Go forth and multiply... responsibly

"Iloilo Representative Janette Garin, a physician, said her bill was centered on educating the public on reproductive health and allowing couples to choose between natural and artificial family planning methods."

Now, what can be wrong with educating the public and allowing them to choose? Really.

Prudence MD invites us to share our views on The State of Reproductive Health Care in the Philippines.

Here's mine. I have nothing against those who are fighting the Bill, especially the Catholic Church. What I have against are the implications of this resistance to our nation.

1. Only 82.27% percent of Filipinos are Catholics. What about the other 17.73% who can actually make use of the artificial family planning methods?
   

2. Are Filipinos stupid that they can’t decide for themselves when given a choice between artificial and natural family planning method (NFP)?
   

3. Aren’t we shortchanging Filipinos in general when the Reproductive Health offers only NFP methods?
   

4. What happened to free will?
   

One of the many things that I have picked up from the Doctor to the Barrios Book series of Dr. Juan Flavier is his belief in INFORMED CHOICE. Meaning, offer several information/option to a patient and let him/her choose. I mean, if we limit the choices to natural methods of family planning, where is the choice in that?

5. I thought that it was eons ago when the State and the Church separated? Are we seeing a comeback of Father Damaso?
   

What ticked me off the most is the fact that our President GMA can’t even separate herself from the Church. Remember her recent State of the Nation Address where she insisted on natural methods? Was she afraid to lose the Church's support? Well, she there's not much of it to begin with. At least, the Former President Fidel Ramos had the balls to make a stand (even if it is against the Church and he could lose its support).

Where and when does the State’s independence start and Church’s influence end? In fact, Rep. Garin revised this Bill, taking into consideration the Catholic Church.

6. Natural family planning methods are the least effective of all the methods of contraception as proven by several studies. Does the Catholic Church even read these?

On a personal note, I am highly frustrated about the opposition that this Bill is getting. I see mothers in the barrio who are gravida (number of pregnancies) 14 or higher and these are not isolated cases.

Does the church even realize what 14 pregnancies can do to a woman, to the child and most especially to this country who can barely support its people?

