A year of vulnerability: The plight of medical workers and the sorry state of the national hospital system and health care services

By Dino Pineda

The consistent lack of attention has caused the

government to sideline health needs, turning more

to ambitious plans of development based on infrastructure.

NEVER IN recent history has the public health system been the subject of so much media attention as in 2021. In 2020, the Philippine College of Physicians held a press conference to call attention to the dire situation that health and medical professionals were working under and dealing with as frontliners against COVID-19. In the second year of the pandemic, the surge of cases caused by the Delta variant more fully exposed the institutional and structural weaknesses that have plagued Philippine hospitals and medical services. 

The crisis familiarized most Filipinos with medical vocabulary: infections, Intensive Care Unit (ICU), quarantine, vaccinations, variants, virality, health protocols — terms found in the news. The coverage, however, should have more consistently addressed the state of neglect of public hospitals and the poor wages of medical workers who have been driven to work in other countries. 

The consistent lack of attention has caused the government to sideline health needs, turning more to ambitious plans of development based on infrastructure. Like education, health and public welfare, issues that profoundly affect the capacity of the poor to survive and to improve their lives suffers from lack of political attention and will — neglect that devolves also to the coverage of these issues in the news. 

There were exceptional reports in 2021, calling attention to the need to prioritize these concerns, to evaluate the general public health infrastructure in the country, and undertake a major overhaul as necessary.

But because the crisis involved a disease, news settled on the downstream end of the problem: the cases, albeit large in numbers, represented only a 

CMFR cheered Rappler for detailing the dire state of the healthcare system under the stress of COVID-19. Questioning the Department of Health (DOH) claim that the health care capacity of hospitals had improved part of the peril. 

As it turned out, Covid-19 drew out into the open the structural weaknesses of the public health system which made the pandemic even more difficult to address during the period, the report holds up to public attention the vulnerability of public health services to politics. Indeed, the lead agency of government was more concerned about public perception rather than reality. The investigative piece zeroed in on the DOH’s lack of action on the issues raised by health workers in the field and on the ground. 

In an exclusive report published on April 12, reporter Sofia Tomacruz showed that hundreds of patients continued to suffer while waiting days, even weeks, in emergency departments (EDs) overwhelmed by the surge in COVID-19 cases. For weeks, hospitals had reported operating with full bed occupancy and patients not getting admitted for lack of beds. Rappler pointed out that many netizens had noted “the discrepancy between official statistics that indicated available space in facilities and the situation on the ground.” DOH reports had not factored in their assessment ED figures which showed more accurately the failure of the system to address the needs of COVID and other patients.  

The report cited data from the Philippine College of Emergency Medicine showing that, as of April 12, at least 310 COVID-19 patients needing hospital care were still waiting for beds across all 14 of its training institutions in Metro Manila and Cavite.  Tomacruz noted that while 14 hospitals represented just a fraction of the 159 health facilities in the areas, the number still highlighted “the strain under which public and private hospitals operate” as the number of cases had yet to “significantly decline.”

Rappler’s overview presented the larger landscape, including the necessary data to confirm its assessment. Furthermore, it documented the consensus among experts and medical workers who opposed the government’s policy shift to the less restrictive modified enhanced community quarantine (MECQ). As argued in the statement of the Healthcare Professionals Alliance Against COVID-19 (HPAAC), authorities had as yet “no clear plans and efforts to fix the root causes…” It also cited Takeshi Kasai, Director of WHO Western Pacific Region who said the Philippines was nearing a “red line,” where the number of cases exceeded healthcare capacity.

Unfortunately, media did not push for the answers to the complaints expressed by the medical groups, issues which reflected doubts about the capacity of government to deal strategically with the challenge of the pandemic or even to respond promptly to legitimate complaints about non-payment of benefits and increased compensation for medical workers, especially the nurses. 

 

On August 13, media carried statements from unions including the Filipino Nurses United (FNU) and Alliance of Health Workers (AHW) calling attention to the dismal plight of frontliners and sounding the alarm on the worsening issue of mass resignations. News accounts also recalled the Bayanihan 2 law that mandates hazard pay and special risk allowance (SRA) for both public and private healthcare workers.  Media failed to include the context in reporting the delay in payments for medical frontliners. 

