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)
Popularity: 2% [?]
Benj, do doctors still swear the Hipocratic Oath? I thought the nobility of the profession is to service mankind regardless of gender, color, religion, AGE, FINANCIAL STATUS, and STATE OF HEALTH.
If you haven’t chosen a specialization yet, two words, Vicky Belo. Leave the healing to people with an ounce of empathy, and stick to wart removals. Mag-kape ka na rin para nerbiyosin ka naman ng konti.
BTW, I’m 35. Call me old and I’ll tae-bo your butt. :-)
Ugly Ugly Ugly AND stupid… *and yes, that was not a sentence***
Go read up on triage. Go read up on palliative care before grandstanding here. You obviously lack the sophistication to even discuss anything remotely medical. If you think that the terminally sick deserve aggressive treatment then you’re definitely not reading evidence-based journals. Ignorance? You don’t even get the concept of prioritizing patients with better prognoses. You don’t know the context of the health sector in the country because you only pretentiously and vicariously “experience” it through your imagination and hearsay. I work in the system. I experience it for hours on end. I see the poverty of the patients and the bureaucracy they have to deal with. My arguments are grounded to those very particular nuances of the PGH situation.
If there’s anyone who was exposed, it’s you. You chose to expose yourself as a bigot so congratulations. Your antagonism was clearly driven by my atheism and nothing else. You have also questioned widely accepted medical concepts and that clearly shows how little you know about the topic. Good luck with the dying brain cells.
It’s amazing how I get on the nerves of old people. I hope I decreased your life expectancy by a lot of years. If I develop a terminal disease, I will probably opt to have palliative care knowing for sure that all treatment would only lead to further disfigurement and disability.
Now if you excuse me, I have lives to save – you on the other hand have more things to bitch about.
Did you ask them if they have money. Did you diagnose them if their lives are still worth saving ?
Your Hipocratic Oath becomes hypocritic oath. mwehehe
Hahahaha and you are threatening to put me down when you resort to calling names when you have nothing to rebut.
You want me to teach you how they prepare the budget allocations for government agencies?
You want me to teach you how to tweak a course syllabus to incorporate a wellness program in all grade levels ?
I think the answer is no because I still have to remind you that you are also a part of the education system which you are labeling as dysfunctional. It is not overhalued yet, is it?
And I have to teach you how to debate without using the word ugly. It shows how pikon you are. I use politically correct words and can still deliver the message.
Are you still ya – hoo? (read: clueless).
mwahahaha
I have nothing against atheism or whatever isms.
I have an issue about a person who believes that those who have no more chance to live and are poor should not be receiving help from the government short to saying LET THEM DIE ALREADY, NOW NA. mwehehe.
To me that person is not an atheist but a frisbeetarianist. Someone who believes that when a person dies, the soul goes up and and gets stuck in the roof. So why bother to save them. Huh?
Don’t use bigotry as your defense. The mustache (bigot) would not even grow in your mouth. Matatakot na patayin mo dahil walang silbi.
Want some rice? California pa? mwehehe
This is like watching an episode of House, M.D.
cvj,
I agree somewhat, but when it’s real people hurling insults at each other, it’s saddening. And at House MD, at least they’re working toward one general goal.
I’m glad I continued to scroll down to be able to read Bencard’s Oct 16 1:19 am comment. It’s good to be reminded of such things from time to time. I find it sobering. So, thanks for writing it :-)
Benj, I must admit that I, too, was somewhat confused about that “beyond salvation” statement. I appreciate your explaining it. Sayang naman if one has much to give and aims to make an important point but ends up being misunderstood only because of what someone (can’t find the comment anymore) referred to as “subtlety”.
Sunnyday, what you say is true but i think Benj’s sentiment is shared widely among the younger generation. With reference to the David C. Martinez’s baby boomer generation apology to the younger generation which i linked to above (at 10:04 am), Martinez ended his apology letter with the appeal…
When the above letter was featured over at Manolo’s blog, a commenter retorted…
…so you can see that the resentment runs deep hence the mutual recriminations.
I’ve read it. I admire his self-realization and humility.
However, doesn’t harboring an intense resentment for an entire generation make one run the risk of having resentment as his motivator? Nakakapagod yata ‘yon…
Sunnyday, i think so. Personally, i think it’s better to build on something positive.
Well, it’s good to build on something positive. But if someone goes assaulting me without any provocation from my end, he/she will get it from me – no matter how ugly he/she may be.
