Oh beautiful Philippines. Everybody’s dealt with different sets of cards. Like everyone and every country, it’s up to us to preserve the good things we have, and improve and gain the things we don’t.

Shortage of Doctors in the Philippines: Opinion, Limited Analysis

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This article is perfect if you’re familiar with the Philippine narrative. Otherwise, I present it open enough that you can understand and follow the article without any prior knowledge. You may find similarities with your respective countries and it might stimulate solutions to your own problems (national or otherwise).

Disclaimer: I’m not a medical professional. This is an opinion piece. This article has nothing to do with Coronavirus (if anything it’s an economic piece). Coronavirus or not, seek medical professionals for proper advice.

It all started when I saw this article: Gatchalian ‘alarmed’ over health workers shortage amid COVID-19 threat from a friend in Facebook.

The TLDR (Too long, didn't read) version:
- that guy's surprised with the lack of medical workers 
- his suggestion / solution was to give financial aid to underprivileged students so the population would have more doctors later on. 

I’m no medical expert but my opinion is that, that’s not the answer. Well it does answer part of the problem, but as I’ve said, just a part. Also it will not be sustainable and future-proof.

My persistent side on this is that talented/skilled workers leave the country (for very obvious, practical reasons: live a normal/better life). As I was researching more for the topic above, I’ve indirectly found a document that supports and legitimizes my opinion; turns out, it’s a fact. This is a document written DURING YEAR 2006 BY THE INTERNATIONAL LABOUR OFFICE IN GENEVA.

TLDR version:
- So much shit going on that people who want/can leave, leave.
- Of those who leave, they are more likely to be skilled.
- This "brain drain" is a recurring cultural pattern

Quick note: this is also a concern on any profession there.

To further laminate that, 2.3 million individuals [table 1.2] of the 105M population are OFWs. That’s just OFW. Migration is a different story. ~3% is more than enough to worry about lol.

Holy shit the world knew about it for the longest time already. Turns out it has been a fact even before I formed my own opinion and even before we even migrated.

I know some people get butt-hurt about it, please don’t. I do not intend to insult or make anyone feel bad about this. I’m merely presenting facts (or reputable documents that I have not vetted for personally, but I assume is written with integrity and that it is true). I am trying to surface the problem, show what can be done, and possibly arrive at solutions. I’m trying to help.

Moving forward and continuing with that article, if you financially assist students, that’s definitely great for the world! You’ll go to your respective heavens for that, but that doesn’t answer that national problems. They will be doctors and nurses yes, but a good noticeable number of them will probably leave. Where am I getting this? I’ve lived there. It’s a trend. It’s a thing they/we all do. We’re a living case of that lol. If you want a more formal document about it, read the Geneva link I provided above.

It’s a simple life psychology. It’s mostly evident in romance, love songs, and relationship:

“You should let me love you Let me be the one to give you everything you want and need”

Mario ; (Also, other countries wooing you for your skillset)

The government’s response

After a while, the government caught up and noticed the pattern. What did they do? Limit and flag people who want to leave the country lol. Okaay…so…two things: One, you’ve screwed over the people practicing their profession, planning to leave. Either they will become demotivated to excel in their field or they will entertain other job opportunities they did not formally study for. The other is that, let’s face it: people enter this field for noble goals (and those are commendable), but of course they’d want to have a good compensation and life too (it doesn’t have to be rich). These are totally fine, logical, and understandable.

So if you close the gates and then you combine it salary caps, who dafuq do you think’s gonna be happy? If you’ve removed all incentives in this sector, how can you expect people to study and specialize for this (excluding personal calling and interest)?

If someone can pull the stats of the number of medical students graduating + graduates who actually follow through and practice, that will dis/prove this statement.

Another Article: Someone else Trying to Solve the Challenge

UHC law to address doctor shortage in far-flung communities – JV

TLDR version:
-He proposes that med students/graduates should have a 3-year mandated "tour of duty", wherein you have to render 3 years being a doctor in far-flung, provincial places.

First I admire him (just strictly on this article, I don’t know this guy), and people like him. He’s trying, he’s serving, he’s doing his job. Noble people are still in the system. Great.

Unfortunately, it’s also not a full solution.
My opinion is that, ok, let’s say students stay, doctors graduate, the country gets quality professionals and the country can afford to send doctors all across the archipelago, great. Unfortunately, treatment and healthcare isn’t just about meeting a doctor. The doctor will need tools, equipment, facilities, to diagnose and treat you. Those are not cheap. Solving the doctor problem alone is an undertaking already.

A quick, direct solution is: “maybe you don’t need to send the doctor to different areas. Maybe it’s equally effective if you find a way to make it easier for patients to go to the doctor instead”. It’s a valid answer I think and definitely more doable. That’s what NEMT or EMT services are for. It costs, but it’s definitely more affordable than the former. I’m not sure if this is currently implemented (if not, why not), but the other challenge is the geography of Philippines, so much water to cross. These are usually land transpos.

One step further, assuming you those in front of you, when (it’s a matter of when) people start to have serious concerns, can/would they want treatment (e.g.: provincial areas do not have that much money). It becomes a societal problem.

