The migration of Filipino medical professionals to developed countries continues despite the global financial crisis. Around 2,000 doctors graduate every year, but most of them opt to leave. Health department data show that 5,000 doctors have left the country in the last five years.
In 2008 alone, around 10,000 doctors became nurses and left the Philippines for greener pastures. Some European countries offer a hefty $6,000 salary for physicians, tempting numerous doctors to pack their bags and leave. But of course, there are the few who stay.
Dr. Chelsa Cacaldo is one of them.
Instead of pursuing a career in Manila or other big cities, she ventured into the mountainous areas of Negros Oriental. Instead of modern technologies, she struggled with meager resources and insufficient funds. Instead of a string of doctors at her beck and call, she had a team of community volunteers.
“The province [Negros Oriental] is 65% mountainous so majority of the people are rural folks, and they have no access to various health services,” says Cacaldo. The challenge of bringing health services to the community prompted her to volunteer as head of the community hospitals project of the province of Negros Oriental in 2001. She now supervises six rural community hospitals in the former insurgency-infested areas of Negros Oriental.
Community girl
Cacaldo has always had a soft spot for the communities, having spent her life in rural areas. She spent her childhood in Mabinay, an upland municipality north of Dumaguete City. Due to financial difficulties, she had to stay with an aunt in Dumaguete until her fourth grade. She finished primary education in the southern town of Sibulan, and then returned to the capital to finish high school.
During her high school days, Cacaldo read biographies of early health missionaries to countries like Africa and China. She was inspired by these stories and volunteered in church-work during her stay in Dumaguete.
“I got a vicarious thrill in reading their works. I think that was one of the reasons that pushed me to go into volunteering,” she says in an interview with abs-cbnnews.com. “We had been traveling to places, especially to the hinterlands, and when I saw their condition, I said, I want to help them someday.”
This inner drive prompted her to take up a Bachelor’s Degree in Biology at the University of the Philippines in Baguio since it was cheaper there. Although she wanted to pursue a medical course, a tight budget prompted her to return to Mabinay and teach in Kabankalan, Negros Occidental.
After five years, she received a full scholarship from Bicol Christian College in Legazpi City, Albay, and then she took her internship at the Davao Medical Center in Davao City. Eager to return as a doctor to the communities she once visited in her teens, she specialized in family and community medicine.
When she returned to Dumaguete, Cacaldo learned that the provincial government was set to implement a community-based health care program. She applied for the job and was immediately accepted.
“There was a clamor to build hospitals in former New People’s Army (NPA) hotspots between Occidental and Oriental,” says Cacaldo. “It was put up in those areas because there was a community perception of neglect. People thought that the government was not doing anything to address the problem.”
‘No Man’s Land’
The community of Inapoy in Mabinay was chosen for the joint project between the two provinces. The barangay is nestled in the mountains. Back then, the roads to the village were rough and dusty during the dry season, and muddy on rainy days.
“We rode for an hour or so in a habal-habal [motorcycle] to get to the community. If it rained, we walked for more than two hours from Mabinay town proper,” Cacaldo recalls. “There was no electricity back then. The situation was really depressing.”
The area was labeled “No Man’s Land” because people seldom visit due to the insurgency problem. Cacaldo says that when her team went to the area, there was a sense of hopelessness within the community. Inapoy has 75 to 100 households, and majority work as farmers for the haciendas in the region.
The citizens of Inapoy were mostly migrants. They came from different barangays in the various areas which were targets of taxes and sustenance by Communist groups, says Cacaldo. “The military thought it would help if they were placed in one barangay.”
Despite the threat, the insurgency was not the primary problem for the group. Cacaldo says families were large and lived in extreme poverty. Although the community was highly-dependent on government support, she says the people distrusted government.
“Initially, it was a difficult process because people were suspicious of what the program was all about,” says Cacaldo. “But if they see that it is for their benefit, that you are transparent in your activities, that you are sincere in dealing with the community leaders, then you get their trust.”
