A Healthy Filipino

by Gilbert Guy D. Murillo

I. Introduction
The World Health Organization defined health as state of
complete physical, mental and social well-being and not merely
the absence of disease or infirmity (1946). This statement
encapsulated

the

mission

and

visions

of

all

healthcare

provider and health systems in many countries. This definition

guided

members

of

the

Organization

to

ensure

equity

and

equality of healthcare among all mankind.

In fact, the advancements of 2Oth century in science and
technology generally increased the life expectancy up to 30
years

(Guinto,

chemotherapeutic
formulated

by

2011).
drug
Paul

The

to

development

combat

Ehrlich

of

syphilis,

in

1908,

the

first

salvarsan,

while

the

was
first

antibiotic, penicillin, was discovered by Alexander Fleming in

1945 (Tortora, 2010). The Salk vaccine also reduced and almost
eradicated

the

poliomyelitis

in

the

whole

world

(Tortora,

2010). These and many discoveries and breakthroughs greatly

improved the total well-being of man as a whole.
In

the

emphasis

on

resolve

the

Philippines,
the

primary

remaining

the

Aquino

health

care

health

administration
for

inequity.

the
Its

gave

Filipinos

to

operational

strategy was termed as Kalusugan Pangkalahatan that aims to

deliver not only primary but a universal sense of health care.

In order to achieve these, three main thrust on 1) financial

risk

protection,

accessibility,
Millennium

2)

and

hospital
3)

Development

and

attainment
Goals

health
of

(MDGs)

care

the

were

facilities

health-related

established.

The

improvement on the coverage and operations of the National

Health Insurance Program and PhilHealth will give priority to
the poor and the marginalized like those in geographically
isolated

and

disadvantaged

area.

The

public-private

partnership will also hasten the upgrading and modernization

of public clinics and hospitals. Lastly, attaining healthrelated MDGs is a very good indicator of improving health
status of Filipinos (Department of Health [DOH], 2010).
Obviously, these great discoveries and innovations made a
great change in the public health scenario of the Philippines
in the last century and up to this moment. We are healthier
than our Filipino counterparts in the last decades and much
healthier during the colonial times. Nevertheless, still there
is inequity and inequality in the delivery of health among
Filipinos. There are still gaps which Guinto (2012) emphasized
to be due to the unequal attention given on the social aspects
of health. We may have improved the physical and mental wellbeing of the Filipinos but the social element was not dealt
accordingly. This aggravates any intervention on the other two
health components leading to persistence of many preventable
diseases and health-related problems.

By examining history, we may be more cautious of the

future. By learning from the past we may prevent repetitions
of unnecessary and undesirable events. The life and works of
our national hero, Gat Jose Rizal was extensively studied, as
most of them, are timeless and still apply to the present
situations.

Rizal

practiced

his

medical

profession

several

times in his life. Fist in Calamba after his first trip to

Europe (August 1887 February 1888); then in Hong Kong from
November

1889

to

June

1892

where

he

first

operated

his

mothers left cataract; and lastly, the longest practice, is

in Dapitan from July 1892 to July 1896. In all of these, he
exhibited many wonders and extraordinary work especially when
he

was

in

Dapitan

professionally
limit

him

to

entrepreneur,

an

(Lapea,

ophthalmologist,

become
public

works

social

2011).
his

Although

he

is

brilliance

did

not

worker,

engineer,

town

farmer,

social

planner,

school

founder, teacher, and a scientist (Quibuyen, 2011). Indeed a

great polymath, a great Filipino.
This paper will tackle first the development of public
health during the Spanish colonial rule specifically during
its last quarter in the Philippines, and then discuss the
present situation. Lastly, we will look into Rizals life and
experiences in relevant to the fulfilment of the gaps in the
past and present healthcare delivery and management especially
when he practiced medicine and community health in Dapitan.

These questions are aimed to be answered by this paper:

How improved is our health system today compared to that of
Rizals time? Are all the gaps of the friars have all been
fulfilled?
never

Or,

been

Spain?

are

there

addressed

still

after

116

existing
years

problems

of

that

independence

was
from

From Rizals experiences, how can we improve further

our healthcare system and delivery today?

