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August 10, 2009

The Modern-Day Doctor to the Barrio

I was reading a beautiful essay of a former DTTB (and one of my personal mentors at that) and I couldn't help but make my own reflection. The essay was basically reminding the present Doctors to the barrios of what it is to be a genuine DTTB. Despite the many challenges and obstacles, the essay tells the reader that
"As humans, we easily complain of what should be done by other people, because we are directly affected by their “irresponsibilities” If this is so, you are not a dttb. DTTBs rarely complain of others’ shortcomings and failures, because DTTBs focus more on the service that they can provide to their communities, just like those who have established “efficient systems” in their respective areas despite the hardships that they need to pass through because of these “irresponsible people”."

The essay continues saying, "This was how the program started…because of service….because of dedication and commitment to create a change. NEVER because of the SG-24 and the additional “perks”. Those who have started the program did not receive any of these things that we are blessed with right now, NEITHER were they acknowledged…or recognized.....or merely given any token or plaques.....YET, still opted to pursue and silently serve, hence, created chains of change."

Perhaps the essay is a product of a current observation on the issue surrounding the Doctors to the Barrios as of the moment. There seemed to have a problem lately regarding the giving of the expected compensation. It almost became a problem that brought a lot of turmoil among the doctors to the barrios. (Thank goodness it is already partially solved).

In fact, the frustration of the essay is glaring,

"Harsh as it may seem, this is EXACTLY what is happening to most of us. For someone who has started to be exposed on both sides of the ballgame, it is VERY DISHEARTENING for me to read every now and then, how some DTTBs are beginning to lose their passion to serve…..our respective communities have nothing to do with the failures in the program..….why make them pay? Why let them suffer for other’s irresponsibilities and failures? They certainly do not deserve such kind of treatment….and why focus so much on our burdens when there are still a lot of blessings that are coming on our lives daily?"

In a way I agree with some points of the essay. When we volunteered to become Doctors to the Barrios, we did it basically because we wanted to serve the way those who came before us did. We were aware of the hazards of the work, the conditions of our areas of assignment and the limitations of the comforts of life. Most of us were not government scholars and basically in some sense we don't "owe" the government. We could have proceeded to residency training and started on the road to private specialty practice. But we still opted to become DTTBs.

Now, let us not be self-righteous however. We are not heroes. We are not martyrs. We are not messiahs. Yes, we serve but we are no more than the Municipal health officers or city health officers hired directly by LGUs, serving their communities for many years already. Yes, we do the same work that these rural health physicians do but we are no special than them. We shouldn't even be feeling that. We are doctors to the barrios, nothing more and nothing less.

We serve only to the best of our abilities not because we have the answers to every problem of the community. We serve in a manner that enables the community to be reliant, empowering the community to find the answers to their own problems. We are not Oracles. We are just facilitators. Many DTTBs fail in their service simply because they come in to their areas with a Messianic attitude. There are clashes between the community or between the Local government or even between the staff and the DTTB because the DTTB comes to the area with an agenda in mind. The key is to elucidate the vision and enable the community to share in that vision. DTTBs are not the answer to the problem.

But that should not stop us from doing our work, as expected of us. We do the work we were told to do and do them to the best of our capabilities. Like any human being, we are limited by our flesh and bones, no matter how much our spirit would want to soar. No matter how much we would allow our idealism to fly, they are grounded by reality.

The reality is, no matter how much you would want to serve, if the conditions within you and around you prevent you from doing so, then you can only do so much. A practical example would be peace and security. If for example your community's peace and order is not conducive anymore for your job, then how can you fully serve? Again, a dead DTTB maybe a hero but then again he is still dead. If your community is resistant to the change you would want to bring and would rather settle for the status quo, then you can only do as much.

Yes, a genuine DTTB never sees the shortcomings and limitations but then again a DTTB is also human, prone to limitations and shortcomings. The problem is, like any human being, a DTTB also feels pain, can also feel frustration, can also feel that he or she is no longer loved. If a DTTB feels this way, how would you expect him to serve his community? A lonely worker is never a productive worker. If a DTTB does not feel that he is loved or appreciated by the community, or by his boss, or by his fellow staff, then it is going to be a sour service. Yes, he will still do what he is expected to do, will still probably report to his clinic and consult patients, will still probably attend local health board meetings and interlocal health zone meetings. He will still do what he is told to do. But he will be an RDTTB instead: a Robotic Doctor to the Barrio.

So, the key here is not just to let the DTTB pine away in his frustrated idealism. He must also feel that he is loved and well taken care of, especially by those people expected to take care of him. The DTTB never expects a luxurious life. The DTTB never expects to be a millionaire. A DTTB even spends out of pocket for his community and would never even think of reimbursing those expenses. There are many things performed by a DTTB which can never be even paid for by either his employer or by his community.

What can make a DTTB happy therefore?
I write this based on experience and actual observation.
First of all, a DTTB is happy when his employers/coordinators check on him from time to time. There have been a few DTTBs not even seen by their DOH representatives or Regional Coordinators. The DOH representative or DTTB coordinator is expected to be the DTTBs ally and friend, his comforter and adviser. But there are DTTBs who haven't even seen their own DOH reps until now. I am lucky to have a hardworking DOH representative who eventually became my closest adviser.

The DOH rep or coordinator do not even have to be there physically in the area. A text message or a call can be enough.

