Sunday, July 31, 2011

Health group threatened anew

BAGUIO CITY — A day before the PNoy’s State of the Nation Address (SONA), a staff of the Community Health Education, Service and Training in the Cordillera Region (CHESTCORE) received a threat on her mobile number again.

At about noon on July 24, Sunday, Milagros Ao-wat received threats from cell number 09093118024 indicating close surveillance on her whereabouts and activities.

“Ingat kau, labas kau ng labas kasla kayo met gamin sigsiguro. Apay dayta trabaho yo mano ti bayad no matay kayo. Parangal laeng met.. ay ay ay. Narigat ti mabrainwash ta haan nga makita ti usto,” (Take care, you are always going out, you are very daring. Why? How much will you get from your work when you die? Only a tribute … ay ay ay. It is hard to be brainwashed because you cannot see what is right) one text message read.

This was followed by another saying, “Sinowak? Haan masapul ti nagan ko. Ammoyo met nu cno dagiti agininteresado kadakayo. Kuna yo nga iharharas mi dakayo,” (Who am I? You don’t need to know my name. You know very well who are after you. You said that we are harassing you).

“Threats continue. Nothing has changed despite Pnoy’s promise of a ‘matuwid na daan’! ,” Romella Liquigan-Rasalan, the Executive Director of CHESTCORE said. The group she said strongly condemns the continuing assault on their staff and their institution inspite of their continuing resolve to render health services.

In earlier reports, Ao-wat, a CHESTCORE staff member revealed to have received several death threats last December, 2010 and January, 2011 on her phone.

“The threats have not stopped. This is appalling because what we do is provide much-needed health services and yet, this is what we get,” Ao-wat said.

“We have already reported this to the Commission on Human Rights. They have yet to bring out their report on the past cases and now, there are new threats,” Rasalan added.

March this year, CHESTCORE launched a campaign to stop the harassment of Cordillera health workers as it exposed continuing threats that happened on staff and volunteers when in Baguio and during field work since 2007.

The campaign aimed not only to expose the threats but to help assert people’s right to health. CHESTCORE, a non-government health institution founded in 1981, has been serving far-flung Northern Luzon communities which are not reached by government health services or where these are insufficient. Unfortunately, instead of being commended for their work, CHESTCORE has been accused of being New People’s Army (NPA) supporters or their staff accused as being NPAs themselves.

“This is not really surprising even if people pinned much hope for change under this administration,” Jude Baggo, the secretary-general of the Cordillera Human Rights Alliance (CHRA) said. PNoy he added has launched his Oplan Bayanihan last December 2010, an anti-insurgency program that includes among its features the vilification or the tagging of progressive organizations as underground organizations.

“This has replaced then president Arroyo’s Oplan Bantay Laya that accounted for the more than 1000 extra-judicial killings among militant groups” he added.

“But this has to stop!,” he stressed. Thus, he said they highlighted CHESTCORE’s case in their Assembly last July 28 & 29 in Ifugao especially in the launching of their anti-vilification campaign.

CHESTCORE and CHRA vowed to put in greater efforts in this campaign to gain broader support in these cases and to stop continuing human rights violations in the region. #

Friday, July 22, 2011

PPPs in health threaten to make health care costlier – health workers

“You go to a public hospital emergency room to have your wound cleaned, you have to first buy some cotton, wound antiseptic, and dressings, before you can be treated,” said Joel Bitanga, 40, an X-ray technician in San Lazaro Hospital.


MANILA – After one year, healthcare in the country has gone from bad to worse — this is the assessment of the Alliance of Health Workers (AHW) on the Aquino government’s impact on health. In a series of protests held by its member unions in different public hospitals in Metro Manila, the group aired the various shocks of Aquino’s touted PPPs (public-private partnerships) on the services of public hospitals and the working condition of health workers and professionals in the country. The group challenged Aquino to stop the privatization “in any form” of public hospitals and to bail out public health by infusing it with a P90-billion ($2.09 billion) budget at least.

UP-PGH health workers urge their hospital management to revert to giving poorest charity patients free treatment. A mother brought out a child patient. (Photos by Marya Salamat /
During Aquino’s first year, the country’s main public hospital, the Philippine General Hospital (PGH), for example, has, for the first time in its history, resorted to charging fees even from its lowest ranked charity or indigent patients. In a memo issued last month, the PGH administration reportedly directed its hospital staff to charge the previously free diagnostic and laboratory examinations of “class D” patients. These are the patients who, according to the hospital social workers, belong to the lowest earners or the poorest of the poor among the four groups who qualify for “social service.” Class D used to receive full support (or full charity), while the other classes under social service get discounts, much like the socialized tuition fees being implemented in the University of the Philippines, explained Jossel Ebesate, AHW national president.

In the Philippine Orthopedic Center, fees have been drastically increased early this year, with some increasing more than twice its old amount.

Because of the budget cutbacks implemented by the Aquino administration in the budget for maintenance and other operating expenses of public hospitals, the previous shortages in medicines, supplies and other equipment have become worse, reported the AHW. The exacerbated shortage in turn prompted the administrations of public hospitals to increase fees and to charge fees on previously free items in the hospital menu of services.