The community hospitals she supervises are located in the barangays of Calumbuyan in Bayawan, Amio in Sta. Catalina, Nabilog in Tayasan, Pacuan in La Libertad, Inapoy along the boundary of Mabinay and Kabankalan, and in Luz-Sikatuna, the border of Isabela, Negros Occidental and Guihulngan, Negros Oriental.
Empowering the community
Aside from providing primary health care services to the communities, Cacaldo’s team also runs a neighborhood family health care program, a health information advocacy campaign where they train willing family members on the basics of primary heath care.
“We train family members who take care of their families and neighbors on disease prevention and health promotion,” says Cacaldo.
Some basic health care they teach are: proper hand washing, tooth brushing, environmental protection, sanitation, treatment of common illnesses, preparation of herbal medicines, and first-aid.
“I have been telling them [locals], the government can only do as much, and our budget is never really enough, so it is up to us community-folks to find solutions to our health problems,” Cacaldo says.
Restricting policies
According to Cacaldo, the biggest challenge for them are government health policies which limit the way they can solve problems, especially with regard to manpower.
For instance, Department of Health rules require that there be at least two registered doctors and four registered nurses in each hospital. This policy is a major constraint, says Cacaldo. It is difficult to get nurses to work in rural hospitals because of low pay, forcing thousands of them to leave the country.
“We have no budget for that [manpower requirement], and considering the bulk of patients that we have, I think it will not be cost-efficient because we will be paying more for less work,” explains Cacaldo.
Each hospital in rural areas can only afford one doctor, one nurse, and at least two midwives. But midwives are not on the list of manpower requirements.
“Unfortunately, they don’t require the presence of midwives, but in our community hospitals, the midwives play a very important role because they also act as nurses. In OB [obstetrics] cases, they are better because of their training,” Cacaldo says. Midwives play various roles in rural communities.
Not enough funds
Funding is a common problem in most community hospitals. According to Cacaldo, the provincial government of Negros Oriental allocates P3.4 million a year for the six hospitals. This amount covers the facilities and expenses for the facilities and medicines.
Each hospital is licensed to operate a 10-bed facility. Despite the common supply constraints, these hospitals have enough facilities and stocks. “We have enough fluids, medicines, and we also have our drug room,” says Cacaldo. The project recently received donations of surgical instruments from private institutions.
A major persistent problem is transportation. “We have at least one ambulance, but our ambulance is as old as the hospital, and the maintenance is very, very expensive.” Cacaldo hopes the problem can be solved. According to her, the provincial governor has been finding ways to assist them in transportation.
“Hopefully, by next month, we can be provided with the needed ambulance,” Cacaldo says. In the meantime, she says they have arranged with neighbors and friends to rent out their vehicles in cases of emergencies.
Community leaders are now involved in the program since they are members of the board of directors. The board was encouraged to seek of ways to provide funding for the hospitals.
A dying advocacy
Despite her accomplishments in strengthening rural hospitals in her hometown, Cacaldo admits that volunteering in the communities is a “dying advocacy.” The current exodus of medical practitioners, although affected by the financial crisis, has made Cacaldo think twice about pursuing her cause.
Out of the five classmates she had in medical school in Davao, she was the only one who went to the barrios to practice. The others opted to stay in the city, but they will probably leave once the demand for medical professionals rises again.
“As of now, I want to experience professional growth. I want to see and experience the program that they have abroad,” Cacaldo confesses. Given the opportunity, Cacaldo says she’ll take it. But she still intends to return and bring the health care practices she will learn to benefit the local community.
At the moment, however, Cacaldo is focused on making the hospitals effective providers of primary health care services.
“Maybe, I see myself ten years from now still working with communities because I want to see the results. In health, we cannot see the results after a month or months—that’s the hard part,” Cacaldo says.
Dr. Chelsa Cacaldo received the Ramon Aboitiz Award for Exemplary Individual in the 4th Ramon Aboitiz Foundation Inc Triennial Awards held in Cebu City last March 6, 2009. Photos coutesy of RAFI. See article here.
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