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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We have a young MD (UP Medicine 2007) working with our environmental science institute. What Benj says is true. In our environment work, at times I have to go to PGH and deal with the interns and residents.
UP PGH MDs and MDs to be learn early on to practice triage. I agree with Benj and the MDs when he writes
” 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.”
Our young doc says that the solution is simple, emphasize preventive and wholistic medicine (through the public education system). If the government is effective in this then expect the PGH to serve only the patients that really need medical care.
But as our MD says, PGH is also a facility used by politicians (through charitable groups like PCSO) to maintain their grip on power.
PGH paradoxically then is the avenue for health doles and health empowerment. The doles prevent health empowerment while the dedicated young MDs emphasize empowerment. But as my young MD says, in the end, the system will prevail.
The UP College of Medicine over the years is also part of the problem. Everyone has heard of a UP Medicine grad who has made good in the US of A at the expense of the Pinoy taxpayer. Several kiss and tell books have come out like Dr Ting Tiongco’s “Surgeons don’t Cry” that exposes the society that is the UP-PGH.
Our young physician doesn’t believe that the service requirement now instituted by the UPCM will work. Why? He says its that the UP Medicine accepts mostly “anak mayaman”, “anak ng Diyos” (doctors who practice in the PGH)
By ‘older generation’, do you mean Ding and above?
I meant everyone older than me (X > 23).
Thanks for the clarification. That’s around half my cut-off and one-third of Bencard’s.
A holistic approach to medicine and strengthening of the preventive aspects could improve the health of people but there are some diseases that are not preventable. What happens then? Should the government dole out?
I agree Blackshama, there is a lot of politics involved.
while you are at it, benj, maybe you can also advocate converting pgh into “soylent green” factory. so you get rid of the “older generation” and, at the same time provide “food” for the young ones. what a shame. i’m glad you are just a student. i hope you never get to be an m.d. it won’t fit.
jeez, what’s this world coming to?
POOR POOR parents who worked hard to provide the young generation with their education.
Pencil that. There is no salvation for you old PEOPLE according to a 23 year old who have not even seen the world. sheesh
…that in the US, the state provides medical care, medicines and milk for the single parents with young kids.
…it is not encouraging mendicancy to provide medical assistance to those who are temporarily below poverty line.
…it is not encouraging mendicancy to provide medicaid for physically disabled people.
Even in the Philippines, there is always a charitable section in a private hospital which takes care of the marginalized patients.
why it has always to boil down on politics?
This issue requires unity among private and public health professionals who can lobby in a positive way to discuss the many problems of our health care system. Present the problems to the President and Congress so that they can be better informed of alternative solutions. The best way to educate our people is to educate Congress first to exercise its political will. Unfortunately, the Philippine government is mostly made up of politics rather than will.Lack of Will maybe because they are not healthcare practitioners. For those who are experts and willing to change the system , then do something about it. Not only one , few or in 100′s but majority of the healthcare professionals must get involve and be proactive. Blaming is not a good solution.
Prevention is the best medicine. This is not very costly except implementation thru education and teamwork. It should start from the very bottom- the local government units.
Governor Petilla of Leyte has a great program.
“ICOT Caravan was launched in the month of June 2007, in Tanauan, Leyte where more than a thousand residents from the 54 barangays of the municipality flocked at the Tanauan Gym to avail of the seminars and the services being offered.”
http://pia.gov.ph/?m=12&sec=reader&rp=1&fi=p081009.htm&no=9&date=10/09/2008
If every barangay kapitan in the Philippines has the basic knowledge and materials to be used to educate the population for preventative medicine including exercise and nutrition, our country will see a better future.
Benj,
Hehehe, see what ya get when you diss the elders, ya young whippersnapper! It’s maybe because you confounded old people with old ideas, the “older generation” with failed plans and decrepit institutions. The lesson of course is a possible irony. For those plans were made when the old were young and full of exuberance and optimism too, of impatience at even more ancient failures and inadequacies. Remember your time at PGH though. Like many of our doctors the chances are, you will continue to describe its horrors and your sojourn there to aghast acquaintances at cocktail parties in America for years to come).
cvj.
