Yen B. Delgado
Carmel Mathilda Blanco Ladeza, M.D. normally wears pants to work but not today. She wants to please her five-year old daughter Juliana by wearing a dress.
She bids Juliana and her two other children, 12-year-old Carlo and 3-year-old Alberto, goodbye for the day and gives instructions to the child minder. She hurries to the car, trying not to let the drizzle soak her clothes too much and thinking about the number of patients that would already be waiting for her at the health center. Many patients, especially those from distant villages, start arriving as early as 6 a.m.
She gets into the car and turns the key, but the car won’t start. She tries again. Nothing. Ladeza, who goes by the nickname Maita, asks the child minder to call a habal-habal driver and steels herself for the ride. For the hundredth time, she questions her decision to relocate the family to Gayam, a tiny seaside village 20 minutes away from the highway. In her small SUV, the unpaved road is challenging. On a habal-habal during the rainy season, it can be lethal.
She thinks of changing to pants but the habal habal arrives. She hops on the motorcycle and rides side-saddle.
The Tampilisan Municipal Hall sits on top of a hill like a king on a throne. On the slopes are several box-like government buildings including the Tampilisan Municipal Health Center, where Ladeza works. The patients loitering in the front yard stare at their doctor bug-eyed. From her hair to her heels she is spattered in yellow-brown mud. She marches in.
In the washroom, she does her best to wipe away the mud and changes into clothes she finds in her office. She takes a deep breath, goes out, and tells one of her workers to let the first patient in.
Perfecting the 3-minute consultation
Ladeza passed the medical board in March 2000. She arrived in Tampilisan as the town’s newly minted municipal doctor two months later.
When she first started, the health center saw an average of 50 patients a month. Sixteen years later, she sees an average of 50 patients before noon, every day.
A few weeks ago she posted on her Facebook wall photos of the crowd of patients waiting to see her, and captioned it, “It’s a Tuesday that feels like a Monday. This was what greeted me when I went out from my clinic to call my 46th patient. It was just 10 a.m. I ended with 70 patients at 11:30 a.m., 2.6 minutes each, my poor patients.”
The comments section of this Facebook post is filled with messages from fellow government doctors in neighboring towns. They compare notes, encourage each other, and joke about strategies. One said, “Even before the patient sits down, I have written out a diagnosis already.”
A popular private doctor in the city might get 30 patients in a day. A really popular one, 50. Ladeza sees an average of 80 per day. Her record was 120.
It is physically and mentally draining. As a medical student, she saw doctors snapping at patients and vowed to be more patient. Now, she admits to losing her cool from time to time.
“It cannot be helped,” she says. “When you are just on patient number 25 and you know 45 more are waiting, you feel the pressure.”
The official list of duties and responsibilities of a municipal health officer is formidable. Not only is Ladeza expected to see patients who go to the health center, she is also on call 24/7. Ladeza has been roused in the middle of the night by midwives to help with difficult deliveries and by the police to do post mortem on victims of violence.
More taxing than being the town’s clinician is the work as administrator of all rural health services: assessing the community’s health status, planning and implementing programs, monitoring budget, managing a staff of 26 and preparing reports.
Ladeza likes to do off-site activities including talking to public school children as they wait in line for their de-worming pills. She enjoys hiking to far barangays to immunize babies.
Her co-workers have long noted Ladeza’s soft spot for visiting distant villages.
Rosa Alalong, 49, is the Barangay Health Worker of the village of Balakbaan. “Organized kaayo si Dok. Sauna mo derecho mga tawo sa private. Karon sa health center na (Dr Ladeza is very organized. Before people would go to private doctors. Now they go to the health center).”
Ladeza strives to be friends with all government officials but knows some of them resent her for her salary grade.
In a bid to attract more doctors to serve in remote towns, the Department of Health increased their salaries to at least P56,000 a month. Mayors receive less. Despite this, several towns still do not have doctors.
Most of Ladeza’s medical school classmates have private practices. She feels she does not have what it takes. “I am not good at marketing myself. I would not know how to collect fees to save my life.”
She is realistic too. “When I was younger, I thought serving the poor was romantic. Now that I am older, serving the poor may not be that romantic, but it is very, very gratifying and humbling. To survive, I need somebody to pay me a salary.”
