Case Analysis - Ang Kwento Ni Rosario

CASE ANALYSIS: Ang Kwento ni Rosario PART I Health does not exist in a vac! and will alwa"s #e a$ected #" an endless n!#er o% %actors ranging %ro! one&s reglar diet and own genetic !a'e ( on a !icro scale) to where one is ta'ing residence and what (olicies the local athorities i!(le!ent in one&s co!!nit" on a !acro scale* Health is !lti+ %actorial and this is evident with the case o% , "ear) -+!onth+old Rosario* Rosario&s %a!il" is destitte . the" cannot a$ord three %ll !eals a da" . instead) the" have a reglar diet o% co$ee) rice) and a !eager P/0 viand) that the" (ortion %or 1 %a!il" !e!#ers to last three !eals* The" live o$ on the P,1/ salar" o% 2ai!e) Rosario&s %ather) who is a la#orer in 3e4on Cit"* 5ith no other !entioned sorces o% inco!e) their %a!il" severel" lac's 6nancial secrit" not onl" to a$ord %ood #t also a decent shelter) clean and (ota#le water) (ro(er sanitation) and other services and goods sch as !edicine and !il' %or!las* Rosario&s !other) Lc") was ill advised to hold o$ %ro! #reast%eeding all o% her %or children) and instead she resorted to %eeding the! with dilted condensada and (owdered !il'* In addition) the (arents) with relativel" relativel" low edcational attain!ent) hold #elie%s) !isconce(tions and (ractices that do not (ro!ote health . li'e how #ottle %eeding (ara(hernalia are washed onl" #" soa( and water) that vaccines case sic'ness) cala!ansi is #ad %or the health) or that (arasitic wor!s are nor!al nor!al and that these aid in digestion* These considerations in Rosario&s i!!ediate i!!ediate context have led to nd her and her si#lings #eing 7  degree !alnorished children) reglarl" contracting cogh) %ever) diarrhea and having n!anaged in%estation #" (arasitic wor!s* 8n%ortnatel") Rosario) Rosario) given her age) her lac' o% vaccines) (oor diet and other %actors leading to her increased vlnera#ilit") is also the sic'liest* A!ong her si#lings) she is the thinnest) (ale and reglarl" diarrheic* It was actall" 9st a !atter o% ti!e %or her to contract an illness) as she eventall" did go down with !easles) and de to a variet" o% %actors was na#le to recover and lti!atel" died* Considering another level in Rosario&s context) the condition o% their %a!il"&s co!!nit" and (lace o% residence) arrio arrio Tan"ong) Tan"ong) %rther elcidates the case o% Rosario* Rosario* It is descri#ed to #e located #eside a highl" (ollted and conta!inated #od" o% water) with (oorl" (o orl" #ilt in%rastrctre leading to accidents that increase the ris' o% ex(osre to canal waters* Even !ore distr#ing) the co!!nit"&s !ain water sorce ;<0=> consists o% two (#lic (!(s or dee( wells that have a high (ossi#ilit" o% #eing conta!inated) given the co!!nit"&s close (roxi!it" (roxi!it" to the canal* Another direct and !a9or contri#tor to the n%ortnate otco!e in the case is the healthcare s"ste!) in the %or!s o% the (h"sician with who! Lc" conslted #e%ore) the #aranga" health center and a (rivate hos(ital* It was nclear whether the doctor that Lc" conslted with #e%ore (racticed in either o% the latter health care %acilities) #t what was evident was he?she did not thin' what was #est %or the (atient) instead ex(loiting Lc"&s (oor gras( o% health+related health+related concerns* @es(ite Lc" %eeling ite well and norished enogh to #reast%eed) she was still diagnosed to have a heart condition and was told this was a contraindication) even

