WIDENING PERSPECTIVES

7th Global Health Course

University of Tampere, Finland
Submitted by BIEN ELI NILLOS, MD
 Introduction

It has been a wonderful experience. What made the experience amazing was it was spent with
participants from other countries – Chile, Tanzania, Nepal, Malawi and Finland. With such an
international group of participants (not to mention the lecturers as well), it was inevitable that the
opinions collected and insights shared would be as diverse as the cultures contained in the walls of
the University of Tampere.

As a Filipino physician whose career path bends toward Public Health, it has been an eye-opening
experience. The Global health course has broadened my vision of the world and has made me realize
many things. Firstly, that there are so many problems shared by the community of nations and are
not exclusively faced by the Philippine health care system. Secondly, each member of this
international community has been struggling to solve these problems in the best way that they can,
employing tools that are socially acceptable to their own community. Lastly, while there is no best
solution that can be generally accepted by all countries of the world considering the diversity of
society and culture and beliefs and resources, there are best practices that can be duplicated from one
country to the other that are socially applicable and scientifically sound.

I am grateful to the generosity of all participants during the 7th Global Health course for unselfishly
sharing their local experiences, opinions and insights. The host country Finland has been hospitable
and accommodating which largely helped in our learning of new things for four weeks. While I
might not be able to capture every detail of the experience in this journal, I do hope that I can
capture the essence of the entire experience: an experience that developed in me a person more
tolerant of others, a person with a broader perspective about health and life as a whole, and a person
more knowledgeable about the world.

The challenge one faces with a widened perspective is how to think globally and act locally. My
fervent hope is that the experience does not end here. The challenge remains and that is how we can
make our respective health care system work for our respective countries. I am hopeful that I shall be
given more opportunities to learn and even more opportunities to put into practice the learning in the
future.
Day 1: Visit to Finnish Medical Association, Laboratories and Duodecim
Venue: Helsinki, Finland
Helsinki welcomed us with a drizzle but that
didn’t stop us from starting our first day of
Practicum for the Global Health Course. The
first agenda was a visit to the Finnish Medical
Association in their office where we were
given an orientation as to the role of the FMA
and how this association is serving the
thousands of Finnish doctors everywhere in
Finland. For the Philippines, it is quite similar
to the Philippine Medical Association. There
are however some notable differences. One
difference is that membership to the FMA is
not compulsory, unlike the membership of
Filipino doctors to the PMA. Another
difference is that the FMA also opens it membership not only to licensed doctors but also to medical
students as well. The PMA is exclusively open to Filipino licensed doctors. However, despite its
being optional, around 94% of all Finnish doctors are members of FMA.

With regards to membership fees, The Association’s membership fees are graded based on
the number of years since you obtained your licence in Finland. No fee is charged for the year you
join. During the following years, the membership fee gradually increases. The full membership fee
(480 euros in 2009) is only due on the fourth year of membership. The FMA membership fee can be
deducted from taxation. The Association notifies the tax office of the membership fees paid, and the
deduction is therefore calculated automatically.

Because of these fees, the FMA can provide

insurance to its members such as Life Insurance, Business
Interruption Insurance, Accident and travel insurance and
even Home and Car Insurances. I am not aware of the
PMA does offer the same kinds of insurances to its
members.

After a brief tour of the office, we immediately

went to the University of Helsinki Hospital where we
were given an orientation on how the hospital operates it
laboratory and other diagnostic clinics. What was
interesting was the fact that the hospitals (which were
more of a complex within a compound) were connected by underground tunnels. We walked from
one specialty hospital to another and at present they are planning to build another hospital within the
complex. Of course, as expected, the instruments and machines used in the laboratory are state-of-
the-art, the type which I can only find in tertiary care hospitals in the capital of the Philippines
(Manila).

The day was capped with a dinner with the representative from Duodecim. During the
dinner, we were given an orientation as to the background of the society, its history and its vision.
What was noteworthy was the Duodecim began as an initiative of 12 medical Finnish students. Now,
the Duodecim has grown into a large organization streamlined towards education and scientific
research. After the dinner, there was some very nice discussion on the question posed by the
Duodecim Representative: what’s next after the Global Health Course?

That question really got me into thinking.

