What Ails You?

Recently the following article is being circulated in the social media about the dilemmas that a practicing doctor in America is facing with regards to healthcare and how politics is wrecking havoc on them. Such is the sorry state of heath care providers here and abroad.

And it seems that this problem is not something new, as the following article entitled “A Fighting Chance” by Dr. Michael Hussin Muin written almost a decade ago in the Pinoy MD forums, still ring true to this day.

what’s your diagnosis?

The ‘Sell Out’ stigma has since died down. It is now a footnote in the obscure pages of Philippine medical history. But the exodus continues and the situation is a fierce topic in conferences. Even business schools have taken up the issue and debated on the reasons of the plight and flight of doctors and the effects on the public administration of health care. And the conclusion has taken a gentler form. No, they now agree, doctors didn’t sell out, they just gave up fighting.

And what are they fighting for? Among other things, doctors—and other health workers—fight for better pay and better working conditions. They fight for protection from bogus health companies and quacks in government. They fight for stronger organizational leadership. They fight for a better government. They fight for their patients. They fight for their families.

It is a sad fact that bank tellers and call center agents get better pay than general physicians in HMOs and residents in training. Bank tellers may get as much as P15,000 per month while GPs get P9,000-P12,000. Call center agents get as much as P21,000 per month while residents in private hospitals are lucky to get anything over P10,000. People who handle money and customer service get better wages than those who handle lives. This says much about industry standards, whatever that means.

But isn’t it true that all Filipinos are fighting for higher wages? Yes, but the fight is done in different ways and have different effects. When factory workers stop working, production goes down. When jeepney drivers wage a strike, transportation grinds to a halt. But when doctors go on strike, patients die.

I have seen doctors fight for a collective cause. They threatened work stoppage at a small private hospital unless conditions for better pay were met. They gathered just outside the emergency room and carried placards and signs. But the whispers and conversations within carried in them the futility of their efforts.

‘Tawagin mo ako pag may dumating na pasyente.’

‘Akyat muna ako at mag-a-assist ako sa OR.’

‘Sandali lang, andyan na yung follow-up ko.’

These are phrases uttered by the doctors on strike. Even the venue of the strike is crucial. They to sit it out in front of the emergency room and scramble in when an emergency case arrives. Once the patient is stabilized and brought up to the floors, they then trickle back into the strike area, anxious and ready for another case.

Doctors are not immune to the effects of graft, corruption and poverty. Some doctors are unemployed, while others take double or triple jobs. Many doctors look outside the field of clinical medicine for extra income. Some are into related fields like academics and research, while others go beyond medicine and venture into medical transcription, nursing, information technology and selling jewelry and health insurance.

Not everyone has government officials and actors for patients. In Batangas, moonlighting specialists settle for P1,000 for normal deliveries and P3,000 for caesarian sections. In the provinces, doctors are often faced with poor patients—and rather than exacting consultation fees, most instruct the patients to just buy the prescribed meds with what is left of their money.

Doctors are pinned to the wall. If they fight back, people die. But if they don’t fight back—well, they go home tired and weary. In any case, the health of Philippine society hinges on the Filipino doctors’ sense of decency—the decency to put the patient first—above anything and everything, even their own needs.

Hospitals and managed health companies exploit this sense of decency to a fault. They know doctors will not abandon patients. Yes, some paper work will be delayed if work stops, but they have administrative clerks for that. Patients will still be treated, surgeries will still be performed, follow-ups will still be done.

So, how will doctors fight back without hurting their patients? How will they go to the streets and protest unjust compensation? How will doctors fight unseen ghosts and forces that threaten to push them to acts of indecency and selfishness?

By bringing the fight closer to home. Everywhere doctors are questioning the choices that lay before them. While society continues to flourish in the notion that doctors get full satisfaction from public service, doctors struggle to face the harsh reality that life is full of syet. There are no right choices, just promises and responsibilities to keep. There are no wrong decisions, just consequences and the courage to live with them.

The fight to leave or stay—and yes, it is a fight—is not found in the loud voices on the streets and the echoing chants in demonstrations, but in the grave discussions at dinner tables and the whispered conversations when the children are asleep. Because doctors are slowly finding out that living—and leaving—for one’s family is a battle worth fighting for.

For some, it has come down to choosing between loneliness and poverty. Some choose to be lonely, while others choose to be poor. Doctors are not leaving, they are driven away. And these doctors carry their own personal battles in foreign lands, where they fight extreme depths of loneliness and immense levels of uncertainty. Those who stay fight their own battles of survival, where each day is a search for some sense of meaning in the care of other people’s lives.

In the gloom spreading all over the country, people are asking for a chance to get past poverty, a chance to make a difference, a chance to rise above the muck of helplessness. In the current state of desperation, people are looking for a fighting chance. And everybody deserves a fighting chance—even doctors.

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About the author:

Michael Hussin B. Muin, M.D. is the Founder and Editor-in-Chief of Pinoy.MD – The Website for Filipino Doctors. He is a professor of Clinical Anatomy and Medical Informatics in Pangasinan.