If using a pill to prevent fertilization is sinful, let me ask you this: is it not equally sinful to bring a child to this world whom you cannot even feed, clothe much less, send to school?

~~~

Photo from here.

This is a contribution to The Blog Rounds 18 at Prudence MD: The State of Reproductive Health in the Philippines. Read more!

The Blog Rounds 6th Edition

Sick citizens lead to a sick nation. No doubt about that.

With the Philippines facing numerous healthcare issues, from low budget to overly expensive health care, from brain drain to underpaid and overworked health care workers, the front liners are now here to offer pieces of their minds.

photo courtesy of Lyle Lahey Editorial Cartoon

The 6th edition of The Blog Rounds tries to give light to the challenges facing the Philippine Healthcare System. Medical bloggers attempt to diagnose, explain the pathology, and even suggest management options to this barely breathing system, where they work (or used to work) for.

SHOW ME THE MONEY. Chronicles from the Middle of Nowhere talks about the painfully obvious problem of no budget for health. The patients she has seen are what see calls the The Lucky Ones because they were able to reach the hospital at all. She describes the system as that does what it can, ill-equipped, severely underfunded, but always working with the best of intentions.

The Saga Continues simplified what is wrong in A Sick System: if you have money, you can get treated. If you don't, sorry. Plain and simple, harsh but true. This very straightforward blogger ends this by saying we just have to do with we have, for now.

BRAIN DRAIN. Prudence, MD's top commented posts are mostly related on the greatest challenge our healthcare is facing -- brain drain. M.D.s on Strike discusses why doctors are and should be leaving while they can. In We are responsibie for the shortage of doctors, not the rich nations, she dwells deeply into why we should look within the country for the solutions to our problem.

The Bubbleman have several posts too. In Why Stop Me? I Am Leaving As Someone Else, he reacts to the Secretary of Health, Dr. Duque's idea of banning the deployment of doctors. In What is the real living proof of RP Doctors' skills?, he expounds on Filipino doctor's proof of skills as not based on a 64-slice Computed Tomography machine but based on his desire to serve his countrymen WITHOUT the benefit of that 64-slice thing.

IT'S COMPLICATED. Beyond Borders: The Lei Si Chronicles, sees the complexity of the system in What seems to be the problem? From “welfare state” country with outdated practices to expensive health care and unending comparison with the United States. But she believes that the most important illness that this system is going through is moral poverty.

An Eye Doctor In A Third World Country details on how the 'rotten' practices of other eye physicians in her hometown have caused undue damage to all of them, especially, starting, well-meaning ophthalmologists like her. Meron ba tayo nyan? Cheeseburger? uses humor to lighten up this very serious issue with our primary health insurance provider, PhilHealth.

Freudian Slip, a visiting blogger, cites several pathologies as to why this tricky machinery, a.k.a., healthcare system is failing. Working in a devolved setting, he has seen why the devolution of the public health system has made it even worse in Philippine Healthcare System. This entry by the way, is the first post to be submitted for this round.

Parallel Universes uses the analogy of the disease staging to illustrate the severity of the system's condition. What stage are we in? Read Diagnosing Philippine Healthcare: When Dying Becomes the Better Option when he asks several questions on long standing laws in the country, analyse the key players and ends with the more alarming reality and diagnosis is the growing apathy about the whole situation.

SKEWED PRIORITIES. Joey M.D. enumerates in Not a priority! how health is not given due importance by this government and patients, which in turn makes a doctor’s practice even more difficult. She even suggest a simple solution that maybe, just maybe, media can do their part in disseminating health information. But again, that is not their priority! Frustrating, isn't it?

Ripples from the River of My Thoughts bring us back to how it is to lose a patient, for the first time in her post Who's to Blame?. This doctor in training relates this experience in trying to figure out who’s responsible for her patient's death: the people behind the system. That would include corrupt government, patients who don't prioritize their health, anesthesized health workers.

WORLD'S APART. Anthology of Abner Hornedo, MD sarcastically posts Is there really a system? pun intended, from the Land of Down Under. His frustration is magnified in this statement, "I cannot compare the Philippine Healthcare system with Australia's Medicare. There is no point of comparing... ang layo talaga at ang laki ng kaibahan!"

On My Way Home, makes us realize that as part of the system, we must look into what we are doing: complaining and doing nothing results to nothing. Letting things as they are may be the path with least resistance but it doesn't solve anything. Philippine Healthcare System ends with these strong words: It is simpler and safer to be part of the problem.

Another visiting blogger, Nelia, compares the Emergency Room Setting of Philippines and Australia. The big difference? Accessiblity. She suggest treating the patient wholistically, and not only the disease, to at least compensate for our problems way back here.

SILVER LINING. Pinay Megamom compares going through the Philippine Health System as taking the History and physical examination of a chronically-ill patient in her post Pipti-pipti. Why the title? Read the post and she will show that things are not as hopeless as they seem.

