Access to Healthcare Outside the City | Paolo Medina | TEDxUERM

Summary

The speaker, a municipal health officer, passionately discusses the complexities of serving communities in healthcare. They challenge the romanticized notion of rural medical practice, emphasizing the reality of addressing social issues like poverty and learned helplessness. The talk highlights the disparity in healthcare services, urging medical students to understand health as a human right and to engage with communities beyond just treating illness. The speaker shares their experience in creating an immersion program to expose future health professionals to the realities of public health and the importance of a robust primary care system.

Takeaways

• 🌟 The speaker emphasizes the importance of serving communities and keeping the passion for service alive.
• 🏥 The decision to work as a health officer in a rural area was a life-changing experience for the speaker.
• 👨‍⚕️ The speaker addresses medical students, encouraging them to consider community service as part of their future careers.
• 🌱 The idyllic image of rural medical service is often romanticized and does not always reflect the reality of the challenges faced.
• 📚 Medical students are often not prepared to deal with the social issues underlying health problems in communities.
• 🏢 The speaker criticizes the glorification of substandard healthcare services in rural areas.
• 🤔 The speaker questions why people trust misinformation about health over professionals and emphasizes the need for better health education.
• 🏥 The Philippine general hospital outpatient department is overwhelmed, with people lining up early in the morning for care.
• 💉 The speaker dislikes the medical mission model of healthcare delivery, viewing it as passive and not empowering communities.
• 🌐 The speaker discusses the importance of understanding health as a complex issue tied to social development and not just sickness or wellness.
• 🌱 The speaker shares their personal journey and the creation of an immersion program to provide medical students with real-world community service experience.

Q & A

What is the primary message of the speaker in the transcript?

The speaker emphasizes the importance of serving communities, particularly in healthcare, and challenges the romanticized view of working in rural areas. He advocates for a deeper understanding of community health issues, highlighting health as a human right and stressing the need for future health professionals to address underlying societal problems such as poverty.

What does the speaker mean by 'over-romanticized' view of serving communities?

The speaker refers to the idealized notion that serving in rural areas is picturesque and easy, with images of beautiful beaches or rice terraces. He criticizes this view because it overlooks the complex and often difficult realities of providing healthcare in underserved areas, such as poverty and a lack of resources.

How does the speaker feel about medical missions?

The speaker expresses disdain for medical missions, viewing them as a superficial solution to deep-rooted healthcare problems. He argues that healthcare should not be treated as a 'gift' or something that temporarily fixes problems, but rather as a continuous, rights-based service that empowers communities.

What is the significance of the line outside the Philippine General Hospital (PGH) mentioned in the transcript?

The line outside PGH symbolizes the dire state of healthcare in the Philippines, where people line up early in the morning to access medical services. It reflects the challenges many Filipinos face in receiving adequate healthcare, particularly in public hospitals.

What does the speaker mean by 'learned helplessness' in the context of healthcare?

The speaker refers to 'learned helplessness' as the resignation and acceptance of substandard healthcare conditions by communities who have experienced poor services for so long that they no longer expect better. This helplessness becomes a significant barrier to improving health outcomes.

What is the story of the seven-year-old boy in Quezon mentioned by the speaker?

The seven-year-old boy accidentally hooked himself with a fishing line while trying to catch fish for his family's dinner. Although the speaker treated him at a local health center, he points out that the care provided was substandard compared to what would be offered in a more affluent area, illustrating the disparities in healthcare quality.

Why does the speaker criticize the 'heroic' view of serving communities?

The speaker criticizes the 'heroic' view because it glorifies temporary or superficial efforts in community service, like medical missions, without addressing the systemic issues in healthcare. He believes that true service should focus on creating sustainable, high-quality health systems that empower communities rather than providing short-term fixes.

What is the role of the Alliance for Improving Health Outcomes (AIHO) mentioned in the transcript?

The Alliance for Improving Health Outcomes (AIHO) is an NGO that aims to train and empower human resources for health. The speaker highlights AIHO's efforts in creating an immersion program that provides medical students and health professionals with real-world experiences in underserved communities.

