Case Analysis - Ang Kwento Ni Rosario f405v

CASE ANALYSIS: Ang Kwento ni Rosario PART I Health does not exist in a vacuum and will always be affected by an endless number of factors ranging from one’s regular diet and own genetic make up on a micro scale, to where one is taking residence and what policies the local authorities implement in one’s community on a macro scale. Health is multifactorial and this is evident with the case of 1 year, 4-month-old Rosario. Rosario’s family is destitute – they cannot afford three full meals a day – instead, they have a regular diet of coffee, rice, and a meager P50 viand, that they portion for 6 family to last three meals. They live off on the P165 salary of Jaime, Rosario’s father, who is a laborer in Quezon City. With no other mentioned sources of income, their family severely lacks financial security not only to afford food but also a decent shelter, clean and potable water, proper sanitation, and other services and goods such as medicine and milk formulas. Rosario’s mother, Lucy, was ill advised to hold off from breastfeeding all of her four children, and instead she resorted to feeding them with diluted condensada and powdered milk. In addition, the parents, with relatively low educational attainment, hold beliefs, misconceptions and practices that do not promote health – like how bottle feeding paraphernalia are washed only by soap and water, that vaccines cause sickness, calamansi is bad for the health, or that parasitic worms are normal and that these aid in digestion. These considerations in Rosario’s immediate context have led to her and her siblings being 2nd degree malnourished children, regularly contracting cough, fever, diarrhea and having unmanaged infestation by parasitic worms. Unfortunately, Rosario, given her age, her lack of vaccines, poor diet and other factors leading to her increased vulnerability, is also the sickliest. Among her siblings, she is the thinnest, pale and regularly diarrheic. It was actually just a matter of time for her to contract an illness, as she eventually did go down with measles, and due to a variety of factors was unable to recover and ultimately died. Considering another level in Rosario’s context, the condition of their family’s community and place of residence, Barrio Tanyong, further elucidates the case of Rosario. It is described to be located beside a highly polluted and contaminated body of water, with poorly built infrastructure leading to accidents that increase the risk of exposure to canal waters. Even more disturbing, the community’s main water source (90%) consists of two public pumps or deep wells that have a high possibility of being contaminated, given the community’s close proximity to the canal. Another direct and major contributor to the unfortunate outcome in the case is the healthcare system, in the forms of the physician with whom Lucy consulted before, the barangay health center and a private hospital. It was unclear whether the doctor that Lucy consulted with before practiced in either of the latter health care facilities, but what was evident was he/she did not think what was best for the patient, instead exploiting Lucy’s poor grasp of health-related concerns. Despite Lucy feeling quite well and nourished enough to breastfeed, she was still diagnosed to have a heart condition and was told this was a contraindication, even

when there are actually very few instances when this is the case. The physician’s motive of personal profit is further evidenced when he/she urged Lucy to buy infant formula from a small dispensary he/she owns. For the barangay health center, it was understaffed of midwives and health workers, and under stocked with vaccines and other medicine. In of health financing, their budget allotment for medicine from the LGU for the year was already consumed, and they were having trouble convincing the Sangguniang Bayan that the additional budget will be used for its intended purpose, instead of being pocketed by the mayor and municipal health officer. They were able to provide free consult, however the instruction regarding the prescription given goes directly against the law, supposedly ensuring Lucy’s right and choice to cheaper, but still bioequivalent drugs. Another questionable practice by the health center was how they rejected Lucy and Rosario for a second consult, instead referring them to a private hospital without clear reasons as to why they could not be accommodated. Lastly, for the private hospital, while it is understandable that as a for-profit endeavor they have a fee for service system, their ‘deposit system’ is contentious, as they have yet to provide health care for the patient. It is also unfortunate that they do not seem to have a charity ward or a program for indigents to at least some of their expenses, asking them to pay also for consumables like cotton, alcohol, gauze and tape. a. Identify which of the health problems presented in the case is core and priority for health program development? Explain your choice. Defining a core for all of the health problems in the case is problematic as these problems have different roots and contexts, and they compound on each other as certain socio-economic factors, such as financial security and educational background, determine the likelihood of these problems arising as well as the capability/vulnerability of the individual when forced to address these problems. More useful to the case would be to strengthen an institution capable of addressing basic and common health problems, instilling health promotion and education and delivering health services especially catering to the felt and expressed needs of the community as a whole – the barangay health center. The case of Rosario is neither isolated nor rare, she is representative of the highly vulnerable under 5 population, and what happened to her could have happened to any other child in their community. I would like to focus on strengthening the barangay health center as, if managed well, it is capable of addressing a lot of the problems presented in the case. The health center is supposed to be equipped enough to capably handle common and basic illnesses (respiratory infections and measles being some of them), and annually holds programs ed by the local and national government to address year-round concerns like malnutrition and parasitic infections. Supposing these problems were common in the community, they could hold feeding and deworming programs in partnership with NGOs or through funding from the local government. The BHC is also a venue for health education and promotion, a place where people can get information, clarify misconceptions

