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October 26, 2009

The Obstacles Of A Rural Health Physician


I must confess that before I began my work as a public health officer 2 years ago, I had no idea on how to do my role. While I have many ideas floating in my head, saturated by the pre-deployment training we had at the Department of health, I was still lost on what to do. I was hoping that there was some manual or guide of some sort that would help me what to do or teach me the first step to take. In the absence of such, I had to rely on my intuition, limited knowledge, creativity and my blind faith in the community I was assigned as a Doctor to the Barrios. Two years after, I have learned a lot about my work. I have experienced so many obstacles that I was at some point of my life not confident whether I could survive the life in the barrio.

Basically, the role of a Doctor to the Barrios is to ensure that the health systems are in place and should be efficiently and effectively working for the people. I was fortunate that when I arrived in Candoni, there was already some semblance of a health system. What was lacking really were logistics, infrastructure and some sense of sustainability.

With the help of the Mayor, the municipal health office got its structures and logistics and while the logistics may be limited, the MHO that was 2 years earlier was different than the MHO that is today.

But actually, it is easy to purchase equipments and supplies. It is easy to put up an infrastructure or renovate an old structure. What is difficult however is to influence or improve health seeking behaviors. Your newly renovated delivery room is of no use if most mothers will still opt to have their babies delivered at home. Your trauma center is of no use if most patients will still seek traditional albularyos and hilots to attend to them. Your medicines and vaccines will be of no use if most of your patients would not prefer to bring their children for immunization.

In other words, while infrastructure and logistics are important, attitude of the community is also important. And this is where I implemented what I have learned from my Family and Community Medicine at the University of Saint La Salle College of Medicine.

We are taught about the complexities of an individual and how the disease process of the individual develops from the contribution of many factors, most of which are inorganic. The individual's culture, belief, social influences, economics, education, etc help contribute to the development of the disease. The same is true when looking at a family as a single unit. Perhaps, it is even more complex considering that the family is a unit made up of numerous individuals bound only by a common tradition or affiliation. Within the family are interactions which also contribute to the development of the disease. Now, consider a community!

But while such fact is true about the development of the disease process, it must also be true in the diagnosis and treatment of the disease. The effectiveness of the treatment of an individual relies also on so many factors, 90% of which are always inorganic. It is easy to prescribe medications and all doctors can prescribe the medicines with authority and credibility. But the trick is how to make the patient comply to your medications.

The behavior of the community is therefore the key to an effective local health system. It is important therefore that the individual must realize that he or she has sole responsibility over his or her health.

This is where many doctors find it frustrating: dealing with poor health seeking behaviors. It is a difficult job therefore to maintain the health of your community. It requires improving not only the logistics but also the health seeking behaviors of the members of the community.

Behavior can be regulated. The presence of laws is an easy way of regulating behavior, through reward and punishment. If you do good, you get incentives. If you don't do good, then you get punished. However, with this kind of method, influencing the behavior of the community will only bring you as far as the supplies of your incentives can last.

Another way and I believe a more sustaining way of influencing and regulating behavior is through education. I believe in education and it is my personal conviction that through education, we empower people. Education need not be formal. Education need not replace the "traditions" either. Education actually adds to the knowledge. True education never replaces knowledge. It expands knowledge. It widens views and insights and provokes further search for knowledge. It also inspires people to take action based on the new knowledge that is given. True education therefore imposes a sense of responsibility.

Thus, as a Doctor to the Barrio, most of my time was spent on giving talks to mothers and children, fathers, couples, health workers, barangay captains, volunteer nurses and midwives, department heads and co-employees, students and teachers, out-of-school youth and other NGO's. A week after I returned from Clark, I had to meet my barangay health workers from all 9 barangays to remind them again of their active vigilance against home deliveries. I told them that they are my agents, my James Bonds, and that they must be active in surveillance and monitoring especially in their respective catchment areas. To treat illnesses is as I have said easy. To make sure the community is healthy is far more difficult.

It requires a lot of patience therefore and at the same time political will on the part of the doctor to the barrio to influence and regulate behavior. Politicians feed on ignorance of the people. They want to make sure that the people remain ignorant and poor so that they will be dependent on the politician for their needs and sustenance. Thus, a politician might be lenient towards the community, afraid to implement the right thing in fear of a backlash. But as a doctor to the barrio, we must remain apolitical although we too must be politically sensitive. A politician, if not regulated and managed, can be an obstacle as well.

There are many obstacles to be faced but as doctors to the barrios we must remain true to our course.
Philippians 4:13.






2 violent reactions. React Here.:

Albert Balbutin Jr. said...

Bayen, kudos to you. Everything you said sums it all up, and everything you do, including sharing your views and experiences here, is contributing more than you think, im sure.

I've been following your blog via rss because I support a mobile children's clinic that works directly with MHO's and midwives on the province of Bohol, and the problems you brought up are the same problems occuring there and the entire nation.

I will be thinking about the solutions you've posed, but in the meantime i'd like to ask your opinion about HB 5043, the reproductive health bill? Im guessing you are like me, that i'd rather have men and women be empowered by inner motivation to not bear more children than they can manage instead of using contraceptives. This opinion of mine is not religious based, but rather "self-empowerment" based if that makes sense.

My opinion also coincides with what you said about politics... it won't work. With that said, you are at the frontlines, so please, keep sharing.

Bayen said...

Albert, thanks for the comment. Feedbacks like yours inspire me to continue maintaining this blog. It is a difficult job we do and sometimes it is a thankless job but when we do it selflessly the impact we leave behind can be big.

About the reproductive health bill, my opinions i think will not fit here so I might as well write a new blog entry about it. Thanks for asking me about my opinion on certain issues.

Good luck as well in all of your endeavors.

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