The
facade of the Philippine General Hospital along Taft Avenue, Manila.
By EMMA P VALENCIA, MD
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.)