“You go to a public hospital emergency room to have your wound cleaned, you have to first buy some cotton, wound antiseptic, and dressings, before you can be treated,” said Joel Bitanga, 40, an X-ray technician in San Lazaro Hospital. He added that if you were brought to their hospital and you can’t breathe, you have to buy the hose and other paraphernalia for your oxygen.

Health workers and a child urge the Aquino government to treat healthcare not as source of profit but as public service.(Photos by Marya Salamat /
Picketing in front of San Lazaro Hospital, then at Jose Reyes Memorial Medical Center and in front of the Department of Health, the health workers decried last Monday the increased fees also prevalent in the Philippine Heart Center, the Lung Center of the Philippines, the National Kidney and Transplant Institute (NKTI), the Philippine Children’s Medical Center (PCMC) and the East Avenue Center (EAMC). These are some of the hospitals retained by the national government after it implemented a devolution of health services in 1992.

The practice of charging and increasing fees which the majority of low-income Filipinos are already finding as tough, would likely worsen if the Aquino government pushes through with its planned PPPs targeting even government hospitals, the AHW warned.

Already, the health group noted that some private companies that were able to get concessions in public hospitals have been profiting from this public-private partnership. They cited as example Himex, which provides the radiology “services” of Jose Reyes Memorial Medical Center; the Carte-blance in Lung Center which profits from its dietary services; and Fabricare for Lung Center’s laundry. In PGH, the privately-operated Faculty Medical Arts Building has begun operations this year.

In public hospitals being operated by local government units, a measure of success is the increase in hospital income, which could be had by adding “private” or “pay wards” and other services that charge fees. The biggest example, for having been the first to be declared as a corporatized hospital is the La Union Medical Center. Provincial hospitals are now trying to follow its example, after its local governments have sent their public hospitals’ directors and staff to “Lakbay Aral” (Study Travel) to learn from “successful” provincial public hospitals.

Up for starting new PPPs soon are the Philippine Orthopedic Center (POC), the San Lazaro Hospital and the Research Institute for Tropical Medicine (RITM). While the moves are seeking to improve and upgrade the said hospitals – something which the health workers’ union said they also wish to happen – they are decrying the fact that these have to be planned under a PPP setup. They urged the government instead to fund the needed development, rather than enter into partnerships with the private sector whose motives for entering health services are mainly for profit.

Health groups blame US imperialist dictates for Aquino’s drive to privatize and commercialize healthcare.(Photo by Marya Salamat /

“What will happen to our mentally ill patients? Will they be abandoned on the streets?” asked Arman Palaganas, vice-president of the health workers’ union in National Center for Mental Health. This mental hospital and the Philippine Heart Center are up for bidding in a public auction set to be held under the Aquino administration, the AHW reported.

When all these upcoming PPPs happen, the AHW warned, health care will become even less accessible to ordinary Filipinos.

Killing you softly

Given the frequently slashed budgets, health workers’ wages and benefits have also taken a beating. In fact, the Department of Budget and Management itself has told public hospital administrators and even local government units that benefits being given to health workers are contingent on the hospital’s savings or on the availability of funds. The result, according to AHW, is either lacking or almost nil benefits especially for health workers under the local government units.

A PGH patient’s charity cards and papers attesting to her indigency could mean little now in terms of free or affordable treatment. (Photo by Marya Salamat /
For twenty years now, the country’s plantilla position for health workers and professionals have barely increased, despite the continued pressure of population increases. Worse, while the plantilla positions are being controlled, the AHW noted that the ranks of the country’s health workers are under attack and being reduced by bouts of retrenchment or streamlining through transfer, attrition and early retirement.

Instead of replacing the lost regular health workers, AHW noted that the government itself has been increasingly implementing “flexible labor arrangements,” a favorite under profit-oriented corporations. In the health sector, these arrangements range from contractualization, job-order employment (similar to project-based hiring), and the notorious “volunteerism” where the hospitals not only do not pay the health professionals who serve them but even make them pay for the “training” and “experience.”

As if to gag the health workers’ groups who have been criticizing and providing proofs of the government’s abandonment of its responsibility top ensure the people’s health, there are alleged moves from public hospital managements to bust the health workers’ unions, or else “deceive, divide and crush” the progressive unions under the Alliance of Health Workers. The AHW complained that the management of some public hospitals, such as the National Center for Mental Health, Jose Reyes Memorial Medical Center, Philippine Orthopedic Center and Philippine Children’s Medical Center, “do not recognize and even try to coerce the accredited sole bargaining unit.”

As such, judging from the way the government has been treating Filipinos as patients and as health workers, the health group charged that “the people has never been Aquino’s real ‘boss,’ as he had boasted, but the politicians, the local big landlords and the big local and foreign investors.”

The poor cannot survive under the Aquino government’s health agenda of privatization, the Health Alliance for Democracy said in a statement. The poor will get sicker and die sooner if the rate increases continued, said PGH nursing attendant Ellen Jamison in a picket protest in front of the PGH this week.

The health groups encourage health workers and the families of patients in public hospitals to join in protesting privatization and pushing for health as a human right.

