Over the past few weeks, we have heard the pleas of our health workers, and alas, the situation is just as dire—if not more so—for patients. The pandemic has given rise to additional hurdles just to consult or get admitted to a hospital; many get turned away for lack of beds, doctors, or funds, leading people to just forego health care altogether. They just endure or ignore whatever pain or symptoms they’re experiencing. As we sometimes hear from our patients and interlocutors: “Sa panahon ng COVID, bawal magkasakit.”
Consider the case of Nanay Joy, who was noted to be suddenly jaundiced at the start of the year, with no other symptoms. In the first few months of 2020, she was undergoing further work-up or investigation of her illness, which pointed toward a mass in her gall bladder. Unfortunately, her admission was cut short when she had to be sent home from a hospital that was suddenly converted into a COVID-19 treatment center. Without what should have been essential care, her condition deteriorated when no other hospital would continue the health management she deserved.
Nanay Joy represents the stories of many Filipinos today. To some extent, the additional requirements are understandable (e.g., requiring COVID-19 tests for elective surgery) and so are the hospital closures that are done to protect health care workers and patients alike. Nonetheless, they disproportionately impact patients, many of whom end up desperately searching for hospitals willing to accept them. They do this on their own, taking chances from one facility to another, with all the delays compounding their medical and financial problems.
Oftentimes, too, these policies are informed by politics more than public health evidence. Some provincial hospitals, for instance, have been ordered to convert themselves into COVID-19 hospitals, depriving Filipinos with many other health concerns. The recent idea of deploying “doctors to the barrios” to Metro Manila also speaks of how COVID-19 is now seemingly prioritized over non-COVID-19 needs, in what we previously described as the “covidization” of health care in the country.
People, of course, are creative, and find ways to manage their own health problems, often resorting to self-medication and self-care practices. But while for minor ailments these forms of “diskarte” might work, it can lead to conditions further worsening in the long run. And it can lead people to turn to unproven, fake, and often dangerous products and practices. When our health care system’s focus is on medical facilities over communities, a “community quarantine” makes essential health services even harder to reach.
It is not just the closure of hospitals or the lack of health care workers that has affected patients’ health, but also the government’s overall approach to the pandemic. The sudden declaration of modified enhanced community quarantine in Mega Manila, for instance, abruptly suspended public transport, depriving patients of their only means to go to health facilities. The mounting financial toll of the pandemic also makes people vulnerable to sickness; even if they find a hospital, they may have already run out of funds to pay for care.
Needless to say, mass and appropriately timed testing, followed by vigorous contact tracing, remains key for communities and hospitals to be operational. But from a patient perspective, the cost of testing also matters. We need to make testing affordable for patients, if not free. And these financial challenges are made all the more painful with the sickening revelations of corruption in PhilHealth. As various medical professionals have argued, we need a “demilitarized” and evidence-based approach to COVID-19.
Even now, it is not enough to deal with COVID-19 alone. As we enter dengue and leptospirosis season, as the protracted lockdown leads to various physical and mental health concerns, and as hunger knocks on the doors of more Filipino families, we urgently need an approach that considers both COVID-19 and non-COVID-19 care by supporting health workers, including community/barangay health workers and rural health staff; investing in technologies like telemedicine that can bridge access to care; and implementing sensible, compassionate, and people-centered policies that make health care a right, not a privilege, in these trying times.
Gideon Lasco and Joshua San Pedro are both physicians and anthropologists.