Wednesday, September 24, 2014

Five Activities for your Health Ministry

Empowering the people to take care of their health is a great strategy for any organization or church health program. It is not like the one-and-done big time medical missions common today. This strategy focuses on prevention which is more cost-effective and has greater impact to the community.

Here are five activities that the church can do to improve the community's health status:

1. Health Forum and Workshops

The church can host a forum on pressing health concerns in the community. This can be an educational forum to teach practical ways on how people can take care of their health. During this rainy season, the church can sponsor a Dengue Information drive in the community with practical tips on how to search and destroy mosquito breeding grounds.

Capacity building workshops and trainings for BHWs, mothers and volunteer health workers can also be sponsored by churches. This helps improve the skills of the people in taking care of their own health. I saw this when I was invited to teach mother, newborn and child health to a successful community-based health care program in Compostela Valley.


2. Vaccination

The church can partner with the local barangay in its vaccination program. An example would be the recent campaign for a Nationwide Measles and Polio Vaccination where local churches and organizations provide the venue and logistical support in the campaign. Another example is flu vaccination. As this is not routinely given for free in the health center, the church can make this one of their annual programs. The church can offer this at a cheaper price. One church in Kamuning, QC even offered flu vaccination for free to around a hundred adult members of the community.


3. Advocacy Programs

Advocacy is an activity with the purpose of persuading leaders to make policies or allocate budget that will benefit the greater good. The church can lead in prayer rallies and advocacy walks that will involve the community in persuading their community leaders to choose what is beneficial for them. In one barangay in South Cotabato, the captain was persuaded to issue a Barangay Ordinance prohibiting minors from buying cigarettes in the store after the church led the community in several dialogues with the barangay leaders.


4. Regular Health Monitoring  

Non-communicable diseases are the new epidemic that affects even middle-class and low-income families. Free BP checks and quarterly sugar (FBS) screening can easily be done before worship service starts on Sunday morning. Mega-churches and big congregations can schedule this as a Saturday church program in the community. Many evangelical churches are doing this to benefit the community.


5. Food always in the home or FAITH.

This is the name of a vegetable garden program by a faith-based organization. It uses the backyard lot of a church as a community vegetable garden where the whole community is encouraged to plant vegetables in the garden and the produce is free for the whole community. The program also teaches backyard home gardening with the church providing the seeds for free.


The health spectrum ranges from preventive to curative care. Researches has been proven that the church can have a great impact in Primary health care and the prevention of diseases. (See my next post on this topic.)

What I listed are just five activities that any church or organization can do to improve the health of the community. I have seen this work in some churches, so it can definitely be done. What other health programs do you think your church/organization can do?


 

Saturday, September 20, 2014

Three Reasons Doctors Do Not Join Medical Missions

It is becoming difficult for organizers to get doctors to join them in their medical missions. I am not an advocate of medical missions. Before I give you the reasons why, let me clarify that what we mean of medical missions are the trend today of one-time events of medicals consults and surgeries with giving of medicines to patients as a tool for achieving something else. Med missions are sometimes beneficial especially during emergencies but other than that, it is an ineffective practice.


Here are three reasons why:

1. Medical missions do not address the health problem.

The medical management does not address the cause of the problem. A patient may come in with Tuberculosis due to the poor sanitation of the area, or poor nutrition, or poor hygiene habits. The current trend in medical management today is holistic approach wherein the doctor not only intervenes at the medical condition of the patient but also considers the other factors surrounding the patient. These factors include the mental, social and spiritual factors. Medical management also includes patient education on how the patient can improve her living condition, environment, lifestyle and other things more than just taking the prescribed medicines. This may not be possible as time is not a luxury during med missions. Also, some cases like TB needs further patient care which leads us to the second reason.

When Jesus healed the lepers, he restored their relationship with society. Remember, patient care is more than just treating the disease.


