June 12, 2003 - Last of 8 parts

The real war (and other views)

The series at a glance: 1 - It's the teachers turn 2 - Doctors bailing out 3 - Arthur's tale 4 - U.S. nursing shortage 5 - Nurses and recruiters 6 - Aries speaks up 7 - A price to pay C - The real war (and other views)

     Several weeks ago, Philippine Daily Inquirer columnist Conrado de Quiros delivered a talk at the graduation rites of the University of the Philippines-Visayas. As much as de Quiros annoys me no end in some of his past columns (you have to be very good to annoy me, so I'll give him that), I'll quote a few lines from his speech. "The country is in the midst of a war with itself," says de Quiros. "The clearest proof of it is the finding by a local survey last year that 19 percent of the population wants to leave the country. Any country that has a fifth of the population throwing its hands in the air and packing its bags is in deep, well, the word is not normally used in polite conversation. Let us just say 'trouble.' I do not know that we will find another country in Asia that shares this lot. Other Asian countries have their share of nationals leaving them too, but never from seething anger and frustration, those who leave vowing never to look back. Other Asian countries have their share of nationals seeking greener pastures too, but never from a feeling of oppression and hopelessness, those who leave saying not goodbye but good riddance."

     De Quiros, obviously was talking in general terms, not about a particular group or profession, and couldn't be more right. I have been ranting about this the past few weeks. I read about the survey before too but I don't know how random with regard to subjects that survey was. Still, the survey results surprised me, not because as much as a fifth of the Filipino population desire to leave but because the number was so low, it could be more than that. My conversations alone with Filipino friends back home tell me everyone wants to leave. Of course, I did not talk to a Jaworski, or a Cojuangco. I did not talk to staunch nationalists like Mr. de Quiros (they annoy me, don't ask me why). I did not talk to the President of the Manila Polo Club, or the chairman of an organization called WARYAPSSY (We Are Rich You Are Poor So Screw You). I talked to 'lesser' mortals like me, people with lesser social advantages.

"Abroad, at least you get the feeling that things are improving. The option to leave the Philippines at least provides us a better chance of pursuing our dreams and putting our education to good use."

     I did not talk to the likes of Mr. Guillermo Luz, executive director of the Makati Business Club, a group that encourages foreign investments and who has argued endlessly that you should create jobs rather than export labor. Mr. Luz, told the New York Times last year he wants Filipinos to stay home. When he was 9, he traveled to Canada with his father, Alfredo Luz, a distinguished architect. He returned 10 years later. He has stayed in Manila ever since, arguing that by remaining in the Philippines he has a less stressful life than his five brothers who live in the United States. "Most important, I can make a contribution here," Mr. Luz told the Times.

     I'd like to agree with Mr. Luz but he comes from a privileged background. He can afford to make those statements. As well as the rest of the powerful elite who can make a bonfire out of their money that can last forever. The rich can afford to stay, it's that simple. And I don't discount the fact that not all riches are inherited. A lot of Filipinos, as Donna Summer would say, work hard for the money, and God bless them. I wanted to stay and contribute too but I happened to have the opportunity to have a better life. I don't believe that makes me less patriotic than Mr. Luz or less nationalistic than Mr. de Quiros.

     According to the International Herald Tribune, the six-millionth migrant to Australia, Cristina Jurado, 29, accompanied by her husband, Karlos, 32, and their two children, was welcomed to Sydney early last year with much fanfare by Australian dignitaries. Before leaving Manila, she said that her patriotism was very much intact and that she did not really want to go. She had a stable job as a systems analyst and her husband worked in his family's industrial gas business. But she did not want her children to grow up, she said, "in a country where even 5-year-olds are raped, the pollution will kill you and the authorities cannot be trusted anymore." I'd like to know Mr. Luz's response to that.

     Going back to de Quiros's speech, if you or someone you knew delivered a speech during this graduation season, it's hard to ignore the topic that he discussed (except if you're a politician, you probably started campaigning for next year's elections). At the end of his speech, he said, "We are at war with ourselves in more ways than that we cannot convince a fifth of our population to stay. We are at war with ourselves in the sense that we are at war with our hearts, with our ability to find the courage to live for democracy as much as die for it. We are at war with ourselves in the sense that we are at war with our minds, with our ability to find the will to do what has to be done. We are at war with ourselves in the sense that we are at war with our souls, with our ability to see that we put in the hands of gods or demons what lies in our hands to accomplish. We are the enemy we must fight. We are the enemy we must vanquish."

     With all due respect, that's easier said than done.