Revolutionary Doctors: How Venezuela and Cuba Are Changing the World’s Conception of Health Care

By Steve Brouwer - Monthly Review Press, July 21st 2011

Revolutionary Doctors, a new book by author Steve Brouwer and published by Monthly Review Press, gives readers a first-hand account of Venezuela’s innovative and inspiring program of community health care, designed to serve—and largely carried out by—the poor themselves. Drawing on long-term participant observations as well as in-depth research, author Steve Brouwer tells the story of Venezuela’s Integral Community Medicine program, in which doctor-teachers move into the countryside and poor urban areas to recruit and train doctors from among peasants and workers.

The following excerpt, also available in PDF, was made available to readers through the International Journal of Socialist Renewal.

Where Do Revolutionary Doctors Come From?

The campesinos would have run, immediately and with unreserved enthusiasm, to help their brothers.

—CHE GUEVARA, “On Revolutionary Medicine,” 1960

Even though he came to Cuba with a rifle slung over his shoulder and entered Havana in 1959 as one of the victorious commanders of the Cuban Revolution, he still continued to think of himself as a doctor. Five years earlier, the twenty-five-year-old Argentine had arrived in Guatemala and offered to put his newly earned medical degree at the service of a peaceful social transformation. Dr. Ernesto Guevara was hoping to find work in the public health services and contribute to the wide-ranging reforms being initiated by President Arbenz, but he never had much opportunity to work as a physician in Guatemala. Within months of his arrival, Arbenz’s government was brought down by the military coup d’état devised by the United Fruit Company, some Guatemalan colonels, the U.S. State Department, and the CIA.

Che never lost sight of the value of his original aspiration—combining the humanitarian mission of medicine with the creation of a just society. When he addressed the Cuban militia on August 19, 1960, a year and a half after the triumph of the revolution, he chose to speak about “Revolutionary Medicine” and the possibility of educating a new kind of doctor.

“A few months ago, here in Havana, it happened that a group of newly graduated doctors did not want to go into the country’s rural areas and demanded remuneration before they would agree to go. . . .But what would have happened if instead of these boys, whose families generally were able to pay for their years of study, others of less fortunate means had just finished their schooling and were beginning the exercise of their profession? What would have occurred if two or three hundred campesinos had emerged, let us say by magic, from the university halls? What would have happened, simply, is that the campesinos would have run, immediately and with unreserved enthusiasm, to help their brothers.”

Since then, Cuban medicine and health services have been developed in a number of unique and revolutionary ways, but only now, nearly fifty years later, has Che’s dream come to full fruition. Today it is literally true that campesinos, along with the children of impoverished working-class and indigenous communities, are becoming doctors and running, “with unreserved enthusiasm, to help their brothers.”

While this is happening on the mountainsides of Haiti, among the Garifuna people on the Caribbean coast of Honduras, in the villages of Africa and the highlands of Bolivia, it is occurring on the grandest scale in the rural towns and city barrios of Venezuela. When I was living in the mountains of western Venezuela in 2007 and 2008, I witnessed the emergence of revolutionary doctors every morning as I walked out the door of our little tin-roofed house. The scene would have delighted Che:

As the sun rises above the mountain behind the village of Monte Carmelo and the white mist begins to lift off the cloud forest, four young campesinos walk along the road in their wine-red polo shirts with their crisp, white jackets folded up under their arms to protect them from the dust. At 7 a.m. they wave goodbye to the high school students who are waiting to begin their classes in three rooms at the women’s cooperative and then hop aboard the “taxi,” a tough, thirtyyear-old Toyota pickup truck that often packs twenty or more people in the back. They travel down the winding mountain road, through the deep ravine at the bottom, and up the hill on the far side of the valley to the larger town of Sanare, where they are going to work all morning alongside Cuban doctors in neighborhood consulting offices and the modern Diagnostic Clinic.

Around 7:45, four more medical students from the village, already donning their white jackets, walk by our house, past the plaza and the little church, and gather in front of a small concrete block building called the ambulatorio. About the same time, they are joined by three more medical students who emerge from Carlos’s bright blue jeep,“the Navigator,” one of the other vehicles in the taxi cooperative that serves the village. These students from Sanare pull on their white jackets, hug their compañeros, and wait for Elsy, a health committee volunteer who is studying to be a nurse, to unlock the gate to the ambulatorio, the walk-in clinic that offers Barrio Adentro medical service.

As I stroll by, I see the prospective patients sitting on the benches of the small, covered patio in front of the entrance door. They are waiting for Dr. Tomasa, the family medical specialist. Two chirpy teenage girls sit next to Dr. Raul’s dentistry room and grin with perfect-looking smiles. “What could be wrong with your teeth?” I ask.

“Nothing,” responds one of them, “Dr. Raul is giving us another checkup.”Another checkup? Their parents never had a single checkup when they were young—consequently, there are many people over forty or fifty who have very few teeth.

