On Greener Pastures: Med Students’ Perspectives on a Community Practice
November 18, 2021
Joseph Rem C. Dela Cruz, UPCM 2024
The future is filled with uncertainty, now more than ever. The post-pandemic world has highlighted concerns regarding resources and other aspects of the healthcare system that may prove to be detrimental to the delivery of services in all levels of community practice. As healthcare professionals in the province struggle to provide the best possible care in low resource settings, medical students from these same areas feel a calling to serve despite these limitations, and through this a brighter future may be on the horizon.
Resources, manpower, and support may be wanting, but this was not enough to deter Jyna Trumata from Leyte. “At first, it was just the will to serve and to give back to my hometown that drove me—feelings I can’t really explain or justify to other people. Now that I am a medical student, though, it has evolved into a much more detailed plan with a sound rationale. In my hometown, I’ve seen the lack of physicians and how it has affected healthcare provision, not only in Sogod but also in the nearby towns. We have a few doctors, but we still need to ask some physicians or specialists from cities to come here once a month if they can,” she recalled.
Indeed, behind the serenity of nature, tight-knit culture, and the inner peace that the province brings, the system still is in shambles. Access to health remains remote for many as Tiki Salcedo from Bicol recounts, “The pandemic has actually led me to be dubious of this commitment to serve, but my resolve was reaffirmed just last June. I was riding a bangka just off the coast of the Pacific Ocean with my family, and as we marveled at the idyllic work of nature, our bangka cruised past this quaint community sitting on a secluded island. I was then reminded of my why. I am here for the people.”
First blood drive after almost 1.5 years in Brgy. Batangan, Valencia, Bukidnon. The pandemic has not only made frontlines out of the provincial communities, but it has laid bare the systemic holes we have not plugged—and people are falling through.
Rekindling the passion to serve
Meanwhile, Aya Dicali from Lanao del Sur and her batchmate Sael Rodriguez from Davao del Sur each had their own epiphanies during the pandemic as well. Sael himself had been turned away from a hospital while experiencing appendicitis in the middle of the pandemic, but he soon found—writhing in pain—that he was still fortunate. “I was able to witness an unconscious old woman rushed to the emergency room. ‘Unsay nahitabo? (What happened?),’ asked the doctor. The bantay, who apparently was a compassionate neighbor of the patient, replied ‘Nahimatay na siya Doc unya kagahapon pana siya wala kamata (The patient fainted and has been unconscious since yesterday).’ They had to rent a jeep just to transport the patient from the highlands. With scant resources and vacancies, the hospital couldn’t do very much but attend to only what was necessary. They were actually turned down and had to find another hospital to accommodate them, one with more rooms and resources, but that meant finances would be an issue considering the patient was not privileged enough. This got me thinking that the only thing that separates me from that old woman was privilege. Had it not been for my parents being able to afford a house in the city, I would have succumbed to complications from waiting for transportation. Had it not been for privilege, I don’t think I would be in this position trying to expose my thoughts. These stories actually made me think of how broken the system is for healthcare.”
Truly, the pandemic has not only made frontlines out of the communities and the provinces, but it has laid bare the systemic holes we have not plugged—and people are falling through. Aya, a Moro displaced from her home during the Marawi Siege, described Lanao del Sur as having little to no access to treatment and insufficient manpower to tackle schistosomiasis, cancer, and other diseases. She recalled, “When I went back to Bubong, Lanao del Sur to get vaccinated, I was pulled out last-minute when they knew I was a medical student. They said they needed help, and true enough, there was a court filled with people waiting to get vaccinated with only a handful of medical workers and volunteers. I had to help… I remember at that moment, I wanted to be of service. My passion sparked again just like the day I was interviewed for UPCM admissions.”
Immersion in Brgy. Laligan, Valencia, Bukidnon. The truth of why provinces need wide-eyed doctors who are eager to serve and carry the skills that ensures commitment and the ability to thrive in low-resource settings.
