Public Health and Climate Disaster: Excerpts from an Interview with a Filipino Doctor

What personal experiences with the medical system in the Philippines drove you to become a doctor?

As a kid, I was inspired by my mother who was an NGO worker, traveling to places that had issues with disaster responses. Then, growing up, I became more inspired by my own experiences with Lumad* and indigenous peoples. 

When I was still in undergrad, a friend invited me on a medical mission to serve indigenous people in a location that was very difficult to get to. We crossed jungles and traveled upstream rivers to set up a makeshift clinic. I worked as a secretary, asking peoples’ names and checking them in. I learned that some had traveled 4-6 hours just to see the doctor, while others told me they hadn’t seen a doctor in 5-6 years – or since birth. 

The patient that struck me the most arrived as we were ending the mission. We were unprepared for emergencies, but the patient – a woman laying in a malong* with her child – arrived looking very pale. Her name was Joanne. An internal medicine specialist checked on her, saying she needed urgent care immediately, and would have to go down the mountain. It was 6AM, raining, and very muddy. While some of her family told her not to go and wait for tomorrow, the doctor insisted she join some of us on our hike down to the nearest hospital. They went. The next morning, we didn’t expect the volunteers who had left to be back already, because they should have been with Joanne. They told us she died along the way. 

A few years later, another Lumad – Jonathan Oya – died from fever due to extreme malnutrition in 2018. Both of these cases were preventable, but at the time, I didn’t know why there was nothing available to help them. This is the reality in the Philippines – especially in Mindanao – in some of the Lumad village areas, there’s so little chance for survival because they have so little access to healthcare. 

Experiences like these revealed problems that I wanted to change. At first, I doubted I would go into this field because of how much work, resources, and money are involved; you need to be middle class or rich to study medicine, but I eventually decided to go into the field, at least to look for solutions.

Source: Lunas Global Health Mobile Clinic

Where do medicines, vaccines, and supplies come from when they’re used in the Philippines? Where do pharmacies, clinics, etc. get the supplies they need? Are they coming from PH or internationally?

Most meds are imported from China, India, US, and some European countries. For public clinics and hospitals, the supplies are retrieved by the government procurement, which is overseen by the Department of Health (DOH), Phil Health, and other local government units (LGUs). 

Private hospitals receive from private distributors, directly from the companies themselves. That’s the thing in the Philippines: there are some small companies that create medicine – traditional, herbal medicine – for the public, but they’re very minimal. The Philippines mostly outsources medicine from other companies. That fills the shelves of the pharmacies, but for a price most Filipinos can’t afford. 

What are your thoughts on private vs public health services in The Philippines, and how do they impact people differently?

In private hospitals, getting care is easier– in minutes, you’re accommodated. There are fewer patients because the prices are much higher, so for the rich, you only have to wait 10 minutes to be served. 

For the poor, you have to wait weeks – sometimes months – to get care. In public hospitals, the workers are overwhelmed. There are so many patients that some even share beds. I once went to one of  the largest medical centers in Mindanao to visit a friend who had given birth. After walking through an alley where waiting patients sat in the hallway, I saw her sharing her bed with another mother. The beds are already small, and then they’re divided in two to accommodate both of them. That was the best hospital in Mindanao. 

The equipment in public hospitals is also very outdated, and many services are unavailable. Distribution of goods gets even worse as you go farther into cities’ peripheries. There’s a trickling of resources… when they send the money, vaccines, and medicines, they’re distributed at the regional level, prioritizing the cities, and by the time they get to the rural level, there’s nothing left. When you go to the rural hospitals or the public clinics, the medicines aren’t there. X-rays aren’t there. 

One time, my father had an accident on a motorcycle in a rural area. He went to the local health clinic and there was nothing available for him. He had a wound in his head, but there was nothing to stitch it. He had to be transported to the nearest city hospital.

Source: Lunas Global Health Mobile Clinic

How does the climate crisis impact health and healthcare access in Mindanao?

As a doctor, I would assess that climate change isn’t just an environmental issue; it’s a public health issue. Everything in our environment affects our health: the temperature, air, water, everything.

Higher temperatures lead to lower crop yields and crop failures, which affects the overall nutrition of a regional population. It also causes vector-borne diseases to increase, like malaria and dengue. Abrupt changes in temperature in general can affect respiratory health, increasing cases of asthma, and allergies. Studies say the changes in climate have also affected peoples' mental health: during winter, it’s very cold, and there’s not much to do. Crops will not grow, and parents worry about their children, and where they’ll get food. 

Regarding access to care, whenever there’s heavy rain and flooding, some of the facilities’ buildings and roads collapse. In Mindanao, it’s already difficult to get to the hospital even without a calamity. It gets worse for people whenever disasters happen. On top of that, there’s a very poor emergency and disaster response in the Philippines. There’s no such thing as prevention. Maybe there’s some planning, but it’s not implemented well. 

Where the government healthcare infrastructure fails, local healthcare orgs and grassroots-led initiatives build alternatives of their own. Lunas Global Health Network works to build solidarity with these communities in the international sphere. To help sustain local health and disaster infrastructure in Mindanao, consider fundraising or donating to our Climate Resilience Fund here. 

*Lumad - a unified group of indigenous peoples of Mindanao, Philippines

*Malong - a tubular, wrap-around garment traditionally used by many ethnic groups in Mindanao, Maguindanao, and the Sulu archipelago