My other concern is supported in this article: The 3-year service is short-lived (see Devolved Service). First, you have a fresh grad with limited experiences and being a doctor/nurse is difficult enough already but now you’re adding extra hurdles (limited equipments, remote areas, etc) right at the gates. That’s a rough start.

The other is that it indirectly causes the service to be a “practice run”. Now imagine if you’re a local in the far-flung areas and you realize you’re just a guinea pig 😐 We don’t even have to talk about migration. What the government does is that upon completion, they absorb and recall these now-experienced doctors to major cities. It makes sense.

It’s logical. It’s really good for the city/country as a whole. It’s just that…this guy originally said he wanted to help people in the far-flung areas lol.

Another Good Read: Probably a More In-Depth Analysis

Here’s another good article/analysis: Doctor shortage in the Philippines: An analysis

“So What Then is the Solution?”

Well to be honest it’s an unfair question because you’re expecting me to solve your own problems ;). Don’t worry, you shouldn’t be solving this yourselves too anyways. You should be banging at the doors of your elected officials.

But hey, you have a pull. There are things you can control. You can still affect change. I also offer some insights below:

I think there is no one solution; In a sense, there is no one problem and one solution. Let’s assume that what I raised is a valid concern: “More students are not the solution. On my experience, they will leave or pursue other incentivized professions. On the referenced articles above, it seems like that’s not the problem either (they cite problems of continuous service to citizens in remote regions for example).

Those said, the gov’t would have to make the country as a whole liveable and enticing even for its own citizens (you know it’s a problem when you’re having to sell your own land to your own people lol). What made some of the citizens lose trust in the first place? Some would mention failing systems and structures like healthcare, economic/financial parity, corruption, etc.

“Well sounds like a service/private problem” (less corruption)

Well yea, it circles back our points above: how can individuals be incentivized to excel if the government is not supporting them? The private sector can and will support them yes, but that’s not making society or the country better. It’s just pushing up that individual and the company (which is usually an international company). Privatization is not the answer to social problems. I’ve learned and accepted that when I was the biggest technocrat before.

“Ok, so it ties back to the government. Now what?”

Well we know corruption’s a thing there, let’s just all admit it and scoff at that loool. It could happen anywhereThe corruption is crippling all things that should be done, money that should be invested, and citizens that should be serviced.

I’ll tell you right now, that’s one of the biggest hurdles. If you solve this, you solve 50+% of the problem. Also, every year you’re bleeding out good soldiers so tick tock.

So how do you solve that? Vote. Vote wisely. Not just you, the entire population. You voting “correctly” doesn’t make a damn difference. You’d have to rally up your team to do the same (btw, you’re running on the fine line of collusion and propaganda here lol). Without having to use external forces for an individual, the best you can do as a society is to educate; that means bolstering your education sector…WHICH TA-DA also is heavily tied in with the government. I know there are lots of private educational institutions there, but come on, let’s be honest with ourselves: bottom line and reputation are what’s important there. Personally this is a social structure that should also not be in the hands of the private sector. Also, removing someone from office is one thing. Replacing them with a better, more educated individual is another. So now you see how important education is (if you haven’t already, omg..).

So anyways, I can go on and on with this and follow the trail. Mind you, that’s just ONE strand of thought. If you ask a medical professional, an educator, or anyone specializing in any field they probably will give you a different (probably better) insight on things.

It’s not just one problem to solve: all steps and levels I mentioned in that thought experiment will have to be attended to and improved. Concurrently, any systems and structures above individuals (e.g.: public government, shared cultural insights, national cohesion, private sector, etc) should also be checked.

So what can I personally do right here, right now?

Well again, collectively and individually you have a lot to do if you want things to kick in tomorrow (metaphorically). It is and can be overwhelming. But you know what, I do have a useful collective insight: be a good person at your core. Be a civilized, decent human being.

That involves (but not limited to): walking to the right of an elevator, driving on the right side know that all left lanes are for passing, not bullying others in school, keeping a critical-mind and healthily questioning information you process, “think we, not me”, not throwing your cigarette butts out your car window, NOT LITTERING, drive properly, knowing when to joke around and be serious, understand and respect nature, knowing how to have healthy and productive conversations, excelling in your work, showing up on time on professional/formal settings, respecting others (in all senses), wash your damn-fucking-hands, etc. I could go on and on.

It’s decency. It’s discipline. It’s all about the things that you were taught during grade school. Sadly some people either forgot or didn’t pay enough attention.

Why is this important? If you don’t have this covered, no amount of money, technological advancements, government/international intervention, etc can save you or anyone. This can also be directly attributed to the solution on corruption.

Being a good person will not answer any/all of the societal concerns above directly but it does lay the foundation that everyone requires so any social structures you build on top of it will stand strong. It’s a long journey but it needs to be done. It’s the right way. Enough of the patch work. Trust (in God, as some of you would prefer) that you’re doing the right thing. Further complex solutions will follow, if not there already.

The next challenge is to have your peers buy in to the whole idea whole-heartedly and genuinely, not pressured. In the same way social distancing was applied for the Coronavirus, you have to do the same thing. No point just saving yourself. No point in being the richest guy is a shoddy town. People outside your town can see through you and besides, you’re just now a beacon for theft and robbery.

Stay strong, keep up the good work. Keep calm and beach. Same teams.

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