Missing link in health care

I’m feeling like one of my students asking for an extension, regarding my article on the need to plan ahead with stuff like wills and powers of attorney. I thought I could have the article ready but was on the road in Davao, so bear with me as I share instead about the past rather than the future.

In the University of the Philippines Mindanao, I talked about community-based health programs, or CBHPs in the 1970s, and how important these CBHPs were. They were part of a global movement rooting for primary health care, and I think the now empty slogan of “Health for All by 2000” would have been attainable if we kept going with grassroots health care.

We hear so much about lifestyle changes as the core for good health. but you can eat right and get enough sleep and exercise and all that, and still be in bad health if you’re surrounded by a polluted environment, lack of access to clean water and proper waste disposal, and have to struggle with inefficient and uncaring health bureaucracies.

In the 1970s, fresh out of college, I saw what it was like in the Promised Land that was Mindanao. Hundreds of thousands of hopeful Filipinos had moved from Luzon and Visayas to Mindanao following government promises of abundant, fertile land and opportunities for a good life. My paternal grandparents were among those who settled in Mindanao and, over the decades, visiting my grandmother every summer, I saw how Davao developed.

But after college graduation, when I took up my first job there with the Catholic Church’s social action arm to promote and implement CBHPs, I saw another side of Mindanao: grinding poverty arising from inequity, villages where there were few children because epidemics had wiped them out, people looking older than they really were, and with the degenerative diseases to match, afflicted with all kinds of aches and pains, some of which I knew were really from despair.

The strength of CBHPs rested with the community health workers (CHWs) who went through many workshops on preventive health care and the treatment of simple ailments that, left untreated, would become serious. More important than the health component, these CHWs were community organizers and social workers, able to mobilize people for immunization, for health education and to go for the government services they were entitled to.

But that was also dangerous, given the times then (and even now). Peasants are supposed to be quiet, to be grateful for what the rich and powerful would give them—a medical mission here and there with a few free medicines and food donations (I still remember wheat!).

The migrants and settlers were still more fortunate, because they had some options. The displaced lumad (indigenous peoples) just kept moving when harassed. Their existence was subhuman: One friend from a rich landholding family told me stories of how the lumad would be “shot like rabbits.”

Muslims were not as easy to intimidate, but they suffered from stereotypes about not being trustworthy—never mind the settlers who betrayed them in the first place.

CBHPs did show that very simple measures went a long way. Working with the late Dr. Mita Pardo de Tavera’s tuberculosis control program, we had one study comparing the CHWs, some of whom were illiterate, with medical technologists on detecting tuberculosis (TB) bacteria in sputum samples. The CHWs did better!

Villages with CHWs did better when it came to finding those with TB, getting them medicines and making sure they took them. CHWs would go around each day to check the patients, asking them to urinate. If the urine was orange-colored, it meant they had taken the anti-TB drug rifampicin, which peasants were sometimes tempted to sell so they could buy food for their children.

Alas, we are now paying for the neglect of more community-based approaches to health care, with a resurgence of old diseases even as new ones emerge. Old or new, these diseases are best handled at the level of communities, and I’m speaking not just of geographical ones but other communities brought together by common causes —for example, parents of children with developmental problems, women battling breast cancer, groups at risk for HIV/AIDS.

In January 2020, the Philippines will begin implementing universal health coverage, which will rely on front-line primary care teams that then guide and refer you to appropriate care. PhilHealth will provide the financial support if you go through this route—I hope with the missing community link more firmly in place.

Universal health care will be challenging; I will be writing more about this (together with the promised article on preparing advanced directives). Health care is complicated, but there are simple community-based measures that go a long way toward unraveling the obstacles. Mindanao taught us that.

mtan@inquirer.com.ph