You rascal. you hehe. “Older generation”? Surely not an epithet so no offense taken. To the point itself, It is testament to the the government’s distorted sense of priorities thar PGH and other tertiary, and in the case of the PGH, that even public teaching hospitals are being neglected. My own second-born, Luis (now 12) was delivered by caesarian section by my wife at PGH, and believe me, the regular ‘paying’ rooms, the service was great. I am not fully updated, but I do pray the services are still at a respectably good level, or are they?
We are fighting a war in Mindanao and I cringe at the thought of how our soldiers are being cared for in the field medical units, if there are any. Not a few have been reported as having bled to death while awaiting med-evacs which never come.
Now that’s HELPLESSNESS.
As usual, the comments section of the Filipino Voices is comprised of things that the original author neither even said nor insinuated. It has become a habit of so many of you on FV so I don’t know why I have to point it out here.
I never said anything about “denying admission” and I definitely didn’t recall anything about “digging a grave for the old”. If the prognosis is poor all you can really do is just make the rest of that person’s life a little bit more bearable. Palliative care, anyone?
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Pencil that. There is no salvation for you old PEOPLE according to a 23 year old who have not even seen the world. sheesh
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Why, have you seen PGH? No? So there,thank you for grandstanding. Now we have an 80 year old who has no idea regarding the specific context of the article.
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if pgh will deny admission of these patients, it is like denying the doctors to be able to learn more about the diseases. In the US, the patients who have these prognoses are invited in hospitals such as Stanford to participate in programs where new medicines and techniques can be tested.
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Right. PGH has the facilities and is on the leading edge when it comes to revolutionary treatment so it function like Stanford. Who said anything about “denying admission”?
And bencard, I’ve already seen your strawman tactics all over FV. You’re fond of building mock ups and victoriously celebrating as you destroy the “opposing argument” that your created yourself. I’m glad you’re old. And oh, unfortunately, you can hope all you want but there’s no stopping the inevitability of me becoming a doctor.
DJB, fortunately(?) , I have no plans of leaving the country.
yeah, great ambition. why not? afterall, frankenstein was a doctor, wasn’t he? don’t worry about me being old, boy. i’m well-cared by medicare (with supplemental coverage) so i can choose my own doctors.
Is our Philippine healthcare system has palliative care team? Patients at these level are concern of pains, fears about the future, worries about their families and feeling like a burden. A good counselor is a full time priest and a social worker to assess the patient’s home environment if appropriate for early discharge. The professionals can provide education to the family on how to care for their sick love ones at home. There are lots of ways to allow a terminally ill patient to have a quality time with his/her family.
Keeping these type of patients in the hospital is definitely a big burden. It’s not even a challenge but one will experience the feeling of helplessness.
Thanks Ding, no offense meant on my part. I just needed a reference point less obvious than Bencard.
@Bencard, soylent green? If that pushed through, at 26 Nick would be chicharon (malutong), at 41 i’d be chicharon-bulaklak (medyo makunat), and at 66 you would be beef jerky.
Benj,
The part regarding “older generations” is, admittedly, vague, so instead of bitching about the strawmen that people set up I think it’d be better to offer a little clarity.
What did you mean by the older generation being beyond salvation? Are we talking about allocation for medicine and healthcare? Are we talking about practices of the older generation vis-a-vis the medical profession and job security? Are we talking about the padrino politics that pervade medical institutions?
Subtlety is elegant, sure, but it is very, very easy to draw strawmen from subtle arguments rather than obvious ones.
Benj, great job bringing up a topic that nobody would dare touch. We all know that by the time we need our SSS or GSIS contributions, they won’t be there anymore, (especially if we succeed in limiting population growth). Let’s face it, the government doesnt have the money to take care of all of us. Those of you in the US arent safe either — cept for the older guys like Bencard — when you grow old, your social security and medicade contributions probably won’t be there for you.
DJB, Im curious how you view this. You have advocated for the government to get out of education. Are you also advocating that the government get out of healthcare and insurance as well? My own ideas on the subject arent fully formed.
“there are some diseases that are not preventable. What happens then?”