What is next after this? After having come back to the
Philippines from Finland, and having seen the things
around me and comparing them in hindsight to the
things I have seen throughout the Global health
course, I couldn’t help but feel depressed. The
Philippine health care system has a long way to go
and the solution to this huge problem is as complex as
the problem itself. It is cultural. It is political. It is
social. And I am not even taking up the medical part
of the solution. Perhaps there is little left to do about
the present situation. However, despite feeling
depressed, I also feel hopeful that the next generation
of Filipino doctors and health professionals can do something and reverse what is seemingly
irreversible. So, what is next for me? The day I arrived in the Philippines, I tendered my resignation
as municipal health officer of a small town called Candoni in Negros Occidental. This has been
anticipated long before I left for Finland. My resignation actually reflects the same perennial
problem in the local health systems in the Philippines. It is a pity that sometimes, politicians who are
neither health professionals or at the minimum knowledgeable about the health care system or
medicine would tend to interfere in the management of the primary health care unit. It is a pity that
there are many Filipino rural health care physicians who are underappreciated and not even fully
compensated, enough to commensurate with their hardship. I have served Candoni for almost 3 years
and in those 3 years we had many accomplishments as well. Despite that, there are still problems left
unsolved simply because the entire system is not compatible to the solutions proposed.

My hope is left to the next generation, the current medical students, who can make a
difference somehow. So I am echoing the principles I have learned from the Global health course,
challenging my students to see beyond the first line of causes, to recognize the causes of the causes. I
am echoing the principle of thinking globally but acting locally. I am passing it forward and
hopefully, if given the opportunity, I can pass it forward to the people who are key players in
society.
Day 2: THL Registry, Disease Surveillance and Service Center for Homeless
People
VENUE: Helsinki, Finland
The second day of practicum was a little
bit hectic. We were actually carrying our bags
around with us considering that by 6 in the
afternoon we would be leaving Helsinki on a train
to Tampere. Fortunately, it wasn’t a hectic day. It
was more of listening to lectures, drinking kahvi
and eating pulla.

We had our first round of coffee and pulla

while listening to a THL representative discussing
the Finnish Registry. The representative discussed
how every Finn has a registry number and they
would get this number right on the day that they
were born in Finland. This registry number functions like an ID number and each Finn’s profile,
particularly health profile, is filed in this ID number. Thus, if a Finn gets admitted in a hospital in a
different city and later relocates to another city and gets admitted again in the hospital within that
city, it would be easy to retrieve records and histories of the individual because all they need to do is
access the profile through the registry.

What was interesting was what the representative said about why such a system became
successful in Finland. “It is a matter of trust,” he said. The people trust their government so much
that they were able to establish this health registry. There are Finnish laws that would protect the
confidentiality of these data and no one can easily access these data. In fact, the major use of these
data is only to supply the government statistics regarding health indicators of their country. They can
be utilized for research which can serve as basis for future policies when it comes to health.

The same system is used when it

comes to disease surveillance and while each
country has its own mechanism of reporting
and surveillance, what is interesting again
with Finland is how to employed technology
in doing so. While the Philippines has also a
good surveillance system, the use of
technology is limited only to maintaining
database and clerical activities. Networking
through WLAN or internet and thereby
linking various government agencies help
facilitate fast communication and therefore
fast response.
 The day was ended with a short visit
at the center for homeless people in Helsinki.
While there are homeless people in Finland,
what was noteworthy was the actions being
taken by the city of Helsinki to address the
problem of homelessness. The Center for
Homeless People is more a temporary remedy.
Residents in the Center are not only provided
temporary shelter, food and clothing but
homes where they can later on move in. Any
homeless resident of Helsinki can come in,
have food and even take some free shoes and
clothes that have been donated and can just
move on or move in temporarily.

There are many homeless people in the Philippines and most of them are informal settlers. I
have yet to see a comprehensive national program that would address this homelessness problem in
the country, not only for the urban poor but most especially to those in the rural areas. The solution
is not only to provide them the shelter which they urgently need but the means by which they can
sustain living under such shelter.