when there are actall" ver" %ew instances when this is the case* The (h"sician&s !otive o% (ersonal (ro6t is %rther evidenced when he?she rged Lc" to #" in%ant %or!la %ro! a s!all dis(ensar" he?she owns* Bor the #aranga" health center) it was ndersta$ed o% !idwives and health wor'ers) and nder stoc'ed with vaccines and other !edicine* In ter!s o% health 6nancing) their #dget allot!ent %or !edicine %ro! the L8 %or the "ear was alread" cons!ed) and the" were having tro#le convincing the Sanggniang a"an that the additional #dget will #e sed %or its intended (r(ose) instead o% #eing (oc'eted #" the !a"or and !nici(al health oDcer* The" were a#le to (rovide %ree conslt) however the instrction regarding the (rescri(tion given goes directl" against the law) s((osedl" ensring Lc"&s right and choice to chea(er) #t still #ioeivalent drgs* Another estiona#le (ractice #" the health center was how the" re9ected Lc" and Rosario %or a second conslt) instead re%erring the! to a (rivate hos(ital withot clear reasons as to wh" the" cold not #e acco!!odated* Lastl") %or the (rivate hos(ital) while it is nderstanda#le that as a %or+(ro6t endeavor the" have a %ee %or service s"ste!) their de(osit s"ste!& is contentios) as the" have "et to (rovide health care %or the (atient* It is also n%ortnate that the" do not see! to have a charit" ward or a (rogra! %or indigents to at least s((ort so!e o% their ex(enses) as'ing the! to (a" also %or cons!a#les li'e cotton) alcohol) ga4e and ta(e* a* Identify which of the health problems presented in the case is core and priority for health program development? Explain your choice. @e6ning a core %or all o% the health (ro#le!s in the case is (ro#le!atic as these (ro#le!s have di$erent roots and contexts) and the" co!(ond on each other as certain socio+econo!ic %actors) sch as 6nancial secrit" and edcational #ac'grond) deter!ine the li'elihood o% these (ro#le!s arising as well as the ca(a#ilit"?vlnera#ilit" o% the individal when %orced to address these (ro#le!s* Fore se%l to the case wold #e to strengthen an instittion ca(a#le o% addressing #asic and co!!on health (ro#le!s) instilling health (ro!otion and edcation and delivering health services es(eciall" catering to the %elt and ex(ressed needs o% the co!!nit" as a whole . the #aranga" health center* The case o% Rosario is neither isolated nor rare) she is re(resentative o% the highl" vlnera#le nder / (o(lation) and what ha((ened to her cold have ha((ened to an" other child in their co!!nit"* I wold li'e to %ocs on strengthening the #aranga" health center as) i% !anaged well) it is ca(a#le o% addressing a lot o% the (ro#le!s (resented in the case* The health center is s((osed to #e ei((ed enogh to ca(a#l" handle co!!on and #asic illnesses ;res(irator" in%ections and !easles #eing so!e o% the!>) and annall" holds (rogra!s s((orted #" the local and national govern!ent to address "ear+rond concerns li'e !alntrition and (arasitic in%ections* S((osing these (ro#le!s were co!!on in the co!!nit") the" cold hold %eeding and dewor!ing (rogra!s in (artnershi( with NGs or throgh %nding %ro! the local govern!ent* The HC is also a vene %or health edcation and (ro!otion) a (lace where (eo(le can get in%or!ation) clari%" !isconce(tions

and ho(e%ll" eradicate #elie%s and (ractices that are not hel(%l and !a" even increase the ris' %or aciring sic'ness* The" were in a (osition to correct the in%or!ation given to Lc" a#ot #reast%eeding her children) ths saving the %a!il" so!e !one" instead o% #"ing (oor !il' s#stittes* Brther!ore) as it is the health %acilit" closest to the grond) the co!!nit" and its constitents) the HC is ex(ected to #e the !ost 'nowledgea#le o% the co!!nit"&s %elt and ex(ressed needs . the need %or (ro(er sewage s"ste!s) toilets and sanitation) clean and (ota#le water sorces) as well as the need to i!(rove in%rastrctre so as to !ini!i4e accidents* These co!!nit" (ro#le!s cold #e rela"ed to the (ro(er athorities and ho(e%ll" the #aranga" or !nici(al athorities cold do so!ething a#ot it*  The #aranga" health center is) o% corse) still li!ited in its sco(e and will alwa"s #e hindered #" 6nancial constraints* 5hile the FHG is #rdened with the tas' o% rall"ing %or a #igger #dget and s((ort %ro! the !a"or and concil) the HC !st (rove its worth to the co!!nit" #" (roviding as !ch as it can %or the good o% a greater n!#er o% (eo(le) given its li!ited resorces* Its (rogra!s shold #ene6t as !an" o% its constitents as (ossi#le) and shold wor' on (reventive rather than crative a((roaches i% the" are to #etter the well#eing o% the co!!nit" as a whole* The (ro#le! o% nder stoc'ing cold #e addressed #" a thorogh evalation o% what !edications are easil" or hardl" cons!ed) #" identi%"ing the !ost co!!on diseases #rdening the (o(lation) and sing these data) (ro9ecting what and how !an" !edications or vaccines the" shold (rocre %or the next "ear* The HC shold also co!(l" with the law and (ro!ote the (rescri(tion o% generic rather than #rand na!es so as to lower the 6nancial #rden o% the (atient* Bor nco!!on diseases that the HC !a" not #e a#le to handle) the" shold have a good re%erral s"ste! in (lace* The" !st (ro(erl" in%or! the (atient as to the need %or a re%erral and o$er (#lic) 6rstl") as well as (rivate health care o(tions* #* Problem Tree Analysis