What does the speaker mean by 'the battle is already lost in the hospital'?

The speaker suggests that by the time patients reach the hospital, many healthcare issues—especially those related to social determinants of health like poverty—have already taken their toll. The real battle to improve public health is fought in communities through preventive care and addressing the root causes of health disparities.

What is the importance of the post-immersion processing sessions mentioned by the speaker?

The post-immersion processing sessions are designed to help participants reflect on their experiences in underserved communities, providing cognitive and emotional 'anchors' that motivate them to continue serving and addressing healthcare challenges. These sessions aim to foster a deeper understanding of public health and inspire long-term commitment.

Outlines

00:00

🌱 Embracing Community Service

The speaker begins by expressing the passion and joy of serving communities as a municipal health officer in Quezon Province. They emphasize the initial enthusiasm of medical students to serve communities and the reality of dealing with complex issues like poverty and learned helplessness. The speaker highlights the contrast between the idyllic image of rural service and the actual challenges faced by healthcare professionals. They discuss the importance of understanding the true nature of health care in the Philippines, where people queue early for treatment at public hospitals, and the need for informed consent in medical procedures, which is often overlooked.

05:02

🚑 The Reality of Healthcare Services

The speaker delves into the public's skepticism towards vaccines and medical advice, questioning why people trust non-experts over professionals. They argue that healthcare is often seen as a divine gift, with people passively receiving it, rather than understanding the active role of healthcare providers. The speaker shares a personal story of treating a young boy, which, while receiving praise, is actually a reflection of substandard care. They emphasize that the same procedure in an affluent area would be conducted with much more care and consideration, highlighting the disparity in healthcare standards.

10:02

📚 The Complexities of Healthcare

The speaker discusses the complexity of healthcare and the need to understand it beyond just treating illness. They use the example of Alexander the Great and the Gordian Knot to illustrate the need to tackle healthcare issues directly and effectively. The speaker shares their personal journey of seeking opportunities to serve and learn about community healthcare, emphasizing the importance of experience and understanding the social determinants of health. They argue for a more holistic approach to healthcare that involves collaboration across sectors.

15:05

🌐 Empowering Medical Education

The speaker talks about the importance of medical education that empowers students to understand and serve communities effectively. They share their experience as a municipal health officer, inviting others to join in the community work and learn from it. The speaker emphasizes the need to go beyond the hospital and engage with communities at the primary level. They discuss an immersion program they helped create to provide students with the experience of serving and understanding the multifactorial nature of health, including social development dynamics.

20:08

🌟 Cultivating Future Healthcare Leaders

The speaker concludes by discussing the importance of involving the younger generation in healthcare leadership and the need for a robust primary care system. They highlight the 'Operation ISIS' program, which aims to provide immersive experiences for medical students to understand the realities of serving communities. The speaker shares pictures and stories from the program, emphasizing the importance of post-immersion processing sessions for reflection and growth. They also mention scholarships in honor of a doctor who was assassinated, reflecting on the challenges and opportunities in advancing healthcare in the Philippines.

Keywords

💡Health as a human right

This concept emphasizes that access to healthcare should be guaranteed to everyone, regardless of their socioeconomic status, background, or location. In the video, the speaker stresses that many Filipinos, particularly those in underserved communities, are routinely denied this basic right due to the poor state of the healthcare system. The speaker argues that serving communities requires understanding and upholding this principle.

💡Community service

Serving communities, especially in rural and underserved areas, is a central theme of the video. The speaker highlights the importance of healthcare professionals going beyond hospitals to meet the needs of people where they live. It’s portrayed not just as a duty but as a transformative experience that builds understanding of the deeper challenges communities face.

💡Poverty and healthcare

Poverty is highlighted as a major barrier to healthcare, with many communities struggling not just with illness but with a lack of basic resources. The speaker discusses how healthcare workers in these areas often face issues beyond medical treatment, including addressing the systemic poverty that causes many of these health issues in the first place.

