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Hospital of Our Hope, System of Our Despair

by Gene Nisperos, MD

The Philippine General Hospital is the face of our perpetually neglected public healthcare system. As the biggest tertiary training hospital in the country, it provides specialized and very specialized services and training. It is also the end referral hospital of other public hospitals. Pero ito din ang Ospital ng Bayan na sadyang pinabayaan.

The ever-increasing number of patients in PGH reflects the country’s worsening social conditions. The poor’s limited access to basic services, aggravated by their absent economic power and the prohibitive costs of healthcare, all lead them to this single health institution.

Thus, we need to take a close, hard look at the state of PGH and its patients.

A casual stroll from the PGH Out-Patient Department (OPD) to the wards can break your heart.

Patients. Families. All are trying their best to get a measure of the health services they need, never mind deserve. Some are eating their baon along the sidewalk. Others are desperately trying to make their patients more comfortable under the sweltering heat and crowd. Many have been waiting in line since 3-4am just to get in.

A walk through the Emergency Room (ER) can break your spirit.

Everywhere, quietly, patients find small consolation in cold metal beds, in stretchers, in wheelchairs, or even in monobloc chairs. They fill up any unpeopled space that they can find and comfort is a luxury that they will readily forego if only to get seen and treated.

And all of them want to be seen, need to be seen. Many have travelled long distances hoping to be treated for their various infirmities. But the hospital is always shorthanded. The 4000-strong health personnel are almost always never enough for the deluge of patients that come daily.

The ER, currently under renovation, only has a 25-bed capacity. But its daily census is easily north of 150. In the last three years, PGH’s patient census has steadily increased from 586,000 to 647,000 per year.

There are patients who should be in the intensive care unit (ICU) but are still in the wards. There are patients who should be in the wards but are still in the ER. There are patients in “ectopic beds”, or beds in departments other than that where the patient should be confined in.

There is just not enough beds or space. There is just not enough health personnel.

Yes, even the best that PGH can provide remains too little. And everyone can do with much more.

Yet in spite of these, for 2020, Congress deemed it fit to cut the PGH budget rather than increase it. Apparently, for our honourable legislators, the less than P3 billion per year allocation is enough and there are more pressing matters to fund, like the P100 million pork barrel they will each get.

To provide its patients with the barest minimum, PGH needs about P5 billion per year. So why give the hospital much less than what it needs to operate?

Limited funds nga daw kasi.

Currently, around two-thirds of PGH’s budget goes to pay for its personnel, whose numbers cannot match those of the patients, even with medical and health sciences students taking up the cudgels.

Because of insufficient budget, the hospital cannot hire the additional health human resources it needs. It cannot even regularize the contractual employees it has. Worse, it is looking to further subcontract the work being done by institutional/utility workers, the “manongs” who brings patients around the hospital for their labs, x-rays, and what not.

About 25% of PGH’s budget goes to its operations, which directly benefit its patients. Even then, supplies and meds are often lacking so patients need to buy these outside.

Some laboratory exams are unavailable so these have to be done outside as well. Basic equipment, like respirators, have also been subcontracted to private firms and their use have to be paid for by patients.

All of these amount to out-of-pocket expenses that are catastrophic for an already impoverished patient.

To be fair, the PGH Administration exerts effort to augment the hospital’s funds. Donations from private individuals and/or corporations help stretch the meager resources. But at the end of the day, patients and health personnel alike, including students, shell out money to cover for what the hospital lacks.

Either that or they become mute witnesses to the consequences of unmet health needs: morbidity if not death.

PGH supporters calling for a higher budget for the country’s most important teaching hospital.

When government refuses to give enough funds, everyone suffers. Because in PGH, the need will always be much greater than what can be given. Sadly, this is being done to almost all public hospitals: they get less than half of the budget they need but are expected to operate fully, with VERY LITTLE support.

When health officials grow tired of asking enough to provide for what patients deserve, what is given is not even enough to provide for what patients need. When health officials console themselves by asking just enough to provide for what patients need, what is given is barely enough, so that patients expect even less.

This is government policy and it must be changed. THIS is the rotten system that refuses to see healthcare as a public good.

It is therefore right and fair to demand for a bigger budget for health and for PGH.

