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‘Hindi pwedeng ganito’

Gusto ko sanang abutin ang maraming pamilyang namatayan dahil sa COVID o mga pasyenteng nagka-COVID na nakaranas ng palpak na responde mula sa sistemang pangkalusugan ng bansa. Hindi dapat sila nagdusa, hindi sana tayo nagluluksa kung naging episyente lamang ang tugon sa atin.

Ni Man Hernando

Walang nag-akala na ang kuha sa litrato na ito ang magiging isa sa huling masasayang sandali natin bilang pamilya. Sana nilubos na natin. Sana nayakap ka namin.

Ang problema lang naman natin sa kalusugan mo ay ang pagiging makakalimutin mo. Minsan bibigyan ka ni nanay ng listahan ng mga dapat bilhin o dapat gawin para siguradong pagbalik mo ay gawa mo ang lahat ng ipinagagawa sa ‘yo. Pero babalik kang nagkakamot ng ulo dahil isa o ilan lang sa mga nakalista ang nagawa o nabili mo dahil nakalimutan mo kung saan mo nailagay ang listahan. May mga biyahe kayo ni nanay na nakakarating ka na sa malayong lugar bago mapagtanto na naiwan mo siya sa bahay dahil humarurot ka na sa pagpapatakbo ng motor nang hindi mo pa siya nai-aangkas. Ang ikinakatakot lang namin noon ay magka-Alzheimer’s ka.

Ang teorya namin, kaakibat na iyon ng iyong pagtanda at iniindang sakit na diabetes at mahinang baga. Pero bukod sa problemang iyan, kaya naman nating i-manage ang blood sugar at baga mo. Dahil na rin sa pandemic, tiniyak nating paborable ang nutrisyon at kaayusan sa bahay para sa inyo ni nanay. Regular ang pagdi-disinfect lalo na sa kwarto niyo. No Smoking Area ang buong bahay. At natuwa ako nang todo nang makumbinse ko kayong lahat na at least maging vegetarian. At pinakamahalaga, nakakakuha kayo ni nanay ng maraming energy kay Aully, Armee at iba niyong apo para manatiling malakas.

Unti-unting binalot ng kakaibang atmospera ang bahay nang nagsimula kang ubuhin. Napag-alaman natin kasunod na may nakatagpo kang isang kaibigang kalauna’y nagpositibo sa COVID. Sinikap natin kaagad noon na mapa-swab at mapatignan kayo pareho ni nanay sa isang klinika. Pero lahat ng subukan natin, mapa-publiko o pribadong pasilidad na malapit sa atin, ay ‘di kayo tinatanggap dahil mahaba ang pila at hindi tumatanggap ng walk-in. Kaya sinikap na lang namin, lalo ni nanay, na alagaan at pagalingin ka sa bahay.

Pero iba na ang pakiramdam mo nitong Martes. Lumala ang pag-ubo at nahirapan ka nang huminga. Hindi na rin kinakaya ni nanay kaya’t kahit walang appointment, nangahas na tayo na dalhin ka sa Bernardino General Hospital sa QC. Bandang alas-otso ito ng umaga. Doon, naigiit natin na i-x-ray at ma-test ka ng rapid antigen test. Agad na lumabas ang resulta. Positibo ka sa COVID at may pneumonia. Pero walang paglapat ng lunas na ginawa sayo o pagbibigay-gabay man lamang sa kasama mo kung paano ka magagamot. Ni hindi itinuro kung ano ang gagawin o paano ba ikino-koordina sa ibang pasilidad ang pang-gagamot sayo. Pinauwi ka ng ospital pagtapos magbayad ng limang libo.

Pag-uwi sa bahay, bandang alas-diyes, lalo ka nang nanghina. Kaya, sa payo ng kaibigang doktor, kumontak kami sa One Hospital Command Center (OHCC) at hotline ng Caloocan City Health Office (CCHO) para masundo at madala ka sa isang COVID facility. Wala tayong napala. Ni hindi makapasok ang tawag namin sa hotline ng OHCC. Palaging busy o cannot be reached ang kabilang linya.