I won’t be like the other young people here on FV who choose to defer to older people simply because they have more experience in a failing system.
Brain cells must be really dying now.
I find it funny that someone in her dying days like you would choose to verbally assault a brilliant young man in his early twenties. It speaks volumes about the oh so sad and empty life that you live. But then again, being that ugly, it’s hardly a surprise.
mahirap gamutin/ tulungan ang mga mahihirap. their obstinacy comes from not knowing anything. akala ng marami pag punta sa PGH papahiran sila ng kung ano, gagaling na sila. we all know the human body is much more complicated than paracetamol can cure. the older we get, the more prone we become to diseases. i’m reading benj’s post in the context of poverty alleviation and not from the perspective of the Hippocratic Oath. Lucky are those who have medical insurance, but the lifestyle of the impoverished is any doctor’s nightmare. they unwittingly dine on salmonella and e.coli and spend what little they make on drugs and alcohol. if you have these people come to PGH for treatment each time they get sick, you’ll be seeing them again the following with the same problems. all the free meds in this world will not cure them. i must say i laud Benj for slugging it out at PGH and NOT planning to be a nurse to work in the US. yeah, he’s young but he has saved a lot of lives along the way. for someone so young, he has done a great deal of service even before he is inducted into his profession. but this is not about him, it’s about all the other Benjs in this country who choose to stay and serve rather than migrate to live the American dream (though it’s not a bad thing either with the remittances and all). yung mga doctor natin medyo naging manhid na sila, kasi hindi sila mapag hili dala ng propesyon nila. they are forced to play god because the situation calls for it. itong mga mahihirap natin paulit ulit ang sakit, hindi naman talaga nakakatulong kahit kanino, kahit na sa sarili nila. we have to accept that our government cannot sustain the medical care for all aging indigents. dahil kulang naman talaga tayo sa pera at panahon, talagang hihimasin mo na lang at ipagdadasal yung mga mahihirap na matatanda na alam naman nating hindi na gagaling. let’s not forget the reason for the post. poverty.
Is this kind of person that you have become with your college degree? tsssk tsssk.
To insult a person with health issues.
and you said that you are a medical student?
Pathetic.
But don’t worry benj, you might expire earlier than i am.
Life is short. You will never know when you are going to die. It might be today, tomorrow or tonight. Accidents do happen.
you really like me to teach you how to prepare a course syllabus so so that you can incorporate your wellness program?
You really like me to tell you how they prepare budget in a government agency? Just tell me and I will do it for you free.
brilliant? Can you not wait for others to tell you that. at your age 23 I am alread Chief Accountant and I am no longer a dependent to my parent.
I have already travelled the world. Have you checked my travel blog?
Ugly. hahaha. Para kang bata. pag napikon, tawag sa kalaban pangit.
pangit ba ito?
http://father-fernando-suarez.blogspot.com/
Did you see my beautiful photo in my blog? hahahaha
Anti-poor? Naggeneralize ka na ininsulto mo pa. tsssk. where is this poorphobic disorders among Filipinos coming from?
Youth is wasted on the Young!
Jego,
Running a terminal care facility like PGH–where seriously ill people basically go to die with a desperate and forlorn hope that they might be saved–is straight out of a horror movie. Last we heard, their Xray machines don’t work so the surgeons are diving in blind…There are so many horror stories from the public hospital system, which Benj is right that it ought to be run with a TRIAGE philosophy, (though he comes off a TAD heartless when making the case for it).
Should the govt get out of health care and insurance? I know it’s not exactly fashionable nowadays, (au contraire, eh?) but yeah I don’t think the govt should be running TWO big national insurance systems (SSS and GSIS) and running Hospitals from Hell.
Whether the matter for discussion is poverty alleviation, science and technology, showbiz, heroic people, or architecture and design, some views are bound to clash. Some words may be uttered in jest and with hardly a thought before hitting “enter”; others may reflect more careful reflection. But I think that regardless of the topic being discussed, the age of the participants, the part of the world they come from and the kind of education they were provided or are being provided with, a minimum level of respect for each other ought to be maintained.
Each person has something to offer, and each person has the capacity to keep on learning — as long as the person believes there are things yet to be learned.
I am learning much from these discussions, but I refer not only to facts and figures, to schools of thought or to narrative styles. From this thread alone I see how resentment can take hold and be allowed to prevail, how “free speech” probably or “healthy debate” — I’m really not sure — can be seen as justifying expressed condescension.