By 8 a.m. one of the medical students stands behind the simple wooden counter, performing receptionist duties. Another shuttles back and forth to the file shelves, organizing and updating medical information that is kept on every family in the community. A third chats informally with the waiting patients, entertaining their small children, and informally inquiring about their families’ health. The other four students stand alongside Dr. Tomasa in the consulting office, watching her take family and individual histories and give examinations. They also fetch medicines, take temperatures, and weigh healthy children who are accompanying their mothers. Today, like every day, Dr. Tomasa says to her students, “Por favor, more questions. This is how we learn. You can never ask too many questions.”

Monte Carmelo is a small village that stretches along a single paved road on a mountain ridge in the foothills of the Andes in the state of Lara. Before Hugo Chávez assumed the presidency of Venezuela in 1999, the road was unpaved and the high school did not exist. According to the 2007 census, its population consisted of 129 families and approximately 700 individuals, nearly all of them supporting themselves by working small parcels of land by hand, or with horses and oxen. That same year nine residents of Monte Carmelo were medical students. Eight were studying Medicina Integral Comunitaria (popularly known as MIC), an intensive six-year course that in English is usually called Comprehensive Community Medicine. A ninth village resident was studying medicine in Cuba. Two more young women from a neighboring hamlet were also in medical school. They were part of a group of sixty-seven students in this agricultural region who were becoming doctors of medicine.

The students are a diverse lot: some are nineteen or twenty years old and have recently finished high school; others are closer to thirty and have young children; a few are even older. Some young mothers have recently completed their secondary education through Mission Ribas, one of the Bolivarian social missions that bring adults back to school on evenings and weekends. All of the students are enthusiastic about their role in fostering good health and introducing reliable medical care into the fabric of their community and the larger world. And many of them dream of emulating their Cuban teachers and one day serving as internationalist physicians themselves in remote and impoverished parts of the world.

This experiment in training new doctors in MIC would be worthy of international attention even if the program was limited to the 67 students in this remote coffee-growing region in the state of Lara. But in fact they represent only a tiny fraction of a gigantic effort to transform medical education and health care delivery throughout all of Venezuela. Nearly 25,000 students were enrolled in the first four years of MIC in 2007 2008, and by 2009 and 2010 they were joined by more students, swelling the ranks of students enrolled in all six years of MIC to approximately 30,000. This is almost as many as the total number of doctors who were practicing medicine in all capacities in Venezuela when Hugo Chávez was elected president in 1998.

One unique aspect of MIC is that the students in Monte Carmelo do not have to leave the campo, the countryside, nor do students in the poorest neighborhoods of Venezuelan cities have to desert their barrios in order to attend medical school. Medicina Integral Comunitaria is a “university without walls” that trains young doctors in their home environments. This is not a short-term course for health aides or “barefoot doctors,” but a rigorous program designed to produce a new kind of physician. Every morning during their years of study, the MIC students help doctors working in Barrio Adentro attend to patients’ illnesses and learn to comprehend the broad public health needs of their communities. And every afternoon, they meet with their MIC professors in a series of formal medical classes that constitute a rigorous curriculum and include all the medical sciences studied at traditional universities.

The MIC education program could not exist without Barrio Adentro, the nationwide health system that first began delivering primary care in 2003 thanks to an enormous commitment of expertise from Cuba. From 2004 to 2010, Barrio Adentro continually deployed between 10,000 and 14,000 Cuban doctors and 15,000 to 20,000 other Cuban medical personnel—dentists, nurses, physical therapists, optometrists, and technicians. Their services are available to all Venezuelans for free at almost 7,000 walk-in offices and over 500 larger diagnostic clinics, and they have been very effective in meeting the needs of 80 percent of the population that had been ill-served or not served at all by the old health care system.

Obviously, Cuba cannot afford to devote so many of its medical personnel to Venezuela indefinitely, nor does the Chávez government want to depend on foreign doctors forever. So when Barrio Adentro was being launched in 2003, Cuban and Venezuelan medical experts devised a new program of medical education that will enable Venezuela to keep its universal public health program functioning permanently. Starting in 2005, the Cuban doctors were asked to perform a rigorous double duty: not only did they continue treating patients in Barrio Adentro clinics, but many of them also began teaching as professor/tutors for the MIC program in comprehensive community medicine. The goal of MIC is to integrate the training of family practitioners into the fabric of communities in a holistic effort that meets the medical needs of all citizens, makes use of local resources, and promotes preventive health care and healthy living.

The Cuban mission in Venezuela is possible because over the past half-century, Cuba has developed a vision of medical service that goes far beyond its own borders. Cuban health workers, in addition to providing free health care for all their fellow citizens, have transformed themselves into a “weapon of solidarity,” a revolutionary force that has been deployed in over 100 countries around the world. Since 2000, however, the Cuban commitment has increased substantially because the Bolivarian Revolution in Venezuela has contributed its own enthusiasm, volunteers, and economic resources. Through various agreements of cooperation, Cuba and Venezuela have embarked upon a number of projects in other fields such as education, agriculture, energy, and industrial development, and then have extended these cooperative ventures to other nations, particularly within ALBA, the Bolivarian Alliance for the Peoples of Our America, which includes Bolivia, Nicaragua, and Ecuador as well as the small Caribbean island nations of Dominica, Antigua and Barbuda, Saint Vincent and the Grenadines.

