Tonee Marie F.

Gabriel BSN - II

TEACHING HEALTH EDUCATION IN THE PHILIPPINES Many existing health beliefs and practices in the Philippines are rooted back in the pre-colonial period. This includes magico-religious elements, such as beliefs in spirits and sorcery as causes of illness, as well as empirical aspects such as the use of medicinal plants. Archaelogical sites in the Philippines have yielded skeletal remains showing intricate ornamental dental work and the use of trephination (boring a hole into the skull as a magical healing ritual). Today's traditional medicinal practitioners can trace their origins back to the precolonial period - the psychic surgeons, with their flair for drama, parallel the pre-hispanic religious practicioners (babaylan and catalonan) who also played roles as healers. Spain laid the foundation for a feudal health care system. The religious orders built charity hospitals, often next to churches, dispensing services to the indio. Medical education was not extended to the indio until late in the 19th century, through the University of Santo Tomas. This feudal system of the rich extending charity to the poor persists to this day among many church-run as well as non-sectarian institutions. The United States established an economic system giving the colonizers full rights to the country's resources. The Spanish feudal system was not dismantled; in fact, through the system of land registration that favored the upper Filipino classes, tenancy became more widespread during the US occupation. A native elite, including physicians trained in the United States, was groomed to manage the economic and political system of the country. The U.S. also introduced western models of educational and health-care systems which reinforced elitism and a colonial mentality that persists to this day, mixed with the Spanish feudal patron-client relationship. In the early years after the declaration of martial law, opposition against Marcos was spearheaded by the Left. The new government is essentially a fractious coalition of conservative forces representing traditional interests as exemplified by their policies on land reform, labor, foreign investments and their antagonism toward progressive groups. Serious questions about the dominant models of development, including those used in health care with its hospital- and doctor-centered orientation, have spurred new initiatives in health care among alternative organizations. Community-based health programs are part of the popular movements that seek to democratize health care even as the struggle goes on for other structural reforms. The struggle against disease has progressed considerably over the years. Health conditions in the Philippines in 1990 approximated to those in other Southeast Asian countries but lagged behind those in the West.

In 1989 the ratio of physicians and hospitals to the total population was similar to that in a number of other Southeast Asian countries, but considerably below that in Europe and North America. Most health care personnel and facilities were concentrated in urban areas. There was substantial migration of physicians and nurses to the United States in the 1970s and 1980s, but there are no reliable figures to indicate what effect this had on the Philippines. Hospital equipment often did not function because there were insufficient technicians capable of maintaining it, but the 1990 report of the Department of Health said that centers for the repair and maintenance of hospital equipment expected to alleviate this problem. In 1987 a little more than one-half of the infants and children received a complete series of immunization shots, a major step in preventive medicine, but obviously far short of a desirable goal. The problem was especially difficult in rural areas. The Department of Health had made efforts to provide every barangay with at least minimum health care, but doing so was both difficult and expensive, and the more remote areas inevitably received less attention. The Philippines has a dual health care system consisting of modern (Western) and traditional medicine. The modern system is based on the germ theory of disease and has scientifically trained practitioners. The traditional approach assumes that illness is caused by a breach of taboos set by supernatural forces. It is not unusual for an individual to alternate between the two forms of medicine. If the benefits of modern medicine are immediately obvious--eyeglasses, for instance--then there is little argument. If there is no immediate cure, the impulse to turn to the traditional healer is often strong. One type of traditional healer that attracted the attention of foreigners as well as Filipinos was the so-called psychic surgeon, who professed to be able to operate without using a scalpel or drawing blood. Some practitioners attracted a considerable clientele and established lucrative practices. Travel agents in the United States credited these "surgeons" with generating travel to the Philippines. Although medical treatment had improved, health education has reached many households and services had expanded, pervasive poverty and lack of access to family planning detracted from the general health of the Philippine people. The Philippines had a social security system including medicare with wide coverage of the regularly employed urban workers. It offered a partial shield against disaster, but was limited both by the generally low level of incomes, which reduced benefits, and by the exclusion of most workers in agriculture. In April 1989, out of more than 22 million employed individuals, a little more than 10.5 million were covered by social security. In health care and social security, as with other services, the Philippines entered the 1990s as a modernizing society struggling with limited success against heavy odds to apply scarce financial resources to provide its people with a better life. The health conditions in the Philippines would have improved a lot, had all Filipino doctors opted to stay in the country. Many Filipino physicians, nurses and medical personnel opted to go to the US, Europe and the Middle East where they could earn ten times as much

as their salaries in the Philippines, leaving only a few doctors attending to the needs of the large population in the country. This in part explains the high cost of medication in the country, forcing some Filipinos to consult faith healers, witch doctors or self-declared physicians who charge less. Others treat themselves with herbal medicine. With a low budget allocation for health and social services, the Philippine government has to confront perennial problems such as the outbreak of dengue fever, cholera and water-borne diseases every year. Limited access to potable water and sanitation among the poor aggravate the problem. Unplanned urbanization and industrialization are also contributory factors to the adverse health conditions. No Philippine city has a modern sewerage system. Public health programs in the Philippines are commonly administered through government hospitals and health centers in local villages. In 1993, the country's Department of Health launched its Hospitals as Centers for Wellness program. It assigned each hospital a health education and promotion officer. In 2010, programs are geared toward managing the major health issues that affect the country. The Department of Health in coordination with the Department of Trade and Industry has been importing much cheaper medicine from India, in an attempt to lower the prices of locally manufactured medicines. In general, health conditions in the Philippines call for improvement. There needs to be a continuity of the public health programs and education so that the public are better informed and aware of their health status. While the public health system was decentralized to local governments, this only led to inequitable distribution of health services. Poor municipalities could hardly deliver health services and education as efficiently as urban cities do. It must be noted that the national government is showing efforts to make efficient health services and health education available to as many Filipinos.