II. Public health in the Philippines: now and then

Unlike

the

experiences

the

American

Indians

when

Christopher Columbus discovered the New World, the Philippines

was not heavily depopulated due to Old World diseases (e.g.
smallpox
2009).

and

measles)

This

was

when

the

inferred

Spaniards

from

arrived

statistics

the

(Newson,
earlier

missionaries have documented, although, there was a relative

decrease in the natives population in the first two centuries
of Spanish rule (Newson, 2009).
Several
marking

the

hospitals
epitome

were

of

also

charity

built
the

in

friars

the
have

Philippines
inculcated

among the native Filipinos (Planta, 2008). The San Juan de

Dios Hospital founded in 1659 rose from the dispensaries the
Franciscan friar Fr. Juan Clemente put up in their convent in
Intramuros

in

1577

(Tiglao,

1998).

Additionally,

five

hospitals were founded in various parts of the country the

earliest of which is the Hospicio de San Jose in Cavite.

Contagious hospitals like the San Lazaro Hospital (1577) were

also

established.

Two

military,

two

naval

and

four

other

specialized hospitals (e.g. asylum, childrens hospital) were

founded, as well (Tiglao, 1998).
The golden age of public health in Philippines during
Spanish times could have happened in the last century of her
colonization. The first compulsory smallpox vaccination in the
Philippines
outbreaks

happened

happening

in
in

1806
the

in

response

country

to

(Anderson,

many

smallpox

2007).

The

Central Board for Vaccination was mandated to foresee this

program (Planta, 2008). Although it was compulsory, Spanish
authorities were not that active in implementing this program.
Thus, even if there were 122 vacundares in 1898 distributed
around the country, smallpox still persisted.
The first university in Asia, the University of Santo
Tomas (UST), started to offer licentiate in medicine since
1877.

Notably,

only

those

who

can

afford

like

Spanish

penisulares, mestizos and other Filipino elites in those times

can be admitted. Gat Jose Rizal started his medical education
in

this

institution.

Santiago

(1994)

identified

the

first

Filipinos to practice medicine and surgery in the country.

Twenty eight of them had licentiate in medicine while half of
that twenty eight had passed a thesis garnering the title
Doctor of Medicine. Most of them got their licentiate in UST
and Universidad Central de Madrid (UCM). It must be noted

that, in those times,

only UCM grant the title Doctor of

Medicine in Spain but those who had their licentiates can

still

practice

medicine.

The

Carriedo

waterworks

that

was

constructed in 1876 provided Manileos of safe and potable

water

reducing

incidence

of

water-borne

diseases

(Tiglao,

1998). Laboratorio Municipal de Manila was also instituted in

1883 to examine food, water and clinical specimens (Anderson,
2007). A school of midwifery in 1879 and the establishment of
forensic medicine in 1892 also marked this golden age.
Such

an

overwhelming

infrastructure

and

public

health

works the Spaniards have brought in the Philippines. But in

closer look, one may noticed that the concentration of which
was only in the last quarter of Spanish colonization where
Philippine trade and industry was opened to foreign market and
Galeon Trade was long abolished. And similir to the smallpox
vaccination
become

program,

passive

other

and

health

institutions

discriminating

with

might

their

have

services

especially to the natives. Just like type two diabetes where

glucose is not utilized by the cell even if it is abundant,
these

services

might

have

existed

but

is

relatively

inaccessible.
Now

let

us

examine

the

current

Philippine

health

situation. The Millennium Development Goals formulated during

the

United

Nations

Millennium

Summit

in

2000

embodies

specific targets and milestones in eliminating extreme poverty

worldwide

(Philippine

Statistical

Authority-National

Statistical

Coordination

Board

[PSA-NSCB],

2013)

by

2015.

Examining its health related components (Goal 4, 5 and 6) will

give us insight of the current public health setting in the
Philippines.
Goal four or the child mortality reduction goal can be
reached with high probability in 2015. Under-five and infant
mortality rates were now greatly reduced while the proportion
of 1 year-olds who was immunized against measles is now 91%
accomplished (PSA-NSCB, 2014).
Goal

five,

on

the

other

hand,

or

maternal

health

improvement goal was poorly dealt with. There is very low

probability of achieving this goal by 2015 given that 2011
maternal mortality rates even increased as compared to its
baseline rate in 1990. There are still many mothers who have
poor accessibility to skilled health personnel during birth.
Contraceptive used and adolescent birth rate is alarmingly
unchanged or even higher than the baseline data in 1993 (PSANSCB, 2014).
Lastly,

Goal

six

or

the

HIV/AIDS,

malaria,

and

other

communicable diseases reduction goal indicate improvement as

well in some of its components. Prevalence and death rates due
to malaria was safely reduced nearing the MDG target rates, as
well as, the efficiency of administering and cure rate of
directly observed treatment short (DOTS) course among those

with

tuberculosis.

However,

prevalence

of

TB

and

death

associated with it is still beyond the MDG (PSA-NSCB, 2014).