Freedom of speech and vigilance are things that I value as well, but I believe it is also worth remembering that the person takes precedence over these and every other value we work to protect and uphold. Since the person is most important and is the reason for all efforts to uphold a just and humane society (if I’m wrong about this, please correct me), it seems to me that treating one another with respect is a basic — even in discussions such as this.
If in the process of discussing we lose sight of the fundamental worth of people — which may be reflected in the manner in which we exchange ideas with them — then I see it as moving forward perhaps, but deliberately trampling and stomping on some people along the way.
I do have faith, however, that the stomping will stop. Eventually. :-)
Should the govt get out of health care and insurance? I know it’s not exactly fashionable nowadays, (au contraire, eh?) but yeah I don’t think the govt should be running TWO big national insurance systems (SSS and GSIS) and running Hospitals from Hell.
Yes, what’s fashionable is for more government involvement in everything because eventually theyll own everything through those bailouts and takeovers. Easy-peasy. They just print money, et voila! :-D
Some people may see Philippine General Hospital as a terminal hospital. I don’t. For me it is a training hospital OPERATED by the University of the Philippines for its UP College of Med and other healthcare-oriented courses. Pamantasan ng Lungsod ng Maynila,College of Nursing is also affiliated with PGH.
So it should not be run like hell because the best minds are in UP?
Without PGH, the financially challenged students from the state universities would not be able to do their internship for free. Private affiliate hospitals of nursing schools charge about 40,000 pesos per student per semester for their internship. I have no stats about medicine students. But i know it runs also to several hundred thousands.
And I wonder why the focus is the PGH when there are other government hospitals like the Jose Reyes MEmorial Hospital, the Philippine Children’s Hospital…the Fabella Hospital in Sampaloc where two or three new mothers share one bed after the delivery.
People see PGH as the only refuge of the poor but I see PGH as the best training ground for our doctors, nurses and other healthcare professionals despite its inadequate facilities. Shut it down or privatize it and many bright students will be affected not only the patients. (When I say bright I do not mean the arrogant blogger who can not wait for others to call him brilliant. I do not even think that he is espousing the triage process of prioritizing the patients when he said that the government should stop allocating big funding to the patients with unfavorable diagnosis.
Prioritizing the treatment of patients according to their severity is triage.
The purpose is to give immediate treatment to those who are with life-threatening issues.
Recommending to stop allocating big funding to patients with unfavorable diagnosis is not triage. IT is simmply an ignorant understanding on how budget allocations are made.
It may be run like hell but the best surgeons, medical practitioners and other healthcare professionals were trained in PGH.
Sue me if I see always the bright side because from where I come from, even the poor people are treated with respect.
And now the trend is to express compassion fatigue for the poor when they are just referring to those street children begging. Gawd. And they do not even drop a coin. So why whine? How much more if they have met the poor people from India where girls are sold by the parents because of poverty and people are dying of sickness in the streets. In other Asian countries which GDP come mostly sex tourism revenues, even 7 year old kids are pimped by the impoverished parents to the sexpats.
DJB, I’m happy that despite all the ribbing, you did get my point about triage. Doctors don’t always to cure/ treat patients. In the face of bad prognosis and LIMITED RESOURCES (money, hospital beds, etc), the clinical guidelines (even those from the US) state that palliative health care should be the approach.
the question is begged then, given the djb’s say and the cat’s opinion — is the PGH primarily a terminal care facility or is it primarily a training hospital? or can these two concepts coexist? what does the PGH charter/ mission statement/ categorical announcement of some sort say?
I’m amused at the amount of ad hominems in this comment thread. Is there such a term as… misogeriatry?
PGH is NOT a hospice care facility but any hospital that tries to treat cancers and other potentially fatal diseases have to also function as a place that would offer palliation and other treatments that aren’t necessarily life-saving.
Doctors give up when the evidence don’t support a particular treatment. Aggression that is not supported by sound science will only result to greater disability, disfigurement and loss in valuable resources (both of the hospital’s and the patient’s).
A hospice is not a hospital or a specific place. IT is concept of care given to people whose life expectancy is less than six months; the main purpose of which is to enable them to live the end of their days to the fullest, with dignity, grace and support.
I should know. My father-in-law who was a head doctor of Saint Luke in San Francisco before he retired was under the care of the hospice doctor,nurse and social worker two months before he died.
