The Philippine General Hospital by virtue of being the largest government hospital serves more than 600 000 patients every year. Most of these patients are those who can’t really afford the high cost of health care in private hospitals and are left to duke it out with the limited beds and medical personnel in PGH. As big as PGH is and as enormous the government subsidy is for the hospital, the resources and manpower are definitely stretched to the breaking point. Despite having a steady supply of extra hands from the robust studentry of the UP College of Medicine and UP College of Nursing, logistical and financial limitations routinely frustrate both patients and health care providers.

Patients don’t have to pay doctors in PGH. Every patient who enters the hospital as a charity case will never be asked a professional fee no matter what the treatment for him/her will require. Even if one was to have an emergency surgery or spend weeks in intensive care, no doctor will ever get even one cent from any patient. Unfortunately, treatment requires more than having the doctor lay his/her hands on the patient. For every move the doctor makes, he will likely require a diagnostic test in the form of laboratory or imaging procedures. Relative to other healthcare delivery facility, the discounted rates in PGH are probably among the lowest in the country but a considerable amount of patients still find paying for this relatively cheap services challenging. I’ve been forced to shell out some money to facilitate labs and I’m pretty sure that this is a very familiar story for a lot of med students.

It doesn’t stop there. The medicine is obviously not dispensed for free. Doctors in PGH double as social workers and philantropists in an effort to maintain the best possible standard of care in the face of really trying financial dilemmas. I’ve seen residents shell out thousands of pesos to pay for a patient’s hemodialysis. Medical representatives unwittingly help patients when they give doctors free drug samples. These colorfully packed brochures with one or two tablets eventually find their way to the bedsides of needy patients.

Sadly, the story of costs and trials doesn’t end once patients leave the hospital. A good number of patients require life-long treatment and monitoring to ensure that their diseases will not worsen or further compromise their quality of life. Patients with end stage kidney disease would require hemodialysis at least twice a week just to clean the toxic off their blood stream. Once you put into consideration that each trip to the dialysis center would set you back 3000 pesos, the gravity of the problem becomes more apparent. It will be a big challenge for a middle-class family to even shoulder 18 000 pesos a month what more to a family that’s way below the poverty line?

I sometimes ask myself what’s in store for the poorest of the poor who don’t even have the ability to set aside extra cash for medical emergencies. It’s easy to say that this shouldn’t be the way things should go but the economic principles on which hospitals and drug companies operate on are simply contradict the goal of affordable health care for all. As it stands now and given the infrastructure of the drug industry, I am not a big fan of a more comprehensive form of socialized health care wherein the government shoulders much of the tab. PGH already receives over a billion pesos in state subsidy aside from millions of donations and contributions from politicians, alumni, charities and other organizations.

The price of care is anything but cheap. For the immunocompromised patient with a raging infection due to an aggressive pathogen, the antibiotics to be used may run up to more than three thousand pesos per dose. How many doses are needed? Three… PER DAY… FOR TWO WEEKS. That sends the grand total to well over a hundred thousand pesos – probably way more than what a poor family makes in an ENTIRE YEAR. This of course is just a small part of the medical regimen and the patient would probably continue to need specialized care and medications for ther rest of his/her life even if great sums are thrown to purchase antibiotics. Though I am very much sympathetic to the needs of patients, I just don’t think it’s right for the government to allocate that much money for the care of a patient with an unfavorable prognosis. I still believe that there should be equity in society. As cold as it is, I think that economic value should play a part in how much the government would be willing to spend for an individual. The mendicancy-driven system and the culture of enforced vampirism has to stop if we are to truly come up with a truly lasting and sustainable solution.

As cliche as it sounds, education has to be the solution out of this because if it isn’t then we’re truly helpless. I’m so tired of seeing poverty in my everyday stint at the hospital. I’m sick of being witness to patients dying because their families could no longer afford to buy medicine to prolong their lives. My heart and ears already too fatigued to the wails and cries of loved ones while we in the duty team try to revive a coded patient. I’m tired -and I’m not even a doctor yet.

For education to work out and provide the new generation with greater opportunities for economic mobility, we have to swallow the bitter pill that the older generation is beyond salvation. Aside from being the ticket of politicians to their respective elective posts, they will also be no longer competitive in the economic game even if they were to get their due. Resources are limited and it will be far wiser to invest those who could help us more in the long run. The older generations are products of the systems of yore – one of patriarchy and shameless cronyism. The rhetoric over the years regarding the poor having more in law along with the church’s poverty-affirming message further made these people exhibit a combination of beholdness with an air of entitlement and pride with a sense of jadedness. It’s not exactly their fault but they’re definitely beyond reform. They have lived this way for so long to the point that a paradigm shift will not sit well with them.

I know this is not the wide-eyed optimistic perspective that most people would expect from a young blogger such as myself but I have never been a populist. We have to be pragmatic in solving the problem and unfortunately, we can’t save everyone. We can’t afford to be a aggressive in our treatment every single time. In medicine, there are times when palliative care as opposed to life-saving therapy is warranted.

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This is my official contribution for Blog Action Day. Do you have something to say about POVERTY? Blog about it TOMORROW! (15 October 2008)

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