2. Medical missions do not provide continuing patient care.

Proper medical care is continuous and personalized. When medical missions are one time event, it does not allow for patient to follow-up with their health care provider for continuing care. Imagine the popular summer medical mission providing free circumcision to young boys. If complications happen to the wound, how will the boy get follow-up care from the healthcare giver? Even if complications do not happen, the healthcare worker are ethically bound to continue care to the patient until they are well. This will not happen in one-time medical missions. Because of time constraints, personalized care are seldom given to patients.

When Jesus touched the sick, he touched their lives and they became his friends. Remember, the doctor-patient relationship is a contract of trust for care not for a one time meeting.


3. The ultimate goal is not patient well-being.

While medical missions looks into the health condition of the patients, the intent of the mission is not always the person's health. It is an open secret that politicians sponsor medical missions with the real intent of campaigning for people support. Churches sponsor medical missions as an evangelistic tool to persuade people to become Christians. Organizations sponsor medical missions as an outreach activity to gain prestige and recognition. There are other reasons individuals and groups sponsor medical mission but few are intent in addressing the health needs of the people. If the intent is to help people achieve good health, then they know that a one-time medical mission is not enough.

When Jesus came to heal the sick, his purpose was to heal the sick. Remember, health is an end not a means.

It is unethical for doctors to violate the principles of medicine. So, like most of my colleagues, I may decline invites in your one-time big time medical missions.

There maybe some benefits to the med missions but we can do better. I can name 5 health ministries churches can do. It is high time we level-up what we can do to improve the health of the community.



 

Thursday, August 14, 2014

Three Ethical Dilemmas on Ebola Virus Medicine

The Ebola Virus outbreak in West Africa has put the spotlight on ethicists. As the health world scrambles to address the problem, bioethicists are also facing ethical dilemma related to Ebola. It is a well known fact that the Ebola virus has not treatment and no vaccine available in the market today. But there are several pharmaceuticals racing against each other to develop a medicine against it. Last week, the US government tested the new drug ZMapp on two Americans infected with the virus. There was a public protest on why the medicines were given to the Americans and not made available to the general public. This raised several ethical issues.

Here are three of the biggest ethical issues that we all need to consider.

1. Is it ethical for us to use vaccines and drugs against Ebola that has not been adequately tested on humans?

So, here is the dilemma. The drug, as reported, is still on trial stage. There has only been the animal test phase. No human trial for its safety and efficacy has been done. The ZMapp given to the infected Americans, at its best, is a human research to its efficacy. Although, early reports showed positive response to the drug, there is no conclusive evidence to show it is effective. Would it be proper then to subject thousands of people to this medicine without knowing its effect to humans?

I will not even dare elaborate on another ethical if not racist issue behind this. Suffice for me to ask the perennial questions, why are experimental drugs done in third world countries? Why subject Africans to experimental drugs with unknown risks or benefits?

The WHO ethics panel agreed that it is ethical to use experimental, non-approved drugs to fight the Ebola outbreak. They reasoned that this outbreak is a special circumstance that needs special consideration. A research protocol needs to be followed in doing human research. Are we following the proper protocol in using these experimental drugs? Human research requires that the risks and benefits to the person should be weighed. Without knowing the gravity of the risk nor any benefits it can provide to the patients, would it still be ethical to provide these medicines to humans?


2. Who would receive the limited number of this new Ebola medicine?

The second, and perhaps the most difficult, ethical dilemma is sorting out questions on the principle of justice - specifically distributive justice. Who should receive the new Ebola medicine? Pharmaceuticals have reported that they have only more than a dozen of medicines available ready. Regardless of problem #1 being resolved, the medicines are now sent to West African countries. It's now time to give them to the people affected by Ebola. As of this writing, WHO has reported that more than 1 million people are now affected by Ebola. Who among them would receive the 12 or 15 or 20 medicines?