Photo credits: http://www.backfixer1.com

Weathering the Storm

Image from the author’s original post

I woke up yesterday to the sound of rain outside my window and news that school and work had been cancelled. It had been raining since last weekend and parts of Manila were under water. I literally had to drag myself out of bed because we still had to go to the hospital. We still had patients to see and take care of at the Philippine General Hospital.

While a tropical storm above the northeastern waters of the country was enhancing the southwest monsoon and bringing heavy rainfall over Luzon, another storm was brewing.

My first patient for the day was Gibb, an 8-year old child who underwent brain surgery for a malignant tumor in his cerebellar region. He was scheduled for an MRI of his head and whole spine.

I saw his mother, Precy, hunched over in prayer, her fingers nimbly going through one rosary bead at a time. I began chatting with her about her son.

Gibb began exhibiting symptoms last year when his family noted that he was becoming cross-eyed. This eventually progressed until the little boy couldn’t stand or walk straight. They brought him to a private hospital in Cavite but decided to transfer him to PGH because of financial constraints. Something we usually hear from a lot of our patients.

Gibb soon underwent the operation he needed. Precy told me they had to use all of their savings and money given to them by her sibling for the surgical procedure. She used to work in manufacturing but had to stop. Her husband, Antonio, currently works as a regular contractual waiter in one of the restaurants in Manila. Both paid taxes. Both had very little. She said it cost them around 60 thousand pesos.

For the craniospinal MRI, Precy shared that she was able to get money from other relatives and from people in her baranggay. She said it wasn’t easy, but she was glad that they were able to come up with the money. I saw the sense of relief in their eyes when Gibb was wheeled into the MRI complex. It was another step towards getting better. Another hurdle passed. It cost them around 18 thousand pesos.

Like most cancer patients, Gibb and his parents were advised chemotherapy. For this, Precy had to approach people in government for help. And as people in healthcare know, it’s no easy task. The 34-year old mother had to secure requirements, papers, and had to take several trips to a number of government agencies and offices. It took her a number of weeks. Precy then began enumerating the Guarantee Letters she was able to secure: P10 thousand from Senator Pia Cayetano, P5 thousand each from Senators Recto, Marcos, and Trillanes, and P2 thousand from Senator Enrile. She also received financial help from her congressman, mayor, and vice governor. All of these, she said, will go to Gibb’s chemotherapy.

Aside from that, Gibb will also have to undergo radiation therapy. The young mother shared that for this, they had planned to sell some of their possessions like inherited jewelry. Papers for aid from PCSO and help from their governor were also being processed.

She sounded hopeful. She admitted that they didn’t expect to end up where they were right now. The whole process of giving their son the appropriate medical and surgical treatment he needed was long and arduous. She said they were tired. There were times she felt defeated. “Para ho kaming nanglilimos,’ she said.

Recently, Janet-Lim Napoles and the P10-billion pork barrel fund scam hit the headlines. I felt bothered, disturbed, and angry. As a tax payer, if things people have been saying are true, I am appalled with how my hard-earned money was ill-spent and allegedly stolen. As a Filipino, I am deeply bothered. I weep for my beloved nation.

If all of the allegations are true, I hope Napoles, her family, and all the other people involved can live a day in the life of our patients. Walk in their shoes. And see how difficult things are for most Filipinos, especially the marginalized ones. I hope they experience the panic and hopelessness our patients face when they are given huge hospital bills prior to a procedure. Or the discomfort of sleeping under the patient’s bed on cardboard mattresses. Or being confined in one of our wards instead of a luxurious suite, where privacy is almost non-existent and where every cough, cry, and sneeze is shared by at least 40 other people in the room.

There is now a movement calling for the abolition of the pork barrel fund. While I am for it, Precy’s and Gibb’s story reminds us of where part of our taxes go and the good that can be done if our financial resources are managed correctly.

Some people have been saying that P10 billion could have bought us new roads and bridges, built new school houses or railroad tracks, paid for badly-needed education or healthcare for thousands of Filipinos. I think that absurdly huge amount of money could have given us something equally important – hope. Hope that the government is investing in its people. That Big Brother has your back during your time of need. That politicians can put the interest of the majority before theirs. That things can get better – not just for some, but for all of us.

I usually just go about my business everyday, reading the headlines. Sure, I get bothered by the troubling things I see on the news. Predictably, I complain with my coworkers over lunch about how our country is going to the dogs, like a couple of rants on Facebook, and then eventually shrug things off. Like the pseudo-couch activist that I am. However, things resonate differently within me now. I’ve decided I’ve had enough and I feel I should do something, even if it’s a small thing. I asked Precy if I could share her story to which she agreed.

On August 26, Monday, people will gather in Luneta asking for an explanation from our government. I hope to be there. Things may not change and we may never uncover the truth. But I hope our voices will be heard. And hope, is hope.

Today, Tuesday, I woke up to the sound of rain outside my window. And while I prepare to go to work, I think about our countless patients like Precy, Antonio, and Gibb and the long journey they still have to take.

It’s still dark outside. A storm is brewing.

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About the author:

Toto Carandang, M.D. is a graduate of UERMMMC Medicine Class of 2003 and is currently pursuing post graduate training at UP PGH. Our heartfelt thanks to him for allowing us to post his article on this blog.