widening perspectives: the 7th global health course

8/9/2019 Widening Perspectives: The 7th Global Health Course

1/17

WWIIDDEENNIINNGG PPEERRSSPPEECCTTIIVVEESS7th Global Health Course

University of Tampere, Finland

Submitted by BIEN ELI NILLOS, MD


2/17

Introduction

It has been a wonderful experience. What made the experience amazing was it was spent with

participants from other countries Chile, Tanzania, Nepal, Malawi and Finland. With such an

international group of participants (not to mention the lecturers as well), it was inevitable that the

opinions collected and insights shared would be as diverse as the cultures contained in the walls ofthe University of Tampere.

As a Filipino physician whose career path bends toward Public Health, it has been an eye-openingexperience. The Global health course has broadened my vision of the world and has made me realize

many things. Firstly, that there are so many problems shared by the community of nations and are

not exclusively faced by the Philippine health care system. Secondly, each member of thisinternational community has been struggling to solve these problems in the best way that they can,

employing tools that are socially acceptable to their own community. Lastly, while there is no best

solution that can be generally accepted by all countries of the world considering the diversity of

society and culture and beliefs and resources, there are best practices that can be duplicated from onecountry to the other that are socially applicable and scientifically sound.

I am grateful to the generosity of all participants during the 7th

Global Health course for unselfishlysharing their local experiences, opinions and insights. The host country Finland has been hospitable

and accommodating which largely helped in our learning of new things for four weeks. While I

might not be able to capture every detail of the experience in this journal, I do hope that I cancapture the essence of the entire experience: an experience that developed in me a person more

tolerant of others, a person with a broader perspective about health and life as a whole, and a person

more knowledgeable about the world.

The challenge one faces with a widened perspective is how to think globally and act locally. My

fervent hope is that the experience does not end here. The challenge remains and that is how we can

make our respective health care system work for our respective countries. I am hopeful that I shall begiven more opportunities to learn and even more opportunities to put into practice the learning in the

future.


3/17

Day 1: Visit to Finnish Medical Association, Laboratories and Duodecim

Venue: Helsinki, Finland

Helsinki welcomed us with a drizzle but thatdidnt stop us from starting our first day of

Practicum for the Global Health Course. Thefirst agenda was a visit to the Finnish MedicalAssociation in their office where we were

given an orientation as to the role of the FMA

and how this association is serving thethousands of Finnish doctors everywhere in

Finland. For the Philippines, it is quite similar

to the Philippine Medical Association. There

are however some notable differences. Onedifference is that membership to the FMA is

not compulsory, unlike the membership of

Filipino doctors to the PMA. Anotherdifference is that the FMA also opens it membership not only to licensed doctors but also to medical

students as well. The PMA is exclusively open to Filipino licensed doctors. However, despite its

being optional, around 94% of all Finnish doctors are members of FMA.

With regards to membership fees, The Associations membership fees are graded based on

the number of years since you obtained your licence in Finland. No fee is charged for the year you join. During the following years, the membership fee gradually increases. The full membership fee

(480 euros in 2009) is only due on the fourth year of membership. The FMA membership fee can be

deducted from taxation. The Association notifies the tax office of the membership fees paid, and the

deduction is therefore calculated automatically.

Because of these fees, the FMA can provide

insurance to its members such as Life Insurance, BusinessInterruption Insurance, Accident and travel insurance and

even Home and Car Insurances. I am not aware of the

PMA does offer the same kinds of insurances to itsmembers.

After a brief tour of the office, we immediately

went to the University of Helsinki Hospital where wewere given an orientation on how the hospital operates it

laboratory and other diagnostic clinics. What was

interesting was the fact that the hospitals (which weremore of a complex within a compound) were connected by underground tunnels. We walked from

one specialty hospital to another and at present they are planning to build another hospital within the

complex. Of course, as expected, the instruments and machines used in the laboratory are state-of-


4/17

the-art, the type which I can only find in tertiary care hospitals in the capital of the Philippines

(Manila).

The day was capped with a dinner with the representative from Duodecim. During the

dinner, we were given an orientation as to the background of the society, its history and its vision.

