Tuesday, 26 June 2012

FOCUS: Endgame ng isang mahirap

The facade of the Philippine General Hospital along Taft Avenue, Manila.

HE IS a relative twice removed, husband to a cousin,  and I have been attending to him ever since he got bed-ridden from colon cancer.
I’m paying back, for all the good things he had done for my family - my parents, my aunts - when he was younger and strong.  
He is now just a bundle of skin and bones – almost like a cow’s carcass, if you have seen one. Far cry from his once-robust physique. 
But he is hanging on. He had undergone colostomy and  chemotherapy, but still  his cancer advanced to stage 4.
Recently, in two months he had two episodes of pneumonia  and bleeding from the stomach which needed hospitalization. 
On his latest hospitalization, he had to be transferred to a government facility because he could not afford the costly medical attention at a private hospital.
The charity ward was so full, humid and smelled of human suffering. Could we - his wife and me -- in all conscience, relegate him to this environment? 
He has only Philhealth, the government health insurance, and senior citizen’s  card, which altogether accounted for a discount of only about a third of hospitalization cost.
 As a retired security guard, his monthly pension was only about 5,000/month, but his former employer has been helping him defray some of his previous hospital expenses in gratitude for his long dedicated service to them.
But help from them this time may not be forthcoming.  He has some savings which he intends to leave to his wife (jobless) and kid (in school yet), but now it is  being depleted fast  because of his medication.
We decided to admit him instead to the payward which he shared with six other patients.
“Bahala na”, we told ourselves. We will see how far our finances will go.  Seeing our quandary, my cousin’s husband consoled us. 

: A family of a patient makes inquiry at the PhilHealth counter in Manila.
He said that that was the last time we will shell out money for him. He proudly told us that he had taken out a modest memorial plan (the cheapest, actually)  so  that   his funeral expenses would be taken cared of. That’s one less headache for you , he said. 

That's what he thought.  I could not tell him that I already knew about his memorial  plan, but he  cannot  use it  because the company from which he got the plan  went bankrupt and is now under receivership. 

The premium he religiously paid   from money saved by  skipping merienda, foregoing eating out or  watching a movie, or foregoing buying  new work shoes to replace his old, worn out pair- all came to naught.  Will his end game  be a  woeful checkmate? 
“Sa isang mahirap, mahirap mabuhay, mahirap mamatay.“
This guy is more fortunate than others in his income bracket.  If my cousin’s husband was not helped by his employers, he could not have undergone treatment, which allowed him to enjoy a  few added  years to his life.
One session of chemotherapy costs P30,000-P50,000 and on average a cancer patient has to undergo from six to eight  rounds.
The health insurance that the government provides is so paltry that most of the poor  and even the not so poor end up in charity wards where  service is – yes, as poor- as the patients.
And mind you, where before, medicines could be given free for the indigent, nowadays, every bit of service and medicine has to be paid, though pro-rated according to one’s means.
So, the sick poor postpone medical consultation and self-medicate, until  their symptoms have worsened. 
Just recently, a child was brought to me with a bloated, hard belly and thin arms. She had obstruction of the bowels and the doctor at the health center advised hospital admission for possible surgery.
The single  mother, jobless, refused going to the hospital because she had no money even for transportation. Even if I give her fare money, she would have nothing to pay for the laboratory exams needed, the medicines, and if needed, surgery. 
Anyway, to make the story short, I treated the child conservatively, and monitored her progress everyday just in case she got worse.
 With God’s help - and who else is there to help? the child is doing fine now. The obstruction turned out to be partial.    
But miracles do not come everyday, and the woes of the poor are so many, they need an avalanche of miracles! 
And so my head went into a tailspin when I read about the government’s plan to privatize government hospitals (reason is to help them be self-supporting or increase their revenues).  
Instead of expanding services to the poor, the government boxes them in a corner and knocks them out. 
The short-sightedness of government policy is truly blinding!
Money transferred or spent on the poor is an investment on human capital! You help them get back to their feet, you get more productive labor, even in the underground economy.
Being ill has tremendous ripple effect - sick bread winners cannot work - children stop schooling-more out of school children—less educated labor force - the poor sink in debt more. 

An indigent patient awaits treatment at the steps of the UP-PGH while protesters opposed to a new policy to charge the poor for basic procedures do their thing in this recent file photo. Photo courtesy of BERNARD TESTA, interaction.com

The cycle of poverty is perpetuated.  
“No budget” has been the mantra of government officials to justify the lack of services to the poor.
Hah, tell that to the generals with hefty retirement benefits, with matching pabaon!
Tell that to the managers of government financing institution who get thousands and hundred thousands of honorarium and allowance for just attending meetings.
 How about all that money used to maintain a bloated bureaucracy?  Since smuggling is so rampant, how about auctioning off the smuggled goods and channeling the funds to government hospitals?  
How about a portion of the toll fees to help improve health institutions? Big Business can also partner with government by “adopting” hospitals.
Community-based financing schemes can be expanded.  Philhealth, with its huge reserve, can expand its benefit package.   
There are many new or innovative ways to solve problems of health care financing, but the main  problem is that government technocrats do not realize  the enormity of the problem  and the human suffering it is creating .
The problem of the poor does not stop when they die.
The wherewithal for funeral expenses can be such a problem to those left behind. Thus, it is common to see a cards table in front of a house where the dead lies in state.
This is  one of the many ways - aside from getting a loan of 5/6 from the neighbourhood “bombay” -  the poor  resort to, to defray funeral expenses: conduct betting (card) games and get a portion of the gambling bets and winnings (from pusoy, tong-its, blackjack, poker, you name it) or what in the local parlance constitute a ‘tong”.
My “American” nephew once asked his Pilipino cousin: is there a party? after seeing a group of men and women singing, laughing, drinking, eating and gambling  in front of a house we passed by along the street where we lived.  
My Pilipino nephew answered with a poker face: no par-ty, only pa-tay.
My cousin’s husband - a poor but  good man,  does not have money for his funeral expenses. But there will be  no cards table in front of his house when he goes.
He will lie peacefully in a chapel, in an ambiance of prayer and remembrance of all the good things he has done.   
I will see to that. 

(Dr Emma P Valencia is a physician and a health policy analyst and researcher. She also writes essays and poems when she is not busy with her work on health. She lives with her 85-year-old aunt and seven dogs.)


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