Day 3: Visit to the Emergency Room (Acuta) and Pediatric Ward at the
University Hospital
Venue: Tampere, Finland
It was great to be back in Tampere. Helsinki is great and definitely a huge city. But small-
city Tampere would have this “homey” feeling
that would make one comfortable. Not to mention
the free internet wi-fi service at Laapinkari flat.

The 3rd day started quite early and this

time we were brought to the University hospital to
visit their Emergency Department (Acuta) and
their Pediatric Department. Of course, what
initially struck me was the advancement in
technology utilized in these two departments. The
University of Tampere Hospital functions like the
district hospital, serving Tampere and its
neighboring towns and cities. Thus, all emergency
cases or medical cases which require acute care
are brought in from their primary health care centers. The referral system is very strict and definite.
Patients visit their municipal health units first or the Acuta whichever is nearer but usually it is the
Municipal health units or the primary health care centers.
 Despite the advancement in technology however (the Acuta was so immense actually), the
consultant who gave us the tour mentioned that Finland has yet to establish a specialty training for
Emergency Physicians. Thus, their ED’s are manned not necessarily by an Emergency Physician but
usually a specialist who would perform the triage. After the acute care is given and the patient is
stabilized, it is up to the triage officer (who can either be a doctor or a nurse) to refer the patient to
the appropriate department. What is interesting is that there is even a department for General
Practitioners. So GP’s can manage patients in a
hospital in Finland.

If the patient is a pediatric patient then he or

she is sent to the Pediatric Department. The
department is divided into a Polyclinic (which is the
equivalent of the Outpatient Department) and the
Wards where patients are admitted. The Pediatric
Wing had everything covered including the comforts
of visiting and admitted patients. Almost every corner
there is a lobby where parents and their children can
play and relax while waiting for their turn at the
polyclinic or just spending some time outside of their
hospital room.

Another interesting feature of the Acuta is a wing for “violent” patients, either psychotic
patients or just drunk patients. They are placed temporarily inside a cell where they are observed for
an hour until they are either calm or sober or sedated enough to be managed at the Acuta or to be
referred to the appropriate Department.

Of course, like every Emergency Department, it

has its own Radiology Room where immediate CT scans
can be produced when necessary.

In the Philippines, one can only find such kind of

facility in highly urbanized areas of the country, but more
specifically in Manila or in Cebu City. Most of these
hospitals in the Philippines are privately-owned and can
be quite expensive. However, since almost everyone in
Finland has some form of health insurance coverage,
there is no fear about medical expenses. In the
Philippines, General Practitioners do not have a place inside a hospital. Only specialists can admit
and manage and even work in a Philippine hospital. Thus, most GP’s are either working as rural
health physicians in far-flung areas (limited only to doing consultations and perhaps minor surgeries
if facility is capable) or are left without a choice but to specialize. Of course, specialty training
entails 3 or 4 more years of hospital-based training and residents on training receive little pay,
almost not commensurate to the load of work they do. That is why, even if there are many in the
Philippines who proceed to specialty training, most would not proceed to specialty training
immediately.
 I think it is time the Philippine health care system
must consider utilizing its General Practitioners to the full,
not only employing them in higher levels of care (to fill in
the gaps) but also to provide some form of exposure for them
in hospital-based training that would enable them to develop
professionally as doctors but without necessarily pushing
them to become specialists. While specialty training is
important, the foundation for a strong health care system is
still a solid primary health care system, and to run a primary
health care system need not require a staff full of specialists.
In this way, the Philippines can help pull back its brilliant doctors who are leaving the country for
better opportunities elsewhere.

Day 4: Day Care Center, Obstetric Ward and Neonatal Ward

Venue: Tampere, Finland
It was a sunny and warm day, just enough for our trip to a Day Care Center. It is called the
Hippos Day Care Center and it is sort of like a city Day Care Center. During the orientation, we
were told that there are other private-owned Day Care Centers and they are quite expensive than the
ones managed by the government. Day Care Centers are free, although for some of its services, it
can charge the parents depending on their family income. Of course, those who have higher income
tend to pay a little bit higher.

While waiting for the orientation to

start, we were able to meet a fellow Filipino
working in the day care. She had been in
Finland for quite some time and she has been
living with her Finnish husband in Tampere. We
were able to chat with her and we found out she
was from Bacolod City, the same city where I
live.

