Heart Center at 32

PINOY KASI


Heart Center at 32
By Michael Tan
Inquirer

Last updated 00:13am (Mla time) 02/14/2007

THE mural is still there, in the lobby, a young Imelda Marcos in the center, hands stretched out in compassion and surrounded by indigent Filipinos.

I’m referring to the lobby of the Philippine Heart Center, the first of several specialized health centers set up during the Marcos era. The Heart Center was inaugurated on Feb. 14, 1975, followed by the Lung Center, the National Kidney Institute and the Philippine Children’s Medical Center, all built in Quezon City in close proximity to one another. Plans for a Brain Center, a Blood Center and an Orthopedic and Trauma Center were aborted after Ferdinand Marcos fell from power in 1986, but in recent months, there has been talk about converting that cluster of hospitals into an expanded Philippine Center for Specialized Hospitals.

But I’m jumping ahead of my story. To go back to the origins of the Heart Center, I interviewed the hospital’s current director, Dr. Ludgerio D. Torres, who founded the hospital together with their first director, Dr. Avelino Aventura.

Noblesse oblige

In 1971, Torres had just returned from the United States after training in heart surgery in Harvard. The political turbulence at that time had led many doctors to leave and Torres admits that he, too, thought about that option. It would have been easy to stay on in the States.

But he was challenged by the situation at home. Cardiac surgery was a very new field and there was no local hospital equipped to handle such surgery. Torres and other surgeons had to bring their own equipment from one hospital to another, depending on who invited them and if there were sponsors for charity cases.

They got the First Lady interested in the possibilities of a Heart Center, but they needed as well to convince the President. Torres still remembers the big break, when they were asked to do open heart surgery on television, for Marcos to watch. The operation was done in V. Luna Hospital on Feb. 14, 1972, on a woman with rheumatic heart disease. After the surgery, the First Lady went to see the patient, who by then was already walking. Imelda Marcos was convinced and three years later, the Philippine Heart Center for Asia was inaugurated, duly attended by celebrity cardiac surgeons Christian Barnard and Denton Cooley.

The specialty hospitals were criticized as another example of the Imeldific noblesse oblige, a way of showing the Marcoses cared for the poor. The Heart Center was targeted in particular, with the argument -- flawed, incidentally -- that heart diseases mainly afflicted the affluent. Besides, activists pointed to the World Health Organization’s call to emphasize community-based primary health care at the village level, through health education, immunizations, clean water and nutrition.

The hospitals went on with their work. Torres rattles off figures: more than 500 cardiologists trained, 80 cardiac surgeons, thousands of patients served, not just from the Philippines but from all over Southeast Asia.

Trailblazing

But what catches my attention is the way the Heart Center did trailblaze in many ways.

To attract more doctors, their founders had asked that they be exempted from the rules of other government hospitals. Their doctors could engage in private practice. Hospital earnings, rather than going back to the National Treasury, could be retained and plowed back into hospital operations.

Today, the Department of Health has modified its rules to allow many other government hospitals to corporatize as the Heart Center did, again not without controversy, but during another interview I had with DOH officials a few weeks back, there was satisfaction with the way government hospitals have been able to improve using these new policies.

In the beginning, the Heart Center seemed intimidating; today, their problem is they get more patients than they can handle. I’ve wondered if part of the attraction comes with their rooms. Within the massive gray building are wards and rooms that should be models for other hospitals, with views of green spaces and wide corridors for the many visiting relatives and friends.

The rooms aside, the patient overload comes because most Filipinos are unaware that the hospital was intended mainly for heart surgery. At the Emergency Room, you’ll find patients who have been brought in from the provinces with all kinds of complaints that can be handled quite competently in other hospitals. Torres says a few private hospitals can even handle cardiac surgery. Several years back, when he had taken leave from the Heart Center, he helped to establish St. Luke’s Heart Institute.

And the public sector? The Heart Center is moving to get the government’s regional hospitals to become satellite heart centers that can handle cardiac surgery. Satellites have been established in the cities of Davao, Cebu and Legazpi, with more to follow. A Heart Center team goes around the country to do open heart surgery, to show, in Torres’ words, that these are “simple lang.”

The main obstacle is cost, rather than technology or skills. A bypass can run to about P500,000. There is a government subsidy fund of P150 million but that’s enough for only 300 surgeries. Other sources of subsidies are PhilHealth (but only up to about P50,000), the pork-barrel funds of members of Congress, the Philippine Charity Sweepstakes Office and occasional Good Samaritans like the Lotus Foundation described in yesterday’s Inquirer.

But, Torres observes glumly, that they still have a backlog of 800 patients and “about 30 percent will die even before they can be admitted for heart surgery.”

Full circle

Critics of Imelda Marcos’ specialized centers, myself included, will have to concede that these hospitals have filled particular niches. If plans push through, the proposed Philippine Center for Specialized Hospitals will include a Women’s Health Center, incorporating the now run-down Fabella Medical Center, which in a way was one of the original specialized hospitals, dealing mainly with child deliveries, currently numbering more than a hundred a day.

The Heart Center shows what can be done to train specialists and to share skills at regional, and hopefully, provincial levels. Torres says that besides heart surgeons, their doctors go on to other sub-specialties, for example cardiac pediatrics.

But he acknowledges they do have problems with staff turnover including, with some of their specialists becoming nurses to get jobs overseas. “They do it for their families,” he explains.

So we come full circle with the story of the Heart Center, founded by Filipino doctors who dared to come home and stay, but who now have to live with a new wave of brain drain. In many ways, the story of the Heart Center is the story of our health care system, one with many trials and tribulations but one, too, with its share of successes and achievements.