Our health infrastructure is deadly

I have been talking to a number of doctors and I am getting the same message: if you should have a heart attack or a stroke, pray that neither happens outside of Metro Manila or Metro Cebu. “The reality is an ordinary heart attack or a stroke can be terminal in this country,” a prominent surgeon told me. He continued, “morbidity/mortality rates particularly in the countryside are definitely Third World. And that is the most charitable statement, I can make.”

He asked: how can we even talk of medical tourism when we can’t even have basic lifesaving facilities for our people outside of the metro areas? “In Boracay, a minor heart attack can be fatal. And that’s exactly what happened to the Chef of a foreign group, which was going to build a 5-star resort in the island. The group has since abandoned its plans. An executive said, ‘it’s not because he died, it was how he died. He didn’t have a shot.’”

That’s along the same lines of the conversation I had with a cardiologist at the Tuesday Club this week. Dr. Tony Leachon related an incident in Boracay involving a St. Luke’s internist who died while 20 fellow cardiologists helplessly watched. The internist was in a drowning incident and there were no facilities around to deal with the emergency even if all those cardiologists were there.

Dr. Leachon said that he himself had to use his bare hands to revive a Korean tourist in Boracay who had a heart attack because that’s all he had to work with. Luckily, the Korean survived. Dr. Leachon confirmed the assertion of my surgeon friend that even in affluent areas like Punta Fuego or Tagaytay Highlands, there are no easily accessible modern health facilities needed to handle heart attacks or strokes within the short timeframes required. How the affluent and otherwise intelligent but older people whose careers involved careful risk assessment can even think of retiring in those places or even spend a weekend baffles my doctor friends.

There are many preventable deaths in this county, these doctors lament. “A fatal first heart attack is an exception not the rule. With modern medicine, one should be able to survive heart attacks or strokes with minimal complications, if any. This is not true in this country. Proper emergency care is not available outside of Manila and Cebu.”  “Outside” includes popular destinations such as Tagaytay and Boracay. Both have some so called hospitals. NONE can properly treat these two medical emergencies, the surgeon asserted.

The surgeon explained that what is available in places like Boracay is the generic hospital as we know them in the country. This, he said, is virtually USELESS for heart attacks or strokes. Actually, the surgeon points out, it isn’t that difficult or expensive to have a clinic designed, equipped, and staffed for medical emergencies that threaten imminent death and time is of the essence. All we need is a place where the patient can be stabilized and then shipped out where proper care can be given.

That is why my surgeon friend is scoffing at all the publicity government is generating about its program to encourage medical tourism. “In reality, outside of a few hospitals in Metro Manila and Metro Cebu, medical services elsewhere in the country are considered inadequate by international standards. Further, service quality varies dependent on the time of the emergency. In short, the healthcare infrastructure of the country is bad and woefully behind most countries in the region. Prognosis is bad, since nothing of significance will be done about this in the foreseeable future.”

Our competitors in the region are way ahead of us. My surgeon friend continues: “there are at least three Phuket hospitals that can handle medical emergencies and ambulance service in mere minutes, I am told – (I believe it considering there was no medical evacuation to Bangkok post tsunami - local hospitals handled all comers)!”

If we are serious about our basic tourism program, retirement program and the development of luxury second homes away from the metro areas, the private sector developers will have to include adequate medical facilities in their plans and not wait for government to provide these. “What is acceptable to average Filipinos is NOT acceptable to most foreigners and the more sophisticated Filipinos.”

My doctor friends are saying something very simple: Private sector developers to be competitive with the region must build the healthcare infrastructure that will meet world standards before they initiate worldwide marketing of tourism or property development projects. They have to remember that the market they wish to attract are more upscale, international, and more knowledgeable and by extension, more exacting in their needs, vis-a-vis EMERGENCY HEALTHCARE.  

While Dr. Leachon agrees with my surgeon friend on our need for emergency facilities outside Metro Manila and Metro Cebu particularly in major tourist destinations, he thinks our problems are bigger than that. “What we want really are hospitals, clinics, doctors and nurses to serve our masses. Without these resources, you can give drugs away for free and they still won’t get to the most needy.”

Dr. Leachon laments that “in the Philippines, at least 40 percent of people will never see a doctor in their entire lives. Clinics and hospitals are rare. PhilHealth, the government-run social insurance scheme, provides very basic cover for only around half of the population.”

What we need is to create healthcare infrastructure for every municipality – 1500 municipalities – 1500 satellite or primary clinics (P2 million) or secondary hospitals (P30 million). Fifty per cent of the doctors in the Philippines are practicing in Manila – there are hardly any doctors in peripheral areas where the maternal and infant mortality rates are high.

Then again, he says the Philippines is not unique; most countries in Africa, and many in Asia and Latin America have dysfunctional health systems, a lack of health insurance and regressive taxes on medical goods and services. “As a result of these failures of governance, less than 50 percent of people have regular access to essential medicines in some parts of Africa and Asia, including the Philippines.”

In the end, Dr. Leachon concedes “it is patients everywhere who are suffering from the current fixation with patents and prices. It is taking energy and discussion away from the things that really matter, such as infrastructure, doctors and nurses. Unless these resources are made more widely available, people will go on dying from easily preventable diseases.”

A bright spot in this regard, Dr. Leachon said, is Palawan. With the enthusiastic support of Mayor Hagedorn, Dr Cris Cabral Pauig, 1995 UP medical graduate who had her residency in Internal Medicine at the University of Connecticut and her fellowship in cardiology from the University of Florida, has set out establishing medical outposts in our country’s last frontier.

Through her effort and the support of the Mayor, there are now three secondary hospitals and one provincial hospital. Mayor Hagedorn has established 10 satellite hospitals (P2 million each) in strategic areas (one for every 10 barangays) providing access for free. Each clinic has a nurse, midwife and a doctor - usually those young graduates who gain experience while waiting for specialty training opportunities.

But even in Hagedorn’s part of Palawan, these health centers can only deal with common ailments and not so serious emergency cases. These are basically start-up medical facilities that must be soon upgraded. But it is significant at least in Palawan, the Mayor realized the importance of such facilities and found the money necessary to deploy these facilities. That makes one think, if Palawan’s Hagedorn can do it, why not the rest?

The surgeon is not too hopeful about positive change happening soon. “The prognosis for the country’s healthcare is BAD as many other factors will kick in, e.g. the exodus of healthcare personnel, high population growth, increasing poverty, decreasing quality of education, etc. The prognosis outside the cities is beyond definition. The recent developments in two of the top hospitals in the country (takeover by more capable private enterprises) will eventually force the issues on the realities of medical development out into the open. This is my hope.”

Green grass

 A young woman with purple hair styled into a punk rocker Mohawk, sporting a variety of tattoos, and wearing strange clothing, entered the ER. It was quickly determined that the patient had acute appendicitis, so she was scheduled for immediate surgery.

When she was completely disrobed on the operating table, the staff noticed that her pubic hair had been dyed green, and above it there was a tattoo that read, “Keep off the grass.”

Once the surgery was completed, the surgeon wrote a short note on the patient’s dressing, which said “Sorry, had to mow the lawn.”

Boo Chanco’s e-mail address is [email protected]. This and some past columns can also be viewed at www.boochanco.com