The Philippines

Rey Vivo, MD Assistant Professor of Medicine Texas Tech University Health Sciences Center



The Islands

7,107 islands making up an archipelago  Climate: Tropical  Area: 115,831 sq mi  #72 in the world  Population: 91 million  #12 in the world  Capital: Manila  Currency: Peso  (PhP47 = US$1)

6 11 9 18

The History

 Negritos – Malay aboriginals  13 th century – Islam  1521 – Ferdinand Magellan “discovers” the islands  Manila is established as capital of the new Spanish colony  Christianity  1880s – Propaganda Movement, Katipunan  1898 – US defeats Spain; “First Philippine Republic”  1935 – Philippine Commonwealth; then WWII  1946 – Independence from US  The Marcos dictatorship, People Power revolution(s)

“300 years in the convent and 100 years in Hollywood”

The People

 Manila is 11 th most populous metro in the world 11 million (11%) overseas; largest diaspora  Literacy rate: 93%  Language: Filipino and English; >180 dialects  Labor force: 34.2 million

The Culture

 Spanish: names, language, religion/customs, food, architecture  “…a Latin American country transported to the Orient…”  American: fast food, music, movies, pop culture  “Brown Americans”

The Culture

 Harmonious social interaction  Debt of gratitude  Colonial mentality  Hospitality

Healthcare Issues

Health and healthcare

 Top causes of mortality: cardiovascular, cancer, accidents, pneumonia, tuberculosis  1940s-1980s: infectious diseases led all causes  PhilHealth – national health insurance program  Out-of-pocket share emphasizes inequality  75% pharmaceuticals imported

 2001 – 2004: >5,000 physicians left  30 medical schools  2000 – 2003: 51,850 nurses migrated  350 medical schools  Approx. 1,000 hospitals have closed in the last 5 years

Physicians

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Top countries of medical education for IMG physicians Country

India Philippines Mexico Pakistan Dominican Republic

Total

47,581 20,861 13,929 11,330 7,892

Percentage

19.9% 8.7% 5.8% 4.8% 3.3% American Medical Assn., 2007

Why leave?

 Harsh realities: Compensation/month for resident MDs Philippines South Africa USA $300 $1,000 $4,000

Why leave?

 Other limitations      Poor working/training conditions, quality of life   Gov’t budget for health MD to person ratio: US……… 1:150 Cuba…. 1:225 Phil…... 1:>10,000 Poor job prospects, difficulties in establishing practice Specialties Research Local political/economic forecast

Challenges

 USMLE  Cost  Visas/Immigration laws  Post-training employment opportunities  Healthcare differences  Disrupted families/relationships

Diaspora

 2001 – 2004: >5,000 physicians left  2000 – 2003: 51,850 nurses migrated  Nursing schools are mushrooming everywhere  40 – 50% of nursing students are “second-coursers”  At present 6,000 doctors are enrolled in nursing schools, all wanting to leave for “greener pastures” abroad  >50,000 caregivers have trained; about half have left for jobs overseas

Nurses

84%

Percent of Hospitals Hiring Foreign-educated Nurses by Country from which They Recruited, 2006

33% 29% Philippines Canada

American Hospital Assn., 2007

India 9% Africa 7% China 6% Korea

Nurses’ compensation

USA Canada Philippines $200 $200 $200 Daily Daily

Monthly



From

MD

to

RN 2000 – 2004: 5,000 MDs left to work abroad as RNs  2004 – 2005: >2,400 MDs took the nursing boards  Currently, >4,000 MDs enrolled in nursing schools  Generalists and specialists; aged 25-60 years  “Retrogression” Alliance of Health Workers

Pros and Cons

 Remittances from overseas workers  Expedited but suboptimal training  Reduced unemployment  Technology transfer  Healthcare cultural diversity  Demoralization of MDs  “Brain drain”

Brain drain

 Filipino-born nurses and Indian-born doctors each represent about 15 percent of all nurses and doctors in the Organization for Economic Cooperation and Development (OECD).

 “The migration of doctors and nurses from the developing to the developed world has only a limited impact on the crisis in health care in poor countries.” AFP

Gov’t solutions

 Manage migration  Mandatory government service  Career advancement programs  Knowledge exchange

JAMA. 2008;299:1753-4.

http://www.youtube.com/watch?v=YdBANriBrlw

Thank you