Doctors without walls

Fresh out of medical school, armed only with a degree behind her name and a license to practice medicine, Che Zablan-Salazar packed up her bag and walked away from the four walls of the hospital where she had spent most of her adult life.

No, she did not turn away from the practice of medicine. Nor did she decide to heed the call of greener pastures abroad. Rather than pursue her residency, or shift to nursing like many have done, Zablan-Salazar decided to become a Doctor to the Barrio.

At 27, she knew this was a sacrifice she was making, especially given the highly competitive nature of the medical profession. By opting to go the road less travelled, she was acutely aware that, while her peers slowly inched their way to their respective specializations, she would be stuck as a general practitioner for the meantime. This also meant leaving the comforts of Manila, where every street corner has a Starbucks and countless malls that held hours of entertainment.

A young girl’s dream fulfilled

Becoming a Doctor to the Barrio was always one of Zablan-Salazar’s childhood dreams. At the age of five, she already knew she wanted to take up medicine someday. Some time during her college years, she stumbled across a book about Dr. Juan Flavier’s Doctor to the Barrio program and from then on, she knew she found her calling.

While the choice was clear for Zablan-Salazar, her family felt otherwise. They were initially hesitant about her going to the barrio, mainly because they were concerned about her safety. Her peers, likewise, tried to deter her from leaving, citing various reasons that ranged from the fact that she would be stagnate professionally to the barrio’s being lonely and dangerous. However, she stood firm by her choice. And if you asked her why, she replied simply: “why not?”

With that mindset, she set off to a remote little part of the country, Alilem, Ilocos Sur, a fifth-class municipality where she had minimal means of transportation and countless of bridges to cross to get to the people she had set off to heal.

The Doctor to the Barrios Program

The Doctors to the Barrio (DTTB) Program was spearheaded by one of the Department of Health’s (DOH) most memorable secretaries, Dr. Juan A. Flavier, in 1993 in response to the findings of a rapid assessment conducted by the DOH. The assessment showed that 271 municipalities in the Philippines had been without doctors for at least 5 years¹.

The thrust of the DTTB Program was to provide medical care by deploying competent, dedicated doctors twice a year to far-flung areas that needed them most. These areas were typically underdeveloped and economically challenged municipalities. Dr. Zablan-Salazar further described these municipalities in an interview as isolated, depressed and hard to reach. Doctors were expected to render two years of service in the municipalities they were deployed to.

In its first year, 46 doctors were deployed to provinces in Northern, Eastern and Western Samar, Tawi-tawi and Masbate. With limited funding coming mostly from donors and non-government support, the doctors who took the challenge of becoming a Doctor to the Barrio were not guaranteed a fixed salary, or if they would even get monetary compensation to begin with. Dr. Zablan-Salazar narrated that in the beginning, compensation even came in the form of shampoos, soap, medicines and other non-monetary donations the DTTB received.

In 2002, the Leaders for Health Program (LHP) was created in the hopes of “developing tri-leaders in health towards local health systems improvement and changing the way people think, feel and behave about health”¹. With this program, doctors who chose to be deployed to the various municipalities under the program are given opportunities to pursue their postgraduate education under the Health Unit of the Ateneo Graduate School of Business.

Believing in the importance of providing health care to all Filipinos, the program gained support from the First Gentleman Jose Miguel Arroyo through the First Gentleman Foundation Inc. (FGFI) in 2006 with the Bagong Doktor para sa Bayan program, which was followed by the Bagong Espesyalista para sa Bayan in 2007. Through this, over one hundred financially-challenged but well-deserving medical students received scholarships to pursue their education with the condition that upon passing the licensure exams, they would give back two years of service to the barrios. Last year, twenty of these scholars began their journeys as doctors to the barrios.

Today, the DTTB program is recognized and supported by the government. Newly licensed physicians are now compensated well. In fact, Dr. Zablan-Salazar says it is competitive given the industry standards. Medical Officers assigned to the barrios are among the higher paid employees of the DOH. However, while the monetary compensation has improved, the sacrifices they make are just as difficult. The loneliness and isolation are still the same, and the struggle of providing quality medical treatment given limited resources remains.

Life in the barrio

While many will assume that danger is the biggest challenge most barrio doctors face, the fact is that most municipalities they are deployed to are relatively safe and peaceful. Of course there are a select few that pose more risks, such as the war-torn areas of Mindanao. Some doctors share tales of how they have gotten caught in the cross-fire during times of conflict. Nonetheless, in the history of the DTTB program, only three doctors have lost their lives during deployment.

A more relevant challenge they face, says Dr. Zablan-Salazar, is being able to mesh well with the local government officials and constituents, especially since they are “outsiders” to the municipality. To be fair, however, Dr. Zablan-Salazar points out that generally, they are treated with respect and acceptance.

The culture shift and adjustment to the simplicity of life in the barrio is also something barrio doctors contend with. The absence of day-to-day comforts, such as television, the internet and even a hot, steaming caramel macchiato (something Dr. Zablan-Salazar often missed in her first few months in Alilem) can leave them homesick and emotionally overwrought. Add to this the lack of accessible public transportation, which can further present unique challenges to the doctors in the various municipalities in the country. This is especially true for those who are deployed in little islands around the country where the only means of getting to the poblacion (town) is a single pump boat that travels just once a day.

Despite these difficulties, most of these unsung heroes are able to complete their tour of duty. As of 2009, only 12% of the 521 doctors in the program were unable to finish for various reasons.

Barrio-tic experiences

Zablan-Salazar shared her experiences of being a doctor to the barrio in her personal blog, a section of which is entitled “Barrio-tic experiences”. There she outlined the nuances of daily life in a barrio where medical care is not provided only in a sterile hospital room or a clinic with four walls. Even the middle of the street is a medical center.

For her, giving up two years of her life for a little known town in the Philippines was an experience that “no amount of money can buy”. It was truly an experience of a lifetime that she would not give up for anything. Through her service in Alilem, she learned how to not only become a better doctor, but to become a better human being.

For information on the Doctors to the Barrios Program, please contact¹:

Hermenegildo M. Caronan Jr.

Administrative Officer

Health Human Resource Development Bureau

Building 12-A Department of Health Compound

Tel: (+632) 743 1776

After her service in Alilem, Dr. Che Zablan-Salazar returned to city life and is presently completing her residency in the Department of Family and Community Medicine at the University of the Philippines - Philippine General Hospital.

¹ Doctors to the Barrios Program: A Growing Tree. Cherrilyn G Zablan, MD. Zablan, MIMS MedReview, August 2009

Photos: “Stethoscope” by Adrian Clark, c/o Flickr. Some Rights Reserved / “road less travelled” by yapatoots, c/o Flickr. Some Rights Reserved.

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Maria Andrea (Ria) S. Tirazona, M.S. (cand.), popularly known as Yapatoots in the online blogging and social networking community, is a preschool teacher at Playschool International and part-time lecturer at the Psychology Department of De La Salle University. She is also an Associate Psychologist at PsychConsult, Inc, where she specializes in Psychological Assessment. She holds a Bachelor's Degree in Family Life and Child Development from the University of the Philippines and is currently working on her thesis for her Master's Degree in Clinical Psychology at the De La Salle University. In her spare time she maintains several blogs, including www.theaccidentalteacher.com, www.fatgirlnomore.com and www.yapatoots.com.