The Hippos Day Care Center is,

compared to Filipino standards for day care
centers, more than just a day care center. It is a
primary school where children learn by playing and socializing with other children. I didn’t see any
blackboard or texbooks. Just rooms filled with toys and toys and lots of toys, appropriate for age
groups. There is even a small indoor-pool for the kids to swim in.

What was interesting was there are some special kids who have mental or physical
challenges also enrolled in the day care and they are mingled with “normal” kids. There are optional
groups where all special kids are gathered, and there are mixed groups where both “normal” and
special children can play with each other. Parents can leave their kids and pick them up depending
on the number of hours. As far as I understood it, there are even kids left at the Day Care for
overnight care just in case the parents cannot be at home during the evenings.

The place is just “child-proof”, with

everything so child-friendly and conducive for both
learning and fun. We even had the chance to play
with the kids and their own toys. Some of us
preferred playing outside at the playground, having
fun at the see-saw and swing set. Talk about
regression.

In the Philippines, it is a sad view when

one talks about the public day care centers. There
are private day care centers or pre-schools but they
are the most expensive ones. There are municipal
day care centers as well but some facilities are not fully equipped. Most of these are dependent on
donations and hardly a trickle of the municipal’s budget would find its way into funding these day
care centers. There are even instances when the day care center workers would have problems with
their compensation and salaries. There are poorer municipalities who cannot even afford to put up or
maintain a day care center.

What happens is children are left in their homes alone while their mothers and fathers
would work on their farms the whole day. If the child has older siblings, the eldest would either skip
work or school just to stay at home and tend to the younger ones. The eldest can be as old as 9 years
old. Worse, the kids are brought by their parents with them in the fields to work with them instead.

Education, even at the pre-school level, in the Philippines is expensive. Because of its cost,
it is made almost inaccessible to the larger population. The quality on the other hand is another issue.
While I would like to believe that we have the best
teachers when it comes to quality of educators, the
system in itself is not conducive for developing
such potentially good teachers and educators and
social workers. While the government may have a
good program on child care, it remains a good
program on paper. When it comes to
implementation, we are still far behind the ideal.

After our visit at the Day Care Center, we

went back to the University Hospital and visited
their Obstetric Ward and Neonatal Care. Again, the
main attractions in these facilities are the
availability of technology and comforts for the patients and their families. It was noted that the
Neonatal Intensive Care Unit where the more critical babies are admitted was quite small and even
the consultant mentioned it. According to him, some folks would complain about the lack of comfort
and some privacy when they visit their patients at the NICU.
 The OB Department has its own Ultrasound Room and it has rooms which are both labor
rooms and delivery rooms. Normal hospital beds can be converted into Delivery Tables and should
the patient require an immediate C-section or surgery, the beds can be wheeled out of the room and
be brought to the Operating Room exclusive for OB Department.

What was interesting during our visit at

the OB Department was when we were brought
inside the Operating Room, where they would
conduct their C-section procedure, we were
expecting to wear at least a scrub suit and a
surgical cap in order to protect the sterility of the
room. After all, that is what is being taught to us
during our training. But the consultant brought us
in, with nothing but our lab gown over our street
clothes, with our outdoor shoes and without the
cap. One of us asked about it and the consultant
said that it doesn’t matter whether one is wearing
those or not. After all, bacteria are spread by hand
so if there is one thing we should be doing was to keep our hands off and wear surgical gloves. Of
course during an OR, for self-protection, they would wear the cap and surgical gown and gloves and
slippers.

In the Philippines, public hospitals pale when they are compared to private-owned
hospitals. Of course, when it is a private-owned hospital in the Philippines, they are usually
expensive.

Day 5: Visit at the Pirkkala Primary Health Care Center and Terveystalo Health
Center on Occupation Health
Venue: Pirrkala and Tampere, Finland
The mid-summer long weekend was
refreshing. It also reminded us how close we were
to the end of the training. It reminded me of the
trip back to the Philippines and what would await
me at work and home. The visit at Pirkkala
Primary Health Care center reminded me of my
own municipal health center back in Candoni,
Negros Occidental where I served for almost 3
years. The Pirkkala Primary Health Care Unit is
like a rural health unit. However, what I saw in
Pirkkala was nothing similar to a typical rural
health unit in the Philippines.
 In Pirkkala, the facility resembled that of an upscale district hospital back home. There
were departmentalized polyclinics, an emergency room, a ward where they could admit patients for
observation, a laboratory, an ultrasound room, even a gym where they could do physiotherapy for
their rehab patients. What they didn’t have was a delivery room. In the Finnish health care system,
all deliveries are to be handled in a hospital. No rural health unit or primary health care unit would
handle deliveries. The PHC units only do prenatal
and postnatal check ups.

