Welcome, please stay

This week, my social media feed was filled with sablay and that new art form, the Facebook essay, about graduation from medical school. The posts had that familiar blend of relief, wistfulness and gratitude that comes from having finished that “boot camp for the soul.”

It’s the time of year when interns, those undergoing their last year of medical training, say goodbye to their hospitals and prepare for licensure. From there, the world is their oyster—or rather, the world is filled with a number of options about the next step. The paths are diverse, reflecting all the spots in our system where young physicians are needed.

The options for my own training and others’ were, depending on how you look at it, limited or enhanced by a return of service agreement, through which medical students of the state university would agree to render service in the country for a minimum number of years after graduation. The initiative was a well-meaning effort in response to the “brain drain” of medical professionals we have heard so much about.

The emigration of skilled physicians, the poor doctor-to-patient ratio—all these are statistics familiar to anyone with any knowledge of health care in the Philippines. The obligation to stay is a heavy but noble one, since there are none more underserved than our fellow Filipinos.

As a result, in our pool of medical professionals, we may have been seeing a little less of that so-called brain drain; those pursuing training abroad are more the exception than the rule—not that there is anything amiss with practicing elsewhere. This year marks the completion of the return of service obligation of the first batch of physicians rendering a return of service. Five years later, we find ourselves for the most part still willing to serve our country, but it’s daunting to see the system that welcomes its new doctors.

Only recently, the scandal on Philippine Health Insurance Corp. losses from fraudulent claims exposed the corruption in our medical institutions that takes advantage of an already fractured system for money. It has also been reported that medical inflation in the Philippines this year is the second highest in the Asia-Pacific region, second only to Vietnam, and higher than the 5.2-percent inflation in goods and services.

This is not a system that will bear that weight easily. Already, it is crushing Filipinos under the weight of out-of-pocket expenses. Even a short illness can make the difference between keeping afloat and bankruptcy.

The transition to all the benefits and changes of universal health care might as well be a pipe dream, for all the heartbreaking expense we’re seeing patients go through here and now. The Philippine Statistics Authority has released statistics confirming what we already know—that the poor suffer most from the rising prices of goods, and despite promises of “change is coming,” our people are just as poor as ever, and just as unable to afford the catastrophic costs of health care.

A recent Young Blood article highlighted the experiences of doctors serving the barrios, where the presence of a doctor is not enough to solve all the ills of a community. In many areas, inadequate sustenance, the inaccessibility of health facilities, poor health literacy and, simply put, a lack of funding, make treating even simple diseases impossible. It is then apparent that it is not enough that we have more medical professionals. Skilled individuals cannot make up the difference that adequate living wages and good health infrastructure ought to make.

It’s also daunting that our new doctors are welcomed by a system more litigious and more critical than ever, and, as this column has explored recently, at increasing risk for workplace abuse and violence, more than other service industries. Doctor-shaming is alive and well.

This run of the return of service shows us that there is no shortage of skilled minds, impassioned hearts and warm bodies who are willing to render service. It is, however, a continuing challenge to newly minted professionals to keep their love alive. Let’s hope the song rings true: “’Di rin magbabago ang damdamin.”

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