1 00:00:02,900 --> 00:00:05,199 Speaker 1: You're listening to AC N A podcast. 2 00:00:16,930 --> 00:00:21,239 Speaker 1: I do not like hospitals. Not many people do, but 3 00:00:21,250 --> 00:00:25,379 Speaker 1: having access to good clean functioning medical facilities is an 4 00:00:25,389 --> 00:00:30,690 Speaker 1: unattainable luxury for millions of people worldwide. Imagine waking up 5 00:00:30,700 --> 00:00:34,799 Speaker 1: mid surgery because your low quality anesthetic has worn off. 6 00:00:35,090 --> 00:00:38,209 Speaker 1: I'm Teresa Tang. In this episode, we're going to explore 7 00:00:38,220 --> 00:00:41,130 Speaker 1: the issue of health care disparities with Buena Brunel, our 8 00:00:41,139 --> 00:00:42,479 Speaker 1: Philippines correspondent, 9 00:00:42,720 --> 00:00:46,098 Speaker 1: she dissects the country's ailing system and what is being 10 00:00:46,110 --> 00:00:49,818 Speaker 1: done to help the people. It's failing. Buena. Hi. I 11 00:00:49,830 --> 00:00:51,860 Speaker 1: have missed catching up with you. It's been quite some 12 00:00:51,869 --> 00:00:55,069 Speaker 1: time since our last episode. Welcome back to CN A correspondent. 13 00:00:55,369 --> 00:00:58,880 Speaker 1: Always great catching up with you, Teresa. Can you take 14 00:00:58,889 --> 00:01:01,709 Speaker 1: us to the Philippines? It's a place where you were born, 15 00:01:01,720 --> 00:01:05,139 Speaker 1: where you were raised, walk me through. What exactly happens 16 00:01:05,150 --> 00:01:07,339 Speaker 1: if you're an average person and you fall sick? 17 00:01:08,099 --> 00:01:11,349 Speaker 1: Well, it really depends on your medical condition. But in general, 18 00:01:11,360 --> 00:01:15,319 Speaker 1: if you're hospitalized and it takes months at a time 19 00:01:15,330 --> 00:01:19,339 Speaker 1: for you to recover from your disease, then health spending 20 00:01:19,349 --> 00:01:23,160 Speaker 1: can be catastrophic. And I'm not using that word just 21 00:01:23,169 --> 00:01:27,059 Speaker 1: to incite panic. Catastrophic health spending is actually a technical 22 00:01:27,069 --> 00:01:30,509 Speaker 1: term in the health sector that refers to the amount 23 00:01:30,519 --> 00:01:32,619 Speaker 1: of household pays that exceeds 24 00:01:32,730 --> 00:01:35,089 Speaker 1: it is their capacity to pay for health care. In 25 00:01:35,099 --> 00:01:38,360 Speaker 1: other words, it can be impoverishing for them. And in 26 00:01:38,370 --> 00:01:41,470 Speaker 1: the case of a TV story we did on Philippine healthcare, 27 00:01:41,480 --> 00:01:46,339 Speaker 1: we spoke to multiple patients with that experience and that 28 00:01:46,349 --> 00:01:50,150 Speaker 1: goes at the heart of universal health coverage because what 29 00:01:50,160 --> 00:01:54,419 Speaker 1: universal health coverage really means is access to health care 30 00:01:54,430 --> 00:01:57,230 Speaker 1: in a way that does not push you into poverty. 31 00:01:57,849 --> 00:02:00,389 Speaker 1: If you look even at the experience of the Philippines 32 00:02:00,400 --> 00:02:05,559 Speaker 1: during the pandemic, stories of people having to pawn their 33 00:02:05,569 --> 00:02:09,418 Speaker 1: properties in order to pay for their hospital bill because 34 00:02:09,429 --> 00:02:13,979 Speaker 1: they contracted COVID-19 at a time where it was still 35 00:02:13,990 --> 00:02:18,109 Speaker 1: very fatal to get COVID-19. You talk about how expensive 36 00:02:18,119 --> 00:02:20,589 Speaker 1: it is if you fall sick for a long period. 37 00:02:20,600 --> 00:02:20,869 Speaker 1: And 38 00:02:21,139 --> 00:02:24,199 Speaker 1: you know, since moving to Singapore eight years ago, my 39 00:02:24,210 --> 00:02:27,550 Speaker 1: local friends here, they've warned me many times that it's 40 00:02:27,559 --> 00:02:30,720 Speaker 1: cheaper to die than to fall sick in this country. 41 00:02:30,860 --> 00:02:32,919 Speaker 1: It sort of said tongue in cheek, but there is 42 00:02:32,929 --> 00:02:35,399 Speaker 1: truth to it because medical bills they can get so 43 00:02:35,410 --> 00:02:38,899 Speaker 1: expensive and it sounds like that's what's happening in the Philippines. 