Medical Professionals and Human Rights in the Philippines
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J Med Ethics: first published as 10.1136/jme.17.Suppl.42 on 1 December 1991. Downloaded from Jrournal ofmedical ethics, 1991, 17, Supplement 42-50 Medical professionals and human rights in The Philippines June Pagaduan-Lopez University ofThe Philippines, Manila, The Philippines to forego taking essential radiographs of many Health and human rights patients. Over 50 per cent of the country's doctors and For most Filipinos access to primary health care is a more than 60 per cent of its nurses work outside of the luxury. Often those in greatest need subsist in country. Of those doctors who remain in the country, desperate poverty where living conditions foster illness most have private practices in urban areas. Manila, the and disease. Well over half the population live in rural country's capital, has 15 times as many doctors as areas without safe drinking water where outlying rural areas. communicable diseases, which are preventable and These conditions, however, tell only part of the curable, account for 43 per cent of total deaths. The story. During the Marcos years, the health situation in Philippines has the highest incidence of tuberculosis The Philippines failed to improve because of schistosomiasis, and polio in the Western Pacific. govenmental neglect, widespread corruption and Sadly enough, Filipino children suffer and die from graft, plus intimidation of rural health care providers. copyright. pneumonia, nutritional deficiencies, gastroenteritis Even though the Marcos government maintained a and colitis at such a rate that they make up nearly 25 blueprint for primary health care facilities, its health per cent of total deaths in the country. Beneath the care delivery programme was severely underfunded. surface of these statistics lies the insidious role of In 1983, Dr Mita Pardo de Tavera, now Minister of poverty: malnutrition, for example, often aggravates Social Services and Development, estimated that, 'in measles, leaving affected infants susceptible to such terms of US dollar value, for every nine dollars spent complications as pneumonia and various forms of per capita on military expenditures, only one dollar was diarrhoea. spent on health care'. As a result, the number of hospital beds per 10,000 population dropped from 18 http://jme.bmj.com/ Health care delivery to 13 between 1977 and 1983. In 1985, the last year of Chronic underdevelopment in The Philippines the Marcos regime, the government's medicare explains much of this country's poor health record. programme was only able to cover 20 per cent of Almost 75 per cent of Filipinos live below the poverty hospitalisation costs, compared to 70 per cent when the threshold, defined by Manila's Centre for Research programme was first initiated in 1969. and Communication as the equivalent of US $1,000 a Equally disturbing was the fact that government year for a of six. In 1985 over three to family alone, medicines and supplies often failed reach hospitals on October 1, 2021 by guest. Protected million people, or 15 per cent of the total labour force and clinics because of graft and corruption. For of20.6 million, were out ofwork. Six years later, under instance, the Philippine Commission on Audit, a the Aquino government, the figure has increased to government agency, reported in 1984 that the former 20.2 per cent according to the July 2 1991 issue ofAng first lady's heart center had 'various anomalies' Malaya, a Manila daily. That same year, the average including 'the failure of management to reconcile the employed labourer earned no more than US $60 per physical inventory of supplies, material, property and month. equipment with accounting records; property and This grim picture is compounded by inadequate equipment amounting to 300.7 million pesos remained transportation and communications systems which unrecorded in the center's records'. hamper the ability of rural residents to reach health But such fiscal anomalies were not limited to facilities in central towns and cities. Even in urban hospitals in the metropolitan Manila area. In 1986, centres the high cost ofprolonged institutional medical President Aquino's newly appointed Minister of care is far beyond the means of the average wage- Health, Dr Alfredo Bengzon, found that in the two earner. Hospitals often have to get by with inadequate years before the fall of the Marcos regime between 30 supplies of x-ray film, bed linens and antibiotics. In and 40 per cent of the national health budget for 1983, for instance, doctors at the Philippine General supplies and materials had been diverted into Hospital, the country's biggest tertiary state hospital, 'kickbacks, corruption, and graft'. As a result, reported that a shortage of x-ray film had forced them Minister Bengzon dismissed eight of the twelve district J Med Ethics: first published as 10.1136/jme.17.Suppl.42 on 1 December 1991. Downloaded from Jfune Pagaduan-Lopez 43 health officers originally appointed by Marcos's health violations of human rights committed by the minister. government. Today, in