Today we spent the morning doing a “Charity” clinic at the RHU Health Center in San Juan. Here we had the opportunity to interact with, assess, and follow through with patients. Some of the most prominent conditions we observed include: cough for 2 or more weeks, TB follow-ups, lacerations needing Tetanus treatment, prenatal care, suspected nephritic syndrome, and hypertension.
Certain aspects of the clinic were difficult for us to experience, such as clients being unable to afford medications and treatments. Some examples were the inability to pay for hypertension medications, Tetanus skin tests, have blood tests done, and inhalers. As Canadian citizens who utilize a universal health care system, which is defined as, “…health care coverage for all eligible residents of a political region and often covers medical, dental and mental health care,” (Wikipedia, 2010) it was sad to see treatments being altered or denied based on a client’s inability to pay.
Health care in the Philippines is governed by a two-tier system; 60% private, and 40% public or charity (Moveforward, 2009). For Filipino residents who can afford private health care, modern and up-to-date technology and tests are used, but at a high cost. The majority of the population utilizing modern (rather than traditional) medical care visit public clinics. These clinics have limited funds, causing a lack of supplies such as blood pressure cuffs, weigh scales, thermometers, private examination rooms, and makeshift charting systems.
Creative ways the clinic works around costs are stocking a pharmacy that offers some medications free of charge. However, it is only stocked four times a year, so often runs short on supplies. Furthermore, other supplies are limited such as swabs, which are used to culture bacteria. In addition, old mercury thermometers are used, examination rooms are shared, and alternate tests and treatment are offered. What was impressed upon us most was that health care workers utilize the space and supplies most available to them and use critical thinking and creativity when faced with less-ideal situations.
The World Health Organization (WHO) states: “The social determinants of health are the conditions in which people are born, grow, live, work and age, including the health system,” (World Health Organization, 2010). Furthermore, they assert that the social determinants of health are the main factors contributing to unfair differences in health status (WHO, 2010). From the above accounts of clients being unable to afford and therefore receive treatments and medications, there are large inequalities in health status amongst the population.
According to Commission on Social Determinants of Health (CSDH), launched by WHO in 2008, three recommendations to address the disparities are: “Improve daily living conditions; tackle the inequitable distribution of power, money, and resources; and measure and understand the problem and assess the impact of action,” (2010). Bringing all these observations and theory back to something meaningful for Canadian health care, we believe that spending a significant amount of time assessing the needs of a community and implementing nursing care like the UP students are doing in San Juan is an effective way to manage health. Furthermore, our ability to meet with political leaders in the area provided key stakeholders capable of providing power and resources necessary to bring about change. If given similar opportunities in Canada, we would be enabled to promote primary health care in practical ways.
As a farewell to the community, we were invited to celebrate the 83rd birthday of Municipal Councillor Hon. Meynardo V. Robles’ father. We’d like to extend a warm thanks for the hospitality and generosity of the people we were in contact with in San Juan.
Pictured:
Top Left - Jessica Key and Joelle Link doing Leopold's Maneuvers on a labouring mother.
Center - Kirsten Finlay counting respirations on a sleeping infant.
Bottom Right - Nursing students and Susan at Meynardo V. Robles’ father's 83rd birthday party.
References
Health care in the Philippines (August 8, 2009). Retrieved January 20, 2010 from Moveforward website: http://www.expatforum.com/articles/health/health-care-in-the-
philippines.html
Social determinants of health (2010). Retrieved January 20, 2010 from World Health
Social determinants of health (2010). Retrieved January 20, 2010 from World Health
Organization website: http://www.who.int/social_determinants/en/
Universal health care (2010). Retrieved January 20, 2010 from Wikipedia website:
Universal health care (2010). Retrieved January 20, 2010 from Wikipedia website:
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