     A reader asks, "So are you trying to say that the nobility of the medical profession is but a mere delusion when the harsh realities are considered?"

     (A very good question but it would have been better if you included your name or nickname so I can at least thank you personally for reading and asking. Anyway, the name field on my Comments form will remain optional. At the risk of sounding corny, your comments and questions help keep this site and this column stay on-line.)

     My response: The nobility of any profession (in this case, medical) should be set apart from the harsh realities of life (in this case, very harsh). I may have talked about the harsh realities but I haven't said or tried to say that affect, in any way, the nobility of the medical profession, or any profession for that matter. Every profession is noble, let's bear that in mind, although we love to rank how noble is one compared to the other. Needless to say, majority of doctors still treat patients. My case is unique and there are a few others in my profession who would prefer (or have been forced) to do other things. That doesn't make the nobility of the medical profession to us any less or disappear. A schoolteacher leaves for Hongkong, definitely not to teach, just to feed her family. That doesn't take away the nobility of the teaching profession.

     Now, why is there such a thing as a "harsh reality" and who is responsible for it? Is it natural? Man-made? Self-inflicted? The rest of this column may provide a part of the answer.

     Since this is a medical school's alumni web site, you may think this is just our problem and I am just writing through experience and talking to my co-alumni. That's why I find in necessary to print the views of other doctors from other schools and hospitals. I am re-printing just a few. I don't want to stretch this series any further.

     This article appeared in the Philippine Daily Inquirer as told to Inquirer reporter Cynthia Allanigue by Dr. Manuel Yuhico, a urologist at the Asian Hospital, Muntinlupa City:

     "My father had told me that of all his children, who became professionals, I would be the most successful. Doctors don't go hungry. It's probably true that before a doctor goes hungry the entire population must be in dire straits."

     "When I started practicing medicine in 1997, after my internship and residency in the Philippines, and five years of fellowship in the United States and France, all my savings went to finding clinics in hospitals where I could practice."

     "I first went to Cardinal Santos and then to Asian Hospital where I now practice. I would have wanted to join the Philippine General Hospital (PGH), having been a graduate of University of the Philippines but PGH did not have enough room for another urologist like me. Makati Medical Center was an option but it required their doctors a total purchase of about P3 million worth of stocks. I didn't have that money. Medical City required a capital outlay of P1.2 million in both stocks and membership fees. That excluded the clinic."

     "People have the mistaken notion that being a doctor is a lucrative job. On the one hand, the many medical students who graduate yearly are not absorbed by hospitals in the Philippines. On the other hand, the career of a doctor requires many years of study, from college, medicine, internship, residency, fellowship. The average Filipino does not have the financial means to go through all that, unless one is rich or has a business to support himself."

     "When I reach the age of 60, I better have my own house. I better have enough savings so when I get sick I will get the medical attention I need, the same one I now give to people. Many doctors I know, just when they have finished long years of studying, find themselves sick and unable to practice. Many doctors like me cannot even afford to buy their own house. As a single person at 42 I still have to rent a place to stay. Many other doctors in a similar situation take a lifetime saving up just to get themselves a clinic."

     "The reality is that the country has not improved economically, politically. The many problems we thought would be solved after we launched the people power "revolution" in 1986 remain unsolved."

     "Abroad, at least you get the feeling that things are improving. The option to leave the Philippines at least provides us a better chance of pursuing our dreams and putting our education to good use. My training abroad exposed me to the best hospital facilities, yet I am unable to put that to good use because most hospitals here do not have the technology I am trained for. The even sadder part is that medical care, a universal right, is not accessible to the people here."

     "There are countless instances when I would waive my professional fees just to treat a poor patient. But when the patient finds out about hospital bills, medicines and other expenses, he leaves. And even if hospitals want to help, they cannot support all the patients or they lose money. There are certain expenses involved in providing medical care. Most patients simply cannot afford them. To a doctor, patients refusing to avail themselves of medical care for financial reasons is very frustrating."

     "So, many doctors leave. And the easiest way is to take up nursing, a profession that has already evolved in many countries. Because of their demand abroad, especially in the United States, nurses immediately become immigrants as soon as they step on US soil. Doctors, on the other hand, have to re-do their residency for another five to six years in the United States to become accredited. If you work as a nurse in the United States, at $3,000 a month, you would be earning a peso equivalent more than the average doctor here would earn at the peak of his career. With that money abroad, you can buy a decent home and drive a respectable car."

     "Besides, nursing abroad has begun to take over many of the responsibilities that normally are fields of the doctor. Nurses are now into research, anesthesiology, primary care, ER and administration. Being a doctor makes the possibility of working as a nurse more exciting."