and hopefully eradicate beliefs and practices that are not helpful and may even increase the risk for acquiring sickness. They were in a position to correct the information given to Lucy about breastfeeding her children, thus saving the family some money instead of buying poor milk substitutes. Furthermore, as it is the health facility closest to the ground, the community and its constituents, the BHC is expected to be the most knowledgeable of the community’s felt and expressed needs – the need for proper sewage systems, toilets and sanitation, clean and potable water sources, as well as the need to improve infrastructure so as to minimize accidents. These community problems could be relayed to the proper authorities and hopefully the barangay or municipal authorities could do something about it. The barangay health center is, of course, still limited in its scope and will always be hindered by financial constraints. While the MHO is burdened with the task of rallying for a bigger budget and from the mayor and council, the BHC must prove its worth to the community by providing as much as it can for the good of a greater number of people, given its limited resources. Its programs should benefit as many of its constituents as possible, and should work on preventive rather than curative approaches if they are to better the wellbeing of the community as a whole. The problem of under stocking could be addressed by a thorough evaluation of what medications are easily or hardly consumed, by identifying the most common diseases burdening the population, and using these data, projecting what and how many medications or vaccines they should procure for the next year. The BHC should also comply with the law and promote the prescription of generic rather than brand names so as to lower the financial burden of the patient. For uncommon diseases that the BHC may not be able to handle, they should have a good referral system in place. They must properly inform the patient as to the need for a referral and offer public, firstly, as well as private health care options. b. Problem Tree Analysis

c. Objective Tree Analysis

PART II The Philippines is currently experiencing the double burden of disease, wherein the top causes of morbidity are communicable, infectious diseases while the top causes of mortality, from being previously occupied by communicable diseases, have changed to more of the degenerative, lifestyle and noncommunicable diseases. In addition, there is also a threat from emergent and resurgent diseases, thus placing a bigger toll on the health care system and the economy. The double burden of disease poses a greater challenge for health care providers, as such trends indicate that while people are getting sick from infectious diseases, people are dying due to other causes- leading the health system to ask which direction should they take? Where should the limited budget allotted for health go? Ultimately, the decision whether to specialize in internal medicine and manage degenerative, lifestyle diseases or into infectious diseases and treat longstanding health problems in the country also lie on these trends and decide the fate of new physicians who aim to uplift the lives of patients, but also to make a living. As a second year medical student, this status and these numbers are still quite distant to me, owing to the fact that I have yet to be truly immersed in the

clinics to see physical representations of these data in the form of patients who come in the hopes of treatment. At the very least, these numbers challenge me to try and get a good grasp of all the diseases included in the lists, as these, by far, are the most common and would definitely be cases I meet on a regular basis. It also requires of me to be novel in that I should be able to address both morbidity and mortality and contribute to improve those numbers by aiming to lessen the burden of disease. Such a feat could only be achieved by changing the paradigm of medicine – from being curative to preventive. By shifting the focus from illnesses to total well being and healthy practices. As a friend of mine said, Medicine is ironic because as a job, it works to eradicate itself. To truly have the patients’ best interests in mind would mean working to keep them from incurring diseases and away from the clinics. In the ideal healthy world, there would be a decreased demand for doctors and other health care providers because there would be no illness to treat (except perhaps for the usual rare chromosomal aberration). But as it is, the burden of disease remains great and a means of affecting and improving it would be through strengthening preventive medicine. Keeping healthy individuals healthy, and working on those who are sick to recover and resume a healthy if not normal life. Emphasizing on moderation and proper nutrition, keeping a healthy and active lifestyle clear of vices, risk-taking and health-depreciating behavior lowers the risk for contracting both communicable and non-communicable diseases, thus addressing the double burden of disease. It is only recently that health care systems in other countries are shifting their paradigm of curative to preventive medicine, and the Philippines has yet to catch up. But for that to happen, not only should authorities like DOH and LGUs step in, but also, on a grassroots level, medical practitioners and the communities themselves should change their idea of what the role of medicine should be. On a personal level, I already am an advocate of preventive medicine – though I may have inconsistencies practicing it on myself as I have yet to internalize that health is not just the absence of infirmity or disease but a total physical, social, mental and emotional well being.