💡Over-romanticization of rural medicine

The speaker criticizes the idealized view of serving in rural areas, where it is often portrayed as idyllic. Instead, the reality is that these areas face complex challenges like lack of resources, poverty, and inadequate healthcare infrastructure. The video seeks to debunk this myth and prepare future doctors for the harsh realities they will encounter.

💡Substandard healthcare

The video discusses how many communities settle for substandard healthcare, which the speaker argues should not be glorified. For example, he mentions how standard medical care procedures that would be done in affluent areas are not accessible to those in poorer, rural areas, and these disparities are often accepted as normal.

💡Medical missions

Medical missions, which are temporary healthcare services provided to underserved communities, are criticized in the video. The speaker views them as insufficient for long-term healthcare improvement, as they treat health as something given sporadically and unsustainably, rather than addressing the root problems within these communities.

💡Learned helplessness

Learned helplessness refers to the condition where people feel powerless to change their circumstances after prolonged exposure to difficult situations. The speaker connects this concept to the rural communities he serves, where poverty and lack of access to basic healthcare lead to a sense of resignation and hopelessness.

💡Primary care and frontlines

Primary care is emphasized as the most critical level of healthcare, where the 'battle' for improving health outcomes is fought. The speaker highlights the need to strengthen primary healthcare systems and ensure that frontline workers are empowered to provide adequate services, rather than focusing only on hospital care.

💡Universal healthcare

The speaker mentions the recent push for universal healthcare in the Philippines, particularly the goal of establishing a robust primary care system. He views this as an opportunity to improve healthcare for all Filipinos, especially those in underserved areas, and urges future healthcare workers to engage with this movement.

💡Immersion programs

Immersion programs allow medical students and healthcare professionals to directly experience the realities of working in underserved communities. The speaker advocates for these programs as a way to educate and inspire future healthcare workers to commit to serving in rural areas and understanding the complexities of community healthcare.

Highlights

The importance of serving communities and keeping the passion for service alive.

Working in Quezon Province as a municipal health officer was a life-changing decision.

Serving communities often comes with a gut reaction and desire to help.

The romanticized idea of serving in rural areas versus the reality of the challenges faced.

The complexity of addressing complaints related to poverty and hopelessness in communities.

The stark contrast between the idyllic image of rural areas and the reality of the people living there.

The reality of healthcare for most Filipinos, exemplified by long lines at the Philippine General Hospital.

The difficulty of obtaining informed consent in healthcare settings.

The public's trust in non-medical figures over medical professionals when it comes to healthcare decisions.

The glorification of substandard healthcare interventions in the Philippines.

The story of a seven-year-old boy who suffered an accident and the reaction to his treatment.

The difference in healthcare standards between affluent and less privileged communities.

The need to understand health as a complex issue rather than just treating illness.

The struggle to find opportunities to serve communities in medical education.

The creation of an immersion program to provide students with the experience of serving communities.

The objectives of the immersion program and the importance of understanding local health systems.

The impact of the immersion program on participants and the potential for future healthcare professionals.

The importance of post-immersion processing sessions for reflection and growth.

The challenge of universal healthcare in the Philippines and the role of future healthcare professionals.

Transcripts

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knowing and heeding the call to serve

