The Road To Perdition

Streetwise
by Carol P- Araullo
The Business World/5-6 November 2005

There's one crisis in our crisis-ridden country that I feel compelled to write about, setting aside the urge to comment on the electoral victory of George W. Bush, the man the rest of the world's peoples love to hate.

The brain drain in the health professions, specifically in nursing and medicine, has been going on since the 1960s as far as I can tell. Definitely, by the time my UP Medicine class of about 145 students graduated in 1979, more than half were destined to go abroad, at first to train, then to establish their practice and stay on. (I bet many of them got to vote in the last US presidential elections.)

So the news that the Philippines has the dubious distinction of being the top exporter of nurses in the world is old hat. We used to be the No. 2 exporter of doctors, but maybe India has taken over considering the cost of medical education and the economic crunch that Filipinos have been living under for two and a half decades. What has got people sitting up to take notice is the fact that physicians are going back to school to become certified nurses. We're not just talking about fresh medical graduates either. Medical specialists who have been practicing five or more years are abandoning their hard-earned professions to work as nurses, mostly in the US and UK.

It doesn't take an economist to figure out why. One estimate is a stark US$400 working as a doctor in a Philippine state hospital versus $4,000 doing duty as a nurse in US hospitals (with immigrant status for family members to boot). I wager $400 is even on the high side since resident physicians, those doctors who are still undergoing specialty training, would be getting much less.

Consider the powerful cultural factors at play in making the switch from doctoring to nursing, but are easily swept aside by the economic imperatives: the general perception, correct or not, that becoming a nurse after having studied or worked hard as a doctor, constitutes a denigration of one's professional status. There is an implied intellectual superiority that derives from the assumption that it takes more brains to be a doctor than a nurse when in fact, in most instances, the more accurate premise is that it takes more money to go to medical school and thus the higher status has more to with socioeconomic class than anything else.

In our still macho society, the shift to nursing constitutes a double demotion on the part of male doctors. In the hierarchy of the health professions, the doctor is still the decision-maker, the leader of the health team, if not the undisputed "boss," while the nurse takes down the doctor's orders and implements these.

The implications of the continuing brain drain deserve to be confronted especially when our political leaders, the bureaucrats at DOLE, the recruitment agencies as well as owners of mushrooming nursing schools all over the country peddle the lie that the country has a net gain in exporting our human resources. They extol rather than decry the fact that we are spending scarce social capital on future doctors and nurses, only to lose them to richer societies that can afford to give them decent salaries and a modicum of respect, if not reward, after all the hard work and personal sacrifice.

This is the stark reality. The country has reached the point where there is now a developing scarcity in medical human power even in the cities, in tertiary care hospitals (i.e. those providing more specialized and expert medical care), and in the private sector. It used to be that scarcity was relative. It followed that doctors and nurses tended to be hospital-based, both to earn more as well as to be able to avail of the newer medical technology and convenience any health professional educated in the Western tradition looks for. It was to be expected that rural areas would have a difficult time attracting doctors and nurses to practice there because of the expected low paying capacity of its population, mostly farmers and small- to medium-size merchants. There were always vacancies in rural health centers and even secondary government hospitals especially in such far-flung areas like Samar, the Cordilleras and western Mindanao.

Metro Manila, on the other hand, had a surfeit not only of doctors, but of world-class physicians, you just had to be able to afford them or have the patience to queue up in the interminably long lines at the Outpatient Department of the University of the Philippines-Philippine General Hospital (UP-PGH). Thus, the crowding in the cities where not only the money is better, the schools for the children are more prestigious, the shopping malls are more complete and the general socioeconomic environs cum cultural life more upscale than anything a small town, much less a barrio could ever hope to offer.

But now, the telltale signs of a worse crisis to come are truly worrisome. Hospitals in Mindanao and Negros Oriental are facing closure because of a lack of doctors and nurses. UP-PGH, that venerable institution which produced the top-notch specialists practicing in the major urban centers of the country as well as top-rated US medical centers, is having difficulty attracting fresh graduates to fill up the slots in what used to be highly competitive residency programs. The high turnover of nurses has accelerated in the last decade with the huge number of nursing schools unable to churn out graduates fast enough to fill in the slots their more-honed predecessors left.

No doubt about it, what has been a long-running crisis in our low priority, under-financed and decaying health care system will soon become a full-blown emergency. It's just another example of how the myopic, or rather, head-in-the-sand attitude, of our political leaders promises to lead us to even greater perdition as a country. That's the fearsome scenario our young doctors and nurses are running away from, and who can blame them.