Nakailang-tawag rin kami sa CCHO, naitatala ang ating request pero lagi lang sinasabi na maghintay. Naghintay tayo maghapon, pero walang dumating na tulong. Mabuti na lang at napakiusapan natin ang isang kakilala sa Barangay Hall ng Barangay 176 para magamit ang ambulansiya nila. Dumating sila alas kwatro ng hapon at kinuha ka, kasama si nanay. Pero hindi nila alam ang gagawin. Hindi pala naka-koordina iyon sa barangay at hindi rin naka-koordina ang barangay sa ospital na pagdadalhan.

Pagdating sa QC General Hospital, doon niyo nakita ang aktwal na kalagayan ng pandemya sa bansa: mahabang pila sa ER; hindi sapat na pasilidad; at over-burdened na mga medical frontliner. Nang lumapit kayo para humingi ng tulong, agaran ang tugon nila na hindi nila kayo magagamot sa mga oras na iyon. Una ay sinisi pa nila kayo kung bakit hindi kayo naka-coordinate. Ano nga bang malay natin na hindi pala tayo ikinordina ng barangay, hindi ba? Sinabi natin na huwag naman tayong pabayaan dahil lang sa hindi sila kinausap ng barangay. Nang maggiit tayo na huwag nila kayong tanggihan, saka lang nila sinabi na dapat kang mabigyan ng oxygen pero wala silang available. Mahaba raw ang pila at kailangang maghintay.

Pero tuloy-tuloy kang nagpapakita ng panghihina. Lumalalim na lalo ang paghinga mo at hindi na humihinto ang pag-ubo. Sa yugtong iyon, may isang kaibigang nagmagandang-loob na kumontak sa East Avenue Medical Center (EAMC) at nang malamang tumatanggap ng pasyente doon ay nagpasya tayong lumipat. Nagpaalam tayo sa QC Gen. Humingi sana ng kung anong coordination o endorsement pero wala silang ibinigay.

East Avenue Medical Center (larawan mula sa Wikipedia)

Pagdating sa EAMC, bandang alas nuwebe, ganoon rin ang sitwasyon. Walang tigil ang pagdating ng pasyente. Hirap na hirap ang mga frontliner. Walang sapat na pasilidad.

Gaya sa QC Gen, sinabi ulit sa atin na hindi tayo matatanggap dahil hindi tayo na-coordinate. Napaisip na ako nito. Bakit ganoon? Yung coordination, yung One Hospital Command Center ng DOH, imbes na makapagpadali sa proseso ng panggagamot sa mga pasyente ay nagiging burukratikong sagka pa para hindi nila gamutin ang tulad mo.

Sabi ng kausap natin sa triage, Lung Center of the Philippines(LCP) lang daw ang tumatanggap ng hindi naka-coordinate na pasyente. Dahil malapit lang, dali-dali kaming nag-inquire sa LCP. Pagdating doon bandang alas diyes ng gabi, sinabi sa information tent na hindi rin nila masasabi kung magagamot ka nila. Nagmamakaawa na kami sa kausap namin. Pero wala raw silang magagawa. Punuan ang pasilidad kaya’t wala silang maipangako.

Mabuti na lang sa oras ding iyon, naawa na sa kalagayan mo ang mga staff ng ER sa EAMC. Sa wakas, pinayagan ka na nilang pumasok sa loob ng ER. Habang tulak-tulak ko ang wheelchair mo paakyat sa ER kinakausap kita. Sabi ko sa yo: “Tatay, ito na, magagamot ka na. May mga doktor nang titingin sayo. Kaya tibayan mo lang loob mo, pagtutulungan nating lahat ang pagpapagaling mo.”

Pagdating sa pintuan, tinanong ko kung kumusta ka. Sumagot ka,” OK lang.” May kasamang thumbs up pa. Iyon na pala ang huli nating pag-uusap.

