Saturday, May 6, 2006

Fight or flight? A medical student weighs between staying in PH or going abroad

by Gideon Lasco

Fight-or-flight response: n. a physiological reaction that occurs in response to a perceived harmful event, attack, or threat to survival.

Sometimes, I feel that we medical students are the most abused breed in the country. Before, our all-white uniforms carried an aura of dignity and prestige. When people find out I'm a medical student, they will express admiration and wish that I'd give them a free consultation as soon as I pass the board exams.

"That's still too far from now, I would always say," adding, jokingly: "If I give free consults all the time, how will I raise a family?!"

Of course those exchanges are light-hearted, but nowadays there are tougher questions we always have to prepare for. Not just the quotidian "What are you planning to specialize in?", but questions that speak of the times we live in.

First: "Are you planning to take up Nursing?"
Second: "You're just end up working abroad, won't you?"

Oftentimes I am tempted to give a vehement "No of course not!" to the first - and an annoyed look at the second, but I try to be polite. Yet should I say no, they would sometimes follow up, "You're just saying that because you're young and idealistic. Let''s see what will happen in the future." Many people expect us to be heroes, but sadly, they judge our profession even there are many things they do not understand.

Coming from a middle class family, my parents work hard so that I can study medicine. The expenses include tuition fees, dorm rentals, books, medical tools like stethoscopes, and of course, my allowance; what makes it heavy for many breadwinners is the fact that it has to be sustained for several years. Indeed, I would likely be still toiling in the hospital long after my high school classmates have graduated and landed on good jobs.

Daily we study, nightly we review. For a single exam, we have to read hundreds of pages, memorize hundreds of terms, and pay hundreds to photocopy lecture transcripts and handouts. It takes a week to do all of those, and there's an exam almost every week. It's been a month since I was last able to go home to my family in Laguna, because I don't want to fail a subject.

We have to bear the foul stench of cadavers and dissect them, inside-out, in the name of learning. Daily, we medical students take the risk of having all sorts of diseases in PGH ranging from tuberculosis to the common cold; from Hepatitis B to flu.

All these for five years. And to specialize, at least three more. Only then can you begin your practice. It will still take some time before patients will fall in line in your clinic.

Yet, I want to become a doctor. I want to learn about the human body and mind, and enter a profession that is both challenging and fulfilling. Being in medical school, I am well on my way in achieving my goal, but the question is: where do I practice medicine?

If being a medical student in the Philippines is hard, being a doctor is even harder. There will always be sick people in need of care, but many of them cannot afford to pay the cost of medicines and medical services. Doctors also have to make a living, and they cannot always render their services pro bono. Patients can go to public hospitals, but with government budget on health being sliced yearly, government doctors feel that their meager salary - after all those years in training - not worth it.

As for choosing private practice, that too comes with its own challenges: If you want to have a clinic or practice in private hospitals, you have to buy bonds or stocks that sometimes amount to millions.

Who then can blame doctors for leaving the country? Or for taking up Nursing?

Flight from the country is a viable option to those who have experienced the difficulties of Medicine. After years of labor, they expect to be rewarded. And in pursuing an opportunity abroad, one can ensure the future of their family.

On the other hand, fighting for the country is also a choice. The fight I speak of is the battle against diseases that plague the nation; both medical and social ills. Having visited communities all over the country, from the Cordilleras to Southern Mindanao, I realize that just one doctor can make a lot of difference. The satisfaction of seeing lives saved, and people uplifted, can make the financial sacrifice worth it.

A less dramatic example of fighting for the country is staying in hospitals that need physicians badly. These hospitals are scattered all over the Philippines, and if doctors choose to stay in their provinces where they were born, it will mean a lot to their people. Finally, highly-specialized doctors who train abroad would also do well by bringing their skills to the country.

It largely depends on the individual. Any profession is a struggle, and one must choose a path in which he will be satisfied. We cannot demand every doctor to make sacrifices, but we have to appreciate those who do. It is unfortunate that the few doctors who remain in the barrios receive death threats, and are sometimes even killed, by powers-that-be who do not wish our people to progress.

Personally, I remain undecided. As I hurdle challenge after challenge in med school, I learn a lot of things: the vastness of human knowledge; the importance of empathy; and the fragility of human life. In time, maybe the path ahead will be made clear.

Fight or flight? With four more years before I graduate, I will wait before making my decision. Surely, it won't be an easy one.

Gideon Lasco
LU IV (2nd year Medicine)
June 13, 2006

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