Healthcare workers threatened to go on strike in August, as the Delta-driven surge began. They were promised allowances by the government and the DOH, under Secretary Francisco Duque III, could not disburse these as scheduled. Close to the end of October, these were yet to be released. A Philippine News Agency report said DOH released PHP15.7B worth of benefits by November 26, but the department clarified that some benefits have a limited scope and coverage period. For instance, the grant of a SRA was only until June 2021.

CMFR also noted other media reports presenting the crisis from specific angles, documenting the plight of families who failed to secure admission for their sick members, as well as those who had to travel to provincial hospitals surrounding Metro Manila for necessary treatment.

But much of the news depended largely on DOH daily bulletins. 

Tracking the numbers ruled reporting in 2021, as reports pieced together the increase or decline of cases in different parts of the country. Most, however, recorded the numbers as announced, as few journalists acquired sufficient background to question the information they were given. 

The daily bulletins seemed designed for goals other than public health purposes.  A clutter of percentages, devoid of analysis, context, and historical comparisons really did not help the public understand whether the threat had diminished or become more severe. 

Perhaps, periodic assessments with analysis of case numbers given a time frame would have been more helpful during the year that experienced the Delta surge. 

In June, when the surge in cases broke out in several provinces, media began to do more than record the number of COVID-19 cases around the country. 

Interviewed by anchor Karmina Constantino, Edson Guido, head of ABS-CBN’s data analytics team, interpreted the numbers, tracking the geographical shift of cases. The cases were increasing outside the capital.

While the numbers showed a lower national average, cases were recorded in places that were even less prepared to handle the spikes. This kind of deconstruction showed the needs arising from a different context, the lack of capacity of hospitals in many areas of the country to provide for the critical needs of serious COVID-cases. 

The finding flagged the need for capacity-building in provincial hospitals, something that national government should have attended to from the earliest stages of the pandemic, knowing there would be internal travel which would cause Covid cases to rise in the provinces. 

Government without a Strategy 

But government action was limited to shifts between more and less restrictive measures of lockdown/quarantine and Alert levels. In cycles, this approach could not be taken seriously unless government supplied a rationale, communicating widely the reason for the changes. 

Explaining policy is part of good governance. It is a necessary step to secure the consent of the governed. Such explanations were sadly missing during the crisis, as most of the time, government demanded blind compliance.   

The lack of rational policy became ever more obvious in 2021. Official discourse was devoid of consideration of fundamental or “root causes,” of remedies for immediate needs, and of long-term programs. 

Indeed, the need to review the status of health services and national hospitals, including the geographic distribution of these in order to reach as many of the national population, these and other related problems demanded a comprehensive discussion not just by the government but also by the private sector, civil society organizations, and the public.

Meanwhile, the administration failed to show any attempt to effectively balance the seemingly opposing needs to protect and promote public health and to restart the economy, sustain selected activities in order to prevent its collapse.

Concerned Filipinos were painfully aware of the peril they faced, given the inability of government to set out strategic actions, calibrate these as required by changing conditions, in order to produce the best outcomes.

When the cases began to drop in the first week of October, the DOH said in a media briefing that it would check whether the decline was “artificial” and if the numbers correctly reflected the situation on the ground. By the third week of October, the assessment of the decrease was proved by a decline in hospital cases in sync with the number of reported cases of COVID. While the numbers remained high, the decreasing trend has continued.

Dr. Maricar Limpin, President of the Philippine College of Physicians, then expressed the need for government to react quickly should the slightest uptick in cases happen again. In order to do that, she suggested that the government take this opportunity, while cases were low, to increase vaccination efforts and to implement changes in the alert levels and the minimum health protocols. She added that doctors and hospitals also had to attend to non-COVID cases. 

On the question of whether health workers were able to breathe easier, Dr. Limpin categorically answered no.

The best outcome has yet to be imagined at this point. 

Media out of its depth

Like the government, the press was overwhelmed by the challenge of reporting more than just the statements issued by public officials. Reporters seemed boxed in by digital briefings, the pre-packaged information handed to them online. 

COVID-19 proved to be an historic global crisis, which even experts in more developed countries were at a loss to address. But unlike the national situation in the Philippines, different communities were involved to identify issues and concerns related to the pandemic. 

Philippine media could have broadened the framework of coverage. The pandemic after all was a global experience. Filipino journalists should have broken through the parochial scope of news and reported more on what regional and international communities were doing and what issues were taken up in continuing discussions. Internet and social media channels allowed access to the international reportage, to discourse conducted in various expert communities or civil society groups around the world. 

The failure of the media to do so was a missed opportunity in the period of COVID-19 crisis.