Access to Healthcare Outside the City | Paolo Medina | TEDxUERM
Summary
TLDRThe 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
🌱 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.
🚑 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.
📚 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.
🌐 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.
🌟 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.
Mindmap
Keywords
💡Health as a human right
💡Community service
💡Poverty and healthcare
💡Over-romanticization of rural medicine
💡Substandard healthcare
💡Medical missions
💡Learned helplessness
💡Primary care and frontlines
💡Universal healthcare
💡Immersion programs
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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