This team is not a part of the skilled facility where he was confined. They just came daily to prepare him for his death. His disease was not even terminal.
And I was involved as volunteer to give care to the geriatric residents of convalescent hospitals.
And I NEVER come to hate these people despite their combativeness that make them verbally and physically abusive. I have never insulted them like I am insulted in this forum because of my health issues. Baka yong mga pasyenteng may dementia at alzheimer’s ay pagtawanan pa ng mga commenter dito na kung makainsulto sa mga maysakit at mahirap ay ganoon na lang.
My Caucasian father-in-law was a Harvard medical graduate but I had never found a single arrogant bone in his body.
to cat, i did not insult the poor. if you read my entire comment i explained why poor people are difficult to treat. now you insult me by saying pointing out my words about benj by saying “I like it when a person i debate with invite his alipores. It means he’s losing.
may dala ka bang canned applause? o rah rah lang ang gagawin mo?” not because we don’t see things your way, you have judged me as “poorphobic”.
being poor and sick is no joke, but you have to respect the ways that people help out. it may not be the same as your way because we all have different challenges. if you don’t agree with someone’s opinion, then stop calling them names like arrogant, et al. if he calls people pangit, then it doesn’t mean you have to counter it with something just as childish. we all agree to disagree. let’s stop the ad hominems please. this is filipino voices, let’s be more mature please and just argue the issue.
If Mohammed can’t go to the mountain, let the mountain come to Mohammed.
Benj draw the lines first when he categorically wrote off the geriatric population as basket cases.
He “brilliantly” chose the language of the arguments, let him deal with it. :-)
reread your comment and then come back to me.
And tell your idol not to engage in adhominem too.
Would you like to give him a certificate of good moral character, i will make a proforma statement for you.
that is based on experience slugging it out in forums. Btw, if you like to discuss about issues, you do not have to patronize anybody.
They can speak for themselves, can’t they?
I think you should work more on your blog para naman may magbasa.
i find FV very entertaining. :)
stares blankly into nothingness. unblinking. spaced out.
then comes to himself.*
that taken from a VGA camera. I hate VGA photos. that wasn’t a question.
goes back in a trance.
When I come to, I should get a life… (When) I should get a life… (How) I should get a life… (Now) I should get a life…
repeat chorus until fade
*moon prop falls unhinged making a huge thud on a parked trolley, stage right, then lights off*
AAAAAAAAAAAND CUT! THAT’S A WRAP!!! PERFECT! ONE TAKE!
I guess this is why Moses dropped the idea of a committee when he took the Israelites back to the Promised land. Otherwise, the poor Israelites would have given up on the idea of the Promised Land and opt to stay building Pyramids for the Pharoahs.
Interesting talk – several good points and a lot of hominem and personal attacks. All part of a healthy debate but at a certain point one has to ask, So whats next?
Is there a point to a discussion that has migrated to an exchange of insults?
I have some friends who earned their medical degree in UP Manila and then did their internship in UP PGH. The education and service in these institutions, I am told, is supposed to make you the best doctor you can be in this country. The harrowing experiences, making do with so little, the sheer amount of patients train doctors to be resourceful, creative and think fast on their feet.
I am saddened by Benj’s account. Primarily because his view on his PGH experience thus far, lacks compassion, as mentioned by a commenter above.
I wonder Benj, whether you see the contradiction of your view regarding healthcare and your own privileged position as beneficiary of the best medical education and training socially financed by the Filipino people.
Healthcare and education are investments in people. There is a reason countries, especially poor ones such as ours, set aside large amounts of their budget on social spending.
If I read your account clearly, are you suggesting some lives are worth more than others? Are you saying some lives should be saved and others not? Please do clarify.
Oh, and on the supposed government dole-outs on human capital investments:
2009 budget: P1.41 trillion
Debt servicing: P768 billion
Spending on social and economic services: P646 billion
Divided by 88 million Filipinos = P20 pesos daily on each Filipino.
What can you buy with P20 daily?
Read more here.
Sparks, speaking of the 20 pesos per day, i proposed that amount as the guaranteed, minimum food subsidy for every Filipino who needs such a subsidy, as a component of an overall framework on taxes, wages and safety nets. Here’s the overall framework in a form of diagram. In turn, it links to my preceding blog entry on the above topic. I invite you (and everyone else) to look into it and see what you think.
