CEBU, Philippines – In Philippine culture, psychiatrists are known as doctors who handle the cases of buangs, the taong grasa, the bag lady, or people who are considered crazy. But Child and Adolescent Psychiatrist Nancy Cinco said that a psychiatrist’s work goes beyond dealing with crazy people.
“Most of the people we deal with are not crazy in the literal sense of the word. They just have problems and most of the time these problems are difficult to deal with and, depending on how these problems are dealt with, these can affect their lives,” she shared.
The 47-year-old Dr. Cinco is a true blue Cebuano. She studied elementary at the St. Theresa’s College until grade 7 and then her family migrated to the U.S. in 1974. She came back to the Philippines and went to medical school at the then Cebu Doctor’s College, had her internship at the Philippine General Hospital and went back to the U.S. to train.
It has been three weeks since she arrived in Cebu to set up her clinic at the Gullas Memorial Hospital and already she has had several patients who came to her for consultations. “Almost everybody who came asked for a card because they know someone who needs my services, so I’m looking forward to working here.”
The stigma of seeing a psychiatrist
Dr. Cinco is positive that the market for psychiatrists in Cebu is wide open, especially since there are only a few doctors who are into the specialization. However, there is a bit of a problem though – the stigma of seeing a psychiatrist.
“It takes a lot for a parent to bring a child to a psychiatrist, especially with the psychiatrist’s ‘label.’ Bringing a child to a psychiatrist does not mean buang ang bata. People are not born crazy,” she explained. “A lot of people know about psychiatry but all they know is that this specialization only deals with mga buang. But dealing with buangs and people who are not in touch with reality is not the bulk of our work. Yes we deal with them too, but psychiatry is a whole lot more. A lot of people do not know that we child psychiatrists, for example, help children and adolescents cope up with the different systems of society.”
She said helping children and adolescents deal with the complexities of the different systems in society - the family, the neighborhood, the school, the church, the barkadas— will help them as they grow up.
According to Dr. Cinco, most of the children and adolescents that go to a psychiatrist have already been checked by another physician who recognizes a problem that is already beyond his or her scope. These problems, she said are usually behavioral manifestations like disruptive behavior, temper tantrums that cannot be controlled or can’t be understood, mood swings, unexplained fears or lashing out type of behavior, abrupt changes in the child’s behavior that cannot be explained and children and adolescents who have experienced trauma.
“Other patients who come to us have more chronic problems, or problems that have been going on for a long time and they have tried different ways to deal with it, and all without success. But most of the people who come are seeking second, third or fourth opinions. Most of them want to have peace of mind. They want to be assured that they are on the right track,” she said.
Confidentiality and sensitivity to the needs of every patient is very important in the practice of psychiatry, which is why those who want to see a psychiatrist have to get an appointment. In her clinic at the Vicente Gullas Memorial Hospital, Dr. Cinco has two waiting areas – one where the kids can play, and another area which is more private and quieter for the adolescents. Dr. Cinco’s clinic also has an observation room where she or other physicians can observe interactions between the patient and their family, for example.
Dr. Cinco, however, admits that seeing a psychiatrist is a lot more expensive than seeing a regular physician. “When you go to a regular physician, you may spend a few hours waiting in the clinic but the actual face to face time is just a few minutes. When you go to a psychiatrist, you will stay for at least an hour, there is more face to face time, which is why it costs more,” she explained, adding that an initial evaluation of a child may even take an hour and a half. Also, when consulting a psychiatrist, it is not only the patient that interacts with the doctor but also the family, the relatives, the yaya, the teachers and the social workers. “Everyone in the child’s life has to be involved,” she said.
Having decided to practice her profession here in Cebu, Dr. Cinco hopes that we will soon have facilities for the whole spectrum of services that are related to psychiatry. She said that although these services are already available in Manila, it is very difficult for patients to go there to get tests, considering the cost of going there.
Aside from access to facilities, Dr. Cinco also hopes that Cebuanos, and Filipinos in general, will learn to be open about seeing psychiatrists for help.
“A culture shift and lots of education is needed for the Filipinos to learn to accept the need to see a psychiatrist or be open about seeing one. With education comes acceptance, a willingness to try something new. People abroad are open to seeing psychiatrists because they are more aware of the need. I hope this stigma will change. I hope I will be able to help take that stigma away,” she concluded.