communities and the idea is how do you

keep that fire burning and when I talk

about myself about what I have done as a

municipal health officer and about

working in communities you all have that

idea right so I I won't talk about that

and that this is fun to serve the town

of Katherine in the island of a lab at

Quezon Province was the best decision

I've made say a couple of course but

it's really among the most life-changing

things that I've ever done and it's an

invitation for you to consider something

similar but I won't talk about that what

I will talk is serving communities

always elicits a gut reaction a feeling

of well I want to do something I want to

go out in the community said I'm talking

to medical students here future

physicians dr. Liang bi and all of these

things they kind of are nice right and I

want that and I want to go to

communities and I want to serve and well

that's a given

and I really don't have to talk about

that for 20 minutes what I do want to

talk about is when we go to these

communities

I always remember whenever somebody

would come for school back when I was a

medical student and tell me about

serving and going to the rural areas to

practice medicine - really sir and the

theme should always be something along

the line said oh you know you be in b

ches and you'll only see coffin cords

and they're just going to be very busy

for a while and then you take a break

and I will step outside of the house

it's a beach or it's a rice terraces or

it's a like you pick fruit and all that

and it's so over romanticized

and so idealized right that when I was a

student I kept on asking is it really

that cuz you know it makes the question

if these community is really very nice

let's go back to Who I am

as a health professional or back then as

a doctor to be and when you when you see

patients on a day to day basis coming to

you with complaints that you read in

books well that's easy

dear medical students that's easy but

when the complaints are about poverty

about a lap of hope about the learned

helplessness what do you do about that

and in these communities while they seem

so idyllic from out we all now know that

well there's something to be said about

the people living there what lies

beneath what lies behind and what lies

beyond I think that's something that I

want to talk about and what I want to

anchor this store horn is that for most

Filipinos and this is the serving part

when you make the decision to go out

there and meet people where they are

what they have what they do what makes

them ill what makes them well then we

start realizing that for most Filipinos

health care is what you see here that is

not a line for a new Apple iPhone that

is the line every single day during the

early morning before the Philippine

general hospital outpatient department

openness imagine people lining up to get

health care at 4 a.m. out in the street

that's nice because it's a dry season

what if it's not

once on the upper left-hand side from

where you're sitting that's a health

center for an immunization program

typical one

and then you start asking why can't we

explain to patients that that seems work

we even put that as a hashtag when in

fact how can you explain to patients who

are mad were uncomfortable with all of

the crying kings come on

and should we actually get informed

consent before we do give an

administrative access for these kids yes

but do we do that for those of you

who've actually gone to health centers

or go to health centers on a routine

basis and I bet nobody does that here in

this hall do we even talk about in

foreign consent for vaccines then we

start wondering oh my god why are they

listening to people who don't know

anything about vaccines why do they

believe a newscaster over an

epidemiologist why do they believe

pretentious lawyer from the power over

the doctors it's because we rarely

engage people where they are right and

well that's your typical setup of what

health is for most Filipinos it's the

medical mission that's one of the things

that I detest the most in this health

care system of ours it's a safe health

is something that falls from heaven like

manna and people are just passive

recipients of something like that but

it's not even about this I think it's

well because if I were to be honest

health care for the people in this room

would be this right

and again there's something to be said

about that why is there a difference and

you might appeals me of being so biased

about it but that's not with what the

government says in 2016 when they began

this administration the Department of

Health in its Philippine health agenda

itself stated that this is what public

clinics and hospitals I like and nobody

will fight them on this because that's

what we know

and I would like to tell you that as a

community doctor and the doctor who's in

public health this for the most part is

true I'm angry about that but the

question now is are you

kaylynn not in tenango NEPAD mahira Heba

Alice Olga mia SS a Mattea see no egg

nog sabe NEPAD Makaha huntin McGaha ma

da da da da para mas neva whoo ha ha

namaste Bandhan submission Pamela Pamela

son eaten or ruin actually it into

Russia systematically in med schools all

over the country in that hidden

curriculum that's so insidious so used

to it but this is something that we

accept as a given

all right so what's the point the point

is when you want to go outside and serve

communities you have to anchor your

decision to do that on the fact that

health is a human right and that no

matter who you are where you are who you

are what you're from Stassi lavender

steaming right there's a certain level

of health care that may or should be

enjoying where do you draw the line and

unfortunately when you say you want to

serve the communities and go out there

let me tell you that routinely we

violate the right to health of

communities every single day and

community is settled for substandard

interventions and services which we

actually glorify let me tell you this

story what's the story behind this

picture this is a seven year old boy in

Kazan Kazan a patient of mine before and

him one eat augment the dinner of his

family went to the SeaWorld and used a

makeshift fishing line to fish muhaha

people Nashua learner and on his last

attempt to catch another fish to add to

the dinner that family best of wind

happened to come by and his mouth was

open and he was the one who was caught

in his fishing line there's an audible

gasp and I understood that's funny from

but I'm a battle-tested BGH doctor I see

this every single day this is easy I

inside to make an incision clean the

wound right and suture it and we had

that in the health center cuz I ensure

that we had that anesthetic that's it

and follow up all of those things and

this kid came well I post this on

Facebook I get a thousand likes easy but

myself on the back and say good job dr.