What is another interesting component of

the Pirkkala PHC unit is the presence of mental
health care. Psychiatrists would work at the PHC
to help manage psychiatric patients. There are
many doctors working in Pirkkala, a good mix of
specialists and General Practitioners.

I personally asked the health

officer/supervisor if the municipality or the
Finnish government would have limits as to the
number of doctors or health workers that can be
hired per locality or municipality. I asked this because in the Philippines, there is a 45-55 ceiling to
the municipal budget. Which means, 45% are to be used for operational expenses and 55% are to be
used for personnel salaries, benefits and other compensation. So, even if the municipality would be
in need of more health workers, if it has already reached its limit for the personnel salaries, it could
no longer hire health workers even if it is in need of more. In Finland, for as long as they are needed,
the municipality can still hire, regardless of the proportion of the personnel salaries to the operational
expenses of the locality; which for me actually makes sense.

The problem in the Philippines is not that we don’t have the sufficient money. We have the
money. In the first place, we have enough population to extract taxes that can fund the government
programs. What we don’t have is an efficient system of collecting these taxes and sad to say
trustworthy government employees (elected or appointed) to manage these collected taxes, both at
the local and national levels.

Another sad reality is that the local

chief executive would hire casual employees
to fill up jobs in other departments which are
in reality not really a priority for the local
government. Thus, instead of filling up the
more vital departments that render important
and priority services to the people, the local
government would hire more clerks than
nurses, more drivers than midwives and even
hire or open positions that are less important
than the position of a rural health physician.
Local chief executives would do this usually
to honor a promise pledged during the campaign period or to repay the loyalty given by these
individuals during the elections.

So, at the expense of healthcare, local chief executives perpetuate themselves in position by
prioritizing political patronage instead of focusing on genuine delivery of quality health care. In a
devolved system, the local chief executive is the boss and while the city or municipal council is
present, the local chief executive is more infallible than the Pope himself when it comes to
Philippine local government units.

Thus, when I left Pirkkala and was

heading with the group back to Tampere, I
could not help but feel sad for my fellow health
workers back home. These health workers had
to suffer so much political intimidations not to
mention the lack of resources to fulfill their
obligations. They are perhaps the most under-
appreciated industrious workers in the country.
The Philippine government would boast of the
Overseas Filipino Workers as the modern-day
heroes of the nation. For me, and without a
doubt, the real heroes are those Filipino health
workers who, despite the challenges that would
even seem to be unconquerable, opted to stay behind and work as diligently as those who are
working abroad but with much lesser pay.

There is a lesson to be learned here in Pirkkala. The lesson is that the government should
really start investing on its primary health care if it is really serious about providing quality health
care services to its people. In Pirkkala, the primary health care unit is so efficient and so modernized
a sick patient in Pirkkala need not worry about not going to Tampere for a consultation. He could
just go to Pirkkala’s health care unit and have himself seen there, tested and referred only when
necessary. The Primary health care unit in Pirkkala could do almost everything, leaving the more
complicated cases for specialists in the hospitals. No wonder the hospitals seemed to be so “empty”
of patients. An effective primary health care system would de-bulk the patient load in tertiary or
secondary hospitals. With a devolved health care system, it is important that the local government
units should be made more accountable when it comes to its failure to delivery quality health care.
As far as I am concerned, the Pirkkala Health Care Unit is a dream rural health unit, something
which I have been aspiring to happen in my own health unit. But despite one’s vision and hard work,
such a reality may not, in all tact and honesty, occur in the Philippine countryside.

