September 2006
Health and the Filipino
First Person

High-quality healthcare on the cheap

Quality healthcare need not cost an arm and a leg.

I HAD no intention of becoming the embodiment of all ills that the Millennium Development Goals stand to eradicate. But that’s pretty much what I was when I found myself jobless, single, and with a 15-month-old baby suffering her second bout of pneumonia in the span of six months and now diagnosed with primary complex.

Half a year later, however, my daughter’s x-rays showed clear lungs, thanks to the care and treatment she got from her doctors. And all it cost to get her well was essentially the price of a bus ticket to Baguio, plus the jeepney fare to my family home in Benguet.

The author with daughter Isis

Okay, so I figured going home to Benguet was about the only option I had then. After all, I had just quit my job, because while the pay was fair and was not too far away from what most Filipino writers/researchers get, it still wasn’t enough to support a growing infant — much less a sickly one. I was working in Quezon City, away from my family in Benguet province, so half of my monthly take was going to rent a small but decent place in the city’s poorer quarters. The other half came to some $3 a day (1999 figures), which, when divided between my daughter and I, would have kept us just a tad away from falling into the ranks of the absolutely poor, or those marked by the development agencies as earning or spending $1/ day or less.

My other confession is that the diagnosis was issued by doctors at St. Luke’s Medical Center in Quezon City, one of the country’s premier — and expensive — hospitals. I may have been hard up, but there was no way I would leave my daughter’s welfare to a public hospital here in Metro Manila. All my experiences with public hospitals in the metropolis bordered on horror stories, without exaggeration. I’m sure that many others have horror stories of their own; the state of Metro Manila’s public health care system is another reason that makes urban poverty so appalling.

I did try a public health facility once, when my daughter first came down with pneumonia, coupled with gastroenteritis. I brought her to the Lungsod ng Kabataan in Quezon City, but the long lines and the way people were being treated there only made me realize real quick that money really talks in the big city. And so I pulled my daughter out and brought her to St. Luke’s, even when I knew this would wipe out my savings. Health is precarious in children before age five, and I certainly did not want my daughter to add to the ranks of the six million or so children who die before the age of five because of completely preventable causes like pneumonia. (Yes, these words actually scurried like frantic mice through my mind at the time, remnants of research I did years back for a PCIJ book on children and the media.)

Anyway, like everyone who has been to St. Luke’s, I paid a fortune for her five-day stay (at the ward). But the sense of security one gets from a hospital with a good reputation can be priceless: as soon as I walked into the emergency ward and we were immediately attended to, I felt reassured that my daughter would be cared for. When bill-paying time came, however, I noticed that even just the stick used to press my daughter’s tongue down (she used several) had a price tag.

That’s when a bus ticket home became part of the prescription to nurse my daughter back to health.

INITIALLY, GOING back home was partly about finding a rent-free place where I could continue to breastfeed and cut down on other expenses. But it was also about finding a place where free anti-TB medications might be easier to get, and where there were more relatives to run to. I never got those free medications, but I was certainly able to keep costs down.

Consider: In Manila, after the rent was paid, the utilities and transportation budgeted, would there have been enough left of my pay to buy infant formula — a kilo a week, at the least, if I remember right? And what about childcare, would there be enough money for that? And would it be possible to find someone who would religiously give my daughter her medications every single day — totally needed to eradicate the developing TB?

Back in the ancestral home, I was jobless. But for the next eight months, I was able to survive on doleouts from friends and relatives that came to somewhere a little above the $2/day threshold. This was virtually the same amount I would have earned back in Manila, but now it bought a higher quality of life for both me and my child.

For one, going back to purely breastfeeding her, which I could not do while holding down a job fulltime, meant no more money went out for infant formula. It also meant that her health began to improve quickly.

In Manila, a monthly check-up with the private doctor would have cost P250 for the consultation alone, but generally ended up with my having to shell out some P500 to P1,000 for inoculations, vitamins, and such. In Benguet, weekly check-ups were free. The basic inoculations were also free, plus easier to access, with less people in a Benguet municipal health center compared to one in any of Quezon City’s thickly populated centers.

