the medical school we are rotating at here, the leyte
branch of the university of the philippines, uses an interesting model. it has
a special mandate to train primary care phyicians to work in rural communities.
all its students complete a fifth year of medical school, one more than other
medical students in the philippines. this year is spent as an “intern” in an
assigned rural community, and major focus is placed on becoming an integral
member of the community as opposed to just its physician. to attract students,
medical education at this school is subsidized by the government and provided
free of charge to the students, provided they pay back the time working in
rural areas. prior to typhoon haiyan last year the school was based in the nearby town
of palo, but the campus was completely destroyed, so it was moved to some
buildings in tacloban which survived the typhoon.
this week all of the local class of interns returned
to tacloban from their work sites to attend a training session on how to train
community health workers. we were priveleged to be able to attend as well. the
village units in the philippines are termed “barangay,” and it is at this level
that many decisions are made, as government in the the philippines is in
general rather decentralized, thanks to geographic isolation and countless
disparate ethnic groups and languages. the intern’s focus is on developing good
relations with the mayors and other leaders of the barangays, in an effort to
address some of the social determinants of health – a preventative effort at
the community level as opposed to simply dealing with individual’s acute health
needs. the training session focused on how to give good presentations and
effectively run a meeting while remaining cognizant of the best interests of
all stakeholders. icebreakers and frequent dancing were a major theme. also
discussed were strategies for identifying public health issues and how to go
about fixing them using the community’s ideas. this was primarily in english, which all educated filipinos speak, thanks to the history of american occupation. often however, talk will trend into “taglish,” a combination of
english and tagalog, the national language which almost everyone speaks. filipinos
love acronyms, indeed even more than americans do. the medical system here, at
least at this school, is profoundly non-hierarchical. the faculty and school
leadership attended the training, and if we didn’t already know who they were
we could never have guessed, as they were following orders and joking around
just as much as the interns. get a group of filipinos together and there will
be a joke told at least every 30 seconds, and everyone will laugh even at
things which aren’t meant to be funny. people here love laughing, and its
great!