Right after nursing school in 1992, Ladeza joined Jesuit Volunteers Philippines, a group that tapped fresh university graduates for volunteer work in poor communities. JVP’s recruitment website requires applicants to be “physically fit and emotionally balanced” as well as “determined to make a positive difference in the lives of others.”
JVP sent Ladeza to work as a nurse among Aetas living in isolated mountains in Floridablanca, Pampanga. Aetas are thought to be the earliest inhabitants of the country. Some Aetas have modernized but the ones Ladeza lived with led a primitive life. They were nomadic, did not send their children to school, and sustained themselves by hunting and gathering.
Once when Ladeza had fever, the Aeta women gathered around her bed to chant and wave banana leaves over her in a ceremony to drive away the evil spirit that was making her sick. Years later, as a new doctor tending to her father at his deathbed, Ladeza teased him and said, “If you do not get well, I will perform an Aeta ceremony on you.”
Ladeza has six siblings. Their parents were Ramon, a military lawyer now deceased, and Annabella, a pharmacist. When Ramon was assigned by the military to Zamboanga City in the late 1970s, the family followed.
After two years with the Aetas, Ladeza went back to Zamboanga City to look into a medical school that was about to open. It had a curriculum radically different from other schools. Instead of lectures and laboratories, students were sent to remote communities to learn on the job. It was a curriculum designed to mold community doctors.
From her second year in medical school until graduation, she lived in Sibuco, a coastal municipality in Zamboanga del Norte. Travelling to Sibuco involved riding a small motorized boat on waters infested with sharks and pirates.
A major condition of her medical school scholarship was to work as a doctor in a marginalized town in the region.
Tampilisan, Zamboanga del Norte, population 24,307, is four hours away from Zamboanga City. It is a mountain town where it rains like clockwork every afternoon. Fog often shrouds the town. Vegetables and flowers thrive here but the leading product is rubber. The town boasts a breathtaking waterfall but locals warn against going there without an armed escort as members of the secessionist group, Moro National Liberation Front, frequently patrol the area.
When the health center was turned over to her in 2000, Ladeza was disturbed by the fact that almost no one availed of the center’s services. Ladeza likes to solve problems. “I took the fact that people regarded government services as second rate as a personal challenge. I thought that with the right leadership, government health providers can compete with private institutions in terms of health services, client relations, technology, etc.”.
Asked if she has succeeded at her job, she pauses and says simply, yes, citing as evidence the immunization vaccine the children receive which is the same one private pediatricians give. But while private clinics charge P 3,500, the center charges nothing. Statistics show 85 percent of pregnant mothers deliver their babies at the Rural Health Center. She says the strongest indication she is doing her job well is the volume of patients.
“A lot of them come because most services – consultation, laboratory, medicines — are free. I also like to think it is because they were treated well the last time they came,” she said.
It was only last year that Ladeza and her husband Julito, an accountant with the provincial government, decided to build their own house.
It sits on a hill fifteen minutes away from the health center. On most weekends the doctor can be found at the garden. Some weekends though, the family goes to Zamboanga City, to visit relatives and spend time at the giant mall.
Long-distance travel is a fact of life for Ladeza. Her most memorable trip was a bus ride in 2010, going home from Zamboanga City. Midway through the journey, as they were traversing an isolated area near the border, armed men strafed their bus. The driver managed to bring them to a nearby village before he collapsed. Lazeda was seated three rows behind the driver who eventually lost his legs to gunshot wounds. Ladeza still has a three-inch scar just above her left knee to remind her of the attack.
She has received kidnap threats as well. However, when asked what she regrets most about the life she chose, Ladeza says she worries about her kids missing out on city opportunities such as access to art and music school.
Ladeza sees herself living out her life in Tampilisan. “It feels like home. When I think about Daddy being buried in Zamboanga, and how he might feel about most of us being away and all, I think that will also be how I feel if I am dead and buried in Tampilisan. I’ve known several homes, Tampilisan is the one of my choosing, the one my kids are growing up in, so it is the one closest to my heart.”
(Photo shows Dr Ladeza biking for fun and exercise in front of the Tampilisan Rural Health Unit. On work days, she either walks or takes the car to and from her home a short distance away.)