A Diagnosis of Public Hospitals

A few days before Health Secretary Francisco Duque visited the Bicol Medical Center (BMC) last Nov. 8, the hospital underwent repair and refurbishing - but only its frontage, some hallways and the garden near the auditorium where Duque dialogued with hospital employees. The rest of the hospital remained glaringly untouched. Such is the state of public hospitals that they could not even get a proper repair and repainting.

BY AUBREY SC MAKILAN
Bulatlat

The Bicol Medical Center (BMC) is Bicol’s regional hospital and located in Cadplan, Pili, Camarines Sur (465 kms south of Manila). The hospital, particularly its psychiatric wing, the former Don Susano Rodriguez Memorial Medical Hospital (DSRMMH), is a mirror of the sad state of public hospitals. In 1982, it was integrated with the Bicol Medical Center (BMC), formerly the Camarines Sur Regional Training Hospital which serves as the regional hospital. Since then, DSRMMH has served as the BMC mental ward unit.

MAKING DO WITH SO LITTLE: Three female patients of the Rodriguez Memorial Medical Hospital rest inside a makeshift strapping area. PHOTO BY AUBREY MAKILAN

BMC is a typical provincial hospital that suffers from lack of funds, lack of doctors and nurses and dismal facilities.

Overworked nurses

Nurse Hermie Ataiza has been with the DSRMMH for 10 years now. Nurse Annabelle Rahmatulin, on the other hand, joined the hospital only two months ago. Both share the dream of someday being able to work abroad.

Rahmatulin is actually an accountancy graduate at the University of Nueva Caceres in Naga City (449 kms south of Manila). Hearing of the big demand abroad for nurses, she went back to school and took up nursing. She finished at the Arellano University last March 2005 and passed the licensure exam in June.

Ataiza’s shift lasts eight hours. But if her reliever does not arrive, she works for 16 hours straight.

Often times, they have the well-behaved patients helping them clean, assist take care of their fellow patients, and even buy some supplies outside the hospital.

That is, she said, she appreciates the work of loyalty nurses, like Rahmatulin. Loyalty nurses, sometimes called apprentices, offer voluntary services to hospitals to train and gain experience.

Rahmatulin, however, said that despite the free service they render, they are required to pay a placement fee to the hospital. In her case, she paid the hospital P500. She said some hospitals charge more. The St. Lukes Medical Center, for example, charges as much as P4,500, she said.

Ataiza used to be assigned at the Bicol Medical Center (BMC), formerly Camarines Sur Regional Training Hospital. In 1982, it was integrated with the DSRMMH. Since then, DSRMMH has served as the BMC mental ward unit.

Lack of doctors

Meanwhile, Dr. Benedicto Aguirre, consultant at the DSRMMH, said that they also lack doctors. At present, there are only three of them who work on rotation. However, one of them has to be based at the BMC to screen patients with mental illnesses before admission to the DSRMMH. Thus, they have to schedule the check up and screening of patients only from Monday to Thursday.

Aguirre, who started as a physician at the DSRMMH in 1976, said the hospital has been facing financial problems since the integration took place. Before 1982, the hospital used to get a budget of about P3 million from the local government.  But it was reduced to a million after the integration. Considering the high inflation rate, it should be getting around P12 million, he said.

The big discrepancy, said Aguirre, could have helped them in improving the mental ward.

Dismal facilities

The DSRMMH was built to accommodate around 200 patients but, sometimes, the number of patients reaches up to 390. Patient admission peaks during summer because of the hot weather and the numerous celebrations like fiestas (feasts), during which mental ill persons get affected and become hyperactive.

It has five male wards, a strap room and an isolation room. But due to overcrowding, the isolation room usually contains four to five patients, usually elderly patients. For female patients, there are two wards and a strap room. The latter however has been converted into another ward to accommodate more patients. The resting area has been converted into a strapping area.

Meanwhile, inside the wards, the patients sleep on the floor.

Ataiza said the nurses’ station is located in what used to be the garage. She said that they neither have a pharmacy nor an infirmary. Sick patients are transported to the BMC.

When the hospital is overloaded they send the well-behaved patients home. But they have to conduct regular visits and provide the patients with maintenance medicine continuously for a month. Aguirre however said that due to lack of funds and shortage in personnel, they had to shorten the monitoring visits and give medicines only for three to seven days. In some cases, they could not even visit or provide medicine, he said.

Unfortunately, if the patient has been abandoned by their relatives, they have no choice but to bring the patient back to the mental ward.

BMC

The health workers and patients of BMC face the same problems as DSRMMH.

