It is a nightly pain for construction worker Gabby Mina to watch his son Axcel sustain prolonged seizures due to focal epilepsy.
But before he can even have his five-year-old’s brain injury treated with a hospital’s facilities and guidance, Mina has to pay a hefty sum of P2,000 in commuting fares in different rides. Carrying Axcel in his arms, they move from taxi to jeepney to tricycle under sweltering heat just for their weekly check-up.
After searching for nearby hospitals in Quezon City, Mina was left with no choice but to opt for Asian Hospital and Medical Center which is a three-hour commute from his house in Payatas. On top of excessive commuting expenses, he shells out P1800 for the doctor’s fee every visit.
It isn’t new for people like Mina to have to go through great lengths just to receive healthcare. After all, there are no government hospitals in Payatas despite it being the third most populated barangay in Quezon City. Hospitals in nearby barangays were off the table as they either already breached their patient capacity or lacked proper equipment.
In Quezon City, a hospital is a rarity as it can be found in only 22 of the city’s 142 barangays. These hospitals are not only rare but also poorly distributed, experts say, as the city’s poor urban planning has made them too close to each other but too far from areas that need them the most.
On average, a Quezon City resident is 1.38 kilometers away from the nearest healthcare facility, according to a Rappler report. This is the length of about 125 jeepneys and a half put end-to-end.
In contrast, Pasig City residents on average are seven meters away from the nearest health institution. That is about seven jeepneys lined up together.
Most of Quezon City’s hospitals lie at its edges, leaving a sparse distribution in the center where the most densely populated barangays lie.
Esmeralda Silva, associate professor at the UP Manila Department of Health and Policy Administration, said that some hospitals are meant to clump together to form “specialized clusters.”
For instance, many hospitals stand along East Avenue, but each of these specializes in a certain type of healthcare.
“Para ‘yang matrix,” Silva said. “Walang magkakapareho ng serbisyo dyan. Heart, kidney, children. Iba-iba siya ‘di ba? They complement each other,” she added, referring to the Philippine Heart Center, the National Kidney Transplant Institute and the Philippine Children’s Medical Center (PCMC), huddled together in the city center.
Specialized clusters operate on a referral system, where hospitals point patients with specific medical needs to a facility in the area whose expertise can better handle them.
But this system needs to be reviewed, Silva added, as referrals are often inefficient and the clusters are muddled with corruption.
In other instances, however, hospitals group together even if they offer the same services. There are clusters in the city where tertiary care or general hospitals compete with each other for clients. Silva said these clusters can lead to higher medical fees due to competition.
“Of course, they want to serve. But still, they’re profit-oriented. ‘Pag private, ta’s nag-cluster kayo, that becomes problematic. Kasi kayo-kayo lang ‘yan,” Silva added.
AHMC, where Axcel was admitted, is a tertiary care private hospital. A few kilometers away stands Ospital ng Muntinlupa, the city’s primary tertiary public hospital. Even closer is another competitor: Alabang Medical Center.
On its website, AHMC boasts its “hotel-like ambiance,” being part of the First Pacific Group headed by business magnate Manuel Pangilinan.
“May kamahalan po [ang gastusin sa ospital]. Nagawa po ang ibang laboratory [fees], pero sa totoo lang po, sa ngayon, hindi na po namin alam [anong gagawin],” Mina said.
Mina reached out to barangay officials for help, but after waiting in long queues, they were only given a scanty P800. Mina said that their hospital fees can surge up to P30,000 — 40 times what they were given.
Silva said the far commute that patients like Mina make to a hospital is not only expensive but discouraging too.
“Ang pasyente, hindi laging default ‘yun na pupunta siya sa doktor,” Silva added. “Marami siyang kailangan isipin: ‘Maliligo ako, magbibihis ako kasi pupunta ako sa doktor.”
In a 2009 study that Silva co-authored, the distance between patients and health facilities was found to be the ‘biggest obstacle’ in getting healthcare. Coupled with bad roads and the lack of transportation, they become a discouraging “potent combination.”
Beyond physical barriers, Silva added that economic and cultural factors can also discourage patients from going to hospitals.
“May pera ka bang pamasahe? Type mo ba ‘yung mga tao doon sa ospital? Gusto mo ba ‘yung serbisyo doon? Hindi rin natin pwede tignan na it’s just physical access ‘yung problem sa Quezon City,” she said.
On the other end of healthcare are medical workers, who themselves struggle to get to hospitals.
During the country’s first enhanced community quarantine in 2020, medical workers had to walk to work or sleep in clinics after the government suspended public transportation.
One of these was Julie, who preferred to withhold her identity. She is a nurse at the PCMC, a hospital in the East Avenue cluster. She has to ride a stretch of seven kilometers on a bus or taxi to get there from her house in Batasan Hills.
