Of course, going "back to the barrios" is a noble endeavor that is much easier said than done. Government has strained every sinew in seeking solutions to the shortfall of health personnel in its facilities at the grassroots. There is, however, a vast chasm between the virtually free but basic health-service delivery one can enjoy at a government health center and the cutting-edge but costly services available in hospitals.

   At Commcare, dedicated doctors like Rolando Jeremillo Jr. (Doctor Jun to his patients) offer exciting solutions to the growing problems of Filipinos lacking access to quality health care. Although it is referred to as a "medical center," Commcare, situated inside the Merville Park subdivision in Parañaque, is essentially a community clinic that operates 24/7. Neither admitting lying-in patients nor large enough to be called a hospital, the clinic is also not small enough to be regarded as a mere health center. The large letters spelling out emergency emblazoned on the facility's lighted signboard give the clear message that Commcare is equipped to attend to a lot more than the usual cough, cold, and diarrhea.

Novel concept

    "This is a very unique market, if you can call it that," Jeremillo told Medical Observer. Commcare is founded on a concept that has been highly successful in some parts of Australia, wherein there is always a community health facility accessible within a few miles. The principal difference between Commcare and the Australian clinics is that the latter fit in perfectly with the socialized health-care system of Australia, while Commcare seems to have fallen into a crack in the Philippine Health Insurance (PhilHealth) scheme, making the facility invisible if not nonexistent within the national health-insurance program.

    While the highly conspicuous "emergency" signboard can be rather misleading, Dr. Jun admits that it does serve its purpose of attracting public attention. Commcare is neither an emergency-medical-service center nor a hospital. It is, instead, a clinic that places a high premium on disease prevention and primary-health-care interventions. "It is basically about educating the patient before a disease comes into full bloom," Jeremillo explained. "We teach them how to avoid sickness and diseases. We promote vaccines and whatever the new trends are in preventive care."

    The young doctor hopes to instigate a change in the typical Filipino attitude toward health and disease which, sadly, is to consult only when a disease has progressed to unmanageable levels. "A lot of Filipinos seek medical attention only when they are really sick. They wait until three to five days, by which time it has really gotten worse," he elaborated.

    Situated deep inside a private residential subdivision, Commcare still gets its share of patients from all walks of life. Majority of consultations for disease prevention, wellness visits, and minor complaints are accounted for by the A and B economic crowd-mostly from among the homeowners themselves. It does, however, attend to a good number of C and D consultations, mostly for accidents and trauma. When such emergencies occur, the clinic stabilizes the patient, and attends to the initial medicolegal concerns if any, prior to transferring the patient to the appropriate hospital for tertiary care.

    Thus, even if the clinic's main thrust is primary health care, it has to attend to occasional heart attack or stroke emergencies, vehicular-accident and violence victims, and even childbirth. It has an adequate staff complement available round the clock. Jeremillo takes two 24-hour shifts every week, alternating with Dr. Antoinette Calvelo and Dr. Lomibao, along with some junior physicians. Thus, even in the bleak of the night, residents in the neighborhood are always certain that there is a doctor just a few minutes away who is not catching some Zs, but is on duty at Commcare.

    What is perhaps among the more important features such clinics possess is the adequacy of their laboratory facilities. Since it is geared to wellness and disease prevention. Commcare's secondary-level laboratory is fully equipped to perform most procedures such as complete blood chemistry, urinalysis, cholesterol, uric acid, and pregnancy tests, and many others. It has complete X-ray facilities, and is equipped for minor outpatient surgical procedures. Jeremillo is particularly proud of the "very deep stocks" of the clinic's pharmacy inventory. Being himself a medical director of a pharmaceutical company, he shares the vision of making medicines accessible to more Filipinos and, therefore, advocates drug-price reduction and the use of high-quality generic drugs.

    While the clinic is serious about its mission to promote preventive health within the community and the village's environs, Commcare is basically a commercial endeavor. Consultations come with a minimal fee, and the health workers are paid salaries. Consistent with this outlook, the clinic offers membership and discount cards, thereby allowing families who pay annual fees to avail themselves of unlimited consultations. This has prompted village residents to enroll their entire families along with their household help in such plans.

 

Intrepid physicians

    Jeremillo's work at Commcare is far from being financially rewarding, but it is something that he loves to do and something that he has to do. Although he was trained in orthopedics and trauma, Jeremillo is proud that he is among the dying breed of general practitioners in the Philippines. He was a Green Archer all his life, having studied in La Salle schools since the first grade until his residency training at De La Salle Medical Center in Cavite.

    Rather than spending time at the golf links, this doctor prefers to be out on the briny off Calatagan, trolling a fishing lure behind a boat waiting for a heavy talakitok or tanguigue to strike. This father of four also indulges in his passion for motor vehicles. He coowns an automotive-detailing business, and has a particular fondness for Vespa motor scooters. Rather than taking the family car to work, Dr. Jun rides to Commcare in his mint condition Vespa PX 150. Of course, he wears the prescribed helmet, being sure not to be among the statistics of trauma injuries seeking attention in the clinic.

    Privileged as he was, Jeremillo never regarded his advantageous position as a ticket to financial gain, whether in a top-end medical center in Metro Manila or in a another country. He chose to apply his abilities as a physician in attending to the family-health needs of a greater number of Filipinos, whether or not they have the financial resources to pay for such services.

    Fortunately, he is also somewhat an entrepreneur and is able to make his businesses finance the needs of his family, allowing him to devote some time to his service at Commcare. "I get in a hot seat here because I do a lot of charity work," he intimated to Medical Observer. "But then, I bring my own stuff like sutures, etc."

    Having devoted a lot of time to charity clinics in the past, Jeremillo finds the work in a community clinic as fulfilling as it is necessary. Although doctors tend to think less of general practitioners, he pointed out, the entire health-care system relies heavily on them. "You can't put a specialist like a pediatrician on duty for 24 hours. What's he going to do when someone comes in with a heart attack?" he mused.

    Although the health-care system in the United States is greatly hinged on the expertise of family physicians, such a setup doesn't seem to be taking shape in the Philippines, he pointed out. He admitted that the orientation of medical practice in the Philippines is highly westernized, but lamented that the attitudes of doctors continues to be very traditional, if not actually feudal.

    Thus, the culture in which the generalist is looked down upon by the specialist is perpetuated. This results in limited numbers of doctors opting to enter public health or residency programs in family medicine. With the growing popularity of outfits like Commcare, there just might be a ray of hope for the floundering doctor in search of a purpose and the Filipino families who wish to maintain good health without having to go to hospitals.

    Are community clinics truly the answer to the problems of primary health care? It is difficult at the onset to find many health workers with the same passion and vision as Jeremillo. Great endeavors, however, are often accomplished in small painstaking steps. Even in its present location inside an exclusive village, Commcare seems to hold a formula that has some promise for the problems beleaguering the health-care system in the Philippines. M

 

Printable Version