There are 4 countries severely affected by the Ebola virus - Guinea, Liberia, Nigeria and Sierra Leone. Who among these countries should receive the most of the available medicine? Should it be the closest ally of the western world? Should it be the country with the highest death toll? Where should the pharmaceuticals developing the medicine send their products? When they have settled that issue, more ethical questions needs to be raised. Who would be the blessed people to get treated first? Two Liberian doctors are going to receive the experimental drugs. Why the doctors? Why not the mother of 8 children whose husband recently died also of Ebola?


3. Why raise the ethical dilemma for the Ebola stricken West Africa?

The third maybe a little difficult for me to explain. This was raised by my Nigerian friend which I am now only beginning to understand. I will try my best to make it simple. When the ZMapp medicines were given to the infected Americans, there was no ethical question about it. It did not bother WHO to convene a panel of ethicists. In reality, experimental medicine are given almost anywhere. Here in the Philippines, stem cell therapy is on top of them. When a patient willingly consents to receive an experimental drug, no one bothers to stop them because it is still experimental. Yet, in the case of the Ebola virus outbreak, the world has to pause and reconsider giving the drugs. At a time where the affected people are crying out to give them anything - even experimental drugs - to stop Ebola, the world has to bring up ethical questions.

Yes, for some people - especially those who desperately need them - to second guess giving a "potentially" helpful drug is tantamount to withholding any hope of cure. Are there underlying reasons behind the hesitancy? Is money an issue? Does the financial gains and costs holding the world back? Are we really concerned about the efficacy of the drug and the safety of the sick people? Are we really being ethical about this?

Friday, August 8, 2014

Three Reasons Why Doctors are Poorly Compensated

Medical ethics tells us that "(T)he primary objective of the practice of medicine is service to mankind..." This principle has been abused to justify poor compensation for doctors with their work. There is injustice. This is specially true for young doctors who receives retainer fees or compensated for the number of hours rendered. But what is the doctor's service worth? If its value is measured monetarily, how much would it cost?

The first and most common argument thrown is that, "medicine is a service and should not be profit-oriented."

It seems to me that the assumption here is that only those that are cheap and free are considered a service. If you receive good money for a service rendered, that becomes profit-oriented. So doctors are made to believe that it is okay for them to receive little to no compensation for their service rendered. If doctors earn good money for their practice, they are not serving humanity.
This is where the professional fee for the professional service given becomes important. Of course, doctors are either compensated with either retainer fees or fee-for-service. But in general, what is a fair fee for the service rendered by the doctor? What will be a "just compensation" for doctors?
The PMA says the "(P)rofessional fees should be commensurate to the services rendered with due consideration to the patient’s financial status, nature of the case, time consumed and the professional standing and skill of the physician in the community."  They also explained that for self-employed professionals, there is no universal fee. It depends on the prevailing and acceptable fee among the practitioners in the community.

If there is an acceptable fee, why are doctors poorly compensated for their service? Again, this may not be true for fee-for-service doctors with good practice. But this is especially true for many young doctors on retainer fees/per-duty fee or resident physicians.


The second reason, doctors are told that the hospital can only afford to compensate them with a small amount for their service. It's either the doctor take it or leave it. Let me illustrate further:

I am looking to hire a helper in our house (pun intended.) She will help cook the food, wash the dishes, clean the house and wash the clothes. I will need her services to have a decent and clean place. For such services, the acceptable rate in our area for helpers is P3000 a month. (Don't ask me where I live.) I can only offer P2000. Although the acceptable rate is P3000, the prevailing rate and the most common rate offered is P2500. Well, times are tough. It's difficult to get a job. I know people need the money. If they don't want P2000 a month, then they don't have to accept it. I am not pressuring them. I am just offering it to whoever is willing to offer their service for that fee. Is it just for me to offer compensation for the service I know is worth more than that? Is it my fault if there are people willing to receive such compensation for their service?


The third and most important reason why doctors are poorly compensated is because NO ONE CARES. Not even the doctors.
 
Maybe because of reason 1 and 2. But this injustice perpetuates because no on is standing against it. A learned prophet once taught, "Learn to do good; seek justice, correct oppression... " (Isaiah 1:17).
 
