Diagnosing the Future of Community Medicine in the Philippines
Our country is in dire
need of doctors for the people. The starkest indicator of this dilemma is
the state of community medicine practice in the country and likewise the
dwindling number of community physicians.
BY PHILIP PARAAN
Our country is in
dire need of doctors for the people. The starkest indicator of this
dilemma is the state of community medicine practice in the country and
likewise the dwindling number of community physicians.
According to the
National Institute of Health, there have been more than 9, 000 physicians
who have left the country as nurses between 2002 to 2005. Likewise, the
Health Alliance for Democracy said around 80 percent of public health
physicians have taken up or are enrolled in nursing. This year, it said,
90 percent of municipal health officers (MHOs) are taking up nursing and
are expected to leave the country. The number of obstetricians and
anesthesiologists are also fast depleting, followed by pediatricians and
During the recent
National Colloquium of Community Medicine: “Pearls and Perils in Community
Medicine-Issues and Challenges in the 21st Century” held Nov.
28, community medicine practitioners and advocates met and discussed the
state of the practice in the country.
Dr. Melecia Velmonte,
chairperson of the Community Medicine Development Foundation (COMMED),
said that while community medicine is relatively a new field in the
Philippines, it is best understood in the context of health and
development. It also represents state of the country’s health situation.
Among the measures
identified that would help promote this discipline include integrating the
concept of community–based medical practice into the medical curriculum
and also linking the Philippine health situation to diseases as well as
other subjects in the medical curriculum. Furthermore, there is a need for
a value re-orientation in the medical school-hospital support system to
promote the viability of community medicine practice while the medical
academe should actively promote and advocate community medicine as a
career path among young doctors and medical students.
In the future, the
best practices in community medicine should be documented and a strong
system of supportive mechanisms for community medicine practitioners both
in the public and private sectors should be developed.
“The health of the
poor is a cardinal indicator of the state of people’s health,” Velmonte
says. Among the resolutions passed was the formation of a community
physicians’ organization to advance the discipline not only in the academe
and medical community but also to gain ground in the promotion of health
and development for the marginalized sectors of society.
community med practice
Also called “social
medicine” in western medical tradition, community medicine embraces the
medical philosophy of the distinguished German pathologist Rudolf Virchow.
He said doctors were
supposed to defend the poor because of the impact of their social
conditions. He said poverty-related diseases are preventable.
It entails a process
where health professionals become one with the people in understanding
their situation and in analyzing the root causes of ill health and
Since then, social
medicine proponents and advocates believe that the health of the
population is a matter of social concern where society promotes health,
not only through individual means, but also through social and collective
undertakings. In this context, they uphold emphasis on the health of the
poor as a cardinal indicator of how well physicians are taking care of
have been developed towards the realization of these noble principles.
Among them was the Third International Conference on Medicine in 1966 that
described the first community-oriented medical curriculum. Another was the
1978 Declaration of Alma Ata that defined the primary health care
approach. In 1985, the World Health Assembly issued an official statement
on community orientation. The Philippines was a participant to all these
In the Philippines,
experiences in community medicine and community health work have spanned
more than four decades. Communities where there are community health
practitioners count their achievements and successes. Over the past 40
years, education and training on the scientific causes of ill health and
disease were disseminated in remote and far-flung barrios. In several
areas, health programs have been set-up.
Later, these programs
were managed by mothers trained as community health workers who have
learned to use various modalities of treatment ranging from conventional,
traditional and alternative. The most valuable lesson learned in these
communities is that despite a hostile environment, the key is collective
action to obtain measures to respond to their health needs.
together with people’s organizations, have negotiated with local
government officials for higher health budgets. These have resulted into
better health care services for the people and work-related benefits for
public health workers.
The odds and
challenges for community doctors
Taking the side of
people’s health comes with a cost.
med practitioners are faced with pressures from family and friends. They
are looked down by other peers in the medical field and are considered in
the lowest rung of the medical field. In the medical organization, they
lack acceptance, are denigrated by peers and colleagues in the medical
field while also lacking support systems from the medical school-hospital
set-up. In the process, they fall into a sense of helplessness.
On the other hand,
there are also frustrations due to non-medical factors affecting healing
and treatment. They cope with the spiraling cost of living when salaries
remain low. Many community health physicians have earned the ire of the
status quo and the government that has subjected them to political
pressures, harassments and red baiting. A number of community doctors
are now being tagged as members of front organizations of insurgents.
Recently, the case of Kalinga’s Dr. Chandu Claver and his near fatal
encounter in the hands of highly armed gunmen believed to be soldiers,
reflects the persecution most development workers including doctors have
to endure. In some cases, they are openly harassed, included in military
orders of battle (OB), and are falsely charged with rebellion.
are constantly challenged on how to deliver quality health care amid the
struggle against recurrent poverty, hunger and social inequities. They
are confronted with the high cost of medicines and the lack of public
policies on health human resource have led, directly and indirectly, to
the decline in community health practice. In fact, advocates believe that
it is equally hard to count the number of practicing community health
workers as it is equally hard to count those who left the country for
Contributing to the
migration of health professionals are push factors that include phenomenon
of globalization, privatization of public hospitals, medical zones, cost
recovery schemes and the rationalization program which are being promoted
purportedly to bring improved health services closer to the majority of
the Filipino people.
Dr. Ramon Paterno, of
the Community and Family Medicine of the University of the Philippines
College of Medicine, in his presentation entitled, “Pesos. Politics and
Pathology: Addressing the Social Determinants of Health,” raised the
question: “What good does it do to treat people’s illnesses and then send
them back to the conditions that made them sick?”
reinforces the need for more community-based approaches to health. Thus,
the role of community physicians to go to the community and organize among
the people is an imperative and that the only way to stem the causes of
the people’s health problems is to address its social determinants.
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© 2006 Bulatlat
Alipato Media Center
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