     "Of course there is a way to make doctors stay. When medical care shall have become a truly universal right of every citizen, doctors will want to stay because they know they can put their training to good use. When the political and economic environment shall have stabilized, doctors will want to stay because they know that even their families' future is secure. The important thing too, is that what we earn as professionals is commensurate to the amount of work we do. When I pay my taxes and I see where they go, that could make me stay."

     This is from an e-mail forwarded to me by Dr. Noel Binayas. It appears to be written by one Karen Puey on a Yahoo Message Group. This is an excerpt from the original e-mail:

     "...After more than thirty (30) years of practicing their profession as a well-known physician, professor, ass't. medical director, ranking colonel as a military or police doctor, they are giving it up and enroll for another two (2) years additional study for a nursing degree (**as required by the PRC and not by CHED or DepEd) just to land a job in the US or Europe."

     "Can we blame them? Will you call it degrading? Can we call it a practical economic alternative? Or simply they have no more confidence & trust that this country will recover again. KAPIT SA PATALIM BAYAN KO...For me its a personal sacrifice, for the welfare of their families specially the kids. Para sa akin, another 2 years of schooling with required duties in some hospitals is very traumatic, nakakahiya. Imagine, DOKTOR KA (30 to 60 yr old) tapos me duty ka to this hospital, you will go there not as a doctor but a mere student earning credits for your subject units and you will be supervised by a regular staff nurse of that hospital only 1/3 your age."

     "Then a regular resident doctor of that hospital will make the rounds and check your works, and this doctor in his late 20's happens to be your student in a medical school some 2 to 3 years ago. Baka kahit anong pagbabaliktad-baliktarin mas magaling ka namang di hamak sa "estudyante" mo lang. Tapos MALI ang DIAGNOSIS or PROGNOSIS niya dahil yun ang specialty na itinuturo sa UP-Manila or UST-Hospital na pinagtuturuan mo na estudyante mo lang sya. Pero at that moment yung estudyante mo ang official resident DOCTOR at ikaw student nurse lang, you are not allowed by your school (and for ethical reason) to question his judgement, dahil yung SCHOOL nyo nakikiusap lang sa ospital na yon para lang makapag-duty kayo as student NURSE. Ang hirap di ba?"

     "To regain your degraded pride you simply shut your mouth and just think of this MAGIC WORD - F O R T H E L O V E O F D O L L A R S ! Alam nyo ba na for the last 3 years wala na halos newly grad NURSING STUDENT ang nag-ta-TOP sa BOARD EXAM. 80% to 90 % of the top board passers were all Practicing Physicians in their 30's and 40's, who want to go to to the US, dahil sa US some states requires them to have another 2 to 3 years schooling before they can take the physician's state board."

     "One good example ng TALANGKA MENTALITY...ng mga pinoy. Isa sa mga school na nagrereklamo sa PRC at ayaw pakuhain ng board ang mga doktor ay ang UST. Dahil before this phenomena na massive deployment ng mga pinoy nurse sa US or before the crisis, UST ang best performing school sa nursing board exam in terms of the number of top board passers. But just recently some 3 years ago, puro doktor na lang ang pumapasok sa top 10 & top 20, wala ng mga newly grads. HAYYY buhay..."

     From the same Message Group, this is a response to the above message, from one Abe Llera. Also, some excerpts:

     "In one hospital alone in CDO (CCC Gen Hosp) there are 80 doctors now in their final stages of becoming nurses. I know because I happen to know some of them due to the various doctors' conventions that are held here at the Xavier Sports & Country Club."

     "Love for dollars? Uhmm maybe. Definitely, their main consideration is money - to have an improvement over their present situation. But craving money for its own sake, no, I don't think so."

     "I base this on my conversations with one of them, whom I know very well- he's a neurosurgeon specializing on babies. In his case, it's the money yes, but it's more of the simple disparity in the pay of a doctor in the Philippines and a nurse in LA. He is in effect protesting. He also said he has lost confidence in our people's ability to correct the corruption, self-interest first, incompetence in the government and the lackadaisical attitude of the Filipinos."

     "I admire the way they carry themselves. I'm sure at the back of their minds is the ever present voice screaming "Hey, you're a doctor, whatever are you doing taking blood pressure? HELLO!?" But it's something every one in CDO has learned to accept."

     From the Philippine Daily Inquirer written by Dr. Acle Luzurriaga of Bais City District Hospital, Negros Oriental:

     "Let's face it. We're not enrolled in nursing for the heck of it. We want to go abroad and earn a better income. When I learned that even highly paid consultants in Bacolod were taking up nursing, I asked myself, "why not?"