44 00:02:38,929 --> 00:02:41,940 Speaker 1: That's right. And the main premise of our TV story 45 00:02:41,949 --> 00:02:44,709 Speaker 1: on health was actually the fact that the 46 00:02:44,824 --> 00:02:48,445 Speaker 1: the main driver of health spending is medicines. So as 47 00:02:48,455 --> 00:02:51,345 Speaker 1: high as 75% of out of pocket health spending for 48 00:02:51,354 --> 00:02:55,574 Speaker 1: the poorest Filipinos and 58% for the richest goes to 49 00:02:55,585 --> 00:03:00,804 Speaker 1: medicines and essential medicines. Not all medicines, but the essential ones. 50 00:03:00,815 --> 00:03:04,174 Speaker 1: We do have a national drug formula that lists what 51 00:03:04,184 --> 00:03:06,994 Speaker 1: are the essential medicines that the government can buy at 52 00:03:07,005 --> 00:03:08,323 Speaker 1: a cost effective rate 53 00:03:08,669 --> 00:03:12,000 Speaker 1: is at least three times more than international prices. That's 54 00:03:12,008 --> 00:03:15,410 Speaker 1: according to government data. So when I learned of that, 55 00:03:15,750 --> 00:03:19,320 Speaker 1: my immediate thought was, is there anything else that we 56 00:03:19,330 --> 00:03:22,109 Speaker 1: should talk about? But this because if it is two 57 00:03:22,119 --> 00:03:25,250 Speaker 1: thirds of your health spending and if health spending is 58 00:03:25,258 --> 00:03:26,888 Speaker 1: so catastrophic, then we 59 00:03:26,979 --> 00:03:30,360 Speaker 1: we should talk about access to medicines. And part of 60 00:03:30,369 --> 00:03:34,039 Speaker 1: the conversation that we had in filming the story, the 61 00:03:34,050 --> 00:03:39,690 Speaker 1: TV story for health was really the idea that poverty 62 00:03:39,889 --> 00:03:45,160 Speaker 1: is an exacerbating factor for lack of access to health care. 63 00:03:45,610 --> 00:03:49,029 Speaker 1: Buena. I was immediately taken in by your TV story 64 00:03:49,039 --> 00:03:52,070 Speaker 1: because right off the top, we meet a Filipino mother 65 00:03:52,080 --> 00:03:55,460 Speaker 1: of four. She basically breaks down in front of you. 66 00:03:55,470 --> 00:03:59,539 Speaker 1: She was so forthcoming. Talking about her health, her financial struggles, 67 00:03:59,820 --> 00:04:03,190 Speaker 1: tell us more about Amelita Debra. How did you find her? 68 00:04:03,475 --> 00:04:06,285 Speaker 1: 01 thing I would say is that for every story 69 00:04:06,294 --> 00:04:09,345 Speaker 1: we do, we do the research we put in the work. 70 00:04:09,354 --> 00:04:12,255 Speaker 1: Meaning to say we ask ourselves, what are the most 71 00:04:12,264 --> 00:04:15,054 Speaker 1: important elements if we have this much time to talk 72 00:04:15,065 --> 00:04:17,284 Speaker 1: about health care? So in this case, we have half 73 00:04:17,295 --> 00:04:20,024 Speaker 1: an hour, what are the most important things we can 74 00:04:20,035 --> 00:04:20,803 Speaker 1: talk about. 75 00:04:21,160 --> 00:04:25,149 Speaker 1: And in the case of a Meita Debra, part of 76 00:04:25,160 --> 00:04:29,500 Speaker 1: our discussion was where should we go? And we thought 77 00:04:29,510 --> 00:04:32,250 Speaker 1: we should go a of course to hospitals, you know, 78 00:04:32,260 --> 00:04:36,450 Speaker 1: the basics. But beyond that, for the social factors involved 79 00:04:36,459 --> 00:04:39,739 Speaker 1: in health, we should go to churches and we should 80 00:04:39,750 --> 00:04:43,980 Speaker 1: go to pharmacies and we should go where people can 81 00:04:43,988 --> 00:04:45,299 Speaker 1: buy herbal medicine. 82 00:04:45,769 --> 00:04:48,750 Speaker 1: So we actually met her at church. And part of 83 00:04:48,760 --> 00:04:51,149 Speaker 1: the reason why we went to a church is because 84 00:04:51,428 --> 00:04:55,190 Speaker 1: we had this conversation about how, how Filipinos when they 85 00:04:55,200 --> 00:05:00,308 Speaker 1: don't have access to life saving cures. And they're really 86 00:05:00,320 --> 00:05:04,399 Speaker 1: at the brink of desperation, they go to church and 87 00:05:04,410 --> 00:05:07,868 Speaker 1: you know, faith is something they hold on to. So 88 00:05:07,880 --> 00:05:11,290 Speaker 1: we met her after she was actually praying for a 89 00:05:11,299 --> 00:05:12,229 Speaker 1: job abroad. 90 00:05:12,670 --> 00:05:16,169 Speaker 1: And right after she prayed, she went straight to where 91 00:05:16,178 --> 00:05:17,769 Speaker 1: she could buy herbal medicine. 92 00:05:18,100 --> 00:05:21,440 Speaker 1: And that's how we learned that she actually had goiter. 93 00:05:21,450 --> 00:05:24,269 Speaker 1: When you tell us about Amelita, we learn that she's 94 00:05:24,279 --> 00:05:27,380 Speaker 1: using supplements instead of medication because she has access to 95 00:05:27,390 --> 00:05:30,230 Speaker 1: those supplements and you can get those things and much 96 00:05:30,238 --> 00:05:35,369 Speaker 1: more on one particular street in Manila, right? Countless pharmacies line, 97 00:05:35,380 --> 00:05:38,799 Speaker 1: Bambang Street. Tell us about that. Well, Bambang Street, the 98 00:05:38,809 --> 00:05:43,570 Speaker 1: pharmacies there actually sell wholesale and they're selling generic drugs 99 00:05:43,579 --> 00:05:46,279 Speaker 1: and that is why it is cheap to buy from there. 