That’s what the young doc and me say as that refers to “patients that really need PGH’s care”
As for the comments on being old and hopeless this truism may be an eye opener
“youth is always wasted on the young”
jeg re your 10:03 question to djb, i think we need to explore whether or not we want our country to be a watchman state or a welfare state.
jeg re your 10:03 question to djb, i think we need to explore whether or not we want our country to be a watchman state or a welfare state.
Im betting that if we held a referendum, welfare state would win hands down.
Jeg, not if you ask the Middle Class.
That’s probably because they have to pay for it. But I do think that the Filipino middle class would favor the welfare state as well, although I could be wrong. I know our politicians would love it.
“there are some diseases that are not preventable. What happens then?”
there are non preventable risk factors and preventable risk factors. this is where education comes in. To educate the people on preventing risk factors. I don’t know any disease that are non preventable. Is there one? if so, dig a hole :)
In the Philippines, we already have dug a hole prior to the disease process. This is linked to poverty.
Jeg, i think it would be reasonable for everyone (the middle class & the poor) to want to have insurance against dire events. The problem, as we all agree, is that the Middle Class bears a disproportionate amount of the burden because we have a very narrow income tax base. The other problem, that you have identified is given our context, politicos will channel the benefits to their respective supporters.
The first one i proposed to address by lowering the tax rate for locally based middle class employees and widening the income tax base by imposing this lower rate on everyone which means no more tax exemptions for the poor and taxing OFW remittances. (I blog about these proposal here).
The second issue we can address by implementing Universal Health Insurance, again deductible from everyone’s income so that the pool would be big enough and the welfare benefit cannot be credited to the politicos (and their pork). Perhaps the Medical professoinals (like Benj) and the Actuaries can then come up with a set of standards on who would be eligible for treatment and a cut-off point where a patient switches to palliative care, trading off affordability, equity and a level of compassion that our Society can afford. Demographically, in terms of healthcare, our dependency ratio is actually favorable since we are a relatively young society. (The demographic burden affects more the issue of education.)
“Demographically, in terms of healthcare, our dependency ratio is actually favorable since we are a relatively young society. (The demographic burden affects more the issue of education.)”
It isn’t simple as it sounds. We in the environmental sciences and those in the medical professions have data to show that a deteriorating environmental condition coupled with bad lifestyles (again in many cases linked to poverty) are contributing to increasing health morbidity and even mortality.
Morbidity as a result of so called “bad habits and lifestyles” results in otherwise healthy and productive 30s to 40s patients swamping the hospitals. As for deteriorating environment,these affects mostly the children and the elderly. Infectious diseases as all docs know are the main problem here.
Point taken Blackshama. I was thinking in terms of an all things being equal scenario (i.e. considering dependency ratio alone) but as you rightly point out, all things are not equal since population pressures affect the quality of the environment, add to that an unhealthy lifestyle.
Sorry ngayon lang ako nakabas pwede pa bang humabol benj sa pagsuporta?
Ang usapan patungkol sa kahirapan ay hindi lang nakabase sa pisikal na nakikita natin, nariyan ang kasalatan ng tao pagdating sa talino, edukasyon, kalusugan, at pulitikal.
benj:
i agree, but let’s just see if we can say the same thing 23 years later. maybe in the future, a paradigm shift may not sit well with us, coz the old were once as young and idealistic as we were.
i hope that doesn’t happen.
But of course, two of my sisters who are UP college of Nursing grads have interned and worked in PGH.
and it is there where they developed compassion which i can not see in you.
Yeah i may belong to the old generation but i know fully well that if your intention is merely to introduce wellness program you do not have to recommend the revamp of the whole education system and label it as dysfunctional when you may have not even participated in simple course syllabus preparation.
You’re recommending surgery for a simple problem of constipation.
How naive and clueless can you get. But of course the medical representatives know that these medications will be given to the patients in PGH. They’re not stupid not to know that. The medical staff can’t sell them even to the paying patients. Only a dum dum would not understand the word FREE SAMPLES and not for SALE.
So what do you think they’re for?
