By Rafael Castillo, MD
Inquirer
MANILA, Philippines–Just when I thought that Filipino doctors have forgotten their solemn oath “to serve humanity to the best of my ability,” and just when I thought that Filipino doctors have no qualms of giving up their medical profession for the prospect of earning green bucks abroad, Dr. Rogie Tanco, the cardiologist-editor of The Filipino Internist, reminds me of the Filipino medical volunteers of the Médecins Sans Frontières or MSF (Doctors Without Borders), who serve in war-torn regions and developing countries facing endemic and pandemic diseases.
The MSF is a Nobel Peace Prize awardee and annually, it recruits about 3,000 doctors, nurses, midwives and logisticians to provide health care in more than 70 underserved developing countries. A good number of these volunteers are Filipinos. “These doctors and other volunteers are unsung heroes,” Rogie told me.
Filipino volunteer
Among these volunteers is Dr. Elpidio Demetria, a board certified internist and infectious disease expert previously of San Lazaro Hospital. Before volunteering for MSF, Elpidio signed up with the Philippine medical contingent to Iraq.
After Iraq, he could have thought that he had done his share of public service and could have started a lucrative private practice. But, he set aside the glamour and rewards of clinical practice, and signed up with the MSF, without any precondition on where he would like to be assigned or what he would be willing to do.
He was initially assigned to Cambodia where he manned and later supervised HIV clinics in various regions of that country. While most of us would not even touch HIV patients with a 10-foot pole, he took care of them with such care and compassion which has earned the respect and admiration of his staff.
After his stint in Cambodia, he was assigned to Sierra Leone, a fledgling African country, which was still rebuilding itself from the devastation of a civil war. Making do with limited resources and facilities, he managed a small hospital and conducted medical missions and malaria control sorties in the hinterlands of this impoverished country.
A sense of fulfillment
Elpidio was in the country last month for a vacation and when his peers teased him of what he was missing as a medical consultant in posh private hospitals here, he replied without reservation that volunteer work was his calling and he has decided to make it his career. “I get a sense of fulfillment in serving the really underserved, and being able to do it in such a professional manner,” he said.
While many private practitioners find fulfillment in handling pampered and demanding well-heeled patients, Elpidio finds a great sense of fulfillment in being able to handle neglected patients with tuberculosis, malaria and HIV-AIDS. While many of his colleagues shun disaster areas, he looks forward to render service to those who may need his expertise in such areas.
And while many of his colleagues do their work in the comforts of their private hospitals, donning their immaculate white gowns, Elpidio and his fellow MSF volunteers do their work in their perspiration-drenched scrub suits, unminding the heat or humidity in the volunteer stations they call their workplace.
Learning a lot
Elpidio also feels that he’s learning a lot from his volunteer work. He learns from his interactions with a team of experts in a multiracial and multilingual environment. In the various teams, color, creed and culture of the volunteers blend in an undistinguishable blur and their common zeal to render service to the underserved is the only thing that binds them together.
Why not work here instead, Elpidio was asked. His expertise can certainly be of great use here having been honed in the treatment of endemic diseases such as malaria and tuberculosis. “I wish to serve where I am needed more,” he answered. “In Sierra Leone and Cambodia, there is a scarcity of medical workers far worse than the Philippines.” He explained that in an MSF mission there may be 375 staff volunteers with only one medical doctor to man all the referral centers, clinics and refugee camps.
Most of the staff are medical assistants, trained for three years by MSF to become physician assistants. They can diagnose and prescribe, but a doctor is needed to back them up. Ministries of health are appreciative of the training that MSF provides its local staff.
Well-planned projects
The MSF has been acknowledged to accomplish its mission in a very organized and professional manner. All its projects are well- planned and there is logistical support in every aspect of the various missions.
Although the MSF volunteers’ work surroundings may be suboptimal, their dignostic facilities for endemic diseases are at par with any modern hospital. For example, MSF introduced rapid diagnostic tests for malaria, which can specifically identify the various species of the organism causing malaria. They also have tests for the various species of schistosoma.
