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University of the Philippines medical students speak on their summer community medicine elective course

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A group of eight students of the University of the Philippines – College of Medicine had a summer community medicine elective course facilitated by the Visayas Primary Health Care Services and the Community Medicine Development Foundation (COMMED) in Cebu and Bohol on May 15 to 30, 2010. Below are some of their insights.– Lee Edson P. Yarcia
I recently learned that the Visayan dialect’s term for the word “medicine” is “tambal.” I can’t help but notice that “tambal” is the root word for the Tagalog term for “partnership.” Interestingly, this word play became my greatest learning in my short stay in Bohol as I underwent the student integration program.

We’ve been repeatedly told that health is a basic right, and it is not just the absence of disease or infirmity, but a state of complete well-being. In our exposure in various communities, a lot is still to be done to achieve holistic health.

In a setting where most pressing and basic needs are not met, it is understandable how people take less care of their health to attend to their concerns. Who would spend more on buying anti-cholesterol and anti-hypertensives when they are still worried where to get the next day’s meal? How can you advise a hypertensive to stay away from intense heat, or to avoid strenuous and stressful lifestyle when it is his occupation to face the heat as a farmer, and arduously till the land day by day?

But I took hope with the people’s organization. They grouped and rallied themselves for their collective dreams and aspirations. I take comfort that institutions like the Visayas Primary Health Care Services established partnerships with the people’s organizations. It is the most sustainable approach to health care, the empowerment of the people.

As I live with the local community, I felt ashamed too for taking for granted the things I appreciate in life. It made me value the opportunities I have been offered, it made me more conscious of being responsible for the life I have.

– Anthony A. Suguitan The experience with VPHCS is very remarkable with a dint to my experience. I had not expected that an NGO such as VPHCS has extensive programs and projects here in the Visayas area. I marveled at how it sustains such activities through training and knowledge enrichment and sharing. With a good sense of appreciation, I think that these things would not have been possible without the people whose dedication to community work and health development is as steadfast as their resolve to make the nation a healthy one, one step at a time, using Primary Health Care as the mode of approach.

Speaking of PHC, health is the responsibility of the government and at the same time the people should participate. It is not a bankable propriety to hinge all the responsibility in the hands of the government when the stakeholders are also deemed to have even the slightest responsibility— participation. I remember what Kennedy once had mentioned in one of his speeches — think not of what your country can do for you but what you can do for your country.

– Carol Stephanie C. Tan The community immersion illustrated very clearly the basic principles of the Alma Ata Primary Health Care Declaration. From my staying in the community, I saw how health is affected by the political, economic and social conditions. For example, the poor economic situation of the people in Ubay and Trinidad caused health to take a backseat. Most efforts were channeled towards income generating projects and land-ownership issues, which is why most of them were unconcerned that their health center was not easily accessible and a lot of medications unavailable.

On the other hand, in the town of Loon where there was strong political will and a fairly sustainable economy. I saw how health was really prioritized as proven by the efficient health centers and strong BHW Training System. From these experiences, I learned that as health care professional, it is not enough to just look at a person’s physical health, but also to consider their living conditions in order to help that patient.

I also realized the importance of providing appropriate and relevant services to the community. From an outside perspective, it seems easy to impose what a community needs— clean toilets, running water in faucets, medications for hypertension, etc. But when you actually live with the community, that’s when you really see what the community wants and needs. In Ubay, the family I lived with didn’t mind that they had to go to the church to use the toilet. Their main concerns were land ownership and sustainable livelihood. Thus, if an outsider were to simply come in and spend money on pipes and toilets, that couldn’t be an efficient use of budget. I learned how important it is to really integrate with the community so that you can best serve them.

All in all, this community immersion program gave me a new perspective on health. It gave me a concrete picture of the ideas that we learned in class. It has really been fun and enlightening.

– Robert Angelo P. Totanes For me, the most important insight that I gained through this elective is that experiencing something is very different from knowing something. In our classes, we are taught that our health care situation is in dire need of help, that our countrymen suffer from poverty, and that we are needed here in the Philippines. This immersion has taught me that all of these really are true, perhaps even understated in the media and unnoticed by the vast majority of Filipinos. Getting a glimpse of what ordinary people do just to be able to eat three times daily is very enlightening, especially when you try to trace the root of their problems. It is true that the health of the individual, the family, and the community is inseparable from their economic condition, ability to organize, and their environment. Understanding this is very valuable in my perspective as a future health care professional because it will enable me to treat their disease, adjust accordingly to their situations, and try to help them get to the root of their health problems. Experiencing what my future patients probably experience daily has made me more aware of the multi-factorial nature of health, and consequently the various approaches one can take to treat illnesses.

It is also apparent that in our healthcare system, if the local government unit does not prioritize health, then most probably it will cause not only poor health for its constituents but also overloading of secondary and tertiary facilities. This highlights the crucial role of effective and efficient governance— particularly local governance — in the struggle for providing health for all. Perhaps we could improve more on educating the public on how the system works in order to properly allocate accountability when things are not running as they should be.

Finally, it cannot be stressed enough how important the role of NGOs is, particularly those who focus on primary health care. Given our very imperfect system of health, it is organizations such as the VPHCS that fill the gap and provide help and training for those who are marginalized. It has been an awesome experience, and I look forward to sharing what I learned in this elective.

