[OPINION] Tenets
February 07, 2022
By Joanna Mae Cepcon, UPCM 2023, Chief Editor of UPCM InSPIRE Magazine
2022—a new year that does not feel new at all.
In a month, we witnessed how the highly transmissible Omicron (B.1.1.529) variant has scrapped any budding relief from low COVID numbers that took months to realize via vaccination. Yet again, record single-day cases were being reported… more than two years into the pandemic. At one point, it seemed as though everyone in the country was either sick or caring for someone who was. With alert levels raised, travel bans imposed, and lockdowns implemented, this year began as an egregious déjà vu.
Then again, there is a noticeable difference. Buildings and billboards are now decorated with prominent faces and taglines. Telling colors are vibrant on masks and various items. Criticisms, acclaims, insults, and accusations alike are ubiquitous across social media platforms. There is a charge of anticipation, as news on COVID-19 seemingly took a backseat to that on the national elections.
“… Going forward, countries should do everything they can to hold elections as scheduled, as enough lessons have been learned to make it possible to conduct elections safely and effectively.”
— The Democracy & Human Rights Working Group of the McCain Institute for International Leadership, Arizona State University
Come May 9, we will be able to cast our votes to elect the highest officials in our country. We know very well that voting in the coming elections is the most basic political participation of an individual. But in the nearing elections in the COVID-19 era, are we health care professionals—present and future—expected to do more?
Health is a right.
The Egregious Déjà vu: A humanitarian tragedy on the relentless wave of COVID-19 cases at the Philippine General Hospital.
Photo by: Brent Viray
Health is a fundamental human right. It has been since before it was included in the Constitution of the World Health Organization 75 years ago [1]. It is a no-brainer concept.
As health care workers, we have a unique personal familiarity with healthcare equity issues that have existed since pre-pandemic times. Our technical knowledge from years of medical education, combined with patient interactions and clinical training, enable us to gain perspective on the systemic problems that continue to block the best possible health outcomes. The sad truth of it is they have not been uncommon encounters in the national government referral center [2].
We may even have our own striking, possibly tear-jerking anecdotes from PGH duties. In fact, in a span of three months, the current clerks have had experiences of bargaining for the approval of mech-vent requests and scrounging unavailable materials for simple procedures. In our limited face-to-face training, we have already become too acquainted with the phrase “ideally, but here in PGH…” and the compromises that came after.
On a larger scale, these compromises can ultimately sustain the same dysfunctional system. We could argue that some compromises are necessary and ethically acceptable to arrive at “common good” solutions [3]. Perhaps, in the long run, we would be able to champion our advocacies without much friction. Looking at it from this angle, what indeed is a small compromise if there were an opportunity to help reverse the inadequate health budget allocation, understaffing and low employee wages, lack of equipment and proper facilities, and other long-standing problems?
A fair number of individuals with sincere and good intentions must have tried.
In this pandemic alone, many recommendations have been given and discarded [4,5]. Though some concessions may be minor, they collectively adjust our limits over time. Despite the urge to look the other way, we see this now among ourselves—fueled by similar goals, but divided by differences in what we can and cannot tolerate.
In a particularly polarizing election year and despite mounting barriers to the ideal, it is part of our social responsibility to advocate this non-negotiable truth: health is a right.
Health is multifactorial.
Veritas Liberabit vos | The truth will set you free: Health is a right. Health is Multifactorial. Health is political.
Photo by: Brent Viray
This is a lesson taught as early as our first year in medicine, repeated over and over until it is embedded in us by firsthand experiences. Health is multifactorial; hence, a multidisciplinary approach is warranted. With new information from ongoing studies that lead to evolving protocols, no one can yet confidently claim sole, superior expertise in this novel pandemic [6].
This is where comprehensive consultations should enter. In our culture where professional titles are incongruously used as honorifics, physicians are privileged with an almost reflexive authority. Corollary to this, we in the system are accountable for how our public statements are perceived and interpreted, as these can influence health campaigns. We should learn to be receptive to ideas and be sorry for our blunders—unintentional and otherwise. Even the top U.S. infectious disease specialist can apologize for careless remarks [7]. We should thus keep in mind that although COVID-19 is a disease, medical doctors do not have the monopoly of knowledge on it.
Public health interventions remain the subject of debates in papers and social media. While unfortunately, some of these can come down to a nauseating exchange of “my horse is bigger than yours,” it is better to keep the conversation going on accessible platforms. It need not be exclusive to health experts.
We need to endorse the consideration of inputs from grassroots organizations in the drafting of policies. It will be instrumental in effecting changes at local and regional levels [8,9]. Let us invite responses from allied health care workers, health economists, public health professionals, communication specialists, engineers, physicists, administrative staff, and the average Filipino without a title before or after their name.
As a population directly affected by such interventions, and later, by a major change in the national administration, we are all well within our rights to take part in relevant discussions. Engage, criticize, and learn. Do not simply yield when asked to sit down.
Health is political.
“Politics, for better or worse, plays a critical role in health affairs”
— T. Oliver in the Annual Review of Public Health, 2006; 27.
In “Dying in a Leadership Vacuum” published by the New England Journal of Medicine in 2020 [10], the editors of the prestigious journal boldly criticized the leaders of the U.S. for their failed COVID-19 response. The article ended on a strong call for action to use the elections to ax the incompetent and demand consequences. This was considered an unprecedented move. The involvement of health professionals in political protests is usually discouraged and contested in several circles, including our own [11].
