Breakthroughs and bumps in health care A look at the health situation in 2016

ACHIEVEMENTS and milestones on health have marked 2016, including some challenges that will spill over in the new year. Mindanao Times gathered highlights of last year’s health situation in the city.

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Duterte on healthcare

The health agenda of President Rodrigo Duterte has made strides in the industry, through efforts and program on universal healthcare carried out by health secretary Paulyn Jean Ubial.

Duterte is making good on his promise to strengthen universal health care by making Philhealth more accessible to poorer sectors and actually delivering services to them when needed.

While there has been fuss about budget, DOH was quick to dismiss it.

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DOH’s budget actually increased contrary to earlier reports that President Duterte slashed the agency’s 2017 allocation by P31 billion.

Dr. Abdullah Dumama Jr., DOH assistant secretary for Mindanao, said budget for health has actually increased from this year’s P122 billion.

“The total budget for the country is actually 141 billion pesos,” Dumama said, explaining that P50 billion of the total will come from the PhilHealth subsidy for poor families and senior citizens.

According to the National Expenditure Program of DOH for 2017, P2.25 billion of the total budget is earmarked for Mindanao.

Health secretary Ubial said in a statement that the DOH budget will be higher than the defense budget for the first time in Philippine history.

Ubial made it clear that the DOH budget under the 2016 General Appropriations Act is P122.63 billion while the proposed budget under the National Expenditure Program for 2017 is P90.9 billion.

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“However, the subsidy for Premium Payment of Indigent Family and Senior Citizens was included in the DOH budget in 2016 and this was separated from the proposed DOH budget in the NEP 2017. Thus, if we add the Philippine Health Insurance Corp. budget, the DOH proposed 2017 budget will total to P141.02 billion or an increase of 15 percent actually,” she said.

The public will also see Duterte’s stance against smoking.

Selling of cigarette pack without the graphic health warning has been made an offense starting November 4, and offenders will face severe penalties.

The Department of Health warned that the public that the full nationwide implementation of the mandatory Graphic Health Warning (GHW) Law started in compliance with Republic Act No. 10643.

Ratified in July 2014, the law mandates that all tobacco products that will be sold in the country should have GHW or pictures showing the health hazards posed by such products.

DOH XI Regional Director Abdullah Dumama Jr. said he hopes that stores selling cigarettes should have already sold all of their old stocks, which only have text warnings, and that manufacturers should now only release cigarette packs bearing graphic images on packages.

Otherwise, the Food and Drug Administration will confiscate merchandise that does not follow the law.

The GHW Law requires that graphic images occupy packs of tobacco products—from cigarettes, cigars, to other forms of smoked and smokeless tobacco which are locally produced or imported into the Philippine market.

DOH is also looking into a total ban of all tobacco-containing products.

The department’s efforts against smoking will extend its coverage to banning all tobacco-containing products—and this will include vapes and e-cigarettes.

“We want any tobacco-containing product should be covered by the smoking ban,” Dumama said, referring to the department’s proposed executive order pending the President Rodrigo Duterte’s signature.

The Republic Act 9211 or the Tobacco Regulation Act of 2003 does not cover the ban vapes and e-cigarettes, which still often encourage smoking.

Dumama said that these devices still contain harmful substances.

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Controversy at SPMC

The Southern Philippines Medical Center has been a crucial venue to many stories that made the headlines. In January 2016, the government-run hospital was thrown in controversy after a stabbing incident involving a patient’s father and an attending nurse occurred in its emergency room.

A CCTV footage of the incident made rounds on social media. The stabbed medical personnel still reported for work the next day after sustaining minor injuries.

The motive of the father for stabbing cannot be explained by the SPMC personnel. Nurses who were at the ER were witness to immediate care given to the patient. This is the first time that this violent incident occurred in SPMC.

Executives of the hospital made it clear that patients rushed to the emergency room (ER) are given immediate care, but limitations in infrastructure make it a challenge for them to deliver optimal services.

Dr. Maria Elinore Concha, who spoke in behalf of SPMC’s chief Dr. Leopoldo Vega, said that even with their goal to serve everyone better, patient expectations do not match their operations.

“We follow a protocol that prioritizes patients,” she said, but this is a challenge to communicate to patients who visit the ER for the first time because their definition of an emergency might not be the same as the hospital’s.

“The system of prioritization that the ER has might not sometimes match their expectations of what is an emergency and what is not,” Concha said.

In another instance, SPMC was also in the limelight after being blamed for the death of a patient.

A lady named Evangeline Carredo reported in a police blotter at the Buhangin Police Station that her husband Luciano Carredo Jr., 61, died because of lack of oxygen supply during admission in the hospital. Luciano was brought to the hospital because of hypertension.

Luciano eventually stopped breathing, which led to his death; the wife attributes the death of her husband to the lack of oxygen supply.