Bago pa man nila tingnan ang kalagayan mo, pinagsulat nila ako ng waiver na nagsasabing walang magiging pananagutan ang ospital sa kung ano man ang mangyari sa’yo. Desperado na kami. Hindi ka makakapasok hangga’t ‘di ako sumasang-ayon. Kaya kahit mabigat sa loob, isinulat ko ang idinikta nila.

Inakala naming malulunasan ka na kaagad. Pero hindi pa rin pala.

Pagpasok sa iyo, natanaw ka namin sa malayo. Ipinwesto lang ang wheelchair mo sa isang gilid kasama ng hindi ko mabilang na kritikal na pasyente. Aligaga ang mga frontliner. Hirap na hirap sila sa sitwasyon. Kami, alam kong ikaw rin noon, umaasa ka na mapapansin at makakatanggap na ng oxygen. Pero wala raw available. Hindi nila masabi kung kailan ka mabibigyan. Anong gagawin namin? May waiver kaming pinirmahan.

Gumawa kami ng paraan. Nanawagan kami kung sino sa kakilala ang pwedeng magpahiram ng aparato para sa oxygen. Nakakuha tayo, ala-una ng madaling araw. Pero sa hindi namin maintindihang kadahilanan: hindi nila pinayagang magamit mo iyon.

Lumipas pa ang ilang oras bago ka unang makatikim ng hangin mula sa oxygen. Sabi ng (nurse na) bantay mo, nangingitim ka na noon. Sa pag-alala namin, kumilos kami para mailipat ka sa isang pasilidad kung saan ka matututukan. Lumapit kami sa lahat ng kaya naming lapitan. May tumugon na ilang kaibigan sa loob ng ospital. Dahil sa paggigiit natin sa ER at sa tulong nila, naiakyat ka sa ward, madaling araw ng Abril 1.

Pag-akyat doon, siguro dahil sa paga-alala mo kung nasaan ka at nasaan kami o marahil dala na rin ng pagdidiliryo dulot ng kakapusan ng oxygen sa katawan mo, naging agitated ka raw. May oxygen ka na ulit. Pero hindi na pala sasapat iyon.

Ilang oras lang, bumagsak sa 60% ang oxygen level sa katawan mo. Lubhang napakababa kaya dinesisyunan na nilang gamitan ka ng ventilator. Last resort na raw iyon. At mula sa puntong iyon ay wala na raw kasiguruhan ang susunod na mangyayari.

Kung anuman ang ibig sabihin noon, hindi namin lubos na gagap. Basta huling kita namin sa iyo malakas ka. Naga-alala, pero buo ang pag-asa namin noon na para iyon sa mabilis mong recovery.

Lumipas ang mga oras na intubated ka. Kahit ang (nurse na) bantay mo ay nagimbal sa mga nasasaksihan niya sa mga oras na iyon. Wala kang malay. May mga oras na may sobrang lalim at bagal ang paghinga mo. May panahong para kang nalulunod. Pero sa mas mahabang panahon, payapa ka. Kaya sabi namin, kaya mo ‘yan.

Google search. Batay sa mga medical articles na nabasa ko, naglalaro sa 30-40% ang global death rate ng mga ginamitan ng ventilator. Inisip ko, malakas ka eh. Siguradong pasok ka doon sa 60-70% na magsu-survive. Hawak namin ang pag-asa na iyon hanggang alas-onse y medya.

Sinagot ko ang tawag ng kapatid ko. Hinatid ng iyong (nurse na) bantay sa kaniya ang balita na wala ka na. Idineklara kang patay 11:10 pm. Sabi ng bantay mo, ilang minuto lang daw iyon pagkatapos mong marinig ang boses ni nanay sa cellphone na sinasabing hinihintay ka niya na gumaling agad. Na mahal na mahal ka niya. Pinipilit mo raw dumilat ng mga panahon na iyon. Gumalaw pa nga raw ang isa mong daliri. Pero pagkatapos noon ay naghabol ka na ng hininga hanggang sa malagot ito.

Si G. Joseph Rumbaua, ang namayapa at ama ng awtor.