     "I enrolled in nursing because it was a group idea. The Philippines is not a good place to practice medicine anymore because there is too much competition."

     "Private practitioners in Negros Oriental, for instance, get very low professional fees, which may not even be enough to pay for the procedures they perform. In Cebu, there are a lot of doctors who are doing general surgery so you compete among each other for a specific number of patients."

     "For us government physicians, while we are assured of a steady income, what we get is not enough. Most government doctors now are into other businesses like running a pharmacy just to sustain their lifestyle."

     "My family is supporting me on this. I told my sister, who is in the United States, about it and she welcomed the idea. So did my mother, brothers and other sisters."

     Also from the Inquirer, by Dr. Geraldine V. Gonzales, an obstetrician from Davao City as interviewed by Inquirer's Alex Pal:

     "I have been a doctor since 1988. As the eldest in a family of five, my decision to become a doctor was influenced by my parents. After high school, I found myself enrolled in a medical school in Manila."

     "The practice of medicine in the Philippines has generally been good. But lately, doctors have been having second thoughts after the Medical Malpractice Bill was introduced in Congress and the Bureau of Internal Revenue started collecting the additional 10-percent value-added tax."

     "That's when the idea of enrolling in nursing became more inviting. My friends were already enrolled so I decided to join them. It's more of a fad -- a growing trend among doctors. If it pays off, at least "nauna na kami."

     "But most of us are not thinking of immediately leaving the country. We look at a nursing degree as a fallback position. With the depreciating peso and political instability in the country today, who can tell what will happen next?"

     "My parents are very supportive of my decision. They were glad I enrolled in nursing because my mother who visited my sister and sister-in-law in the United States found that life was good for them there. I also have a sister who is a nurse in Saudi Arabia."

     "Our nursing school now is having its third batch of doctors. The first batch consisted of 23 doctors. There were 43 doctors in the second batch. For this third batch, there are 130. They are mostly private practitioners and specialists."

     In his Philippine Star column last week, Jarius Bondoc wrote that Philippine airport authorities have acknowledged that human smuggling has become rampant in their jurisdictions. Airports have become the targets of choice of human smuggling syndicates who have connections with the Philippine government.

     Bondoc also related the story of two TNTs (tago nang tago) who were bragging at a Texas jail, a Filipino and a Mexican. To end it, the Pinoy sneered at the Chicano, "At least I flew in on a jet plane, you came here in a tomato crate."

     This week's top ten:

     Top Ten Signs You'll Never Be A Good Surgeon:

1. "Your English is outstanding."
2. "The first words you heard at the OR were 'Damn it! You just cut the aorta!'"
3. "You believe that a Journal Club is educational and not an excuse to party."
4. "When everybody else ordered beer, you ordered Mountain Dew."
5. "Asked why you did an ex-lap, you replied, 'I was trying to find Nemo!'"
6. "Your high school yearbook says, 'so you want to be a surgeon? who are you kidding?'."
7. "You consider touching a nurse's behind highly immoral."
8. "You wear your surgical mask with your nostrils exposed (you should be an Anesthesiologist!)."
9. "You don't think Dr. Marte's jokes are funny."
10. "When a consultant asked you to give him 10 pushups, you only managed 9."

     My thanks to everyone who took time to drop me a line or two the last few weeks - Robert and Delight M., Dan G., Liza, Rey P., Marell, Perry J., Absoluteone, Manny M. of Michigan, Aries B., Mi-an P., Homer B., smallpointcls, Vic S., Hitler A. (I hope that's not your real name), Mailblumen1214, Arthur, Noel B., and to all named Anonymous and Blanks :). I try my very best to respond or acknowledge your comments (if you provided your e-mail, of course). If I missed any of you, my apologies.

     This week's FINAL WORD comes from iskulmeyt'88:

     "...kon madumduman mo pa na gani ang breast/kidney most embarrassing moment, magyuhum ka na lang sang pinakamatam-is kag mag-ulong-ulong kag kon may mamangkot sa imo kon naano ka, hambalon mo, 'i'm just talkin' to myself, man. don't ever disturb my/our conversation. i'm havin' the best time of my life...'"

     I admit, I've been talking to myself a whole lot....and enjoying it.

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     The author's e-mail address is at drgarcia@wvsumedaa.com

     Views expressed on this column and any other by-lined articles on this site are the authors' own and do not necessarily reflect the views of the organization or its members. For comments, please e-mail the author.