By Jessa Mae B. Rosete, MD with Larielyn Hope C. Aggabao, MD; Thea T. Hilomen, MD; Joan Rose G. Lampac, MD; and Micah L. Masbad, MD (ΜΣΦ 2017)
Entering the domain of the University of the Philippines College of Medicine (UPCM) implies a desire for rendering service to others, which is why one of the four pillars of the Mu Sigma Phi Sorority is that of Service. Service comes in many different forms but the important thing is to provide where it is most needed.
While majority of medical graduates proceed directly into residency for their specialization, there are those who choose the road less travelled: to become a doctor in far-flung areas that may be mountainous, isolated and hard to reach. These primary care providers may have different goals in mind, but share a common objective of delivering health services to the underserved.
“Helplessness and futility – two things that I remember, most especially during my last two years in medical school. Every time a patient came to the ER because of a heart attack (after stopping his maintenance medicines) or late-stage cancer (because he was afraid or had no resources to seek consult earlier), my heart broke.
“Oftentimes, the patients come in too late and their condition is irreversible. What’s frustrating is these could have been prevented had they come in earlier or had the means to regularly take their medications.
“Thus, I applied to the Doctors to the Barrios (DTTB) program, hoping to do my share in preventing these illnesses before they became severe or irreversible,” said Dr. Joan Rose G. Lampac, who was assigned to the distant mountainous municipality of Danglas, Abra.
“I’ve wanted to join the DTTB program ever since I heard my uncle’s stories, a DTTB alumnus who was posted in Caraga. This desire was strengthened when I entered UP and reinforced even more when I joined the Mu Sigma Phi Sorority,” Dr. Thea T. Hilomen, of a coastal municipality of Lubang, Occidental Mindoro, said, adding: “I also took my community elective in Coron, Palawan.”
A survey conducted in 1992 revealed that there are 271 municipalities without a doctor for at least five years, and these are areas that are economically disadvantaged and geographically isolated. This was the aftermath of the devolution of national services in 1991 when the administrative responsibility of the Department of Health (DOH) for public health was transferred to the local government units (LGUs), including the hiring of municipal health officers (MHOs).
The DTTB Program was initiated by former DOH Secretary Juan M. Flavier as a result of this alarming data and aimed to bridge the gaps in access to quality health care through the deployment of competent and dedicated physicians to serve as MHOs or Rural Health Physicians in doctorless communities.
The program has been running for almost 26 years; however, there are still gaps that remain in the provision of health services to the underserved. As years passed, doctorless municipalities remain constant because of different reasons: both internally within the municipality or externally in the DOH program. To sustain the program, the DOH has made it more attractive by offering a plantilla item with a salary grade of 24, a representation and travel allowance (RATA) and all other benefits as provided for in the Magna Carta for Public Health Workers. They also offered a free two-year masters program under the Development Academy of the Philippines.
Among all the doctorless municipalities, the DOH makes a priority list of the areas every year where the DTTBs will be assigned, depending on the consensus of the batch – a diverse list of municipalities in the mountainous areas, isolated islands and those municipalities with an extremely large population.
Being a DTTB bears the challenge of being deployed to a far-flung, often geographically isolated, and disadvantaged area — away from all the comforts and conveniences that the city has to offer.
It was difficult for Dr. Larielyn Hope C. Aggabao, DTTB of a coastal municipality in Mercedes, Eastern Samar who did not understand nor speak its Waray dialect. “I come from Baguio but, due to more areas available in the Eastern Visayas region, I was led to that location.” She admitted having a difficult time learning and understanding the dialect, adapting to its culture and food, aside from adjusting to her staff and local chief executive, all of whom are from the Visayas.
But for Dr. Jessa Mae B. Rosete, DTTB of an island municipality, Limasawa, Southern Leyte, this is not a concern. “Being born and raised in the province of Southern Leyte, I enrolled in the UP College of Medicine with every intention of returning to my hometown because of the lack of doctors in my area.” She added, “My desire to serve the underserved was reinforced when I joined Mu Sigma Phi Sorority, where I was elected Service Committee Chairperson. It gave me opportunities to connect more with the people in the community through our various outreach programs, most especially the Mu Caravan: Women Empowerment and Literacy through Health Education (WEALTH) with my inspiring and energetic mentor and sis, Dr. Bootsie David-Ruaro.”