Malinda the claw power the best right

that is what we glorify that's what we

value when we serve communities but let

me tell you and again this is this is to

the med students and for those who're

none health professionals when we go to

a pediatric surgery rotations and

lectures this is substandard care why

because when a kid is traumatized

you don't be traumatized the kid despite

you wanting to help him or her so what

am i driving at if this happened in a

metro manila suburb or Lapera tiny

suburbs in metro manila right and this

happened in an affluent community and

don't tell me nobody would think of

doing that

kids these days we know what they

they're into they eat tide buds and all

of those things so I bet this could

happen very easily if this happened in

an affluent upscale neighborhood guess

where this kid would have been seen an

attendant do this necessitates at least

a semi fall or a fall or set up at the

very least the kid should be sedated and

then the surgeon comes in scrubs

very well and dance the down please have

the new Hustler's play on his iPhone

December avenues I like that and right

and before the chorus to son Alan open a

big is done how very sad guitar bassoon

the surgery is done and scrub out and

any charge an arm and a leg for you but

that my friends is standard of care when

we did we accept that that is something

that only a privileged view would be

able to enjoy see we glorify this and

this we share and that's serving

communities for you and that's fine

that's why it's not to this the desire

its to cast shade about understanding of

how bad the system makes us behave and

this is the next point I want you to

realize that that decision to serve

communities it's not about the service

it's not about the procedures but it's

about that understanding of health as a

very complex thing anti-venom chana

masala mood knows have been no pollution

Greg do you know this place is so know

what this is when I ask my medical

students first missus nobody knows

anymore this is the burden not and its

associated with that semi-historical

mythical personality Alexandre degree

and when he talked about the knot that

couldn't be unraveled or entangled or

untied when Alexander heard of that like

a thousand years whatever my passion and

anger

Alexander heard of that and said well I

can and I know that what he did was to

cut right through it with his sword

cheating anyway yeah sure but this is

about understanding that there is

something about knowing how bad or how

convoluted or how complex healthcare is

and health systems are and that we can

actually start unraveling

so this is me trying to pitch to the

future doctors here maybe the future

health professionals people here not

even health professionals but people who

actually want to help communities you

know we're Millennials we you know they

tell us that we're the me generation and

all of that I disagree I think we're the

people who always want to find really

what you do in that sense actually would

want to relate my story to you but when

I was your age trying to look at how I

would deal with this desire of mine to

serve communities I was blessed and

privileged to have had opportunities to

do so but let me tell you 20 years ago

12 years ago 15 years ago it was a

struggle to find the curricular and

co-curricular and extracurricular having

used to be able to express and actually

find and actualize what I wanted was to

serve people it was a struggle and I had

to find my own way I had to grab

opportunity since I actually had to make

my own opportunities we were a group and

my wife is part of this picture we we

were a group one thing to serve people

and serve communities and because there

was none we just created something for

us we went to communities we went to

Palau and for six weeks going up from

Puerto Princesa up to el nido doing tile

and municipalities just going around and

looking at what people were experiencing

in terms of health care what was it

there six weeks of doing that and

immersing and learning and knowing and

so I look back at that and when I was

still a municipal health officer I

wanted people to actually have that

experience as well so even while I

Mitchell I was inviting and I was asking

people to come this is my community

it was privy to

highlight what I was doing per se but

it's actually trying to share in that

dream because I was always looking at

how it used to be I didn't know anything

about serving I didn't know what that

manner and I wanted the kids now kids

they say that with a lot of a state to

have those experiences because well you

guys have the energy you guys have the

dream you have the intellectual capacity

the heart the courage the compassion so

I want you to understand what it means

when you want to serve I want you to

conquer the fear of the unknown

the unfamiliar and the uncomfortable I

want you to go outside of your comfort

zones because I believe that when we are

studying to be doctors and that we are

being educated to be physicians our

education should be emancipating instead

