A shot at long life
CEBU CITY’S FREE MEDICINE PROGRAM
Aniceto Racoma coughs profusely. He cannot see clearly and, for the past two years, has suffered from hypertension.
At 72, his limbs are not his best allies. Months ago, his knees were swelling and his hands could not seem to stop shaking. The pharmacy nearest to his shanty in the mountain barangay of Tagba-o in Cebu City is located in another village 24 kilometers away.
Then again, even if he had the money, he could barely walk the 150 meters to the sari-sari store where he often gets a loan for food.
Aniceto has a wife and six children but they seem to have forgotten him, he says. He suspects they fear of catching the virus that tortures his system.
“Nahiubos ko nila (family) kay mahadlok silang matakdan nako. Pwerteng paita uy nga mag-inusara rako. Kanang naang makaingon ko nga maayo kining laing tao pa ang moanhi nako,” he says in between tears.
One Saturday morning in July last year, a group of people arrived at his doorstep. It wasn’t his family but they brought him good news: From that day on, he would receive free medicines Metoprolol for hypertension and Vitamin B Complex for energy.
At the pharmacy, Metoprolol can cost between P6 to P15 each while Vitamin B Complex can cost at least P3 each.
Aside from medicines, Aniceto also received P12,000 cash and saw a doctor for the first time in a very long time.
PROGRAM
Aniceto is among the 47,000 recipients of the city’s Long Life Medical Assistance Program (LLMAP), one of the priority programs of Cebu City Mayor Tomas Osmeña, aimed at helping residents with hypertension, diabetes, and arthritis.
At least 800 health workers bring the medicines to residents like Aniceto who could no longer walk or are bedridden due to their ailment.
Last July, the City Council approved P19 million for the program. Of this amount, P14 million is being spent to buy the medicines while P5 million goes to the salary of out-of-school youth the city has tasked to deliver the medicines alongside health workers.
Health workers who deliver the medicines to 50 recipients in the city proper get P100 per day while those who travel to mountain barangays get a minimum whole day salary.
One of those servicing the mountain barangays is Glycel Alegado, a 35-yearold mother of five.
On board her motorcycle, she drives from one house to another in Barangay Tagba-o where at least 112 residents suffer from hypertension.
"Gaan kaayo ang paminaw makatabang sa isig ka tawo. Nindot gyod. Makapalipay," she says.
“Kana si Tatay Aniceto ang usa sa tabangonon kaayo kay siya ra’y gapuyo sa ilaha. Pa-check-up pa pod na nato sa doctor para sa iyang sige’g ubo,” she says.
The program’s operations head, Neil Visitacion, says the programs “aims to lower the mortality rate of such sickness.”
Its medical director, Dr. Marlo Maamo, says taking the maintenance medicines is needed to prevent further complications of the disease the person is suffering from. Hypertension can cause heart enlargement and/or stroke if not addressed medically. Meanwhile, those with diabetes who do not get proper medication can suffer from complications in the kidney and nerves.
“Maong our objective aning program is to lessen ang mortality sa hypertension and diabetes kay the cause of their deaths is not hypertension or diabetes per se. It’s because of the complications,” he tells The FREEMAN.
The first phase of the program involved identifying the patients and distributing the medicines. The second phase involves training the health workers in getting the patients’ blood pressure and administering blood tests, among others. During the third phase, the city will venture into buying prepaid blood test kits for quick results.
“This is the best monitoring system you can get. We can monitor the vital signs, and immediately refer to a doctor if the existing dosage is no longer effective,” Osmeña says.
BEGINNINGS
Visitacion discloses that the program kicked off in Barangay Zapatera in February last year during the campaign period for the May elections.
At that point, Osmeña, then mayoralty candidate, used his personal money.
“During sa campaign, na-discover namo ang idea nga mas mu-choose sa food kay sa medicines. Ang DOH is giving free medicines for hypertension and diabetes pero nakita nato nga mga tambal ang na-taken for granted especially sa pobre. You have to take it every day pero kun naproblema sa bugas, nakita nako nga pagkaon ang i-prioritize ug ibaligya ang tambal,” Visitacion says.
Over 9,000 reportedly benefited from the program’s early stages.