Hindi na namin alam kung ano talaga ang pahiwatig mo noon. Pero naniniwala ako na yun yung panahon na lubhang tumaas ang kagustuhan mong bumangon at makauwi pero nasa rurok na rin ng dominasyon sa katawan mo ang COVID. Lumaban ka hanggang huling hininga. Sana naramdaman mong nakipaglaban rin kami. Sadya lang talagang napakalupit ng kalaban natin at pinalalakas siya ng palpak na sistemang pangkalusugan sa bansa.

Sa pagpanaw mo, tatay, lalo kong naunawaan kung bakit natin iginigiit ang episyente at komprehensibong sistemang pangkalusugan. Kung sana naging masinsin ang sistema ng contact tracing at quarantine, pwedeng hindi ka na-expose sa COVID. Kung may accessible at maagap na testing, laboratoryo, at check up sa iyo, higit sana kaming mulat sa paga-alaga sa iyo. Kung malakas, nadaragdagan at napangangalagaan ang mga medical frontliner natin, may nakakatugon sana kaagad sa mga pangangailangan ng mga tulad mo. Kung may sapat na pasilidad lamang sana, hindi mo kailangang pumila ng matagal para madugtungan ang iyong hininga. Kung may episyente sanang polisiya at koordinasyon ang DOH at buong gobyerno para tuluyang wakasan ang pandemyang ito, siguro kasama ka pa namin ngayon.

Pero ayaw kong dito tapusin ang istorya mo. Hindi pwedeng ganito. Para sa iyo at iba pang tatay at nanay, lolo, lola at kapamilya, ipatigil na natin ito. Gusto ko sanang abutin ang maraming pamilyang namatayan dahil sa COVID o mga pasyenteng nagka-COVID na nakaranas ng palpak na responde mula sa sistemang pangkalusugan ng bansa. Hindi dapat sila nagdusa, hindi sana tayo nagluluksa kung naging episyente lamang ang tugon sa atin. Maaari tayong manghingi ng indemnipikasyon dahil sa kapalpakan nila. Higit doon, maaari nating ipanawagang palitan sila at ang nakamamatay nilang sistema. #

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Si Man Hernando ay kasapi ng Migrante.

Proposed 2021 health budget shrinks, neglects public health–IBON 

by IBON Media & Communications

Research group IBON said that the lower budget for the public health in the proposed national government budget for 2021 will keep health care inaccessible and expensive for too many Filipinos. The pandemic highlighted the lack of capacity in the privatized health system. IBON however criticized the merely fleeting increase in health spending and the cuts next year in important health areas.

The Department of Health’s (DOH) budget is at least Php171.5 billion in 2020, consisting of the Php104.5 billion under the General Appropriations Act (GAA) 2020, Php49 billion under the Bayanihan 1 law, and at least Php18 billion under the recently passed Bayanihan 2 (RA 11494). IBON noted that the proposed Php131.7 billion DOH budget for 2021 is Php39.8 billion or 23.2% less than this.

IBON said this indicates a merely short-term response to the pandemic and an unchanged trajectory of health privatization including allowing the public health care system to whither away. In particular, health infrastructure spending and support for public hospitals are seeing large cuts next year.

The proposed 2021 budget for the Health Facilities Enhancement Program (HFEP) covering the building of health infrastructure and purchase of medical equipment is just Php4.8 billion. This is 62.9% less than this year’s Php12.9 billion budget composed of Php8.4 billion under the GAA 2020 and Php4.5 billion under Bayanihan 2. 

The HFEP budget has actually been falling steeply under the Duterte administration in the regular GAAs even before the pandemic, IBON pointed out. It was Php30.3 billion in 2018, Php15.9 billion in 2019, then Php8.4 billion in 2020. The group also noted that the government’s Php1.1 trillion infrastructure program for 2021 only allots Php2.3 billion or one-fifth of one percent (0.2%) to the DOH, which is also a 36.7% cut from the GAA 2020. 

Health privatization-driven budget cuts for public health facilities like this have already caused public hospitals numbering 730 in 2010 to fall to just 433 in 2018.

