Saturday, August 16, 2008

Barrio 101

Perfect way to end my stint as a doctor to the barrio. Read on....

Barrio 101
By Che Zablan
Philippine Daily Inquirer
First Posted 01:38:00 08/12/2008

You would feel the same way if you were me 20 months ago. I was a Manila-educated, Tagalog-speaking, newly licensed physician sent to a remote, fifth-class municipality in Ilocos Sur province as a doctor to the barrio. I couldn’t help but feel important and all-knowing.

However, I wasn’t even in the barrio when it started teaching me lesson No. 1: Be patient.

To get to this upland community takes about eight hours by bus from Manila, three hours from the provincial capital and another 45 minutes from the main highway. You either enjoy the bumpy ride and take in the view of mountain on one side and cliff and valley on the other, or kill yourself with boredom.

Since Filipino is the national language, you would think you wouldn’t have much difficulty communicating anywhere in the Philippines as long as you speak it. During my very first week, this barrio taught me lesson No. 2: Filipino may be our national language, but it is not understood, much less is it spoken, by all Filipinos.

This is true of the patients I see here, especially those who grew up in upland villages. What’s even more striking is that some older folks speak better English than Filipino. So much for knowing the national language. I thought I could survive without having to learn the Ilocano language, but if I wanted to serve them well, I needed at the very least to understand it. And I did.

It was harvest time when I came to this barrio, and almost immediately I learned lesson No. 3: Rice does not grow in grocery stands. Real, hard-working people quite literally break their backs to plant, grow and harvest it. No wonder, during the harvest season we get the highest number of patients complaining of muscle or back pain. If we could learn to value the effort a farmer puts into growing rice, we might not have the crisis we have right now.

A doctor to the barrio is not only a healer but also a manager of the community’s health. I thought I was cut out for the job. After leading student organizations in school, two months’ training in community medicine and with “MD” after my name, how hard could it be? Four months after arriving in this barrio, I learned lesson No. 4: Leadership is earned and learned.

Education and a title can make one an instant leader, but only for a very short time. Effective leadership takes time to learn. One may be named leader because of one’s stature or education, but true leadership requires respect and trust from the followers.

I joined the Doctors to the Barrios Program with the crazy idea that I could change the world. (No kidding.) But after six months, the barrio taught me lesson No. 5: If you want the world to change, change first.

I had a plan in my mind: what to do, what to change. What I forgot to consider was that I was entering a community that had its own system and values, employees who were here long before I was born and structures that took half a century to build. If I wanted to carry out the changes I had in mind, I might as well have built a new community from scratch.

I was the one who changed—with great difficulty. I changed the way I talk, the way I dress (occasionally), what I can and cannot eat. I did all these to fit in and know the community well. Then, small changes followed. I may not have changed the world, but I made a significant difference in a few lives.

The journey wasn’t easy. Most of the time, idealism wasn’t enough to get me through. Reality bumped me hard in the head. I was already in the barrio for nearly a year when I realized that sometimes doing your best is not enough. What put me through rough times was lesson No. 6: When all else fails, pray.

Imagine coming up with a million ideas, only to find out that your budget can only fund one or, if you’re lucky, two of these. Imagine coming face to face with a 70-year-old man complaining of chest pain. You know he is having a heart attack and that he needs to be given medication promptly to prevent further disabilities and then rushed to the hospital. But the reality is, you don’t have any medicine on hand and the nearest hospital is four hours away—by foot. What can you do except pray?

It took me over a year to learn and practice lesson No. 7: Live simply.

I used to consider a cup of Starbucks coffee to be essential and thought missing a blockbuster movie would kill me. This barrio taught me otherwise. It taught me to identify real necessities from the “necessities” dictated by a consumer society. Water is a necessity, but a soda is not. Knowing the latest news is a necessity but catching up with your favorite TV series is not. Weeding out the unnecessary baggage in my life does not only lighten my journey, it also gives me more opportunities to share my blessings with those who need them most.

After a year and half in this barrio, I finally accepted lesson No. 8: Not all politicians are corrupt, but stay away from those who are.

Being educated for four years at the University of the Philippines puts your mind in default: All politicians are corrupt. However as a public health advocate, you encounter all kinds of politicians. Believe me, I have met truly honest ones. One is a village council captain who earns barely enough for his family from politics and supplements his income by farming but still manages to fix his constituents’ problems. Another is a councilor who genuinely has a calling to serve the people and you know this by just shaking his hand. Indeed there are politicians whose hearts, minds and actions speak of honesty and service.