100 00:05:46,290 --> 00:05:46,760 Speaker 1: So 101 00:05:47,119 --> 00:05:51,140 Speaker 1: how cheap it is. I have spoken to buyers there 102 00:05:51,428 --> 00:05:55,618 Speaker 1: and compared prices of when they buy it elsewhere, it's 103 00:05:55,790 --> 00:06:00,079 Speaker 1: three times cheaper. That is why there is really part 104 00:06:00,089 --> 00:06:03,779 Speaker 1: of covering this story, really going there and learning about 105 00:06:03,790 --> 00:06:07,600 Speaker 1: the people who buy medicines from that place, the supplements 106 00:06:07,609 --> 00:06:11,118 Speaker 1: or the herbal medicine that we covered there 107 00:06:11,260 --> 00:06:15,000 Speaker 1: near the church where we met Amelita that sidewalk. It's 108 00:06:15,010 --> 00:06:18,118 Speaker 1: not in Bambang, but it's also known for those herbal 109 00:06:18,130 --> 00:06:23,149 Speaker 1: medicine when we went there. I guess the takeaway from 110 00:06:23,170 --> 00:06:25,679 Speaker 1: the fact that this is sold wholesale and this is 111 00:06:25,690 --> 00:06:29,730 Speaker 1: generic drugs is the fact that of course, that there 112 00:06:29,738 --> 00:06:33,279 Speaker 1: should be strong legislation for these generic drugs. And in 113 00:06:33,290 --> 00:06:35,320 Speaker 1: the Philippines, there is actually 114 00:06:35,559 --> 00:06:40,220 Speaker 1: and the doctors I spoke to would explain bioequivalence and 115 00:06:40,350 --> 00:06:45,200 Speaker 1: the fact that generic drugs are nearly as effective. Meaning 116 00:06:45,209 --> 00:06:49,660 Speaker 1: to say there's just a small percentage as the branded medicines. 117 00:06:50,000 --> 00:06:53,209 Speaker 1: Uh So it's important to have that as well. But 118 00:06:53,220 --> 00:06:57,100 Speaker 1: the other conversation happening there is that medical facilities in 119 00:06:57,109 --> 00:06:57,350 Speaker 1: the Philip 120 00:06:57,782 --> 00:07:02,122 Speaker 1: and localities in the Philippines buy medicines separately at different 121 00:07:02,132 --> 00:07:05,791 Speaker 1: volumes at different price points. So there has been a 122 00:07:05,803 --> 00:07:09,583 Speaker 1: conversation about how you can create a national pool of 123 00:07:09,592 --> 00:07:14,643 Speaker 1: medicines and just like figure out not necessarily a blanket 124 00:07:14,653 --> 00:07:17,933 Speaker 1: distribution but a targeted distribution. Meaning to say that you 125 00:07:17,942 --> 00:07:19,102 Speaker 1: have already surveyed 126 00:07:19,346 --> 00:07:24,205 Speaker 1: the needs prior, meaning you've spoken with the hospitals and 127 00:07:24,216 --> 00:07:29,205 Speaker 1: with the localities about what their needs are. And then 128 00:07:29,216 --> 00:07:32,776 Speaker 1: after that, you create a national pool where you do 129 00:07:32,786 --> 00:07:37,566 Speaker 1: the distribution yourself and that might be cheaper than having 130 00:07:37,575 --> 00:07:41,085 Speaker 1: all these small purchases at a time. 131 00:07:41,519 --> 00:07:45,730 Speaker 1: The other conversation about procurement that we had is this 132 00:07:45,739 --> 00:07:49,230 Speaker 1: conversation with Doctor Gap, who is the medical director of 133 00:07:49,239 --> 00:07:52,630 Speaker 1: the Philippine General Hospital, who shared in a senate hearing 134 00:07:52,640 --> 00:07:55,950 Speaker 1: how in the middle of operation a patient woke up 135 00:07:55,959 --> 00:08:00,140 Speaker 1: because of low quality anesthetics. And that just 136 00:08:00,660 --> 00:08:06,179 Speaker 1: shocked the legislators. And that's a conversation about how the 137 00:08:06,190 --> 00:08:10,760 Speaker 1: current law for procurement he said is not in line 138 00:08:10,769 --> 00:08:14,589 Speaker 1: with basically the interest of the patient because sometimes the 139 00:08:14,600 --> 00:08:15,679 Speaker 1: current law force 140 00:08:15,790 --> 00:08:20,450 Speaker 1: this medical facilities to buy the cheapest one in the market, 141 00:08:20,459 --> 00:08:24,359 Speaker 1: which may not be the best one. Doctor gap was 142 00:08:24,369 --> 00:08:29,279 Speaker 1: saying that this may work for supplies like pencils, you know, 143 00:08:29,290 --> 00:08:30,809 Speaker 1: in the Department of Education, 144 00:08:31,100 --> 00:08:35,799 Speaker 1: school chairs, but medicines is a different item altogether that 145 00:08:35,809 --> 00:08:40,820 Speaker 1: should go through much stringent quality control measures. So sometimes 146 00:08:40,830 --> 00:08:44,450 Speaker 1: we think of big pharma as a big bad wolf 147 00:08:44,460 --> 00:08:47,280 Speaker 1: in terms of access to medicines. But in our case, 148 00:08:47,289 --> 00:08:48,239 Speaker 1: when we spoke to 149 00:08:48,619 --> 00:08:51,599 Speaker 1: uh Michelle, we who is the global head of access 150 00:08:51,609 --> 00:08:55,210 Speaker 1: to medicines, we were really impressed at how they were 151 00:08:55,219 --> 00:09:00,469 Speaker 1: making