Pen Point 47

Duterte & his allies have mastered the art of deception and selective justice. Deception of people for the sake of the people is a contradiction in democracy. Indeed, politics is a dirty game. Remember that there are no permanent friends, or enemies, only permanent (sometimes selfish) interests.

Inaction is action. Our government is responsible both for the things they do and the things they don’t do, especially when they could choose otherwise. Not until the majority of us choose to side with true democracy, we will continue to fail as a society.

Haven’t you had enough?

Burned and scarred

WARNING: This post contains sensitive content which some people may find offensive or disturbing.

Many of us assume that pay and other rewards are all that we can expect to receive from our work. There is less emphasis on less-tangible but equally important benefits like trust, respect, civility, and the opportunity to make a positive change. This view of our work encourages behavior and attitude that lead to employees’ burn out. Thus, contributing to a workplace culture that harms people’s well-being and sense of self.

Over the past years, I’ve struggled with the unprecedented consequences of psychological harassment (also known as bullying). Truth be told, I may not be the only one experiencing this. There are many who might have been blinded to see this kind of harassment as simply ‘part of the job’ or an act of ’keeping the organization intact’. Many of whom would not even know that they, too, are victims.

Our culture and system both cultivated a workplace environment that is punitive, antagonistic, cynical, and perhaps self-serving. Some of you might agree that culture, much like a system, is one that is hard to break or change. It takes considerable effort and political will to accomplish this. However, it is my fervent prayer to see the day that workers get to enjoy working in a workplace that emphasizes the importance of openness, trust, transparency, respect, integrity, and accountability.

It has been months since I began thinking about my next big step. And, the recent burn accident that happened to me while on duty showered (figuratively) me with enough motivation to seek some enlightenment. For now, nothing is definite. But I am only sure of one thing: my conscience is clear. Nothing that I ever did or said intended harm to anyone. My views, opinions, and actions are all in accordance with my personal principles, the ethics of nursing, and the vision and mission of the organizations I am affiliated with.

It saddens me that my pure intention to help, no matter how it is expressed, is often dismissed with prejudice. These preconceived opinions, which I believe are not based on reason, have led to several instances of misunderstanding, manipulation, and most especially misinterpretation. The constant desire to prove one’s worth and sincere intentions has surprisingly taken a toll on me.

Today, I begin to seek ways on how to regain myself. I might be better off seeking fertile soil elsewhere to cultivate my skills and share the fruits I long to offer our society, rather than trying to build a garden in a barren desert. I wish to end the nights of loneliness and self-doubt. I pray that one day I will be able to regain or improve my confidence, well-being, self-worth, and sense of self. Tomorrow, we start the process by going back to the bedside and care for people who currently need us most.

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Disclaimer: Views and opinions in this post are my own. They do not reflect the official positions of the organizations I am currently affiliated with. If the shoe fits, wear it.

WE SHOULDN’T BE SILENCED. WE MUST BE HEARD.

WE SHOULDN’T BE SILENCED. WE MUST BE HEARD.

It is almost always difficult to make a decision. Probably, it is harder during a pandemic when you battle against time and limited resources. Not all administrators will make the right decisions. Not all employees will have the same opinion. What’s common, I suppose, is the collective vision of ending the pandemic at the soonest time possible.

Everyone is afraid, anxious, or worried about dealing with many uncertainties. As a result, everybody is doing all things they can to be saved. Obviously, some *subordinates*, as they call them, would want to be heard. Some people talk in small groups. Some in bigger groups. During a pandemic, it is natural for these people to begin to raise their concerns about how things are being handled. It is common for people to criticize decisions they think are doing more harm than good. It is common for people to propose solutions to problems that directly (or indirectly) affect them.

On the one hand, it should NOT be common and natural for people to blatantly silence critics who are airing valid concerns. Issues, concerns and criticisms are all part of leadership. Rather than thinking of them as bullets attacking or undermining the administration, it is more important for administrators to consider them as challenges. Rather than play the victim, administrators can own criticisms and convert them into opportunities.