Even with some downsides, the above parameters imply that
children who were born in 2011 and onwards will have a higher
probability of living after birth and by their fifth year,
than their counterpart decades ago. Our risk for malaria today
is much lower, than those who lived in 1990. Nevertheless,
despite

all

these

positive

indication

of

improved

health,

maternal health is still far-fetched to be realized. There are

still a lot of mothers who died due to various complications
of pregnancy and birth, and poor accessibility to competent
health

personnel.

Universal

reproductive

health

is

still

crippling and is minimally accessed.

III. Rizal as a public health practitioner

When our national hero, Jose Rizal was exiled to Dapitan
in July 8, 1892, he was in great despair and disappointment
that he wrote to a friend: "I was greatly bored without books
or periodicals to read. I had not even the desire to write. I
had no friends or acquaintances (Bantug, 1961)." His sentiment
like this was eventually changed as he adapted to the place
and explored its inner beauty. In one of his correspondences
with his best friend Ferdinand Blumentritt: I am now much
nearer to nature. I hear constantly the murmur of the waves
and the rustling of the leaves and seethe palms waving and
swaying

in

the

gentle

breeze

(Pambansang

Komisyon

ng

mga

Bayani [PKB],1963; Bantug, 1961)." He maximized further his

time and potentials in this community and transformed it from
a prison into a paradise (Padilla, 2011).
Examining

the

WHO

publication,

Evaluation

of

the

Implementation of the Global Strategy for Health for All by

the Year 2000 (2003), they have identified these factors that
could stagnate and degrade efficiency in health care delivery:
1)insufficient political commitment;
2)failure to achieve activity in accessing all primary
health care elements;
3)continuing low status of women;
4)slow socio-economic development;
5)difficulty

in

achieving

inter-sectoral

action

for

health; unbalanced distribution of, and weak support

for human resources;
6)widespread inadequacy of health promotion activities;
7)weak health information system and no baseline data;
8)pollution,

poor

food

safety

and

lack

of

safe

water

supply and good sanitation;

9)rapid

demographic

and

epidemiologic

changes;

inappropriate use of and allocation of resources for

high-cost technology; and
10)nature and man-made disasters.

Interestingly, several of these factors were coincidentally,

or perhaps initiatively, addressed by Rizal when he was in

Dapitan despite his difficulties. In his own words to Jose

Basa on 18th of December 1894, he narrated his helplessness and
difficulties as a physician:
This town of Dapitan is very good. Im in good terms
with everyone. I live peacefully, but the town is very
poor, very poor. Life in it is not unpleasant to me
because it is isolated and lonesome; but I am sorry to
see so many twisted things and not be able to remedy
them, for there is no money or means to buy instruments
and medicine. Here a man fell from a coconut tree and
perhaps I could have saved him if I had instruments and
chloroform on hand. I perform operations with the little
that I have. I treat lameless and hernias with reeds and
canes. I do the funniest cures with the means available.
I cannot order anything, for the patients cannot pay; at
times I even give medicine gratis (Quibuyen, 2011).

He

once

wrote

to

Blumentritt

describing

his

roles

in

Dapitan as half-physician and half-entrepreneur (PKB, 1963).

His knowledge of medicine is so extensive that he did not
limit his treatment and interventions to eye-related maladies
only. He also practiced general medicine, general surgery,
obstetrics

and

gynecology,

and

even

dentistry

(Padilla,

2011). He even constructed a one-man hospital (Lapea, 2011).

Such is a truly dedicated physician!

But this did not stop there. His brilliance of medical

practice flourished and spread even beyond Dapitan. He said in
his letter to Blumentritt dated April 15, 1896, that many of
his patients came from different islands of the archipelago,
from

Bohol,

(PKB,

Panay,

1963).

Sebu,

Moreover,

Luson,

he

also

Sikihor,
expressed

Mindanaw,
he

had

Negros
so

many

patients that he can no longer finish what he had started.

Despite the hospitals and health initiatives of the Spaniards
during the time, health services either not reach these people
or there is nothing at all.
With this gestures and efforts, he already fulfilled some
of the factors listed above. He fulfilled the insufficient
political commitment of the Spaniards at that time. He brought
primary

health

care

to

the

needy

and

the

poor

people

of

Dapitan and nearby provinces by treating them free of charge.

Rizal, as a product of his time, treated women differently
from how his society treats them. He adores her mother; he
loves her sisters. Fernandez (1990) discerned the fact that
Rizal recognizes the role of women beyond how the society sees
them; that women can make or break a country. He addressed
factor six, as well, by prescribing and reminding his patients
of appropriate practice for their total recovery.
He also led many innovations and projects in Dapitan to
alleviate their health conditions not only by treating them
with medicine but targeting social and environmental factors
in the community.