Just to clarify, the P20 pesos daily food subsidy i referred to above (at 11:50 am) is not to all Filipinos but only to those Filipinos ages 18 to 64, i.e. those who, in my proposal are obligated to pay taxes (as stated here.)
i’m not a doctor. But I have a doctorate on laws.
why are you people so worried about poor people? i mean, come on! poverty is a choice. it is not the fault of government for poor people to become poor. i mean, look. we must laud government for trying to give their hand to help the poor, but they should help themselves.
and i have’nt been to pgh, because the very name of it sounds so poor “pgh” as if you cough so loudly you poo.
don;t give any more subsidy. it makes poor people lazy.
Highpriest (at 12:15 pm), the subsidy i proposed is not enough to make them ‘lazy’ since it is only 20 pesos (reference Sparks’ remark at 11:37 am on what 20 pesos can buy) and it is restricted to food. What it does is give people access to food that will in turn give them the energy to try to make a living. Our society, if it is to be distinguished from the jungle, has to have a concept of regard for the common welfare (to the extent that it is able to). In terms of benefits, here’s a possible outcome i envision happening with my proposed reconfiguration of taxes, wages and subsidies.
And to answer your question (at 12:15 pm) on why i’m ‘worried’ about poor people, it’s not purely because of altruism. It’s also because of wasted potential. With our population of 90 million people, i’m pretty sure that among those poor people is a potential Einstein (in whatever field he/she chooses) who, given the opportunity, can help save the Philippines and even the world. So helping the poor is in our society’s long term self-interest.
high priest
“it is not the fault of government for poor people to become poor”
true for united states , the land of plenty but for philippines , your doctorate in law do not apply. when government policies hinder economic growth , it is not people’s fault. the biggest monster is the IMF and world bank. its policies are beyond our means, not to mention corruption. the people are left with nothing. Economic growth and influx of foreign investment are lacking due to political instability.
aw, c’mon, leytenian and cvj! why do you blame the IMF, WB and the government for just about everything bad that happens in that country of yours. hey, i’ve read enough laws to say that those measures are note-worthy. Gloria’s government is on the right track. and I don’t agree that “government policies hinder economic growth”. Nah.
And it’s not really political instability that causes all these so-called misery you so arguably say.
about the reconfiguration of taxes. do know cvj that if you do that, it would impact on inflation? it would also have an effect on interest rates. your proposal would further cause more economic misery and would create more misery to your people.
i disagree with those who view one generation as superior to the previous one, if only because our whole body of knowledge is built on the successes -and failures- of all that came before. in the history of medicine the worst stagnation came when the ancients gave up on observation and experimentation and started viewing the classical texts as sacred texts; on the other hand, lose the human and humane aspect of medicine and you get josef mengele experimenting on live twins in auschwitz.
previous generations built up the learning we can then discard, improve upon, pass on or eliminate once we’ve received it. but it’s well to bear in mind the saying of chesterton that we ought not to submit to the small arrogant oligarchy of those who happen to be alive.
with regards to pgh and public health, perhaps what we have, as with so many of our public institutions (and private ones) is that we have a culture and an ethos built up when the country was relatively small, when everyone could know each other and actively pass on and belong to a culture people shared. pgh was created at a time when the entire philippines had the population of today’s metro manila, it was part of a public health system built with a missionary -and colonial- ethos to uplift the natives from the filth and ignorance of the medieval era. to that extent it has outlived its purpose because no single teaching hospital, no single public hospital, no single state school, can possibly remain as relevant and useful to the entire body politic as up and pgh once were from its foundation to the 1960s.
it will have to accept it is just one school, one hospital, among many in a population more gigantic than anyone in the days of its foundation and the formation of its institutional culture could have imagined. it doesn’t help that after marcos, even leaders gave up on submitting themselves to pgh: presidents prior to marcos pretty much led by example as state officials by submitting themselves to the public health system; government workers had their children in pgh, and there was an incentive all around to keep the facilities up to standards because, not just symbolically, both presidents and paupers were dependent on up for their survival. this hasn’t been the case since edsa and it says something that ramos, estrada and arroyo refuse to submit themselves to pgh -it demotes the public health system to second class status, symbolically and in reality.
there is truth to the question why, up to now, only one pgh when you need a pgh in manila, northern luzon, in southern luzon, in the visayas, in mindanao and still, none have been set up. we are way past the era when the handful of doctors in pgh could minister to the country. that’s the real issue.
whatever language benj uses and whatever offense elders take to that language shouldn’t detract from the reality that doctors particularly in the public health arena, just like medics on the battlefield, must make tough choices all the time, with few resources, surrounded by some of the most horrific conditions people can imagine. the amazing thing is they stick to it and don’t go insane. nor do they become mengeles.
youth has a right to be arrogant because it inspires innovation. elders have a right to put the uppity in their place but in the end, time takes its toll and todays elders will be replaced by today’s youth -who will be criticized in turn by today’s babies.