medicines more equitable, especially in the global South. Let's 152 00:09:00,479 --> 00:09:03,919 Speaker 1: hear what she has to say. We group our countries 153 00:09:03,929 --> 00:09:09,719 Speaker 1: into different tier and these tier is determined um with 154 00:09:09,729 --> 00:09:12,900 Speaker 1: regards to the economical dynamics of a country. So the 155 00:09:12,909 --> 00:09:17,119 Speaker 1: GDP the healthcare infrastructure framework of a country, 156 00:09:17,460 --> 00:09:21,280 Speaker 1: the out of pocket segment as well as the policies 157 00:09:21,289 --> 00:09:26,929 Speaker 1: and enabling access to specific um therapeutical areas. So pricing 158 00:09:26,940 --> 00:09:31,010 Speaker 1: is determined on these economical factors and the dynamics of 159 00:09:31,020 --> 00:09:31,869 Speaker 1: these countries. 160 00:09:32,280 --> 00:09:35,390 Speaker 1: One thing that never really crossed my mind is the 161 00:09:35,400 --> 00:09:40,400 Speaker 1: link with geography. There are 7000 islands in the Philippines Buena. 162 00:09:40,409 --> 00:09:43,640 Speaker 1: That poses a big challenge, doesn't it? That's right. When 163 00:09:43,650 --> 00:09:47,460 Speaker 1: I spoke with a former health minister, Paulino Bal, she 164 00:09:47,469 --> 00:09:51,380 Speaker 1: was saying that this is really one of the biggest 165 00:09:51,390 --> 00:09:54,429 Speaker 1: challenges of the health department, which is the storage and 166 00:09:54,440 --> 00:09:57,849 Speaker 1: distribution of medicines. And you know, 167 00:09:57,914 --> 00:10:01,914 Speaker 1: we talk about how do you transport these medicines to 168 00:10:01,924 --> 00:10:05,275 Speaker 1: these islands, you look back to the pandemic where they 169 00:10:05,284 --> 00:10:10,714 Speaker 1: used helicopters to bring COVID-19 vaccines to remote islands in 170 00:10:10,724 --> 00:10:14,434 Speaker 1: the Philippines. And on a regular basis, you just can't 171 00:10:14,445 --> 00:10:17,755 Speaker 1: do that with the resources of a lower middle income 172 00:10:17,765 --> 00:10:21,965 Speaker 1: nation like the Philippines. So logistics is part of what 173 00:10:21,974 --> 00:10:23,455 Speaker 1: makes medicines, 174 00:10:23,729 --> 00:10:27,179 Speaker 1: you know, less accessible in areas that are far from 175 00:10:27,190 --> 00:10:32,309 Speaker 1: urban centers, but it's not just medicines, it's also medical facilities. 176 00:10:32,320 --> 00:10:35,479 Speaker 1: Because if you have these areas where for example, you 177 00:10:35,489 --> 00:10:40,909 Speaker 1: have indigenous people's communities who aren't registered voters, then there's 178 00:10:40,940 --> 00:10:45,320 Speaker 1: very little incentive or political will for elected officials to 179 00:10:45,330 --> 00:10:48,289 Speaker 1: cater to their needs. Because at the end of the day, 180 00:10:48,299 --> 00:10:49,090 Speaker 1: sometimes 181 00:10:49,184 --> 00:10:52,205 Speaker 1: it's about how big is the voting populace in that 182 00:10:52,215 --> 00:10:57,965 Speaker 1: area and what kinds of services should I prioritize in 183 00:10:57,974 --> 00:11:01,585 Speaker 1: these areas. So it's not just about logistics, sometimes it's 184 00:11:01,594 --> 00:11:05,284 Speaker 1: also about political will. Let's talk about the patients. Again, 185 00:11:05,294 --> 00:11:08,885 Speaker 1: patients inside hospitals are actually considered to be the lucky 186 00:11:08,895 --> 00:11:12,755 Speaker 1: ones in many ways. Right. Because the alternative is waiting 187 00:11:12,765 --> 00:11:14,723 Speaker 1: on the sidewalk outside, 188 00:11:14,979 --> 00:11:17,299 Speaker 1: describe what it's like for people on the pavement. I 189 00:11:17,309 --> 00:11:20,400 Speaker 1: can't believe this. So people are outside just, just waiting. 190 00:11:20,830 --> 00:11:23,830 Speaker 1: That's right. If you go around the compound of the 191 00:11:23,840 --> 00:11:28,718 Speaker 1: Philippine General Hospital, right at the back are people living 192 00:11:28,729 --> 00:11:32,099 Speaker 1: on the sidewalk and I'm not even sure if this 193 00:11:32,109 --> 00:11:35,950 Speaker 1: is too graphic to, to share. But on the four 194 00:11:35,960 --> 00:11:38,640 Speaker 1: times that I went back there, there is a certain 195 00:11:38,650 --> 00:11:39,319 Speaker 1: smell 196 00:11:39,729 --> 00:11:44,280 Speaker 1: on that sidewalk and it's not garbage, it's not sweat, 197 00:11:44,340 --> 00:11:48,419 Speaker 1: it smells like mold and it stays with you hours 198 00:11:48,429 --> 00:11:50,429 Speaker 1: after you stay there. 