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.

Soul-seeker

“What is your specialty, Doc?” I got asked this question by a wide-eyed, enthusiastic third-year student in the medical school where I teach.

“I think I can call myself a public health specialist,” I replied.

“But did you take up residency?” referring to the usual post-graduate clinical specialty track taken up by majority of medical graduates.

I relented. “No, but I took a master’s degree in public management for health systems. I’d say that would be my post-graduate training.”

“Then, Doc, you are a soul-seeker.” He explained that he considered as such those medical graduates who have not pursued residency. I tried to suppress a look of shock. “I guess I am,” I replied.

What disturbed me a bit in that encounter was this realization: that, as far as majority of people I know are concerned, the choice to exclusively pursue an academic or research career after pursuing a medical degree is still considered a transitional career choice towards a goal of eventually obtaining a clinical specialization. I cannot blame them.

To be fair, he is not entirely incorrect. I had just come from an almost yearlong hiatus in my academic career, having come from a live-in vocation discernment program for men considering religious life. I ended up not getting accepted to the religious order I had desired, but my experiences in discerning my true calling bolstered my conviction that my calling is in the academe. Soul-seeker I really was, in this sense. But I digress.

That encounter made me think hard. By now, and especially after my yearlong discernment last year, I now have a stronger conviction for my career choice; that, instead of pursuing the conventional career path of clinical specialization, I am choosing an academic one. Instead of aiming to become a specialist in, let’s say, surgery or psychiatry, I am aiming to gather enough academic exposure and experience to earn a professorial chair instead.

My colleagues in the medical school faculty, majority of whom have finished their respective residencies, have told me that I can do both anyway. But for the past few years, I realized that, as a medical graduate orientated more towards a population-health perspective, going through the path of clinical specialization would introduce bias in the way I would do my public health work and advocacies.

This leads me to one instance three years ago, when my former research institute director asked me this question: are you geared towards specializing in ‘content,’ or in ‘process’?  He further explained that specializing in ‘content’ would mean studying all aspects of that field, exclusively, with the expected consequence of getting heavily invested in a topic. If that would be a field like road traffic injuries, that would require studying factors that affect it, its special considerations, its prevalence, and even how it affects popular culture.

My director told me that doing so for a particular field would open up a Pandora’s box, and would lure me towards studying the field further, and potentially ignoring other important public health matters. I’d now call it an option of getting attached to a particular topic. Nothing bad with this at all, he said, but it represents a lost opportunity to study about other health concerns that pose similar risk to the general population.

On the other hand, it is his explanation of specializing in ‘process,’ that attracted me. It meant that I had to specialize in a particular way of analyzing public health matters, like epidemiology, health technology assessment, or even philosophical analysis.

By specializing in epidemiology, the study of how diseases spread, I gain tools that can analyze how much of the Filipino population would be prone to any health risk.

By specializing in health technology assessment, I gain the skill of assessing which intervention would be the most economical and answer questions like these: for instance, would implementing a large-scale healthy lifestyle program lower down the percentage of the population suffering from high blood pressure, or a government-sponsored distribution program of medicines? What is the more economical option?

Finally, by specializing in philosophical analysis, I can explore how lifestyle diseases, or any health matter in general, can ultimately come from the individual’s ability to reflect on his daily existence, to make logical and ethical decisions, and make sense of his role in the world at large.

These three modes of ‘process’ that I have been exposed to can be applied to any public health topic, which makes it possible for me to affect the lives of people millions at a time. When I decided to pursue medicine, my goal was to help as many lives as possible. I now feel that by choosing to specialize in ‘process’ and not ‘content,’ I can potentially contribute towards solving any health problem by using a particular way of analyzing the problem. I just had to know what problem needs to be analyzed. This required frequent introspection, zooming out from the situation, as well as sensitivity towards concerns that impact the general population. I know that by specializing in ‘process,’ I am becoming the kind of doctor I want myself to be.

However, I also realize now where specializing in ‘process’ led me. It eventually led me towards an appreciation of discernment, and even led me to think that perhaps a life of continual soul-searching within a religious context was for me. But events and circumstances led me towards where I am now, and I was never this affirmed of where I am called to serve.

Notwithstanding, my experience in specializing in ‘process’ also points to me that I have to free and zoom-out myself enough so that I can serve as many people as possible: my personal definition of why I am a doctor in the first place. Needs and circumstances change rapidly, however. This inner search should therefore be a way of life. Specializing in ‘process’ led me to be what precisely that student called me that fateful afternoon: a soul-seeker.

This leads me to pay attention to what is happening in the Philippines nowadays. I think that we are beset by problems that are mostly resolved by focusing and getting heavily invested on the situation, instead of looking at it from a non-biased, zoomed-out perspective. My experience in public service tells me that government can only do so much within its means, but my renewed perspective in studying ‘process’ also reminds me of the value of unbiased points-of-view.

Moreover, I think that as a nation we need to have a better sense of our identity. Specializing in a particular ‘process’ of resolving matters of national importance is one part of making sense of this identity, but I think that we need to search for what is indeed our soul and our purpose as a people. I learned that one leads to the other. Perhaps we need more people who specialize in ‘process’.

In sum, I never realized that such an innocent question from my student would set me off towards rationalizing my career choice and my reasons for choosing ‘process’ over ‘content,’ and realizing how the study of ‘process’ requires continual discernment. Continual discernment requires that, imperfect as I am, I should have the attributes of a soul-seeker in good faith: resolute, passionate and untainted. These are attributes that I am not so sure now if I can confidently claim them for myself.

I take solace that being a soul-seeker was who I am in the eyes of that student of mine. I hope he is right after all.