us have experienced being physically ill at one point or has had a loved one diagnosed with an acute or chronic disease. The feelings of helplessness and impending doom are commonplace. We also get confused and lost in the medical jargon. Would I get better or not? What would happen to my family? 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 loved ones who are unconscious or having difficulty 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 would at times choke up while hearing their histories, and their living and financial situations. 

What’s worse is this statistic: four out of ten Filipinos die without even seeing a doctor.

A Doctor's Heartache

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 to. Despite the 0.9 percent increase in the government health expenditure from year 2000 to 2010, we are far behind other countries.

Health authorities state that the health expenditure should be at least 5 percent of the Gross National Product (GDP); the Philippines is at 4.1 percent. As a mere doctor, I have very little knowledge of budget allocation and distribution. But every time I attended to a dying patient, especially the ones who could have been saved if not for a more efficient health care delivery system, my heart ached.

Up to 27.9 percent of Filipinos are below the poverty line, approximately 23 million. These families are surviving one day at a time, with frankly little to no contribution in the productivity and advancement of the economy.

Health is an inarguable and fundamental human right. Despite the existence of public hospitals, regional health units and barangay health centers alongside health programs, there is an ever growing and colossal demand for health care in the country. The present health care delivery system employed by our government is functional but not optimal.

Interns bringing their own supplies in public hospitals are merely the tip of the iceberg, one tiny sign among a multitude of indicators we choose not to see and confront. The health care 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 paki” (nonchalant/couldn’t care attitude).

Dr. Catalan's clerkship year in Cebu Doctors' University Hospital (Photo courtesy of Dr. Elisse Catalan)

People do not actively think and care about health care 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 firsthand.

Similarly, the government, on which the health care system is fully reliant for budget and decision-making, is caught up in red tape and corruption. In the light of the pork barrel scandal, I am awestruck at how brilliant corrupt officials are in finding ways to launder money. The level of intricacy and effective outcome is astounding. Maybe if we put these people in health care, they can help devise strategies on how to make the delivery more efficient, so that fewer people will die.

What To Do

With our health care problems entailing herculean solutions, we may feel helpless as individual citizens. 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 health care 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, balanced 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 to help 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, a patient’s mother handed me this big 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 tears from welling up.

Despite the health care 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. I had answered the call for help in my own little way, one step at a time.

Dr. Elisse Nicole Baricuatro Catalan

Dr. Elisse Nicole Baricuatro Catalan

Dr. Elisse Nicole Baricuatro Catalan is currently in New York for her Masters in Public Health at the Icahn School of Medicine at Mount Sinai in Manhattan. She plans to apply for residency in Gyne Oncology, learn everything she could in the U.S., then return to the Philippines where quality health care is most needed. She hopes to someday help define health care policies there.