What was noteworthy was the Duodecim began as an initiative of 12 medical Finnish students. Now,the Duodecim has grown into a large organization streamlined towards education and scientific

research. After the dinner, there was some very nice discussion on the question posed by the

Duodecim Representative: whats next after the Global Health Course?

That question really got me into thinking.

What is next after this? After having come back to the

Philippines from Finland, and having seen the thingsaround me and comparing them in hindsight to the

things I have seen throughout the Global health

course, I couldnt help but feel depressed. ThePhilippine health care system has a long way to go

and the solution to this huge problem is as complex as

the problem itself. It is cultural. It is political. It issocial. And I am not even taking up the medical part

of the solution. Perhaps there is little left to do about

the present situation. However, despite feeling

depressed, I also feel hopeful that the next generationof Filipino doctors and health professionals can do something and reverse what is seemingly

irreversible. So, what is next for me? The day I arrived in the Philippines, I tendered my resignation

as municipal health officer of a small town called Candoni in Negros Occidental. This has beenanticipated long before I left for Finland. My resignation actually reflects the same perennial

problem in the local health systems in the Philippines. It is a pity that sometimes, politicians who are

neither health professionals or at the minimum knowledgeable about the health care system or

medicine would tend to interfere in the management of the primary health care unit. It is a pity thatthere are many Filipino rural health care physicians who are underappreciated and not even fully

compensated, enough to commensurate with their hardship. I have served Candoni for almost 3 yearsand in those 3 years we had many accomplishments as well. Despite that, there are still problems left

unsolved simply because the entire system is not compatible to the solutions proposed.

My hope is left to the next generation, the current medical students, who can make adifference somehow. So I am echoing the principles I have learned from the Global health course,

challenging my students to see beyond the first line of causes, to recognize the causes of the causes. I

am echoing the principle of thinking globally but acting locally. I am passing it forward andhopefully, if given the opportunity, I can pass it forward to the people who are key players in

society.


5/17

Day 2: THL Registry, Disease Surveillance and Service Center for Homeless

People

VENUE: Helsinki, Finland

The second day of practicum was a little

bit hectic. We were actually carrying our bagsaround with us considering that by 6 in the

afternoon we would be leaving Helsinki on a train

to Tampere. Fortunately, it wasnt a hectic day. It

was more of listening to lectures, drinking kahviand eating pulla.

We had our first round of coffee and pullawhile listening to a THL representative discussing

the Finnish Registry. The representative discussed

how every Finn has a registry number and they

would get this number right on the day that theywere born in Finland. This registry number functions like an ID number and each Finns profile,

particularly health profile, is filed in this ID number. Thus, if a Finn gets admitted in a hospital in a

different city and later relocates to another city and gets admitted again in the hospital within thatcity, it would be easy to retrieve records and histories of the individual because all they need to do is

access the profile through the registry.

What was interesting was what the representative said about why such a system became

successful in Finland. It is a matter of trust, he said. The people trust their government so much

that they were able to establish this health registry. There are Finnish laws that would protect theconfidentiality of these data and no one can easily access these data. In fact, the major use of these

data is only to supply the government statistics regarding health indicators of their country. They canbe utilized for research which can serve as basis for future policies when it comes to health.

The same system is used when it

comes to disease surveillance and while each

country has its own mechanism of reportingand surveillance, what is interesting again

with Finland is how to employed technology

in doing so. While the Philippines has also agood surveillance system, the use of

technology is limited only to maintaining

database and clerical activities. Networkingthrough WLAN or internet and thereby

linking various government agencies help

facilitate fast communication and therefore

fast response.


6/17

The day was ended with a short visit

at the center for homeless people in Helsinki.While there are homeless people in Finland,

what was noteworthy was the actions being

taken by the city of Helsinki to address theproblem of homelessness. The Center for

Homeless People is more a temporary remedy.

Residents in the Center are not only providedtemporary shelter, food and clothing but

homes where they can later on move in. Any

homeless resident of Helsinki can come in,

have food and even take some free shoes andclothes that have been donated and can just

move on or move in temporarily.