“Of course, it's politics. It's good politics. People don’t recognize there's such thing as good politics. People would sa y, if it's politics, it's already bad. ” TOMAS OSMEÑA Cebu City Mayor
When Osmeña won, his first executive order was to implement the LLMAP.
“Maintaining a healthy citizenry through preventive measures will provide high value to society since lives are improved at a relatively low cost. Health promotion and disease prevention measures will eventually save the city government money as oppose to the cost of medical treatments that the city will stand to be burdened by an ailing citizenry,” the order reads.
Osmeña does not deny that the program is politically motivated.
"Of course, it's politics. It's good politics. People don't recognize there's such thing as good politics. People would say, if it's politics, it's already bad," the mayor says.
He explains, “If everyone took their daily dosage of medicines, less people will become sick. If less people will become sick, we spend less in the hospitalization.”
"This is good politics because we're talking about service. There's innate care for the people. Bad politics is when they try to stop the services. Good politics is when you try to provide the services. And we're doing it efficiently," he adds.
COMMON ILLNESSES
According to the Department of Health (DOH) in Central Visayas, hypertension and diabetes are among the top causes of deaths in the region in 2015. At least 211 died of hypertension and at least 285 died of diabetes that year.
The numbers did not look good in succeeding years either. In 2016, the City Health Department recorded 9,550 cases of hypertension and 1,077 cases of diabetes. From these numbers, 170 died of hypertension while at least 357 died of diabetes.
This year, 94 died of hypertension and 87 died of diabetes in the first quarter alone.
CHALLENGES
The program's first year was not smooth sailing. Alegado, for one, says that because of distance, the harsh terrain in the mountain barangays, and unpredictable weather conditions, she could not deliver the medicines daily.
"Bisag uwan unya dangog, ihatod gihapon nako kay maintenance man ni nila. Ako lang itingob kay layo," she says.
Houses in the mountain barangays are often kilometers apart. Some sit atop mountains while others are located downhill.
Alegado's fellow worker, Obrein Ramos, 27, wasn't very lucky. He was on his way back to the office after delivering medicines to Barangay Punta Princesa when he met an accident.
“Nadisgrasya last October 24. Naay kasugat nga motor. Akong gitumba akong motor; Naa man siyay angkas. Padulong balik sa office gikan Punta Princesa naghatod og tambal,” he says.
His left foot, which was fractured, had to be supported by a stainless brace.
Vicitacion says measures are being put in place to protect the health workers and volunteers. One way is reducing the number of trips per day.
“It is because of their concern sa terrain, especially sa mountain barangays. Lagyo kayo so we are thinking nga instead of 30 patients a day, atong i-reduce lang para ma-every day gyud ang paghatod sa tambal,” he says.
He hopes to provide motorcycles to health workers and volunteers who deliver the medicines, something that can be addressed by a bigger budget.
This year, the Council did not approve the proposed P88 million budget for the project's operation for the whole year.
“Politics. Bottom line is very good politics and this is bad for the other side… good for us, bad for them. Ingon ana lang ka simple,” Visitacion says.
To remedy this, the program gets money from the Department of Social Welfare and Services (DSWS), City Health Department, and even the Department of Health (DOH).
“We got the help of DSWS and DOH. Naa man sila budget for drugs and medicines niya wala man sila'y tig-distribute… bali, kami ang ilahang arm,” Visitacion says.
At least P10 million has been spent to buy the medicines.
The city allocates P35,000 to each recipient. Of this amount, P25,000 is for hospitalization; P5,000 is for medicines; and another P5,000 is for laboratory procedures.
The latest move of the executive department is to propose a budget of P100 million for the program for 2018.
“Gi-project namo nga by 2018, molapas pa gyud ta sa 50,000,” Visitacion says.
FUTURE
Osmeña would want to expand the program eventually to cover other diseases but to do that, the city would need an estimated P60 million a year to purchase the medicines alone. It would also need P15 million to pay the health workers and another P5 million to purchase the necessary apparatus.
Much still needs to be done and Visitacion says, “We are still continuously studying how to improve our approach.”
Alegado, for her part, hopes that the city would eventually provide for digital blood pressure apparatus; paracetamol; medicines for fever, cough and urinary tract infection; and vitamins for children.
Whether or not the program will be the “best health care system in the world,” as Osmeña has declared, remains to be seen.
For now, at least, residents like Aniceto can see a ray of hope for a longer, healthier life with or without family.