ALONZO, MA.

MELISSA MIKAELA BSN III-Irregular

Commentary: Issues in cardiovascular care in the Philippines

Date Posted: 1 December 2008 Author:Willie T. Ong, MD, MPH Reference: http://www.procor.org/advocacy/advocacy_show.htm?doc_id=698378

A few years ago, as a trainee, I saw a patient at the Philippine General Hospital outpatient department. Rodel, age 21, was suffering from a severe form of rheumatic heart disease and heart failure. I advised immediate surgery which would cost around US$2300. With no charitable institution to cover such expense, I saw Rodel's conditions deteriorate. I will never forget his eyes as he implied, "It is your duty and the government's duty to care for poor people like me." Rodel's case urged me to look deeper. It was a bigger problem than I had ever imagined. I found out that Rodel is just one of the millions of Filipinos with heart disease. The parameter health officials use to measure the magnitude of a disease is by looking at the ten leading causes of deaths. Latest data available shows that diseases of the heart and other cardiovascular diseases rank as the number one and two killers respectively (1). All in all, this means that approximately 243 people die of heart disease every day, more than any other disease. With such prevalence, heart disease exerts a tremendous yet unseen burden on the Philippine economy. With the downturn of the Philippine economy and the devaluation of the peso, the cost of medical care has increased in time. These include the cost of medical procedures, laboratory tests, medicines and doctors' fees. There are, of course, laudable institutions for the poor, like the Philippine Heart Center, the Heart Foundation of the Philippines, and the charity wards of hospitals. But none of these institutions are totally free and we are only addressing the tip of the iceberg. Sad to say, the Filipino government has neglected heart health in its agenda. The Department of Health's (DOH) Cardiovascular disease program, with its flagship Bantay Presyon or Hypertension Program, has been going on since 1994, but there is little evidence that this program is effective (2). It is ironic that, since 1994, deaths from heart disease are still increasing, yet the budget for heart disease is steadily decreasing, from US$1,262,019 in 1995, down to about US$38,462 for the year 2002. Poor patients, seen at the rural health centers, are only given one-week supply of heart medications and asked to buy the rest. But why is heart health a low priority in the Philippines? A public health nurse confided that the DOH-Cardiovascular Program is a "sleeping" program that needs to wake up. The lack of priority for heart disease may be due to the nature of the disease - a silent and chronic killer. If hypertension was infectious like tuberculosis, then it would evoke fear from media and policymakers, hence more attention. If it were a high profile and sensational disease, like the dengue

epidemic, then surely it would get the budget. Here, we understand why it is more attractive for a mayor to invest in visible programs like roads rather than in health. I have to admit that doctors are also part of the problem. A clinical doctor, trained in western medicine, might be crippled by his correct but sometimes irrational quest for quality care. Simply put, if we advocate a high-quality yet expensive drug for heart disease, then we may ensure quality at the expense of accessibility for the majority of the population. To illustrate, if Filipino doctors prescribe a drug like Clopidogrel that costs US$1.87 per day for life, then how many patients will be able to sustain such treatment? A cheap and effective alternative drug, like Aspirin, taken for a longer time would obviously have greater health benefit. Much as we like to point out areas for improvement for our health professionals and government institutions, the patient is also a big part of the problem. Latest data shows that the average Filipino allocates only 1.9% of his income for health care, but, he would also spend 1.9% for tobacco and alcohol (3). The Filipinos' fatalistic attitude toward illness contributes to their poor health. If the Filipinos do not demand for health care, alone or as a group, then there is no pressure for the health care givers and the government institutions to supply their need. Organized lay groups can exert a strong influence by vocalizing their demands for adequate health care. Dr. Marilyn Lorenzo, Director of the Institute of Health Policy at the National Institute for Health, says, "We need a critical mass of individuals to create real change in our country." Only a multi-sectoral approach involving policy makers, administrators, doctors, public health workers and educated laypersons, can come up with real change, not only for improved heart health but for medical care in general. For every day that we wait, hundreds of patients will die. These patients are neither nameless nor faceless. It has been three years since I last saw Rodel, yet not a week has passed when I have not thought of him. I do not know if he is still alive or if he has passed away. Perhaps, I would rather not know. Instead, I resolve to just focus on the other sick patients, patients who have a little more time, to wait for people like me, to wake up from their slumber.

