No Time to Die: Healthcare and its Discontents

Daniel Craig was not thinking of the Philippine healthcare system when he starred in his last movie, No Time to Die.  Even so, the movie's title is less about James Bond and more about failing healthcare systems across the globe ---  where social welfare systems are woefully underfunded,  poor people bear the burden of unaffordable healthcare costs,  the choice to live or die depends on the depth or shallowness of one's pockets,  and an extra day in the ICU is a matter of how far resources can be stretched. 

What is it about James Bond movie titles?  These don't convey images of gorgeous male actors that played James Bond, all muscles and brawn, fighting odious villains across the globe in souped-up technological hero gear.  Instead, they conjure images of struggles with the healthcare system when life-threatening diseases confront a person with existential choices.  Does s/he live and let die?  Or die another day? 

Take my friend and colleague Mike whom I have known for over two decades.  A former faculty member and program director at a prestigious Philippine management institute, a thought leader, former cabinet member, and civil servant. 

He came down with COVID-19 in 2021 and spent 40 hospital days battling the disease.  Then another two weeks in January 2023 due to sepsis.  By now, Mike must know every inch of the hospital walls, windows, doors, and ceilings. 

 Those were days of reflection for Mike.  From his hospital bed, he reflected on the urgently needed reforms to boost the Philippine healthcare system.  

First, Mike sensed that doctors didn't coordinate with each other.  All seven of them, each with their specialization, gave conflicting instructions to nurses on medications and procedures.  Because of this lack of coordination, check-out procedures proved tedious.  Mike and his wife spent an extra day in the hospital, adding to unnecessary expenditures, to chase doctors for clearances so he could be discharged.  A classic case of the left foot over/misstepping the right foot.     

Second, Mike's inflated hospital bill was due to differences in the pricing of hospital-purchased drugs and medicines he bought himself.  He was not allowed to use his supply of maintenance medication (such as insulin).  He got double-, triple-, and quadruple-whacked because of what he called "price gouging." No wonder when poor people get sick in the Philippines, they prefer to go to their local herbalist (albularyo), faith healer, or local masseuse --- mostly paying a measly amount in exchange for loyalty and a long-standing relationship as psychic payment.

Third, incentives suck.  Doctors and nurses are so underpaid that they can only think of migrating abroad.  Nursing assistants were the least paid.  All of them thought nothing but packing up and hiving off to greener pastures.  During the pandemic, then-President Duterte issued a travel ban for all doctors and nurses.  They had to stay put and serve on the frontlines while trying to keep afloat financially as they battled to keep themselves safe from COVID. 

Whereas I was truly fortunate.  My COVID recovery for twenty-five days at Tan Tock Seng Hospital in Singapore was the total antithesis of what Mike endured.  The attending physicians came together every morning to explain my situation.   No out-of-tunes, no mixed messages.  Straight talk, streamlined, authoritative, straightforward, and comforting.    

Two doctors came to explain the prognosis when my fever spiked one evening.  Mobile X-rays were brought in every four days to monitor pneumonia.  Blood tests and pulse meters round the clock to check my vitals.  A disk was attached to my belly and connected to a computer outside the nursing station to monitor fever fluctuations. Every morning one of them would call my husband for an update.  Immediately, my husband broadcast updates to my entire family spread across the globe through a WhatsApp group.  Doctors and diasporic families remained connected and informed throughout.

Nurses and medical technicians were all deployed to the National Center for Infectious Diseases (NCID), full force, full strength, full throttle to battle the pandemic.  My attending physician, a hematologist, returned to his laboratory for research on blood disorders only when the pandemic eased and Singapore went into modulated versions of quarantines and lockdowns.  Singapore's medical system was fired up on all cylinders. 

The nurses who swabbed me (many Filipinos) recounted their training sessions for swabbing so that the procedure wouldn't be too uncomfortable.  One of them worked in the dermatology clinic but, like everyone else, was deployed to the NCID for the duration of the lockdown.  She was one of many who left the Philippines for greener pastures.  The Singapore medical system gave her a long financial rope to comfortably support her family back home, especially during the pandemic.  Financially at least, she didn't have to worry about them. 

Of course, I worried about the costs of lengthy hospitalization.  Imagine my surprise and relief when I was informed that the Singapore government would foot the bill.  I paid zero.  So did all others who were confined.  Whether migrant workers, employment pass holders, dependents, or residents, we all paid nothing.  When vaccination season came around, everyone received free vaccines and booster shots.  Singapore has one of the highest vaccination rates in the world (90.09% as of 24 June 2023) and comparatively one of the lowest mortality rates (1722 out of 6.9 million deaths globally, or .02%). 

My abiding faith in Singapore's medical system is profound and permanent.  Their system prevented me from becoming another mortality statistic in global pandemic accounting. 

I end this post on a note of both optimism and anxiety.  Mike fought valiantly to be restored to health.  He had the resources to finance his healthcare needs.  However, for those who did not enjoy the same privileges that he did, Mike has proposed several reforms to fix the broken healthcare system in the Philippines:  better health governance and improved delivery services, incentives for medical workers to remain in the healthcare system, and a financial structure to make healthcare affordable to all Filipinos. 

However, anxiety prevails.  Failing, flailing healthcare systems are a legitimate cause for concern, not only because of states' responsibilities towards their citizens to provide for and protect them.  But more importantly, for the fear that the next pandemic is already lurking. 

WHO Chief Tedros Adhanom Ghebreyesus delivered his report to the 76th World Health Assembly in late May.  While COVID-19 was no longer a global public health emergency, Ghebreyesus reiterated that the "threat of another pathogen emerging with even deadlier potential remains."

Not to be a doomsday naysayer, but let's get real.  The WHO purportedly keeps "a list of viruses and bacteria with pandemic potential," reported Sheila Murooney Eldred, a freelance health journalist.  This list of nine diseases "keeps epidemiologists up at night." Could any of them spread more quickly and efficiently with a 50% fatality rate?  What would become of the human species if this were to come to pass? https://www.npr.org/sections/goatsandsoda/2023/01/29/1151039454/9-diseases-virus-epidemiologists-pandemic-potential-who

I prefer not to enumerate these pathogens.   Memories of extended hospital stays are sad and sordid enough.  And why indulge in scare tactics?  Instead, I echo Mike's calls for healthcare reform in the Philippines and worldwide.

Like what India hopes to do: give its healthcare system a makeover.    Revisit healthcare financing, adopt more realistic pricing policies for affordability, especially for the poor populations, promote generic drugs to ensure provision all over the country, and tackle mental health due to the latter's direct impact on physical health.  The Healthcare System in India is Getting a Makeover | Entrepreneur.

Let's keep our species healthy and thriving.  And not to Live and Let Die or Die Another Day, but instead, to find our Quantum of Solace.   Thank you, James Bond.