The joy of seeing your post-operative patients follow up in the outpatient clinic, feeling much better than before you operated on them, could not outweigh the helplessness you feel whenever you tell the many others waiting in line for their surgery, “Pasensya na po, wala pa po kaming bakanteng kama. Hindi pa po namin kayo maooperahan. Bumalik na lang po kayo pagkatapos ng dalawang linggo kung hindi pa rin po namin kayo tinatawagan.” (I am sorry but we still do not have a hospital bed for you. We cannot schedule your operation yet. Please come back after two weeks if we have not called you by then.)
It still breaks your heart a little, every time.
You are part of the busiest charity neurosurgical service in the country. Your team is in charge of eight intensive care unit beds and 24 ward beds. At any given time, you have 30 to 50 referred patients from Neurology, Pediatrics, and Trauma. You and your co-residents do elective surgeries from Mondays to Thursdays, and emergency surgeries all day, every day, for as long as the patients who need emergency treatment keep coming to your hospital. That’s easily 1,000 to 1,200 charity operations each year.
Despite the figures, it is not enough. You and your co-residents just cannot accommodate all your underserved fellowmen, who most certainly feel that they have nowhere else left to go.
“Saan pa po ba kayo nakatira?” (Where do you live?) You ask your 34-year-old patient with Cushing’s disease. The tumor at the base of her brain is causing her blood pressure and blood sugar to rise, her skin to develop violaceous stretch marks, pimples to resurface on her cheeks, and fat to develop on her face and nape while her arms and legs are thinning. She has become prone to recurrent infections, too.
“Sa Catanduanes pa po, Dok.” (In Catanduanes, Doc.)
“Ha? Eh Saan pa po kayo nanggaling niyan?” (That far? Did you come all the way from there today?)
“Nakikitira lang po kami sa kaibigan niya sa may Taguig, Dok,” (We are staying with her friend in Taguig, Doc) her sister and companion responds. They have been living with her friend for the last four weeks, awaiting the results of their laboratory exams and imaging studies, and their schedule for surgery.
When you do the math, you easily realize how much more money they would have to spend just to cover their everyday expenses for sustenance while waiting to be admitted in your hospital. And that is on top of the money you asked them to prepare for the supplies and medications that your patient would need for her operation and recuperation period.
Often, patients who come to the city for treatment lose the income from their livelihood in the provinces, too. The spouse would usually have to stop working in order to accompany the patient and make the necessary health care decisions.
“Nauubos na nga po ‘yung panggastos namin, Dok.” (We are running out of money for expenses, Doc.)
“Pasensya na po talaga. Kung pupuwede lang ho, ooperahan na po namin kayong lahat ngayon na, para hindi niyo na po kailangang maghintay. Pero alam niyo naman po, puntahan po talaga ito ng lahat ng pasyente sa buong Pilipinas.” (I am really sorry. If it were up to me, I would operate on you right here and right now so that you would not have to wait. Please try to understand that this hospital is where people from all over the Philippines go.)
And it is true. You have interviewed and examined patients from Ilocos, Neuva Ecija, Mindoro, Cebu, Aklan, Davao, and Zamboanga. Even OFWs forced by their employers to come home because of their newly diagnosed tumors or cerebrovascular diseases end up in your hospital, desperately seeking treatment that would not have been affordable elsewhere.
You look at your watch. It is 8:30 am and you are the lone resident in the outpatient clinic: everybody else is either in the operating room or attending the department conference. On days like this, sitting in your cubicle, you wish you can just snap your fingers and rid all your waiting patients of their neurosurgical illnesses. You try to compensate with empathy and sincerity, but it is always with a heavy heart that you explain to your patients and their families the long waiting time for surgery.
“Boss, ilan ba ang nakapila ngayon?” (Sir, how many patients are in the queue today?) you ask the nurse at the receiving desk.
“Kuwarenta na ito, Sir. Hindi ko lang alam kung ilan pa ang mga hahabol na chart galing sa ibang clinic.” (I now have forty, Sir. I just don’t know how many more referrals we will get from the other clinics.)
You have long resolved that you have no right to complain. You may be tired and sleepless, but so are these patients, who have had to endure fatigue and hunger to secure a queue number. They would wake up and commute at the break of dawn (some even camp overnight just outside the hospital) to be able to spend five to ten minutes talking to you, hoping to be given hope for a cure, or at the very least, an honest disclosure on the prognosis of their illness.
Your next patient, a 56-year-old female with a tumor on the frontal part of her brain asks, “Dok, puwede ba akong magpagawa ng panibagong medical certificate at quotation (i.e., approximate expense for operating room and anesthesia needs)?” (Doc, may I ask for a new medical certificate and quotation of expenses from you?)
“Bakit po, Nay? Ano po ang nangyari doon sa dati?” (Why Ma’am? What happened to the previous ones?)
“Nag-expire na po kasi ‘yung pondo ko, Dok.” (My approved funding has expired, Doc.)
She shows you her guarantee letters from PCSO and local officials. Indeed, today is past the validity dates indicated in the documents. The funds originally appropriated to her could no longer be used. She would have to ask for a re-approval, which would mean waiting in line. Again.
Patients who are unable to save cash for hospital expenses are advised to approach charitable institutions and politicians for financial assistance. They come back with guarantee letters, indicating the amount that can be deducted from the politician’s PDAF to be used for the patient’s treatment.
Usually, the amount allocated to patients is measly, in the range of Php 5,000 to Php 15,000 — certainly not enough to defray the expenses of a patient undergoing major surgery. Patients’ families would often have to approach several government officials to come up with the money they have been asked to prepare. Sometimes, they would come in with guarantee letters amounting to Php 20,000 or more, and the families would later confirm your suspicion that they knew people “close to Mayor/Governor/Congressman/Senator.”
Expiring guarantee letters are not uncommon.
You pull out a blank clinical abstract form from the desk drawer and fill it out with your patient’s clinical information. You write a letter on a separate sheet addressed to PCSO and local officials, detailing the tentative expenses she would incur.
“Nay, pasensya ka na ha? Lakarin mo na lang ulit itong mga ito.” (I’m really sorry, Ma’am. Please just submit these documents again.)
You recall last night’s news and compute just how many patients you would have helped with Php 10 billion worth of pork barrel.
It’s a shame. If that amount, or even just a small part of it, had instead been used for the improvement of facilities and purchase of surgical equipment in regional hospitals, or to expand the health coverage of the marginalized so that their illnesses would not worsen only because “Wala pa po kaming pera pampaopera, Dok,” (We do not have money for surgery, Doc) how many families would have been spared from the unnecessary loss of a breadwinner, homemaker, son, or daughter?
The economic progress you hear of every day would have been more palpable, in the form of improved social services, to the Filipino people.
A 20-something female in another part of the world is throwing lavish parties, flaunting her designer dresses and shoes, and posing with Hollywood celebrities, while your patients are waiting, dying a little each day.
The wanton greed is disconcerting — if only you could apologize to your patients for that, too.
Author’s Note: This was written at the time of the pork barrel scam involving Janet Lim-Napoles. An edited version of this article was later published in Inquirer’s Young Blood.