Of all these ambitious undertakings, delivering medical services is by far the most prominent. In order to extend universal health care to the poor and working classes in way that is compatible with the new, egalitarian vision of these societies, many more physicians are needed. With this in mind, Cuba is educating more doctors at home even as it trains tens of thousands in Venezuela. In 2008 there were 29,000 Cubans enrolled in medical school, plus nearly 24,000 foreign students (including more than one hundred students from the United States) studying at the Latin American School of Medicine in Havana or at the schools of the New Program for the Training of Latin American Doctors that are located in four other provinces.

An Army in White Jackets

I first became aware of the magnitude of this medical revolution in 2004 on my first trip to Venezuela. When Dr. Yonel, a young Cuban dentist working in a barrio of Caracas, informed me there were more than 10,000 doctors working in Venezuela, I exclaimed, “Un ejército de medicos! An army of doctors!”

Dr. Yonel smiled and replied, “Un ejército de paz. An army of peace.”

Clearly the collaboration of the rejuvenated Cuban Revolution and the nascent Bolivarian Revolution was yielding impressive results. And a growing number of countries in the Western Hemisphere, long under the yoke of wealthy conservative minorities or military authoritarians who were dependent on capital and political instruction from the North, were no longer willing to listen to the United States when it told them to shun Cuba and Venezuela. Since its long-standing economic blockade of Cuba was failing to deter these developments, the United States tried to launch a disruptive dissident movement in Cuba and assist a coup d’état in Venezuela. When these efforts failed, the U.S. government imposed more draconian economic and travel restrictions on Cuba in 2004 and funded various schemes to undermine both revolutionary governments. In 2006, the United States stooped to an especially low level when it attempted to directly sabotage Cuba’s humanitarian medical missions by creating the Cuban Medical Professional Parole Program. This was a law specifically designed to lure Cuban doctors, nurses, and technicians away from their foreign assignments by offering them special immigration status and speedy entry into the United States.

These antagonistic efforts did not succeed in diminishing the international solidarity and prestige that Cuba and Venezuela were acquiring around the world, nor did it keep them from expanding their programs of humanitarian medical aid and international medical education. In 2007, a young Chilean, a member of the third class graduating from the Latin American School of Medicine in Havana, spoke at her commencement and told her classmates: “Today we are an army in white jackets that will bring good health and a little more dignity to our people.”

By 2010, Cuba and Venezuela further demonstrated their capabilities by being among the most prominent providers of both emergency and long-term aid to Haiti after its devastating earthquake. Brazil, the economic giant of Latin America, signaled its admiration by announcing that it would be delighted to join Cuba in a partnership to create a new public health system in Haiti. José Gomés, the Brazilian Minister of Health, explained why his country was choosing to work with the Cubans on such a significant and demanding project: “We have just signed an agreement—Cuba, Brazil, and Haiti—according to which all three countries make a commitment to unite our forces in order to reconstruct the health system in Haiti. . . . We will provide this, together with Cuba—a country with an extremely long internationalist experience, a great degree of technical ability, great determination, and an enormous amount of heart.”

For Cuba, Venezuela, and by extension their allies in ALBA alliance, these triumphs throughout the first decade of the twenty-first century were more than diplomatic coups, they were moral victories. They demonstrated the power of social solidarity and humanistic concern for other people, values in stark contrast with the materialistic, self-centered, and aggressive behavior of the advanced capitalist societies.

This book aims to acquaint the reader with the ways that revolutionary doctors and health care workers have developed into major protagonists of socialist change and are defining what that change should look like. Chapters 2 through 4 offer some glimpses of Cuba’s international medical missions, their profound impact on various parts of the world, and their relation to the overall development of Cuban health care over the past fifty years. Chapters 5 through 8 describe how a new public health system, Barrio Adentro, has been created in Venezuela, and how new Venezuelan doctors are being educated to assume responsibility for this system in the future. This description is based on my own observations of day-to-day interactions of doctors, medical students, health committees, and the members of the communities they serve. Finally, the last four chapters illustrate how capitalist cultures and imperialist forces are resisting the development of revolutionary medicine and revolutionary consciousness, while the emerging socialist cultures are pressing forward with new ideas and creating the patterns of practice and commitment in daily life that are producing the revolutionaries of the future.
Source: International Journal of Socialist Renewal

Wednesday, July 20, 2011

Health workers march against privatization; call for meaningful health budget

Various health groups today challenged the Aquino government to be true to its word of making health care accessible to the poor. In a dialogue with leaders of the Deparment of Health, Health Alliance for Democracy (HEAD) and the Alliance of Health Workers (AHW) led government hospital employees, doctors, nurses and other health professionals in seeking an end to privatization of health care delivery system. The group also demanded a P90B budget for health.

According to Jossel Ebesate, AHW National President, “As President Simeon Aquino prepares for his State of the Nation Address, he should remember and fulfill the promises he made as he assumed office a year ago. Foremost amongst these is to give utmost priority to the health of the people.”

The group noted that after one year, healthcare in the country has gone from bad to worse.

