An exercise in disillusionment

This column has mentioned “Ang Kuwento ni Rosario” a handful of times, and so have other physician writers with increasing frequency during the pandemic. (I mentioned it in “Case studies,” 3/23/20.) It is the case study of the death of an infant, Rosario, within a family burdened by poverty, malnutrition, poor health education and literacy, and poor access to safe, equitable, affordable health care. Young medical students often begin their education with the case study, which helps them to analyze the factors that lead to poor, and frequently preventable, health outcomes. Given our health crisis, the story of Rosario is more relevant than ever, highlighting how the futility and helplessness faced by sick Filipinos are not the fault of individuals but of systems of inequality and oppression. Anyone interested can find the study online.

For some of us the story of Rosario is but the first hint of a flawed health system we are entering. For all of us it is an exercise both in critical thinking and in empathy. To give a name to Rosario, the infant victim of structural violence, is to separate her from millions of faceless Filipinos—to make her human. For young medical students, this humanized experience with Rosario is the first of many, as the sick patient becomes more than a clinical question or a statistic. To make Rosario and her family human is to grant them, in our minds, the dignity and complexity befitting of human beings.

Any physician with a heart and a moral compass is thus encouraged to analyze the interconnected web of factors that makes it so difficult for Filipinos to be healthy. It’s hoped, then, that the young doctors are guided in several ways: In leveling expectations about the underserved communities they are meant to be serving; in helping them apply both compassion and critical thinking to each patient; and in driving them to be advocates for systemic change in the future.

This is why the pandemic has been an exercise in disillusionment. Prominent physicians, once held by myself and colleagues in high esteem, have repeatedly shown that they have no empathy with the Rosarios of the world. Our health secretary has blamed individual lapses in health protocols for the high number of COVID-19 cases, sparing no thought to the lapses in our government’s pandemic response and how they contribute. Other physicians, motivated by profit or by a disdain for evidence, have pushed for unproven COVID-19 therapies, further contributing to the miseducation of families like Rosario’s and leading them to spend accordingly. And now, with the rise of community pantries, we have witnessed Dr. Teodoro Herbosa’s unfortunate comment on the death of an elderly person who lined up for one such pantry. “Death by community pantry,” he wrote in a tweet last Friday. “I told you so!” He also lamented how crowded community pantries can easily transmit COVID-19 infections — in part a correct sentiment, but bereft of compassion for the extreme circumstances faced by Filipinos who line up.

What is most striking about such sentiments is the undercurrent of disdain for those struggling to survive. They are a new iteration of 2020’s “Why don’t you motherf***ers just stay at home?” — this time made by those who know our flawed health system intimately, and who should know better.

Is it so difficult to grant the beneficiaries of community pantries the same empathy and critical thought that we give to baby Rosario? Is it so hard to connect such long lines with hunger, with desperation, with poverty and unemployment, and all things exacerbated by the pandemic and our nation’s response? That a special adviser to the National Task Force Against COVID-19 did not seem to appreciate this nuance is both telling and worrying.

Doctor Herbosa has since apologized and resigned as executive vice president of the University of the Philippines system, with a self-awareness heretofore unseen among our public officials during the pandemic, but the whole incident just underlines how out of touch our officials can be, health care workers or otherwise. How ordinary Filipinos become the subject of lofty contempt rather than the objects of sympathy and public action. Maybe prominent physicians and those in high office would benefit from a two-hour session discussing “Ang Kuwento ni Rosario.” The way things are now, young medical students—those just beginning their sojourn into public service — might be able to teach them more about empathy and analysis.

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