There are many homeless people in the Philippines and most of them are informal settlers. I

have yet to see a comprehensive national program that would address this homelessness problem in

the country, not only for the urban poor but most especially to those in the rural areas. The solutionis not only to provide them the shelter which they urgently need but the means by which they can

sustain living under such shelter.

Day 3: Visit to the Emergency Room (Acuta) and Pediatric Ward at the

University Hospital

Venue: Tampere, Finland

It was great to be back in Tampere. Helsinki is great and definitely a huge city. But small-city Tampere would have this homey feeling

that would make one comfortable. Not to mentionthe free internet wi-fi service at Laapinkari flat.

The 3rd day started quite early and this

time we were brought to the University hospital to

visit their Emergency Department (Acuta) andtheir Pediatric Department. Of course, what

initially struck me was the advancement in

technology utilized in these two departments. TheUniversity of Tampere Hospital functions like the

district hospital, serving Tampere and its

neighboring towns and cities. Thus, all emergencycases or medical cases which require acute care

are brought in from their primary health care centers. The referral system is very strict and definite.

Patients visit their municipal health units first or the Acuta whichever is nearer but usually it is the

Municipal health units or the primary health care centers.


7/17

Despite the advancement in technology however (the Acuta was so immense actually), the

consultant who gave us the tour mentioned that Finland has yet to establish a specialty training for

Emergency Physicians. Thus, their EDs are manned not necessarily by an Emergency Physician butusually a specialist who would perform the triage. After the acute care is given and the patient is

stabilized, it is up to the triage officer (who can either be a doctor or a nurse) to refer the patient to

the appropriate department. What is interesting is that there is even a department for GeneralPractitioners. So GPs can manage patients in a

hospital in Finland.

If the patient is a pediatric patient then he or

she is sent to the Pediatric Department. The

department is divided into a Polyclinic (which is the

equivalent of the Outpatient Department) and theWards where patients are admitted. The Pediatric

Wing had everything covered including the comforts

of visiting and admitted patients. Almost every cornerthere is a lobby where parents and their children can

play and relax while waiting for their turn at the

polyclinic or just spending some time outside of theirhospital room.

Another interesting feature of the Acuta is a wing for violent patients, either psychotic

patients or just drunk patients. They are placed temporarily inside a cell where they are observed foran hour until they are either calm or sober or sedated enough to be managed at the Acuta or to be

referred to the appropriate Department.

Of course, like every Emergency Department, it

has its own Radiology Room where immediate CT scans

can be produced when necessary.

In the Philippines, one can only find such kind of

facility in highly urbanized areas of the country, but morespecifically in Manila or in Cebu City. Most of these

hospitals in the Philippines are privately-owned and can

be quite expensive. However, since almost everyone in

Finland has some form of health insurance coverage,there is no fear about medical expenses. In the

Philippines, General Practitioners do not have a place inside a hospital. Only specialists can admit

and manage and even work in a Philippine hospital. Thus, most GPs are either working as ruralhealth physicians in far-flung areas (limited only to doing consultations and perhaps minor surgeries

if facility is capable) or are left without a choice but to specialize. Of course, specialty trainingentails 3 or 4 more years of hospital-based training and residents on training receive little pay,almost not commensurate to the load of work they do. That is why, even if there are many in the

Philippines who proceed to specialty training, most would not proceed to specialty training

immediately.


8/17

I think it is time the Philippine health care system

must consider utilizing its General Practitioners to the full,not only employing them in higher levels of care (to fill in

the gaps) but also to provide some form of exposure for them

in hospital-based training that would enable them to developprofessionally as doctors but without necessarily pushing

them to become specialists. While specialty training is

important, the foundation for a strong health care system isstill a solid primary health care system, and to run a primary

health care system need not require a staff full of specialists.

In this way, the Philippines can help pull back its brilliant doctors who are leaving the country for

better opportunities elsewhere.