For instance, several state-run hospitals like the Philippine General Hospital and Philippine Orthopedic Center (POC) are already charging patients various additional fees that were not done during the previous administration. In PGH, even Class D patients who used to receive full support (full charity) are now being charged various rates ranging from ₱20 to ₱340 for diagnostic and laboratory examinations, all of which were previously free. Similarly, at the POC, the new rates are more than double the previous rates.

The promise of universal health care has been reduced to expanded coverage of the Philippine Health Insurance Corporation (PhilHealth), which remains a stop-gap measure. Doctors and nurses, still badly needed in the country, are not being employed properly with adequate remuneration. The RN HEALS program for nurses does not even provide nurses with the salary mandated by law and offers no real job security.

Worse, according to HEAD, the promotion of public-private partnerships by the Aquino administration has left public hospitals in a state of disrepair and neglect to justify the entry of private investments. Unfortunately, the poor and indigents patients are left to shoulder the burden.

Dr. Geneve Rivera, HEAD Secretary General, “Rather than promote the commercialization and sale of public hospitals, Aquino should stop the privatization of healthcare and provide a meaningful budget that allows public hospitals to fulfill their mandate of serving the underserved.”

“Enough of dole-outs and stopgap measures,” added Dr. Rivera. “President Aquino should stop the politics of palliatives and come up with long-term solulions that will address the roots of age-old problems in health.”###

Dr. Geneve Rivera
Secretary General,
Health Alliance for Democracy
0918 927 6381

Jossel Ebesate,RN
National President
Alliance of Health Workers
0908 862 4524

Thursday, July 14, 2011

Malaysia: Free Jeyakumar Devaraj, activist doctor

Jeyakumar Devaraj, Sungai Siput MP, is currently detained without trial under the Emergency Ordinance, together with five other Socialist Party members, on suspicion of “causing civil unrest by any means”.

[Protest letters still are urgently needed to be sent to the Malaysian government, please visit for details of where they can be sent. See also "Malaysia: Protests demand release of democracy activists" and "Asia-Pacific socialists demand: 'Free all political prisoners! Democracy for the Malaysian people!'"]

By Khoo Boo Teik

July 14, 2011 -- Malaysiakini -- Dr Jeyakumar Devaraj, or Kumar as I call him, is a public figure of enormous stature. Very much respected for his achievements and contributions to medicine and public health in Malaysia, he was the recipient of the Malaysian Medical Association’s 1999 Award for Community Service. As a government physician, Kumar served many years in hospitals in Penang, Sarawak and Perak, and chose optional retirement when he ran in the 1999 general elections. In addition, Kumar is a tireless social advocate and activist.

Kumar and I were classmates from Form 1 to upper sixth form in the Penang Free School between 1967 and 1973. In subsequent years, while we attended universities in the United States (and, for Kumar, the Universiti Malaya as well), and after we began our own careers, we maintained frequent, though irregular, contact.

Some people may think of the dispossessed and marginalised communities as simply being "unfortunate" in that they have neither benefited from booms nor been protected from slumps. Others consider them to belong to the past – to sunset sectors and redundant labour ready to be dumped by globalisation’s sunrise industries, new technologies and emerging divisions of labour.

I believe Kumar’s reply would be: the history of marginalisation covers the past, present and future. If our economic system and structures of power are not significantly changed (for the better), then we already have a very good idea of how an entire developmental process will reproduce our treatment of the marginalised of the past and present as our treatment of the dispossessed of the future.

Precisely for the above reason, one has to understand and act. Kumar’s insistence on uncovering the roots of economic deprivation and his refusal to rationalise away the causes of social injustice supply the radical edge to his activism.

Above all, it is Kumar’s willingness to do something about the injustices he encounters, and to do so here and now, that is the hallmark of his blend of personal conviction, intellectual criticism and activist intervention.

Kumar has never treated people as "topics for research". He did choose, out of a sense of professional responsibility and social concern, to be posted to Sarawak after his housemanship at the Penang General Hospital in 1983: "All my three posting options were for Sarawak."

Kumar spent seven months in Kuching, and then requested a posting to Kapit, a "more rural, more remote" location. That was in 1984, and Kumar was stationed there for the next one and a half years.

Kapit was remote -- "the last boat for Sibu left at 2 pm and you couldn’t send any patient to a bigger hospital after that" – and "challenging for someone in his third year out of medical school". The doctor in Kapit had his or her hands full since, for instance, "one had to do surgical procedures even though one wasn’t a surgeon".

But one had considerable freedom, and there was the chance of working with the Flying Doctors Service that sent doctors by helicopter to clinics in the remote interior twice a week – a service that Kumar praised.

Kumar found his posting in Kapit and his experiences with the Flying Doctors "very challenging". Besides the medical work – "immunisations, examinations, treatments" – there were opportunities to observe at first hand even more remote areas, around Belaga, for example. Kumar saw "areas that had been logged" but noted that in areas that had not been logged, the "waters were still blue" and the "rivers full of fish".

Being a doctor in those remote parts -- "a very high position" – and especially being the humble, likeable and curious individual that Kumar is – opened doors, brought invitations and eased conversations. Kumar could talk with people from all walks of life – longhouse residents, headmen and logging camp managers.

He asked questions and made comparisons: Why were there "more cases of protein malnutrition in logged areas" in contrast to unlogged districts whose rivers were "still blue" and "full of fish"?

