Caring medicineBy Michael L. Tan
Philippine Daily Inquirer
The Ramon Magsaysay Awards have tended to emphasize community and service, with many of the awardees coming from civil service organizations or CSOs. (CSOs are also known as nongovernmental organizations or NGOs, but the “Napoles” pork scam has caused irreparable damage to the term.)
This year one of the awards went to Dr. Ernesto Domingo, and I found that significant because the award recognizes someone known for his contributions to scientific research (he is a National Scientist), as well as someone who has practiced medicine in hospital settings, and has devoted most of his life to teaching, at the UP College of Medicine. Over and above all this, he has been an advocate for change, for a new medicine.
Doctor Domingo is known in medical circles mainly for his work around hepatitis and for demonstrating a link between hepatitis B infections and liver cancer. He fought hard, and successfully, for infant hepatitis B immunization, which is now included in the government’s childhood vaccination program. As with so many medical breakthroughs, many people are unaware about how many lives will be saved because of this hepatitis B immunization.
Beyond hepatitis though, Doctor Domingo’s award comes for his work as one of the moving forces (together with Dr. Alberto Romualdez) behind the campaign for universal health care in the Philippines. He has used a more manageable Filipino term, “Kalusugang Pangkalahatan,” and emphasizes that this includes, but is not limited to, national health insurance. Universal health care means every Filipino must have access to quality health care. Many countries in the world, including several which are poorer than the Philippines, have universal health care, supported through taxes.
Last Wednesday, Peter Wallace wrote in his column about an excellent example of universal health care with “baby boxes,” which Finland first introduced in 1938, at a time when that country was still trying to bring down death rates among infants, especially the newborn. Each new mother received a box with infant clothing, a blanket and sleeping quilt and all kinds of baby supplies. Even the mother got bra pads and, I just have to quote Wallace, “condoms.” (Catholic Church, please note.)
I did go into the Internet to look for more information and the best one was at the BBC site with photographs. Just google “Why Finnish Babies Sleep in Boxes.” One new Finnish father who was living overseas said he still claimed the box, feeling it represented how the Finnish government cared. I also noticed that the Internet now has ads for infant gift boxes that you can buy, again a wonderful symbol of caring.
In our own government labor wards, I’ve seen countless mothers coming in with almost nothing for the new baby. They are just totally unprepared, and the situation is made worse when they’re told to cross the street to buy a basic package of medicines and supplies for the delivery; and although the packages cost less than P1,000, many mothers have not even saved up that money.
Universal health care could mean automatically providing each new mother with similar boxes, and conditions for eligibility. In the beginning the Finnish government simply gave the boxes for free. Later, they attached one condition for getting the box: to be eligible for the box, mothers have to have a prenatal check-up before the fourth month of pregnancy.
The Finnish ones emphasize heavy clothing because of their cold climate; Filipino versions could be much simpler. I noticed one picture book mentioned for the Finnish baby box; ours could have more materials, colorful and well written, about baby care.
The Finnish baby box, incidentally, is made of sturdy materials so it doubles as a sleeping crib and this use became so popular that even today in affluent Finland, babies still sometimes sleep in those free boxes. Again, we forget that in poor households, there are no cribs. And don’t even think of a banig or mat, which has become so expensive that the poorest of the poor sleep on the floor, with newspapers or cardboard as bedding.
PhilHealth already has a maternity package to cover hospital expenses during delivery and that certainly should be retained—and enhanced—in a Kalusugang Pangkalahatan system. But after all’s said and done, with insurance coverage and baby boxes, universal health care, Domingo-style, would need one final, vital ingredient: caring.
This is where Doctor Domingo has been trying to make a difference. Teaching for more than 40 years in the UP College of Medicine, he has seen the many fads and fashions that come and go with medicine. There was primary health care and community care in the 1970s sadly de-emphasized through the years. Then there was problem-based medical education, which tried a more integrative approach, linking anatomy, physiology, pathology through case studies. Then there was evidence-based medicine, emphasizing research to look at whether certain medicines and therapies really work.
In the last few years there has been much talk about transformational medical education, which doesn’t just look at technical competence but also the way future doctors might be socially and culturally competent, able to relate to patients regardless of class, ethnic background or religion. More importantly, as the term implies, transformational medical education should mean doctors who make a difference for society.
Being able to care seems almost commonsensical for doctors, but medical education’s rigors often harden our medical students. They are also taught to distance themselves from patients, to be “objective,” even unemotional, to avoid getting too personally involved and burning out.
In one newspaper interview Doctor Domingo admitted he has wept for patients, but he would do this privately. It would be good for medical students to know they can do that, too.
Beyond weeping though, caring is being able to seize strategic moments with patients to show one cares. I can imagine if we have a universal health care system and those baby boxes, we could have simple but important rituals where the obstetrician and a pediatrician would team up to give new parents their baby box, congratulating them, then explaining how important the contents are. I would like to see pediatricians explaining that the box does not have free samples of infant formula because the best nutrition for the newborn infant will be breast milk.
Transformational medicine and universal health care are big words but they are based on the basic principles of caring and empathy. Yet, because they are so simple they can lead to breakthroughs—like those Finnish baby boxes—that save countless lives.
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