My two years are almost up and this barrio is still teaching me lesson No. 9: Health is in the hands of every Filipino but only a few know this.

The Department of Health, together with nongovernmental organizations, has 50 or more health programs. Few people can name even just 10 of these. For instance, health centers are equipped to deal with primary cases and anti-tuberculosis drugs are given free. If half of Filipinos knew these, then they can be empowered regarding their health. If every parent knew that measles or hepatitis B vaccines are given free to infants, we could reduce the incidence of these diseases in a decade, if not eradicate them totally. If every Filipino knew that enrollment with Philippine Health Corp. can reduce their health expenses by almost half, he would know where and when to seek health care.

If there is one thing about this barrio that had the strongest impact on me, it is lesson No. 10: Humility.

No experience can be more humbling than meeting a farmer whose entire existence is driven by his dream of seeing his children earn college degrees, never mind if he misses a meal or two a day. You feel so little in the presence of teachers who walk several kilometers to mould young minds or a village health worker who earns P200 a month but never complains when she is awakened in the middle of the night to tend to a mother giving birth.

I am humbled by the experience, by the place, but most especially, by the people. You would, too, if you tried living here.

Che G. Zablan, M.D., 29, hopes to enter a residency-training program in a government hospital in two months’ time.


Anonymous said...

another must- read YB article for other doctors.. thanks for sharing your lessons doc che. this is very enlightening. :-D

MerryCherry, MD said...

Your are welcome linapuhan :)

Em Dy said...

I recognized your byline right away but only now had the time to comment here. I was excited while reading it. I feel like I know you personally. Congratulations on a well-written piece!

MerryCherry, MD said...

Thanks Em Dy. :)

rheiboy17 said...

merrycherry: tumaas ang manipis kong buhok pagkabasa ng blogpost mo. i'm so proud of you. mabuhay ka doctor. teka, kung ganun, dito ka na sa maynila, residency ka na adeng? apay?

Anonymous said...

hi doc che, its been a while, naghihintay pa rin ako ng next blog entry mo . :-D.. god bless and godspeed

Ling Xiaoyu said...

Wow! What a recollection! I'm hoping you'll get your residency!

My Mom was a rural health nurse (before she went to a supervisory position), and yup, she encountered the same problem as yours...well except for the language thing, of course!

jerald said...

This girl is really a wonderful person. I have learned a lot from reading her blogs. Che's heart is as big as her and I'm truly proud to be one of her friends! Love you Che, keep up the good work.

MerryCherry, MD said...

Rheiboy17, haan pa doc, nabayagan pa. (Tama ba? hahaha) Exam muna then will know after kung kailan start pre-res. Salamat ng marami.

Linapuhan, hay, busy with the transition. Will blog soon. Thanks for being a masugid na taga-basa. :)

Ling Xiaoyo, thanks! The language thing was a real challenge but I am happy I can understand Ilocano now.Thanks again.

Je, awww, thanks for the visit. Miss you kasi di ka dumating last dinner!

Pinay MegaMom said...

And you probably learned that "nabayag ti agpapokis" means "it takes a long time to get a haircut" and not natives cussing at you, hehe...

You're really worthy of your hero status! Galing Doc Che.

However, as I commented in a previous post of yours, what about sustainability? Why do most DTTB leave their adopted barrios and never return?

Some long-term solutions must be thought out for the shortage of medical expertise in these areas of the country.

MerryCherry, MD said...

MegaMom, when I get the appropriate degree to make a study on that, I will. It's one of my plans to make a study on the sustainability or non-sustainability of the DTTB program.

I was thinking that if the program is effective, there should be less and less DTTBs by this time. But that's not the case.

Anyway, I hope to do that paper in the future.

en|gma said... this the infamous tear-jerking article? Something must be wrong with me...I didn't cry :(( But I took in the essence of your article. Congratulations for learning PATIENCE! You must be a different person now from what I know...the better version...the upgraded version LOL! Hmmm...I'm not sure I have that virtue yet.

bricalz said...

Haha, I have the exact same thoughts about changing the world doc.

Yes, I've thought about DTTB as well, along with Ligaya. And I will always consider it open as an option.

I love diagnosing to much to let IM go. Haha, I may be headed in that direction.

Beautiful article doc. It certainly made my day.

MerryCherry, MD said...

Enigma, tear jerking for some friends. Awww, thanks. I just hope I am really upgraded by the time we see each other down there. You never fail to make me laugh.

Bricalz, thanks. As they say, follow your heart. BTW, would you like to take over my hosting of the TBR on the 22nd of Oct?