– Ferdinand Luis G.Suarez I chose this community medicine elective because I wanted to see whether I am amenable with practicing in the provinces. It was not a hospital setting but I was able to see for a little time the health condition of different towns and communities in Cebu and Bohol. So far, the whole elective program was awesome. Maybe the biggest obstacle was the language barrier. Although at the end of the rotation I was able to understand Bisaya.

I’m particularly impressed with the municipality of Loon. I think the LGU is doing a great job with its health programs. The mayor, a doctor, prioritizes health over other programs and can be seen in the RHUs.

The people’s organizations are doing a great job in their communities. They empower the people, they lead the people and they help the people. I think the government should recognize POs and help them build their organization.

Overall, I learned a lot from this rotation. I hope I can use this knowledge in the future.

– Patrick Sy I didn’t expect this summer elective to be this fulfilling and exciting. Considering this was my first real community experience ever. I didn’t only learn how to survive but I was also able to render happiness to my foster families and patients as well. I was able to experience a lot of Philippine customs from eating raw seafood to living the same life as our foster families for a couple of days. I really appreciate their most warm welcome.

There was even a time when we were treated as guests but nevertheless, we managed to integrate with them by assisting them with their household chores / every work (e.g. fishing and travelling through plains/ farmlands) and hearing out their struggles to own their land against greedy landlords. It was good that we were able to do a Tuli (circumcision) mission, some house to house consults and medical check-ups to enforce our medical skills although it would have been better if we had some basic medicines so that our patients would feel optimistic (taking into the fact that even if we prescribe medications, most of them don’t have the financial capability to complete their treatment regimen).

I really like how VPHCS handled the course of the itinerary. The tasks were arranged and planned well in the sense that we were always actively involved with the community (courtesy call to the Mayor, having small group discussions with the POs at specific barangays). The amount of tasks was also sufficient to achieve the objectives but not redundant enough to exhaust our energies. We would like to thank everyone in VPHCS who guided us through the course of the elective. They weren’t just our temporary teachers and translators but they also acted as foster parents who cared for us.

Overall, everything went well and if I were required to give a suggestion it would only be to experience integrating with foster families that have lesser in life (like what was shown in the documentaries) in the future so that it would be a whole new experience yet again.

– Arthur Z. Gallo As stated in the Alma Ata Declaration, HEALTH IS A RIGHT. It shouldn’t be treated as a luxury that only those who can afford may avail it. However, this is not always the case especially for those urban poor and rural communities. Health centers may be inaccessible or lacking in medicines, facilities or even doctors. Fortunately enough, there were communities that have formed their own organizations. These organizations are the means for these communities to exercise their right to health. This exemplifies that people participation is also important for the projects of the people’s organization to be successful.

It was also stated that the GOVERNMENT has the PRIMARY ROLE to promote health. During the course of the integration, I’ve come to observe how the government (LGU) affects the promotion of health among its constituents. The higher the priority for health is the more accessible and available health becomes to the people.

Lastly, one of the most important lessons I’ve learned in this elective, it is important to know the social determinants of health. The integration process has allowed us to understand the lives of the people in the community where I was assigned. It is not enough to treat only the biological aspect of illness but also look at the patient as a whole and in the context of the community where he/she belongs. The biological aspect of the illness may be only a symptom of the entire disease entity and thus, we may not be able to address why the patient became ill.

In conclusion, as a future medical practitioner, a full understanding of the patient’s illness is needed and empowering patients will be my contribution for health promotion.

– Raoul Felipe Community medicine has always been a field of medicine that attracted me. It is why once we were presented with a chance to do an elective in Cebu and Bohol, I immediately grabbed the chance! And now, as I look back on these past two weeks, I can say with conviction that it has been the most blessed two weeks of my medical education.

In Cebu, we visited three key locations: Barangay Pasil, Sitio Mary grace and Sitio Backmatimco. Pasil, a breakwater community was the dirtiest of all. It actually seemed like a barangay from Tondo or Pasay, as they both were river communities – thriving on what little the river had to offer. Mary grace was a different story. They were a forgotten community, forced to be in exile by another claiming landlord. Their community was small…but their sense of family and togetherness was so immense. They fought for their land and each other. Backmatimco, in my opinion was the most organized of them all. Their health center was clean and had educational posters and paraphernalia yet they lacked the most basic of medical equipment and medicine. From these three communities, I learned that in every community, no matter where, you need the spirit of family and belonging more than anything else. Everything begins with unity. When communities fight and stay together, that is the start of something big. Organization and structure without unity is a lost cause.

Bohol was another story. More than exposure, immersion was our key goal. The first community was Pangpang, Ubay. For me, the five days we spent in Ubay was BITIN. I could stay there for 2 weeks! We enjoyed our stay so much. In Pangpang we felt very welcome – our integration into their community took little effort because they made it easy for us. I welcomed the chance to fish everyday, as well as teach the community about health, and as a bonus we had the chance to circumcise! I felt very sad as we headed for Trinidad. There, it was entirely a different story. It was very hard for us to integrate in Trinidad because the family seemed to treat us as outsiders…plus we had no interpreter this time to help us out. Regardless, we still tried hard; farming, getting water, etc. and our immersion went well.

Those whole two weeks have taught me that there is a much bigger world outside the hospital…outside Manila. There are people who need much much more than medicine…the look for acceptance and belonging and recognition. As doctors, we need to be able to address their needs as people and not only medical needs.

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