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
Bulatlat

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 surgeons.

During the recent National Colloquium of Community Medicine: “Pearls and Perils in Community Medicine-Issues and Challenges in the 21^st 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. 

Anatomy of 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 disease.

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 people’s well-being.

Global initiatives 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 initiatives.

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.

Health workers, 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. 

Oftentimes, community 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.

Community physicians 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 health facilities.

The government’s 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 employment.

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.

Beyond health

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?”

This succinctly 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. Bulatlat

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