The MSF also provides advanced treatment regimen for tropical diseases such as malaria (artemisin-based treatment) and anti-retroviral treatment for HIV/AIDS. Come to think of it, the MSF volunteers probably have a higher sense of professional fulfillment that cannot be equaled by our doctors-to-the-barrio program of the Department of Health. Our rural doctors have to make do with crude methods to diagnose malaria and schistosoma.
We salute Elpidio and all our healthcare volunteers both here and abroad. You provide the true meaning to the type of service to humanity which the oath of Hippocrates embodies.
November 10th, 2007 at 2:59 pm
Really took the words out of my mouth… This is based on FACTS, a humble REALITY!
Hope you’ll have the time and patience to read it to the very end.
How I wish I’d still live to see the day when what really matters would REALLY matter…when my fellow Filipinos would finally be shaken off the mentality that only lawyers, politicians and moviestars deserve to be duly compensated in this country….. *sigh*
Filipino Doctors, Sacrificial Lambs
by: Michael Hussin B. Muin, M.D.
By now, everybody knows of Elmer Jacinto–the February medical boards topnotcher who publicly announced his plans to work in the US as a nurse. I was in Zamboanga City visiting my parents when that news broke out. A topnotcher from Lamitan, Basilan hit close to home and I showed the article to my brother. His only question was, “Why? Doesn’t he have any offers?”
I could only laugh and muster a short, “No, I don’t think so.”
Elmer Jacinto’s situation and the reactions from various sectors are both funny and sad. I can only think of my brother’s question and wonder: What can the country offer its best and brightest in the medical profession?
The short answer is none.
Unlike the legal profession, of which the medical profession is often compared to, there are no offers made to topnotchers. We’ve read news of bar topnotchers invited to join prestigious law firms. Top law graduates are employed even before the bar results are released, while some receive hefty signing bonuses from happy employers.
Medical board topnotchers are not that lucky. After a day or two in the light of fame, most fall back to the shadows of anonymity–their achievements a mere footnote in their résumé. We hardly remember the board topnotchers of the previous years. How many of them are practicing in the provinces, much less in the country? Can you just imagine the public outcry if we found out that only a few have stayed?
Therein lies the problem–the public outcry. Why is the public so pent up about doctors going abroad as doctors or nurses or caregivers or whatever? Because my short answer is not exactly correct. The country does have something to offer the graduates of the most noble profession: the poor and sick of the Philippines. Physicians, especially new ones, are expected to grab the opportunity to serve–for a pittance of a fee, or even for free.
I tried my hand in volunteerism once when I was “in between jobs”–or, in short, unemployed. Living a few blocks from the Malate Parish, I volunteered my services to their social services division for one day a week. I scoured the streets of Manila for jobs on Mondays to Thursdays, while I devoted Fridays to the urban poor of Malate. They gave me an old desk in the small office at the back of the church. The social worker announced my presence to community leaders, and, in no time, I was seeing 10-15 patients a session, which isn’t exactly heavy.
It was a fun experience. A patient wanted me to give him a medical certificate stating that he should sleep on cement benches because it was good for his back. He was supposed to show this document to police officers of Luneta where he spent his nights. Another patient, a jolly 80/M, went to see me not for a check up but to show off that he was in perfect physical health. He would do jumping jacks and push ups in front of me.
It was also a time of desperation. A stroke patient, with half her body paralyzed, persistently showed up every Friday, limping her way through Manila traffic. She continued to have a BP of 200/140. Another patient had a resting systolic BP of 220-240. The list goes on. And I could do nothing but prescribe the cheapest anti-hypertensive. But they all had the same excuse: they didn’t have the money to buy the drugs.
Not willing to lose a battle, I wrote the Parish for some support, financial or otherwise. I was asking for some drugs, about P800 worth, and a P500 money pool, in cases of emergency. And they replied that they can’t contribute at the moment since they’re finishing the wing for the missionaries, putting in a library and air-conditioning. I kid you not! I wrote a short letter to the city government, but they said all health support should go to the local health center.
