Christmas wishes
December 18, 2003
I don't mind telling you that I have Christmas wishes. I don't mind telling you that 99.9% of my Christmas wishes come true. If I remember it right, the .1% was a wish for a 6-inch addition to my height. Of course, it did not happen, but you know, I was on a roll at that time. It was worth at least a try. Since this is Christmas and in the service of the Filipino medical community, I'll share my Christmas wishes this year.
1) I wish for salary increases for all Filipino government doctors.
A few weeks ago, an article published in the San Francisco Chronicle quoted a Department of Health (DOH) official, a certain Dr. Maria Soledad Antonio, who said, referring to doctors taking up nursing and going abroad, "They've traveled abroad. They've seen the systems and compared them, and they want to leave. It is a problem of nationalism: When we have no more nurses, no more doctors, what will happen to the Filipinos?"
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"...doctors leave for a better life. Doctors leave to feed a family. And more important, doctors don't leave because they hate their country. The same is true for nurses. The same is true for the rest of the overseas Filipino workers. Why treat the latter as heroes while regard the doctors as traitors?"
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In the spirit of the holiday season, I won't go as far as to say that somebody's brain has turned into whipped cream. Or those air-conditioned rooms at the DOH have some serious effects on the intellect. I'd say though that if someone like Dr. Antonio runs the country's healthcare system, then the question is very appropriate - What will happen to the Filipinos?
I am not saying there's not a tinge of truth to her statement. I can only surmise the reasons myself why nurses and doctors leave. Who knows, perhaps the DOH did some kind of a study and gave nurses and doctors questionnaires and one of the questions was - what's your reason for leaving? And all of the respondents answered - "we are freakin' traitors!"
I have a problem with the good doctor's statement. In fact, when I read it, it made me throw up my eggnog. It is obvious that the DOH recognizes the problem, but it doesn't want to be a part of the solution. The "problem of nationalism" remark is a convenient statement, hoping that the public turns their ire on the doctors. Oh, so they are the problem, let's crucify them.
In the spirit of giving, here are some clues for Dr. Antonio - doctors leave for a better life. Doctors leave to feed a family. And more important, doctors don't leave because they hate their country. The same is true for nurses. The same is true for the rest of the overseas Filipino workers. Why treat the latter as heroes while regard the doctors as traitors? The idealism can only hold for a while. Survival is still the key. If we keep on paying a government doctor the same amount of money as a government clerk, pretty soon, he or she will break, and will start looking for employment elsewhere.
"When I became a doctor, I just wanted to heal the sick, whether they pay me or not," Dr. Arthur del Rosario (1980), now a pathologist in Las Vegas, told me once. "Seeing them get well gave me great pleasure and fulfillment. I love it when they thank you for treating them. Even those who could not afford to pay me, they remembered to come back to me especially during harvest season and gave me a bagful of monggo, some vegetables, eggs, chickens, etc."
"But human beings, Filipinos or not, have the basic right to pursue happiness," Dr. del Rosario added. "The vast majority of Filipinos leave their country with the hope of getting a better life. Here in the U.S., if you work hard, you'll get paid accordingly. It is easy to buy 2 new cars here. In the Philippines, my parents loaned me a 2-door Toyota Corona. It got so rusty I could not afford to have it repainted. Not with my WVSU salary and the negligible income from my practice."
Tell that to DOH officials and you'll get a scorned face worse than Donald Rumsfeld. "So what if you have a rusty car? Take the jeep, for heaven's sake," they'll probably add for good measure, while they cruise around in their brand-new Pajeros. This is where they have a serious brain tissue meltdown. Needless to say, doctors are highly-educated people who have a lot of choices. And it is still the government's job to make the doctors choose to serve their own country, their own people, with a compensation that could at least support a family of three. Right, the government chose not to.
Is the government worried at all? "Apparently not," says Dr. Mike Muin, writing for Pinoy.MD. "As the main proponent of manpower exportation, it probably does not see long-term implications of the problem to the health of Philippine healthcare. The government is quick to point out the returns: dinars for every father sent abroad, euros for every sister employed abroad and dollars for every daughter who migrates. With the elections fast approaching, no 'self-respecting' politician will dabble in issues not directly affecting the 'masa', of which doctors are apparently not. As Philippine politicians categorize it, the 'masa' are the poor and uneducated. Some doctors may be poor, but they are definitely not uneducated."
Are the honchos at the DOH worried? "They're not, it seems," continues Dr. Muin. "Besieged by more pressing healthcare problems brought about by poverty and overpopulation, it does not have the capacity to tackle the issue. This is quite understandable, but providing health care can be difficult if there are limited health care providers. And with the continued career shifts and professional migration, it won't be long before DOH would have to be scraping the bottom of the barrel to look for willing physicians."
And this continued indifference to the real problem will ultimately lead to the "scraping the bottom of the barrel". And I don't doubt for a second that for every reporter in the world who'll ask DOH's Dr. Antonio, the answer would still be "the problem is nationalism". It won't be long before we can't scrape the bottom of the barrel anymore. Then maybe we should start searching for 6' x 8' rat holes.
Consider this - during my time at a government hospital which was not too long ago, a resident physician earns about 12,000 pesos. With the deductions and everything, his take home pay may be between 6,000 to 8,000 pesos. It's hardly enough to support one's self, much more a family. I presume a Medical Officer 1 in a rural health clinic earns the same. And get this, in the hospital I used to rotate, almost a quarter of the residents were not in the government payroll. A friend finished his Surgical residency training at a government hospital without getting a single cent. He was paid (read: sponsored), on his own efforts, by a drug company in the amount of 4,500 pesos a month. And the payments didn't come every month. He was lucky to get 8 payments a year. This is beyond wrong and ridiculous. This is plain b*, well, let's just say that's a word I won't use in the spirit of the season.
