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August 21, 2008

The Doctor Of The Barrio

Nine months ago, I was deployed to a small-but-not-so-unfamiliar town of Candoni, in the Southern region of Negros Occidental. Prior to my deployment, I was already quite aware of a few details concerning Candoni. I had the information that this town had been doctor-less for at least 3 years and that there had been DTTBs (Doctors to the Barrios) in the past who were deployed in the area. In fact, I am the third DTTB to be deployed here. I also had the information that Candoni is a mountainous area, agricultural, relatively poor, being a 4th class municipality, and had a history of insurgency especially in the early 1980's and even early 1990's. It is 4 hours away from Bacolod and the roads, I was told, were not entirely hospitable. With these perceptions I began to work as their new doctor and in my first day, I was already able to identify some problem areas in the town with regards to health. As a DTTB, my primary task was to perform my situational analysis and conduct my community diagnosis which I was to report to Manila a few months later. As far as my own observations were concerned, Candoni had some problems on the following areas: Lack of access to cheap medicines and laboratory services, high rate of maternal mortality, low rate of facility-based deliveries, lack of supplies and equipments, poor health seeking behaviours, lack of adequate skills especially in the care of patients. I knew right from the start that I had a lot of work to do. Although the conditions in the area may seem luckier compared to other DTTB areas, there were things that nonetheless moved to feel frustrated.

The appropriated budget for our RHU could not perhaps catch up with the many ideas that were running through my head. I knew then that the success of these ideas in my mind would require a lot of cooperation and constant engagement with the LGU and the community at large.

Since then, little by little, I was able to gain their trust and confidence. Little by little, I was also able to introduce my ideas that I felt could benefit my area. Addressing the problem of inaccessibility to cheaper medicines, we were able to lobby for every barangay to put up a Botika ng Barangay. Candoni used to have 1 BnB outlet and 1 Health Plus outlet. Now, Candoni has 10 Botika ng Barangay outlets selling cheaper generic medicines. Now, people no longer need to travel to Kabankalan (which is 40 kilometers away) to buy some of the common medications I would prescribe for them.

Addressing the problem of high maternal mortality rate, I was able to gather the traditional birth attendants (hilots) and our barangay leaders and was able to ask for their cooperation in our promotion of facility-based deliveries. Now, as of June of this year, 68% percent of live births were done in our facility (RHU and BHS) compared to a dismal 40% last 2007. In order to provide quality service, we are constantly upgrading our health facility. Lately, Candoni was identified as one of the centers in the South to be converted to a BEMOC facility. With this new development, we are assured of funding for equipments and supplies and training of our medical staff with regards to Obstetrical emergencies. Many are now preferring to have their babies born in our Health center.

Of course, the opening of our Infirmary is a blessing to the Candonians. Now, they need not go directly to Kabankalan to avail of medical services. The Infirmary will serve as a center for primary health care, catering especially to our indigents who could not afford even a fare for the bus that would bring them to Kabankalan.

As of the moment, we have already submitted our proposal for the establishment of our laboratory. This would require some big funding but with a supportive mayor, I am confident that by the start of next year, we will be able to open our Laboratory, which will be capable of performing routine lab exams such as CBC, urinalysis and stool exam. As of the moment, our laboratory can only perform AFB sputum smear exam.

Addressing the problem of poor health seeking behaviours, I have invited the community to participate in the planning, organizing and implementing of our health programs. The establishment of the C.H.A.R.T. or Commmunity Health Allies and Reform Team I believe would help bridge the gap between the apathetics in the community and the RHU. Advocacy is the key and by constant dialogue with the community through weekly lectures and barangay visits, my hope is that the people of Candoni will realize that it is their primary responsbility to ensure optimal delivery of health care. As I would always say, Health is the responsibility of everyone.

In the last 9 months, I have learned a lot about myself and my community. I have learned skills which I haven't learned in Medical School. My eyes were opened much wider to the realities of life, of poverty, of inadequacy. These same eyes were honored to have witness the power of community spirit, of resoucefulness, of creativity and self-less dedication. I went to Candoni as a doctor to the barrio. Hopefully, through God's grace, and I am beginning to feel it so, I shall finish my term as a Doctor of the Barrio.

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