At Random Ness contributed the most optimistic of all the posts, in the nick of time. The good, the bad and the ugly enumerates the different efforts of their provincial government to improve their health service and despite the endless list of bad and ugly things, there is, after all, something to smile about. Hopefully though, this very uplifting entry is already posted by this time.

Doralicious gives a very different but uplifting light in Philippine Healthcare System: Why is it far from the ideal? Being both a physician and a Councilor in Quezon City, she details how the government can't be solely blamed for what's happening. Or better yet, let's just all stop blaming or pointing fingers and do our part. She aptly ends this by concluding, "It is the inter-relationship of all the parties involved that cause our healthcare status to be this dismal... THERE IS HOPE." Very well said Councilor.

In case you are wondering what the host has to say about this? Health in the hands of the people suggests a simple solution to our ailing system-- focus on primary health care or preventive medicine. It may not be the ideal solution, but it is what this nation can afford and what the people can do with what we have right now.

It's a daunting task to try to figure out what ails the very system where we are parts of. But coming up with solution/s is or will be an even greater task. As we engross ourselves in these socially relevant posts, let us always keep in mind that most of us, if not all, are part of this very system we tried to diagnose.

"Knowing is not enough; we must apply. Being willing is not enough; we must do.” -- Leonardo da Vinci

Now what can we do? What will you do?

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Watch out for the next edition of The Blog Rounds in The Orthopedic Logbook. Who's hosting Bone MD? -- So Far So Good is hosting, by the way, for the 7th ed of TBR.

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Health in the hands of the people

Not your usual. No, I am not discussing the very low annual health budget (which is only 2% of our annual budget!), brain drain, overworked and underpaid health workers, the skewed priorities of our politicians, or the corruption that debilitated the healthcare in this country. For I bet my right, and even left arm, my fellow health care workers will discuss these in their own post.

In this time where the Philippine healthcare system is being challenged with the same issues, we must come up with solutions dealing with what we have, what we can do and where we are right now.

Primary Health Care. The focus on curative more than the preventive aspect of health is one of the most important but less discussed issue in a system like ours. Even in medical school, preventive medicine is not given as much as importance as the other major specialties. In return, the laymen have come to practice the same thing – depending on the damn pills for everything.

Primary care is anything that focuses on the preventive aspect of a disease. The 10 leading causes of mortality and morbidity in this country are mostly preventable and infectious. Now, if primary care is advocated and vigilantly taught to our countrymen, these data might just change. If only, half of those who smoke right now stop completely, the rate of cardiovascular disease in this country will decrease in due time.

Image from hapi naples

Health in the hands of the people. With politician like ours who don’t give a shit about the health sector, whose definition of healthcare amounts to medical missions prior to election, we have to empower the people. Make them realize that their own health is their responsibility. It is neither the government’s responsibility (even though rightfully, it should) nor their doctor’s responsibility.

Laymen should be taught, first and foremost, that their most common illness – acute gastroenteritis, pneumonia, hypertension, upper respiratory tract infection, to name a few, are all preventable. Health is reachable and it is cheaper if you start early.

Healthy Lifestyle. A doctor cannot overemphasize the importance of healthy lifestyle. Proper diet, moderate alcohol intake, no smoking, exercise. This entails little, if not zero, monetary investment at all. Every one can do this. The total return, patients have to worry less about money for hospitalization of some common but preventable diseases. In cases like hypertension, if only it is detected early, eating habits are corrected, less and less people would be needing maintenance medication.

The old adage an ounce of prevention is always better than a pound of cure won’t last for years if it wasn’t true. Healthy lifestyle will definitely lead to healthier Filipinos. Healtheir Filipinos lead to a healthy country, well, hopefully.

More importantly, hospitals will also be de-clogged of patients seeking acute care. This just might do the trick in lessening the work of our underpaid health workers.

I know, I know, most of you are thinking this is like an ideal but far-fetched solution. But it will do in a situation like ours where we always end up in dead end. It might take awhile to see it's effect, but it will do. At least in the rural areas who are most deprived of the health services.

Seek care early. Finally, in case primary care doesn’t work, especially for more acute illnesses, please, please, seek secondary care EARLY. Don’t wait for a 3 cm breast mass to grow up to 10 cms with lymph nodes to go with it. Money is not, and should not, rule you when to seek medical care. Besides, will you ever have enough if your disease is growing proportionally with your medical needs? Really. Remember, God always provides.

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This is my entry for the 6th editon of The Blog Rounds, which this blog is hosting for this week.

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Sixth Edition of The Blog Rounds: Philippine Healthcare System

A few weeks back, there was this CNN special where Dr. Sanjay Gupta discussed the health care system of the USA and how it pales in comparison to that of the other countries like France, Canada, United Kingdom, Australia and Italy. USA? Paling in comparison? What about OUR health care system? Would it look utterly anemic or deathly pale in comparison then?

