Gov't physicians to population ratio

By: Annie Ruth M. Calambacal | Photos from Dr. Dax Nofuente | July 26, 2015 9:22 AM, Interaksyon.com

MANILA, Philippines - Doctors earn big, ride in flashy cars, and live in charming homes.

But not Dax Edward Nofuente. The 33-year-old physician from a middle class family in Iloilo City earns a monthly income of only five figures, rides a low-cost motorbike, rents a P6,000 a month apartment, and often eats in cheap food stalls or carinderia.

"I've never collected a professional fee since I became a doctor seven years ago. I am poor but I am happy. Kanya-kanyang trip ‘yan [To each his own liking]," says Doc Dax, chief health program officer of the Department of Health (DOH)'s Bureau of Local Health Systems Development.

File photo of Doc Dax Nofuente on his red motorbike

Amid the shortage in the number of public physicians in poor communities, Nofuente decided to take the road less traveled, literally and figuratively.

In 2008, after finishing medicine at the West Visayas State University and passing the board exam, Doc Dax shunned air-conditioned clinics and big hospitals and instead went to far-flung farms and trekked the highlands where doctors were a rarity.

For two years, under the DOH's Doctors to the Barrios Program, Nofuente became the health officer of San Francisco, a fifth class municipality in Southern Leyte where four in every 10 households had incomes less than P7,107, the monthly cost of basic food and non-food requirements for a family of five, based on 2009 data from the National Statistical Coordination Board (NSCB).

It was in the farming communities of San Francisco where Doc Dax helped treat melancholic, sluggish children, who had flaky skin and straw-like hair.

"The problem in Francisco at the time was malnutrition. It had a 15 percent malnutrition rate. It was the second worst in Southern Leyte," he says.

The malnutrition problem in San Francisco was directly tied to the lingering poverty in the province. In 2009, Southern Leyte registered the highest increase in poverty incidence in Eastern Visayas with 43.3 percent of the province's households earning less than the cost of basic survival needs.

File photo of Doctor Dax Nofuente (center) with families from San Francisco, Southern Leyte.

Also, Southern Leyte is among the more than 70 provinces nationwide that failed to meet the ideal ratio of 1 public doctor for every 20,000 population set by the DOH's Human Resource Development Bureau.

[WANT TO KNOW THE DETAILS? CLICK INTERAKSYON'S MAP OF GOV'T DOCS TO POPULATION RATIO PER PROVINCE FROM 2009 to 2012 based on data from DOH's Field Health Services Information System]

Based on DOH's latest available data, the average public doctor to population ratio in Southern Leyte from 2009 to 2012 was 1 for every 44,446 people, which was worse by 36 percent than the national average ratio of 1 government physician per 32,674 individuals during the same period.

Like in other poverty-stricken towns, San Francisco has health units that do not have enough medicine and facilities. "Maraming kailangan ng gamot at gamit pero kulang sa supply," says Nofuente, who remembers the case of woman in the town who was about to give birth but lost a lot of blood and had to be transported to the district hospital that was one-and-a-half hours away from her home.

Doc Dax's experience in San Francisco, however, was not the worst.

In the latter part of 2011, Nofuente was assigned to Calanasan in Apayao province. There, in the rugged and mountainous Cordillera town of some 11,000 people, Doc Dax witnessed and understood what poor access to health services really meant.

"In Langnao, one of the farthest barangays in Calanasan, a 78-year-old man suffering from cataract told me that it was the first time that he had seen a doctor," says Nofuente.

While it is the largest town in Apayao and is categorized as a first class municipality, life in Calanasan remains difficult. Based on data from the NSCB, the poverty incidence in the town was 33 percent in 2009.

"To get to Calanasan, you have to take a jeep from Claveria, Cagayan for a five-hour trip. But that trip will just take you to the poblacion (downtown). To get to a barangay, you have to walk for four hours," Doc Dax says.

File photo of Doc Dax Nofuente trekking the hills and mountains of Calanasan town in Apayao to reach patients, some of whom had never seen a doctor before.

Nofuente says that it was in Calanasan where one of his patients died giving birth.

"The baby was breech. Thus the pregnancy was high-risk. I told the mother to go the district hospital. But she chose to give birth in her home. She lost a lot of blood. It took the midwife hours to get to the mother's house because her home was far away. When the midwife finally came, the mother was already dead," Doc Dax says.

Transportation from one remote barangay to another far barangay in Calanasan is often expensive, according to Nofuente.

He says residents usually commute via habal-habal (modified motorcycle that can accommodate more than two passengers) or a single motorbike that costs P500 for a one-way travel.

The lack of mobile phone signal also impedes communication and access to health service.

"Usually, pag may manganganak, kailangang puntahan sa bahay ang midwife. Hindi kasi makapag-text kasi walang signal [Usually, if there's a mother about to give birth, somebody has to fetch the midwife from her home. You can't send text message to the midwife because there's no signal]," Doc Dax says.

"I spread them out…I also tried to spread myself as thinly as possible," says Doc Dax.

To improve access to health services, Doc Dax says Calanasan Mayor Elias K. Bulut grouped the 20 barangays into clusters and made the services available to the poblacion available, too, in the clusters. Nofuente said Bulut had made members of the Sangguniang Barangay responsible for the health needs of every cluster.

As he looks back on his being a doctor to the barrio, Nofuente can't help but get emotional about the rich and fulfilling experience he had.

File photo of Doc Dax Nofuente (center) with health personnel of San Francisco, Southern Leyte.

"Sana, marami pang doctor na mamukid o mag-isla. There are still a lot of areas that don't have doctors. Masaya naman kasing maging doctor to the barrios, kahit walang masyadong pera. Akyat ka ng gamot sa kanila, pag baba mo, pagkain ang dala. Eh di happy," he says.

[I hope that there will be more doctors who will go the field or islands. There are still a lot of areas that don't have doctors. It's happy to become a doctor to the barrios even if it's not financially rewarding. You bring medicine up to the highlands and when you go down, you have food from them. And that's a happy experience.]