of being so sharply knee break by to the

hospital too much but the battle is not

there it's already lost in the hospital

the battle is out in communities the

battles out at the primary level in the

frontlines and medical medical education

should be empowering I should be able to

show you so you make the decision for

yourself you should see what's out there

so you choose to do what I did what I'm

paying you time so what I want to share

with you now that I'm faculty I have a

bit more space and more elbow room to

create things and since there was none

before what we did was with our NGO the

Alliance for improving health outcomes

incorporated or aho since we are

planning to be an NGO that wants to

capacitate human resources for health

what we did was to create an immersion

program built on what we were already

doing get like-minded individuals and

create spaces for students to go out

there explore that desire to serve and

actually

understand what it means and so these

are just objectives we're not going to

talk about them in detail but it's

really about providing the experiences

that your medical particular that are

existing are not providing and it's

about showing you that local governments

and frontline health systems are

actually working despite the reputation

of corruption and all these things when

I show you that government can actually

work isn't that something simply the

sort of a nudge that I want to do that

because frankly it's not about you and

when we talk about that framework it's

about the meaningful immersion or the

meaningful break or the meaningful

summer vacation where I make you realize

that health is not just about sickness

or wellness but health is about social

development and dynamics and you have to

understand that health does not exist in

a vacuum here it is a multifactorial

thing so there has to be sectors there

has to be collaboration it has to

function from a certain level of

development that's what you get in the

immersion and it's about you reflecting

what good is it to treat the person's

illness if the person would go back to

the conditions that led to the illness

in the first place it's about you seeing

that and suddenly thinking of how can I

change that because when I'm back in the

hospital when I read my books it's all

about curing nobody really talks about

what happens after they said that's

something that's exciting as well so

when we tried to operation Isis it's now

the third cohort and I'm going to end

soon but I'm just way to show you that

there are people providing these spaces

you just have to be mindful about that

and hopefully by the next month we'll be

getting sign up soon so last year the

third cohort we had 32 sites and 350

participants from several medical

schools in the country imagine what we

can do

with that when they understand what it

really means to serve and actually want

to serve they create the space for the

enabling environment to serve with me

mean that's the dream it's not about the

heroics it's not about the sacrificial

nature it's about choosing to do

something and doing it correctly and

just to show you that who are the

professors the professors are young

people as well these are doctors to the

barrios who are willing to teach and to

actually show you what happens out there

so that we replicate our good practices

and we multiply ourselves and just a few

pictures and I mean in soon it's about

going to the farthest places

the TOWIE sangani behold

abra the only life touristy again and

don't Peron among you happy

Adam parinama and then the higher

nobility national a lamp of an opinion

of the inan paraffin and adding it but

the enum I type and then then a Filipina

sat on the Fenian potential but hit well

I'm not really array in terms of health

care so what's important also in the

immersion is these post emergence

processing sessions in that what's what

we gave them we give them the cognitive

and affective anchors to want to do it

again next year with now a different

hand growing through the process and

ultimately when they become doctors

hoping that they choose the path to be

done and for some funding we were able

to get a few scholarships and this is in

honor of dr. Dreyfus Perlas the doctor

to the barrier former gdb who was

assassinated back in 2017 while he was

returning from a medical mission in a

beside his town of service so I'm ending

with this this one just passed last week

this is the universal health care and it

talks about setting up a primary care

system

robust to be able to sort of swing the

whole thing about health care in the

country this is an opportunity but you

know what see the line where the sky is

the seed called me hope it goes you know

the challenge with this is you will be

the dog person this new hopefully new

but we have to be involved in the

conversation because we have to change

things the challenge really is for the

Philippines and the Filipino how far you

guys will need to go how much are you

willing to try and how much are you guys

willing to do thank you

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