GMA: BRING CHRISTMAS CHEERS THROUGH PRICE ROLLBACKS, WAGE HIKES

PRESS RELEASE/November 7, 2004
Reference: Rev. Fr. Allan Jose Arcebuche, OFM
National Co-Chairperson
Contact: 4107623PCPR

The Promotion of Church People’s Response (PCPR) stated today that Malacañang can truly bring Christmas cheers by ordering price rollbacks especially on oil, power and water rates; substantial wage and salary hikes; re-channeling of the debt-service and military budgets to social services, tax reduction and other beneficial moves for the poor.

The activist church group criticized Malacañang for acting like a clown who expects the people to smile amidst intolerable economic hardships.

“How can jobless fathers and mothers bring cheers to their families in the face of dimmer prospects of stable incomes and the burden of eight new sinful taxes? There are tears and no cheers as many Filipinos can hardly cope with the ever increasing cost of living. We cannot be cheerful when despite the sacrifices of the poor, the shameless corruption of high government and military officials continue to worsen the country’s economic crisis,” Rev. Fr. Allan Jose Arcebuche, OFM, PCPR National Co-Chairperson stated.

“It’s so easy for the President and her spokespersons to say “cheers” as they don’t suffer the plight of many Filipinos who are doomed to spend Christmas with less paychecks and ever increasing debts,” the activist priest added. PCPR further decried the government’s ‘no permit, no rally’ policy and its increasing repression against workers groups rallying for wage hikes and other people’s organizations demanding urgent socio-economic reforms.

“Tomorrow, November 8, marks the death anniversary of Capt. Panfilo Villaruel – a man who was brutally killed by police agents under the orders of Malacañang officials who were not amused by his extra-ordinary expression of outrage against the corruption in government. We demand justice for Capt. Villaruel and all victims of police brutality as we continue to demand long-term resolutions of the main causes of the country’s economic crisis,” PCPR concluded.

UPDEYT sa Rice Subsidy

Ngayong araw na ito, ika-25 ng Oktubre 2004 ay pormal nang ini-award sa lowest bidder and ating rice subsidy sa UP Manila (kasama siyempre ang PGH) para sa taong 2004. Ang ating bigas na nagkakahalaga ng P1,000.00 kada sako ay aabot sa 56 Kgs. o P17.86/kilogram. Ito ay Sinandomeng variety pa rin. Tinatanyang ito ay sisimulang ididistribute sa atin sa ika-3 ng Nobyembre 2004. Ang distribution ay ayon sa opisina o yunit na kinabibilangan at may eskedyul bawat opisina para hindi uli magkakaroon ng biglang buhos ng tao sa pagbaba ng bigas. Mayroong kinaukulang Memorandum na ipapalabas ang Opisina ng Tsanselor o ang Direktor kaugnay dito.

Wala pa man ang ating bigas, ay mayroong mga samut-sari at walang batayang haka-haka. May petisyon pa ngang inikot ang mga ilan nating kasamang walang magawa at mas naniniwala sa sabi-sabi kaysa makinig o humingi ng opisyal na pahayag mula sa All UP Workers Union.

Ang ating rice subsidy ay malinaw na nakapaloob sa Collective Negotiation Agreement (CNA) sa pagitan ng UP at All UP Workers Union kayat obligado ang Administrasyon ng UP na ipatupad ito, gayundin ang ating year-end incentive bonus at iba pang mga economic benefits sa ilalim ng nasabing kasunduan. Wala ring dahilan para pag-awayin ang rice subsidy at year-end incentive bonus kaya't hindi totoo na ang rice subsidy ay kukunin mula sa ating year-end incentive bonus.

At dahilan sa ang CNA benefits ay kabilang sa mga exemptions sa mga "Austerity Measures" sa ilalim ng Administrative Order 103 ng Pangulong GMA, nasa ating mga kamay kung gayun kung papayagan nating magdahilan pa ang UP sa usaping ito.

Sa ating mga kasamang kawani na patuloy na sumusuporta at sumasama sa mga pagkilos ng unyon para sa tuloy-tuloy na kampanya sa ating Sahod, Trabaho at Karapatan; taus puso kaming sumasaludo sa inyo! Nagsisilbi kayong inspirasyon para sa ibayo at mas masikhay pa nating mga pagkilos! MABUHAY!

TULOY-TULOY ANG LABAN SA P3,000 ACROSS-THE-BOARD SALARY INCREASE!

Makiisa sa Gagawing Noise Barrage at Makisalo sa Pagdildil ng Asin sa Lunes, October 11, 2004 12:00 –1:00 PM sa PGH Flagpole.