Day 4: Day Care Center, Obstetric Ward and Neonatal Ward


It was a sunny and warm day, just enough for our trip to a Day Care Center. It is called theHippos Day Care Center and it is sort of like a city Day Care Center. During the orientation, we

were told that there are other private-owned Day Care Centers and they are quite expensive than the

ones managed by the government. Day Care Centers are free, although for some of its services, itcan charge the parents depending on their family income. Of course, those who have higher income

tend to pay a little bit higher.

While waiting for the orientation to

start, we were able to meet a fellow Filipino

working in the day care. She had been in

Finland for quite some time and she has beenliving with her Finnish husband in Tampere. We

were able to chat with her and we found out she

was from Bacolod City, the same city where Ilive.

The Hippos Day Care Center is,compared to Filipino standards for day care

centers, more than just a day care center. It is a

primary school where children learn by playing and socializing with other children. I didnt see any

blackboard or texbooks. Just rooms filled with toys and toys and lots of toys, appropriate for agegroups. There is even a small indoor-pool for the kids to swim in.

What was interesting was there are some special kids who have mental or physicalchallenges also enrolled in the day care and they are mingled with normal kids. There are optional

groups where all special kids are gathered, and there are mixed groups where both normal and

special children can play with each other. Parents can leave their kids and pick them up depending


9/17

on the number of hours. As far as I understood it, there are even kids left at the Day Care for

overnight care just in case the parents cannot be at home during the evenings.

The place is just child-proof, with

everything so child-friendly and conducive for both

learning and fun. We even had the chance to playwith the kids and their own toys. Some of us

preferred playing outside at the playground, having

fun at the see-saw and swing set. Talk aboutregression.

In the Philippines, it is a sad view when

one talks about the public day care centers. Thereare private day care centers or pre-schools but they

are the most expensive ones. There are municipal

day care centers as well but some facilities are not fully equipped. Most of these are dependent ondonations and hardly a trickle of the municipals budget would find its way into funding these day

care centers. There are even instances when the day care center workers would have problems with

their compensation and salaries. There are poorer municipalities who cannot even afford to put up ormaintain a day care center.

What happens is children are left in their homes alone while their mothers and fathers

would work on their farms the whole day. If the child has older siblings, the eldest would either skipwork or school just to stay at home and tend to the younger ones. The eldest can be as old as 9 years

old. Worse, the kids are brought by their parents with them in the fields to work with them instead.

Education, even at the pre-school level, in the Philippines is expensive. Because of its cost,

it is made almost inaccessible to the larger population. The quality on the other hand is another issue.

While I would like to believe that we have the best

teachers when it comes to quality of educators, thesystem in itself is not conducive for developing

such potentially good teachers and educators andsocial workers. While the government may have a

good program on child care, it remains a good

program on paper. When it comes to

implementation, we are still far behind the ideal.

After our visit at the Day Care Center, we

went back to the University Hospital and visitedtheir Obstetric Ward and Neonatal Care. Again, the

main attractions in these facilities are theavailability of technology and comforts for the patients and their families. It was noted that theNeonatal Intensive Care Unit where the more critical babies are admitted was quite small and even

the consultant mentioned it. According to him, some folks would complain about the lack of comfort

and some privacy when they visit their patients at the NICU.


10/17

The OB Department has its own Ultrasound Room and it has rooms which are both labor

rooms and delivery rooms. Normal hospital beds can be converted into Delivery Tables and shouldthe patient require an immediate C-section or surgery, the beds can be wheeled out of the room and

be brought to the Operating Room exclusive for OB Department.

What was interesting during our visit at

the OB Department was when we were brought

inside the Operating Room, where they wouldconduct their C-section procedure, we were

expecting to wear at least a scrub suit and a

surgical cap in order to protect the sterility of the

room. After all, that is what is being taught to usduring our training. But the consultant brought us

in, with nothing but our lab gown over our street

clothes, with our outdoor shoes and without thecap. One of us asked about it and the consultant

said that it doesnt matter whether one is wearing

those or not. After all, bacteria are spread by handso if there is one thing we should be doing was to keep our hands off and wear surgical gloves. Of

course during an OR, for self-protection, they would wear the cap and surgical gown and gloves and

slippers.