The head of SPMC made it clear that the incident was not an oversight on the hospital’s end.

SPMC chief Dr. Leopoldo Vega said that the watcher refused the life support service for the patient, as signed in a medical waiver.

Vega said that the patient came in the hospital with a stroke—a brain attack—with a bleed that was progressing beyond normal. The patient, he said, was no longer breathing on his own. During that time, the body could start deteriorating without machine-assisted support because the brain can no longer respond to normal respiration.

A way to keep him alive was through intubation that can support breathing through a mechanical ventilator. This, according to a waiver, was an option that was turned down by the patient’s watcher.

In response to these two incidents, the hospital announced that it has allocated a total of 200 million pesos to put up a centralized intensive care unit (CICU) in their compound to address its limited infrastructure, which has been keeping them from giving patients optimal services and care.

Malnutrition

Another health issue worth noting is malnutrition among children: one third of school populations in the region are stunted, and Davao del Sur is among the key areas in the country to be severely affected by malnutrition.

Dr. Maria Teresa Ungson, regional nutrition program coordinator of the the Department of Health’s National Nutrition Council (NNC) said stunted growth is an indicator of malnutrition.

“Stunted growth among school children is an indication of long term malnutrition,” she said. She added that this could mean that many parents are not feeding their children properly in households.

An intervention program by the council—called Early Childhood Care and Development (ECCD) System—rolled out with hopes to change this.

ECCD, which will run for 1000 days, will cover development programs on “health, nutrition, early education and social services” to provide basic needs of infants to children up to four years old.

Davao Del Sur, which has a malnutrition rate of 10.95 percent among 0-71 months old of preschool children, ranks 10th among the ECCD key areas identified by the Department of Health. According to Ungson’s earlier data, there could also be 9,526 pregnant women; 3,674 infants aged 0-5 months old; and 11,023 infants 6-23 months old who could benefit the program.

Sta. Cruz, Don Marcelino, and Sulop are among the top three areas in Davao del Sur in need of intervention services. The malnutrition prevalence rates in the three areas are 18.09 percent, 17.26 percent, and 16.9 percent, respectively.

Mindanao’s first IVF baby

The first in vitro fertilization facility in Mindanao made its first pregnancy—and delivery—from its first embryo transfer on February this year.

Kristine Gepte, in-house embryologist of the In-Vitro Fertilization Davao, Inc. (IVF Davao) in the Woman Center of Brokenshire Hospital, said that the pregnancy was confirmed 14 days after the embryo transfer was made, and when the patient was tested for B-HCG (human chorionic gonadotropin), a hormone produced in the body during pregnancy.

Gepte said that the patient, a 38-year old from Wao, Lanao del Sur, is showing high values of HCG. The patient turned to IVF Davao because she previously went through ligation, and her fallopian tube is blocked.

Gepte described the quality of embryo to be “very good” and that the in-vitro fertilization process and transfer was smooth.

The nine months that went by lead to one beautiful event in Brokenshire Hospital’s In-Vitro Fertilization Davao, Inc. (IVF Davao). Last Oct. 13, at 3:43 p.m. was the birth of a healthy baby boy named Muhager. He is the first take home baby of the facility.

Doctors reported that Mydean delivered a healthy baby boy via caesarean section with an appearance, pulse, grimace, activity, and respiration (APGAR) score of eight and nine. The baby weighed 3.2 kilograms.

This couple’s IVF experience marks history for the health sector in Davao City and in Mindanao. The days ahead of them are testament to the 42% success rate of IVF Davao.

Gamal said that he has long been excited about their baby—especially when he found out on the fourth month of pregnancy that they are going to have a baby boy.

Through IVF, doctors are able to help a couple conceive a child by collecting ovum of a woman and have this fertilized by a male sperm in a lab. The fertilized egg will then be transferred back to the uterus. IVF Davao opened on Oct. 28, 2015.

Dental health

Local dentists also sent out an important reminder to the public this year: to take oral health seriously regardless of age.

February as the National Dental Health Month served as a reminder for the public that maintaining oral hygiene should be a lifestyle and not just a routine for school children that starts and ends with brushing teeth.

Dental health is also a concern that cuts across ages, and adults, too, should keep in mind that food intake plays an important role to this. Dentists from the Davao City Dental Chapter attributed the wide availability of sugary food to poor dental health.

Dr. Marilyn Cabiles, president of the organization, said that there appears to be little to no balance between sugar intake and toothbrushing habits among school children, and even in some adults!

She said that another recurring challenge, apart from offsetting sweet food intake with good oral hygiene, is how to make older people understand that dental health should also be their primary concern. It is not just a health concern of kids, she said.

Hope amid HIV

Dance and fitness instructor Nash Villa shared a story in M Magazine that is worth remembering.

