The Philippines is an island nation in Southeast Asia. Although the Philippine Archipelago has literally thousands of islands, there are three main islands that are more prominent in size and population. The country was colonized by Spain for three hundred years, by the Japanese during World War II, and by the Americans during the post-war era. The way of life of Filipinos is an amalgamation of the influences of its former colonizers as reflected in its religion (85% Christians), culture, language (Tagalog and English are the two official languages). There are more than 150 dialects indigenous to the islands and the main currency is the peso. As of 2000, the population of the country was estimated to 76 million. The Philippines has a fairly high prevalence of poverty which is greater in rural than urban areas (37% vs. 12%).
The world’s biggest city in land area, Davao is one of the country’s metropolitan centres and sits at the southeastern tip of the Philippines, about an hour and a half by plane from the capital Manila. Having been named as the Philippines’ most livable city by Time Magazine Asia, it boasts of picturesque scenarios and distinct flora and fauna indigenous to the city.
HEALTH OF THE POPULATION:
Beyond the metropolitan lifestyle and the influence of western culture which has dramatically swept the city in recent times, Davao City has its share of social issues whose answers are yet to be sought and actions taken. From the standpoint of the rehabilitation profession, there exists a significant vacuum wherein a number of poor people do not have access to rehabilitation services, particularly to physiotherapy. Sadly, the current scenario of accessibility to physiotherapists reflects a 1998 United Nations study which showed that in developing countries, only 2-3% of persons with disabilities (PWDs) can access rehabilitation services. In 1990 and 1997 the Census and the Department of Health respectively, conducted surveys on the number of disabled persons in the country . Because of the large discrepancies in the results of both studies and the low turn out on the survey conducted by the latter (Census:755,474 vs. Department of Health:469,707), there is still a heavy reliance on the estimates from the World Health Organization that in any given country, 10% of its population has some form of disability. This puts the country’s disabled population at 7.6 million. It is noteworthy, however, that the rights of persons with disabilities in the Philippines are upheld by law such as the Magna Carta for Disabled Persons (Republic Act 7277), considered the definitive legislation for disability in the Philippines. Other laws which protect the rights of PWDs include the Accessibility Law (accessibility requirements for all buildings and establishments) and the White Cane Act.
HEALTH CARE SYSTEM IN THE PHILIPPINES:
Various health maintenance organizations provide insurance for medical expenses. Furthermore, the government has in place agencies such as the Philippine Health Insurance Corporation and Social Security System. With these agencies, available for both company employees and those who are self-employed, a certain amount is deducted from a worker’s salary as a monthly contribution. Although the services covered by SSS, for example includes provision of appliances and supplies, rehabilitation benefits cover only medical, surgical, and hospital treatment, excluding physiotherapy services. In cases where a client has either a partial or total permanent disability, benefits include a monthly pension or a lump sum amount, depending on the number of months that has been paid by the employer or employee. Monthly pension is a cash benefit paid to a disabled member who has contributed at least 36 months, and the lump sum amount is for those who have paid for more than three years. Moreover, private insurance companies rarely, if at all, pay for physiotherapy services. Therefore, for poor people who cannot afford either SSS or the Phil Health Insurance (both of which are normally offered as employee benefits), medical services and/or physiotherapy services can only be availed from public/government-run hospitals and health centers (community clinics). In a country where there are more poor people concentrated in the rural areas and most public hospitals are found in urban places, the government has decentralized health service and has designated such to local government units (LGUs). These LGUs are comprised of a community doctor and community health workers (mostly midwives) who are responsible in implementing government programs like vaccination. In the field of rehabilitation, some services are provided by non-governmental organizations which are funded by foreign donors (mostly community-based rehabilitation). In the Philippines where 12-13% of the population lives on less than US$1/day (1997-2000 estimate), this scenario is a blessing for families who cannot afford the services of private rehabilitation practitioners/private clinics. It is interesting to note that government hospitals offer free physiotherapy treatments, both for in-patients and outpatients.