199 00:11:50,960 --> 00:11:54,619 Speaker 1: And my conversation with my team was, do you smell me? 200 00:11:54,630 --> 00:11:57,939 Speaker 1: Do you find that distinct smell every time I go 201 00:11:57,950 --> 00:12:00,500 Speaker 1: and stay on that sidewalk? You know, speaking with the 202 00:12:00,510 --> 00:12:03,340 Speaker 1: patients there and they said yes. And they all said 203 00:12:03,349 --> 00:12:06,650 Speaker 1: it smells like mold and that's when it hit us 204 00:12:06,659 --> 00:12:09,979 Speaker 1: as a team that, oh, how do they clean that 205 00:12:09,989 --> 00:12:14,099 Speaker 1: area up? When there is always someone there living there, 206 00:12:14,520 --> 00:12:18,239 Speaker 1: there is no time to clean the sidewalk because it's 207 00:12:18,250 --> 00:12:21,940 Speaker 1: just one patient after another living there. And the reason 208 00:12:21,950 --> 00:12:26,098 Speaker 1: why they live there is because sometimes they come from 209 00:12:26,109 --> 00:12:30,069 Speaker 1: provinces outside of metro Manila and they don't have the 210 00:12:30,080 --> 00:12:31,689 Speaker 1: money to go back and forth. 211 00:12:31,784 --> 00:12:36,844 Speaker 1: Philippine General Hospital. Where they can get free services. And 212 00:12:36,854 --> 00:12:40,934 Speaker 1: that's the only hospital in the creator metro Manila area 213 00:12:40,945 --> 00:12:44,955 Speaker 1: that can cater to their needs. So at that cost, 214 00:12:44,965 --> 00:12:47,924 Speaker 1: so by the way, because there are private hospitals but 215 00:12:47,934 --> 00:12:48,965 Speaker 1: they can't afford them, 216 00:12:49,229 --> 00:12:53,239 Speaker 1: so they stay there for months. And that means they 217 00:12:53,250 --> 00:12:57,770 Speaker 1: are outpatient services that they wait for sometimes in multiple 218 00:12:57,780 --> 00:13:00,630 Speaker 1: days for a month and they just sleep there waiting 219 00:13:00,640 --> 00:13:04,520 Speaker 1: for the next schedule. Sometimes they are a relative of 220 00:13:04,530 --> 00:13:06,849 Speaker 1: a patient and they can 221 00:13:06,945 --> 00:13:11,335 Speaker 1: stay inside the hospital. Maybe they have an infant with them, 222 00:13:11,534 --> 00:13:15,005 Speaker 1: things like that. And doctor Gap, the medical director has 223 00:13:15,015 --> 00:13:18,614 Speaker 1: done strides to provide for the needs of the patients 224 00:13:18,625 --> 00:13:21,695 Speaker 1: of the Philippine General Hospital. But it's really just too 225 00:13:21,705 --> 00:13:24,525 Speaker 1: many needs. Their emergency room 226 00:13:25,349 --> 00:13:30,729 Speaker 1: is catering to patients twice its capacity at any given day. 227 00:13:31,349 --> 00:13:37,320 Speaker 1: And so he's shoring up funding support from legislators from philanthropists. 228 00:13:37,440 --> 00:13:40,650 Speaker 1: He's already set up a dormitory inside the Philippine General 229 00:13:40,659 --> 00:13:44,569 Speaker 1: Hospital and yet there are still people living on the sidewalks. 230 00:13:44,909 --> 00:13:47,468 Speaker 1: And I think this is a testament to the kind 231 00:13:47,479 --> 00:13:51,579 Speaker 1: of service that this hospital provides to the Filipino people. 232 00:13:51,590 --> 00:13:54,799 Speaker 1: It's not like this is a secret. People know that 233 00:13:54,859 --> 00:13:56,848 Speaker 1: if you want to get the best service, 234 00:13:57,229 --> 00:14:00,489 Speaker 1: medical service in this country, you go to that hospital. 235 00:14:00,599 --> 00:14:04,369 Speaker 1: But at the same time, sometimes we speak to people 236 00:14:04,380 --> 00:14:06,900 Speaker 1: who fall through the cracks. So these are the people 237 00:14:06,909 --> 00:14:10,210 Speaker 1: living there on the sidewalk because we do want to 238 00:14:10,219 --> 00:14:14,760 Speaker 1: highlight that there are still these problems that exist. My 239 00:14:14,770 --> 00:14:17,289 Speaker 1: mother is a nurse. She's been one for 40 years. 240 00:14:17,299 --> 00:14:20,419 Speaker 1: And I know firsthand how medical professionals are really at 241 00:14:20,429 --> 00:14:22,450 Speaker 1: the heart of any healthcare system. 242 00:14:22,739 --> 00:14:25,229 Speaker 1: And it's hard to believe what some in the Philippines 243 00:14:25,239 --> 00:14:28,830 Speaker 1: are going through. Buena low salaries, poor working conditions, you 244 00:14:28,840 --> 00:14:29,320 Speaker 1: name it 245 00:14:29,719 --> 00:14:32,099 Speaker 1: and then you have post COVID. Now a lot of 246 00:14:32,109 --> 00:14:34,859 Speaker 1: the issues they were dealing with have only gotten worse. 247 00:14:35,099 --> 00:14:40,169 Speaker 1: So we spoke to various union leaders across the political spectrum. 