I don’t know. But you can’t blame us young people who thinks bencard’s generation had the chance to change the Philippines yet didn’t do so.
Much could have been done with regards to laying the foundations of a great country in the post-war and even the post-Marcos years. But the previous generations, for some reasons, didn’t deliver much.
Hope our generation would do better.
It is not being philantrophists. It is being aware that they are luckier that these people. And being in PGH as a medical staff or nurse as UP graduates, this is one way of paying back.
If they have taken their medical and nursing degrees in the private universities, they have paid more. the free drugs are courtesy of the medical representatives who are making good business in a government hospital where the free med samples may not even constitute 1 per cent of their sales and promo expense accounts of the pharmaceutical company.
so what does this stupid statement mean?
It means you’re the ugly and you have to look up the meaning of the word prognosis in the dictionary. I’m sick of your strawmen and poor rationalizations of your ideas. If the proper allocation of resources to people with better prognosis doesn’t make sense to you, look up this word – TRIAGE. This is elementary but given the OBVIOUS context of limited resources and overwhelming demand, there needs to be a great deal of prioritization to help those who have a realistic chance of survival. If that doesn’t make sense to you then you don’t have any business pretentiously trying to use medical analogies because you obviously don’t have the cerebral capacity to even grasp the most basic concepts of the science.
Free samples are not given as an act of charity – it’s given to influence the behavior of doctors once they step out of the government hospitals and branch out to their respective practices. Of course, you are largely unaware of this particular nuance because you have no idea on how the system actually works. You are simpleton who pretends to know the dynamics of something because you are much closer to your grave than I am. Pathetic. AND UGLY.
I am happy that you are old as well. You clearly lack the intellectual sophistication that this generation has.
And did I mention that you are the ugliest THING I’ve ever seen? I’m sorry but I just posted an article here and I have no idea why you have to go psycho on me. Being that aggressive will not help you look any better or any more human, I’m sorry.
Hi Leytenian,
Yes, we do have a “palliative care” facility in PGH. The Department of Family Medicine has a special ward called the “Hospice Unit” where terminal patients spend their last days. This helps patients and their families live out the patient’s dying days in relative seclusion from the rest of the chaotic hospital. Psychiatrists and Family Medicine practitioners also routinely visit the patient and their relatives to help them learn coping mechanisms for the inevitable.
Aside from this, the Department of Surgery and Radiology also engage in palliative care via tumor debulking and radiotherapy. These procedures are rarely sponsored by donors though. :)
Now I know what happens when brain cells die.
By beyond salvation, I clearly didn’t mean that old people should not be treated in the hospital – I meant that the older generation will not be able to “shift to a new paradigm” due to their preference for what they were used to. This was of course made in the context of poverty alleviation.
On the other hand, the reactions of some of the >50yo crowd proves the rigidity of the mindsets of some people here. You are so convinced that what you know is the right thing – now tell me, where did your generation bring this country to? Your claims of knowing better are laughable considering how your generation has dismally failed in making the changes.
Pathetic. You are beyond salvation – too much of your brain cells have died.
now i am the ugly person in your plurk. childish,
Seriously speaking…if you were the doctor who diagnosed me with cancer last year…i may not be alive today exposing your ignorance and stupidity on how budget is being allocated…how pharmaceutical companies are promoting their products thru samples regardless of who get them.
It is just so happen that the doctor who is my primary health provider who knows about programs of pharmaceutical companies where I can get the medicines at big discounted prices thru his recommendation. this is not about mendicancy. this is about doctors who do not deny assistance if they have the resources whether it is their own or they can easily get it from their own network. i repeat, I shudder to think what kind of doctor you will become.
You are still a runnynosekid whose concerns are only focused on what you read what you gossip in your plurk.
Instead of critizing the subsidy of PGH and how it
helps the marginalized sector of the society why not criticize the whole Department of Health where budgets are spent on acquisitions of equipment for hospitals which do not even exist…for drugs that expire in the warehouses.
Why you do not know this. Because kid, marami ka pang kaning kakainin.
Why you do not know this. < that’s not even a sentence. Dead brain cellsmuch?
Marami pa akong kakainin?