Dr. Micah L. Masbad, DTTB of a populous doctorless municipality of Dapa, Siargao, considers being deployed to a geographically isolated area as both an advantage and a challenge. “My primary goal after clerkship and internship was to move out of Manila and live on an island. The Doctors to the Barrios route was the obvious choice for me. I will live on an island, “serve the underserved” AND acquire a masters degree. It was the perfect choice, with all the added benefits.” She added: “James Nazareth, my brod in the Mu Sigma Phi, practically a sibling for me, was a big influence in this decision. His stories made me feel scared and excited … enough for me to push through with my DTTB plan.”
However, the privileges of being a DTTB come with gargantuan tasks and responsibilities and, more often than not, these have not been taught in medical school. More than diagnosing and treating diseases, most of a DTTB’s time is consumed in supervising the health staff, and managing the health department of the whole municipality, which includes the provision of quality and accessible health services to the residents and having to make do with meager material and financial resources. Typically, a young DTTB is faced with a myriad of recurring challenges. “Working in the community was hard. I had to contend with decades of misconceptions and learned helplessness in the community. Other issues like politics, limited financing for health, bureaucratic red tape, and conflicts in the community have not made serving in the grassroots any easier,” commented Dr. Joan.
More than the physical sacrifices, there are emotional and mental hurdles a DTTB needs to overcome after encountering overwhelming realities one may not have anticipated. Dr. Jessa shared her experience in transporting a patient from the island to the mainland. “It was almost 10 in the evening during the habagat season when a young man was brought to our health unit. He had sustained multiple injuries, including an open fracture on his left arm which was bleeding profusely. After administering first aid, I had no other choice but to transport the patient to the mainland in a small motorized boat with only a flashlight on hand, despite the gusty winds and turbulent waves.” She fervently wishes for a fully-equipped and sturdy sea ambulance, one that her municipality could not afford despite the need. Hope springs eternal.
Overcoming challenges are small wins for a DTTB. For Dr. Joan, giving up on the people she serves is not an option. “I have to just forge ahead, even if takes one patient at a time. I know that every patient I could convince to religiously drink his maintenance medications is a stroke/heart attack that was prevented. Every patient that I can encourage to seek consult earlier for a suspicious mass is a Stage IV cancer that may be averted.”
And with every struggle comes a multitude of opportunities to learn and a means towards self-actualization. For Dr. Thea, delivering basic health services to those with limited means and access gives her a sense of purpose. “I keep thinking that each patient I see is one less patient that needs to endure the long queues and prohibitive costs of tertiary hospitals in the city,” she shared. Dr. Micah echoes her gratitude to the program,
“Two years, tens of nearly-depressive nights, hundreds of frustrations, and a thousand liberating experiences after, I am indeed grateful that I was led into this once-in-a-lifetime experience. Now, I feel more grounded and connected with humanity.” She adds, “I will stay on the island, not as an MHO, but as my normal self, taking a masters degree in life. It’s outrageous! I am scared and excited again. And voy a surf!”
Working in the grassroots has been a humbling experience for the DTTBs. Dr. Larielyn shares, “My experience being a DTTB may have been challenging and beset with more than just a few political rifts but it opened my eyes to the reality of the health situation at the grassroots. It kept me grounded.”
Aside from learning a new dialect, it broadened her perspective and honed her skills in creativity and resourcefulness. “I was motivated to become innovative in ensuring that the marginalized get the quality health services they deserve, no matter how difficult it is to accomplish it. When everything seems so hopeless, you just have to go back and remember your purpose,” she added.
“Serving the underserved” is one mantra oft-repeated by the UP College of Medicine’s community-oriented medical education. With the Return Service Agreement1 being implemented, the Doctor to the Barrios Program provides an opportunity for UPCM alumni to serve the country with all its perks, attendant duties and responsibilities.
Apart from the management and leadership journey of a DTTB, one valuable outcome is the eye-opening experience to the realities on the ground from a public health perspective. Not read in medical books nor taught in class, these lessons may well be priceless and the most enriching.
1 Return Service Agreement: an absolute requirement for admission to the UP College of Medicine. The agreement states that the student has to serve for a minimum of 2 years in the Philippines within 5 years after graduation and in accordance with the role of the health-related profession. This is signed by the UP Manila Chancellor for the University and the prospective students and parents, as witnessed by the Dean.