Doctors of the People
Donning white blazers,
many doctors stay in air-conditioned clinics serving well-off patients.
Some work abroad for higher financial rewards. There are even those who
trade their blazers for nurse’s uniforms just to be able to seek
employment abroad and bring their families along with them.
But there are also
doctors who work in understaffed public hospitals and make do with
whatever benefits provided by government. There are doctors who walk
through mountains to be able to reach and provide medical services to
people in remote areas who have been abandoned by the government. Without
the sanitized environment of hospitals and proper equipment; with no
nurses and attendants to assist them; they try the best they can to treat
patients and educate the people in primary health care. These doctors
live a life away from the comforts of the city; make do with a modest
allowance; and sometimes even risk their lives.
BY AUBREY MAKILAN
Bulatlat
Dr. Natie Castro: The 'Misyonera'
Doctor
Being a community
doctor is already difficult. But this doctor is taking on more challenges,
engaging in paralegal and human rights work.
From rallies to
communities
Dr. Natie Castro and
Dr. Caguiat were both from batch 1995 in medical school. They were the
only doctors from their batch who went into community service.
Natie also joined
COMMED. She had her exposure in a farming community in Nueva Ecija and in
a tribal area in Mindoro.
Since her graduation
from medical school, she has practiced and lived with the people of Butuan,
Agusan del Norte.
Living and working
with the poorest of the poor was not hard for this Manila-raised woman.
During her pre-medicine days, she was very active in political rallies and
met a lot of people from different walks of life with varied concerns but
united in one struggle.
“Dismal”
government health care delivery
Her first experience
in delivering a baby at the patient’s home was the most challenging
experience for her. Six out of 10 Filipinos are born at home, she said.
But doctors like her are trained to deliver babies in the comfort of the
hospital.
Alone and with only a
stethoscope, she was uneasy during her early years in the community
because of her fears of encountering complications in the birthing
process. But confidence comes with experience, she said.
But not all medical
cases could be ensured by skills.
She remembered her
child patient with pneumonia. After a hospital refused to accept the
patient because the parent is incapable of paying the deposit, Natie
decided to do the treatment in her clinic. She instructed the mother on
what to do while her son was confined in the clinic. The boy was already
recovering. But the mother fed her child who was in a lying position. The
child vomited and inhaled food particles causing his death by aspiration.
“Pag hindi handa
ang community sa panahon ng
krisis o catastrophic illness, walang ibang matatakbuhan,”
(When the community is caught unprepared in times of crisis or
catastrophic illness, there is nowhere to run to.) she said. “Kahit
gaano namin kagustong makatulong, limitado lang ang aming resources
at walang suporta ng gobyerno” (Even if we want to help, we have
limited resources and we do not get government support.)
Natie is the only
community doctor in the two Agusan provinces, and one of only two in the
Caraga Region or Region 13.
“Y’ung
state ng health care na doctor-oriented, city-centered,
tapos curative lagi, ‘yun rin ang pumapatay sa public health
delivery sa community” (The doctor-oriented, city-centered
and curative-oriented state of health care is what kills public health
delivery in the communities), she said, assessing government support as
“dismal.”
She also criticized
the Philhealth, saying it is not sustainable and does not cover all the
costs of treatment, especially out patient expenses.
Learning and
unlearning
In community work,
she did a lot of unlearning of many things taught in school. On the other
hand, she learned from the people she serves.
Through her training
under COMMED, Natie acquired skills in organizing, social scanning, social
investigation, networking, communicating with patients, and developed the
attitude of unlearning unneeded and irrelevant interests.
“Mas gina-ground
ka galing du’n sa prestige na meron ang medical profession”
(You are trained to be more grounded in contrast to the prestige and air
of respect that the medical profession has), she said. She said she could
be a doctor with special skills but she is not apart from or higher than
the people she serves in the community.
There was an instance
when their program was running out of funds. To cope, they all received
the same minimum allowance regardless of job description and training.
“Sa CBHP
(community-based
health program), hindi naman hiwalay y’ung doktor sa overall
kahirapan ng lipunan kaya dapat i-simplify ang buhay para umabot
man sa gano’n, hindi gano’ng kabigat (tanggapin ang pagbabago),” (In
the CBHP, the doctor is not immune from the overall poverty of the
community, so you have to simplify your lifestyle so that if worse comes
to worst, it would not be too difficult to adjust) she said. This, she
also said, is especially true for her who is still single and does not
need much.