The injustice must stop. People must do something against the unjust practices. Desmond Tutu famously said, "If you are neutral in situations of injustice, you have chosen the side of the oppressor." We must take sides now. No, one or two person cannot do it.  There needs to be a collective effort to stand against it. The government, the health industry, hospitals, doctors and even patients must do their share. Together, change can happen.

Doctors still do service to humanity. But what is its value to you?

Monday, July 14, 2014

Three Messages That Tells Me My President is Arrogant

Tatlong mensahe na nakuha ko sa DAP explanation ni PNoy. Three things that I heard from what PNoy said about his DAP explanation.

1.       “Presidente ako, kaya puede ko gastusin ang pera ng kahit sino”
-          The President can use and transfer the use of any savings from other appropriated budget according to the Administrative Order he has cited. It doesn’t matter whose money is it, the Philippine president is the most powerful person in the country and so he can touch and use anybody’s money whenever he wants to. It doesn’t matter if it was indeed appropriated and approved by congress, the president can appropriate the money according to his own budget. After all, DAP is not PDAF. According to PNoy, hindi naman pumunta sa NGO ni Napoles ang DAP kaya magkaiba yun sa PDAF. Regardless if the budget were diverted illegally, napunta naman sa mabuti kaya OK lang na i-manipulate ang budget appropriations.

2.       “Mali sila, dahil tama ako.”
-          The Supreme Court is wrong in their decision for the simple reason that they do not agree with the President’s interpretation of the law. It implies that only and only the President’s understanding and interpretation of the law is the correct interpretation. Any other interpretation by the 13 magistrates who have dedicated their lives in studying and upholding the law are definitely mistakes. I can even hear the threat to the SC, when he said “gusto nila ng personalan.” I will not wonder if another “Corona Impeachment” will happen to any of the justices sometime soon.

3.       “It’s okay to disobey the law, as long as your intentions are good.”
-          Obviously, for PNoy, the end justifies the means. Yes, even if it means breaking the law. Using the example of parking on a “no parking zone,” PNoy justifies that even if DAP was deemed illegal, it is still to be lauded for the good intentions of the program. We should not wait for another two years following proper procedure to use the money saved. Forget the bureaucratic procedure. It is okay to disobey the law, as long as one aims to help the needy. It is okay to beat the traffic light because you are rushing to help another. It is okay to steal, because you will give the money to the poor. It is okay to kill a person because you will save the innocent. I can hear PNoy shout at me saying, “Let us forget the law and order, and do what is convenient in the guise of doing good towards a matuwid na daan.”

Thursday, June 19, 2014

Para Kay Pepe sa Iyong Kaarawan

Pareng Pepe,

Isang maalab na pagbati mula sa mga bagong bayani. Oo, mga bayani daw kami. Hinahanay kami sa mga katulad mo at ilan pang nagbuwis ng kanilang buhay para sa ating bayan. Marahil tinawag kami ng gobyerno na mga bayani dahil inaaasa nila sa amin ang pag-angat ng bayan na dapat sana'y kanilang sinumpaang tungkulin. Ngunit ang liham na ito ay hindi pagpuna sa kakulangan ng gobyerno. Mahirap pag-aksayahan ng panahon ang hindi nagbibigay ng tamang panahon para sa iyo. Nais ko lamang gunitain ang iyong kaarawan bilang tanda ng pasasalamat sa Poong Maykapal sa ginamit niyang buhay bilang huwarang Kristiyano upang mapulutan ng aral ng kapwa Pilipino.

Ang iyong dedikasyon sa pagpapahalaga sa kapakanan ng iyong kapwa Pilipino ay tanda ng isang mabuting Kristiyano. Katulad ng isa sa mga mahalagang pangaral ni Hesus, "mahalin mo ang iyong kapwa katulad ng iyong sarili, (Marcos 12:31)" ang buhay mo ay naging halimbawa ng aral na ito. Hindi mo inalintana ang mga puedeng mangyari sa iyo, sa iyong pamilya at sa sarili mong buhay alang-alang sa ikabubuti ng maraming Pilipinong nagdurusa sa pang-aabuso at kawalang ng hustisya. Nagbunga ang iyong mga pasakit at nakalaya nga ang iyong bansa mula sa mga dayuhang mananakop. Ngunit nakalaya nga ba sila sa mga pahirap ng pang-aabuso at walang katarungan?