One Sunday after mass, the parish social worker informed me that the Rotary Club of Manila was conducting an outreach program. I went with her and talked with the President of the club. They agreed with the whole package, insisting only that I submit proper accounting reports every month for their newsletter. I can’t say it was smooth sailing from then on. It definitely helped me with some of my patients, monitoring for drug response rather than just looking on helplessly.
My experience is not unique. Volunteerism doesn’t have to be so obvious. Surgeons forego professional fees after operations, internists accept P20 for consultation fees, pediatricians charge break-even for immunizations, and general practitioners accept eggs and chickens in exchange for services. These may be small acts, but they are by no means less heroic.
There are, of course, doctors who work with the poorest of the poor. Volunteer doctors to the war-torn parts of Mindanao would have different stories: their experience more colorful, their desperation more intense, their helplessness more personal. Their dedication is a strong testament to their character. These doctors who work with the poor often become poor themselves, and I have nothing but the utmost respect and admiration for them.
In all these cases, doctors are found in the frontlines of poverty. They work with almost no logistic and financial support. They carry the burden of salvation for their countrymen, with little or no compensation, with little or no thought of self. But the fact remains that mere presence can only do so much. What can a doctor give if he has nothing more than compassion and care? Is that really enough?
It’s ludicrous how the public expects too much of a sacrifice from Filipino doctors, when it expects too little from its government officials. The fight for better health is a fight against poverty. It is not won by doctors becoming poor themselves, but by government officials becoming the leaders they need to be. Doctors do not make laws, allocate resources, handle budgets, public officials do. Doctors do not get kickbacks, destroy public trust, and plunder taxpayer’s money, government scalawags do. So, when did doctors become sacrificial lambs for the ineptitudes of Philippine government?
The public flogs physicians, living on P10,000 a month, who pack up and go to the US as nurses, when they pay no mind to regional directors, earning P22,000 a month, who go abroad as tourists for weeks at a time. People look suspiciously at doctors driving a brand new Toyota Corolla after 5 years of practice, when they find nothing wrong with mayors sporting shiny Ford Expeditions after 6 months in office. If we should mourn for doctors who leave, let us grieve more for corrupt officials who stay. If we should complain of doctors who dream of decent living, let us condemn more those unscrupulous government employees who lead obscene lives. Wounded souls search for healing in other countries, but there is no cure for callous hearts.
A mayor once asked me to join a free medical mission he sponsored. I humbly asked if there was any payment involved for my services. “Ah, eh, wala. Pero libre naman ang pagkain. Tapos ipapahiram ko naman yung Pajero ko at isa kong Starex para libre na rin yung transpo.”
I wanted to bitch-slap him until his lips bled.
August 16th, 2007 at 3:42 am
It is a pleasing to know that Filipino doctors are contributing to this organization, ” Doctor’s Without Borders “. It is my favorate charity and I am proud to all of those doctors from my own people who are in the field for the good of humanity.
August 14th, 2007 at 4:00 am
Dr. Elpidio,
Gracie para sus servicios con los paciente’s en los paises los servicios de los doctores muy necesidad. Y gracias tambien por so humilidad acceparon el trabajo para servir los hombres pobres en los cuatros localidad del mundo.
Kayo po ay isang huwaran na nagpapakita ng pagmamahal at pagmamalasakit sa kapwa. Sa bandang huli ay mabibigyan kayo ng biyaya. Iyan po ay iyong magugustuhan at siyempre marami ang maiinggit.
Mabiag ni Dr. Elpidio. One day, we hope that you have the oppurtunity to come and join us in our South America destination but it is simply nice to read about the works of our Filipino compatriots and friends around the world.
Onegam
August 13th, 2007 at 8:16 pm
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August 13th, 2007 at 8:40 am
Its a true meaning of being a servants of God. They indeed not look for his self glamour and earning lots of money but for the needs of others. Lets lookup with him and whatever endeavor your in we can emulate him. A Big UP!! to you Dr. Elpidio Demetria…Mabuhay tayong Filipino!!!