The proposed 2021 budget for health workers and supporting the operation of DOH hospitals also falls by Php1.7 billion or a 2.6% cut, from Php64.3 billion in 2020 to Php62.6 billion next year. This is because the Php12.6 billion increase in Human Resource for Health (HRH) and DOH hospital budgets in the GAA 2021 from GAA 2020 is off-set by the discontinuing of Php13.5 billion in fleeting support under Bayanihan 2.

The government has played up how the 2021 budget for Human Resources for Health (HRH) Deployment increases to Php16.6 billion from Php10 billion in 2020 to hire 26,035 health workers. This seems urgent because the government doctor-to-population and government nurse-to-population ratios have been worsening under the Duterte administration, between 2016 and 2018 – from 1:32,644 to 1:33,909 doctors and from 1:17,269 to 1:17,769 nurses.

However, the health sector group Alliance of Health Workers (AHW) has pointed out how this increase is only temporary and does not indicate a sustained increase in health workers for the public health system. They highlight that 14,553 DOH plantilla positions will still remain vacant in 2021 with public hospitals still understaffed and government health personnel still overworked over the long-term.

AHW also points out that 23 of 66 DOH hospitals, which many of the poor depend on, will see their maintenance and other operating expenses (MOOE) budgets cut by Php4 million to as much as Php209 million. IBON meanwhile noted how the budget of two COVID-19 referral government owned- and -controlled (GOCC) hospitals will also be cut next year. The Lung Center of the Philippines sees a 2.9% budget cut to just Php405 million in 2021, and the Philippine Children’s Medical Center (PCMC) a 13% cut to just Php1 billion.

The budget of the Epidemiology and Surveillance program that is crucial in controlling the spread of diseases through timely data and research has already been cut by over 50% from Php263 million in 2019 to Php116 million in 2020. Yet despite its obvious importance in dealing with pandemics, IBON said, government proposes to reduce it further to Php113 million in 2021.

The budgets for the National Reference Laboratories (NRL) and Health Information Technology (HIT), which are vital in detecting, testing, databasing and reporting coronavirus cases and other emerging diseases, are also slashed.  The proposed allocations for NRL and HIT decrease from Php326 million to Php289 million, and Php1.2 billion to Php97 million, respectively.

The second biggest chunk of the proposed 2021 health budget, or Php71.4 billion, still goes to the Philippine Health Insurance System or PhilHealth. While noting recent corruption controversies in the agency, IBON pointed out that it is difficult to reconcile the unchanged budget with increasing health expenses of Filipinos. At the same time the group stressed that government resources are better spent on expanding and improving the public health system rather than subsidizing private health sector profits.

IBON said that the Duterte administration should increase funding for health infrastructure, personnel, and operations. Filipinos right to health and affordable health care cannot be realized if, as is happening today, more and more of the country’s health system is being turned over to the profit-driven private sector. The group stressed that this will always result in health care that is too expensive and health capacity that, as the pandemic has shown, is insufficient for public health emergencies. #

‘We are all victims of the gross neglect of the DOH and Duterte administration’

“We are saddened and angered by what happened to our dear colleague and other health workers who died fighting COVID-19. We are all victims of the gross neglect of the DOH and Duterte administration. This administration does not value health workers because even in (Duterte’s) 5th State of the Nation Address, he still did not lay down comprehensive, systematic and scientific measures on how to defeat the virus.” Cristy Donguines, President, Jose Reyes Memorial Medical Center Employees Union-Alliance of Health Workers

Health workers decry loss of fellow front liner

By Joseph Cuevas

Members of the Jose Reyes Memorial Medical Center (JRMMC) Employees Union-Alliance of Health Workers held a protest rally last August 3 to denounce the death of their fellow health worker who died of Covid-19 they said was due to gross negligence of the hospital management, the Department of Health (DOH) and the Rodrigo Duterte government.

Judyn Bonn Suerte, a JRRMC employee and active union member succumbed last July 31 to Covid 19. He was among the 20 health workers of the hospital infected last month.

In a statement, Cristy Donguines, President of JRMMC Employees Union said that Suerte’s life would have been saved if it had been immediately treated by JRMMC and not brought to Dr. Jose N. Rodriguez Memorial Hospital where he died. 

