Dy, Louie

2014-01555

FCH 101
Community-Oriented Medical Education

The first thing that I encountered with FCH101 was making a flowchart that would delineate
the causes of Rosario's unfortunate death. When I was asked for the word that would describe the
Philippine Health Care System as perceived by Rosario's story, I described it as a "Wasteland",
because of the utter inaccessibility and inadequacy of health care. I realized that such depraved
conditions cannot be a result of a single cause, but rather multifactorial and multifaceted - finance,
government, corruption, socio-political factors, malnutrition, lack of sanitation, overpopulation,
dangerous roads, lack of education, and more. Consequently, making a flowchart made me more and
more frustrated to the fact that I can't just fulfill my wish of making a good, ideal world because of a
lot of social problems that served as landmines. Arrow after arrow, cause after cause - the questions
"Why?", "How?" can never seem to end. It seems that changing the country is an immense task, much
more if it is the world.
On the following meeting, we went through the Alma Ata Declaration of Health, through
which we have a clear grasp of the definition and concept of health. Being healthy is defined as a
state of complete physical, mental, social health and not just the absence of a disease. Health is a right.
Inequality thereof, which gives others privileges while not to others, is unacceptable in all aspects,
yet for often "Health is a privilege." is a commonly tolerated notion. Health is a common concern to
all countries, and health and development are closely intertwined with each other. Everybody has a
right and duty to participate individually and collectively, such as a patient having an informed
consent about, for instance, surgical operation. Health is a responsibility, and it is universal. However,
because it is also multifaceted, we need to solve the multifaceted problems we have now. In the latter
part of the discussion, we were admonished with the need of health to adhere to accessibility,
affordability, availability, acceptability, appropriateness (5 A's) and efficiency, effectiveness,
empowering, equity (4 E's). Overall, I find these enlightening and it created a conviction within me a drive for action to the currently existing conditions. I find myself valuing health more.
Then, we discussed the principles of human rights, which are inseparable to the aspects of
health, especially patients and health workers. The principles of interdependence, accountability,
participation, inalienability, universality, and non-discrimination should be continually upheld. Each

person is covered by the rights; each person is a Rights Holder. Consequently, institutions and systems,
and even people who hold leadership positions are Opportunity Givers or Duty Bearers who allow
Rights Holders to fulfill their rights at the end of the day.
The next meeting, Dr. Nisperos overviewed the situation of Philippine Healthcare System,
and that made me realize even more the plethora of problems present. Tertiary hospitals are congested
because primary health care is not done good enough. Our human resources on heathcare are faced
with many problems misallocation, not based on need, with the inadequate budget adding insult to
injury. Devolution has tremendous impact. Medicine is increasingly getting more expensive to the
benefit of private drug-producing corporations. Access to healthcare remains a malignant tumor in
the wasteland of healthcare. Consequently, as health is a right, even as a future doctor I should at
least aim to minimize this catastrophe by Doctors to the Barrios allowing the first thing that is
needed adequate access to healthcare.
For three meetings the structure, organization, vision, mission, objectives and role of the
Department of Health and PhilHealth were discussed. Setting all the intricate details aside, I realize
that it is not so simple after all to say that the Health Care System is a "Wasteland" because people
really are doing something to improve the situation. Nevertheless, I wonder and ask, "Are they really
doing their job?" Are the programs effective enough? Unfortunately, the 1:20000 (Health Workforce :
Health Dependent) ratio is kind of overwhelming. Also, PhilHealth may just be (or really is) a tool
for political purposes. On the good side is the increased budget for health, although I am not sure if
it is properly allocated among both urban and rural regions or just concentrated to the urban ones.
The structure, organization, vision, mission, objectives, role, problems and challenges of
Philippine General Hospital were elucidated by its very own director, Dr. Gap Legaspi. I'm glad to
see that despite the sad stories I hear from there, the hospital serves a lot of people - around 600000
patients each year. However, there are still too much primary cases for such a tertiary hospital.
Primary Health Care should be at the very least taken care of by Local Government Units.
Through the numerous discussions, I slowly come to realize that it is true that devolution of
health has a significant impact. Most LGUs hardly fulfill their roles; in fact, some of them are used
for political purposes. Nevertheless, because I was assigned to do a report on an LGU, this opinion
of mine had to change.

Then the three weeks of reporting came. First were the Public Hospitals, followed by Private
Hospitals and then finally, Local Government Units. Setting all the details aside, I noticed common
goals, objectives, and at the same time, common problems in each of the three groups. Public
Hospitals need more funds, better facilities and greater sphere of influence for people to access them.
Private Government Hospitals may at times have proper equipment, workforce and facilities, but have
limitations such as peoples accessibility and the pricing. Meanwhile, Local Government Units also
actually help and play a vital role in the Philippine Healthcare System by propagating the programs
implemented by the Department of Health, although oftentimes they need to pay attention to fulfilling
their plans, not just planning. Community and public health should be given more value such as
sanitation.
During the week where International Women's Day is celebrated, we discussed about gender
as a social determinant. I was made aware of gender-sensitive language and how important respect
towards women is. In fact, in the first place, I realized that there was a need for this day to be present
precisely because of our social issues how we view and treat women. Fundamentally speaking,
there should be no issue at all, and everyone should be equally respected.
To wrap everything up, I believe that FCH 101 for me has been a fruitful experience. Its not
just some class that gives me lectures on the healthcare setting, but its like a philosophy class that
makes me think about what I know, how Im thinking, and why I should think otherwise.