(CONTRADICTIONS IN)
THE SCIENCE OF MEDICINE, THE ART OF HEALING
I wanted to be a Doctor. And I had to be in the College of Medicine, University of the Philippines at the time the First Quarter Storm was brewing in the horizon.
More contradictions.
They taught us Hygiene and Community Garbage Disposal in the airconditioned classrooms at the UP College of Medicine. A few meters away in the old Philippine General Hospital (PGH), they threw rotting placentas and surgical specimen in a stinking garbage pile under the water tank.
Inside PGH, overworked resident doctors and interns fought a valiant losing battle against the effects of filth, infection, malnutrition, parasitism and corruption.
In the classrooms of the UP College of Medicine, we learned more about the diseases of the white man - diseases of overnutrition and overcivilization. We were taught by America-trained Filipino doctors -- some of whom slurred their speech pathetically in irritating imitations of their mentors.
Before our inevitable exportation, as a lame gesture to relevance, we were required to render medical services to the townspeople of Bay, Laguna.
This was sponsored by the Rockefeller Foundation.
I was once assigned to a Barrio which could be reached by horseback after fording a river. I brought along my own supply of medicines which we were supposed to sell at cost to our patients. We also charged them 50 centavos per consultation. I was given a cantankerous horse but dutifully endured the castrating effects of a tight saddle made of rattan and jute because I had visions of the barrio people rejoicing to see me bringing them the benefits of modern medicine.
But on my first day in the barrio - nobody came.
I thought that perhaps it was because the barrio people could not afford the consultation fee. So I asked the Hermana Mayor, whose house I utilized as my clinic to announce to the people that henceforth, I would forgo the consultation fee. I had two patients the next day -- the Hermana Mayor herself and her husband. Nobody else.
I discovered later to my mortification that my "competitor" -- the village Herbolario, charged a minimum of 5 pesos per consultation and the people flocked to his house and gladly paid. The Hermana Mayor later explained to me that the barrio people preferred the Herbolario because even if I did not charge for the consultation, the drugs I prescribed were too expensive for them to buy. The Herbolario only had to boil some concoction for them to take or plaster their foreheads with small pieces of paper with some inscriptions -- and they were cured. Besides, his wife cooked and cared for the family of the sick person during the illness.
I discovered that illness in our culture is a social event with cosmic considerations but the UP College of Medicine was training me in the western concept to treat illness as a personal event with commercial considerations.
Back to the College of Medicine raging, I accused Dean Florentino Herrera of turning me into an embarassing luxury few of my countrymen could afford. The Dean countered by saying that the UP College of Medicine was the finest in the country and altering the curriculum would cause the Science of Medicine in the Philippines to lag behind other countries in the world. I disagreed with him and pointed out that Medicine was more an Art than a Science and as such, must pertain to people. The Dean, at that point in time, had no patience for an impertinent Intern.
But there were people who listened. As editor of the college paper, I had written about the oceans that existed between the Preaching of Medicine in the UP College of Medicine and the Practice of Medicine in the Philippine General Hospital. I attracted a group of university and medical students as well as some professors who thought the same way.
So we organized the first strike ever in the history of the Philippine General Hospital in September 1970. We marched from the University of the Philippines campus in Diliman to the PGH in Taft Avenue. We demanded the necessary emphasis and correlation between the University and the Hospital.
The Hospital Director, Dr. Reginaldo Pascual, lost his job after two weeks of work stoppage. The Dean escaped unscathed but I am sure he developed a healthy respect for student opinion after that.
Twelve years later, when he had retired as Dean, he would seek me out in Davao to tell me I was right. I was then in the middle of yet another demonstration line. But it was too late. He was no longer Dean. That is the trouble with Hindsight. One's eyes are in the wrong part of one's anatomy, One tends to close them when one sits in power.
True to form, I refused to march in the UP College of Medicine graduation ceremonies of 1971.
After Medical School, the decision to go back to Mindanao was never in question. But specialization beckoned. I knew that if I were to eventually go back to Davao or even farther into Mindanao, I had to be a doctor among doctors, a Surgeon.
Life as a surgical resident from 1971 to 1976 in PGH was no bed of roses. As a matter of fact, I seldom saw my bed. One worked with a sense of urgent time lack in an atmosphere of scarcity. There were just too many patients with precious little to work with. Equipment were almost always out of order or had no parts or reagents, supplies were always ahort and medications rare as hen's teeth. On top of all that was the veritable realization that Medical School provided only a modicum of the vast amount of knowledge one had to have to be able to do creditable surgery.
