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November 6, 2008

What Happened in the First Year So Far


I have just turned one year as a doctor to the barrio and so far in the last year, I have learned a lot while working as a municipal health officer in a 4th class municipality in the mountains of Negros Occidental. A few weeks ago, I started writing my memoirs, hoping that I could finish writing them before my contract ends. Time does fly fast and a lot of things have happened already since the time I was deployed as a doctor to this small town of about 21,000 plus people. I really didn't know what to expect. I was also quite nervous the day I arrived in Candoni. It was a Monday and the Mayor's trusted adviser on Barangay Affairs went to fetch me in my house. We travelled for at most 4 hours. Along the way, the municipal treasurer was able to hitch with us at Dancalan, Ilog. In our further dialogues, I happened to discover that the treasurer is not only a schoolmate but also a relative of my wife. He became one of my first friends in Candoni. When I arrived in the place, I was introduced to the Councilor who is the chairperson for health, the DOH representative and the Nurse-2 of the rural health unit. These three ladies became ultimately my triumvirate of advisers. I remember how the staff and employees greeted me with a simple welcoming ceremony outside the Rural health unit, with no less than the Mayor himself leading the ceremony. Of course, the Vice-mayor and the rest of the council members were there to greet me also. After the ceremony, I was able to meet with the rest of my medical staff. I met my 9 midwives and the rest of the young staff. They became my closest friends as well.

I have to admit that my first night in my area was kind of weird. It was really a hodgepodge of feelings. I was kind of excited (this is it!) and at the same time apprehensive. I was missing my family back in Bacolod and there was no television! It was pure boredom. The following week, I brought my sister's old TV set back to Candoni. And since I didn't have any external antenna, I could not comprehend any picture coming out from the box, so I was using it as a radio instead, listening to the news instead of watching the news.

I started making new acquaintances in the area, knowing the people who are important in the community. I began sharing my ideas and plans as well with the staff and later with the rest of the community, slowly but surely trying to sell the ideas which I feel can benefit the community. But it was largely ideas drawn out from the suggestions and desires of the community. Through various dialogues with the community leaders, I was able to draw out from them their expressed desire for their community when it comes to health.

The first problem I really noticed when I was starting as a doctor to the barrio was the lack of access to pharmacies. Despite prescribing the drugs for my patients, it was still pointless since they didn't have any pharmacy to buy their medicines from. I assembled the village chiefs (barangay captains) and introduced to them the concept of the Botika ng Barangay (Village Pharmacy). They were quite hesitant about it at first but through continuous advocacy, I was able to convince them to start putting up and operating at least one Botika in their respective barangays. In Candoni I have 9 barangays (villages). As of July of this year, I now have 9 fully functioning and operating Botika ng Barangays. Actually I have 10, because in one barangay, there were 2 approved botikas, one of which was operated by a Non-government organization.

The next problem I noticed was the high maternal mortality rate and the high preference for home deliveries. It seems many are still dependent on traditional birth attendants and would not go to the rural health unit to have their babies delivered. Perhaps the reason is that they trust their palteras more than the registered midwives we have at the rural health unit. So, what we did was to upgrade our facilities, convince our mothers through persistent advocacies and assembled all the traditional birth attendants in the municipality and informed of their new role. Their cooperation was crucial to the success of a high facility based delivery. As of June 2008 during our mid-year Program Implementation Review, my percentage of facility-base deliveries has already overtaken last year's percentage by a huge margin. Maternal Mortality rate is still zero in Candoni.

Through the leadership and vision of the Mayor, who is by the way the great advocate of health in the municipality, the old building of the rural health unit was renovated and has been transformed into an infirmary, equipped with its own Delivery Room, 5-bed ward, Laboratory, Dispensary, Emergency and Trauma Room and even an office for the Public Health Department. Currently, construction of the Morgue and an extension of our Laboratory/TB DOTS center is being finished.

There have been a lot of struggles along the way as well. As of now, I am still fighting for an ample budget to work with for 2009. I am also lobbying for the implementation of the Magna Carta for the health workers. I am also working for the accreditation of my facility by PHILHEALTH in all 3 major programs: TB DOTS, Maternal Care Package and Out Patient Benefit Package.

Hopefully, in the last year of my stay, I can accomplish more for this community. The objective is to develop a community that is self-reliant and self-sustaining when it comes to their health program.


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