Decisions, decisions

In my tenure as a municipal health officer, there were two things that demanded much patience and diligent preparation.

One was whenever I would propose a project to the municipal council, in which case I had to write project proposals, talk to stakeholders and check with the budget officer, accountant and treasurer if my office still had enough remaining funds.

But for me, a more important and challenging task is this: deciding how to apportion the allotted budget for the coming year. It should be a well-informed and well-decided process, since a well-planned budget stands to benefit a lot of people.

The task of proposing a budget is one important application of decision science: what would influence an important decision, especially if people rely on it?

Another is deciding how much medicines to request from the health department. To give a backgrounder to this arrangement, in the Philippines, the funding and staffing of health offices at the municipal level have been devolved to individual local  governments. The national department of health (DOH) only provides technical assistance and augments resources by providing medicines and facilitating upgrade of health facilities.

One program the DOH implemented during my tenure was the Complete Treatment Pack program, in which medicines are packaged not by bulk nor individually; they are packaged with the goal of providing the complete course of treatment for patients, especially important for antibiotics.

For instance, a patient requiring amoxicillin, a medicine for bacterial infections, will receive enough medicine to complete the recommended treatment: three capsules every eight hours for seven days.

But this program has a list of drugs to request. For me, the difficulty of relying on previous health statistics to decide on this is the possibility of running out medicines if in case an outbreak occurs. This is why making decisions like this should also consider the context of the target communities: what are their potential exposures? What are their lifestyles? Would I have a good reason to get ready to treat many patients with non-communicable diseases?

Decision making is an essential skill in public health, and it should not just be made out of the desire to exert power: it should be based on what the community really needs.

Who is a barrio doctor

A few days ago, while mentoring junior medical interns doing their community medicine rotation, I received a text message from a fellow doctor-blogger. It wasn’t good news.

Jim pls check out FB and twitter another DTTB killed

Still reeling from the impact of the yet-unresolved killing of Dr. Dreyfuss Perlas, who graduated from the Doctors to the Barrios program one year after I did, I barely managed to keep my composure as I excused myself and caught up with the news. It turned out that the victim was Dr. Jaja Sinolinding, brother of DOH-ARMM secretary Dr. Kadil Sinolinding Jr. Dr. Jaja and his security escort were shot Tuesday morning, 18 April, by a gunman who had pretended to be a patient in his Cotabato clinic.

Notably, as news about the tragedy spread through news and social media, Dr. Jaja was tagged by DOH Secretary Dr. Paulyn Ubial as a “barrio doctor.”

Strictly speaking, at the time of his murder, he wasn’t part of the DOH Doctors to the Barrios program. He was an ophthalmologist who chose to establish his practice in Cotabato instead of putting up shop in more affluent areas in the country. His death has shown that the risks of serving the underserved do not only affect physicians who have chosen to join the Doctors to the Barrios program, nor those who became municipal health officers or rural doctors. It affects all health professionals, regardless of one’s specialty, as long as one has chosen to unflinchingly stand up for what is right.

Notwithstanding, in my opinion, amid the horrific circumstances of his supreme sacrifice and despite his specialist affiliation, Dr. Jaja has affirmed what it really takes to be a “barrio doctor.”

By choosing to put up practice in the provinces, he shared in the commitment to provide care to the underserved, despite the risk. Dr. Jaja provided free consultation services, and, as affirmed by people who worked with him in Cotabato, was a well-loved doctor.

By choosing to consider medicine as service and not a means for personal profit, he shared in the commitment to ensure that health is accessible to all.

Finally, by choosing to serve despite existing threats, he exhibited unparalleled courage.

Definitely, he was a barrio doctor.

A barrio doctor who, along with Dr. Perlas, deserves swift justice.