When I was an intern at a government hospital, intravenous fluid bottles were a prized resource. When the fluid had been consumed, the nurses would unhook the bottles from the patients’ lines and then dispose of them, and this was when we would pounce: We would collect the bottles and cut them in half. That way, the bottom half could be recycled into a container that we filled with water or ice, and that we used specifically for holding syringes of blood prior to bringing them to the Arterial Blood Gas unit. The affluent among us would stock up on store-bought plastic cups for this purpose, but in a pinch, the halved IV bottles would do. Necessity is, after all, the mother of invention.
This wasn’t the only instance of ingenuity. We also collected scraps of cardboard, wrapped them in scratch paper and converted them into makeshift splints. We did these “arts and crafts” in our little pockets of spare time. We went into our work in the wards armed for battle, lugging scissors, sphygmomanometers, pulse oximeters, rolls of medical tape, secret stashes of medical gauze, calculators, items for neurologic examinations. We hid in our bags small bottles of heparin that we would need when extracting arterial blood gas samples. We always had at hand our own syringes and specimen bottles for blood.
Ideally, our patients would replace these supplies, since our hospital would not and could not replace them. We extracted the blood specimens needed and then gave the patients a prescription of what supplies to replace in their own time: a syringe here, a vial there. If they never replaced them, then that was fine. We knew what we were getting into; it was a charity hospital and patients were better off spending their money on medication rather than on replenishing an intern’s stash of medical equipment.
As a result, I often ended up spending more money on my stash of items than on my food or daily needs, and I’m certain many of my colleagues did the same. It was worse for the residents, who shelled out thousands of pesos for blood products, for operating room needs, and for use of mechanical ventilation machines, just to keep their patients alive. One pediatrics resident took compassion to the next level by legally adopting one of the sick neonates who had come into his care.
I offer these stories as an alternative, almost an apology, to those who think of medical professionals as heartless gold diggers.
Recently a story of a family’s tragic experience with a private hospital—more specifically, with a medical resident—made the rounds on social media and brought with it a torrent of hate against medical professionals. “Mukhang pera” was one of the kinder terms used in these conversations; many words are not fit to print. As many well-written retorts have explained, the failure of our health-care system to support those with limited financial capabilities might be to blame, but it’s easier to blame those at the frontlines of medical care, especially when they don’t seem to display the compassion that patients in distress expect and need.
The glory of medicine—the romantic idea of people dedicating their lives to aid the poor and the sick—dissipates a little when money is thrown into the equation. Unfortunately, in the Philippines, money always is: There is the unavoidable reality that healthcare is expensive, and that the quality of healthcare received is often directly proportional to a person’s financial capabilities. As trainees we are taught repeatedly that a patient is a patient, whether charity or private, and while we can do our best to make sure that our bedside manner is the same when treating either category, it’s an unavoidable fact that while our services may be free, supplies and medication cost money. At the beginning of our training it’s difficult for us to resist the temptation to pay for everything. Our seniors often warn us that we can’t pay for everyone’s laboratory exams and medical needs, and that we have to harden our hearts at some point. But the impulse to help is always there. Many of us have slipped bills into the hands of a patient’s bantay, and the truth is that we don’t really expect to be paid back.
This may not be a universal experience. Many trainees in private hospitals don’t encounter these extreme situations because the assumption is that patients who are admitted into these hospitals can afford to pay (or at least their insurance companies can). But this doesn’t mean that these private-trained medical professionals don’t help in their small ways—by suggesting a less expensive brand of drug, by sometimes bringing their own dressing materials rather than using the patients’, and so on.
This isn’t to say that all nurses and doctors and allied medical professionals are self-sacrificing and faultless. Some might be curt or cold only out of exhaustion or out of disillusionment, but we can’t rule out the possibility that there are those of us who are truly in it for the money—who went into the profession with the expectation of future financial stability at least, if not affluence. Maybe for some people medicine is a living, and not a calling. After all, who hasn’t heard stories of doctors overcharging their professional fees?
We can only offer our sincerest condolences, as well as these stories—anecdotal evidence that it is in these most dire of situations that the greatest compassion can be displayed; that even in the barren landscape of our least-equipped hospitals, hope springs through daily acts of compassion. We are all aware of the disparity between the needs of sick Filipinos and the capability of our health-care system to cater to them. We can only offer the reminder that there are many of us who work daily in an attempt to bridge that gap, and not to reinforce it.
* * *
kaychuarivera@yahoo.com