c* Obective Tree Analysis

PART II  The Phili((ines is crrentl" ex(eriencing the do#le #rden o% disease) wherein the to( cases o% !or#idit" are co!!nica#le) in%ectios diseases while the to( cases o% !ortalit") %ro! #eing (reviosl" occ(ied #" co!!nica#le diseases) have changed to !ore o% the degenerative) li%est"le and non+ co!!nica#le diseases* In addition) there is also a threat %ro! e!ergent and resrgent diseases) ths (lacing a #igger toll on the health care s"ste! and the econo!"* The do#le #rden o% disease (oses a greater challenge %or health care (roviders) as sch trends indicate that while (eo(le are getting sic' %ro! in%ectios diseases) (eo(le are d"ing de to other cases+ leading the health s"ste! to as' which direction shold the" ta'e 5here shold the li!ited #dget allotted %or health go 8lti!atel") the decision whether to s(eciali4e in internal !edicine and !anage degenerative) li%est"le diseases or into in%ectios diseases and treat longstanding health (ro#le!s in the contr" also lie on these trends and decide the %ate o% new (h"sicians who ai! to (li%t the lives o% (atients) #t also to !a'e a living* As a second "ear !edical stdent) this stats and these n!#ers are still ite distant to !e) owing to the %act that I have "et to #e trl" i!!ersed in the

clinics to see (h"sical re(resentations o% these data in the %or! o% (atients who co!e in the ho(es o% treat!ent* At the ver" least) these n!#ers challenge !e to tr" and get a good gras( o% all the diseases inclded in the lists) as these) #" %ar) are the !ost co!!on and wold de6nitel" #e cases I !eet on a reglar #asis* It also reires o% !e to #e novel in that I shold #e a#le to address #oth !or#idit" and !ortalit" and contri#te to i!(rove those n!#ers #" ai!ing to lessen the #rden o% disease* Sch a %eat cold onl" #e achieved #" changing the (aradig! o% !edicine . %ro! #eing crative to (reventive* " shi%ting the %ocs %ro! illnesses to total well #eing and health" (ractices* As a %riend o% !ine said) Fedicine is ironic #ecase as a 9o#) it wor's to eradicate itsel%* To trl" have the (atients& #est interests in !ind wold !ean wor'ing to 'ee( the! %ro! incrring diseases and awa" %ro! the clinics* In the ideal health" world) there wold #e a decreased de!and %or doctors and other health care (roviders #ecase there wold #e no illness to treat ;exce(t (erha(s %or the sal rare chro!oso!al a#erration>* t as it is) the #rden o% disease re!ains great and a !eans o% a$ecting and i!(roving it wold #e throgh strengthening (reventive !edicine* Kee(ing health" individals health") and wor'ing on those who are sic' to recover and res!e a health" i% not nor!al li%e* E!(hasi4ing on !oderation and (ro(er ntrition) 'ee(ing a health" and active li%est"le clear o% vices) ris'+ta'ing and health+de(reciating #ehavior lowers the ris' %or contracting #oth co!!nica#le and non+co!!nica#le diseases) ths addressing the do#le #rden o% disease* It is onl" recentl" that health care s"ste!s in other contries are shi%ting their (aradig! o% crative to (reventive !edicine) and the Phili((ines has "et to catch (* t %or that to ha((en) not onl" shold athorities li'e @GH and L8s ste( in) #t also) on a grassroots level) !edical (ractitioners and the co!!nities the!selves shold change their idea o% what the role o% !edicine shold #e* Gn a (ersonal level) I alread" a! an advocate o% (reventive !edicine . thogh I !a" have inconsistencies (racticing it on !"sel% as I have "et to internali4e that health is not 9st the a#sence o% in6r!it" or disease #t a total (h"sical) social) !ental and e!otional well #eing*