Compassion is overrated in this “debate” (I’m not treating it as one due to the tone that the first few comments took). It just reeks of grandstanding without knowing the full context of the matter.
Every person has a baseline level of compassion. Nobody wants to see other people suffer and die but in a hospital, it does get a bit common place and having a more pragmatic approach to medicine does make you less vulnerable to depression. You can’t shed a tear for every sad story in PGH because by the time you’re done crying, you’ll be within an inch away from death due to dehydration.
Moving on, Sparks, while I do agree that making decisions on triage (who gets to be admitted to the hospital, who gets to have treatment and who will charities help) are VERY cold choices these are NECESSARY in the context of an overburdened and overstretched system like the one we have in PGH. To you, it’s cold. For a lot of doctors, sending people away (to other hospitals) due to lack of vacancies and opting for palliation over treatment due to unfavorable prognoses comes with the territory.
It’s so easy to invoke the ideal – greater funding, better allocation of funds, reducing corruption… yes, they’re great to listen to and it sure makes the people who say these terms very Obama-esque, but at the END OF THE DAY, THE REALITY IS THAT PEOPLE ARE DYING NOW. The decisions HAVE TO BE MADE NOW. Those are the specific nuances that we don’t get.
Even as a student, I’ve taken money off my allowance to help patients in my limited capacity as the student-in-charge. I’ve seen residents literally pay for dialysis and harass charities for expensive medications for their patients. We are doing our part – but it’s still lacking. What should do now? Bitch? Sure, we can. But for now, we have to prioritize.
This discussion is all about context – unfortunately, those who insist on knowing more couldn’t be more unaware of what the condition is like on the ground. It’s very easy to grandstand when you just vicariously ‘experience’ PGH via second-hand information and hearsay.
Benj,
I expected a real answer from you.
So let me reiterate:
I wonder Benj, whether you see the contradiction of your view regarding healthcare and your own privileged position as beneficiary of the best medical education and training socially financed by the Filipino people.
If I read your account clearly, are you suggesting some lives are worth more than others? Are you saying some lives should be saved and others not? Please do clarify.
I don’t think there’s much of a contradiction. The environment of med school isn’t a school per se. Though there is a considerable amount of didactices (during the first two years), the last three years are heavily geared towards service (going on 24 hour duty every 3 days, no post-duty status and no weekends/holidays). Despite being in training, we become unpaid and over utilized members of the hospital work force. In these three years, I don’t think I’m pushing it when I say that my hard work pays off (at least partially) what that subsidy has enabled me to achieve. Secondly, I intend to stay in the country after graduation even in the absence of a formal bond that bars me from going to the US (freshmen now have to sign a 5 year contract to stay after graduation). Sorry for missing this question. If you don’t think that this is a valid point, then I can’t do anything about it.
Let me reiterate that the only things that are subsidized are professional fees, stay at the charity wards and the few basic supplies (like cotton balls) that the hospital can afford. Patients buy all their meds, catheters, cathulas, etc while Students buy the syringes, laboratory vials etc that they need for their patients. Despite the budget allocation, it still is a dole out system wherein everyone (doctors, students and patients) hemorrhage money just to come up with an acceptable level of health care.
As for the second question NO and YES.
No, there are no arbitrary values on lives, BUT we have to make tough choices if faced with the decision between cases with different prognosis. Doctors are obviously more aggressive in cases wherein patients have a good chance of survival and complication-free discharge. On the other hand, doctors would be more guarded and conscientious when it comes to spending the money of a terminally-ill patient when they very well know that further management will not improve survival or quality of life. I think I’ve answered this second question already. Sorry if I wasn’t being clear.
Yes, doctors make the tough choices on when to give up and when to push. They take into consideration the extent of the disease, the resources of the family and the chances for survival.
Several years ago, i got a chance to peak at PGH’s numbers. i don’t know how they do it now, but back then they do charge for patients, if only minimally.
There are far too many people who are sick and even at minimal cost— maintenance and equipment can be overcome.
