Medical practice – the poor are likely to die

By DANILO REYES, AHRC
August 31, 2011

The common phrase that the poor suffers the most, in all aspects of life, is not difficult to comprehend. But no one could ever grasp the depth of the poor's suffering in a life in which he was conditioned to live. It is not like an experimental exposure where a person can immerse himself in a situation in order to get a feel, knowing full well that he can simply step out of it when it becomes too much for him.

The experience I had as to how the disadvantaged suffer from the poor state of the medical practice in the Philippines is limited to me, my family and my relatives. I could articulate the experiences of the others but it would be broad and in an abstract idea as to how they have suffered; and my evidence to those experiences are anecdotal.

Yes. If you are poor, you have no political connection, you are not known to the medical service provider and if the latter thinks you have no education, you are likely to die.

Recently, I took my family for a holiday in my wife's hometown, a remote village in the southern part of the Philippines. After having been away for over two years, I thought of our travel as good experience for our two children, the eldest of which is five; and youngest, two. The latter was born in Hong Kong and has not been seen by our relatives since he was born.

A few days after we arrived, both children fell ill. One eldest had fever and was vomiting; and the youngest had loose bowels. In the village there are no taxis; there is an ambulance service but there is no way to contact them. In an emergency the villagers take the patients, some of whom are even dying, to the hospital by themselves – if not on foot, on a public bus or passenger jeep at the highway. These means of transport are only available about ten to twenty minutes walking distance from the house were we stay.

It was high noon, I carried my eldest and my wife our youngest to the highway to go to the hospital which was almost an hour away from where we were staying. After waiting for the passenger jeep to arrive we then had to wait until it was full as the driver was reluctant to leave without a full jeepney.

For me it was an emergency. Try to imagine the scene inside the jeep: I was carrying a plastic bag for my daughter to vomit in; and my wife, who was carrying our boy, was making sure the contents of the malfunctioning diaper of low quality (the best available) did not spill out of his pants. We waited in agony of despair for the jeepney to leave for the nearby town where the hospital is.

Finally we were there. We immediately went into the emergency section of the provincial hospital. Here, I saw an ambulance parked by the door and I wondered how it might be possible to contact the service. I did not see any sign or instructions on how to contact the ambulance service. At that time, I did not bother to find out. I had my two children with me right at the door to the emergency room. It had taken an hour and now we were just as worried and clueless as no one was telling us what to do.

Along the hallway, a hospital staff (probably a nurse), who did not bother introducing herself, asked us why we were there. She didn't stop to talk to us and we had to walk along with her. I had always assumed that in an emergency room where the lives of patients are at stake you do not waste time. Surely, no one would go to such a place unless it was a genuine emergency. Was it necessary for this nurse to ask such an obvious question? Apparently it was.

In an emergency situation the first duty of the hospital staff is to ascertain the immediate situation of the patient. However, without making any such inquiries the nurse arrogantly asked why we did not bring our sick children earlier. Before I was able to answer she told us that if we wanted to have our children attended to by a doctor, we would have to choose between submitting them for admission or just go away.

She then arrogantly demanded to know as to why we were unaware that the doctors at the provincial hospital only serve patients half day every Saturday. Thus, even if we admitted our children they would not be attended to by a doctor until one or two days later.

It was only after I told the hospital staff that we lived in Hong Kong and were staying at a nearby town, that she took the time to explain to us properly how we could get treatment at the hospital; something that should have been a part of her normal duties. My siblings and friends has told me that we were only likely to be accommodated by government employees, such as hospital staff, if they thought we had money, or were a professional and, most importantly, if you arrived at the hospital in a private car.

In this instance all we had was this arrogant woman to deal with. There was no one dealing with newly arriving patients, their conditions being an emergency or otherwise.

There was no apparent system or mechanism. I did not see any instructions on what the newly arriving patient should do to get registered and treated; that they are only open half days on Saturdays; that a patient could be admitted without being examined by a doctor; that patients have to wait until the doctors are available. There were no instructions, only posters from the health department on general public announcements.

When I realised this, what came to mind was not me and my two sick children, but how terribly the poor and ordinary person might suffer daily when they seek treatment from that government hospital in an emergency. Our case was vastly different. At least I had an idea of how to deal with government employees and we, at least, could also afford to go to a private doctor and hospital.

I was told how patients were refused treatment in health centers and hospitals for very petty reasons. My sister-in-law told me a story about an indigenous child, who came down with a relative from a far flung village in the mountains, sent away by health worker in the village because he did not carry proof that he was a resident there. The patient, whose foot was badly swollen was in pain, was refused treatment by the health center. The boy and his relatives had to leave the health center without being treated.

In the remote and far flung villages, villagers do not bother securing referral letters or any documents to prove that they are residents of that village. Most villagers know who live in their village regardless of how far a distance neighbor's house is from the other. The indigenous people, unless they could not remedy the illness in their own, also prefer to treat their patients on their own because – firstly, hardly any of them had any experience of getting treatment from medical services; secondly, hospitalization and medication means you need a lot of money which they do not have.

Even if you can afford to pay or are covered by health insurance in private hospitals, the doctors and hospital staffs make money from you in their own way.

Unlike in Hong Kong, the doctor's fee when you go to private doctors and hospitals in the Philippines is only for the consultation. Medicine is not included. The doctor would prescribe a medicine for you to buy at the private pharmacies outside. The prescription of medicine is where the doctors get money or commission from medical representatives (MedRep). The medical representatives are persons selling medicines for doctors to prescribe. They also have their own way of checking at pharmacies as to whose doctors prescribed what medicine.

Thus, when my wife and I fell sick few days later, the medicines prescribed by a doctor at a private hospital, which could possibly be cheap had it been prescribed as a generic brand, were very expensive. Usually private doctors in private clinics asked the patients what they do for a living (which has absolutely nothing to do your sickness) before prescribing medicines. The medicine that the patient would get depends on the patient's response – depending on the doctor's judgment as to whether the person can afford or not.

At the private hospital where my wife and I went, I could hear a female patient who was sitting next to me, trying to explain to a hospital nurse (who was attending to three to four patients at once) that she be admitted for treatment. The nurse refused to register her because she had no money to pay and she could also not produce a document showing the bus company would cover her hospital expenses. She was being a victim of the bus accident. The patient had not been admitted even after we left the hospital.