Ramon Magsaysay awards: Pinoy doc champions health care for all

MANILA, Philippines - There was a time when Dr. Ernesto Domingo, the Filipino among this year’s crop of Ramon Magsaysay awardees, thought of staying in the United States for good.

It was the mid-’60s and he was a Brainard Fellow in Preventive Medicine at the Case Western Reserve University in Cleveland, Ohio.

Coming from a humble background in Manila, the American dream beckoned.

“Besides, the conditions back then were not favorable. It was a time of political turmoil and the country was on the verge of martial law,” Domingo told The STAR during an interview at his clinic in the Manila Medical Center where he is a practicing hepatologist.

At the time, the 76-year-old Domingo said many of his fellow doctors opted to stay in the US for a much more comfortable life.

“The likelihood of achieving what you want is higher in the US because the opportunities are all there. We are not very rich, my father is a simple bookkeeper and my mom’s relatives are fisherfolks. The opportunities in the US became very tempting to me,” he said.

Deep in his heart though, Domingo wanted to go back to Manila, to fulfill the social side of his profession. And he did – he followed his heart.

“Being poor was a major influence in all the big decisions that I made in my life, particularly my decision to go back in the Philippines, I know what it’s like to have nothing. I returned to the Philippines from the US because my fellowmen need me,” he said.

From there, Domingo devoted most of his adult life to research and using medical science to promote the quality of life of everyone, especially the poor.

In electing Domingo to receive the 2013 Ramon Magsaysay Award, the board of trustees recognized his “exemplary embrace of the social mission of his medical science and profession, his steadfast leadership in pursuing health for all as a shared moral responsibility of all sectors and successful advocacy for neonatal hepatitis vaccination, thereby saving millions of lives in the Philippines.”

Domingo said he felt very honored and inspired to receive the award.

“Coming from a prestigious award like the Magsaysay, this is really, really special,” he said.

Focusing on the scourge

Domingo said when he came back in 1967, he joined UP-PGH to be a full time assistant professor, as part of his agenda was to study liver cancer.

Liver cancer particularly sparked his interest because at the time, it was a high profile scourge and he was bothered by the number of patients dying at the PGH ward.

He lost no time in organizing the UPM Liver Study Group, which had members all over the Philippines.

“We found out the most important cause of liver cancer is an infection with a virus called Hepa B, an infection that if not cured, will be a major cause of liver cancer, so we thought, we must vaccinate the babies for prevention of Hepa B infection,” Domingo said.

Domingo’s group determined the preventive solution to liver cancer was the immunization of newborns from birth, which would reduce the probability of acquiring hepatitis by 95 percent.

There were challenges along the way because during the mid-80s, a Hepa-B vaccine was very expensive.

What Domingo did was to secure funding from international donors to green light the project. Domingo and his group also embarked on efforts to lower the vaccine cost.

“Finally the vaccine price came down, so we began mass vaccination,” he said.

Another challenge was to reach mothers living in far-flung areas, and the Department of Health’s lack of budget for the Hepa B vaccines.

“In our quest for the mass vaccination of infants, we encountered all of these problems in the 80s to the ‘90s, but we found solutions, so finally in early 2000, with the help of Sen. Pia Cayetano, who legislates free vaccination for all infants in the country, we have finally succeeded,” he said.

The Hepa-B vaccine became available in all birthing facilities. Mothers who give birth in birthing facilities are given the Hepa-B vaccines for free, Domingo added.

But Domingo said even if the vaccines became available, most mothers, especially in the rural areas, would only avail of the first vaccine.

For effective immunization, babies should get all three vaccines.

“But for some reason, mothers are not able to give their children the second and third, there are many non-medical reasons why it can’t be completed and that’s why the mass vaccination for Hepa B is still a work in progress,” he said.

Domingo admitted there’s still no dramatic drop in cases of liver cancer today.

“We haven’t achieved a 100 percent rate for zero liver cancer. For us to see the dramatic drop, we need a minimum of three to four years from vaccination starting in the mid-80s. It should be a continuing advocacy, we are not stopping with our work,” Domingo said.

Unless you reduce the carrier rate at two percent, Domingo cancer cases will not drop. “Our current rate is 12 percent, lowest carrier rate is 6 and the highest carrier rate is 16. They said to bring it down, we should achieve at least two percent for the carrier rate. To achieve a two percent rate, at least 95 percent must be vaccinated within 24 hours and at least 85 percent must complete the three vaccines,” he explained.

Domingo stressed the importance of mothers giving birth at birthing facilities, not at home.

“But there are cases that they can’t give birth in birthing facilities. The vaccines are available there,” he said.

This is why said it is important to achieve Universal Health Care for Filipinos, he said.

Universal Health Care

In 2008, Domingo and colleagues formed the Universal Health Care (UHC) study group, committed to advancing, through research and advocacy, the goal of universal health care in the Philippines.

Based on intensive studies of the country’s health system, the group produced a “Blueprint for Universal Health Care” and actively campaigned for its adoption when the current administration assumed power in 2010. As co-convenor of the group, Domingo was influential in crafting the government’s Kalusugang Pangkalahatan (Universal Health Care) program.

“Our goal is to make the dream of health care based on health needs – rather than the ability to

pay – a reality for the Philippines within the near future. Any Filipino would like to see a situation in other countries that you don’t have to worry about a single thing, where everything is taken care of,” he said.

Domingo cited Sweden, a socialist country where all the needs of its citizens are taken care of.

In Sweden, Domingo talked to a doctor and they discussed their salaries. He learned that the Swedish doctor salary’s is slightly higher than a bus driver, but he is not complaining even though the government tax is high.

“I asked him why he is not migrating to America like other doctors and he said the living conditions in Sweden are better. The government taxes them at 50 per cent of their salary but no one is complaining because he doesn’t worry about housing, he has a flat provided by the government, the education of his children is taken care of from elementary to college. They have vacation leaves with pay,” Domingo said.

“He has a point. Sweden is a socialist country but it’s just a name. Who would want a big pay if it’s all spent on food, house, education, etc... I don’t mind if the government will get higher taxes just as long as it will take care of my needs from cradle to grave. I wish we were like that,” he said.

Domingo expressed hopes that universal health care will not just address inequities in health.

“Hopefully it will address the other basic needs of a Filipino citizen. The important thing is if you get sick, you must have access to it, health is a fundamental right, it is right to life, everyone has a right to health …because these services were not delivered to you, the government has a responsibility and you have a right to sue,” Domingo said.

He said it was saddening to see the conditions in the 70s for needy patients are still the same today.

“You go to the PGH in real time, in real terms. The patients have no transportation fare, they cannot go home. They will ask the doctor for money and the doctor will give from his own pocket. But the doctor is poor too because his salary is very low,” Domingo said.