Thursday, December 25, 2014

Doctors and 'hilots': Healing in the Philippines through the ages

by Gideon Lasco, MD

Doctors have largely replaced the manghihilot (traditional healer) as the face of health in the Philippines. Although traditional medicine is still widely-practiced in the country, particularly in the rural areas, doctors are the standard of care.

But health must be seen as a continuum, a function in terms of a country's cultural history. If you compare and contrast between Western medicine and traditional healers today, Western medicine has the upper hand. But in the historical context, they must be seen as successors of these healers, and as fillers of their shoes they must know that these hilots, however much they may be belittled today, have set the standards of healing in the country. Anything that falls short of this standard might lead to disappointment in the part of the public to whom doctors cater.

Thus doctors must know how medicine was practiced before they came along. A lot of doctors complain that patients do not follow their instructions. How well a patient follows doctors' orders is termed as compliance. Compliance is very important because the patient ('client' is now emerging as a preferred term) is a partner in health care. And if he or she fails in some way, the treatment might not be successful. For instance, many antibiotics have to be taken for 7 days and no less, or else drug resistance might set in. Compliance, aside from lack of education and poverty, is dependent on rapport. And rapport is in turn dependent on how well the doctor satisfies the patients' expectations.

The most important legacy of the hilot is the 'healing touch'. For centuries, healing involved the act of touching the part of the body that is affected. Hilot is a Tagalog verb that loosely translates to massage, and it is so central to the act of healing that it became the root word used to define a healer (hilot or manghihilot). What defines him is his touch. If we delve deeper, we could probably make the connection with other Asian traditions such as the Chinese “qi” and the Ayurvedic “prana”. What they have in common with Filipino folk medicine is the concept of a life force that flows within the body in channels not defined by Western anatomy. The act of “hilot” is essentially realigning the flow of the life force. Yet more than this, the act of hilot establishes the physical and emotional connection between the patient and the healer. That in itself is therapeutic. If achieved, this connection is what makes patients say, “Makita ko lang si doc, parang gumagaling na ako!” (Just to see my doctor would suffice to make me well!)

That is why in the public hospital, when patients complain about the doctors they've consulted, their most common complaint is not the lack of knowledge of a doctor. It it is the doctor's lack of concern. Specifically, one of the most common compliants is “Hindi man lamang ako hinawakan.” (The doctor did not even touch me!). His body may ache for antibiotics to help it fight the pathogenic bacteria, but his mind is aching for comfort and ease, a need that the healers of the past understood. They made use of the power of touch. Faced with the unfamiliarity of the illness experience, at least the patient had the familiar and comforting presence of the old community healer that has been there in the community since he was born.

How does a doctor fill the shoes of a traditional healer then? Will he rely on the proven ability of his laboratories to diagnose and medicines to cure disease? Yes, but that is not enough. To be a healer in the Filipino sense of the word, to be a manggagamot and not just a doktor, he must meet the expectations of the patients. When he enters the clinic, the doctor with his white coat, fine clothes, and stethoscope is like the traditional healer with his beaded necklace and wizened garb.

The stethoscope, then, is part of the rite. It is a magic wand. Doctors, hold it close to your patient's heart. Touch his body with hands that not only examine, but empathize. Listen well to his story. You are an inheritor to healing process that has been started through the ages. Let your patient be awed by the ritual of healing that you unfold before him, and for him. You will then gain his trust and he will go home vowing to do what you have ordered. You have not let him down, he will not let you down. 

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