Nash confessed that he was really scared with the idea of coming out to public as HIV positive. He was also confused.

“I really want to help. I don’t know how or why,” he said were the thoughts that were running in his head at that time. “I want to raise awareness.” It took him many deep breaths before he made his first move. And when he did come out, time worked its magic.

Nash’s yearning to help and to inspire people like him came into fruition when he realized that all he needed to make his own little changes was inside of him this whole time: his passion for dancing.

“I really love to dance and to teach,” he said. “HIV is not a hindrance for me to reach my dreams.”

Today, he raises public awareness on HIV through his medium: dance.

Dance, too, has worked wonders for his health.

He said that his doctor was in awe at how it kept his CD4 count at a good number. A CD4 count is a lab test that measures the number of CD4 T lymphocytes (CD4 cells) in a blood sample. For people living with HIV, this is an important indicator of immune system status; it also predicts HIV progression.

With his job centered around doing dance workouts, Nash said that this helped him to be at his best, despite whatever health condition he has.

“Until now I’m still dancing,” he said, saying that he will never stop. He passionately hones his skills while constantly being grounded by his trainings and his experiences in leading dance groups (from Davao City National High School’s Dance Troupe to the University of Mindanao’s Makabayan Dance Ensemble). He also leads Navida, a dance company that he founded in 2010 which covers dance workshops across genres: from jazz to hip-hop, ballet to contemporary and foreign dances.

With partners from health organizations, Nash uses his skills to bring testing and medical services out in the open by holding dance and Zumba sessions for a cause.

The Davao Region remains to be one of the top five areas in the country with high HIV rates but with efforts from the community and support from the stakeholders, this health issue will be addressed one day at a time.

Chemical leak

The patients were rushed to SPMC after reporting to be experiencing dizziness and nausea caused by inhaling chlorine that leaked from a facility in Sitio Licanan in Lasang.

SPMC chief of clinics Dr. Ricardo Audan said that chlorine inhalation is not to be taken lightly. There is no antidote to this and patients are treated by the symptoms. Eye burns, skin irritations, and respiratory distress are among the symptoms showed by the patients.

Most of the patients showed respiratory distress and they were relieved by the use of nebulizers.

Lasang barangay captain Allan Simuag said liquid chlorine leaked from a cylinder found inside the building of Jedaric Chemical Corporation. The establishment is said to be given permit by the barangay as a storage facility but during an inspection, the same place was also used to repack chemicals.

Digital health services

Technology helped healthcare make a leap forward this year.

For example, a medical telephone service by a telco provider connects patients to a real doctor and discourages dangerous self-medication.

The KonsultaMD Health Hotline was launched this year to bridge a communication gap between patients and the limited number of doctors.

KonsultaMD is being operated by Global Telehealth, Inc., an affiliate Globe Telecom and Salud Interactiva, a health hotline space in Mexico. The service currently employs physicians that focus on general health, operating three shifts per day.

The Department of Science and Technology also started the roll out of telemedicine equipment to 16 regions in the country to link patients in remote areas to health services.

DOST-XI assistant regional director Mirasol Domingo said this service, called RxBox, is designed to provide better access to “life-saving health care service in isolated and disadvantaged communities nationwide.”

There will be 1,000 units of RxBox to be deployed in the country. The Davao Region has been allocated a budget of P902,000 for this project and has identified 42 key municipal health centers to receive the equipment.

As of now, Maco in Compostela Valley, Talaingod in Davao del Norte, Baganga, Caraga, Governor Generoso and Lupon in Davao Oriental have been named pilot sites.

Domingo said that RxBox, a multipurpose device, is a potential solution to extending health services to remote areas. It has medical tools, and electronic medical record system and communication features for telemedicine training. It can also transmit health information via internet to a clinical specialist in the Philippine General Hospital for expert advice.

Another range of medical services was also made available in a rural hospital in Buda after the deployment of a digital health platform by a Luxembourg-based satellite operator.

After three years in the making, SATMED, a range of health tools that medical professionals in remote areas can use to deliver services, was launched to augment the existing services of the hospital of German Doctors for Developing Countries in Buda, Marilog District.

This technology, the first of its kind in the country and in Southeast Asia, is created by satellite operator SES, in partnership with the Luxembourg Ministry of Foreign and European Affairs.

“SATMED will allow German Doctors to enhance healthcare provision and deliver accessible e-health services to remote communities in Mindanao,” said Glen Tindall, SES vice president of sales in Asia-Pacific.

Focus on mental health

Councilor Mary Joselle Villafuerte said earlier this year that she is looking to create a mental health unit under the City Health Office to be able to create programs down to the grassroots level.

Villafuerte, chair of the city council committee on health, said during the opening of the National Mental Health Week last October that this unit take shape in the next six months in line with President Rodrigo Duterte’s announcement of the country’s health agenda.