Too many administrators get too defensive and choose to focus more on their reputation. They tend to impulsively react and dismiss legitimate issues and concerns, rather than objectively assessing or reevaluating the situation at hand. There have been times when administrators turn the criticism around the person speaking up. They end up chasing the ‘mastermind’ who can easily be blamed, rather than seeing it as an opportunity to learn from someone else. Yes, even from someone among the “subordinates”.

Criticisms are sometimes a clear reflection of poor judgment, but never of character or personality. TAKING CRITICISM IS A DIFFICULT THING. But criticism can always be considered a form of communication – an honest feedback on what transpired after a decision was made. Such feedback can make us stronger by allowing us to listen to honest views that tell us what can be done better. Moreover, TAKING CRITICISM IS UNCOMFORTABLE but it forces us to think about how we work and how we decide. Constructive criticism can guide us away from making poor judgment and subscribing to bad practices.

I believe one of the most important qualities of an administrator is being a good listener. And that applies more when one is being criticized. Don’t always shut them down. Turn up the volume, lend your ears, and listen to what is being said. Be the change agent people want you to be. Turn the negativity into an avenue that enables growth, maturity, and innovation. Turn words into action. Show that you can listen to feedback and at the same time get the job done. Together, let us change the workplace culture of blame. Let us heed the call to become more honest, transparent, and consistent.

Rather than flashing your palm at someone, open up your arms and say…
“I have thought about what you said and this is what I’m planning to do. What more do you think can we do?”

The frontline

As a nurse, waking up each day is a struggle knowing that there is a high risk for us to acquire the disease. However, we are constantly reminded of our duty to the people. That it is our duty and responsibility to help those in need, especially the poor, weak, and vulnerable.

Times like this make us realize that effective communication is key. Sadly, the field of health has failed to do it well in many instances. Today, more than ever, I fervently ask our leaders to first show TRANSPARENCY. Make things clear for us. Make us understand how things will be managed, coordinated, and disseminated. Make us feel that you are on top of this and that processes are as clear as they can be.

Second, I ask for CONSISTENCY. We are tired of hearing conflicting statements, especially those from the higher ranks. Such conflicting statements create confusion which in turn causes panic. Let there be a single message from a single source.

Finally, I ask for INTEGRITY. Let us not fool each other. Again, kabaro mo na. Sana hindi ka na isahan pa. Tayo-tayo dapat ang nagtutulungan. Hindi dapat nag-gugulangan. Let us be honest to each other so we can all work well together. After all, we all aim for one goal – the end of this crisis.

The coming weeks will show how resilient and responsive our health care system is. The circumstances will test how our current systems will adapt and change according to the pressing needs of the people. Our experiences during this pandemic will surely change how we will implement the UHC law in a bigger scale in the following years.

Please pray for everyone, especially those in the frontline. It is a scary, scary world and we have nobody to save us but ourselves. Ingat!

DISCLAIMER: There is no way this post pertains to a particular individual, hospital, or organization. Before you try to twist whatever I said in this post and send complaints, please clarify them first with me. Send me a message. It’s free.

Foreign ownership in the health care market

The proposed measure to allow foreign ownership of transportation and telecommunication services clearly sets a precedent for other public services in the Philippines, such as health care.

Opening the Philippine health care market to foreign ownership, obviously, has potential benefits including employment opportunities, better provision of health services, and health technology exchange. Foreign ownership of health facilities/service providers, however, has the potential to negatively affect the already struggling health care system of the country.

First, foreign investors may be enticed by the government to own hospitals and other health facilities (laboratories, ambulatory clinics, etc) in places where the government has failed or is yet to invest in. In this way, the government is lifting itself from the burden of expanding its public health services by allowing foreign investors to build and own these facilities. While this could be a win-win situation, poor regulation might undermine the primary intention of such set-up which is to improve access to health care services. In places where there is only one (monopoly) or few firms (oligopoly) providing health services, there is a potential for these firms to collude in order to maximize profits.

