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Poor patients find hope and healing in ‘Orthopedic’


Randy Tomol worked odd jobs around Manila to support his wife, Irish. When Irish gave birth to their firstborn twin sons, the couple decided it was time to leave the big city.
 
They returned to their hometown, in Abuyog, Leyte. Tomol would leave his family whenever he found work in construction sites. The 40-year-old father would come home every so often to help harvest corn and coconut and reunite with his family.
 
But during one of his trips home in August 2013, Tomol began experiencing symptoms that would later render his legs useless.
 
"Kino-complain niya lagi noong pag-uwi niya, namamanhid daw iyong mga paa niya, mga daliri niya sa paa. Tapos parang ano daw, umaakyat. Hanggang sa nalumpo siya nung February 10, 2014. Talagang binubuhat na lang siya," Irish recounted as she waited for her husband's surgery to finish on the afternoon of days ago.
 
Typhoon Yolanda uprooted their family's coconut trees and crops, leaving them with nothing but an upright home.
 
But with Randy's legs failing and their land still fertile, the Tomols decided to pawn off part of their land to pay for a check-up at Divine Word Hospital in Tacloban City a month after the disaster.
 
A neurosurgeon advised Randy to get a CT scan.
 
The CT scan bore the bad news. "Doon namin nalaman na may bone tumor," Irish recalled. The tumor was lodged in Randy's spine.
 
After months of raising funds, they faced the difficult decision of leaving their twins to Randy's mother and step-father in Leyte. Irish brought her husband to the Philippine Orthopedic Center (POC) in June 2014.

The POC, established in 1945, is known to many Filipinos simply as "Orthopedic." 
 
The couple needed P160,000 for the operation to remove the tumor. The money will cover the use of the hospital's equipment and supplies, and the implant that Randy will need. The Philippine Charity Sweepstakes Office (PSCO) helped in paying some of Randy's medical bills.
 
"Gumagawa din ako ng mga beads, mga wallet, tapos keychain, bracelet. Ibinebenta namin dito. Siya rin, tumutulong sa pagbebenta, paglalako," Irish said.
 
By saving money, the former daycare teacher was able to raise P30,000 for the procedure. They again sought help from PCSO, and they were given P100,000.
 
They were still P30,000 short. Last month, an article about the POC's planned privatization featured Randy, albeit with a different last name. It prompted a good samaritan from abroad to donate the needed P30,000. 


A Philippine Orthopedic Center Operating Room
 
Randy's surgery began at 7 a.m. on June 18. It took nine hours for his physician Dr. Victor Illescas, and surgeon Dr. Ryan Itchon, to remove the benign tumor on his spine. But for Randy, the wait took a year.
 
Illescas said Randy's case was rare for the Spinal Surgical Unit, which normally treats more extreme cases.
 
"Usually fractures or tumors sa spine, metastatic. Ibig sabihin mga cancer sa spine. Konti lang actually iyong mga kaso na primary spinal na tumor. Siguro in mga span ng three months, siguro mga dalawa, pero hindi siya ganoon kasing dami," Illescas said.
 
All of Randy's medication, he added, was available at the hospital's pharmacy and was usually given to the patient for free.
 
“Binibili po kasi namin iyan (gamot), P53, tatlong beses sa isang araw. Iyong ginawa po namin, humingi po kami sa congressman (ng Leyte), pati po ng walker,” he said.
 
The donations made by the PSCO, Tomol's anonymous overseas donor, and their own savings covered the P160,000 bill, the cheapest they could get in the country.
 
The POC's status as a public hospital means that most of its patients cannot pay for their treatment.
 
Data from the POC shows that 3,659 cases or 53.49 percent of its cases were purely charitable cases. Only 167 cases or 2.44 percent of their patients paid for their treatment.
 
"Karamihan talaga, medyo may financial constraints," Illescas affirmed.
 
The free healthcare is assured by an intricate system of paperwork designed to help indigents get help as quickly as they could.
 
"A lot of patients are well-instructed by the doctors, kung papano iyong papeles, binibigyan namin ng papers. As soon as they leave the OPD, they have all the requirements needed for the PCSO processing so by the time they get the PCSO, na-schedule naman yung surgeries nila," Illescas explained.
 
