‘Doctors to the Barrios’

They were in Surigao during the earthquake, in Leyte during “Yolanda,” and in Marawi throughout the crisis, and as I write this they are all over the country. They have faced, and continue to face, death threats; in March, one of their alumni, Dr. Dreyfuss Perlas, was killed. But despite the peril and the pressures, they continue with their mission of serving the underserved.

I speak of the “Doctors to the Barrios” (DTTB) — the group of fresh medical graduates who spend two years to serve as rural physicians and health officers of doctorless municipalities all over the country — from Itbayat in Batanes to Cagayancillo in Palawan. Youthful and idealistic, most of them are motivated by the desire to serve the country, admixed with a yearning for adventure.

The DTTB program, run by the Department of Health since the days of the great Juan Flavier, actually goes beyond the provision of health services. Alongside the two-year immersion in a community, the DTTBs take a master’s degree at the Development Academy of the Philippines — a course that helps prepare them, if they so wish, to be future leaders in public health. Considering that it usually takes two years to complete a master’s degree, anyway, and some medical graduates have a “return of service agreement” in any case, the DTTB program has become an attractive option for young physicians.

But not all goes according to plan, and the DTTBs quickly get their loading dose of hardships and challenges.

Perhaps the most obvious of these challenges is the geographic and health landscape. The farthest sitios remain very hard to reach; maternal and infant mortality remains high, and so does malnutrition. Over 150 years after the link between sanitation and infectious diseases was established, many communities still don’t have access to clean water.

What overwhelms the DTTBs, however, is the patronage system in which they soon find themselves: a system where the mayor is king, and local officials mostly cater to his wishes. One DTTB made the mistake of not paying a courtesy call on the mayor: He ultimately had to transfer to a different municipality. Another told of a mayor who holds medicines hostage in his office so that he can get the credit for handing them to patients.

The DTTBs, while mostly respected, are moreover not immune to intrigue. One of them recounted being accused of absconding from a disaster when in fact she herself was a victim but still managed to treat others despite her personal pain. More worrisome, because of their reformist impulses or simply because they happen to be in conflict-riddled places, there are very real threats to their own life.

Still, the young doctors find the job rewarding, drawing their strength and affirmation from the gratitude and love of their newfound communities. And they feel that they emerge wiser. “I thought I would be jaded by the experience, but instead of feeling a sense of helplessness, I’ve learned to see the value of incremental, but no less important, steps,” said Dr. Juhani Capeding, DTTB of Tagapul-an, Samar.

“I’ve learned to be grateful just for being who I am, seeing how much our people suffer,” Dr. Kevin Mendoza, of Dumaran, Palawan, said, adding: “And the least I can do to bridge this disparity is to help.”

The DOH calls the DTTB program a “stopgap measure”; ideally, it is the doctors from the barrios that would serve their communities. But while I generally agree with this ultimate goal, I think there is still value in the program. Aside from delivering health services and improving local health systems, the program is also exposing a new generation of idealistic doctors to the realities on the ground, from which a public health perspective can take root, ultimately benefiting the nation.

Of course, only with mentoring and career guidance can they find their niche in public service: And this is one challenge for the DOH. Another is the pressing matter of ensuring their safety. As a new batch of DTTBs — named “Perlas,” after their heroic alumnus — gets deployed in the coming weeks, I hope we can give them the support they need — and the appreciation they deserve.

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