Sunday, July 30, 2006

TB Spreads Because of Poverty: Health Services Becoming More Inaccessible

Commercialization of health services, the lack in budget, facilities, and personnel of government hospitals, and poverty combine to make health services more inaccessible. This explains the spread of diseases such as tuberculosis (TB) even as the cure for it has been discovered as early as 1952 and has been available locally since the 70s.


The former livelihood center is jam-packed with children running barefoot around a wet, mud-spattered floor while male adults play billiards in one corner. Some of the women do the laundry while others gather in front of a sari-sari (small consumer store) store for a small talk. Inside this center are around 50 houses made of bamboo and nylon sacks. The two-by-four square meter dwellings inside the evacuation center serve as temporary housing for more than 100 families whose houses were burned in December last year.

Outside the evacuation center, children – some naked, some clothed – play around dark muck. Some women peel garlic, teenage boys collect plastic bottles and steel scraps; young men repair furniture or tinker with vehicles while the rest of the neighborhood play card games in a wake.

This is Barangay (village) 105 Happy Land, a community in Tondo, Manila with a total population of 3,496. A survey conducted by the Canossa Health and Social Center (CHSC) in 2004 shows that 67.8 percent of the residents here peel garlic for a living. The same survey shows 99 percent of the community’s population earn less than the minimum wage of P350 ($6.78 at an exchange rate of $1=P51.56).

In the same survey, 55.1 percent were diagnosed to have upper respiratory tract infections, 15 percent had diarrhea while eight percent had skin diseases. The rest of the 21.9 percent had fever at the time of the survey.

An index of poverty

Marilyn Miane, 26, her husband Melchor, 27, and children Melvin, 3, and Marichu, 2, live in the evacuation center in Happy Land.

While Marilyn takes care of the kids and does household chores, Melchor drives a pedicab from 7 p.m. to 6 a.m. He gives P60 ($1.16) of his earnings to the pedicab’s owner and takes home around P50 ($0.97) to P80 ($1.55) a day for their family’s needs.

In February this year, Marilyn was diagnosed by the CHSC to have tuberculosis (TB). In an interview, Marilyn said she had cough and colds three weeks before she decided to have herself checked up.

Since the CHSC promotes an anti-TB program, the rest of Marilyn’s family underwent TB diagnostic tests. Results showed Marilyn’s two children had also acquired primary complex or pediatric tuberculosis. The three are now under the CHSC program receiving free medication everyday for six months (the allotted period for TB medication).

Edna Masangya, CHSC TB Program Senior Coordinator, said the local government unit provides medicines for adults while the center’s German benefactors provide those for children. The center also has a feeding program for its patients.

However, Masangya said TB treatment does not depend on medicines alone. “Patients need proper nutrition and good environment,” she said.

TB, an airborne disease, is usually transmitted to family members just like what happened to Marilyn and her children. “Ang mga pasyente namin pami-pamilya, hawa-hawa sila,” (We have whole families as patients as they tend to contaminate each other.) Masangya said the spread of TB within and among families is mainly due to congested houses and poor diet.

TB is known as a sensitive index of a nation’s poverty. In 2003, the World Health Organization (WHO) named the Philippines as having the highest rate of TB occurrence in the Western Pacific with 36 percent of 82 million Filipinos infected. The same report says 75 Filipinos die of TB daily while 100,000 contract the disease yearly.

This is despite the fact that the cure for TB was discovered as early as 1952 and has been available in the Philippines since the early 1970s.

Inaccessible services

Masangya said the budget for one TB patient is a minimum of P6,000 ($116.37) for six months using generic drugs. She said most if not all of their patients in CHSC have gone through self-medication before going to the center for proper diagnosis.

“Karinawan ay umiinom sila ng gamot na bigay lang ng kapitbahay kasi hindi naubos. Madalas tuloy mali o hindi sapat ang gamot na iniinum nila,” (They usually take medicines which have been given to them by their neighbors. Oftentimes they have either been taking the wrong medicine or have been taking insufficient dosages.) she said.

Dra. Geneve Rivera, the lone resident doctor of the CHSC, said in an interview that most if not all her patients reach the center “kung malala na.” (when they are in a worse state)

This, she said, is a common practice nationwide due to the inaccessibility of health services. “Pag tinatanung ko yung pasyente kung bakit ngayon lang sila nagpa-check-up, ang sagot nila ay kasi wala silang pambayad sa doctor,” (Whenever I ask patients why it took them time before having a check-up, their usual response is that they do not have money to pay a doctor.) she said.