I can't blame some doctors who go the extra route to earn more. Well, you may not see doctors selling tocinos and kakanin like some teachers and other government employees do, but I did know a friend who sold panties and bras at the nursing stations of the hospital where he did his PGI and residency training. He said he had a decent commission from Avon. Most General Practitioner's dispense their own medicines for a profit. Other's go into politics. Still others resort to - and this is a very bad idea which I don't encourage - kidnapping. Over the last few weeks, a doctor who doubled as a kidnap-gang leader was killed in a shootout with police. A Most Wanted Kidnappers poster had one person with an M.D. at the end of his name.
And of course, the most popular these days - doctors taking up Nursing.
A doctor posting as Xinrob in the Pinoy.MD Forums shares his story, "I was on residency training (IM) in one of the hospitals in Manila when a couple of difficult times hit my family. First, my father was diagnosed with lung CA and we have to spend for all the procedures and chemo+radiation. Of course, I did not contribute even a penny because I was only earning a very minimal allowance from the private hospital. All I could do was to explain to them what was happening. Then, after several months, my kuya's wife was diagnosed with brain tumor and she underwent craniotomy. Heaven knows how BIG the hospital bill was! She didn't make it though."
"These events made me stop residency," Xinrob continues. "Never mind if all my life, I envisioned myself to be one successful IM-cardio. We became so financially burdened(!!) that I thought of stopping residency and do moonlighting. At least, this way kahit papano, I earn pretty good amount and help my family. Then this idea of nursing came in. Not for the greed of being rich but the idea of helping my tatay and nanay and kuyas'. I thought that this way, sa ganda ng salary, I can help pay our debts and live a decent life. I'm not dreaming of ultra-rich life but just to give a comfortable life to my parents and siblings who sacrificed a lot just to send me to school. So i guess, mine is another reason why MD's go to RN way."
Another reason I have read and heard over the last few months is the economic situation in the Philippines in general. The thieves in the government. The possibility of Fernando Poe being President. But that is a column for another day.
Others may say that re-structuring the national budget is hard because of the sagging economy. The government has no money to pay the doctors. Well, I'd say they tell that to their mama. Or better yet, tell that to the congressmen with all the pork barrels, the discretionary funds. Or maybe, it won't hurt telling that to Jose Pidal.
2) I also wish for young doctors who have clinics to have more patients in the coming years.
It's hard setting up a clinic and getting patients in a city dominated by the old school, so to speak. Your Surgery professor was right (in a few instances that he was). You can't compete with them oldies. How can you get a patient when the decking at the hospital you're in consists of 15 doctors? Worse, when it's your turn, you get service/free cases.
You find it hard to work for the government too. You're a specialist. You can't go back to being a resident again at a district hospital somewhere. But it's worth a try. Others have. They work for the government at the same time tending to their clinics during their off-hours.
You can't go the provinces, especially if you were born and raised in the city. Most of the people in the provinces and towns are very patronizing. They'll go to the doctor they've known since childhood, or his or her mother is their elementary school teacher. They'll go to the doctor who's the nephew of the Mayor.
Take heart. Eventually, those oldies will ... (I won't even finish the sentence, again, in the spirit of the season). Everybody appreciates your efforts. Nobody will mind, even the DOH, if you dispense your own medicine. And who cares if you have a little business on the side? But for the life of me, please don't sell bras and underwears at nursing stations even if you get a hefty commission from Avon.
And you can always take up Nursing. It's your life, your choice. Don't mind the buffoons over at the DOH.
And as for the nurses, it's also unfair to blame "nationalism" for their plight. You don't need half a brain to realize that one of the reasons they're leaving is the lack of jobs at home. Stay home and work as volunteers? Please. The reason most government hospitals are understaffed is they can only afford a few nurses to fill their payroll, hardly 2 nurses per station. The main reason nurses are leaving is, or course, more money abroad and I am not denying that. Who wouldn't?
And to the rest of the doctors who are doing very well (that means, you're not working for the government), I also wish that you continue to do good in the years to come.
Have a Merry Christmas and a Wonderful New Year.
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"Open wide and say Ahhh.."
I normally turn on the TV on Sunday mornings just to check how crappy the weather is that day. But last Sunday, when I turned on the TV, I noticed a bearded man over and over again that seemed familiar. For a few seconds, I thought it was Fidel Castro or the Unabomber or some dude from "Survivor" or that homeless man in front of Provincial High School we used to call Robocop.
Well, as you all know, it turned out to be Saddam Hussein after being taken out of a rat hole by U.S. Special Forces.
With all due respect to the American troops who did a marvelous job, the star of the moment to me is the unidentified doctor (why wasn't he identified?) who examined Saddam moments after his capture. He shared the TV screen with the disgraced dictator for the next 48 hours.
Maybe it's just me, but what's more gratifying than telling Saddam, "Open wide and say ahhh, you RAT!!!!"
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This is my last column for the year. I'll have a longer than usual holiday but I'll check my e-mails, post in the Forum and responds to queries whenever I can. Dan G may still have an article for December.
Enjoy the holiday.
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This year's FINAL WORD comes from Yours Truly:
"Peace on earth and goodwill to all men. God bless the Philippines."
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The author's e-mail address is at drgarcia(at)wvsumedaa.com
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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.
