Day 5.2: Power in “tsismis” (aka Gossip)

Updated: Oct 13, 2018

The struggle for Pharmacist to be acknowledge as Health Care Providers is real, especially here in the Philippines.

Pharmacist are described in the Philippines as “sales ladies”. Counseling on medications does not occur at retail pharmacies. My cousin described having to chase down patients in order to fulfill her pharmacy school requirement to counsel only 4 patients that day!

Prescriptions are required for Antibiotics and controlled substances, but medications for diabetes and hypertension can be purchase like Over-the-Counter medications. If you go to a less mainstream pharmacy, even antibiotics can be purchased without a prescription.

“You can purchase as many or as few tablets as you can afford, and then stop. This is common with blood pressure (hypertension) or “high blood” as it’s called here in the Philippines. People take the medicine when they feel bad, and stop taking it as soon as they feel better.”

If MD appointments are describe as quick interactions and medication purchasing is like ordering fast food, then who is educating the patients regarding their medications and disease state?

Because here is a quick snippet of things I have heard Filipino patients describing their perception of the meds they take:

  • “I heard from my neighbor that is on insulin I can eat whatever I want because I can just inject more insulin.”

  • “It has already been 2 days and my wound is not healing, I am going to stop taking my antibiotics.”

  • “I took the cough medicine from the Medical Mission and my cough went away in 2 days and if I take the local medicine, I still have a cough after 7 days.”

  • “When you say limit my alcohol to 1 bottle of beer, the biggest size bottle would be okay right?”

“Thirty out of 100 of Filipino customers who buy medicines here are taking hypertensive medicines. However, of the 30 patients, 12 of which will stop taking medication on the second month, and only three will continue their medication in a year’s time"

My next questions was, then how do people find out they are diabetic and hypertensive? Esp after reading: 1.7 million people with T2D remain undiagnosed.

They have neighbors who have diabetes and hypertension. They hear about what symptoms they have and then go to the doctor once they start experiencing the same symptoms.

Healthcare for our Filipino patients is reactive instead of proactive.

That’s where community programs come in to save the day: There are Diabetes and Hypertension Clubs and RHU programs that provide occasional health teaching, screenings and medications. However:

  • The medications are a limited supply. Some medications are more ample than other, but once they run out, it is a timely process of obtaining more.

  • The Diabetes and Hypertension Clubs are more accessible for the community, but have a smaller supply of medications to provide. Same goes for the more Rural RHU centers. Thus, the patients in these areas have to travel long distances and “often times patients will choose to use that money to feed their family instead of paying transportation to get medications”

  • That leaves them with the option to purchase the medications and again there are higher priorities

Because we now better understand the areas of opportunity with the existing programs, here is how our CCC program can provide tailored assistance beyond simply providing free on-going medication:

  • We plan to travel to our patients. Even though that is going to be a time commitment on our Program’s directors part, it will be an intentional act to eliminate one of the barriers for our patient

  • From talking with cab drivers and family, the education talks that are provided by the local programs really do get instilled in their understanding. So what greater potential await as we take the "occasional education seminar" and turn that into walking alongside of our patients to provide encouragement and accountability. I would say Education and accountability would be the most power aspect of our program because making necessary lifestyle changes is not easy.

  • I am still unsure of how the existing programs handle obtaining regular labs on their patients (such as SCr and I don't think eGFR is an option), which concerns me for medications that need to be renal adjusted. Our program will ensure baseline and ongoing labs are free and regularly obtained for our patients.

Lastly, there is power in “tsismis” (gossip)

Even though we have to start with a limited number of patients who we can enroll into our program, they will obviously talk to their neighbors. Whatever we teach our patients will hopefully disseminate into the community through the power of “tsismis”.

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