248 00:14:40,179 --> 00:14:42,979 Speaker 1: You know, from the far left to the center left 249 00:14:42,989 --> 00:14:46,880 Speaker 1: where there was a common theme in our interviews with them, 250 00:14:46,890 --> 00:14:51,239 Speaker 1: these basically the delayed health allowances that were promised to 251 00:14:51,250 --> 00:14:56,280 Speaker 1: them during the COVID-19 pandemic. And it's not like these 252 00:14:56,289 --> 00:14:59,299 Speaker 1: allowances are growing in interest. You know, the more 253 00:14:59,424 --> 00:15:02,864 Speaker 1: that you delay paying them to these health workers. No, 254 00:15:02,875 --> 00:15:06,205 Speaker 1: it's just the same amount but they're just waiting for it. 255 00:15:06,215 --> 00:15:09,484 Speaker 1: And in my case, I was able to speak with 256 00:15:09,494 --> 00:15:12,724 Speaker 1: center left union leader who said, you know, my wife 257 00:15:12,734 --> 00:15:16,875 Speaker 1: has a chronic kidney disease and this amount that the 258 00:15:16,885 --> 00:15:20,195 Speaker 1: government owes me could have gone to her dialysis to 259 00:15:20,205 --> 00:15:23,734 Speaker 1: her medicines. But I'm still waiting up until now. And 260 00:15:23,744 --> 00:15:26,715 Speaker 1: I guess, you know, we can listen to health workers 261 00:15:26,724 --> 00:15:29,005 Speaker 1: rights activist Robert Mendoza 262 00:15:29,299 --> 00:15:33,450 Speaker 1: who explains to us what's driving low morale among health workers. 263 00:15:36,010 --> 00:15:36,169 Speaker 1: The 264 00:15:36,179 --> 00:15:40,840 Speaker 2: government has no genuine care for health workers. One, we've 265 00:15:40,849 --> 00:15:44,239 Speaker 2: always called for a living wage. Health workers in the 266 00:15:44,250 --> 00:15:49,400 Speaker 2: Philippines have the lowest pay in Southeast Asia. Second, the 267 00:15:49,409 --> 00:15:53,979 Speaker 2: work is inhumane. The ideal ratio is oneness for every 268 00:15:53,989 --> 00:15:56,919 Speaker 2: 12 patients that's not being met. 269 00:15:57,539 --> 00:16:00,280 Speaker 1: And some nurses can't even leave their work behind them 270 00:16:00,289 --> 00:16:04,469 Speaker 1: because patients literally show up at their door at home. 271 00:16:04,530 --> 00:16:07,200 Speaker 1: I know you took a two hour journey to visit 272 00:16:07,210 --> 00:16:11,820 Speaker 1: health care workers in island communities. What struck you about them? 273 00:16:12,500 --> 00:16:15,250 Speaker 1: So the boat ride was two hours. But to get 274 00:16:15,260 --> 00:16:17,539 Speaker 1: to the port that takes us to that island is 275 00:16:17,549 --> 00:16:21,450 Speaker 1: another three hours or so. And I would say that 276 00:16:21,460 --> 00:16:23,869 Speaker 1: the Lim Island which is in the middle of the 277 00:16:23,880 --> 00:16:28,039 Speaker 1: Philippines largest lake, isn't it actually a remote area? So 278 00:16:28,049 --> 00:16:31,799 Speaker 1: there is a technical term called geographically isolated 279 00:16:32,109 --> 00:16:35,520 Speaker 1: and depressed areas. And the Lim Island isn't even part 280 00:16:35,530 --> 00:16:39,169 Speaker 1: of that list. So there are even more remote islands 281 00:16:39,179 --> 00:16:41,190 Speaker 1: in the Philippines that we were unable to go to 282 00:16:41,200 --> 00:16:44,780 Speaker 1: because of the time frame. And so we chose the 283 00:16:44,789 --> 00:16:49,380 Speaker 1: Lim Island where I met this wonderful nurse named Rose 284 00:16:49,539 --> 00:16:52,429 Speaker 1: who was so dedicated to the job. And she was 285 00:16:52,440 --> 00:16:53,369 Speaker 1: telling us, you know, 286 00:16:53,780 --> 00:16:57,919 Speaker 1: patients would go to her home because they know her 287 00:16:57,929 --> 00:17:02,219 Speaker 1: as the island's nurse. And sometimes, you know, we complain 288 00:17:02,229 --> 00:17:07,719 Speaker 1: of overwork, but literally this, this nurse is opening up 289 00:17:07,729 --> 00:17:10,520 Speaker 1: her home to the entire island. We have nothing to 290 00:17:10,530 --> 00:17:14,550 Speaker 1: complain about. I think, correct the facto rural health unit. 291 00:17:14,949 --> 00:17:17,159 Speaker 1: And what's even, 292 00:17:17,900 --> 00:17:21,889 Speaker 1: you know, impressive about this nurse is just how happy 293 00:17:21,900 --> 00:17:24,439 Speaker 1: she is with the work. You know, how meaningful she 294 00:17:24,449 --> 00:17:28,319 Speaker 1: finds that. Because if you ask her, what are the 295 00:17:28,329 --> 00:17:31,679 Speaker 1: challenges here? She'd say, you know, the challenge is transportation. 