“It is painful to think but it is clear to us that this is a major negligence of the hospital management and the DOH itself due to their anti-health workers protocols,” Donguines said.

She added that the management blindly implemented the DOH’s defective protocol that led to the death of a health worker of the said hospital.

DOH has instructed all medical center chiefs and hospital directors that all employees admitted to their respective hospital with severe COVID-19 cases should be transferred to any designated exclusive COVID-19 referral hospitals.

The union revealed that the JRMMC has no free re-swabbing test for its health workers after undergoing quarantine protocols.

“It should be one of the protocols to be implemented by the hospital to ensure that they are really fit to work. Worst, in order to make sure that they are really fit to work, they need to pay for re-swabbing test outside of the hospital that costs P5,500.00 for drive-thru and P4,300 for walk-in tests,” it said.

Colleagues mourn the death of Judyn Bonn, an employee of the Jose Reyes Memorial Medical Center who recently died due to COVID-19. (Contributed photo)

‘Generals infesting health response

Meanwhile, more doctors and other health care workers agreed with 40 medical associations who earlier asked the Duterte government to again implement an enhanced community quarantine period in Metro Manila.

A statement signed by almost 200 doctors and health care professionals and issued on Second Opinion Facebook page reiterated that the quarantine was a public health measure aimed at saving lives by stopping the spread of disease.

It also rejected the government’s “military type quarantine” it said is oppressive and devoid of scientific sense and health purpose.

The signatories prescribed the immediate removal of DOH Secretary Francisco Duque and all generals and czars “infesting” the Inter-Agency Task Force (IATF) and replace them with team players from health and related fields.

In addition, the petitioners asked:

* active and aggressive recruitment of health workers;  

* immediate provision of substantial funding and financial support for both national and local government interventions; 

* continuity of care from the primary to the tertiary levels, and between public and private health facilities;

* enhancing capacities in testing, tracing, isolation, and treatment at the institutional and community level, and utilizing appropriate technologies in the promotion of preventive; and

* public health measures and immediate improvement of COVID-19 data processing and management.

President Duterte has placed Metro Manila and provinces of Bulacan, Rizal, Laguna and under Modified Enhanced Community Quarantine starting today. tomorrow, August 4 as recommendation of IATF to President Duterte.

According to DOH, as of August 3, Covid-19 cases has risen to 103,185, including 5,032 new cases while there had been 4,823, infected health workers and 38 deaths. #

Filipinos deserve more than the minimum under MECQ – doctor

By Sanafe Marcelo

A community medicine expert warned that so-called minimum health standards the government is implementing under the new modified enhanced community quarantine (MECQ) strategy will not solve the spread of the coronavirus pandemic in the Philippines.

University of the Philippines College of Medicine professor Gene Nisperos told an online forum the government seemingly wants the people to accept so-called minimum standards and capacities as the best that can be offered to combat the virus.

“Filipinos deserve more in terms of health, and given our problems during this time of COVID-19, it’s hard to say that this is the minimum standard and when we reach this, we are good,” Nisperos said.

In an online forum by Second Opinion (An Alternative Voice on COVID-19 and Health PH), Nisperos was reacting to the government’s decision to place the majority of the country under MECQ after placing the entire Luzon Island and some other parts of the country under lockdown for two months without mass testing.

Department of Health report as of May 17, 2020.

In its Administrative Order No. 2020-0016, Nisperos said the Department of Health ordered the development of “minimum public health standards” on detecting, isolating and treating coronavirus cases as the main strategy for the country’s Minimum Health System Capacity Standards for COVID-19 Preparedness and Response.

The medical doctor however said the government’s so-called minimum is inadequate as the guideline targets one ambulance per province for medical transport.

“What if there are 10 cases in a province? How will this be enough? This is injustice,” Nisperos said.

“We must insist that we should not only be given what is minimum [in fighting COVID]. Thus, we must demand that not just the minimum that they [government] can provide, but what is right and just based on how we value life and health of every Filipino,” Nisperos added. #