This adds a strain to her work of tending to COVID-19 patients in the facility.
“Pikit-mata na lang sa pamasahe para safe makauwi. Pagod talaga, mas lalo ngayon naka PPE in-full,” she said.
Joyce Aguirre, a landscape architect, said that medical workers like Julie already faced commuting pains like traffic congestion even before the pandemic. Road problems hampered emergency operations, which spelled life or death for many patients.
“The speed of going [to the hospital] is limited by the traffic, the time, the distance and are limited by money. Because if you do not have the money to hire an ambulance, you have to commute,” Aguirre said.
Julie mentioned that some of her colleagues go home to provinces as far as Bulacan or Rizal. Although she shares the same commuting pains with her patients, she feels helpless that she cannot help them.
The Hospital Licensure Act (HLA) took effect in 1965 to set in place requirements to build hospitals in the country. But amendments that considered hospital distribution in cities took around 40 years to enact.
In its 2006 version, hospitals had to submit a “Certificate of Need” (CON), which necessitated that its construction would relax the current bed-to-population ratio. They should also be built at least one hour away from the nearest hospital if traveling by the “usual means of transportation.”
However, the 2006 planning-sensitive amendments were imposed too late, as many hospitals in the city were already built prior to its implementation, with some dating older than the Hospital Licensure Act itself.
Hospitals lining E. Rodriguez Avenue for example, such as De Los Santos Medical Center, St. Luke’s Center and the National Children’s Medical Hospital were all built decades before the 2006 amendment of the HLA. The same applies to another cluster in Brgy. Ramon Magsaysay, with Quezon City General Hospital, Allied Care Experts Center – Quezon City and J.P. Sioson General Hospital and Colleges, Inc.
None of these hospitals were required to submit a CON as they preceded the licensure law’s amendment.
“The law could very much be outdated. There are variables used in 1965 that could have already changed,” Aguirre said.
Aguirre added the outdated HLA and its implementing rules and regulations should be revisited.
TNP reached out to the Quezon City Planning and Development Office for comment, but there has been no response as of press time.
Despite intense criticism from members of the community, the University of the Philippines (UP) decided to keep the wheels turning for the construction of the Philippine General Hospital (PGH) in its Diliman campus.
UP President Danilo Concepcion revealed in 2017 that PGH-Diliman will be part of a “medical complex” in Quezon City that will include a College of Medicine and a Genomic Cancer Research Institute.
Nine and a half hectares of the university’s Arboretum were reclassified into an “Academic Support Zone” in November 2020 for the construction of the 19-billion PGH-Diliman. The construction entails uprooting trees in the city’s last rainforest, much to the risk of the community that has long lived there.
Residents of the Arboretum have long protested against the destruction of their community, with a successful blockade of the university’s ocular visit to the construction site on May 14 being their latest triumph.
“My question is always: ‘Does Diliman really need one?’ I mean there’s no problem if you put a facility in Diliman. As far as I’m concerned there’s really no problem with that. You could always build one. But the thing is, anong klaseng facility?” Silva said.
Aguirre said that while Quezon City is already saturated with the biggest hospitals in the metro, there is still a rising demand from the city’s growing population.
“I think people have the right to question [the construction of PGH-Diliman]. Because why [would it be built] in this area, why now, why here?” Aguirre said.
Silva said hospital access has been a time-old issue.“Nalaspag na siya nang sobra-sobra. Everybody talks about it and we can’t make heads or tails about it,” she added.
Governments should be “more proactive and less reactive” in their urban planning policies, Aguirre said. She adds that a lack of political will can easily derail projects.
“Priorities always change, especially [since] we have this upcoming election here. The direction of the next administration can be different,” Aguirre added.
Calls for better hospital access in the country were dilated by the global COVID-19 pandemic. Six house bills submitted to the House of Representatives during its 18th Congress aim to amend or repeal HLA altogether, in favor of a more “updat[ed] regulation of the industry.”
Four of these bills appeal for the creation of a Bureau of Health Facilities and Services which will oversee the creation and maintenance of health facilities in the country. The other two bills seek to toughen up penalties in the HLA and change the hospital classification it enables.
The local government of Quezon City has yet to set in motion plans to improve hospital access to its citizens, particularly those lacking hospitals in the most populated barangays.
Non-government organizations continue to advocate better urban planning in the country, but better hospital access for Filipinos will remain up in the air as long as deciding officials sleep on it.
While access to a hospital might be too large of a problem for government agencies to tackle, it is a matter of life-and-death for people like Mina and his son Axcel.
“Sana po ay ‘wag nila hayaan ang kagaya naming mahirap na hindi makakapagpagamot dahil sa kapos sa financial,” Mina said.
You may donate to Gabby Mina and his son Axcel through his GCash number 09959545768.
With reports by Gabryelle Dumalag