BARMM 'Doctors to the Barrio' share experiences with ASMPH

Former Doctors to the Barrio (DTTB) who served in the Bangsamoro Administration Region of Muslim Mindanao (BARMM) shared their experiences at a brownbag session hosted by the ASMPH’s Dr. Rosita G. Leong Hub for Primary Physician Formation on Saturday, November 12, 2022.

According to them, while serving as a doctor in geographically isolated and disadvantaged areas can already be quite challenging, serving in BARMM presents an additional set of challenges.

First, some areas in BARMM are incredibly isolated. Dr. Lorenzo de Guzman, for example, was assigned as the Municipal Health Officer of Turtle Islands which is 30 minutes away from Sendakan, Malaysia and 24 hours away from Tawi-Tawi. He shared that there was no transportation away from the islands during the so-called “ber” months.

Many areas that they were assigned to were so isolated that they were the first municipal health officers to set foot in the municipality. Dr. Paige Recasata, who was assigned to Lugus, Sulu, shared that the community members were deeply appreciative of their presence and made it a point not to make her feel like she was an outsider.

The second set of challenges of health service delivery in BARMM is that health services in the area were not devolved. As such, the relationship between the DTTB and the local government unit (LGU) is not clear. Some of the LGUs do not even allot a budget for health. Compounded by the isolation of several areas, access to resources and networks proved to be difficult.

Since they were the only doctors in their areas, they found themselves on call all the time and had to multitask between clinic duties and municipal program duties. Dr. Paolo Chavez, who was assigned to Pangutaran, Sulu, recalls experiences when he had to be pulled out of meetings at the municipal hall to attend to emergencies. Dr. de Guzman shared his experience of being woken up at 2 a.m. to perform surgery to take care of a fisherman who lost two fingers due to a boat accident. Dr. Recasata shared that she had to live a nomadic life because access to many barangays was so difficult that she had to stay in certain barangays for one or two days to provide services.

All of the doctors shared that their experiences were deeply enriching. For example, Dr.  Chavez shared that what was taught in medical school about the Social Determinants of Health came to life during his stint as a DTTB. He, and the other doctors, for example, saw first hand the impact a long history of armed conflict had on health and health-seeking behavior. They also saw the impact (or lack of impact) of policies and politics on health services and outcomes.

Because their experiences were so enriching, all the doctors deeply appreciated the chance to share their experiences at the brown bag session, particularly in the presence of Dean Cenon Alfonso of the Ateneo School of Medicine and Public Health (ASMPH), Dr. Manuel M. Dayrit, former Secretary of Health and former Dean of ASMPH, and Dr. Rosita and Mr Ricardo Leong, Board Members of the RGL Hub for Primary Physician Formation.

When Dr. Alfonso asked the doctors what kind of support the RGL Hub for Primary Physician Formation and the ASMPH could provide, most of the doctors mentioned that spaces such as the brown bag were very helpful in processing their experiences and would have been helpful while they were still in the field. Dr. Chavez said that it was rare for people to be interested in their stories.

Dr. Weena Bravo, who graduated from ASMPH in 2018 and who was assigned to Maimbung, Sulu, also said that it would help if the university could connect DTTBs to NGOs who could help them with projects. This was particularly difficult in some areas in BARMM because there are relatively few NGOs there. Dr. Jose Lumbaya Claver who was assigned to Pandami, Sulu, had to deal with a few scabies cases and immediately asked for medicines from his networks. By the time the medicines arrived one and a half months later, the number of cases had risen exponentially and the medicines delivered weren’t enough.

Aside from material resources, the former DTTBs talked about the need to establish a support network for DTTBs who could be on call to provide guidance. When Dr. de Guzman was woken up to perform surgery on a fisherman who lost two fingers and had other complications, he had to call doctors in his personal network to ask for guidance on what he could do given his limited resources. It would have helped if DTTBs had access to a network of doctors who could provide guidance to situations DTTBs might face in the field.

Dr. Chavez also suggested that there could be a repository of information for DTTBs which would be the equivalent of clinical practice guidelines in the field containing information on successfully implemented and sustainable solutions that other DTTBs had been able to put into place.

All the DTTBs said that there is also a need to better prepare DTTBs for the experience, a sentiment echoed by Dr. Dayrit in his closing remarks given his own experience working in the provinces that now constitute BARMM when he was a young doctor.

All these insights from the DTTBs provide leads for the RGL Hub for Primary Physician Formation which seeks to provide training for primary physicians who will be at the forefront of the implementation of the Universal Health Care Law.