Philippines

Philippine healthcare system was already walking in crutches

By Joel Pablo Salud

Healthcare is the nation’s ability to address concerns related to the public’s well-being, be it physical, emotional, psychological. 

The arrival of Covid-19 in Jan. 2020 tested our country’s capacity to contain the virus. While there are no easy answers to the continuing pandemic, it is crucial to understand where our healthcare system stood prior to the new coronavirus’ arrival. 

Dr. Mutya Espina-Varona’s recent post on Facebook is an eye-opener. It gives us an alarming scene of the enormous challenges our healthcare system is facing. It has long been said that the country’s capacity to address health matters is amputated at best, what with factors that continue to evade all attempts at improvement regardless of the efforts made.

Funding, of course, takes centerstage. Without it, no exertion to manage outbreaks would be possible. The number of health workers like doctors, nurses, medical technicians, come in a close second. 

The capacity of health facilities like hospitals and clinics to accommodate and care for huge numbers of patients during a national health emergency brings to light what the country has so far achieved, or failed to achieve, in this regard.

The multiplicity of problems that go with the onset of infectious or fatal diseases—clinical depression being foremost in the list—add to the growing number of concerns that need immediate answers.

Based on Dr. Mutya Espina-Varona’s social media post, our healthcare system has been neck-deep in problems from the very start:

“Overwhelmed are for ordinary days—it refers to the number of patients we see. But times have changed. We see less patients, but we are now engulfed by the consequences brought by this pandemic. This is where our health care stands, always have been. This has been a problem, even without Covid-19. We, as a tertiary regional hospital under the Department of Health, cater to the most unfortunate ones. We see those who cannot afford to have a private consult; buy and maintain their medications; people who will wait—choosing first to put food on their family’s table until such time they can no longer bear it […] These people rely on social services, on Philhealth. They almost always want to seek help. But poverty remains a hindrance. And yes, it kills you. They do not have the privilege then, more so in our current state. And when Covid-19 came, it kills you so much more to see them defeated and lose hope.”

“Overwhelmed”

“Overwhelmed” is quite an understatement when seen from the looking-glass of statistics. In 2019, doctor-patient ratio in the Philippines stood at one physician per 33,000 patients, with only 70,000 doctors out of the licensed 130,000 going into practice, according to the Philippine Medical Association.

With these figures, it comes as no surprise that the chances of Filipinos living in far-flung provinces to see a doctor had been close to nil.

While it is encouraging to note the changes in statistical data during the arrival of Covid-19, in many areas outside of Metro Manila, the problem persists. 

Statista, a health-based research group, pegs the current doctor-patient ratio in the Philippines at 10 per 10,000 as of April, but only within the National Capital Region (NCR). The Cordillera Administrative Region comes close at 6 per 10,000, with Zamboanga Peninsula coming in last at 2.5 per 10,000.

It is apparent from these figures that the Philippine healthcare system was already walking in crutches by the time Covid-19 arrived.

Dr. Espina-Varona continues: “My heart breaks especially for our cancer patients. Since we went on lockdown last April, we had patients who were lost to follow up. We had patients scheduled for operations, but were cancelled. What can they do? What can we do? In ordinary days it was hard for them. Without transportation and support, it was the most difficult of times. I cannot imagine their dilemma. It was like choosing and wanting to live, but how? They had a fighting chance—but now they are losing the battle. And when the quarantine eased, some of them came back after months. And medically, you knew what was coming.”

Cancer is third

Cancer is third in the list of top 10 causes of mortality in the country, based on Department of Health (DOH) figures. Roughly “189 of every 100,000 Filipinos are afflicted with cancer while four Filipinos die of cancer every hour or 96 cancer patients every day, according to a study conducted by the University of the Philippines’ Institute of Human Genetics, National Institutes of Health,” the DOH says.

To give you a bigger picture of how cancer and three other deadly diseases wreak havoc in the country—aptly called the “four epidemic non-communicable diseases (NCDs) or lifestyle-related diseases (LRDs) which also include cardiovascular diseases, diabetes mellitus, and chronic respiratory diseases,” the treatment of which had been sidelined in view of the Covid-19—the DOH says, “the NCDs are now considered a ‘silent disaster’ of massive proportion that is ravaging the Filipino population, killing 300,000 victims a year, 800 every day, and 33 every hour. Its toll on lives is likened to ‘two 747 planes packed with passengers crashing every day’”.

Even with a doctor-patient ratio of 1 per 1,000 in NCR, it is nearly impossible to be of service to patients other than those suffering from Covid-19. The pandemic called for a “all-hands-on-deck” scenario. And with an average of 4,000 to 5,000 new cases each day, this leaves many with cancer and other deadly diseases waiting in line. 

Let’s not even go to pregnant women, who, by reason of the perils associated with Covid-19, are advised not to consult inside hospitals.

The doctor continued: “During my previous Covid rotation, we were informed by a family, that one of the previous patients I operated on, before any of this happened, ended his life. He was already undergoing chemo that time. The last time I saw him, he smiled, as he always does. I was shocked. I was devastated. Saddened. Angered. I may not know the circumstances why he chose to do what he did. I may not know what made him do it. Whatever it was, know that I prayed for you, to rest easy. And I prayed for all the others, too. The family sent us a photo of him, with a mask, in their house, with him holding a manila paper, thanking each and every one of us. I cried.”

Depression

While debilitating illnesses like cancer or Covid-19 are not included in the DOH’s list of reasons why some people choose to end their lives, it is important to note that clinical depression is as real a condition as the pandemic in our midst.

“Each year in the United States, depressive disorders affect an estimated 17 million people or about 14% of adult person; 10% in Germany; 7% in Brazil; 4.2% in Turkey; 5.3% in the Philippines (Perlas, 1994). One in four women is likely to experience an episode of severe depression in her lifetime with 10-20% lifetime prevalence, compared to 5-10% for men. The average age a first depressive episode occurs is in the mid-20s, although the disorder strikes all age groups indiscriminately, from children to the elderly. Common among those without close relationship, separated and divorced,” says the DOH.

According to the World Heath Organization (WHO), “Despite progress, one person still dies every 40 seconds from suicide.” This situation puts doctors and nurses on extra alert while fighting enemies on two other fronts: a raging virus on one side, government neglect and insensitivity on the other.

Everyone deserves a chance

“Do not make us choose who deserves to live,” Dr. Espina-Varona concludes. “Because neither of us, wants to hear and utter these words: ‘Ma’am, sorry, we’ve run out of rooms for you’. Yes, this is our reality. Hardened by times. We are crying and screaming, for us to be heard—not just because we are tired […] but because we know we cannot help and accommodate everyone both in private and government hospitals. That is why we are making our voices louder: for you, for every patient, for each and every Filipino. Because every one of us deserves a chance.”

After all’s said and done, this is perhaps the reality, brutal as it may seem, that doctors will have to live with for the time being: to make the choice of who must live and who must die. This could’ve easily been avoided if funding—in the billions—earmarked for healthcare had not been lost to corruption.

“Do not treat our colleagues as part of the statistics. Do not treat the Filipino people as mere numbers. You are stealing billions while thousands of us are left to die.”

Salud is the author of several books of fiction and political nonfiction and is a member of the  Philippine Center for International PEN, Unyon ng Manunulat sa Pilipinas (UMPIL) and the Manila Critics Circle.