296 00:17:31,810 --> 00:17:35,530 Speaker 1: The challenge is sometimes that people would be mad at 297 00:17:35,540 --> 00:17:40,319 Speaker 1: her for the lack of facilities in their rural health unit. 298 00:17:40,900 --> 00:17:42,968 Speaker 1: And she'll explain, you know, this is just what we 299 00:17:42,979 --> 00:17:46,130 Speaker 1: can provide. So uh given your case, you would need 300 00:17:46,359 --> 00:17:49,219 Speaker 1: to go through that two hour boat ride and go 301 00:17:49,229 --> 00:17:52,170 Speaker 1: to the mainland and be in a hospital there because 302 00:17:52,180 --> 00:17:54,939 Speaker 1: that's not what we can deal with here. So she 303 00:17:54,949 --> 00:17:56,170 Speaker 1: has to explain that to them. 304 00:17:56,609 --> 00:17:59,880 Speaker 1: But she lights up when I ask, what's the best 305 00:17:59,890 --> 00:18:03,089 Speaker 1: part of the job? And that's when she says, you know, 306 00:18:03,099 --> 00:18:06,640 Speaker 1: when a baby cries after birth, you hear that first cry, 307 00:18:06,849 --> 00:18:10,129 Speaker 1: that's the best part. And she says when she walks 308 00:18:10,140 --> 00:18:11,119 Speaker 1: around the island, 309 00:18:11,569 --> 00:18:15,319 Speaker 1: sometimes mothers would come to her and say hi and 310 00:18:15,329 --> 00:18:19,369 Speaker 1: she would see that the baby she helped deliver is 311 00:18:19,380 --> 00:18:23,239 Speaker 1: already what, four years old, three years old. And that's just, 312 00:18:23,250 --> 00:18:25,979 Speaker 1: you know, it's a small island. So like just knowing 313 00:18:25,989 --> 00:18:28,599 Speaker 1: that a lot of kids growing up there, that she 314 00:18:28,609 --> 00:18:33,079 Speaker 1: helped deliver them in that two bed capacity birthing facility. 315 00:18:33,650 --> 00:18:36,839 Speaker 1: When uh we've talked so much about the problem. 316 00:18:37,089 --> 00:18:40,169 Speaker 1: What about the solution? What is the government doing to 317 00:18:40,180 --> 00:18:44,198 Speaker 1: get things under control? I guess part of the solutions 318 00:18:44,479 --> 00:18:48,910 Speaker 1: is really expanding that pool of funds for medicine. 319 00:18:49,369 --> 00:18:55,160 Speaker 1: And that's the challenge, right? Because doctors including former health ministers, 320 00:18:55,170 --> 00:18:59,400 Speaker 1: I spoke to such as Dr NPK OA said that 321 00:18:59,609 --> 00:19:02,680 Speaker 1: we really have to accept that right now, we can't 322 00:19:02,910 --> 00:19:06,969 Speaker 1: cover everyone's health expenses, you know, for. 323 00:19:07,849 --> 00:19:10,069 Speaker 1: And he said, he said, you know, I was on 324 00:19:10,079 --> 00:19:12,810 Speaker 1: the board of State Health Insurance firm, Phil Health and 325 00:19:12,819 --> 00:19:16,229 Speaker 1: up till now I pay for my premiums and I 326 00:19:16,239 --> 00:19:20,439 Speaker 1: don't even get services back. So kind of an acceptance 327 00:19:20,449 --> 00:19:23,520 Speaker 1: that that's where the Philippines is right now. That's why 328 00:19:23,530 --> 00:19:27,239 Speaker 1: advocates are saying, you know, let's focus on primary health 329 00:19:27,250 --> 00:19:31,569 Speaker 1: care so that you know, there's early diagnosis, there's preventive 330 00:19:31,579 --> 00:19:32,439 Speaker 1: health care 331 00:19:32,719 --> 00:19:36,859 Speaker 1: and there is a chance to cover everybody because right 332 00:19:36,869 --> 00:19:40,260 Speaker 1: now the funding for health care, the Department of Health 333 00:19:40,390 --> 00:19:43,839 Speaker 1: can't even pay for the health allowances of the workers 334 00:19:43,920 --> 00:19:48,390 Speaker 1: that were promised to them and can't cover everyone all 335 00:19:48,400 --> 00:19:52,020 Speaker 1: their health expenses. But in terms of access to medicines 336 00:19:52,030 --> 00:19:55,000 Speaker 1: as well, the plan of the government is kind of 337 00:19:55,010 --> 00:20:00,599 Speaker 1: to create these zones that would provide tax incentives for 338 00:20:00,609 --> 00:20:02,000 Speaker 1: pharmaceutical companies. 339 00:20:02,464 --> 00:20:06,484 Speaker 1: Hear what Albert Domingo, the Filipino Assistant Secretary of Health 340 00:20:06,494 --> 00:20:09,425 Speaker 1: has to say we have to promote competition. There has 341 00:20:09,435 --> 00:20:13,334 Speaker 1: to be many more brands, many more companies coming in. 342 00:20:13,464 --> 00:20:16,004 Speaker 1: So not only do we allow products from the outside, 343 00:20:16,015 --> 00:20:18,714 Speaker 1: but if we can actually manufacture those products locally, then 344 00:20:18,724 --> 00:20:19,323 Speaker 1: why not? 345 00:20:20,160 --> 00:20:24,300 Speaker 1: You have won awards Buena for your reporting covering development 346 00:20:24,310 --> 00:20:28,060 Speaker 1: and human rights issues. Clearly, you're passionate about this topic. 