Changing med schools

When I was told, some three years ago, that Bicol University was going to put up a medical school I sighed: “Another one?”

I had lost track of the number of medical schools in the country but even back in the 1980s, there was a growing consensus among government and nongovernment groups that more medical schools were not solving the country’s many problems, with the medical schools oriented toward producing more doctors for hospitals in urban areas… or abroad.

In the last 50 years or so, our educational system for health professionals had been responding to foreign market demands. Schools would proliferate every time there was a demand for a particular profession, and when that demand subsided we would find ourselves with a surplus of jobless professionals.

The problem has been especially acute concerning physicians and nurses. Remember the time when everyone wanted to become a nurse so they could go abroad? Even licensed physicians went back to school and enrolled in a nursing course.

Alternatives

Going back to Bicol University, I have been assured, however, that this new medical school would be different. For starters, Dr. Ruben Caragay, who had just retired from the University of the Philippines, agreed to become dean of the school. Ben is well-respected for his work in public health and community medicine, and his agreeing to move to Bicol (which is not his home region) meant he was convinced that this new school would be different.

I was hopeful. There have been alternative medical school models, the most notable one being UP’s ladderized program, first piloted in Palo, Leyte, and now expanded to Baler, Aurora, and Koronadal, South Cotabato. In this ladderized program, students are nominated by local governments to train, picking up a certificate in health work, a certificate in community nursing (midwifery), a bachelor’s degree in nursing and, eventually, a degree in medicine, with stints of service to their communities.

Ateneo de Manila University’s medical school, which took in its first freshmen in 2007, offers a joint MD-MBA degree program, with the goal of producing physicians who also excel in management and public health. I was part of the team that brainstormed and planned for Ateneo as early as the 1990s, so the curriculum includes social medicine, to which students get introduced as early as their first day in medical school.

There was a time when this included a short film on the medical dimensions of the aswang. I could imagine their going home to dinner and their excited parents asking how it had been in med school, with the budding physician responding: “Oh, we learned about the aswang.”

MD-MPA

Bicol University’s med school also offers a joint degree, this time an MD with an MPA or a master’s in public administration, major in health emergency and disaster. I first thought it odd to have such a specific major, but then remembered Mayon Volcano as well as the many typhoons that wreak havoc on the region each year.

True, typhoons hit the entire Luzon and Visayas each year but the natural disasters cause so much more suffering when they ravage areas marked by high poverty incidence such as Eastern Visayas (Samar-Leyte) and Bicol.

Among the Bicol provinces, Albay is the most developed. Bicol University is in fact in Legazpi City and serves as the regional center. But Albay’s human development index (HDI) puts it (as well as Sorsogon and Camarines Sur) at par with India. Moving to lower HDIs, Camarines Norte is at the level of Laos, and Masbate, the poorest province in the region, has an HDI equivalent to Lesotho’s.

Can an MD-MPA training provide better doctors for Bicol, or for the Philippines? (Bicol University does accept a few students from outside the region.)

I finally agreed to go to Legazpi last month, to deliver a lecture and to meet Bicol University’s faculty and students.

It was only a weekend visit, but I’m hopeful about the medical school. The infrastructure is impressive, with a brand-new building and with fully-equipped classrooms and laboratories. That includes two plasticinated cadavers, named after Typhoons “Glenda” and “Henry.” (These cadavers are injected with a kind of plastic resin that preserves the internal organs so these can be used year after year. The cadavers are imported from China.)

More importantly, there is an innovative curriculum that includes two full months of community immersion each year. My lecture was scheduled right in the middle of one such immersion so the students—two batches now—had many stories (and adventures) to share from their communities.

Bicol University is particularly open to alternative medical systems. In the communities, students are encouraged to interact with the hilot and albularyo. At our symposium there were a few of these folk healers as well, some of them clearly from the middle class, talking about antioxidants and supplements. Ben Caragay himself, when in Manila, has flocks of patients going to him for acupuncture.

My lecture, “From Quiapo to Legazpi,” was meant to give an overview of the mixing of medical systems. I was candid about my skepticism vis-à-vis many of the nostrums—whether amulets or supplements—but urged an open mind, as well as an understanding of how healing takes place in the context of people’s symbols, meanings and everyday life.

The open forum was lively, and I realized at one point how different the students’ level of enthusiasm was compared to the many other more traditional medical schools in which I’ve lectured. Bicol University’s medical students are curious, less intimidated by their books, and much more animated by their encounters with real people (apart from Glenda and Henry).

(I had the privilege of being with Dr. Susan Balingit, an anesthesiologist who now practices natural medicine. She did her community service in Bicol many years ago, and can thus relate even more to the local situation. Her lecture emphasized how changes in society have transformed our risks, as well as potentials, in health and medicine. )

We won’t have our first licensed doctors from Bicol University until 2018, but I think that even as students, these future physicians, together with their mentors, will change medical education and the practice of medicine.

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mtan@inquirer.com.ph