its fifth year, the Aquino government Disheartened by the medical community's failure to seems nowhere close to solving the myriad problems it formalise the creation of the Medical Action Group inherited from the Marcos regime. Saddled with a (MAG) and clinics for the treatment of torture deteriorating economy, destabilisation efforts from survivors, a handful ofdoctors banded together a week both right and left wing factions, graft and corruption after the murder of Dr Remberto 'Bobby' de la Paz, a and poor central planning, it has often been accused of doctor working in Catbalogan, Samar, to form MAG. resorting to increased militarisation to contain political Among the group's founding members were the slain violence against its continued existence. doctor's wife, Sylvia, and his sister, Dr Alicia de la Paz. At the time of writing, in spite of a state of They soon opened a small office in downtown Manila. emergency declaration that has been in effect for more Now, ten years later, MAG maintains offices in several than six months, the economy continues to deteriorate provincial capitals and performs a wide range ofhealth and human rights abuses to rise. The Presidential care programmes, including a prison medical project, a Commission on Human Rights (PCHR) reported that network of primary health care programmes, it received a total of 1,653 complaints in 1988, 1,570 in educational seminars on the medical consequences of 1989 and 1,880 in 1990. The Catholic-Church-based nuclear war, and clinics for the treatment of torture Task Force Detainees ofThe Philippines (TFDP), has victims. noted a higher occurrence of political arrest in the past Since its formation, MAG has worked closely with five months - involving 305 persons, of which 70 the Free Legal Assistance Group and the TFDP to gain remain in detention - than at any time since the Aquino access to detainees in need of urgent medical care. In government came into office. At the height of the 1983, MAG reported that the following health and Philippine-US exploratory talks in Manila in May living conditions were common in several, if not most, 1990, 155 anti-US bases activists were arrested. of the 100 detention centres and military stockades throughout the islands: overcrowding, with common The medical community responds criminals and political detainees sharing the same cell;copyright. Filipino doctors and health workers active in the meagre food rations (roughly 6 pesos or 42 US cents a human rights movement have mixed views of the role day); insufficient medicine for a variety of ailments played by the Philippine medical and health including tuberculosis, anaemia, gastroenteritis, and associations in defending threatened colleagues during colitis, and irregular visits by prison health personnel. the years of martial law. The national nurses' These conditions, the group said, were further association, they say, spoke out in defence of aggravated by the fact that many detainees had been colleagues who were harassed or jailed for their human held for a year under such circumstances. rights activities or non-violent opposition to the During the first two years of its existence, MAG Marcos government. Similarly, some provincial encountered several barriers to their gaining access to http://jme.bmj.com/ medical associations, such as the Quezon Medical detainees who were in poor health. In 1983, for Society, responded with appeals and petitions when example, MAG doctors in Manila were only permitted their members were detained. But, for the most part, to attend to prisoners on three occasions. In addition, the Philippine Medical Association (PMA) remained the group lacked adequate resources to dispatch silent. doctors to remote areas where detainees were often in The PMA did, however, issue a statement in 1985 the greatest need of medical care and basic medicines. urging President Marcos to release detained doctors In some areas, local military commanders were into the custody of the association so they could serve unwilling to let civilian doctors enter detention on October 1, 2021 by guest. Protected their patients. To protect doctors, the PMA submitted facilities to examine prisoners on the basis that such to the National Assembly a proposal providing stiffer visits could only be allowed after authorisation by the penalties for various crimes committed by doctors prison medical system or the International Committee against their patients. But such well-intentioned of the Red Cross. initiatives were undertaken only in the last three years Despite these obstacles, by 1984 MAG had reached of the Marcos regime. Clearly, fear of government agreements with several regional government and reprisals may partly explain this lack ofaction. Equally military officials, which allowed civilian doctors access apparent was the international medical community's to prisons. This new development meant that failure to support and encourage the PMA to speak out detainees, particularly in areas where official prison in defence of Filipino health professionals in serious health care was non-existent, could finally receive trouble.