347 00:20:28,180 --> 00:20:30,550 Speaker 1: Do you feel like telling the story of health care 348 00:20:30,560 --> 00:20:34,339 Speaker 1: inequality in your country amplifies the cause? Can it make 349 00:20:34,349 --> 00:20:38,750 Speaker 1: a difference? Well, I find that when we cover development stories, 350 00:20:38,760 --> 00:20:40,930 Speaker 1: part of our job is really to 351 00:20:41,189 --> 00:20:44,829 Speaker 1: look at a social problem from different angles. So we 352 00:20:44,839 --> 00:20:48,680 Speaker 1: speak to a variety of people, but at the same time, 353 00:20:48,689 --> 00:20:52,290 Speaker 1: we speak to those who have an idea of what 354 00:20:52,300 --> 00:20:53,050 Speaker 1: to do. So 355 00:20:53,310 --> 00:20:56,129 Speaker 1: look at the social problem from different angles, but also 356 00:20:56,140 --> 00:20:59,750 Speaker 1: look at the possible solution from different perspectives. I keep 357 00:20:59,760 --> 00:21:02,750 Speaker 1: mentioning Doctor Gap because the medical director of the Philippine 358 00:21:02,760 --> 00:21:06,689 Speaker 1: General Hospital because even before trying to brainstorm for this story, 359 00:21:06,699 --> 00:21:08,739 Speaker 1: when I speak to doctors and I ask, you know, 360 00:21:08,750 --> 00:21:10,929 Speaker 1: who do you think we should speak to his name? 361 00:21:10,939 --> 00:21:14,649 Speaker 1: Kept popping up? And I would say that that interview 362 00:21:14,660 --> 00:21:17,650 Speaker 1: with him gave me an idea of what are the 363 00:21:17,660 --> 00:21:18,260 Speaker 1: motivations 364 00:21:18,640 --> 00:21:21,669 Speaker 1: and drivers of people in the medical sector in the 365 00:21:21,680 --> 00:21:25,250 Speaker 1: Philippines who stay. And that was an important part of 366 00:21:25,260 --> 00:21:28,489 Speaker 1: the story because it's not just about those who migrate 367 00:21:28,689 --> 00:21:31,569 Speaker 1: because they are forced, you know, out of economic coercion 368 00:21:31,579 --> 00:21:34,849 Speaker 1: and things like that. But doctor Gap in particular said, 369 00:21:35,060 --> 00:21:37,310 Speaker 1: you know, if you want to be a great doctor, 370 00:21:37,319 --> 00:21:39,209 Speaker 1: which he is, by the way, he is the only 371 00:21:39,219 --> 00:21:43,319 Speaker 1: Filipino who has spoken to Harvard about this brain surgery. 372 00:21:43,680 --> 00:21:46,589 Speaker 1: That he was a pioneer of in the Philippines during 373 00:21:46,599 --> 00:21:48,689 Speaker 1: his younger years. So I mean to say this is 374 00:21:48,699 --> 00:21:51,760 Speaker 1: a guy who could have been in any other or 375 00:21:51,770 --> 00:21:55,930 Speaker 1: in the world operating room. And I asked him, why, 376 00:21:55,939 --> 00:21:58,149 Speaker 1: why did you stay here? What you don't hear in 377 00:21:58,160 --> 00:22:01,649 Speaker 1: the TV? Story is him telling me that, you know, 378 00:22:01,660 --> 00:22:04,409 Speaker 1: if you want to be a great doctor in the Philippines, 379 00:22:04,619 --> 00:22:08,209 Speaker 1: which was his priority during his younger years before you know, 380 00:22:08,810 --> 00:22:12,530 Speaker 1: all these needs in the Philippine General Hospital struck him 381 00:22:12,770 --> 00:22:16,099 Speaker 1: and forced him to become medical director. He said if 382 00:22:16,109 --> 00:22:19,030 Speaker 1: you want to be a great doctor, you train abroad 383 00:22:19,369 --> 00:22:23,189 Speaker 1: because that's where the cutting edge technology is. But what 384 00:22:23,199 --> 00:22:24,579 Speaker 1: I did was 385 00:22:25,290 --> 00:22:28,948 Speaker 1: use that as a challenge to bring the cutting edge 386 00:22:28,959 --> 00:22:31,310 Speaker 1: technology here. And I think 387 00:22:31,760 --> 00:22:36,430 Speaker 1: when you meet visionaries like that, it just kind of 388 00:22:36,439 --> 00:22:41,079 Speaker 1: helps you understand or go through or navigate through that 389 00:22:41,089 --> 00:22:44,739 Speaker 1: vicarious trauma because while there are cracks in the Philippines, 390 00:22:44,750 --> 00:22:47,129 Speaker 1: there are also people who are trying to work on 391 00:22:47,140 --> 00:22:50,880 Speaker 1: those cracks and really trying to forward that cost for 392 00:22:50,890 --> 00:22:53,899 Speaker 1: universal health care in the country so much more to 393 00:22:53,910 --> 00:22:56,188 Speaker 1: the story than just what made it to your reports. Buena. 394 00:22:56,199 --> 00:22:59,909 Speaker 1: Thank you so much for this deeper. Look, always great 395 00:22:59,920 --> 00:23:01,300 Speaker 1: speaking with you, Teresa 396 00:23:02,069 --> 00:23:04,459 Speaker 1: and a reminder that the TV episodes of CN A 397 00:23:04,469 --> 00:23:08,329 Speaker 1: correspondent air every Wednesday at 930 pm, Singapore Hong Kong 398 00:23:08,339 --> 00:23:11,670 Speaker 1: time and you can find Bueno's reports on youtube as 399 00:23:11,680 --> 00:23:13,560 Speaker 1: well as on CN A dot Asia. 400 00:23:14,290 --> 00:23:17,099 Speaker 1: The team behind this week's episode is Sa W Clara 401 00:23:17,109 --> 00:23:21,050 Speaker 1: Ong Christina Robert Craig Dale and myself, Teresa Tang. Thanks 402 00:23:21,060 --> 00:23:22,069 Speaker 1: for joining us this week.