“The dissection of truth and the anticipated resistance is the novelty of polarizing movements”. Featuring a PGH surgical team on a complicated operation.
Photo by: Keziah Agripo
Traditionally, the medical community is regarded as competent, compassionate, and, importantly, non-partisan. For over two years, its members have been hailed heroes and brave warriors at the frontlines of this global crisis. Medical societies and health experts have collaborated with government units in formulating plans, programs, and protocols as part of the pandemic response [12]. This proactive participation has influenced policy-making and raised widespread awareness of the state of our healthcare system. The pandemic reinforced a frequently overlooked reason for medical workers to engage in political discussion: health is political.
Policy-making is a key determinant of health. And, like a physician’s clinical judgment, our choice in political engagement should be allowed to reflect the core of our integrity, competence, and capability. Recognizing areas of improvement and campaigning for the reform we believe in are still in line with the biopsychosocial approach to patient care.
“… So long as when the physician treats patients, they do not let their advocacy efforts interfere with the care of that patient, [addressing policy failures and social ills through engagement in political advocacy] is a trade-off they should be allowed to make in their best judgment.”
–M. Rock in the Georgetown Medical Review, 2021; 5(1).
True to the mission of the College, we are professedly committed to community-oriented medical education, research, and service directed to the underserved. The strength of our commitment will, in some ways, be measured in the imminent momentous elections. It is unlikely that we will be singled out to count the ways we did more, but we should be cognizant of how little actions in this period can snowball into policy-changing, life-altering results.
We should elect leaders who believe in these same basic tenets. Our votes should be dedicated to candidates who plan on applying the principles of the primary health care approach to address the gaps in our healthcare system, especially in our fight against COVID-19. We owe it to Dr. Amor Trina Dait, Dr. Raul Andutan, and several other doctors who have unjustly lost their lives to violence. We owe it to our own alumni, Dr. Bobby Dela Paz and Dr. Johnny Escandor, and to other victims of Martial Law.
We owe it to the health care workers who died in the COVID-19 line of duty. To us who remain, our hard work and individual sacrifices—from maximizing learning in a restructured medical education system to juggling administrative tasks, teaching future doctors, and managing long patient lists—all these and our lost opportunities should not be disregarded.
We owe the victory of this fight to ourselves, too.
References
[1] WHO. WHO remains firmly committed to the principles set out in the preamble to the Constitution. Available from: https://www.who.int/news-room/commentaries/detail/health-is-a-fundamental-human-right. [Accessed 2nd Feb 2022]
[2] Baticulon RE. Opinion: The Philippine health care system was never ready for a pandemic. [Internet]. CNN Philippines Life. CNN; 2020 [cited 2022 Feb 04]. Available from: https://cnnphilippines.com/life/culture/2020/3/20/healthcare-pandemic-opinion.html
[3] Raus K, Mortier E, Eeckloo K. In defence of moral pluralism and compromise in health care networks. Health care analysis: HCA: Journal of Health Philosophy and Policy. 2018; 26(4): 362-379. https://doi.org/10.1007/s10728-018-0355-0
[4] Cole D. Fauci admits earlier COVID-19 mitigation efforts would have saved more American lives. CNN Politics [Internet]. CNN; 2020 Apr 12 [cited 2022 Feb 04]; Available from: https://edition.cnn.com/2020/04/12/politics/anthony-fauci-pushback-coronavirus-measures-cnntv/index.html
[5] Mandavilli A. 239 Experts With One Big Claim: The Coronavirus Is Airborne. The New York Times [Internet]. NYT; 2021 Oct 01 [cited 2022 Feb 04]; Available from: https://www.nytimes.com/2020/07/04/health/239-experts-with-one-big-claim-the-coronavirus-is-airborne.html.
[6] Lavazza A, Farina M. The role of experts in the COVID-19 pandemic and the limits of their epistemic authority in democracy. Frontiers in Public Health. 2020;8:356. https://doi.org/10.3389/fpubh.2020.00356
[7] BBC. Dr. Fauci apologises for saying UK ‘rushed’ coronavirus vaccine – video. The Guardian [Internet]. 2020 Dec 04 [cited 2022 Feb 04]; Available from: https://www.theguardian.com/world/video/2020/dec/04/dr-fauci-apologises-for-saying-uk-rushed-coronavirus-vaccine-video.
[8] Achremowicz H, Kaminska-Sztark K. Grassroots Cooperation During the COVID-19 Pandemic in Poland. DisP – The Planning Review. 2021; 56(4): 88-97. https://doi.org/10.1080/02513625.2020.1906062
[9] Satpute J, Poddar T. Grassroots organisations are essential to empowering the communities they serve. The Elders; 2020 Dec 07 [cited 2022 Feb 04]; Available from: https://theelders.org/news/grassroots-organisations-are-essential-empowering-communities-they-serve
[10] Editors. Dying in a Leadership Vacuum. New England Journal of Medicine. 2020;383(15):1479-1480. doi:10.1056/nejme2029812
[11] Rock M. The Physician’s Role in Political Advocacy. Georgetown Medical Review. 2021; 5(1). https://doi.org/10.52504/001c.21357
[12] Department of Health [Internet]. DOH; 2020 Aug 06. DOH Updates on collaboration with healthcare workers, deployment of C.O.D.E. protocol [cited 2022 Feb 04]. Available from: https://doh.gov.ph/press-release/DOH-UPDATES-ON-COLLABORATION-WITH-HEALTHCARE-WORKERS-DEPLOYMENT-OF-C-O-D-E-PROTOCOL.