In the Philippines, public hospitals pale when they are compared to private-owned

hospitals. Of course, when it is a private-owned hospital in the Philippines, they are usually

expensive.

Day 5: Visit at the Pirkkala Primary Health Care Center and Terveystalo Health

Center on Occupation HealthVenue: Pirrkala and Tampere, Finland

The mid-summer long weekend was

refreshing. It also reminded us how close we were

to the end of the training. It reminded me of thetrip back to the Philippines and what would await

me at work and home. The visit at Pirkkala

Primary Health Care center reminded me of myown municipal health center back in Candoni,

Negros Occidental where I served for almost 3

years. The Pirkkala Primary Health Care Unit islike a rural health unit. However, what I saw in

Pirkkala was nothing similar to a typical rural

health unit in the Philippines.


11/17

In Pirkkala, the facility resembled that of an upscale district hospital back home. There

were departmentalized polyclinics, an emergency room, a ward where they could admit patients for

observation, a laboratory, an ultrasound room, even a gym where they could do physiotherapy fortheir rehab patients. What they didnt have was a delivery room. In the Finnish health care system,

all deliveries are to be handled in a hospital. No rural health unit or primary health care unit would

handle deliveries. The PHC units only do prenataland postnatal check ups.

What is another interesting component ofthe Pirkkala PHC unit is the presence of mental

health care. Psychiatrists would work at the PHC

to help manage psychiatric patients. There are

many doctors working in Pirkkala, a good mix ofspecialists and General Practitioners.

I personally asked the healthofficer/supervisor if the municipality or the

Finnish government would have limits as to the

number of doctors or health workers that can behired per locality or municipality. I asked this because in the Philippines, there is a 45-55 ceiling to

the municipal budget. Which means, 45% are to be used for operational expenses and 55% are to be

used for personnel salaries, benefits and other compensation. So, even if the municipality would be

in need of more health workers, if it has already reached its limit for the personnel salaries, it couldno longer hire health workers even if it is in need of more. In Finland, for as long as they are needed,

the municipality can still hire, regardless of the proportion of the personnel salaries to the operational

expenses of the locality; which for me actually makes sense.

The problem in the Philippines is not that we dont have the sufficient money. We have the

money. In the first place, we have enough population to extract taxes that can fund the government

programs. What we dont have is an efficient system of collecting these taxes and sad to saytrustworthy government employees (elected or appointed) to manage these collected taxes, both at

the local and national levels.

Another sad reality is that the local

chief executive would hire casual employees

to fill up jobs in other departments which arein reality not really a priority for the local

government. Thus, instead of filling up the

more vital departments that render importantand priority services to the people, the local

government would hire more clerks thannurses, more drivers than midwives and evenhire or open positions that are less important

than the position of a rural health physician.

Local chief executives would do this usually


12/17

to honor a promise pledged during the campaign period or to repay the loyalty given by these

individuals during the elections.

So, at the expense of healthcare, local chief executives perpetuate themselves in position by

prioritizing political patronage instead of focusing on genuine delivery of quality health care. In a

devolved system, the local chief executive is the boss and while the city or municipal council ispresent, the local chief executive is more infallible than the Pope himself when it comes to

Philippine local government units.

Thus, when I left Pirkkala and was

heading with the group back to Tampere, I

could not help but feel sad for my fellow health

workers back home. These health workers hadto suffer so much political intimidations not to

mention the lack of resources to fulfill their

obligations. They are perhaps the most under-appreciated industrious workers in the country.

The Philippine government would boast of the

Overseas Filipino Workers as the modern-dayheroes of the nation. For me, and without a

doubt, the real heroes are those Filipino health

workers who, despite the challenges that would

even seem to be unconquerable, opted to stay behind and work as diligently as those who areworking abroad but with much lesser pay.