Patients in the hospital die of the preventable social disease called Poverty too often that people became inured. I came to know Death by so many faces and so many names. Some of which, I would carry around with me for a long time. They would dance around my head deep into the night in a dizzying whirl of Ifs and Buts. There was really nothing a doctor and a surgeon could do about it.
It was not part of our education and training.
"MERCY" MISSION
The fall of Marcos brought hopes among us that things were finally changing for the better.
We were ready to cooperate with a new and enlightened administration. We proposed plans to improve the delivery of health care in the hospital. We devised an integrated training program in the Davao Medical Center which extended to include the neglected doctors in the far-flung District Hospitals of Mindanao.
But the rise of Aquino did not really usher the changes that the people wanted. It was only a different collar for the same dog.
People power could stop tanks and all the military hardware that the Americans threw behind Marcos.
But with a dithering leadership, the tremendous possibilities the Filipinos displayed to the world in 1986 fizzled out.
People Power became a shibboleth that the power brokers used to delude people into thinking that things had changed for the better.
To replace their discredited, discarded twenty-year old puppet, the Americans now had their new Cory Doll.
The first thing that she did was to journey to America to address their Congress. One of the offshoots of this pilgrimage was her request to have the USNS Mercy, a hospital ship of the US war machine, sail to the Philippines to do surgical missions.
In a trice, we were at loggerheads with the Aquino Administration.
The Philippines is the main supplier of Doctors and Nurses to America.
Now, here was the small Republic of the Philippines, requesting the great United States of America to send us their doctors and nurses for surgical missions.
It was incomprehensible by any housekeeping standards!
The part that galled us most in the DMC was that we were required to process patients who needed only minor to medium type of surgeries to feed to the hospital ship. These were the only patients their ship doctors would consent to do surgery on.
We gritted our teeth because there was no dearth of expertise among us to operate on these patients. As a matter of fact we were operating on them daily.
The backlog we had in the hospotal was due to prioritization of our limited resources for the more serious and urgent cases.
But because the USNS Mercy was a priority project of the Aquino government, we were now using our precious X-ray plates, EKG and laboratory procedures to process patients with hemorrhoids and hernias.
Our more seriously ill patients had to wait.
But that was not all. In order for the USNS Mercy to enter the Davao Harbor, the Philippine Government had to dredge the area. It cost Juan dela Cruz 60 million pesos to do it. Twice the yearly budget of the Davao Medical Center.
To add to this extravagance, the government spent millions converting the public schools into hospitals to accommodate the patients mobilized by all the government health workers in their areas.
All this for hemorrhoids and hernias.
This was clearly American Propaganda at the expense of the Filipinos. This was not our idea of enlightened leadership.
The Department of Surgery of the Davao Medical Center refused to take part in this vapid exercise. We aired our objections to the hospital administration. We questioned the entire project and we expected their answers.
None came.
We dared the American Consul based in Davao City to a public debate over television and radio.
He did not come.
So we registered our outrage by picketing the USNS Mercy at the Sta. Ana wharf when it anchored in Davao City.
We almost got thrown into the waters of Davao Gulf by a gibbering crowd of our countrymen, greedy for "free" goods and services from America.
We returned to the DMC to lick our wounds, consoling ourselves with the thought that even if we failed to open our people's eyes, at least it was not from lack of trying. Davao was the only place in the Philippines which publicly protested the entire sordid USNS Mercy affair.
Months later in the Surgical Department of DMC, we were still repairing the battle-ax surgeries the USNS Mercy doctors inflicted on our countrymen.
But it did not take long for the Department of Health under the direction of Dr. Alfredo Bengzon and his undersecretaries, Mr. Mario Taguiwalo and Dr. Antonio Periquet to institute reprisals against us.
They began to systematically root us out of the DMC. They took over our training program and gradually decimated our graduates from the hospital ranks.
Aquino suceeded in what Marcos could not do.
The Davao Medical Center reverted to its old dismal status.
TILTING AT WINDMILLS
Bitterly disappointed, angry and frustrated, we knew then that there was no future in working in the government. It was not just our patients who were sick.
It was the System.
The System needed radical surgery.