PGH i think is a reflection of how things are. Just like the state of EDSA is a mirror to the Filipino’s soul. There are many things wrong with PGH that can easily be solved. Its problems aren’t as huge as one might think. It suffers from the same disease as any government run agency is.
i humbly submit that PGH isn’t equal to health care, but it is an important aspect of delivering service. That’s not to say there isn’t a challenge in delivering health care in the Philippines, just as there is around the world.
but that’s not the point.
I see where MLQ3 is coming from.
Our nation stands a captive of our apathy and a prisoner of incapacity. Lulled by good intensions and seduced by rhetoric, we’ve permitted our national life to be gamed by politicians.
In this darkness, our Apathy stems from.
We’ve lost faith and that apathy born of broken trust, from young and old, powerful and small– every Filipino, arrogant and greedy, is all for himself now.
It is a universe where heroes are ruined. They fall from grace.
There is no common cause, only anger and fear. There is no one willing to make our world strong and free, to overcome challenges that threaten to overwhelm us. There are no heroes, only the blame game. Always with us what can not be done.
It is the disease of incapacity.
Many quarters are still holding on to hope that this Republic can somehow overcome these challenges. The slate of 2010 is shaping out to be merely the same old game: uninspiring, not surprising. Simply put: old, tired. ancient. Perhaps it is time to consider more vigorously that we must already write this Republic’s epitaph because it would be easier to start anew.
The Future does not wait for the Filipino.
The Frontier ahead of us is a world of profound transformation. It is filled with unknown peril and yet equally, opportunity.
Can you not see it?
Without doubt any future Republic will be born in the same universe we buried the dead one. It would be a universe of undefeated poverty, of unchallenged ignorance, of powerful prejudice and unequal surplus. It is understandable to shrink from that daunting task. Understandable but should be unacceptable.
Are we equal to the challenge?
Can our people draw upon courage that flows naturally in the Filipino? We require vigorous leadership. We require invention, innovation, imagination and most importantly— decision in our politics, in our economy, in education, in health care, in our pursuit of science. I would like to write, “abangan” (trans: wait for it).
I fear the truth is far more bitter. It is a deep “no,” for a Republic that is the land of the dead, the incapacitated where there is no hope at all.
mlq3 is correct.
My generation fails to see that if we do not hold on fast to our politics. If we refuse to engage our elders with blatant rebellion— rebellion the kind of running for public office. Of challenging the status quo. Of raising the bar of expectation for everyone— not just those in government. We will join generations before us lamenting.
The bitter pill is that it may be the sins of our Fathers, but it is our children’s country. Every generation has its challenges. The bitter pill is that we maybe unwilling and unable to take it, conquer it. And our children shall inherit a nation similar to the one that we entered. That says something about us than it does the generation we critique.
I agree but what generation are we talking about? There is no need for change if we start anew purge everything a new start with lessons from previous generations. Several coup attempts have tried to install a new government with support from old politicians if we want change we must ALL be willing to stand aside.
Save lives?Your just a clerk, clerks are supposed to just do routine and generalized procedures that even nurses refuse to do. Spare us the “Messiah Complex”. Pass the board first then bitch about how opinions you. I have been there all doctors have been through the rigid training.
Please respect your elders they have been through worse shit than you will ever see in your life. I belong to the current generation as well and I really don’t see why this generation differs from previous generations heck they are more similar. For example almost all generations spawn cocky jerks that has no remorse and not respectful of older people.
Religion is not an issue here. Your lack of religion doesn’t make you unique it makes you even less noticeable. Atheism is just the lack of belief in a higher power it is not label that will make you famous. If 60% of the population are atheist you wont even stand out.
As for politicians they do help too but for their own benefits but we must all agree on one thing, they help. As long as there is no politician who have a real concern about the pitiful health care system here nothing will change.
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.
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I notice that the writer of this entry has this messiah complex. Hey, you can’t save those old people. Let them die.
MLQ3, there’s no justification on what you said that young ones have the right to what was the word you said, ” be arrogant.”? Because it leads to innovation? Do you have historical basis for that assertion, given that you tell people you’re an historian?
there is no superior generation. only a weak generation replaced by a weaker one.
Yes the older generation has no intellectual sophistication, so your parents’ decision to conceive you was undoubtedly a mistake since they were idiots…
I’m just kidding okay :)
jepoy,
i’ll not take umbrage at what you just wrote, since you seem to be a mere mortal without brains. your remark only strengthened my earlier comment.