500 years of public health

The pandemic has toned down plans to commemorate a Quincentennial, 500 years of contact between the Western world and the Philippines, with subsequent encounters that have reshaped the Philippines, Asia, and the Western world: Religion, medicine, food, languages to name a few.

With the pandemic, we may well think of the Quincentennial in terms of public health. Sadly, we might well be an example of a country that suffered more from COVID-19 because we have neglected building a public health care system. Worse, over the 500 years, actually even earlier, we did have what we could call public health, but along the way, especially in the 20th century, began to lag behind other countries.

Carlos “Botong” Francisco’s famous four-panel mural entitled “The Progress of Medicine in the Philippines,” gives us glimpses into public health in our country. Completed in 1953, the mural greeted visitors to the Philippine General Hospital (PGH) for more than half a century before being taken down for restoration, and transferred to the National Museum. What you see in the PGH lobby today is actually a photographic reproduction, done very well but, of course, nothing beats the original.

The first panel is supposed to show precolonial health care and depicts a priestess praying over a sick man. Shamanic healing, using prayers and medicinal plants, is still part of folk medicine today but the early Spanish chronicles also document how entire communities cared for the sick. Other accounts through the last 500 years show how indigenous communities, in particular, had elaborate systems, including communal offerings for healing, and even quarantine systems to limit entry into villages in times of epidemics. That’s public health, too.

Francisco’s second panel depicts the Spanish colonial period and depicts two elderly monks writing. Friars did care for the sick, as well as produce extensive documentation of medicinal plants, and writing health care manuals for lay people but Francisco forgot the nuns, including orders founded by Filipino women, who played an even more important role in public health, including, I am certain, providing health advice.

The panel also misses out on other important developments in public health during the Spanish period, including smallpox vaccination, a system of “mediquillos” (herbal scientists), and a waterworks system in Manila, with a fountain in Carriedo still there to commemorate the system.

A third panel shows the American colonial period with images of “modern medicine”: A male physician, a female nurse. Central to the panel is what might have been vaccination but, sadly, using a police model of public health that we still have today. There’s a glum-looking Filipino about to get vaccinated and behind him is an American soldier with a rifle!

The Americans did emphasize public health but it was one that was built on American models, centered on hospitals and health professionals, all concentrated in urban areas.

The last panel shows health care in the new Philippine republic but again focusing on hospitals, a surgery room. Curiously, in the background there’s a huge cow and I believe this was to depict the production of vaccines. Sen. Richard Gordon correctly observed recently that we used to produce our own vaccines and even exported them.

I would add that in the 1950s and 1960s, our neighboring countries sent scholars to train in the Philippines for the health professions, including public health.

Alas, we went downhill beginning in the 1960s, neglecting medical research and content to import all our medicines, vaccines, diagnostic kits. Only recently have we ramped up medical research but we have a long way to catch up.

Not depicted in Francisco’s murals were the many health campaigns conducted to prevent diseases. We neglected that as well and, today, without a strong public health communications system, our citizens are so vulnerable to fake news and misinformation.

There’s one bright spot in this vital area of public health communications. If you need information on what works and what doesn’t for COVID-19, check the site of the Philippine Society for Microbiology and Infectious Diseases (psmid.org), and look for “living recommendations” based on expert consensus. For example, you’ll find a “thumbs down” for chlorine misting and foot baths.

We need more organizations like PSMID but ultimately, the backbone for strong public health comes with good governance. The funds are there, the taxes from tobacco and alcohol alone running into billions of pesos. The problem has been in its proper allocation and use; read: corruption. Now that won’t be appearing in any mural.

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