We had broken out of the walls of our operating rooms and taken on the hospital administration and the Department of Health.
What happened pushed us to the next step.
We prepared to risk everything to break out of the hospital and give health care back to the people.
Years before, when we first began our training program, we asked ourselves in the Surgical Department what people's perceived goals or models of success of a hospital training program were.
Looking around, we found out that the Community's model of a successful surgeon was a middle-aged practitioner with a wife and about four children. He had at least one house in an exclusive subdivision and at least two cars. He was a member of a Civic Club, played golf and sent his children to Manila for college education. His children struggled with the usual vices of upper middle class boredom. One of them was probably a drug user/addict and the others were school drop-outs. But he usually had at least one child, his fair hope, who was preparing to study Medicine, following his footsteps and eventually take over his practice when he retired.
Taken at that, there was really nothing immoral about this comfortable little world that the private medical practitioner carves out for himself in society.
Some of the young doctors in the department were probably products of such a lifestyle.
But the other part of the equation was thick and grim with contradictions.
There are more than 30 medical schools and more than a hundred nursing schools in the country today. We graduate 4,000 doctors and 28,000 nurses every year.
Sixty eight (68%) of all the doctors and 88% of all the nurses are exported abroad.
Imelda Marcos once boasted that the Filipinos were the nurses and doctors of the world because wherever she went she met them taking care of the sick in other countries.
But here in the Philippines, 62% of the Filipinos die without seeing a doctor or a nurse.
The Philippines is the leading country in the incidence of tuberculosis, schistosomiasis, whooping cough and diptheria in the western Pacific Regions. We also lead in the incidence of blindness worldwide.
While we educate the cream of our children to serve the needs and whims of people in other countries, we systematically starve the rest.
Eighty percent (80%) of our children suffer from first to third degree malnutrition despite the fact that the Philippines, small as it is, is the number fourteenth exporter of food worldwide.
With malnutrition comes mental retardation.
We are now facing the grim prospect of having 80% of the next generation of Filipinos in various stages of mental incapacity.
Yet the country's rich spends hundreds of millions a year for weight reducing preparations and procedures.
While 30% of the population suffers from lack of potable water, the country spends billions of pesos a year buying Coca-Cola.
One particular horrifying experience I had was to see a father shelling out his few precious pesos to buy a bottle of Coca-Cola as a treat for his sick malnourished child who was wasting away in the ward.
I realized how twisted the values of our poor have become from the millions Coca-Cola and other soft drink companies spend to advertise their paltry overpriced calories represented by clear-skinned Yoth exuding Health and Vigor.
At great cost, we import rice which the poor people need to eat daily, yet we devastate thousands of hectares of our prime land to plant bananas and pineapples which we export to the rich countries for their dessert.
There are about 1,500 hospitals in the Philippines.
One thousand of these are in private hands and 500 are government hospitals.
Eighty percent (80%) of the population of the Philippines or about 50 million are living at or below the poverty level. They therefore can access only the 500 government hospitals.
Only the upper 5% can fully afford the 1,000 private hospitals which depend on profit for their continued existence.
But the worst part of this scenario is that 48% of all the hospitals and 70% of all the doctors in the country are located in the Metro Manila Area.
Metro Manila accounts for only 2% of the total land area of the entire country. The Central Government is located in Metro Manila and so is most of the upper 5% of the population.
Eighty-seven (87%) of all financial activities in the Philippines happen here.
Small wonder then that the migration rate from the destitute rural areas to cash-rich Metro Manila is tremendous.
But it is interesting to note that inspite of the mind boggling concentration of Health Facilities in Metro Manila, 59% of the population there dies without medical attention.
With this gruesome statistics in mind, we, the remnants of the old Department of Surgery of the DMC, regrouped ourselves and concentrated our efforts on the MEDICAL MISSION GROUP HOSPITALS FOUNDATION INCORPORATED -- a non-stock, non-profit group we had organized.
There was a lot of soul-searching, question and answer sessions, heated discussions, shouting matches and even fistfights -- all tempered by a group imagination and humor that ran from the comic absurd to the cosmic mystical and, as was typical in the Department, ad libitum doses of the mind-altering brew called Beer.
In the end we concluded that people had reason to call our group "Crazy".
We began to tilt at windmills.
Reprinted from his book, "Child of the Sun Returning," Published in 1996