Every year, PGH should get P10 billion to give its patients the care THEY DESERVE. The hospital should not have to rely on the kind heart of philanthropists or on corporate social responsibility just to keep itself financially afloat. The hospital should NOT EXACT any more from the pockets of its patients and its staff.

The amount also enables PGH to hire and regularize enough hospital personnel to meet the ever-increasing demands of healthcare. The money affords the hospital enough to provide essential supplies and medicine, and ensures that the laboratory and diagnostic equipment are working.

If PGH is given the budget that it deserves, then it can fulfill its most important role: enable the poor and destitute to exercise, and maybe even experience, their right to health. #

KODAO KLASIK: Diagnosing Poverty, Building Community

In the 1990s, young medical doctors Julie Caguiat and Gene Nisperos spent the first years of their practice helping poor peasants and indigenous peoples in the hinterlands of Bukidnon Province. Here is a video of their work, produced by Kodao for the Belgian humanitarian organization Intal.

Even then, Doctors Caguiat and Nisperos were threatened by the military for their advocacy and humanitarian work. Last Monday and Tuesday, Caguiat and Nisperos became victims of death threats anew for their continuing advocacy on community medicine and higher health budget.

Kodao is reposting this video to show who the perpetrators are threatening with death.

Doctor, family receive death threats

An activist doctor and professor received death threats against himself and his family mere hours after joining a rally demanding a bigger 2020 budget for the Philippine General Hospital (PGH).

Dr. Gene Nisperos, president of the All UP Academic Employees Union-Manila Chapter (AUPAEU-Manila), received a text message Monday night, October 21, saying he and his family would be killed soon.

The death threat received by Nisperos Monday night. It was redacted to hide the condominium’s address and the date when the perpetrators said they will carry out the attack.

“I know where your condominium is. We will get your family one by one…You are dead by…including your children and wife,” the message in part said.

The message was sent by an unidentified person through mobile phone number +639567955995.

Nisperos told Kodao he blames the climate of violence created by the Rodrigo Duterte government against those who seek substantial reforms and genuine change in Philippine society for the latest threats against him and his wife, also a doctor.

“The climate under the Duterte government has fostered the kind of violence inflicted on those who stand for what is just and right. Sa panahon ngayon, ang gumawa ng kabutihan at manindigan sa tama ang siyang tinutugis. Naghahasik na takot dahil sa takot dinadaan ang pamumuno. Dapat ito labanan. Sa lahat ng anyo. Sa lahat ng pagkakataon,” Nisperos said. (In these times, those who do good and stand for what is right are persecuted. It is sowing fear because it rules by fear. This must be opposed in whatever form and whenever it occurs.)

The threat received by Nisperos Tuesday morning.

As he was being interviewed by Kodao online, Nisperos received another threat from the same number Tuesday morning.

He however clarified that it was not him who issued the challenge to government officials to line up at government hospitals.

“It was at a different press conference by other doctors who challenged (Department of Health secretary Francisco) Duque and other government officials to line up at government hospitals. I was not even there,” Nisperos clarified.

Nisperos spoke at a rally at the PGH lobby last Monday, demanding a P10 billion budget for the country’s premiere government hospital.

A graduate of UP College of Medicine’s prestigious Intarmed program, Nisperos and wife, Dr. Julie Caguiat, served as community doctors in Mindanao before returning to Metro Manila to advocate for community-based health programs on the national level.

Nisperos is a professor at their alma mater.

Duterte government as suspects

The AUPAEU-Manila condemned the most recent death threats against Nisperos and family.

“Following months of profiling, red-tagging, vilification, threats, and harassment of members in other AUPAEU chapters, the Union sees this as a continuation of the attacks to activists, teachers, and unionists perpetuated by State security forces under the administration of President Rodrigo Duterte,” the group said.

“This threat comes at a time when the AUPAEU-Manila is calling on all faculty, administrative staff, and REPS of the university to unite against the impending budget cut for the University of the Philippines, particularly on the UP Manila and Philippine General Hospital (PGH), regularization of contractual workers, among others,” it added.

The union said the threats are attempts to sow fear among teachers and unionists who assert for their rights and to fight for a higher state subsidy for social services such as education and health.

“[O]ur Union will not tremble in the face of vicious repressive measures and increasingly fascist attacks by this administration,” AUPAEU-Manila said. # (Raymund B. Villanueva)

Health Workers storm Malacañang over budget cuts and lack of salary increases

Nag-protesta ang mga manggagawang pangkalusugan, nurse at doktor sa Mendiola sa Maynila para tutulan ang malaking budget cut at manawagan ng dagdag sahod noong Oktubre 15. Binatikos nila ang P10 bilyon na budget cut sa sektor para sa 2020.