The proposed unit will also create jobs for psychologists and psychiatrists in the city.

“I want to create positions for the mental health unit of the CHO,” Villafuerte said, mentioning that there will be psychologists and psychiatrists per district who will spearhead programs on mental health in the barangays.

She added these personnel will be the ones who will go to the communities and organize teams in barangays that will help bring services to people may have mental health issues.

Villafuerte is authoring an ordinance that she hopes can institutionalize mental healthcare in the city.

Davao City’s Mental Health Code of 2016 is being drafted in the city council.

The ordinance hopes to adopt “an integrated and comprehensive approach to the development of the city’s mental health care delivery system.”

The system aims to deliver appropriate services and interventions—from care to protection and treatment—to those with mental illnesses and disability.

Villafuerte also hopes that the ordinance will also promote a shift from a hospital based system to a strengthened community based mental health care delivery system. This will allow more people to access services in their areas.

“Mental health has long been an overlooked aspect of health care,” said Dr. Louie Lacno, a former resident physician at the Southern Philippines Medical Center’s Institute of Psychiatry and Behavioral Medicine (SPMC-IPBM).

There is no law that protects patients from recurring stigma, and there are not enough doctors in the profession.

Sara’s little angels

Last September, Mayor Sara Duterte also announced the “fetal demise” of two of the triplets in her womb. She said that doctors told her that heartbeats were no longer detected from the two babies. She learned of the sad news after making rounds at hospitals, visiting the victims of the September 2 Roxas night market explosion.

CIO head Jefry Tupas, in an interview with reporters, said the identical twins suffered a “fetal demise,” around three months in Mayor Duterte’s pregnancy.

Dengue management

Mayor Sara Duterte earlier this year also threatened to withhold the holiday incentives of some employees of the City Health Office (CHO) as the body count from dengue continues to soar.

From January to June, CHO has recorded over 4,000 dengue cases.

The mayor blamed the Tropical Diseases and Prevention Control unit of the CHO, which is handling diseases like dengue, for these deaths.

“I think the tropical diseases unit of CHO will not receive their bonus. I will give their bonus to the families of those who God forbid will die in the next six months,” she said in a press statement.

In December last year, plantilla workers received as high as P12,000 as Christmas bonus from the local government unit.

Mayor Sara also threatened to suspend and replace employees of CHO if it could not arrest the rising body count caused by dengue. The mayor wants zero casualties from July to December.

The head of CHO assured the public that they are on top of the dengue situation despite the alarming toll from the mosquito-borne disease.

“We will be doing our part,” said city health officer Dr. Josephine Villafuerte. “Once we control the number if mosquitoes, the cases will decline.”

Villafuerte explained that the reported dengue increase that was noted by her office was only attributed to the advent of the rainy season. She added that consistent rains made it conducive for mosquito colonies to proliferate.

She said that mosquito eggs can stay in dry surfaces and the increase in cases from January to July have been due to how these eggs survived the dry season from 2015, and hatched in the first half of this year.

She assured that the prevention efforts are in place, and was expecting for the suspected dengue cases to decline by September and October.

“We can’t stop the rain from coming but we can stop the colonies from proliferating,” she said. “We are hoping that the barangay officials and residents will do their part, too.”

By December, all city hall employees still received their bonuses.

Helping hands

Efforts from private groups will also be remembered.

A civil society organization this year partnered with an American hospital in the city to add support and referrals to medical outreach programs and services.

The Junior Chamber International (JCI) Davao inked a partnership with CURE Philippines, Inc. to further bring the services of Tebow CURE Hospital to a wider range of indigents throughout Mindanao.

JCI Davao member Ernesto Jose Reyes said that the main objective of their partnership is to emphasize delivery of medical treatments through their network. By doing so, he said that they can provide corrective surgeries and interventions to JCI Davao-referred children.

Reintegration of drug surrenderers

Drug surrenderers were trained by the city’s Disaster Risk Reduction and Management Office to be emergency responders.

At least 30 drug surrenderers, trained under a reformation plan by the PNP’s 11th Regional Public Safety Battalion called Disaster Action Team (DAT), are poised to be reintegrated back in their communities as disaster volunteers responders.

The drug surrenderers, aged 17 to 35, are from barangays in the city that are identified as disaster prone areas in the city: Tigatto, Ma-a, Matina Pangi, Matina Crossing, Matina Aplaya, and Bucana.

DRRMO chief Emmanuel Jaldon said that efforts of his department will also be directed to support programs of the City Anti-Drug Abuse Council (CADAC).

“Disaster response trainings will be incorporated in the aftercare program of drug surrenderers,” Jaldon said. CADAC has so far recorded at least 9,322 drug surrenderers as of October 5.

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