There is a lesson to be learned here in Pirkkala. The lesson is that the government shouldreally start investing on its primary health care if it is really serious about providing quality health

care services to its people. In Pirkkala, the primary health care unit is so efficient and so modernized

a sick patient in Pirkkala need not worry about not going to Tampere for a consultation. He could

just go to Pirkkalas health care unit and have himself seen there, tested and referred only whennecessary. The Primary health care unit in Pirkkala could do almost everything, leaving the more

complicated cases for specialists in the hospitals. No wonder the hospitals seemed to be so emptyof patients. An effective primary health care system would de-bulk the patient load in tertiary or

secondary hospitals. With a devolved health care system, it is important that the local government

units should be made more accountable when it comes to its failure to delivery quality health care.

As far as I am concerned, the Pirkkala Health Care Unit is a dream rural health unit, somethingwhich I have been aspiring to happen in my own health unit. But despite ones vision and hard work,

such a reality may not, in all tact and honesty, occur in the Philippine countryside.

The rest of the day was spent learning about Occupational Health at Terveystalo Health

Center. It is actually more of a private insurance company for workers. Companies and factorieswould insure their employees as their responsibility for taking care of their health. There are healthhazards encountered at work and because of these hazards, workers are at risk of developing

illnesses due to exposure to these hazards. The Terveystalo Health Center is focusing on those type

of illnesses related to occupation.


13/17

In the Philippines, I am not sure how Occupational Health is really considered in the health

care system. Unfortunately, there is really no comprehensive health care program for our workers

and laborers. The main issue facing our labor sector is still their health care benefits amongst otherbenefits they should be getting.

Day 6: Koukkuniemi and Viola Homes for the Elderly


The second to the last day of the practical

part of the Global Health Course was spent

visiting two elderly homes. The first elderlyhome, Koukkuniemi, is a government-run elderly

home in Tampere. It is close to our flat in

Lapinkaari. In fact, we once played football in the

field within the compound of the elderly home. Itis quite a huge complex and it is more than just

homes for the elderly. There is an available health

care facility that can cater to geriatric care. Thereare also facilities for rest and recreation.

For Filipinos, sending the elderly to homes likethis is not a common practice. Culturally, it is

even seen by many Filipinos as a taboo. Maybe because the Filipino culture is family-centered and

Filipinos are not only closely-knit as a family but to a certain extent even clannish in nature. Theearly Filipino settlers occupied the islands by families. One family would migrate from neighboring

Indonesia or Malaysia riding on one long boat called the balangay. Present day Filipino villages are

called barangays as taken from the name of the long wooden boat.

The Western culture, including the Finnish culture, does not in any way though undermine

the value of family just because they are sending their aged people in homes. There are certain

circumstances why they would opt to do so. In the first place, according to the people running theelderly home, the primary objective really is to enable old people to take care of themselves right in

their own homes. In fact, government would even assist families with old people in renovating their

homes that would be friendly to these aged people, especially those suffering from chronic illnessesor some forms of disabilities.

In many cases, children grow up and they would usually study or work far from their

original homes. And since the Finnish family is not typically large like the regular Filipino family,there are not enough children or relative to stay at home and take care of the aging parents. Thus,

there are instances when children have to decide to send their parents to elderly homes where they

can be taken cared of 24 hours a day, 7 days a week.

Due to improved health care services, the Finnish society is also experiencing some form of

demographic shift. It used to be that the population distribution follows the pyramid pattern, wherethe young population is more than the elderly population. Now, with lengthening life expectancies


14/17

and lesser mortalities, the elderly population is beginning to increase, even more than the younger

population. In a few years time, the population pattern will follow an inverted pyramid pattern.

The difference with a government owned

and private elderly home is the type of amenities

present and the expenses for the resident of theelderly home. Of course, it is expected that it can be

more expensive in a private elderly home but the

amenities are quite better compared with thegovernment owned elderly home.

In the Philippines, while we dont usually

send our old people to homes, it is a fact that thereare old people who were either abandoned or are

living alone and could not really take care of

themselves. There are old people who are chronically sick and are homeless at the same time. I amnot aware though of any comprehensive program that would take care of these elderly people in the

Filipino society. There are NGOs and church groups which would run elderly homes in various

parts of the country and I am not sure if they are subsidized by the government. However, if onetalks about a government policy or initiative, I am pretty sure there is none.

