The Doctor is Out >> The Doctor is Out

Revisiting DOH Doctors to the Barrios
by Dr. Paul Bisnar

Unsung heroes

           During the early period of World War II, embattled Gen. Douglas McArthur withdrew his weakening forces from Corregidor and Bataan and uttered the famous quote “I shall return!”. He left a small American and Filipino military resistance against the mighty invading Japanese Imperial Army. The small resistance forces heroically defended our country eventhough they knew it was a matter of time that they will be overwhelmed and crushed by the behemoth Japanese forces. True enough, after few months of bloody fighting they surrendered to the Japanese. Their surrender eventually led to “Death March” and thousands of heroic American and Filipino soldiers perished.

            My article is not about revisiting our Philippine war history, but I want to make an analogy about this novel piece of history and to our current medical crisis. While legions of Filipino doctors are leaving the country, there are remaining small resistance forces manning the frontline of our health system. These are the doctors to the barrios. They entrenched themselves in the far-flung 5^th and 6^th class municipalities guarding and protecting our poor rural countrymen against sickness and diseases. 

            Dr. Juan Flavier, the forever flamboyant former Secretary of Health and now a veteran senator, created Doctors to the Barrios Program (DTTB) on May 1993 with this main objective – to deploy competent and dedicated doctors to doctorless, hard to reach, and economically underdeveloped municipalities. Doctors to the Barrios will render 2 years of service and they have an option to continue if they opted to.  

         Since its conception up to 2003, it deployed a total of 337 doctors to these targeted areas and 26 % of these doctors remain and continue to serve our countrymen. According to DTTB website, of the original 271 municipalities identified, 198 of them were already served and most of them were served more than once due to exigency of service. 

            The Department of Health Centers for Health Development (CHD) is the agency responsible for implementation of DTTB program, recruitment, monitoring, supervision, and deployment of doctors in their respective areas with the coordination and participation of DOH-Central Office and Local Government Units. These doctors to the barrios assume the position as local health leader, rural health physician and municipal health officer. 

            The minimum requirement for interested applicant for entering this program are the following: a licensed Doctor of Medicine, Filipino citizen, physically and mentally fit, had a good moral character certified by his medical school, dedication to work in depressed far flung areas, interested in community health, and not more than 50 years old. 

            For them, to be a doctor to the barrio is somehow a personal achievement and fulfillment. Aside from fulfilling its noble intention, the salary is high compared to other government doctors. Their starting salary grade is 24 which translate to Php 20,000 plus a month exclusive of other incentives such as hazard pay and etc. A resident physician in Philippine General Hospital earns Php 15,800 a month while a junior military doctor only earns a measly Php 18,200 a month. However, these figures are now cliché considering the current dismal economic reality. 

             To be a doctor to the barrio is a sacrifice. It needs dedication and endurance considering the hardship it entails to be far away from their love ones. To survive and succeed, the doctor should be adaptable to the tradition, folklore and ways of life of the local community. He is expected to successfully manage and maintain a healthy community and not to mention the intricacies in dealing with local government bureaucrats, politicians and local government unit leaders. Most importantly, there is danger in losing his or her life especially in areas of armed conflict.

            Last July 5, 2003, despite the danger of insurgency in Samar, 7 doctors to the barrios agreed to work in towns described as rebel hotspots. They agree to work even their parents are apprehensive in letting them go. Four of them are assign to Northern Samar municipalities of Mapanas, Lope de Vega, Rosario and Silvino Lobos. The two serve the towns of San Jose de Buan and San Jorge. The other one serve in Maslog, Eastern Samar.

            The Philippine Center of Investigative Journalism (PCIJ) reported several months ago about the crucial role of doctors to the barrios in protecting their patients against the corruption of local government leaders. Despite of rampant corruption in rural municipalities, doctors are determined to secure medicines and medical supplies for their patients. However, there are cases they failed.

            According to PCIJ, up to 70 % of local health funds lost to corruption due to overpricing of medicines. Due to overpricing of medicines, only few and low quality medicines are left to their patients and most of the funds are pocketed by officials of LGUs. 

           A young doctor resigned from his post as rural health doctor in Mindanao after he refused to sign a deceptive and questionable delivery receipt of medicines bought by the mayor’s office. Eventually, his mayor humiliated him publicly. The principled doctor knew that medicine is 100 % overpriced. After that unpleasant fateful incident, the doctor left the municipality and swears never to practice community medicine again.   

              Despite these discouraging stories, there are private organizations sympathized and support doctors to the barrios. Last July 2002, tripartite partnership between Pfizer Foundation Philippines, Ateneo Graduate School of Business, and the Department of Health promoted “Leadership Health Program”. Doctors to the barrios are given a free chance to earn Master in Health Care Management degree. Pfizer Foundation provides the funds, Ateneo provides the training and DOH provides doctors to the barrios as students.

            Ateneo teaches the doctors about principles and concepts of health and development, health informatics and research, health care management, resource management, public sector and policy making, health technology, and other related topics.

            The good thing about this Leadership Health Program is it involves the local chief executives and community leaders. It provides capacity-enhancement workshops, learning activities, and basic knowledge and skills for strengthening and sustaining health care system to these local leaders. This program makes local chief executives realize the importance of partnership and role of doctors in promoting health to their respective communities. Since 2003, 19 mayors and 38 community leaders from depressed provinces of Western Samar, Biliran, Camarines Sur and Surigao del Norte, with populations averaging 10,000, benefited from this program.

            Senator Flavier is active in promoting DTTB. He even went to UP College of Medicine and encouraged the medical students to join the program. In 2001, he initiated Senate Committee on Health Awards for Community-Oriented Student Batch or Organization in enticing students to practice community medicine.

            Unfortunately, due to current medical crisis and massive exodus of doctors, DTTB already feels its effect. According to Dr. Ariel Pastor, a veteran from DTTB Batch 1999, there is a decreasing applicant to the program. 

            “Several years ago, there are numerous applicants to fill our DTTB batches, but since 2003, due to numerous doctors turning to nurses, applicant decreases,” he said.

            However, Dr. Pastor admits that despite the decrease number of applicants, they were still able to fill the current DTTB batch quota.      

            For the past 12 years, DTTB fulfilled its vision and missions. It provided doctors to the poorest far-flung municipalities and gave our sick countrymen a chance to see a doctor. Through the years, the program proved itself as one of the credible and important achievement of the Department of Health.

            I just hope that the siege of current medical crisis will not defeat this noble program. I hope that our heroic doctors to the barrios will not think the same way as our World War II soldiers think that it was a matter of time that they will be overwhelmed and crushed by a behemoth forces such as this current medical crisis.

             Remember, World War II lasted for few years and this medical crisis will surely last. I don’t know when but it will last. Let us continue the resistance until the crisis is over.

10/23/05 9:12:51 A
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