The rest of the day was spent learning about Occupational Health at Terveystalo Health
Center. It is actually more of a private insurance company for workers. Companies and factories
would insure their employees as their responsibility for taking care of their health. There are health
hazards encountered at work and because of these hazards, workers are at risk of developing
illnesses due to exposure to these hazards. The Terveystalo Health Center is focusing on those type
of illnesses related to occupation.
 In the Philippines, I am not sure how Occupational Health is really considered in the health
care system. Unfortunately, there is really no comprehensive health care program for our workers
and laborers. The main issue facing our labor sector is still their health care benefits amongst other
benefits they should be getting.

Day 6: Koukkuniemi and Viola Homes for the Elderly

Venue: Tampere, Finland
The second to the last day of the practical
part of the Global Health Course was spent
visiting two elderly homes. The first elderly
home, Koukkuniemi, is a government-run elderly
home in Tampere. It is close to our flat in
Lapinkaari. In fact, we once played football in the
field within the compound of the elderly home. It
is quite a huge complex and it is more than just
homes for the elderly. There is an available health
care facility that can cater to geriatric care. There
are also facilities for rest and recreation.

For Filipinos, sending the elderly to homes like

this is not a common practice. Culturally, it is
even seen by many Filipinos as a taboo. Maybe because the Filipino culture is family-centered and
Filipinos are not only closely-knit as a family but to a certain extent even clannish in nature. The
early Filipino settlers occupied the islands by families. One family would migrate from neighboring
Indonesia or Malaysia riding on one long boat called the balangay. Present day Filipino villages are
called barangays as taken from the name of the long wooden boat.

The Western culture, including the Finnish culture, does not in any way though undermine
the value of family just because they are sending their aged people in homes. There are certain
circumstances why they would opt to do so. In the first place, according to the people running the
elderly home, the primary objective really is to enable old people to take care of themselves right in
their own homes. In fact, government would even assist families with old people in renovating their
homes that would be friendly to these aged people, especially those suffering from chronic illnesses
or some forms of disabilities.

In many cases, children grow up and they would usually study or work far from their
original homes. And since the Finnish family is not typically large like the regular Filipino family,
there are not enough children or relative to stay at home and take care of the aging parents. Thus,
there are instances when children have to decide to send their parents to elderly homes where they
can be taken cared of 24 hours a day, 7 days a week.

Due to improved health care services, the Finnish society is also experiencing some form of
demographic shift. It used to be that the population distribution follows the pyramid pattern, where
the young population is more than the elderly population. Now, with lengthening life expectancies
and lesser mortalities, the elderly population is beginning to increase, even more than the younger
population. In a few years time, the population pattern will follow an inverted pyramid pattern.

The difference with a government owned

and private elderly home is the type of amenities
present and the expenses for the resident of the
elderly home. Of course, it is expected that it can be
more expensive in a private elderly home but the
amenities are quite better compared with the
government owned elderly home.

In the Philippines, while we don’t usually

send our old people to homes, it is a fact that there
are old people who were either abandoned or are
living alone and could not really take care of
themselves. There are old people who are chronically sick and are homeless at the same time. I am
not aware though of any comprehensive program that would take care of these elderly people in the
Filipino society. There are NGO’s and church groups which would run elderly homes in various
parts of the country and I am not sure if they are subsidized by the government. However, if one
talks about a government policy or initiative, I am pretty sure there is none.

Many of our elderly people would just die without even having received their pensions.
The GSIS, the government-run social security system, is under raps because of failed fiscal
management and failure to deliver the pension benefits of many retirees on time. There are elderly
people who have retired from work for 10 years and still they have yet to receive their GSIS
benefits.

In the health care system, there is no comprehensive program for the geriatric population.
By comprehensive program I would mean a health care program that would involve preventive,
curative and even rehabilitative aspect of health care, covering not only physical illnesses but also
mental illness as well.

Day 7: Hospital and Private Pharmacies

Venue: Tampere, Finland
The last day in Tampere, Finland was spent visiting pharmacies. The first pharmacy we visited was
the hospital pharmacy in Tampere. It was a big pharmacy since it actually works as a central supply
office for all the other primary health care units within the district. That is why it has a huge
warehouse filled with medical supplies and drugs which they either dispense at the hospital or would
send out if other municipal health units within the district would purchase some of their needed
medical supplies and drugs.

