Why?

PINOY KASI


Why?
By Michael Tan
Inquirer

Last updated 01:36am (Mla time) 04/25/2007

MANILA, Philippines -- Even as a child, Remberto de la Paz (“Bobby” to friends) was said to have been the ever inquisitive one, always asking why and figuring out how to repair things. He would have wanted to become an engineer, but math was his Achilles’ heel so, coming from a family of physicians, he ended up in the University of the Philippines College of Medicine.

The why’s didn’t stop there but came to deal more with the state of the Philippines. It was the 1970s, the era of Ferdinand Marcos and martial law, and the health sector -- professionals and students -- were not spared by the social ferment. Which shouldn’t be surprising given the way social inequities are always amplified in the health sector, the poor dying of diseases that are both preventable and curable.

The rural areas were in particularly dire straits, with hundreds of municipalities having no physician. In the 1960s, there had been a massive brain drain of Filipino doctors and nurses, mostly going to the United States. Those who stayed on would practice in the cities.

Marcos’ health technocrats came up with a six-month rural service requirement for all medical graduates, hoping to provide far-flung areas with medical services, however temporary. There were also hopes that young idealistic physicians would end up staying on after their rural service.

But the program didn’t work out. If you had the connections, you could get assigned to a fairly urbanized “barrio” in the cities, sometimes even in Metro Manila. As for those who went out, there was a total mismatch between their medical training and the rural service. The medical curriculum was oriented to high-tech hospitals, but they were working in rural health units with few supplies beyond small kits of medicines marked “Medical Assistance for Rural Communities and Other Sectors” (MARCOS).

For most of the medical graduates, rural service was a nuisance, a requirement that they needed to get over with as soon as possible so they could leave for the States.

There were exceptions. The medical schools had their share of student activists who went out, even as students, to serve in urban slums and looked forward to rural service. And after doing their rural service, some were crazy enough to want to stay on.

In the 1970s, health activists had formed a national network of community-based health programs (CBHPs) mainly to serve rural areas. Bobby and his wife, Sylvia, also a doctor, eventually ended up working in one of these CBHPs, with an organization called AKAP, founded by TB specialist Dr. Mita Pardo de Tavera. I was also working with AKAP, and that was how I came to know Bobby and Sylvia.

The CBHPs believed that the solutions to health would come not from individual behavior change alone, but through community organizing so people could come up with collective solutions to their health problems. Dr. Tavera’s vision for TB control involved training of local health workers, some with hardly any formal education, to conduct health education classes, mobilize communities for BCG vaccinations, collect and examine sputum samples from people to check if they were infected with TB, and supervise patients with their anti-TB medication.

Bobby’s and Sylvia’s lives revolved around TB, but they knew, too, how the obstacles to TB control were often rooted in economics and politics. Patients couldn’t afford the TB medicines, so AKAP provided them for free, but we found out that some of the patients were selling the medicines so they could feed their families. We ended up having to check their urine for an orange tinge, proof that they were taking their rifampicin, the most expensive medicine in their treatment.

There were other people asking why as well: Why were these UP medical graduates working in godforsaken, “NPA-infested” Samar province, rather than in the States? The heat was on, and eventually the couple had to move from Gandara, one of the poorest towns in Samar, to the capital Catbalogan, but continued to care for patients from several towns.

On April 23, 1982, late in the afternoon, a man walked into the De la Paz’s clinic, and fired away. A total of 11 bullets entered and exited Bobby’s body. The gunman was said to have threatened people who were watching: “Who else will help the people from the mountains?” He was referring to the NPA.

Word spread quickly, with at least 200 people rushing over to offer help. Twenty-nine people donated blood. Bobby lived long enough to see his mother, who flew in from Manila. He would have turned 30 on Sept. 11 that year.

Twenty-five years on, I still hear of health workers active in Samar and other places where the likes of Bobby had served. The other CBHP doctors are still around, scattered all over but most are still serving in their own ways, teaching in medical schools, doing private practice, even working through government. Our paths cross from time to time: Sylvia went on to train in obstetrics and was the one who attended my daughter Yna’s birth.

Changes have come all too slowly in the health system. The government now has a TB program very similar to what AKAP was doing in the 1980s, but many Filipinos still die of the disease. The rural service requirement for medical graduates has been abolished and the Department of Health came up with a voluntary Doctor to the Barrios program, but there are few takers.

A new wave of brain drain now plagues us, mainly of nurses, including doctors-turned-nurses. It’s mostly for economic reasons, but I hear more people talking of hopelessness and despair with the political situation here.

Bobby’s case has never been solved. Ironically, even without Marcos and martial law, we face a new round of assassinations of suspected leftists, and on a scale more vicious and bloody than we ever saw under Marcos. Medical Action Group (MAG), a human rights medical group formed after Bobby’s death, is holding a training workshop in forensics this week together with the Commission on Human Rights, specifically in response to this wave of killings.

Last year, Dr. Chandu Claver and his wife Alice, both active with the group Bayan and with community health programs, were shot in Tabuk, Kalinga. Alice died from her bullet wounds. The Clavers’ assailants remain at large.

What would Bobby have done if he had lived? I suspect he would have gone for postgraduate training in medical bioengineering and continued finding ways to serve the poor. But wherever he might have ended up, I have a strong feeling he would have continued to ask why, perhaps with greater urgency than he had back in medical school and in Samar.

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Health Action for Human Rights will sponsor a forum on April 26, Thursday, at 4 p.m., at the Philippine General Hospital Emergency Room complex, with lectures on “The Current Human Rights Situation” and “The Alston Report.”

If you want more information on the life of Bobby de la Paz, look up an excellent biography written by Dulce Festin Baybay in the anthology “Six Young Filipino Heroes,” edited by Asuncion David Maramba.