The migration of Filipino medical professionals to developed countries continues despite the global financial crisis. Around 2,000 doctors graduate every year, but most of them opt to leave. Health department data show that 5,000 doctors have left the country in the last five years. In 2008 alone, around 10,000 doctors opted to become nurses and left the Philippines for greener pastures. Some European countries offer a hefty $6,000 salary for physicians, tempting numerous doctors to pack their bags and leave. But of course, there are the few who stay. Dr. Chelsa Cacaldo is one of them. Instead of pursuing a career in Manila or other big cities, she ventured into the mountainous areas of Negros Oriental. Instead of modern technologies, she struggled with meager resources and insufficient funds. Instead of a string of doctors at her beck and call, she had a team of community volunteers. “The province is 65% mountainous so majority of the people are rural folks, and they have no access to various health services,” says Cacaldo. The challenge of bringing health services to the community prompted her to volunteer as head of the community hospitals project of Negros Oriental in 2001. She now supervises six rural community hospitals in the former insurgency-infested areas of Negros Oriental. Community girl Cacaldo has had a soft spot for the communities, having spent her life in rural areas. She spent her childhood in Mabinay, an upland municipality north of Dumaguete City. Due to financial difficulties, she had to stay with an aunt in Dumaguete until her fourth grade. She finished primary education in the southern town of Sibulan, and then returned to the capital to finish high school. In her high school days, Cacaldo read biographies of early health missionaries to countries like Africa and China. She was inspired by these stories and volunteered in church-work during her stay in Dumaguete. “I got a vicarious thrill in reading their works. I think that was one of the reasons that pushed me to go into volunteering,” she says in an interview with Abs-CBNnews.com. “We had been traveling to places, especially to the hinterlands, and when I saw their condition, I said, I want to help them someday.” This inner drive prompted her to take up a Bachelor's Degree in Biology at the University of the Philippines in Baguio since it was cheaper there. Although she wanted to pursue a medical course, a tight budget prompted her to return to Mabinay and teach in Kabankalan, Negros Occidental. After five years, she received a full scholarship from Bicol Christian College in Legazpi City, Albay, and then she took her internship at the Davao Medical Center in Davao City. Eager to return as a doctor to the communities she once visited in her teens, she specialized in family and community medicine. When she returned to Dumaguete, Cacaldo learned that the provincial government was set to implement a community-based health care program. She applied for the job and was accepted. “There was a clamor to build hospitals in former New People's Army (NPA) hotspots between Occidental and Oriental,” says Cacaldo. “It was put up in those areas because there was a community perception of neglect. People thought that the government was not doing anything to address the problem.” ‘No Man's Land' The community of Inapoy in Mabinay was chosen for the joint project between the two provinces. The barangay is nestled in the mountains. Back then, the roads to the village were rough and dusty during the dry season, and muddy on rainy days. “We rode for an hour or so in a habal-habal [motorcycle] to get to the community. If it rained, we walked for more than two hours from Mabinay town proper,” Cacaldo recalls. “There was no electricity back then. The situation was really depressing.” The area was labeled “No Man's Land” because people seldom visit due to the insurgency problem. Cacaldo says that when her team went to the area, there was a sense of hopelessness within the community. Inapoy has 75 to 100 households, and majority work as farmers for the haciendas in the region. The citizens of Inapoy were mostly migrants. They came from different barangays in the various areas which were targets of taxes and sustenance by Communist groups, says Cacaldo. “The military thought it would help if they were placed in one barangay.” Despite the threat, the insurgency was not the primary problem for the group. Cacaldo says families were large and lived in extreme poverty. Although the community was highly-dependent on government support, she says the people distrusted government. “Initially, it was a difficult process because people were suspicious of what the program was all about,” says Cacaldo. “But when they see that it is for their benefit, that you are transparent in your activities, that you are sincere in dealing with the community leaders, then you get their trust.” The community hospitals she supervises are located in the barangays of Calumbuyan in Bayawan, Amio in Sta. Catalina, Nabilog in Tayasan, Pacuan in La Libertad, Inapoy along the boundary of Mabinay and Kabankalan, and in Luz-Sikatuna, the border of Isabela, Negros Occidental and Guihulngan, Negros Oriental. A dying advocacy Despite her accomplishments in strengthening rural hospitals in her hometown, Cacaldo admits that volunteering in the communities is a “dying advocacy.” The current exodus of medical practitioners, although affected by the financial crisis, has made Cacaldo think twice about pursuing her cause. Out of the five classmates she had in medical school in Davao, she was the only one who went to the barrios to practice. The others opted to stay in the city, but they will probably leave once the demand for medical professionals rises again. “As of now, I want to experience professional growth. I want to see and experience the program that they have abroad,” Cacaldo confesses. Given the opportunity, Cacaldo says she'll take it. But she still intends to return and bring the health care practices she will learn to benefit the local community. At the moment, Cacaldo is focused on making the hospitals effective providers of primary health care services. “Maybe, I see myself ten years from now still working with communities because I want to see the results. In health, we cannot see the results after a month or months—that's the hard part,” Cacaldo says.