The BMC is a tertiary hospital that serves as the regional hospital in Bicol, the seventh most populous region in the country. It also has the seventh highest death rate, based on the Philippine Health Statistics of 2000.

BMC however operates like a private hospital, said Rey Dacuno, president of the BMC Employees Union-Alliance of Health Workers (BMCEU-AHW).

Dacuno said that the BMC’s objectives mirror that of private hospitals.  Dacuno cited two objectives of the hospital which as posted in BMC’s website: “To increase hospital revenues by 20% of CY 2003 actual income of P30 M” and “To improve hospital facilities in order to encourage PhilHealth patients.”

Dacuno said that although there is no plan to privatize the hospital, these objectives and the rates it charges show that the priority of BMC is to earn profits.

Johnny Bermejo of BMC’s Wellness Program, confirmed this. “Nagtataka nga rin kami. Pagpasok mo ng emergency room, may babayaran ka na. Tapos tests sa laboratory may bayad din, pati sa pharmacy. Lahat ng departments na pupuntahan mo halos merong bayad.”(We were surprised. Patients are charged upon admission at the emergency room. Patients are also asked to pay for simple laboratory tests such as a urinalysis, which used to be free. Almost every department charges the patients for their services.)

BMC patients are categorized based on their income. Class A and B patients pay for their bills. Class C-1 patients pay 75 percent of their bill, Class C-2 pay 50 percent, Class C-3 pay 30 percent and Class D do not pay anything.

Bermejo, who has been in the hospital for almost 18 years, said he tries to find ways and means to lower the bills of poor patients.  He refers indigent patients to politicians with funds or to the Philippine Charity Sweepstakes Office (PCSO).

Bermejo however said that even if the patients are classified as class D, with supporting documents certifying that the patient belongs to the poorest of the poor in his/her barangay, some are still made to pay 30 percent of their total bill.

Bermejo supports the House bill filed by Rep. Raul Del Mar of Cebu City seeking “to prevent the undesirable practice of hospitals and medical clinics of preventing the release of fully recovered and/or dead patients for non-payment, either partially or fully, of hospital bills.” The proposed bill was approved by the House on June 7, and transmitted to the Senate July 25. Sen. Ralph Recto introduced the counterpart bill in the Senate, and it has been referred to the committees on health and demography, and social justice, welfare and rural development.

Meanwhile, a few days before Health Secretary Francisco Duque visited BMC last Nov. 8 for the launching of the campaign against Filariasis - an illness characterized by the enlargement of the entire leg or arm, genitals and breasts caused by thread-like, parasitic filarial worms - the frontage of the hospital and some hallways were repainted.  Rep. Luis Villafuerte of Camarines Sur reportedly donated the paint.

The landscape near the auditorium where Duque dialogued with hospital employees was also brushed up. Employees were reportedly made to work on the garden Nov. 4 - even though it was a holiday - to prepare the grounds for the secretary’s visit.

Dacuno said the back of the hospital remained glaringly untouched.

Effect of devolution, neglect

In the morning of Duque’s arrival at the BMC, an old woman was catching her breath in front of the emergency entrance of the hospital. After being seen by a doctor, she was told to buy medicines for her respiratory problem. More than willing to take the medicines immediately for her comfort, she neither had money to buy the drugs nor to be admitted in the hospital. Left with no choice, she stayed in the waiting area in front of the Emergency entrance for almost half of the day waiting for her daughter who might have the means for her admission.

The old woman was not alone. Relatives of other BMC patients were there, too, thinking of ways to get help to pay for their bills. Some were asking who among politicians gave the larger assistance funds.

Since the hospital has been striving to support its own operations as aimed by the devolution, Dacuno said these scenes are just ordinary occurrences not just at BMC but in several rural hospitals were poor patients could not shoulder the cost of hospitalization.

The DoH stressed that devolution, through the Health Sector Reform Agenda, aims “to improve the health status of the Filipino people through greater and more effective coverage of national and local public health programs, increase access to health services especially for the poor, and reduce financial burden on individual families.”

“But with the decreasing budget for health, the devolution of health services to cash-strapped municipalities, and the privatization of government hospitals, how can the poor access the necessary services?” asked Dr. Gene Nisperos, secretary general of the Health Alliance for Democracy (HEAD).

Moreover, the devolution, Nisperos said, “only reflects the government’s abandonment of its responsibility to promote and protect the people’s rights to health.”

“The people’s health should not be compromised,” he said. “Nor should the quality and availability of health services be made contingent on the people’s capacity to pay.” Bulatlat

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