Sunday, October 10, 2010

…but only if you can pay

Stewart Sloan

(The Sunday Examiner, Hong Kong 12 September 2010) I visit once every two or three years, despite the fact that my late wife and I bought property and a house in Cebu City. On every visit I notice an improvement in the country’s infrastructure. The roads, the communications and the public services have all improved over the years since my first visit in 1983.

Unfortunately, this cannot be said for the country's health services to the needy, or even for those in the provinces who could afford them.

On my first visit, I was taken to my father-in-law’s farm in the hill provinces of Cebu; Bulak Dumanjug in those days was a village that ran less than half a mile along a dirt road. There were a general store and several small shops that sold daily-need items. There were no communications, and transport to and from the village was by a jeepney that did two trips a day – when its wheels did not fall off!

There were no health services apart from the so-called witch doctors, who diagnosed every illness as having been caused by a spirit. For a few pesos they were willing to bless a candle, the burning of which would drive the evil out.

On the evening of my first day, relatives carried in a young man who had a cyst on his hip and asked me to help him. The cyst was by this time the size of a tennis ball. Although I was not medically trained at that time – I later went on to become a first aid instructor – I could see that hot compresses could reduce the swelling until the puss was extracted.

If there had been no doctors for miles around I might have been willing to at least try something. However, even today I would not be willing to risk a person’s life in the knowledge that there was, in fact, a doctor in the vicinity. "Why didn't you call him," I asked? The answer, even today, leaves a sour taste in my mouth. The doctor would not come, as the patient had no money to pay him.

"I will pay him," I said, still unable to come to terms with the fact that a medically trained physician, who had taken the Hippocratic oath, refused to treat a person because he could not afford to pay him. "I will pay him," I said, but I had no intention of speaking with him or even acknowledging his existence.

In a short while the doctor arrived. He was a young man who carried his equipment and medicines in a black leather bag. When he arrived, the first thing he did was to take his fees and only after that he looked at the patient.

It was a quick operation; an incision to drain the puss, suturing, bandaging and a few pills to ease the pain. The patient healed quickly and within a week was back on his feet. What is terribly sad is the fact that even today, despite all the roads, electricity and televisions, there are still scant medical services available in the hill provinces of the Philippines, and the few available demand payment first.

On a later visit, my wife and I went to the only hospital in the seaside town of Barili, a beautiful little town that has retained a great deal of its Spanish influence. The hospital is on the outskirts of the town. The person we went to visit suffered from diabetes and the disease had caused gangrene in his leg, which had to be amputated.

By the time we visited he had recovered from the operation and was sitting up quite cheerfully in bed. He was grateful for our visit and we spoke for some time. During the discussion a nurse came in to give him his antibiotics and it was then that the patient’s wife unlocked the cabinet beside the bed and withdrew the medicine for the nurse. The nurse administered the injection and returned the unused portion to the wife, who locked it up and went away.

When I asked why the medicine was locked up in the cabinet, the wife explained that patients had to supply their own medication. ""Isn't it supplied by the hospital," I asked? "It could be," came the answer. "But the quality and supply is unreliable and so it is better to personally get it if one can afford it."

This is the state of healthcare in a country where the rich and famous, who travel in chauffeur-driven cars, accompanied by minders and government officials of the health department travel overseas to conferences in which they seek international aid for their health schemes.

It is almost 26 years since my first visit to Bulak Dumanjug. The road is slightly better, with fewer potholes, and villages have electricity by which to watch television. But there are still no medical facilities, no doctors and no clinics. Yes, the jeepneys run more frequently and can transport a sick person to Dumanjug, the nearest town, or the hospital in Barili – but only if you have the money.

(Stewart Sloan works for the Asian Human Rights Commission. He is the author of three works of fiction based in Hong Kong, where he has lived all his life, and a collection of anecdotes about the Royal Hong Kong Police Force, whom he served as a civilian for 11 years. He was married to the late Quirina, who was born in Cebu).

This article was first published in UPI Asia under the title, The cost of ill health in the Philippines.

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