Makiisa din sa gagawing “Sanduguan” sa Huwebes, Oktubre 14, 2004Simula ng 8:30 AM sa Department of Budget and Management (DBM)

Hindi pa man din nakakaraos sa sunod-sunod na pagtaas ng presyo ng petrolyo at mga pangunahing bilihin, ay mayroon na namang pagtaas ng singil sa kuryente at nakaambang pagtaas ng singil sa tubig! Bukod pa diyan ang iba pang maiitim na balak ng gubyerno upang tugunan daw ang “fiscal crisis”, mga hakbang na lalong nagpapahirap sa mga mamamayan! Ilan dito ay ang mga tax measures, early retirement, at budget cut sa edukasyon, kalusugan, atbp. – mga band-aid sa nagnanana at nabubulok na sistema. At habang nag-iisip ng mga patapal-tapal na solusyon ang gubyerno, libo-libong empleyado naman ang patuloy na umaasa at naghihintay na tugunan ang panawagan sa karagdagang sahod!

Sa kasalukuyan ang sweldo kada buwan (gross) ng Utility Worker I (SG1) ay P5,082.00, Nursing Attendant II o Clerk III (SG6) ay P7,606, Nurse I (SG10) ay P9,939.00 at ang Medical Officer III (SG18) ay P15,831.00. Ito ay napakaliit kung ikukumpara sa poverty threshold sa NCR na mahigit P16,862.00 (ayon sa NSCB) para sa isang pamilya na may apat na miyembro!

Ang tunay na halaga ng piso ay nasa 40 sentimos na lamang. Sa kinikita ngayon ng isang ordinaryong kawani, halos bigas at asin na lamang ang kayang mabili nito para sa pang-araw na pagkain.

Sa harap ng lumalalang kalidad ng pamumuhay, nananawagan ang All UP Workers Union kasama ang kalakhan ng mga kawani sa pamahalaan ng patuloy na panawagan para sa P3,000 Across-the-Board Monthly Salary Increase. Ang tinatayang P43B na kailangan para sa P3,000 monthly increase ng may 1.2M na mga kawani ng gubyerno ay barya lamang sa P695B na ibabayad ng gubyerno sa kautangan para sa susunod na taon, kung saan marami dito ay hindi ang sambayanan ang nakinabang at napunta lamang sa iilang pribadong kumpanya at mga indibidwal. Bukod pa dito ang iba’t-ibang anomalya na kinasangkutan mismo ng nasa posisyon, lalo na ng mga kasapakat ni Pangulong GMA, halimbawa na lang dito ang tinatayang halos P15 – P17B mula sa PCSO, PAGCOR, GSIS, OWWA, at DA na ginamit sa nakaraang kampanyang reelection, ang Diosdado Macapagal Blvd, mga tax credit scam, malawakang “conversion” sa AFP at marami pang isyu ng graft and corruption.
Ang ating laban sa sahod ay makatarungan. Ang P3,000.00 dagdag sahod ay may 5 taon na, at sa patuloy na pagtaas ng mga serbisyo’t bilihin, inflation at depreciation ng Peso, ito ay halos hindi na angkop sa kasalukuyang panahon. Ang tuwina ang sagot ng inutil, incompetent at puno ng corruption nating gubyerno, ay patuloy na pagbubulag-bulagan at pagbibingi-bingihan.

Tinutulak tayo ng gubyerno sa bingit ng kahirapan, na magdildil sa asin habang ang mga nasa matataas na posisyon ay namimihasa sa garbo ng taas ng sahod at mga benepisyo. Ang mga ahensiya ng gobyerno ay pilit pinapatupad ang mga “austerity measures” subalit taliwas naman dito ang dalas ng foreign travel, pagtaas ng budget para sa advertisement at mga descretionary fund tulad ng Intelligence Fund ng mismong opisina ng Pangulong GMA. Walang katotohanan kung gayon ang “burden sharing” na ipinamumukha ni GMA! Ang mga karaniwang mamamayan lamang ang nagpapasan ng hirap, samantalang puro pagpapapabor sa malaking negosyo at kanilang mga kasapakat sa Kongreso at Malacañang ang naging prayoridad ng ating gubyerno. Mga tax incentives, tax holidays, tax amnesty, ang unilateral na tariff reduction, mga batas tulad ng EPIRA, Oil Deregulation Law, atbp. Lahat ito ay malinaw na ang mga nakinabang ay mga malalaking negosyo lamang at hindi ang mamamayan.

Patuloy na ipaglaban ang ating salary increase! Ito ay bahagi pa rin ng ating panawagan para sa pagtaas ng badyet pangkalusugan at pagkakaloob ng iba pa nating mga benepisyo – quarterly rice subsidy, backpay ng COLA, increase ng hazard pay, subsistence allowance at iba pa.

All U.P. Workers Union, Manila Chapter

"Lansagin ang Ibagsak" Part I