“Hindi ko naman
maatim na sumusweldo nang mas malaki e
single naman ako, kesa du’n sa may
pamilya” (I’d be ashamed if I earned more than those with families,
when I’m single), she said. “Malaking bahagi ng community health
work in general ang pag-i-involve ng buong community sa
ginagawa mo”(A good part of community health work in general entails
getting the whole community involved in what you do.)
But oftentimes,
medical students treat community service as a vacation, she said, that’s
why their minds are also at break. This thinking has a great effect on the
students’ preparedness to go to community service, she added. They then
experience difficulties in organizing the community; and in making health
services and programs adequate and appropriate to the community.
For Natie, it is
easier to work in an “organized” community where people’s organizations
have been established and the people in the area are united. In areas
where no people’s organization is formed yet, the task of delivering
health services is accompanied by organizing.
“Mobilizing through
health programs makes the people aware of the bigger societal problems
they face and makes them realize the need to unite through creating their
own organizations,” she said.
A rights defender,
too
As if being a
community doctor is not difficult enough, Natie is also involved in
paralegal and human rights work.
Natie admitted it was
not hard for her to do paralegal work since “it is never apart from health
work.” She joined Karapatan (Alliance for the Advancement of People’s
Rights) in 1999.
“Y’ung
advocacy struggle ng tao para sa health ay malaking bahagi din
ng struggle for comprehensive human rights, pag-enjoy ng
lahat ng aspect nito, kaya madali sa akin na ma-appreciate ‘yun
at dalhin ‘yung ganong panawagan” (The people’s advocacy and struggle
for health is a large part of the struggle for comprehensive human rights,
the enjoyment of all its aspects, so it was easy for me to appreciate and
carry such a cause), she explained.
She revealed that a
lot of doctors are afraid to do medico-legal services to victims of human
rights violations. This is because, she said, they are afraid that the
military or the police would call them for investigation. Because of this
fear, doctors forced to do medico-legal work tend to downplay their
findings by using safe terms, she added.
“E maaawa ka naman
sa biktima kaya ako na lang”
(I’d pity the victims so I take up the work), she said. She explained that
immediate medico-legal work is important as certain signs such as bruises
fade out.
Aside from doing
medico-legal work, she also leads the conduct of legal services and the
handling of the campaign for the victims.
Contradictions
Her family expected
her to work in a hospital, wearing that white, long dress gown. Until now,
they have been encouraging her to work in a “safe” environment. Her
decision to work in the countryside was seen by her family as “a waste of
talent, a waste of education.”
Thus, she maintains
constant communication with her family to make them understand and somehow
accept her chosen vocation. She said her mother would say to friends
asking about her, “ang anak kong doktor misyonera, y’ung tumutulong sa
mga tao” (my daughter is a missionary doctor, the kind that helps
people). This makes Natie laugh, saying she would accept whatever pet name
is given to her for as long as they accept her decision.
But she never denies
that doctors like her in community service encounter contradictions.
Health professionals like her are confronted with conflicts in the
economics and politics of the community.
Being a community
doctor, especially when she joined Karapatan, she knows she is very near
danger.
She cited the case of
a hospital built by the Religious of the Good Shepherd in Barangay
(village) Balit, San Luis, Butuan City. The hospital administrator was
killed by motorcycle-riding men wearing bonnets. Natie said the hospital
received equipment worth millions and was ready to operate since December
last year but no doctor would take the task for fear of the risks
especially after hospital staff members also received threats.
“Habang y’ung
environment mas nagiging harsh, hindi conducive para sa
practice, laging nasa likod ng isip mo na pwede naman to run
back to safety,” (As the environment becomes harsher, it becomes
less conducive to medical practice and at the back of your mind you always
contemplate running back to safety) she said. “Para sa akin, kung y’ung
pagbabalik sa mainstream practice, sinusuka talaga ng puso at isip
ko ‘yung ospital. Sa ngayon, sa tingin ko habang kaya pa ng katawan,
bulsa at nandun pa y’ung commitment, patuloy pa rin ako sa
community service” (Personally, I shirk at the thought of going
back to mainstream practice and my heart and mind revolt at the prospect
of working at the hospital. For now, I think while my body and pocket can
manage and the commitment stays, I’ll go on with community service.)
Bulatlat
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