Second, foreign ownership has the potential to further promote a two-tiered health care system, separating the upper class from the low and middle classes. Having a two-tiered system means enabling price discrimination as an effective price-setting strategy. With price discrimination, some consumers will end up paying higher prices.

Unpaved road to UHC

Almost every day I see patients (or their relatives) looking for stretcher beds as there are no longer available beds in the emergency room. This scenario, I suppose, will persist even when hospital renovations are finished this year. While increasing the hospital’s bed capacity potentially decreases waiting time for patients, no amount of beds will ever suffice. The neverending influx of patients in the Philippine General Hospital is a result of the increasing demand for health care among poor Filipinos amidst rising health care costs. The same is true, or even worse, for other government hospitals.

PGH is a microcosm of the Philippine health care system. Our experiences in this hospital mirror big challenges that the country will continue to face while implementing the universal health care law. First, poor gatekeeping at the primary care levels will allow patients to seek care at higher level facilities even when lower level facilities are capable of handling their medical conditions. This, coupled with patients’ poor confidence of primary care health workers, encourage them to flock in tertiary level facilities which results in overcrowding.

Second, chronic lack of manpower and other resources delay necessary care. Patient waiting time is high for common radiologic procedures (e.g. x-ray, ultrasound) because there are only few machines available for hundreds of patients. Nurses, faced with high patient workload, leave out essential care elements to meet only the urgent physiologic needs of their patients. Our study on nursing care rationing in PGH showed that 45% of nurses kept a patient who rung for a nurse waiting longer than five minutes. More than half of respondents disagree that there are enough nurses to get the job done or to provide quality care. More than half of nurses also reported a physician did not come or took a long time to arrive after a call.

These are few of the challenges that patients and health care workers in PGH continue to face. While we strive to be a model of health care delivery, our current set up is far from what we all have dreamed of – a hospital that transforms lives through excellent care, education and research. I cannot imagine how other hospitals and health workers deal with poorer work conditions.

The road to UHC is quite long. PGH is a reflection of the government’s failure to adequately lay concrete interventions that will make our journey smooth. Gatekeeping at the primary care level and provision of adequate human resources for health are two key elements that will drive the realization of universal health care.

Top Nine Questions This 2019

It has been a great year. I cannot thank enough the people who have been part of this amazing 2019!

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In the past, I wrote top lessons I learned during the year. For this year, I will have to put them aside and share with you nine questions I had in 2019 that remain unanswered (or partially answered). I hope to find answers in the coming new year.

  1. Can the healthcare system achieve both equity and efficiency at the same time? Or are the two concepts contradictory in healthcare? Should one be achieved before the other?
  2. How can we make the procurement process be more flexible and less corrupt while being strict on the quality of materials procured?
  3. What incentives could eventually reconcile self-interest and social interest?
  4. Should state-funded health care be rationed? How should the government ration health care to meet the current demand? How does rationing of care contribute to universal health care?
  5. Does the current national social health insurance program increase or decrease the efficiency of the use of scarce resources?  Is ‘access’ rather than ‘utilization’ of health services a better measure of equity in health care?
  6. Do patients’ preferences affect the supply of health care services? Or are variations in the supply of health care services in various settings simply a response to high levels of patient demand? If not, how much do patients’ preferences contribute to utilization of health care services?
  7. How do we go about the Filipino culture of putting too much trust on one’s doctor to the extent that we lose exercising our right to participate in decision-making?
  8. Do we cast our nurses as “global goods” rather than “domestic providers” of health care, implicating them as sources of remittance income rather than for their potential contributions to the local health system? Is this kind of trade (trade in health services/providers) not only motivated by the desire for revenue, but also by the desire to cope with overproduction and lack of opportunities for nurses in the Philippines?
  9. Do people’s preferences and tastes change in situations where there are very few choices? Or do they develop an acquired taste/preference because of limitations posed by societal inequities?