DISABILITY, REHABILITATION SCENARIO, AND PHYSICAL THERAPY STATUS:
Filipino therapists receive their Bachelor’s Degree in Physical Therapy from universities whose curriculum resembles that of the United States, although such a scenario may eventually change as most programs in the States now offer either a MPT or DPT. Typically, physiotherapists in the Philippines work in hospital/clinical settings and a number of colleagues belong to the academe and research. Licensure examinations, on the other hand, are administered by the Professional Regulation Commission, a national government office. While a number of physiotherapists earn their Bachelor’s degree every year, the healthcare system in the Philippines means that only a limited number of positions are available. This discrepancy between supply and demand has led some physiotherapists to work in other countries or to other fields not often related to rehabilitation. Moreover, the law also prohibits physical therapists from providing services without a referral from a medical doctor, hence, contributing to the difficulty in going to private practice for example. In addition, knowledge of the important role of physiotherapists is not fully understood especially among people in the rural areas where traditional medicine (TM) has always been an important part of rural health. These TMs include herbal medicines and the acknowledgement of the existence of quack doctors, locally called hilots. Because of its large influence to public health, the Department of Health has recognized their contribution to community health and is now part of some of its programs like selling herbal medicines as an alternative to prescription drugs. Malnutrition and unsanitary living conditions are identified by the Department of Health as the important causes of disability especially among children. Also, the lack of pre-natal care has been contributory to the incidence of pediatric disability. In some areas of the country, on the other hand, the unstable peace and order has contributed likewise to disability.
PERSONAL EXPERIENCE ON VOLUNTEERISM:
When I earned my Bachelor’s Degree in Physical Therapy in the Philippines, I was practicing in hospitals. However, there was a need to provide physical therapy services to the poor communities and equally important, to accept the challenge of working in a unique clinical scenario away from the four-walls of hospitals and clinics and where the boundary seemed endless.. The call was so strong that together with close friends and colleagues (all physiotherapists), we established a non-stock, non-profit organization called Kapansanan ay Akibat sa Kaunlaran ng Bayan (KAAKBAY) (Disability is a partner towards nation-building). I was one of its first volunteers and the organization’s founding president. Registered with the Philippines’ Securities and Exchange Commission in 2001 as a non-stock, non-profit organization, its mission is to provide accessibility to the services of rehabilitation professionals by poor families. It is composed mainly of physiotherapists and medical doctors working in close partnership. Recently, two other equally important rehabilitation fields have been added to the organization: occupational therapy and special education for children with learning disabilities. As a community-based organization, it has strong links with the local government units and organizations: the Davao City Welfare for the Disabled (a local government office), the Department of Social Welfare and Development (a national government office), the Partnership of Philippine Support Agencies (a national organization of NGOs), the NewZealand Embassy, and the Catholic Archdiocese of Davao. It has gained support and affiliations from local universities as well for the physical therapy placement of their students (termed internship in the Philippines). To note, the organization has been recognized by the Philippine Physical Therapy Association and has likewise been named one of the first winners of the Ten Accomplished Youth Organizations of the Philippines, a national award given by the country’s president.
Aside from providing rehabilitation services to its clientele at the Center, the group goes to the community for home-based care (for bed-ridden clients) as well. As educating the masses regarding the important role of rehabilitation professionals is of paramount importance, small-group lectures are also done in the community alongside with other members of the local government units like health workers. Medical outreach programs, on the other hand, are organized by the Center to visit far-flung areas. The Center likewise has been receiving visitors from Vanuatu, Indonesia, and China.
As for the cases often encountered, stroke and cerebral palsy remain on top of the list. Emphasizing therapeutic exercise, clients get hands-on treatment from licensed and volunteer therapists, all rendering their services pro-bono in a team-oriented approach. Five years from its conception, the Center has already rendered 8000 treatment sessions and has welcomed close to 70 volunteers, past and present alike. To address the academic needs of its members on the other hand, the KAAKBAY Rehabilitation Center has also been organizing seminars and symposiums which address clinical and professional issues in physical therapy. Fortunately, most, if not all of the invited speakers often waive their professional fees and donate it to the cause of the Center instead. When I left for Canada four years ago, I became part of the KAAKBAY International, a group of KAAKBAY members who are establishing themselves as therapists in different parts of the world (United States, United Kingdom, and the Middle East) and continue to send financial support for the various endeavors of the organization, as funding from international donors is yet to be realized. As such, any donation (most especially physiotherapy paraphernalia and materials) will be greatly appreciated.
While it may have been very challenging at the beginning to start my career here in Canada as I had to do my equivalency studies and hurdle the written and oral national examinations, the experiences, insights, and lessons I have learned from KAAKBAY were and continue to be important tools as I continue my practice.
Affiliations: College of Physiotherapists of Ontario New York State Board of Physical Therapy Canadian Physiotherapy Association American Physical Therapy Association Philippine Physical Therapy Association