Many of our elderly people would just die without even having received their pensions.

The GSIS, the government-run social security system, is under raps because of failed fiscalmanagement and failure to deliver the pension benefits of many retirees on time. There are elderly

people who have retired from work for 10 years and still they have yet to receive their GSIS

benefits.

In the health care system, there is no comprehensive program for the geriatric population.

By comprehensive program I would mean a health care program that would involve preventive,

curative and even rehabilitative aspect of health care, covering not only physical illnesses but alsomental illness as well.

Day 7: Hospital and Private Pharmacies


The last day in Tampere, Finland was spent visiting pharmacies. The first pharmacy we visited was

the hospital pharmacy in Tampere. It was a big pharmacy since it actually works as a central supply

office for all the other primary health care units within the district. That is why it has a hugewarehouse filled with medical supplies and drugs which they either dispense at the hospital or would

send out if other municipal health units within the district would purchase some of their needed

medical supplies and drugs.

Since its a hospital pharmacy run by the University of Tampere, it is also involved in

clinical research. Drug companies can collaborate with the Hospital where they can conduct theirclinical trials on certain drugs.


15/17

What I loved about the tour was how

centralized everything was even if the drugs

were just dispensed within the hospital. ThePharmacy department would prepare all the

ordered drugs and pack them and label them

with the patients name and bed number or roomnumber whichever is appropriate. This would

minimize erroneous drug administration and

wastage of drugs as well.

If one is admitted in the hospital, he or

she gets some medicines for free, especially

antibiotics. For over-the-counter drugs though,the patient has to purchase it from a private

pharmacy or any pharmacy outside of the hospital. So, if the patient is discharged with take home

instructions of continuing his Ibuprofen at home, he must buy that Ibuprofen from an outsidepharmacy.

That is where we went next. We visited a Pharmacy run by the University of Helsinki.What was so unique in this private pharmacy is that all over-the-counter drugs are placed on stands

just within the pharmacys lobby so if one needs an Ibuprofen (which is an over-the-counter drug),

he could just go to the aisle where they keep this kind of medicines and grab a box and proceed to

the cashier and pay.

For the prescription drugs, these are stored behind the counter and of course one would

need a prescription from the doctor in order to buy these drugs. The counters in this pharmacy are sowell organized. People take a number and wait for their number to be called. If your number is called

you go to the available cubicle where a pharmacist is waiting behind the table with the computer and

he or she will take your prescription and encode on the computer the medicines prescribed by the

doctor. While she is doing this, an assistant would already retrieve these medicines for you.

What is nice is that the pharmacist,after storing the data on the computer, can

advise the patient or call the prescribing doctor

if the medications the doctor prescribed would

have some drug interactions with the presentmedications being taken by the patient. At the

same time, since there is already a record of the

patients medications, if he or she comes back tothe pharmacy for another prescription, his or her

record will come up and the pharmacist can thengive advice or call the doctor again if there aresome missing drugs or drug interactions present.

There are medicines that are covered


16/17

by insurance and these are reimbursable drugs. There are some over-the-counter drugs that are not

reimbursable. Another interesting observation is that, there are assistants present in the lobby of the

pharmacy who can also give advice as to the kind of over-the-counter drugs you might need. What isnoteworthy is that, these assistants would usually give advice as to what drugs that are affordable for

the patient. Assistants would also teach and remind the buying patient as to the doctors instructions

on how to take the medications. Drug prices are also controlled in a sense that the price of Ibuprofenfor Private Pharmacy A is the same in Private Pharmacy B. In fact, drug prices are the same

throughout Finland thus the price of Ibuprofen in Helsinki will be similar to the price of the same

drug in Tampere.

In the Philippines, accessible to cheaper drugs is still one of the many health issues

hounding the health care system. While there have been laws imposed already such as the Generics

Act and the Cheaper Medicines Act, there are still certain essential drugs that are not available formany simply because they are not affordable.


17/17

widening perspectives: the 7th global health course

Documents