Ultimatums

Last week, Manila Mayor Isko Moreno challenged health workers: if you can’t be kind, then you can quit. He says it poetically: “P’wede naman kayong magpaalam.”

It’s a blow to the gut, a harsh reminder that the state of local health care is filled with tired, unhappy public servants who are comfortable with an environment where it’s okay to talk down to the poor and sick. It is true, and many of us have experienced it to some degree, with unkindness ranging from briskness and sarcasm to outright verbal abuse.

He may have been speaking, however, from a perspective that’s all too simple. The mayor mentions that health care workers are often unkind when they’re tired or unhappy, and completely glosses over systemic problems brought up by public health advocates time and again: poorly compensated and sometimes poorly trained health workers, struggling to provide time and services while under-staffed and under-resourced.

He’s also conveniently not mentioning that barangay health workers, who are overworked and straining to fill duties that shouldn’t be their own (pharmacist, social worker, educator, among a dozen others), are themselves part of the same sick, underprivileged communities that they serve. They’re also struggling to get by with a meager stipend, and deal with the same difficulties when they themselves seek medical care.

It’s true what he says, that these health care workers are the frontliners in delivering government services, but the services are so limited and health care workers are sometimes expected to fill those defects and provide what isn’t provided, sometimes from their own pockets. In these circumstances, health care workers should probably still try to smile and be kind — some apparently manage, through some miracle of patience and forbearance — but it would be a darn hard job. One is tempted to issue the same ultimatum to the mayor and his ilk: if you can’t make it so that health workers work in an environment where it’s relatively easy to maintain their sanity, then you probably should quit. But then the health care system isn’t that simple, too.

Still, the #notodoctorshaming trends have opened up an avenue for the layperson to understand the plight of health care professionals, at the risk of making us complacent. Health care workers can be so quick to respond to this type of criticism by bemoaning our myriad problems, sometimes forgetting that missed sleep and burnout are nothing compared to the mountain of challenges that the poor Filipino meets in trying to
seek medical care. The frustration, fear and desperation of being sick and moneyless don’t need to be coupled with the humiliation of being shouted at by a health care worker. We know this, and we know that the struggle to be both kind and effective never ends.

I’d like to give the mayor the benefit of the doubt, that he could truly be a champion of the underserved, not just in words but in actions; that there’s talk now, but there will be actual work later to overhaul this howling, broken system. Why so much focus on the little man—in this case, the little health care worker, nurse or doctor—instead of addressing problems that we know frontliners confront every day? It’s the street vendors all over again, with streets cleaned up in the interest of orderliness, without much thought being given to the consequences for the little man driven out of his livelihood, and with no solutions in sight for the systemic reasons that illegal vendors exist and peddle where they peddle.

If we really are dealing with the dawn of change in Manila, maybe there could be less interest in appearances — of clean streets, and of pleasant-looking health care workers — and more interest in diving in and solving things from a systems perspective. Furthermore, this ultimatum, this clear demand for health care workers to do their job and be professional—shouldn’t it apply to those who are also in government, paid more, and given more power? Let’s come to an agreement: we should try to be kind, and those in power should try to be effective.

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