REACTION: I have decided to choose this article for my Emergency Room duty because patients with cardiovascular diseases are often catered to the said area of course an attack of CVD is a real medical emergency. People often say that life is too short, so we must live it well. Life is not just about playing our favourite games, watching our favourite movies, or about having our own family someday. It is also about living healthy not just physically but also spiritually. But it is so ironic that some people just dont care about themselves, or say most appropriately, just dont allot much time for their health because of different reasons. A lot eat foods which are sumptuous but are not nutritious, drink alcoholic beverages too much until they are not able to carry themselves home, take prohibited drugs, smoke too many packs a day and many other things that are not good for their health. If they will then get sick, they will not be able to seek immediate health care because they are busy doing those things, setting aside their own health. No matter how our government, especially the Department of Health, has been so active in promoting programs that are helpful for us, they are not being furnished because of some Filipinos think for themselves only and not for the benefit of the many. Those factors that I have discussed above contribute to the causes of mortality of people in our country and to different disease such as on cardiovascular. According to the Department of Health, cardiovascular diseases are still the number one cause of death among Filipinos and are expected to be a growing problem in the next few years. The increasing number of cardiovascular diseases does alarm Filipino people. I know that not all who has this kind of disease does seek for health care immediately, because heart disease is a silent killer. A person who experiences some of the common manifestations such as chest pain, difficulty breathing and dizziness can be tolerated by the person itself by having some bed rest or taking some analgesics for the thought of suppressing the pain. Filipinos who suffer from heart disease are either poor or rich, and we all know that there is a larger population of Filipinos who are poor and thus, there is a chance of not submitting themselves to health care if their health worsens because of a high cost of health care facilities even in government hospitals. Our country is not very productive that is why health care systems supported by the government have low levels of health care facility. However, poor Filipinos who suffer from such disease do consult a physician once they can no longer hold the pain they are experiencing but after they no longer feel the pain, they already wanted to go home because they are worried of how much they would pay for the physician and the medications they would be expected to take as a maintenance. There are many things we can do to decrease or prevent of having cardiovascular disease, so why do we need to spend too much for health care facilities rather; we can do some preventable measures. As nursing students, we contribute in health promotion and prevention of illnesses. Health education is a big thing we can do as nursing students, especially now that we are

assigned at the emergency department of a secondary hospital. We should spread to the community about information that cardiovascular disease can be prevented by having a good lifestyle such as good diet wherein we should take healthy diets and avoid excessive eating, avoid heavy smoking, drinking and the most important thing is to have exercise. Information dissemination is very beneficial. It is also important that we should prioritize our own health than those vices that can be a factor of having a worst health condition. We must budget a bigger part for our health needs, for an ounce of prevention is better than a pound of cure. Doctors lamented that although Filipinos are aware of the need to be fit and healthy, but do little to counter their sedentary lifestyles and improve their diet. What is more alarming is that, doctors said, is that all of these factors may have been prevented at an early stage through a proper balanced diet which includes an antioxidant which helps the body to combat the damage caused by free radicals in its system, proper exercise and a healthier way of life. A better way to prevent us from illnesses is that we should take good care of ourselves by doing such measures to help us strengthen our immune system from any diseases. Seeking health care immediately when there is something wrong that you feel can be helpful for early diagnosis of what your present condition is. Live life as if its your last! a quotation that strikes me most! Simple but is very meaningful. Take good care of yourself; eat what you need, not what you want and stay healthy

Nursing Theory: For me, the best nursing theory related to my journal is the theory contributed by Dorothy Johnson which is Behavioural System Model. As stated, health care practices of individuals can highly contribute to factors that may trigger a person to have a cardiovascular disease. Unhealthy diets, smoking, drinking alcoholic beverages, unhealthy lifestyle and lack of exercise are those contributing factors not just for cardiovascular diseases but can also lead to a more problematical complications which may lead to death. A persons own behaviour does contribute to the prevalence of such disease. Nursings primary goal is to foster equilibrium within the individual, so nurses can help an individual in prevention of any illnesses by redirecting them to have a good behaviour towards their health and improving a good and healthy lifestyle.