Doctors who show up

By Herman M. Lagon

There are government programs that look good in press releases and disappear the moment the camera leaves. The Doctors to the Barrios program is not one of them. It has survived because the need has never left. In 1993, then Health Secretary Juan Flavier started DTTB to send physicians to doctorless and underserved communities, the places maps recognize but systems often forget. Thirty three years later, the principle still holds: if people cannot reach a doctor, the doctor must reach them. The shortage in rural areas remains, making DTTB as relevant as ever. It stands as one of the late Senator Flavier’s most practical and humane programs.

This hits closer to home now. My daughter serves in a rural health unit in Iloilo, and through her, I have seen what “last-mile care” really looks like. In earlier fieldwork with barangay health workers, one thing was always clear—kulang gid ang doctors. Plain, steady, and real.

Inside a rural health unit, numbers lose their abstraction quickly. 100 patients in a day is no longer a statistic. It is a line of mothers carrying babies, senior citizens clutching envelopes of laboratory requests, farmers waiting for blood pressure checks, laborers asking for clearance, and tired staff trying to make the hours stretch wider than they can. What I observed in a short period with my daughter was already enough to unsettle anyone who still thinks RHUs are sleepy outposts. There are consultations, follow-ups, barangay visits, dental checkups, circumcision drives, awareness seminars, medicine distribution, immunization work, forms, referrals, emergencies, and the unglamorous administrative tasks that keep a public facility from falling apart. The work goes beyond office hours, even into late-night messages, because disease does not clock out, and neither do the needs of the poor.

Some patients do not come for dramatic illnesses. They come for things city people take for granted. A medical certificate, for instance, so they can qualify for short-term work under DOLE’s TUPAD. That little paper can mean food on the table for a family, so they wait for hours, not because bureaucracy is romantic, but because hunger is punctual. Others come because they have already delayed care for too long. My daughter once told me about a volunteer medical drive in the hinterlands of Antique where a lola crossed rivers and mountain paths just to reach the site and receive a few generic multivitamins. Imagine what that means. Not a CT scan. Not a private room. Not imported medicine. Multivitamins. I have also heard of patients struggling to buy even a single regular tablet of losartan that costs only a few pesos. “Only” is a word that belongs to those who still have spare change. In many homes, even P2.50 has to justify its existence.

DTTB deserves praise, but not blind praise. It works because it reaches communities others do not. Studies confirm improved access, yet also highlight shortages—people, equipment, funds. Field reports show doctors delivering care across distant barangays. The impact is clear, but so is the burden. The system still relies on too few to do too much.

And let us be honest: the doctor is never alone in that burden. The barrio health story is also the story of overworked midwives, public health nurses, barangay health workers, counselors, ambulance drivers, first aid responders, barangay kagawads, municipal health officers, job order and contract-of-service personnel, sanitation staff, clerks, utility aides, and that ever-reliable errand person who has no regular salary yet somehow keeps showing up to help carry forms, fetch supplies, wash dishes, call patients, or prepare the next barangay visit. They are the people who make rural medicine look more stable than it really is. The DTTB may become the face of service, but the whole RHU is the body that absorbs the strain. In many municipalities, understaffing is not an occasional inconvenience. It is the default weather.

That is also why the old line that doctors to the barrios are a “stopgap measure” is only partly true. Yes, even supporters of the program have long argued that the dream is not permanent dependence on rotating deployed doctors, but a health system strong enough to produce, retain, and support doctors from and for those communities. RA 11509, the Doktor Para sa Bayan Act, tried to move that logic forward by creating the Medical Scholarship and Return Service program, harmonizing nationally funded medical scholarship tracks under MSRS, assigning a major implementation role to CHED, and requiring return service in underserved areas. CHED is now publicly implementing MSRS in state university medical schools, while DOH, for the last time, deploy their last DTTBs in places that still need them. Funding has gone steady, somehow. But paper gains do not automatically reach the RHU—where staff, supplies, and support are still lacking.

Security is another matter. Not theory, but record. After the death of WVSU alumnus Dr. Dreyfuss Perlas in 2017 in Lanao del Norte, the risks became clearer. Rural doctors continue to face threats and pressure in the field. Other reports on rural health have described municipal physicians being asked to sign questionable documents, tolerate medicine procurement irregularities, or bend to political convenience in ways that place both principle and life at risk. It is one thing to ask young doctors to serve in hardship posts. It is another to normalize danger, bullying, corruption, dirty politics, and abandonment as part of the package. Service should demand courage, yes, but not martyrdom as a routine job description.

It is not just duty that keeps them there. It is what they see every day—real people, real gaps, real need. They come to heal, but end up doing much more. The work changes them. That is why my pride is quiet but steady, seeing my daughter serve where the country has long fallen short.

But pride should not make us lazy. We should salute the DTTBs who report on time and go home beyond duty hours. Salute the health workers who keep things going. But do not normalize a system that depends on sacrifice. That is not strength—it is strain.

What is needed is simple: real investment, enough people, working systems, and shared responsibility. LGUs must build, communities must support.

Sen. Flavier understood this: the barrio is the nation—waiting, patient, and overdue. That is why the DTTB deserves both applause and reinforcement. We should praise it for what it has done, and protect it from becoming just another good idea that government slowly underfeeds. The countryside does not need our sentimental admiration alone. Doctors who stay. Health workers who are protected. A government that invests. Until then, every DTTB, midwife, BHW, and patient on the road to care proves one thing: the barrio has waited long enough.

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Doc H fondly describes himself as a “student of and for life” who, like many others, aspires to a life-giving and why-driven world grounded in social justice and the pursuit of happiness. His views do not necessarily reflect those of the institutions he is employed or connected with.