Since it’s a hospital pharmacy run by the University of Tampere, it is also involved in
clinical research. Drug companies can collaborate with the Hospital where they can conduct their
clinical trials on certain drugs.
 What I loved about the tour was how
centralized everything was even if the drugs
were just dispensed within the hospital. The
Pharmacy department would prepare all the
ordered drugs and pack them and label them
with the patient’s name and bed number or room
number whichever is appropriate. This would
minimize erroneous drug administration and
wastage of drugs as well.

If one is admitted in the hospital, he or

she gets some medicines for free, especially
antibiotics. For over-the-counter drugs though,
the patient has to purchase it from a private
pharmacy or any pharmacy outside of the hospital. So, if the patient is discharged with take home
instructions of continuing his Ibuprofen at home, he must buy that Ibuprofen from an outside
pharmacy.

That is where we went next. We visited a Pharmacy run by the University of Helsinki.
What was so unique in this private pharmacy is that all over-the-counter drugs are placed on stands
just within the pharmacy’s lobby so if one needs an Ibuprofen (which is an over-the-counter drug),
he could just go to the aisle where they keep this kind of medicines and grab a box and proceed to
the cashier and pay.

For the prescription drugs, these are stored behind the counter and of course one would
need a prescription from the doctor in order to buy these drugs. The counters in this pharmacy are so
well organized. People take a number and wait for their number to be called. If your number is called
you go to the available cubicle where a pharmacist is waiting behind the table with the computer and
he or she will take your prescription and encode on the computer the medicines prescribed by the
doctor. While she is doing this, an assistant would already retrieve these medicines for you.

What is nice is that the pharmacist,

after storing the data on the computer, can
advise the patient or call the prescribing doctor
if the medications the doctor prescribed would
have some drug interactions with the present
medications being taken by the patient. At the
same time, since there is already a record of the
patient’s medications, if he or she comes back to
the pharmacy for another prescription, his or her
record will come up and the pharmacist can then
give advice or call the doctor again if there are
some missing drugs or drug interactions present.

There are medicines that are covered

by insurance and these are reimbursable drugs. There are some over-the-counter drugs that are not
reimbursable. Another interesting observation is that, there are assistants present in the lobby of the
pharmacy who can also give advice as to the kind of over-the-counter drugs you might need. What is
noteworthy is that, these assistants would usually give advice as to what drugs that are affordable for
the patient. Assistants would also teach and remind the buying patient as to the doctor’s instructions
on how to take the medications. Drug prices are also controlled in a sense that the price of Ibuprofen
for Private Pharmacy A is the same in Private Pharmacy B. In fact, drug prices are the same
throughout Finland thus the price of Ibuprofen in Helsinki will be similar to the price of the same
drug in Tampere.

In the Philippines, accessible to cheaper drugs is still one of the many health issues
hounding the health care system. While there have been laws imposed already such as the Generics
Act and the Cheaper Medicines Act, there are still certain essential drugs that are not available for
many simply because they are not affordable.
 Postscript

The challenge now for alumni of the Global health course is how to transform the learning
into practice. My experience as a public health officer has been enriched by this opportunity to see
other health care systems and study public health from a global perspective. Now, as an educator, it
is perhaps an obligation to pass on the knowledge to future medical doctors regarding the importance
of public health and primary health care.

It is important that Filipino medical students must realize that there is more to being a
doctor in white coat doing rounds in the hospital. The doctor has many sides. Sometimes the most
neglected and least attractive side is the public health side, that side of the doctor which is
multifaceted in its own right; that side of the doctor which does not involve so much clinical work
but more of administrative, analysis, community organizing, epidemiologic study, policy making
and influencing, even politicking.

The Global Health Course has made me realize that the Philippine health care system,
while flawed, is not at all hopeless. Its development and progress relies on dedicated people who are
willing to work within the system, influence the system and streamline the system that will make it
more responsive and accountable to people.

It is a gargantuan task and perhaps it may require more than just a mere attendance to a
global health course. However, being an educator and physician, it is important to remain steadfast
in our passion to change the world by changing the little corner of our country and society. The
challenge is always to think globally but act locally. The struggle for a better health care system can
be frustrating. But having met new friends and like-minded people in the course, it is no longer a
lonesome fight.