He added, "Kung meron pang kulang iyong PCSO, it's either makapag-ipon sila ng konting pagdagdag or nagi-improvise kami. Halimbawa, instead na mamahaling gamit, gagamit kami ng simple techniques to lessen the burden of expense for the patients."

And despite their years of experience and expertise that would command steep professional fee in private practice, doctors at the POC get a fixed salary. This pulls down the cost of medical care for POC patients.

"The compensation is actually pretty decent kung wala ka namang family at kung hindi ka inggitero," said surgeon Itchon. 
 
World Citi Inc., together with Megawide Construction Corporation partnered with Philips Healthcare for the P5.6 billion modernization of the POC on August 22, 2014, after signing a contract with the Department of Health on March 6, 2014.
 
The announcement said the Modernization of the Philippine Orthopedic Center (MPOC) project will involve the construction of a 700-bed tertiary orthopedic hospital along East Avenue, Quezon City.
 
POC Medical Chief Dr. Jose Pujalte told GMA News Online that 30 percent or 210 of these beds will be dedicated to private or paying patients, while 70 percent or 490 beds will be allotted to government-sponsored patients or PhilHealth members.
 
In 2014, 2,690 patients or 39.32 percent of cases were sponsored by PhilHealth and 325 patients or 4.75 percent were co-paid by the patients.
 
Dr.  Julyn Aguilar, the head of POC’s children’s ward, says the initiative to put almost all of their patients under PhilHealth only made sense if the government ran the hospital itself.
 
“If they’re treated in a government hospital and the government pays for the treatment through PhilHealth, then the money that will be spent on that treatment will go back to government,” she contended.
 
She added, “Whereas if we go to privatized POC and the government says that the government will be able to pay for it, then the question is why do we have to pay a private sector in order to treat your patients?”
 
While unopposed to the benefits brought by the modernization of the POC, she said PPP in health will focus its operation on “earning from the rendering of service rather than the service itself”.
 
“I have nothing against partnering with private sectors, but what needs to be taken into consideration is the effect on the services that we render to the charity patients,” she surmised.
 
Pujalte said indigents may still get free healthcare through PhilHealth and have their enrollment to the program subsidized by the government.
 
“(Sa PhilHealth) ang patients, categorized. Meron noong no balance billing, those who should not be putting out any money. But to qualify for no balance billing, it must be demonstrated that you are incapable of paying,” he said.
 
He added, “Eventually, there shouldn’t be any charity patients because all patients can be enrolled in PhilHealth… We’re slowly starting to enrol them pero hindi lahat because it comes from the hospital's income. As much as possible, we’re enrolling the very poor.”
 
The doctor remarked that no one knew if the new management will treat patients without PhilHealth memberships, nor if World Citi will retain nurses and other employees  in the transition.
 
“Their future is uncertain. We don’t know what the plans of the private sector will be… You have to resign from government to be accepted in that PPP hospital,” Pujalte admitted.
 
GMA News Online tried to reach Health Secretary Dr. Janette Garin and DOH spokesperson Dr. Lyndon Lee Suy  to get their side on the issue, but they did not reply to requests for interviews. 
 
A week after the surgery, the Tomols are waiting patiently until Randy is able to undergo therapy. His doctors made arrangements with the St. Paul’s Divine Word Hospital in Tacloban City for his rehabilitation sessions there.
 
“Iyong rehab ko sa ngayon, pinapaupo po nila ako para po sa recovery ko. Baka bukas, transfer wheelchair to wheelchair na po ang gagawin nila,” Tomol said.
 

Irish and Randy Tomol are now preparing to return to Tacloban City 

In five weeks, Irish will return to the field to earn money for their family while Randy works to gain back the use of his legs. 
 
"Uuwi siya. Doon muna siya magre-recover sa Leyte. Siguro kung palarin na gumaling, makapagtrabaho uli sana. Dito sa (Manila) ulit kasi wala naman kasing masyado sa Leyte," Irish said. - JJ, GMA News
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