Engaging people

Public health is essentially a field that requires engaging people. But in my years of working in public health I realized that engaging people does not only entail having to design policies and programs, and promoting them to the people who will benefit from them. Instead, I learned that I had to listen to the people, and cater to their actual needs.

These needs aren’t what you usually ask in relation to the programs one plans to implement. You don’t go out and ask people around their knowledge, attitudes and practices related to vaccination, for instance. What’s needed is knowing their context, their culture, and their daily life.

In my two years in the field, while implementing programs for preventing non-communicable diseases, I realized that the right question wasn’t about their attitude on taking maintenance medications. The right question to ask was what has been leading them to an unhealthy lifestyle. I’ve found that answers to this question come from precisely these: their context, their culture, and their daily life.

In the Cordillera region, for example, in my practice I’ve been seeing a lot of people with elevated blood pressure. I’ve come to know that this trend was not really attributable to the failure in taking maintenance medications. I also didn’t think that exercise was a problem: navigating daily the difficult terrain was more than enough. However, because of the Cordilleran preference for meat and salt, some of my patients not only develop hypertension, but also develop gout and kidney disease.

This is also similar to my experience with an urban poor health program, shown in the picture, where non-communicable diseases are related to food choices, as well as lack of safe spaces to conduct healthy lifestyle activities.

The clinical approach is usually to respond with medications. What appeals better to me is the public health approach: nip the problem at the bud.

In the case of my host municipality in the Cordillera, we instituted a program for monitoring blood pressure, blood glucose, and cholesterol, in cooperation with senior citizens and the local women’s organization. In turn, the municipal employees’ association and our nurses implemented a healthy lifestyle campaign that focused on increasing physical activity through zumba dancing. We launched the campaign in what would be the best date for cardiovascular health: Valentines’ Day, 14 February. The Department of Health has since implemented a similar approach nationwide.

Meanwhile, in the case of the health program with the urban poor, we trained health workers in monitoring blood pressure and vital signs, which is the first step in recognizing the presence of health issues in the community.

It’s a source of pride for me that my host municipality did it first in the province. I plan to go back and monitor its progress within the context of a research project, but with the pictures I see on Facebook, I’m happy the effort has survived after a few years. Similarly, the effort with the urban poor health program blossomed into a corps of community health volunteers. The long-term impact of our little training program remains to be seen and the efforts need to be sustained further, but I am happy it has impacted positively on the health-seeking behavior of the community.

All because of a genuine interest in the lives and well-being of people.

All because of engaging people.

The Interview

(originally published 30 January 2009)

I just sat for an interview this morning.

Last night, as I stayed for the night in my friend’s condo unit, my mind was already filled with questions about my future and about what I am to do with my life after, God willing, I get my medical license and become a full-fledged doctor. I wondered if the decision I made earlier that day would finally answer those.

There had been an intense urge, since that day began, to do something that will change my life forever. I eventually felt this urge being satisfied as I finally walked in the scholarships office and signified my intention to apply for a unique scholarship program.

Admittedly, half of me wanted the benefits. These times are tough times for me and my family. Petty quarrels have been becoming quite frequent at home, because of how that very precious wad of bills is being spent. I felt badly that I had to do something about it.

Initially, I did just that by entering a business venture with some fraternity brods. During the past months I had built a business of my own, which was grounded on the principles of free-enterprise and private franchising.

But, now, it seems to me that prospecting and showing business plans occupies too much space in my already complicated mind. My ideas and feelings about building a business may change in the future, but I really feel that I have to focus. Right now I wanted to fixate my mind on this objective: To study hard, and become the best doctor I can be for other people.

This time, I wanted to find a way to augment the family’s finances without having to lose my focus in becoming a dedicated physician. With this in mind, I finally applied for a scholarship grant that will take me to a far-flung area right after passing the medical boards.

Yesterday I had been told that the interview will start at 7, and found the day opportune to staying for the night at a nearby condo unit of a close friend. Just this morning I readied myself, imagining what questions will be asked and what expectations are to be met. I tried to answer each question sincerely and with heart.

I told them how much I would risk to serve my nation. As corny and as patriotic this may sound.

I told them how much I felt ready to be part in building the nation one rural health unit at a time.

And I told them, that in the future, I want to establish a medical practice that will make my family and friends proud.

Right after I sat for the interview, I called my parents and thankfully I heard from them how much they supported me for a decision I made on my own: to pledge two years or more of my life to serving the underserved. I have yet to discuss these personally, I am still here in an internet joint across the college, searching for experiences of people who have trodden this path ahead of me. Some reassuring, others even discouraging.

But all of them, heroic.

I know, I am not yet leaving for an island town or a barrio nestled in the middle of the Cordilleras. But it is quite a different feeling waking up early in the morning and doing one’s daily tasks in the hospital while thinking of the future two years that you will spend in the barrios.

I have been told that the slot will be secured once my parents give me their blessing.

I can’t wait to talk about it with them tonight.

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EPILOGUE: I did get assigned to the Cordilleras. I have been at times doubting my motivations, even to the point of questioning myself why I did this. But after reading this and looking at the pictures of the areas I’ve served, absolutely no regrets.

Why health policy

Today I’ll be writing about the reason why I’m in health policy, which is a reseach-oriented field that responds to health needs through policy interventions such as laws, guidelines and rules.

For me it wasn’t crystal clear that it’s something I wanted to pursue as a career. It developed out of a desire to be helpful to more people.

It was a usual morning in my clinic. I was assigned as a municipal health officer in a mountainous region in the north of the country. I usually arrive in the clinic seeing patients already in line to see me, most of them having crossed hills and mountains to see me.

Normally, I try to greet them with a welcoming smile, looking forward to listen to their stories but also concerned about what ills have forced them to see me. I see the kindly old lady from the nearby village, following up for her usual blood pressure check-up, who greets me with a warm smile and an enthusiastic nod whenever I ask her to take her medications. I see a couple coming for advice on their family planning options. I see babies brought by their mothers for their vaccination.

Then I saw this middle-aged man, with impending doom written on his face, holding a plastic envelope containing various documents. It turned out that he wanted to seek advice about an important concern: how to pay for his hospital bills.

To be fair, the existing national health insurance system has paid for much of his bills. But he still had to pay for a few thousand pesos, which he cannot produce within the week alloted for him to pay his balance. I advised him that perhaps he just needed to see a social worker who can refer him to the proper channels for financial support.

But that was an encounter that got me thinking. I thought:

“What is the point of prescribing medications and treatment plans to patients who can’t afford them in the long run?”

I then realized that perhaps health policy was a good career after my stint in the health center. Not because it was a lucrative career option, but because I knew that I could at least work towards making sure that patients achieve better health because the health system works for them.

After my two-year experience as a municipal health officer, I received an invitation to apply for a researcher position at the Institute of Health Policy and Development Studies, a research institute under the aegis of the National Institutes of Health in UP Manila. With my director, I had the opportunity to do research on health insurance, health management and human resources for health, aspects of the health system which directly affect the health of patients in public health facilities.

Now, a few years have passed since I made the decision to pursue health policy as a career. I have been given the opportunity to present my work in some fora, gotten the chance to network with like-minded people and broaden my knowledge in dealing with complex health policy issues.

But I still wonder about that man who approached me in the clinic years ago. I think the best measure of my success as a health policy researcher is whether or not I have done something that directly impacted him and millions like him. The task is far from over. In fact, I think I’m just getting warmed up.