A system of care

The COVID-19 crisis has in many ways exposed the incompetence of several of our country’s public officials, not just in terms of pandemic response, but also in the apparent absence of development and support for several important sectors and societal institutions over the past years. Among these key areas is the healthcare system, shoved into the spotlight by the ever-rising patient numbers compounded by the lack of medical supplies and facilities.

Clearly evident is the need for greater investment in local scientific and medical sectors; however, financing the provision of medical services alone cannot guarantee good health. To empower the local health system, we must move with the understanding that health is not solely a biological concept, but more so a social undertaking.

From a purely biomedical standpoint, our approach to diseases typically revolves around aspects such as causes and prevention, detection methods, prognosis or possible outcomes, and treatments and interventions. This involves a more individualistic lens, focusing on the dynamic between patient and healthcare personnel, such as a doctor or nurse, and although wholly important and necessary, its scope often proves insufficient.

When we talk about health, this scale expands to the community level—encompassing facets of equity, collaboration, and social determinants, including socioeconomic class, livelihood source or employment conditions, and educational attainment.

However, we have seen time and again that the bigger picture is often overlooked. For infectious diseases, for example, the issue lies not just in harboring the bacteria, viruses, or parasites within one’s body, but also in environmental factors like poor sanitation increasing the risk of acquiring infection. Treatments could be administered, but re-infection remains likely if there is no consistent water supply to encourage proper hygiene, or if malnutrition continues to be unaddressed, aggravated by impoverished conditions; families may be hesitant to take medicine or may be averse to vaccination, even if supplies are available, due to not comprehending their purpose and significance.

The COVID-19 situation is rampant with similar issues if we examine the different measures that were put in place. Limited transport options hinder those in need of hospital visits and medical services. Health protocols like physical distancing are impossible to comply with in crowded settlements. In the first place, guidelines and the implications of the disease have rarely been communicated clearly and not in a language comprehensible to all.

The quarantine has been disparaging for many—disproportionately affecting the low-income class whose economic stability and job security had already been on a knife edge prior to the pandemic, but were jeopardized further by the lockdown. Movement restrictions and industrial shutdowns on a large scale have immobilized sources of livelihood for numerous households, blocking their means to make a living. Those who earn on a daily basis cannot afford to not work if they are to feed their families. For them, the crisis was not defined in terms of the disease outbreak, but in the income loss, piling debts, extreme anxiety, starvation, and even violence.

These circumstances have also created additional strain on doctor-patient relations. Individuals would be reluctant to disclose their medical history or would deny symptoms, especially since being tagged as sick during this time would likely deprive them of work opportunities. Health workers themselves have been discriminated against, for fear of being viral carriers.

Mutual trust was severed. This top-down approach was problematic because it was detached from the problems occuring on-the-ground and paid no heed to the value of nurturing partnerships with a participative community. The response was not rooted in people’s lived experiences before and during the crisis. Treating the pandemic as a security problem, interventions have focused on compliance rather than care.

The sobering reality is that availability does not equate to accessibility. Indeed, what most fail to realize is that the problems that a person experiences are always intersectional; they cannot be segregated, and attempts at solutions cannot be segregated either.

Instead, health systems must be integrated and coordinated through a multi-faceted, holistic approach. On top of funding medical centers and equipping personnel, public leadership that acts toward people-centered healthcare entails establishing support structures in other sectors—such as shelters for the homeless, technologies for remote working or schooling arrangements, guaranteed distribution of food, and subsidized wages or more sick leaves with pay.

Health itself must be fostered within the context of communities. Marginalized sectors, including indigenous groups, the LGBTQ+ community, and persons with disabilities, need to be listened to and considered when making decisions about implementing policies and programs. With co-production and inclusivity as guiding principles, citizens themselves are empowered to be more involved, with the most vulnerable recognized as vital parts of society and as active agents of social change.

By Erinne Ong

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