UP Manila School of Health Sciences (SHS):

A model for non-traditional community-based health training

 

 

By Maria Teresa Antonio-Santiago, MD

UPCM Class '79

 

 

 

(Published in the UPMASA Newsletter of the U.P. Medical Alumni Society of America, December 2000.)

 

 

 

It began in 1976 as the Institute of Health Sciences of Leyte, a bold experiment in medical education by the UP College of Medicine.  The school was designed to develop community-oriented health workers and counteract the twin problems of "brain drain" and the maldistribution of health care. In the 1900's, more than 50% of traditionally trained Filipino physicians left the country for affluent countries like the United States. It was also estimated that while medical care was concentrated in urban areas, 70% of Filipinos living in rural areas were left with inadequate medical resources.¹ In 1989, the school became the School of Health Sciences, an independent unit of the University of Philippines, Manila.

 

Twenty years and ~1400 graduates later, SHS has attained international acclaim and recognition as an innovator in the field of health personnel training. It is a "model for shifting health sciences education towards community orientation and community-based training." These accomplishments were made despite an annual budget that has not exceeded 4% of the UP Manila budget, at 40% the cost of producing a "traditional" physician and <75% of the DAILY interest ($350,000) paid by our government for the defunct Bataan Nuclear Power Plant.²

 

Sixty three per cent (63%) of students enrolled in the school come from the Leyte-Samar region. Majority of the graduates train to be grass roots community health workers or midwives. Of 1165 graduates who completed the barangay health worker program, 899 continued to complete the community health worker or midwifery program. Four hundred twenty-six (426) finished the community health nursing program and 281 finished the Bachelor of Science in Community Health program. Forty-five (45) graduates are physicians (3.4%). Eighty percent (80%) of licensed physicians are employed in different district hospitals or provincial and rural health units. Four (4) are municipal health officers. The school estimates that 75% of graduates at all levels are rural based and 95% remain in the country.²

 

To train a unique community-based professional with deep roots in the community and who will be committed to serving it, the school developed innovative "counter-culture" curricula and training programs that depart radically from traditional methods. The school has a highly democratized admissions procedure that gives the greatest responsibility for student recruitment to the community. A "step-ladder" curriculum emphasizes community health relevance in manpower health education RATHER than academic excellence. The principle of "service leave" at each level of professional training integrates worker's training with the needs of his home community. The school relies on links to community organizations and manpower as well as Research and Development activities to "contextualize the school's academic pursuits with field realities." ¹ The school trains relevant and effective rural health workers but also plays a vital role in health sector reform in the Philippines.

 

The heart and soul of the institution are heroic community-based workers and innovative academicians in the field of "health social sciences" like Professor Rolando Borrinaga. In numerous speeches and articles, one sees the spirit and ingenuity of mentors like him. He acknowledges the importance of the rural health worker in establishing rapport and changing health-related attitudes of the people in their communities. His resourcefulness and creative thinking show through as he approaches the myriad of health problems facing people in rural communities.

 

In a talk to rural midwives in 1997, he cites reports that describe the poor nutritional status of mothers and children in the Leyte-Samar region as well as a Philippine Daily Inquirer article stating that 60% of Filipino children drop out of school in the second grade because of poor brain development traceable to malnutrition in early infancy. Instead of focusing on the lack of food or trying to buy expensive packaged versions of locally available food, he feels that the answer to solving rural malnutrition is enhancement and diversification of food that is abundant and cheaply available locally.³

 

The barangay health worker and community midwife face a unique set of daily challenges including cultural misconceptions about health, rising floodwaters, rebel groups and opposition from community leaders. Prof. Borrinaga writes that "Actual experiences with life-and death situations had always provided our students with opportunities for continuous self-realization and reassessment of their own strengths and limitations in terms of the required health knowledge, skills and attitudes at the community level. Their helplessness over failures have always inspired them to study more and perform better the next time around."⁴ The school uses the community as the classroom where students can learn from their mistakes and benefit from their experiences. 

 

Many of us schooled in traditional medicine still recall our most dramatic life and death experiences as young doctors in training in city hospitals. Maybe we can still feel and remember our first delivery: the chlorine smell mixed with blood in the delivery room, the bright lights, the resident or intern and nurse right behind us with words of encouragement, the constant beeping of monitors, and hurriedly putting on cap, gown and gloves as we waited to welcome a new life into the world. Our first experience was probably a mixture of fear, excitement and exhilaration as the child's head emerged and it gave out its first loud cry.

 

Picture the same experience as a 16 or 18-year-old barangay health worker, in a dark house in the barrio where the hilot is not available. The story told by one such worker is a revelation:        

 

"…There were no other hilots around, I was called to handle the delivery of the laboring woman. I felt afraid of the invitation. I tried to explain that I had no authority to handle deliveries; that I had not observed any child delivery myself. Still I went with the family members who fetched me, to help them look for another hilot who can handle the delivery.

The "true labor" came and there was still no hilot around. When the contractions in the woman’s stomach became more frequent, to minutes’ intervals, my heart also beat faster and faster.

I did not show my fear to the family of the woman, even if I knew I did not have a cord clamp to use, betadine solution with which to clean the cord, and scissors to cut the cord. I kept on imagining the steps involved in handling a delivery as lectured to us in SHS.

The head of the baby was coming out, then it got stuck in the vaginal opening. After about 30 minutes in that same situation, I said that the woman needed to be referred to the clinic, some four hours travel from our barangay. Somebody called for a vehicle, another prepared a pack of extra clothing for the woman, and another was praying aloud.

I was on the verge of crying myself, but I tried to hide my tears. The vehicle had arrived; the bags had been packed. As the laboring woman was about to be lifted, she held her breath and this caused another contraction in her stomach. This was enough to push the head of the baby out. There was a shout of thanks from everyone.

I noticed that the cord was strung around the neck of the baby. I was afraid to handle that, but I tried to remember the appropriate procedure taught me by the rural health midwife. I inserted two fingers between the baby’s neck and the strung cord, and gently pushed up the cord towards the head.

After this procedure, I cut the baby’s cord using a bamboo stick sharpened with a knife, tied the cord stump with cotton thread, and then bathed and dressed the baby. I also gave tips on handling newly born infants.⁵

 

It is through articles and personal experiences of workers and Prof. Borrinaga and his colleagues that we see the miracle that is SHS -- once a dream like an infant with a whole world of possibilities ahead of it, now after twenty years of enterprise and hard work, a young adult that can stand with his head raised proudly: an accomplished innovator and model for community based health care training and a resource for Philippine health sector reform.

 

 

References:

 

1.        Borrinaga, Rolando and Tantuico-Koh, Isabel. The Roles of the U.P. Manila-School of Health Sciences (UPM-SHS) in Health Sector Reform in the Philippines.  Paper and poster presentation at the "Regional Conference on Health Sector Reform in Asia," May, 1995.

 

2.        Borrinaga, Rolando. The Accomplishments of the School of Health Sciences. http://www.oocities.org/rolborr/shshome.html

 

3.        Borrinaga, Rolando. Thoughts on the Devolved Midwives. Speech before the 3rd Scientific Meeting of the Integrated Midwives Association of the Philippines, Inc. Biliran Province. May, 1997

 

4.        Borrinaga, Rolando. Significant "Service Leave" Experiences of BHW students. Case study commissioned by the Philippine Health Social Science Association (PHSSA) and presented at its scientific session in Bacolod City on April 6-7, 1995.

 

5.        Memorable "Service Leave" Experiences of BHW Students. A case study commissioned by the Philippine Health Social Science Association (PHSSA) and presented at its scientific session in Bacolod City on April 6-7, 1995.