Ikaw konti nalang.
I shudder to even begin to imagine that you’ve lived in this pathetic mental state for so long. You thundercats can’t boss us young guns here in FV forever. I don’t care about your annual rings – I’m here to cut you all down. Some of you are clearly rotting from the inside.
benj,
i understand about the Helplessness issue. We should not take it personally nor professional. We just have to deal with it with solutions I made mentioned above. Politically, I would support cvj’s proposal for Universal Healthcare. Employer and employee sponsored plan mandated by government’s policy thru income deductions.
I will add a third proposal: For those who can afford, one can purchase an extra supplemental insurance ( private insurer) that will cover the deductible, medications and long term care( palliative and life-saving therapy.
For those who have pre-existing conditions that will not be covered thru Universal healthcare is another issue. anybody?
to all the “young ones” (in age as well as in mind) in this blog, particularly benj. let me give you a simple truth which even the most immature mind can understand: you’re all gonna get old too, it’s only a matter of time. the generation that will come after you will always find something to blame you for, then you realize, it’s not easy, maybe even impossible, to change the world the way you want.
btw, benj, i’m pretty sure you were not a “med student” when you were born. your parents (as most parents do) nurtured you, protected you, labored to try to make life easier for you. most parents are imbued with a desire to improve the society of which they are a part if only for the immediate benefit of their family, especially their children. just because they didn’t succeed (because there weren’t a lot that they could control) their children would have a right to condemn, discard, or judge them harshly.
i just hope you guys are just going through a phase. the world-wide influence of libertarian values, self-centeredness, abhorrence of authority of any kind, aversion to the weak and the aged, hatred of physical ugliness or infirmities, are no help. nonetheless, good luck on your quest for a brave new world.
p.s., benj. i don’t think you like your parents and grandparents very much, do you? why, what did they do to you?
cut us all down? how many octogenarians have you knocked down lately? it feels good doing it, huh? hail to the terror of the geriatric population!
Bottom line is the government cant afford to take care of all of us. So all the young people better take care of yourselves now, or try to earn enough money and put some away in case your profligate lifestyles sentence you to a future of hospital visits. Universal Healthcare is compassionate but unrealistic; we’re already up to here in debt and we’re burying the generations after us even deeper in it. Bencard’s generation didnt do the right things to take care of us, and we’re doing the same to the generations after us. It’s time citizens took care of themselves because Mommy Government can’t, and won’t be able to.
(The old vs. young turn this comment section has taken has been very entertaining. ‘It means youre ugly…’. Classic.)
It’s time citizens took care of themselves because Mommy Government can’t, and won’t be able to.
I know, I know. They keep confiscating money from us and assuring us that theyll take care of us. But that’s what government does: make dishonest promises.
FWIW, someone from the older [aka baby boomer] generation did apologize to us younger folk.
Jeg, I try my best, thanks. LOL
Anyway, being old is one thing – being old and expecting some special treatment because of the perceived “wisdom” that comes with aging is totally different from that. People (young or old) who attack me off the gates without much attention to context deserve what they get from me. If the thundercats here choose to prance around and pretentiously claim that they know medicine or health policy then I will not hesitate to put that person in his/her proper place.
Yay for young people.
For a champion debater, you disappoint me. You are more of an effasaurus hahaha
Yeah and I hope you will not be in the same shoes of those people who have been diagnosed with terminal sickness. Your money will be nothing.
Yep, you can criticize that sentence for all I care. You can call me any name in plurk. That is where most wimp-insecure blogger hie off and asks for rahrahrah of their Eddie-Haskell- da-poss-e some stupid names to boost their bruised ego . I know a doctor who can operate a constipated and burst ego. Want one?
You are just damned lucky that you got parents who can send you to medical school.
Compassion is the language of the soul which you are lacking because you got no soul. godless people don’t believe in any.
Cut me down. you make me laugh.And after your ignorance is exposed you run to plurk to recharge.mwehehhe
To me you’re still an educogob trying to recommend a change in education when you do not even know the difference between a curricular program and a course sylabus.
For me, you are a DOHAB generation Dot X.