Ang tinuro sa iyo ng nanay mo na magdasal sa Diyos ay dala mo hanggang sa huling hininga mo. Hindi ka nakalimot sa iyong Diyos sa lahat ng pagkakataon lalo't higit sa mga panahong ikaw ay sinusubok. Ang tunay na Kristiyano ay laging inuuna ang kanyang Panginoon sa lahat ng bagay. Hindi ka nakalimot sa kung ano ang tunay na mahalaga. Nang ang simbahan ay lumihis sa turo ng Biblia, binatikos mo ito. Hindi ka lumayo, bagkos ang pag-ibig mo sa Diyos ang naging dahilan ng pagtuligsa mo sa mga mali na iyong nakikita. Hanggang sa huli, nananalig ka sa Diyos at siya ang iyong naging sandalan. Ang paglapit mo sa Panginoon sa huling sandali ng iyong buhay ay tanda ng mataimtim na pananampalataya na dapat tularan. Ang hinahon ng Diyos ay bakas sa iyong mukha bilang tanda ng lubos na pagsuko ng iyong buhay sa Kanya.

Ikaw ay bayani. Ngunit huwaran ka ding Kristiyanong matuturing. Nawa'y ang iyong halimbawa ay makita at maging inspirasyon para sa mga sisibol na tunay na bagong bayani.

Wednesday, May 28, 2014

A Daughter's Love for Her Mother: A Kidney Transplant Story

I just want to appreciate my sister who donated her kidney to our mother who has end-stage renal disease. God has a plan but we never saw it.

When there was too little option for a donor for our mother, we started looking for relatives. Although it may have higher chances of familial disease, we had to take the chance. Now there were only a handful of our relatives who were willing to donate their kidneys. You can count them on one hand. However, all of them failed the matching test. Then we started looking to those people beside us. We candidly asked ourselves, would anybody from the family would like to donate a kidney to mom?

How much does a child love one's parent when the child is not willing to donate a kidney? Would donating a kidney a test of a child's love to one's parent? Maybe not. But how much then does the child love the parent?

A child choosing not to donate a kidney to one's parent is not a measure of a child's love to the parent. But donating a kidney to one's parent speaks a thousand words.

People ask, why would a daughter donate her kidney to her mother?

She never answered it. She just did. Even the ethics committee never bothered to ask the question because they saw the answers in her eyes.

My sister is a social worker. She once explained to me why she loves doing good deeds. I always thought she would do good deeds because as Christians that is expected of us. I never understood what she meant when she explained that most people would imitate a movie star idol or an athlete. She was doing good to imitate Christ. Jesus sacrificed his body, his career, his future and eventually his life for other people's sake. I never thought my sister would go that far imitating Christ.

When it was time to have the transplant, every body was anxious. What will happen? Will it be successful? What if something goes wrong? What if the kidney was rejected by the body?

It was a test of faith. It was a simple pure surrender to God's plan. It helped that we are a God fearing family. It is cliché that "a family that prays together, stays together."

More than that, there were people, relatives, church family and friends who showed support. It was an outpouring of God's love through the people around us.

Then the time has come. The nurses and the doctor came to the room. There was silence. As the nurses prepared my sister, she was calm. Everything was set, then they started rolling her bed out of the room. There was one last thing that needs to be done. The family gathered around her... and Auntie Bing, who is a clergy, thanked God for a daughter's courageous act... The doctor assured her, the single kidney she will donate is healthy enough to support her mother. My brother squeezed my sister's hand and said, "it is all part of God's plan"... tears fell.