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A Fighting Chance
by Michael Hussin B. Muin, M.D.

The ‘Sell Out’ stigma has since died down. It is now a footnote in the obscure pages of Philippine medical history. But the exodus continues and the situation is a fierce topic in conferences. Even business schools have taken up the issue and debated on the reasons of the plight and flight of doctors and the effects on the public administration of health care. And the conclusion has taken a gentler form. No, they now agree, doctors didn’t sell out, they just gave up fighting.

And what are they fighting for? Among other things, doctors—and other health workers—fight for better pay and better working conditions. They fight for protection from bogus health companies and quacks in government. They fight for stronger organizational leadership. They fight for a better government. They fight for their patients. They fight for their families.

It is a sad fact that bank tellers and call center agents get better pay than general physicians in HMOs and residents in training. Bank tellers may get as much as P15,000 per month while GPs get P9,000-P12,000. Call center agents get as much as P21,000 per month while residents in private hospitals are lucky to get anything over P10,000. People who handle money and customer service get better wages than those who handle lives. This says much about industry standards, whatever that means.

But isn’t it true that all Filipinos are fighting for higher wages? Yes, but the fight is done in different ways and have different effects. When factory workers stop working, production goes down. When jeepney drivers wage a strike, transportation grinds to a halt. But when doctors go on strike, patients die.

I have seen doctors fight for a collective cause. They threatened work stoppage at a small private hospital unless conditions for better pay were met. They gathered just outside the emergency room and carried placards and signs. But the whispers and conversations within carried in them the futility of their efforts.

‘Tawagin mo ako pag may dumating na pasyente.’

‘Akyat muna ako at mag-a-assist ako sa OR.’

‘Sandali lang, andyan na yung follow-up ko.’

These are phrases uttered by the doctors on strike. Even the venue of the strike is crucial. They to sit it out in front of the emergency room and scramble in when an emergency case arrives. Once the patient is stabilized and brought up to the floors, they then trickle back into the strike area, anxious and ready for another case.

Doctors are not immune to the effects of graft, corruption and poverty. Some doctors are unemployed, while others take double or triple jobs. Many doctors look outside the field of clinical medicine for extra income. Some are into related fields like academics and research, while others go beyond medicine and venture into medical transcription, nursing, information technology and selling jewelry and health insurance.

Not everyone has government officials and actors for patients. In Batangas, moonlighting specialists settle for P1,000 for normal deliveries and P3,000 for caesarian sections. In the provinces, doctors are often faced with poor patients—and rather than exacting consultation fees, most instruct the patients to just buy the prescribed meds with what is left of their money.

Doctors are pinned to the wall. If they fight back, people die. But if they don’t fight back—well, they go home tired and weary. In any case, the health of Philippine society hinges on the Filipino doctors’ sense of decency—the decency to put the patient first—above anything and everything, even their own needs.

Hospitals and managed health companies exploit this sense of decency to a fault. They know doctors will not abandon patients. Yes, some paper work will be delayed if work stops, but they have administrative clerks for that. Patients will still be treated, surgeries will still be performed, follow-ups will still be done.

So, how will doctors fight back without hurting their patients? How will they go to the streets and protest unjust compensation? How will doctors fight unseen ghosts and forces that threaten to push them to acts of indecency and selfishness?

By bringing the fight closer to home. Everywhere doctors are questioning the choices that lay before them. While society continues to flourish in the notion that doctors get full satisfaction from public service, doctors struggle to face the harsh reality that life is full of --. There are no right choices, just promises and responsibilities to keep. There are no wrong decisions, just consequences and the courage to live with them.

The fight to leave or stay—and yes, it is a fight—is not found in the loud voices on the streets and the echoing chants in ---strations, but in the grave discussions at dinner tables and the whispered conversations when the children are asleep. Because doctors are slowly finding out that living—and leaving—for one’s family is a battle worth fighting for.

For some, it has come down to choosing between loneliness and poverty. Some choose to be lonely, while others choose to be poor. Doctors are not leaving, they are driven away. And these doctors carry their own personal battles in foreign lands, where they fight extreme depths of loneliness and immense levels of uncertainty. Those who stay fight their own battles of survival, where each day is a search for some sense of meaning in the care of other people’s lives.

In the gloom spreading all over the country, people are asking for a chance to get past poverty, a chance to make a difference, a chance to rise above the muck of helplessness. In the current state of desperation, people are looking for a fighting chance. And everybody deserves a fighting chance—even doctors.


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