Health is a Human Right

In the Article II Section 15 of the 1987 Philippine Constitution, it is written that health is a basic human right. The country follows a "dual" health system, which consists of the public sector and the private sector. All Filipinos are entitled to PhilHealth, which is intended to alleviate the cost of medical bills. Its purpose is to guarantee 'free' health care for all. While 92% of Filipinos are covered by PhilHealth, most still have to pay a significant amount out-of-pocket to cover the expenses. One of my coordinator's comments stuck with me: how are we supposed to expect them to pay out-of-pocket when many do not even have pockets?

After our orientation about the healthcare system, we visited the Philippine General Hospital the following day. For me, this was one of the biggest culture shocks thus far. At the public, specialized hospital, patients are given free care from some of the most intelligent doctors in the country. While this intent is ideal, the conditions of the hospital were not.

We learned that patients and their families from all over the country must line up at 4:00 AM to try and make an appointment. They are considered lucky if they receive one the same day. Some patients are scheduled appointments in three-day's time. What does this mean for those who traveled from the other end of the country? If they have no other option, they stay in the hospital for those three days. If they miss their appointment, they are subject to being turned away. In the building, there is no air conditioning or food courts, and they are long past full capacity. We apparently visited at a "quiet" time, and still, you could not walk in a straight line without bumping into someone. It is also important to point out that the hospital is not open 24/7! For those wanting to make appointments, the lobby is open from 8:00 AM to 5:00 PM, Monday to Friday. One of the consultation rooms consisted of a dozen desks with no curtains between them, and basically no privacy. Those in the in-patient department have to share beds if there are not enough. There was a long line of elderly people in wheelchairs - waiting to use one of (if not) the only single-use handicap accessible bathrooms on that floor. We passed by a guardian ventilating her own sick patient with an airbag in the hallway, because there were not enough medical professionals. Parents and guardians are told to find a stretcher and a wheelchair for their sick loved ones. They are sometimes shamed if they cannot navigate the maze of a hospital quick enough. They are told that they "do not have a sense of urgency" for their loved one.

Although there are other local health centers, we were told that for everyone seeking free, specialized care, PGH is the place to go. It is considered a tertiary public hospital, meaning that the care is free and many doctors have pursued sub-specialties. Many of the medical students who intern there study at the University of the Philippines - Manila, which is one of the most prestigious medical/health sciences schools in the country. As a teaching hospital, interns have duties up to and including diagnoses, which are then approved by their attendings, or superiors. However, the medical professionals at the hospital are also forced under strenuous, disorderly conditions. First and foremost, the hospital is run mostly on paper medical records. While some departments are converting to electronic records, there is no centralized means of organizing medical records. For the patients, if the staff cannot find their records, they are pushed to basically the bottom of the list...even if they were the first in line at 4:00 AM. Secondly, the staff's hours and number of patients they must see each day are overwhelming. Although there have been some improvements, it continues to be a struggle for the medical professionals. On top of their morning rounds for their registered patients, they must also meet and consult all of their new patients for that day.

Understanding Tagalog, the Filipino language, has always been a blessing for me. And for the first time, I wish I did not understand it. On the announcement speaker, a nurse was shouting and insulting the patients for not following directions. She started, "I have told you. All the nurses have told you. Everyone has told you. You must wait your turn..." It got much, much, much worse from there. Sick patients wait hours upon hours and days for their appointments; the staff become overwhelmed and frustrated with the pressure they are under.

Yes, all of these conditions are terrible and wrong. But that was not the worst part. The most heartbreaking scene was moving from the public section of the hospital, to the private section. When we arrived at the latter, I had to ask where we were exactly. When I found out that it was the SAME hospital, I almost cried. To put it simply, the private section of the hospital was for those who could afford it. In that building, there were no lines or overcrowding. Patients were seen within minutes and could leave within minutes. There was air conditioning, working elevators for all, multiple food options...overall beautiful, clean conditions. Don't get me wrong - of course paying extra should give you extra benefits - just like on a plane. Someone who pays for a first-class ticket of course should receive benefits. BUT IN THIS CASE, the disparity between the two sections were UNJUST. Just because care is FREE does not mean patients should suffer more than they already are. I cannot even imagine a fraction of what the patients in the public sector are enduring just to get a consultation.

If health is a right, these conditions should not exist. The wide gap between private and public promotes inequities in health. While improvements have been made in the Philippines, there is still a great deal to be done. Of course, I do not know everything. I have learned only this much within a few day's time. But it only takes one glance at PGH to see the inequities. While I was unable to take pictures inside the hospital out of respect for the patients, I hope anyone reading this got a small glimpse of the healthcare system here in the Philippines.

Love,

Jen