Health on a budget
I remember witnessing a resident speaking in an abrasive manner to a grandmother who was asking for a clinical abstract. In most instances when a patient asks for such a document, it may be an indication that their finances are dangerously low. Having that document on hand enables them to ask for support from a government agency or political figures. I decided to stay on the sidelines and watch. After the exchange and the grandmother had walked away, I took him aside a good distance from the nurses’ station, and in a low tone reprimanded him. Part of that conversation was a stern reminder for him to be more mindful and compassionate, knowing that our institution mostly caters to service patients. I also asked him whether he realized that people who are financially challenged are more sensitive.
After that interaction, I paid a visit to their training officer. The resident was called to his office and later, I was told, he almost quit the program. It came as a surprise to see him years later, as a fellow-in-training in a subspecialty that was badly needed in his province. Currently, he is doing well in his practice and recently, a common friend said that he was relaying his kind regards to me. Apparently, he had shared our encounter, and the years have fashioned it to be one that both of us can remember in a more positive light.
While I may have caught him in a moment that shouldn’t really define him as a person, dissecting how he acted could have been a compilation of stresses that come from a highly demanding job in an environment which was less than ideal. Being accountable for a life can be overwhelming on top of the other responsibilities that come as part of the training. But apart from the physical fatigue, it is the emotional and mental exhaustion of working within a health system that at times doesn’t enable one to render optimal care that is heavier to bear. Seeing it from this angle helps deepen one’s capacity to understand and leave room for allowance. However, it still does not excuse unfavorable behavior.
My story may be more than half a decade old, but it still remains fresh because nothing has really changed. Patient load has increased substantially, but facilities and needed infrastructure have not kept pace. Reading about the proposed budget cuts for the Philippine Health Insurance Corp. subsidy, the Health Facilities Enhancement Program, and hospital operations of the Department of Health and how these will inevitably impact health care delivery makes one wonder where national priorities lie. The burning question is whether the decision-makers are fully aware of the gravity of the situation. If you have ever set foot in a public hospital or traveled to an area where there are no health facilities, let alone a nurse or a doctor to attend to patients with even the most common illnesses, let that be your reality check.
A couple of days ago, I was one of the panelists in the recently concluded Philippine National Immunization Conference. The topic was how medical societies can collaborate to strengthen vaccine advocacy and mobilize members to advance immunization across the life course. The discussion started off with the challenges that we faced as a society and ended by providing possible solutions. We were all in agreement that the number one concern was the lack of supply of vaccines, including those in the national immunization program. To lend evidence, more than a month ago, I received a call from a former household help whose grandchild was already nine months of age and still had not received the free vaccines from their local health center in Bulacan. Her daughter had to pay a private practitioner for the needed measles shot, and they were willing to travel to Manila just so that he can be immunized.
Other issues that emerged were safety concerns, including misinformation and disinformation about vaccines. In response, solutions that were offered included embarking on continuing projects aimed at increasing awareness and providing knowledge about the importance of immunization. Individually and as a group, that has always been one of our greatest strengths. Physicians, fortunately, remain to be the principal figures that the community turns to for needed medical information. There was also a proposal to incorporate vaccinology in the medical curriculum.
Last September, you may have come across data provided by the Second Congressional Commission on Education on poor immunization coverage and vaccine wastage. This included all seven childhood vaccines in the national program and was attributed to problems regarding inventory and tracking. In 2025, estimated vaccine wastage amounted to P590.3 million. How can you remain unaffected when imagining how many children could have benefited from these lifesaving vaccines?
It doesn’t take much to see the long-term advantages of focusing more on preventive care. The trouble is that not everyone is invested enough to make it a priority.
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