Kumar heard stories and made connections: How could it be that "six villages unsuccessfully applied for land for 20 years, while local politicians obtained logging concessions which they passed onto businessmen, in return for royalties and payoffs?" He was shown letters by headmen, and maps and data by camp managers, and drew his own conclusions.

Towards the end of his Kapit posting, Kumar was sometimes worried, "even paranoid". The stories he had heard and the things he had learnt were politically "sensitive" and potentially damaging to people with vested interests.

Nonetheless, he wrote about the effects of the Batang Ai dam construction on longhouse residents, logging accidents ending in terrible injuries or fatalities and suspected corruption in the awards of timber concessions to the politically influential and commercially powerful.

Kumar would be the last person to romanticise the things he did while he was in Sarawak. I have related Kumar’s Kapit experience at some length because it shaped his modus operandi, which was to detect the "social dimensions of health", when other similarly conscientious and caring doctors would have contended merely with medical problems.

The privatisation of health care

Reposted from Kapit to the District Hospital in Teluk Intan, Perak, Kumar treated a number of cases of beri beri (thiamine deficiency) among migrant workers of East Timorese origin and especially among those detained in immigration detention centres.

He sent letters to the health ministry, general hospitals in Ipoh and Kuala Lumpur, and to all government clinics and hospitals located close to said detention centres to alert them and to ask for feedback. Subsequently, "sad to say, a spate of beri-beri deaths in the Semenyih Camp was exposed by Tenaganita in 1995".

In a replication of his work in Kapit, Kumar established connections between the medical and the social problems of the Orang Asli [Indigenous people]. Working in a state which has one-third of the Orang Asli population, Kumar called on health-care professionals to understand that the "health problems of the Orang Asli are but the epiphenomenon of their progressive marginalisation", and to "urge a strict prohibition of all economic ventures that impinge adversely upon Orang Asli".

As a chest physician in Ipoh Hospital, Kumar wrote of the "increased transmission of tuberculosis in Malaysia and the weakening of the existing TB control program". This was an unfortunate development because the incidence of TB in Malaysia had fallen from more than 150 cases per 100,000 people in 1960 to 61 cases per 100,000 people in the late 1990s.

The re-emergence of the dangers of TB transmission was definitely linked to the "cramped and unhygienic living conditions … malnutrition and heavy physical labour" that contributed to the "reactivation of … latent TB" in poor migrant workers.

But Kumar also traced it to the deleterious outcome of "the government’s fascination with corporatisation and privatisation" which would sacrifice "one of the few success stories of TB control in the Third World" at "the altar of market economics".

From these kinds of positions, it was a small step to critiquing the dangers privatisation posed to the state of public health services. Together with his medical colleagues in public hospitals and NGOs, Kumar organised opposition to the "corporatisation of government hospitals", "the privatisation of the Government Medical Store", "the dismemberment of the Malaysian health services", each time making linkages among health services, economic policies and political priorities.

It was not the first time that a medical doctor, with primary responsibility for the treatment of the human body, came to be just as involved with the reform of the body politic. Of course, there have been doctors before, indeed other professionals too, who, while devoted to their areas of specialisation, have found it impossible to resolve their concerns without referring to "society as a whole".

They began as technical experts and ended up as social critics. But this tradition of integrating social criticism with professional work has sharply declined.

I cannot imagine that Kumar would regard his experiences to be unique. But I think of Kumar’s approach as being different from that of the "public intellectual" who first picks a cause, an issue or a concern – human rights, the environment, consumer protection – and then adds said cause to his or her intellectual pursuits.

For Kumar, professional work, intellectual criticism and activist mobilisation were inseparable, wherever he found himself. As so often happened, such a critical and activist approach led directly to "politics", as most people would understand the term.

An outsider who wants to be a credible organiser among marginalised communities must have several virtues, among which are an ability to render needed services and a readiness to stand by people in times of trouble.

Estate communities in Sungai Siput

The story of Alaigal is a case in point. Alaigal was founded by several social activists, including Kumar and his wife, Maharani Rasiah, an activist in her own right, after they had worked with five estate [plantation] communities in Sungai Siput for several years. Alaigal is a community organisation that grew out of years of selfless, voluntary services that won the confidence of workers and their families.

Initially, the main form of service was educational in intent and approach – the activists held extra-curricular tuition classes to improve the academic performance of estate children. There was then a strong sense that educational achievement, family supported but individually attained, was the answer to the poverty prevalent in the mostly Indian estate communities.

But the workers, their families and communities also made wider connections – between, say, their children’s low educational attainments and their income levels and housing conditions. They began to understand that, if their children failed to make the cut, the failure was not theirs and theirs alone, which was what certain organisations argued.

In short, the communities discovered "structural" problems – their "unfavourable" position in the economy and society – and this realisation helped to alleviate the "blame-the-victim" syndrome under which they had laboured for generations.

Around 1993, a network of like-minded NGOs, including Alaigal, began an estate-based campaign to upgrade estate living conditions. The main demand of the campaign was that the government should categorise estate quarters as "rural" so as to bring them under the responsibility of the rural development ministry.

