Life in the time of Ebola: Where are our health workers?

In the past few months, we found on our doorstep a monstrous plague barely under control. The whole situation surrounding the Ebola virus seemed like a plot culled from a Michael Crichton novel. The difference was we weren’t turning the pages of a paperback – we were staring at the headlines of major broadsheets from around the world.

Initial projections showed that the number of those infected may hit 9,000, and more than one million infected had the disease not been contained. Fortunately, large strides have been made, with Nigeria declaring itself to be Ebola-free, and other countries controlling the spread of this disease.

Soon, 132 peacekeepers from Liberia will leave Caballo Island to join their families and loved ones. Much has been said on the appropriateness of their quarantine, and such has been the debate worldwide, with various countries imposing different measures ranging from a similar quarantine to none at all. More importantly, even before population protection was brought up, the need to help out in West Africa has been hotly debated.

Over here in our own little corner, the public witnessed a curious battle on this issue. Should the Philippines send health workers to the heart of the epidemic, in West Africa, to lend our world-renowned expertise? Some argued that we should help out the way the world came to our aid when we were struck by Super Typhoon Yolanda (Haiyan).

Others argued that we need to buttress our own health response here before we even begin considering going out of the country. Malacañang put in the final word that the Philippines is not sending any workers.

Inconsistent?

The Ebola epidemic has indeed lent some perspective to our government regarding our human resources for health, but it may be quite a myopic and microscopic one at that. This is because on a broader scale, instead of strengthening our response to our basic health needs, we have become the biggest exporter of health care professionals in the world, with or without an epidemic.

We supply 25% of the world’s nurses. We are second only to India in exporting doctors. Couple that with non-communicable diseases that kill 300,000 Filipinos annually, and we have our own smoldering disaster here in the country.

That’s precisely why the official response seems disingenuous, if not totally inconsistent with the way various local officials have dealt with the shortage of human resources in the health sector in our country.

Since the fall of the Marcos dictatorship, we have seen an efflux of healthcare workers to various parts of the world. For those who have traveled abroad, it may be reassuring to find a Filipino face, or a familiar Filipino word in a distant city. It’s not wrong to feel that instant kinship, and share a smile with our countrymen. What is wrong is that we celebrate their diaspora without addressing the root causes. What is wrong is that we rake in the benefits of their remittances, more than one trillion pesos in 2013 alone, while not creating jobs that would be worthwhile to come home to.

The reality is that we have done a bad job at taking care of our healthcare workers. We hear the tired story of nurses paying their way to get experience. We hear the repeated tale of health professionals turning into call center agents. Do not get me wrong: the BPO industry is booming,and accounts for a large part of the Philippine economy, providing P704 billion in revenues, and employing more than 900,000 Filipinos.

The BPO industry provides the dignity of labor that many health professionals find more attractive than their own field, with better pay, and concrete work benefits. We’re not only losing health professionals to other countries, we’re also losing them to other industries.

It’s very easy to lay the blame at anyone’s feet. Playing the blame game is a national pastime, performed daily by tinderas (vendors) in a market place, drivers of vehicles in a car accident, and politicians in halls filled with cameramen and journalists. It is a pointless exercise. And that’s because health is everyone’s responsibility.

Bigger monster

So while we have the specter of Ebola just outside our door, we must face an even bigger monster already in the room: the healthcare worker crisis. The increasing population, an epidemic of non-communicable chronic diseases, increased access to health facilities through PhilHealth, and the diaspora of health professionals all contribute to this crisis which sees almost 50% of all deaths in Filipinos going unattended by a physician.

Even now, we have so few health workers in the public sector that our ratios are 0.2 physicians, 0.4 nurses, and 1.7 midwives for 10,000 people. That means 2.3 workers per 10,000 Filipinos – the workforce that’s supposed to provide first-level care. Let’s not even go into the numbers for other health professionals.

On July 22, 2014, 74 groups from different sectors came together to form the Primary Care Coalition, which declared a healthcare workforce crisis and called upon the administration to address this immediately. The groups represent health professionals, community workers, researchers, economists, lawyers, teachers, students, farmers, the differently abled, the elderly – people from just about every walk of life. It was one of the few times where a broad consensus was formed about a single subject. This seminal moment was one filled with both hope and urgency.

Since then, what has the government done? How has it responded to this crisis?

A scenario where Ebola strikes the Philippines is playing in the minds of many Filipinos today. With the odds of dying literally at 50/50, people are scared. In hushed tones, some confess that they are fearful enough to leave the country.

But when Ebola does strike, is it only then that we finally ask: where are our health workers? – Rappler.com 

Photo of healthworker and the Ebola virus via Shutterstock. 

Dr Adrian Paul Rabe is a graduate of the University of the Philippines College of Medicine. He was the youngest to pass the Philippine Medical Board and the Philippine Specialty Board of Internal Medicine. He is now a consultant for health policy and evidence-based medicine, primarily pursuing the implementation of Universal Health Care.