Friday, April 18, 2008

The Lucky Ones

I grew up in the art and practice of medicine in one of the largest tertiary charity hospitals in the Philippines, the UP Philippine General Hospital.

As a leading charity referral center, we received patients coming from all over the country. Most of them, if not all, could ill-afford the medical services they sorely needed. Most, if not all, were riddled by diseases given free reign to wreak havoc on the landscapes of their bodies until they were all but unsalvageable. PGH, for these patients, often became the bastion of last resort.

Even as a medical student, I would see emaciated patients with lumps as big as a melons on various parts of their bodies who would tell me that they have been growing the masses for months. Or the elderly patients with feet all swollen and reeking of gangrene saying their wounds had been there for weeks. Or patients in severe diabetic emergencies who have not been taking any anti-diabetes medications since they were diagnosed. I have heard stories of the same kind from different patients, with different diseases, from all over the country too many times to count.

Frustration was my constant companion. While after so many years I would already know the answer, I couldn't help but ask them anyway. "Why did you wait so long? Why come only now, when there's not much more we can do for you?"

The response was constant as well. They would shrug almost apologetically and say without mincing words, "Ngayon lang po kasi kami nagkapera, dok."(We were only able to come up with enough money now.) Their silent gazes of mixed helplessness and painful hope were heartbreaking. Often all the more so because I knew that without capital and given the late extent of their diseases, there's really not much I could do to help them.

Sure as day, whatever little money these patients have with them runs out within their first day at the hospital. And while there are institutions that could be tapped for assistance, both by the families and by the residents (who are doctors and social workers at the same time), when working with disease, time is a constant and ruthless enemy.

While all of us has had many success stories, both through the generosity of benefactors or sometimes by sheer divine providence, we have also had to watch patients slip away all too often when all that would have been needed to save them was a regular dose of IV antibiotics or other medications regularly given. Or an operation that could not not be done on time because until the last minute, the relatives were still looking for the money.

It was always hard to lose patients this way, but it was a hard reality we came to live with - and had to learn to accept, if, as trainees, we were to stay sane.

On hindsight, I realize now that these PGH patients were actually the lucky ones - because they were the ones who were able to reach our hospital at all. Poor as these patients are, they are not even the poorest of the poor in terms of health care in the Philippines.

The poorest of the poor are those who live in remote places that are hours of travel away - whether by boat, by jeep, by tricycle, or on foot - from any form of health care delivery system. The poorest of the poor are those who live in areas accessible by transport in the heart of the city but cannot even muster the fare to come. The poorest of the poor are those who do not even know where their next meal will be coming from and live from day to day - and will certainly not prioritize a visit to a doctor who will only prescribe medicine they will not be able to afford anyway.

The reason behind this can be over-simplified into one painfully obvious problem: we simply have no budget for health care.
Can I offer any solution to this problem? The answer there is painfully obvious as well.

So in the meantime, I and others of my ilk will continue to be small cogs in the wheel of the Philippine Health Care system - a system that does what it can, ill-equipped, severely underfunded, but always working with the best of intentions. But until things can be changed, inequity in health care will continue to be a fact of Philippine life. All that others can hope for is to be among "the lucky ones" as well.


See the rest of The Blog Rounds, 6th ed, over at Merry Cherry's place.


Panaderos said...

I remember those times when I had to go to the PGH to visit either a sick relative or friend. I always came away from each visit with heartbreaking memories of what I witnessed while I was there.

It's easy for those of us who have the wherewithal to take certain things for granted such as medical care. However, witnessing how even the basics of medical care are beyond the reach of some of our countrymen, kind of puts things into perspective.

Anonymous said...

On the other hand, there are those who can afford to do the right things early on (quit smoking, avoid sweets, good diet, get vaccinated) and yet refuse to. Then when things have gone really bad, it becomes someone else's accountability. Go figure.
Yours is the perfect complement to my post Claire. Shows both sides of a patient's accountability for his health.

Vanessa said...

I can't imagine how heartbreaking this is to watch firsthand. This is a personal plight of mine, those without health insurance that don't get the care they should. When will it be realized that health care isn't something that should only be available to the rich?

dr_clairebear said...

@panaderos: even for people who are relatively well-off, health care costs are appalling. people rarely save up for health disasters, so when they happen it is devastating.

@megamom: i agree with your premise - people do need to be responsible for their own health. on the other hand, there is always some form of denial coming into play when dealing with our health problems. on the other hand, some people simply cannot delay seeking consult because of lack of funds. it's terrible.

@vanessa: we have no full medical insurance system in place here... just one of the myriad problems plaguing the health care system in the philippines. as doctors, it's really difficult to deal with this kind of misery day to day. very, very frustrating work. on the other habd, we also learn the art of making do. we do what we can. *sigh*

Manggy said...

Dr. Heidi! :)

Anyway, I don't stress the point of why they're delayed any more than the history.. It's hard to feel blamed, harder still to feel worse because you're poor. I think the "KASI!!!" mentality is threaded deep into the Filipino psyche...

I think there's a serious lack of health-seeking behavior in this country (but I guess that is true around the world, past the age of pediatrics).

dr_clairebear said...

@manggy: i think that lack of health seeking behavior is a phenomenon common the world over. just a bit worse here, because of the financial problems of majority of Pinoys.

dapat nga talaga hindi tanungin, pero it can't be helped sometimes. nakaka-frustrate talaga all around.

Joey said...

When my cousin was struggling in a Phuket ICU after the 2004 tsunami, she was put on a respirator, chest tubes, and expensive antibiotics. All without expecting any payment from us. I didn't go but I communicated with the doctor-in-charge. Although she eventually passed away, we cannot fault the Thai doctors for doing nothing, because they truly did their best and used everything they could. And my grieving aunt (she also lost her husband and her son) wasn't charged ANYTHING. Everything was paid for by the Thai government. And to think that my relatives were tourists and not locals.

I don't see the same scenario happening here.

MerryCherry, MD said...

The Blog Rounds 6th Edition here. Thanks!

gigi said...

"...and by the residents (who are doctors and social workers at the same time)..."

how true. it happens even in private hospitals.