In this way, facilities and utilities provided to traditional kampungs could also be enjoyed by the estate population. The campaign actively sought to make these issues known to Malaysian society at large and to obtain public backing via petitions, postcards and other forms of publicity.

At the end of 1994, a second campaign was launched to ask [the ruling party] Barisan Nasional as well as opposition party candidates in the 1995 general election to include the demands of the estate communities in their election pledges.

These campaigns brought estate problems to national attention. But, apart from causing a shift of official responsibility for estates of less than 1000 acres from the labour ministry to the rural development ministry, the campaign brought no tangible benefits to the estate communities. In 1996, another campaign was initiated to demand monthly and minimum wages for estate workers across the country.

Accusations of "outside agitation" always missed the point. It was never a question of anyone brainwashing entire communities. The estate communities did not lack self-reliance or independent thinking. They organised themselves and mobilised to overcome shared obstacles. They networked with groups having similar concerns. The wage campaign networks stretched from Kedah to Negeri Sembilan and, at a critical point, sent 1000 workers to gather before parliament.

Other voluntary organisations had previously helped estate communities to articulate their grievances and problems. But powerful commercial and political interests were alarmed when the communities moved beyond a narrow focus, say, on education. And then the vulnerability of marginalised communities became evident: again and again, their activities were paralysed by overt and covert police action.

The "coalition of the marginalised", as Kumar called it, expanded: estate workers, urban pioneers, Orang Asli, displaced vegetable farmers, retrenched factory workers, van drivers facing harassment from the authorities, stall owners threatened with eviction, and others.

The point was that "our team had a lot of credibility" for being "sturdy and reliable" and "people trusted us; they knew we would not leave them when the going got tough". Soon "people stood by us" because "we had stood by them", and a very helpful network of the various groups was established.

A comradeship of humanity

One might call this approach a non-standard way of entering politics. Kumar did not become a politician by joining a party, accepting its program and obeying its leaders’ instructions.

From Kapit to Sungai Siput, Kumar was compelled to address real situations and genuine difficulties experienced by different communities of people. For a long time – and even now – his politics consisted of learning from these people, offering them a voice, solidarity and setting an example.

In the context of the 1990s, that seemed to be the most sensible way of struggling for social justice. But notwithstanding the apparent triumph of global capitalism, Kumar and his friends decided that questions of ideology could not be simply set aside. They, and Dr Mohd Nasir Hashim and friends, believed that socialism should remain the alternative to capitalism.

At the same time, the "grassroots" pushed for a party, "our party" – "instead of always supporting the opposition parties". That was how Parti Sosialis Malaysia (PSM, Socialist Party of Malaysia) came to be formed. For 10 years, the government refused to register it as a lawful political party. Characteristically, the PSM took the government to court.

Kumar is realistic: the PSM has "no ghost of a chance of forming a government". But the unlikelihood of a grand triumph should never stop anyone from posing alternatives to injustice.

In this case, Kumar and his friends pose socialism as a moral alternative to BN’s unfettered capitalism that has undermined what had been "an equitable health-care system", and other improvements to social services and social security that had provided significant benefits for common working people.

To me, that is a responsible assessment of current political realities in Malaysia. More than that, such an assessment affirms the core of Kumar’s politics. I am not suggesting that Kumar embarked on his activism with no more than goodwill. When he started, he already possessed more than an intelligent grasp of political economy and socialist theory.

However, his socialism was never based on doctrines, abstractions and propaganda. Today, Kumar "speaks truth to power" with the kind of courage and sincerity that Malaysian politics has rarely seen with the passing of Dr Tan Chee Khoon, himself a labourite and Christian.

At heart, Kumar’s socialism derives inspiration and sustenance from the moral principles, values and examples of "liberal Christianity" that were, to put it simply, "found at home".

These were the moral principles and ethical values of the Devaraj family – Dr T. Devaraj and his wife, Elizabeth, and their children, Kumar, Sheila, Rajen and Prema, and their spouses.

Those who know the Devaraj family are aware of how its principles and values have been expressed in a long list of social commitments: the National Cancer Society, Hospice, Children’s Protection Society, Aliran, Women’s Crisis Centre.

With his family, Kumar shares a humble yet compelling combination of moral conviction, professional dedication and social duty. The combination expresses itself now in social work, now in activism, and, when the times call for it, in politics, too.

In it, you and I will not find sectarian tendencies, or dogmatic dependence on ideological lines, or textbook fetishes. Nor will we find arrogant and easy assumptions about what to do with the lives of people with whom one finds a comradeship of humanity.

Instead, we will discover a deep and intuitive awareness that marginalised communities live in our midst, dispossessed by progress, expropriated by capital and neglected by the state.

Is that enough of a summons to a struggle for justice? For Kumar, it is. And if he calls such a struggle for justice "socialism", who are we to differ?

[Khoo Boo Teik is the author of Paradoxes of Mahathirism: An Intellectual Biography of Mahathir Mohamad and Beyond Mahathir:Malaysian Politics and its Discontents. The above is an abstract from an introduction by Khoo in Jeyakumar Devaraj's Speaking Truth to Power:A Socialist Critique of Development in Malaysia.]