France, according to the World Health Organization, have the best health care system in the world. What's WHO's criteria? That for a health care system to be considered 'ideal', each and every citizen of that country should have access to health services, or at least the basic health services. Each and every citizen includes the unemployed, those who live on the streets, in prison, retired, whomever.

The Philippines ranks 60. Yes, 60. Our neighboring countries who fared way better than us are Singapore (4), Thailand (47), and Malaysia (49). But we fared better than India (112), Indonesia (92), and China (144). But that's not any consolation because we know, we are still FAR behind. Why is this the case then?

In relation, let me introduce our theme for the 6th Edition of the The Blog Rounds.

Philippine Healthcare System: Why is it far from the ideal?

This is about the social/cultural/political (maybe even spiritual) issues (or causes) that you can think of why our health care system is far from being ideal?

Bakit hindi lahat ng Filipino na may sakit o gustong magpatingin sa doktor ay natitignan ng doktor?

Where is the GAP? Is it the health budget? Our politicians or legislators? Is this government incapacitating us to deliver basic health services to every Filipino?

Or maybe, there is also something wrong among us medical practitioners? Those physicians who treat their pockets more than they treat their patients illness? On the other end of the spectrum, do we have overworked, underpaid health care workers, who in turn, can't give ideal health service? What about the Philippine Medical Association? Yeah, what is its role in all of these?

What about our patients? Is it really just about the extreme poverty in this country that prevents our patients from seeking health services or is it MORE than that? Like skewed priorities?

For those who practise/train in other countries, we would really appreciate hearing your analysis as to why we are far behind, in comparison? Both in terms of the system and the people behind it.

Please be radicals , activist or advocates of change, if possible. No holds barred. No censorship. Just give it to us, at face value, ano ang bulok o MALI sa sistema (kung may sistema man)? Bakit marami pa ring Pilipino ang namamatay na di natitignan ng doktor? O kung natignan man ng doktor, di nabibigyan ng karampatang lunas?

So that just in case Secretary Duque or our President, or any body who is in power to do something, runs into any of our posts, they might just wake up and realized what's wrong. And start doing something, of course.

Please send the URLs or links to your posts to merricherri[at]gmail[dot]com on or before April 21, 2007 at 5:00 pm (Philippine time). Or just leave a comment in my blog and I will come visit your page.

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The topic for this edition of The Blog Rounds was originally laid back but Dr. Ness of At Random Ness did a great job of hosting the best laid back topic ever -- I know what you did last summer. Thanks to Pinoy MD though, because coming up with a new topic was an easy fit when I came across its forums. The topic for this 6th edition of TBR was inspired by the thread Grand Challenges in Philippine Medicine.

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Going around it

Language has always been the most difficult part of my stay here in Ilocos Sur. As I’ve mentioned in my previous blogs, I don’t understand a world of Ilocano, much less use it.

I knew that I could have been more effective if I speak and understand Ilocano. Sometimes, I get really frustrated because I cannot get my message across to patients. Like how in the world could my interpreter, usually a midwife, explain to a patient, in Ilocano, that the improper use of antibiotics can give rise to resistance? Or that an aortic abdominal aneurysm is usually caused by atherosclerosis and that it can rupture anytime?

In fact, there are activities that I cannot implement in the barrio – like mother’s class, or lectures on several health programs – for very obvious reason. It would be entirely pointless because the older residents in the upland barangays barely understand Filipino, much less English, and those 2 are the only medium that I will use. It’s like speaking to a blank wall and for them, it’s like watching a Chinese movie. If I wanted to implement this, I would have to ask my staff to speak for me and that is all against my work ethics – doing thing myself.

As I was doing my consults in the first two months, I realized that the younger population in this municipality speak and understand Filipino more than the mature population – because they are more exposed to TV and they already use Filipino as medium of instructions in school. I figured, why not focus on this group? Besides, my FLCD (that would be Family Life and Child Development) degree could be put to use here.

And so I did.

Today has been one of the most fulfilling days since I got deployed here. I gave an audio visual presentation on healthy lifestyle to the elementary students of the Alilem Central School. It may be hard to imagine, but brushing of teeth and wearing of slippers is not a basic need for some kids here. For them, basic would include only food because they only earn enough for that. So my AVP included washing of hands, brushing of teeth and wearing of protective gears. And thanks to my friend Poy and her officemates, each kid was even given a set of toothpaste and toothbrush, kiddie size of course.

For the first time, it felt like my message was getting through. I kind of missed my pre-school teaching days too. But most of all, I realized that you never let one obstacle stop you from getting to your goals. If you can’t get through it, why not go around it? If I can’t be understood by mothers, then why not their kids?

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