Because I wanted to be certain my daughter was getting the best possible treatment, we alternated between going to the charity ward of St. Louis University Sacred Heart Hospital and the newly built Benguet General Hospital, which was walking distance from where we lived. At Sacred Heart, all resident doctors and interns work both the pay and charity units. Since many politicians and well-known Baguio citizens go to this hospital, I was assured that specialists (and pediatricians) there would at best be qualified, and at the least be careful. The doctors and nurses at the government-run Benguet General Hospital also turned out to be well-qualified, although many of them were just waiting for their papers to go abroad.

Yet it was not just about qualifications, but also about the quality of care my daughter got, which was outstanding in both hospitals. Perhaps one reason for this is that the average number of patients the doctors had to see in a single day was not too big, and they thus did not end up too harassed. And because Benguet is not a commercialized a place (it got its McDonald’s only at the beginning of the new millennium), the low pay must have been less of a bother to these Benguet doctors. But whatever the reason, the doctors there were easier to talk to: I was able to ask questions about my daughter’s condition, and was even taught alternative ways of caring for her. Many of the Benguet and Baguio doctors, too, acted like the sort of family doctors you would see on TV or in the movies, comforting crying babies, playing with toddlers — the works…and the sort of thing that I don’t see at all in public hospitals in Metro Manila.

EVEN IN terms of medications, there was quite a big difference in cost and quality here and in Benguet. In Manila, for each bout of upper respiratory tract infection — and there are many in a child who has primary complex — the doctor would prescribe one medicine for the clogged nose, one for the cough, and one for the infection. In contrast, doctors in Baguio/Benguet were more inclined to do things the natural way, which tends to be cheaper and actually safer. They were in fact quite appalled by her medical record and told me that she had been given “third-generation cephalosporins” that they felt was not necessary, since the use of conventional antibiotics had not been ruled out as effective. Also the third-gen stuff was far stronger, more expensive, and branded. I suspect more doctors in the big city are tempted by the perks and benefits they get from pharmaceutical companies. Or perhaps it’s just a matter of perspective. But for sure, the Baguio/Benguet method was clearly more effective for a poor and developing community.

So it was back to the simpler stuff for my daughter and me: erythromycin (as our family is allergic to penicillin) for the infection, steam inhalation for the clogged nose. I was also taught how to do the “bronchial tap” or the tapping of the back to loosen phlegm trapped in the lungs. And of course the anti-TB meds.

On top of these, fees for laboratory work — such as urine tests or x-rays — were half the price of those I paid for at St. Luke’s. And they were about a third cheaper at Benguet General Hospital. An x-ray, for example, was some P400 (in 1999) in St. Luke’s; it cost about P200 in Sacred Heart Hospital in Baguio and around P160 in Benguet General Hospital. I’m not an expert in the medical field, but I didn’t see much of a quality difference between the x-ray itself and the interpretations in all three places.

By the time I brought my daughter down again to Manila (where the jobs for writers are, alas, despite the higher cost of living) eight months later, she was healthy. She would stay healthy and, as bonus, seemed to have benefited from the extra care and early childhood teaching I would have only been able to do in more relaxed Benguet. When it was time for her to go to school, she was the first in her 3’s class (three-year-olds) to be able to write her name. Her teacher also said she had a “huge stock knowledge of concepts” for her age. Today she is a lively, independent and smart eight-year-old who has not been sick with any major respiratory illness since her recuperation in Benguet.

In retrospect, it seems to me that Benguet province shares my story: in the 1970s and 80s, Benguet used to be among the country’s poorer provinces. For many years until 1997, it had been among the country’s 20 poorest provinces.

But nine years ago, Benguet was able to pull itself out of that rut. Today it stands proudly as the only province in the Cordillera Administrative Region that is not found among the country’s 44 poorest provinces. Despite the fact that its economy today is hit hard by the freer importation of potatoes, beans and other Baguio vegetables from cheaper and better subsidized farms in China and elsewhere.

In 1999, it was even considered as the country’s top 8th province in terms of quality of life. This was according to the group of economic activists at Action for Economic Reforms.

For me, this only shows that having the right kind of information and focusing on priorities can spell the difference between abject poverty and a simple but quality life.

The author believes that if health officials muster enough political will, this alone could improve the country’s healthcare system by leaps and bounds.