Going where we are needed
Inspiring stories such as these highlight one truth: provinces need wide-eyed doctors who are eager to serve. However, sentiment only carries one to the provinces, but skill ensures one can stay and thrive. Adaptability is key as Ellpi Rosales from Cebu and Ford Galano from Cagayan point out. “I think the essential skill is [being] able to understand the limitations in the province, particularly in the diagnostic and treatment phase. From there, you can devise ways to arrive at a diagnosis and provide the available treatment options at a given time,” Ellpi said.
In addition, leadership and management skills are necessary to deal with the gargantuan task of serving as the only doctor for miles. However, no one has to do it alone, as Jyna points out, “From what I observed, there are three necessary support systems in order to establish good practice in my town: the community, the local healthcare workers, and the local government.” To bridge this gap with stakeholders and their interests, a community practitioner’s finest tools are often proper communication, networking, and pakikipagkapwa tao. Aya retold how banking on relationships with her often shy but warm and receptive fellowmen often is the best way to practice in Muslim Mindanao. All this, of course, without compromising one’s people-centered values, as Tiki notes, “Without a doubt, the healthcare system in Philippine provinces is marred by political interests, and so, as a future practitioner, I always remind myself to strive for a just system when my time comes and to never surrender my truth.”
Considering the expansive skill set necessary to succeed in a practice of community medicine, it’s understandable that many do not feel confident enough to pursue it. Yet again, the resolve to serve comes first. “With the pandemic, I lost a hefty amount of opportunities to start practicing and immersing myself in communities. I do think there is a need to establish rapport and a need to understand firsthand what is actually happening in the communities. The best solutions you can come up [with] are through involving the community and learning from them. Although I have experience in community work, it was not specific to my region or province. I don’t have that many experiences in serving my community aside from time-limited volunteer programs for public health education, vaccination programs, and medical missions. I might not have the confidence to do so right now, but I think I’ll get there somehow,” Sael shares. Ford puts it best: “When the time comes, I have no choice but to be very confident because they deserve a confident doctor, and I can't afford to fail them.”
Put down your roots. Thrive. The Countryside is waiting. The province is a green pasture rich with experiences. All this generation’s doctors need are support systems. Our approach to health should be overhauled to give fertile soil in which young doctors can be planted.
Growing strong
Added to the immense pressure of serving as a community’s paragon, one must bear having to see multiple opportunities pass—or is this just a myth? Opportunity costs such as sacrificing one’s passions are certain, but these do not deter Aya. “I want to try a fellowship or specialization abroad. This could be a boon or bane to my aspiration, but hopefully it will be the former. Of course, I'll work consciously on bringing something useful abroad to my hometown. This would possibly become a stepping stone to helping my own community instead of a barrier,” she said. Meanwhile, Tiki remains optimistic in a life immersed in the arts, “An apprenticeship from renowned contemporary artists is something I look forward to, and I’m seeing a Parisian école on the horizon. After all, lifelong learning is a concept that extends well beyond the field of medicine.”
One may miss much, but the province is a green pasture rich with experiences and opportunities. All this generation’s doctors need is ample assistance—especially from their own support systems and provinces. “One thing I noticed in my community (some of my relatives and patients I’ve talked to) is that people put doctors who work in big cities and abroad into a higher pedestal than those who work in the community. It’s hard to understand because I know that being a community physician is a difficult feat,” Jyna laments. Add to that, the frontlines remain undersupplied, understaffed, and unprepared for the influx of patients, especially due to the pandemic. In response, our approach to health should be overhauled to give fertile soil in which young doctors can be planted. According to Sael, “It’s vital for a healthy healthcare system in general which aspires to take care not only of the patients but also doctors.”
At the moment, life in the province for students remains the path less traveled, but that’s precisely where the true frontiers of development lie. Perhaps paving this road is not for everyone, but those with grit and wit will often find themselves enamored with the immense sense of purpose the province offers—knowing one’s contributions do not just benefit individuals but communities. There may truly be no shortage of things to do, but one finds growth, respect, and belongingness in a provincial practice. All one has to do is ask themselves, “How can I serve?”