My Visit to Kampung Tamparuli: A Preview of Malaysia and the Philippines Healthcare Delivery System

I quit being a nurse. The four-year course had me realized the kind of person worthy enough of dealing the sick and the dying. That individual must have a strong sense of self whose empathy can transcend to the frail and the needy. I was weak-hearted. I thought I was.
I was once a school nurse then volunteered in a district hospital for months. But later on, I quit. That was the end of my nursing career. It ended before I had the full-grasp of the profession. But why did it end that way?
I became too attached to my patient. The compassion I felt was more than enough to be part of their significant others. I fell into the trap of being a nurse and being a patient. Or should I blame the healthcare delivery system in the Philippines?
"Together with the Malaysian Nurse and the Philippine Regional Nurse Director" 
Off to Tamparuli, Malaysia
It was one humid day when I had the taste of the first Malaysian air. At that time, I had nothing in mind but to stroll around Kota Kinabalu City Centre as recommended by the hotel's manager.
However, my roommate who happened to be a Nurse Regional Director in the Philippines would be meeting a Malaysian Healthcare Provider in Tamparuli, a District in Tuaran. It grabbed my attention so I asked them if I could come and join them.
"It was a long ride but surely scenic."
I was privileged enough to be with them in a certain Rural Health Care Unit in Tamparuli. Indeed, as a nurse by profession, I could not avoid but to compare the Philippine Delivery System that of Malaysia's.
"Together with Tamparuli Nurses and Dr. George"
It was on 2006 where I was first exposed from my Community Health Service as a practicing Rural Health Nurse. I was assigned in the mountainous area kilometers away from the the City Hospital where I had a 10-day community duty that gave me an opportunity to mingle with the locals and sort out their primary health concerns and problems.
"There waiting area"

An Introspection of the Philippine Healthcare Delivery System
Having visited a certain Rural Health Unit in a different country made me realized the wide range of differences in my country and that of theirs. From their facilities up to their services and staff. Here is a preview about Malaysia and Philippines Healthcare Delivery System:
According to the Asian Development Bank Statistics of 1999, the ratio of patient per physician in the Philippines is 9,689 which is lower than Malaysia's 1,465 patients per physician. As per hospital bed, Philippines is higher than Malaysia's. At the year 1998, there are 909 persons per hospital bed in the Philippines while there are 500 persons per hospital bed in the latter country.
"Their interns"
The sole reason why there are less Filipino doctors, nurses and other medical personnel in my country is they opted to go to the United States, Europe and the Middle East where their compensation is ten times higher. This leads to increased cost of the medications that will eventually result into patients' seeking medical attention to look for alternative cure such as faith healers, witch doctors, self-declared physicians, where they could pay less, and even rely to self-treatment with herbal medicines.
"Laboratory and their Med-Techs"
While both countries have relatively young population, each differs with it's causes of mortality and morbidity. As of the year 2000, the top 5 leading cause of death in Malaysia are IHD (Ischemic Heart Disease), Mental Illness, CVD (Cardiovascular Disease), Asthma and Chronic Obstructive Pulmonary Disease (COPD) and Diabetes Mellitus (DM) whereas in the Philippines, the leading cause of death as of 2002 in all ages are Lower Respiratory Infection, IHD, Tuberculosis, Hypertensive Heart Disease, and Perinatal Conditions. These account to the differences of topology, lifestyle, health factors, culture, tradition and beliefs and even environmental sanitation.

Rural Health Units - A Special Concern
Primary care starts in the community. It has a wider scope that provides preventive care and health education and palliative care for the patients in all ages and in all socioeconomic statuses in a certain geographic origins or location that require initial consultation and new health problems. They will be referred, if necessary, to either secondary or tertiary care in collaboration among healthcare providers.
However, the ideal description does not fit from the reality. It saddened me that most Philippine Primary Health Care Centers are poorly maintained and supported. The underdeveloped and lacking facilities, understaffed healthcare providers such as doctors, nurses and midwives and medicines that aren't subsidized by the government are the explicit reality how healthcare delivery system is not strongly given attention to the Philippine government. 
"Dr. George explaining about child delivery - they practice bath tub delivery here"
Manpower is the greatest resource in a country; without it infrastructures, transactions and environment resources are immobile. Workforce and healthcare are both proportional with each other. Healthy people promote a healthy community thus providing a healthy country.
As implied by the Nursing Theorist in her Transcultural Theory of Nursing Care, Madeleine Leininger:
"While it is important to look at a patient as a whole person from a physiological, psychological, spiritual, and social perspective, it is also important to take a patient's culture and cultural background into consideration when deciding how to care for that patient. After all, the values and beliefs passed down to that patient from generation to generation can have as much of an effect on that patient's health and reaction to treatment as the patient's environment and social life."
My visit in Kampung Tamparuli, Sabah Malaysia, left me an impression how two countries perceived the importance of the Healthcare Delivery System. 
"Nurse interns at the station"
That visit in a Rural Health Unit in Tamparuli, marked a clear manifestation of a healthcare delivery system that is beyond at par from my place. 
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About Marie Angelique Villamor

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