Ayon sa Alliance of Health Workers, tuluyan nang tinalikuran ng gobyerno ang obligasyon nito na bigyan ng maayos at abot-kayang serbisyong medikal ang taumbayan. Taun-taon ay binabawasan ang budget sa mga serbisyo habang pinalalaki ang budget sa pambansang depensa at pork barrel ng mga kongresista.

Nanawagan din sila na taasan ang sahod ng mga manggagawang pangkalusugan sa P16,000 sa minimum kada buwan, P30,000 para sa mga nurse at P80,000 para sa mga doktor. (Background music: News background / Bidyo ni Joseph Cuevas-Kodao)

Tanggal benepisyo, binatikos ng mga empleyado ng NKTI

Isang protesta sa harapan ng ospital ang ikinasa ng mga empleyado ng National Kidney and Transplant Institute (NKTIEA)-Alliance of Health Workers bilang tugon sa ginawang pagtanggal sa kanilang mga benepisyo simula noong Setyembre 13.

Ayon sa NKTIEA, inalis ng management ang rice and groceries subsidy na dekada na nilang natatamasa. Gayundin ay binawasan ang Philhealth Sharing Benefit mula P30,000 noong 2018 ay ginawa na lamang itong P12,000 ngayong taon. Naniniwala sila na ang pagtatanggal at pagbawas ng mga benepisyo ay pag-atake sa kanilang kabuhayan bilang mga manggagawang pangkalusugan.

Dagdag nila, napakalaki ang kinikita ng ospital dahil ito ay halos pribadisado na samantalang kakarampot naman ang kanilang sahod kumpara sa pagtaas ng mga presyo ng bilihin at serbisyo. (Music: News Background Bidyo ni: Joseph Cuevas/ Kodao)

Health Workers commemorate national health day

Public health workers trooped to the Department of Health headquarters in downtown Manila May 7 to commemorate National Health Workers’ Day with a protest rally.

Calling for free health service for the people and increased salaries, the workers slammed the Rodrigo Duterte regime for implementing contractualization in the health sector.

Health workers protest vs TRAIN law

The Alliance of Health Workers held a protest action in front of the National Kidney and Transplant Institute last April 26 to protest the Tax Reform for Acceleration and Inclusion (TRAIN) law.

The protesters revealed that the so-called tax reform law has increased health care expenses for Filipinos and must be scrapped as anti-health and anti-people.

They also demanded a higher budget for health services.

Health workers prescribe pursuance of peace talks for better health service

Members of the Alliance of Health Workers held a rally in front of the Philippine Heart Center last Friday to express support for the fourth round of formal peace negotiations between the Government of the Republic of the Philippines (GRP) and the National Democratic Front of the Philippines (NDFP).

The group said a comprehensive agreement on socio-economic reforms would ensure better health service for the Filipinos.

They also called on both the GRP and the NDFP to increase the salaries and benefits of health workers.

The rally was supported by the Bagong Alyansang Makabayan. Read more

Health workers vow to block Fabella’s closure

Health workers and urban poor residents protested at the gates of the Dr Jose Fabella Memorial Hospital in downtown Manila today to denounce its impending closure by the Benigno Aquino government on June 9.

Alliance of Health Workers (AHW) members said that as many as 2,000 patients per day, including hundreds of mostly poor birthing mothers, will lose free medical services offered by the 700-bed hospital when it closes. Read more

Health workers decry low wages, privatization of public hospitals under Aquino

Rank and file public health workers protested in front of the National Kidney and Transplant Institute last March 23 to condemn the Benigno Aquino government for its “anti-poor” policies in the health sector.

Members of the Alliance of Health Workers (AHW) said Aquino’s Salary Standardization program only aims to keep ordinary health workers poor through a measly and staggered wage increase.

They also condemned the “unabated” privatization of public hospitals and the services these institutions offer to the poor.

They said President Aquino has betrayed the interests of poor patients by worsening the state of health institutions in his more than five years in office.

AHW is pressing for a monthly national minimum wage of PhP16,000 for Salary Grade 1 workers and substantial budget increase for public health.