in the Philippines: The Poor Are Likely to Die
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
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
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
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
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 <http://www.ahrchk.net/index.php>.