Second of all, a DTTB is happy when he feels he has someone to trust. In a strange area, where a DTTB is the stranger, it is important that a DTTB can refer to a person whom he can depend or rely on. Trust is an important commodity for a DTTB, something which he cannot live without. Of course, a DTTB must feel he can trust his employer, or his staff, or his LCE or his batchmates. Trust depends so much on being true to your word. Honesty is the foundation of Trust. But for honesty to flourish, there must be two-way communication between the trusted and the trustee. In the modern age of technology, the world has been made smaller thanks to modern means of communication. A cellphone is as common as a television set. But the truth is some DTTBs have not even heard from their employers or representatives. The only way these DTTB can hear from these people is during the bi-yearly CME. While this is not a general observation, it is not by any means an exaggeration.

Third and lastly, a DTTB is happy when he feels appreciated. The power of affirmation is strong. And to be affirmed from time to time always re-fuels the passion to do great things.

Let me share with you a story. There were four frogs who were one day taking a stroll in the forest. Two of those frogs did not notice the huge hole in the middle of the road. The two frogs fell into what appeared to be a deep pit while the other two frogs almost barely made it out of the hole, thanks to their strong grip. The two unlucky frogs tried their best to leap out of the hole but they couldn't. The other two lucky frogs tried their best to show their support to their two friends. Until, one of the unlucky frog told the other frog, "I couldn't stand it anymore. We won't make it out of this hole. Night is near and snakes will be coming out. We will surely die if a snake finds us here inside this pit. I'd better take my life rather than be eaten by a snake." And so the frog killed himself. The other frog inside the pit became all the more scared. He tried his best but he could not leap out of the hole. Meanwhile, the other two frogs out of the pit started talking to each other. "This is a hopeless case, friend," the other frog said. "Look, our other friend already killed himself and looks like the other one won't even last. Let's leave him and tell him he should kill himself as well." And so they screamed at him, waving their tiny arms and telling the frog below that he should give up his idea of jumping out of the pit. Unfortunately, the frog inside the pit could not hear them. He was way too deep and although he could see them waving at him, he could barely hear them. He kept on jumping. His two other friends meanwhile kept on screaming at him to give up. Until the frog inside the pit gave one last push on legs, jumped out of the pit with all his might. He was able to jump high, out of the pit, even reaching the lowest branch of the nearby tree! When he reached ground, his two other friends were shocked. "How did you do that?!" "How were you able to leap out of the deep pit?" After catching his breath, the frog told them, "It was a frustrating sight down there my friends. I almost gave up. From down below I could see you two and although I could not hear you, I was sure that you were trying to cheer me on, screaming your support, never letting me go, encouraging me that I could make it. I am so glad to have friends like you two. Thanks for the encouragement."

The Power of affirmation.

And it is not just the DTTB who needs this affirmation. Everyone, every human being, needs our affirmation. The DTTB is no exception. Unfortunately, some DTTBs feel they are never affirmed. It is only natural therefore to feel frustrated, to feel demoralized, to feel neglected, to feel lost. It is natural.

The question now is, should we leave it at that?

Of course, the DTTB is there to serve despite the limitations, despite the handicap, but then again, he can only serve within what others would allow him. Of course, money is never an issue and should not be an issue in the first place (shame on us) but then again, if this is to be true, then Why not we DONT pay our DTTBs instead. Let us think and re-shape the mindset of our DTTBs that they are there for charity. If this is how we wanted it, then let us try telling our recruits that they will receive nothing less than just the applause of the community and perhaps the affirmation of the Divine for their hard day's work.

Will someone still apply for a DTTB if this would be the case? I am quite curious of this hypothetical scenario.

No one would apply of course, not even perhaps the greatgreatgrandson of Jose Rizal (if he ever had one). For even the Good Book said, "give to the servant what is due to him" (and I am paraphrasing Scripture here, so sue me. hehehe).

But of course, we must support our DTTBs. Our DTTBs expect that; because who else would support the DTTB if not those who know the program very well? Support can come through financial means, through emotional means, through whatever means.

And to think this is not the only concern exclusive to the DTTB. Consider the hardworking Rural health physician hired by the LGU and has been working in that area for many years and has yet to receive his hazard pay. Consider the hardworking midwife hired by the LGU to traverse dangerous rivers just to immunize children and has been working in that area for many years and has yet to receive her hazard pay. I am now speaking for the entire public health sector who feels abused, neglected, politicized and thus becoming cynical, demoralized, dispassionate and eventually eaten up by the "rotten system", the same system poised to be changed by the ever glorious DTTB.

Indeed, to be a DTTB is tough. Very tough. It is never for the faint hearted. The hazards and dangers that lie around the DTTB are tougher than any tough consultant doing his rounds. But should that be made as an excuse? I think not. It should never be an excuse. Rather, it should be an opportunity to show that the DTTB is being loved, not that he needed it to do his job (for he can do his job without being loved) but because the community he serves need it. For a happy DTTB begets a happy and healthy community.

So, to my fellow Doctors to the barrios, let us find comfort amongst ourselves, should we not find it elsewhere. Let us share our war stories, cry upon each others' shoulders, listen to our complaints and heartaches, find meaning in what we do, and at the end of the day, sleep with the thought that we are not alone in what we do. I pray that such a thought may be enough solace, even for just a while.

Long live Doctors to the Barrios. Mabuhay kayong lahat.


2 violent reactions. React Here.:

Mark said...

Very interesting.

siobe19 said...

Touching and the article fed my soul today. I am an MHO here in Sagay City and the youngest among the 4 of us...took the boards last August 2008. I am so proud of you docot for having done so much in the community of Candoni.

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