September 2011


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Medical Practice in the Philippines: The Poor Are Likely to Die

Danilo Reyes

The common phrase that the poor suffer the most in all aspects of life is not difficult to comprehend. No one, however, could ever grasp the depth of the poor’s suffering in a life in which they were confined and conditioned to live. It is not like an experimental exposure visit where a person can immerse themselves in a situation in order to get a feel for it, knowing that they can simply step out of it when it becomes too much for them.

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

It is a sad fact in the Philippines that if you are poor, have no political connections, 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 to my wife’s hometown, a remote village in the southern part of the Philippines. After having been away for more than two years, I thought of our visit as a good experience for our two children, the eldest of which is 5 and the youngest is 2. The latter was born in Hong Kong, and our relatives have not seen him since he was born.

A few days after we arrived both children fell ill. Our eldest child had a 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, then on a public bus or passenger jeep they catch at the highway. These means of transport are only available about 10 minutes to 20 minutes walking distance from the house where we were staying.

It was high noon. I carried my eldest child, and my wife carried our youngest to the highway to go to the hospital, which was almost an hour away. 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 low quality, malfunctioning diaper (the best available) did not spill out of his pants. We waited agonizingly in despair for the jeepney to leave for the nearby town where the hospital is located.

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 about 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 to arrive, and now we were just as worried and clueless as no one was telling us what to do.

Along the hallway, a hospital staff member—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 why we were unaware that doctors at the provincial hospital only serve patients half a 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 had 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 attending to 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 with general public announcements.

When I realized the sad state of this level of service, 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 this 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 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 and who was sent away by a 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 but 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 distant 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 neighbor’s house is from the other. The indigenous people, unless they cannot remedy the illness on their own, also prefer to treat their patients themselves because, firstly, hardly any of them have any experience of getting treatment from medical services and, 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 staff 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 prescribes medicine for you to buy at the private pharmacies outside. The prescription of medicine is where the doctors get money or a commission from medical representatives, who are people selling medicine for doctors to prescribe. They also have their own way of checking at pharmacies as to which doctors prescribe what medicine.

Thus, when my wife and I fell sick few days later, the medicine prescribed by a doctor at a private hospital, which could possibly be cheap had it been prescribed as a generic brand, was very expensive. Private doctors in private clinics usually ask patients what they do for a living, which has absolutely nothing to do with one’s illness, before prescribing medicine. The medicine that the patient gets depends on the patient’s response and on the doctor’s judgment as to whether the person can afford it 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 indicating that the bus company would cover her hospital expenses as she was a victim of a bus accident. The patient had not been admitted even after we left the hospital.

Doctors are subject to rules and regulation by the law and medical profession. To refuse treatment to needy patients is illegal. However, hospitals and health centers get away with not meeting their responsibilities by not registering the patient in the first place. They do not have any liability or any responsibility to any patient for which they do not have any records.

* The Asian Human Rights Commission (AHRC) is a regional non-governmental organization monitoring and lobbying human rights issues in Asia. The Hong Kong-based group was founded in 1984. More information is available on AHRC’s web site at <>.