The inaccessibility can be due to, first, the commercialization of health services.

She said the consultation fee of private clinics ranges from P150 ($2.91) to P350 ($6.79) per visit. This does not include expenses for medicines and laboratory fees.

Even public hospitals such as the Jose Reyes Medical Hospital in Manila asks for P50 ($0.97) as consultation fee for out-patients, Rivera said.

Although the CHSC offers free consultation, not all patients can be accommodated by one center alone, Rivera added.

Lack of budget

Hospital and laboratory fees are unaffordable to patients even in cases of emergency or severe illnesses.

Emma Manuel, radiological technologist of the Tondo Medical Center (TMC) and chairperson of the Alliance of Health Workers (AHW), said public hospitals are now expected to augment their budget.

For 2006, the national government only allocated P10.4 billion ($201,706,749) for health services or 25 centavos ($0.0048) per Filipino. TMC, a tertiary hospital, was given a P124 million ($2,404,965) budget for 2006 where P24 million ($465,477) goes to maintenance, operating, and other expenses (MOOE) while P100 million ($1,939,487) goes to personnel services.

Manuel said the budget for MOOE is not even enough to pay for water and electricity for one year. Their water and electricity bills amount to a maximum of P25 million ($484,877) a year.
This is why public hospitals are forced to charge laboratory and other fees, Manuel said.

Manuel said in the late 1970s, they only ask for a P5 ($0.09) donation for x-ray. Today, the lowest fee for chest x-ray (the most common due to the prevalence of TB) is P120 ($2.33) for adults and P240 ($4.65) for children.

Furthermore, Manuel said patients in the Emergency Room are made to buy practically everything. (see table)

Fees of Materials to be Bought by Patients of the TMC Emergency Room

Plaster - P5.75/ruler
Cotton - P.25/ball
Gauze - P7/pack
Dextrose - P61/1000ml bottle
Gloves - P5/piece
Oxygen - P473/tank

Rivera said inaccessibility can also be due to the urbanization of health services. This means a high percentage of health institutions are concentrated in Metro Manila and other urban centers in the country like Baguio in Northern Luzon, Cebu and Davao in Central and Southern Philippines, respectively.

Far-flung provinces, meanwhile, depend on provincial or regional hospitals that lack facilities and health personnel, she added. (link to Aubrey’s article on health devolution)

The greatest manifestation of the inaccessibility of health services, Rivera said, is the health seeking behavior of patients.

“Kanino ba pumupunta ang mga tao pag may nararamdaman sila? Di ba sa mga albularyo o hilot o yung tinatawag na traditional health workers?” (Where do people go if they are sick? They usually go to quack doctors or traditional health workers.) she said.

She said this practice is prevalent even in urban centers.

Working with limited resources

Dr. Gerry Ymson, Assistant Municipal Health Officer of the Manila Health Department (MHD), said in an interview that the Department of Health (DoH) has no definite commitment to local government units with regards the health budget.

“Hindi namin inaasahan ang budget na manggagaling sa DoH kasi if we do we will fail with our programs,” (We do not rely on the DoH for our budget otherwise our programs will fail.) he said.
Although the devolution of health services started in the early 1990s, the Manila City government has been working with its own budget since 1940, Ymson said. This was the same time the MHD was established.

The MHD has programs on TB and other communicable diseases, leprosy, venereal disease, childhood illnesses and dengue. The budget that comes from the DoH is given to the MHD in the form of medicines, Ymson added.

The MHD also boasts of a feeding program for children under five years old who are enrolled in day care centers.

Ymson also said that since TB ranks fourth among the 10 leading illnesses in the city, one of its thrust programs is towards containing TB. A big chunk of medicines for TB comes from the DoH.

Despite this, in March this year, 33-year old Arlene Hernandez has again been diagnosed with tuberculosis. She was first diagnosed with the same disease in 2001. Today, she is already considered a Category II patient which means she has to undergo re-treatment for eight months.

But Arlene’s misery has tripled today. Her two children, John, 5, and Jerryson, 11 months, have also been diagnosed with primary complex.

Arlene’s husband, Julioto, 36, is, at present, jobless.

They also live in one of those two-by-four square meter dwellings in a community they call Happy Land.

© 2006 Bulatlat ■ Alipato Media Center

Permission is granted to reprint or redistribute this article, provided its author/s and Bulatlat are properly credited and notified.

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