Doctors to the barrioBy Rafael Castillo M.D.
Philippine Daily Inquirer
After giving a talk several months ago, I was approached by a young doctor, whose name unfortunately I can no longer recall, who identified himself as one of the government’s doctors to the barrio. There was enthusiasm in his voice but one could also sense the frustration in his voice that he could do more for his barrio if not for the nonmedical—more politics-related—problems he has to deal with.
I promised to write about it then, but with several conventions and meetings getting on the way, I totally forgot about it until I read in the papers this week about the efforts of the Department of Health to sustain the motivation of our young doctors volunteering for the Doctors to the Barrio (DTTB) program.
There was a time before when it was the dream of every medical graduate to try their luck abroad immediately after graduation from medical school. Although this may still be the dream of many of our young graduates, it is heartening to see that many young doctors are answering the call to do their share in delivering much-needed healthcare services to underserved areas in the country.
We have to credit our nationalistic colleagues like the couple Doctors Willie and Liza Ong, who really go out of their way to encourage young medical graduates to stay and serve their country. They have founded the MIND (Movement of Idealistic and Nationalistic Doctors) which has a big following already, consisting mainly of young medical graduates and even medical students.
Several years ago, when doctors were quitting their jobs as government physicians and working abroad as nurses, Willie and Liza initiated a signature campaign gathering thousands of signatures from doctors who committed that they won’t join the exodus of doctors and would stay put and do their share. It’s not far-fetched that because of the efforts of Willie and Liza, they have inspired some of these young doctors to enlist themselves for the DTTB program.
The program was started in 1993, and since then, more than 500 idealistic doctors have responded to the call and served 390 municipalities, many of which have never known before what it’s like to be seen by a doctor for their medical problems.
It is also noteworthy that the DOH is addressing the problems besetting the doctors in the DTTB program. Although the doctors may have reasonable academic and medical training to treat common medical conditions, many of them do not have enough experience and competence in attending to the other things required for health governance and health service delivery. The lack of competence in these areas is another source of demotivation that may finally make them decide to pack their bags and go back to the city or not-so-rural areas, with all the lures and enticements of a good clinic practice.
The program now provides opportunity for professional advancement, enabling the doctors to gain more competence as community health leaders. Through a partnership between the DOH and the Development Academy of the Philippines, the doctors are given scholarships to receive a master’s degree in Public Health, major in health systems and delivery. The course equips them in critical service areas like health governance, health financing, service delivery, health policy, standards and regulations, human resources for health and health information.
This training maximizes the potential of these young doctors to—not only treat medical problems—but to effectively manage the overall health needs of the people in their respective communities. We’re certain that opportunities for professional advancement like this, and the feeling they get that their efforts are truly appreciated and recognized, will go a long way in motivating and inspiring them to look at their stint as lifetime careers, and not just a stepping stone.
We hope the DOH can also address the “nonmedical and more politics-related” problem which serves as a barrier for these idealistic doctors to become more effective in playing their role in the community. In many instances, the doctors have to learn to dance to the music played by the mayor or the other town officials. There are even instances—hopefully isolated ones— when medicines procured by the local government unit are kept in the mayor’s office, and are only given if the patients attended to by the doctor are known allies or supporters of the mayor. The rest are told that the medicines are out of stock. This is referred to as “color coding” of patients.
Partisan or patronage politics should have no place in healthcare delivery, particularly in impoverished areas wherein the people have no other alternative to gain medical access except through the assistance of the rural health unit. The DOH should make representations with the Department of Interior and Local Government and together, they could come up with measures to censure or even penalize local government officials infusing patronage politics in healthcare delivery.
But it’s not all bad news in the DTTB program. There are also inspiring success stories. Several years ago, Dr. Pascualito Concepcion, was given an award of distinction for his persevering efforts in improving the health status of the residents of Talusan in Zamboanga. He credited also the local government for his success in showing that a community doctor can accomplish much more when the local government recognizes the value of health and is very cooperative.
He has convinced the town mayor and council to support his projects including the conversion of what used to be a warehouse into a clean and decent-looking health center. Philhealth was also convinced of the services Dr. Concepcion was giving the barrio residents such that the center was accredited with more than 500 poor families able to avail of PhilHealth benefits.
Stories like that of Dr. Concepcion provide a whiff of fresh air for the DTTB program. We’re sure to hear more of it if the DOH persists in continually acting on the feedback of our young doctors before their initial level of idealism and nationalism run out.