He once noticed and keenly observed the dominant mosquito

species whenever he came near several swamps in Dapitan. He
found out that it was Anopheles minimus var. flavus, a malaria
vector, which is why he initiated the draining of these swamps
to

prevent

their

further

growth

and

the

eventual

malarial

outbreak (Bantug, 1961). He also constructed a modern gravity

water system from a nearby falls to supply the locality with a
cleaner and safer drinking water. He also constructed a dam
made

of

bricks

he

himself

backed,

with

the

help

of

his

students. This dam was connected to his house with fluted

tiles and bamboo joints to irrigate his farmlands. He was also
the first to construct underground pipes made only with empty
gin containers (necks and bottoms removed) and joined together
with a mortar. He only formulated the mortar from shells and
corals of nearby beach (Bantug, 1961).
With

this

infrastructures

and
from

simple
local

initiatives,

materials,

he

and

filled

simple
the

gaps

brought about by factor eight and nine in the list above.

Rizal also engaged in social entrepreneurship in Dapitan.
Quibuyen

(2011)

defined

social

entrepreneurship

as

an

innovative business activity aimed principally at benefiting

and transforming the community in which it is undertaken (with
most of the profit reinvested back into the community).
He
Sociedad

founded
de

cooperative

the

first

Agricultores
will

come

cooperative

Dapitanos.

from

socios

The

of

farmers

capital

industrials

for

named
this

(industrial

partners)

and

socios

accionistas

(shareholders).

This

will

allow the improvement and promotion of their products to have

better profits. Part of the profit will serve as capital for a
co-op selling cheaper and affordable basic necessities of the
farmers (Quibuyen, 2011). He also improved fishing techniques
in Dapitan by seeking the help of his brother-in-law Manual
Hidalgo to supply him with pukutan or net, as well as, fisher
folks from Kalamba who knows how to weave fishing nets to
train some Dapitanos.
He

also

introduced

brick-making

in

the

locality

he

learned from Europe. He constructed an oven that can bake at

least 6,000 bricks a day which eventually composed his dam and
reservoir of drinking water previously described (Quibuyen,
2011).
With these activities he achieved community mobilization
and

community

Dapitan.

engagement

for

healthier

and

prosperous

He empowered them for them to be more sustainable.

III. Conclusion
After

the

Spaniards,

American

imperialists

ruled

the

Philippines. Though there are a lot of controversies, they

indeed contributed greatly also in the healthcare system of
the Philippines.

Up to now, we are trying to improve the

health of Filipinos by relevant programs and health policies.

With the recent issues of corruption and bad governance, the

supposed improving health might, just be like the superficial

efforts of Spanish colonizers in the past. We thought we will
be vaccinated of proper and complete healthcare, but the
vacundares of our time either forgot to come, or there is no
supply of vaccines at all. We thought that when we get sick
and approach the doors of our hospitals we will be admitted
and treated accordingly, but the hospitals are either nonfunctional or chose only those few who can afford. There are
still these persisting gaps in the current healthcare system
because they are rooted in the fact that the social aspects of
health is not managed and solved completely together with weak
and

incompetent

policy-makers

and

government

officials.

Guinto (2012) pointed out that if we could only reverse

and improve the following essential problems: lack of policy
coherence

and

implementation;

political
corruption;

will;
lack

weak
of

accountability

motivation

and

and

skills

among government worker; and limited participation of citizens

and

civil

society

groups

in

decision-making

especially

in

health governance, our general health profile would be better

and consistent.
Rizal clearly changed Dapitan from an unknown isolated
land to a progressive and sustainable little civilization of
Mindanao the moment he left. The social aspects of health he
accordingly addressed should be imitated by our current health
policy

makers.

His

resourcefulness,

industriousness,

and

flexibility despite lack of financial supports are exemplary.

These chracteristics are easy to follow. We dont have to
bepolymath, a genius, or a martyr to do that. But all of us
can become a hero. Rizal did it in his own way, so we will do
it in our own personal ways.
Guerrero (1963) wrote that Rizal to his patient he gave
sight

and

to

his

country

understanding of still
system

and

the

general

many

he

gave

vision.

deficiencies

social

in our

conditions

as

With

the

healthcare

well,

we

may

continue to pass on the vision Rizal gave us. May we the

current generation not always speak of the young as the sole
hope of the motherland. May we act as well to become the
current source of hope and change for the younger and future
generations to come. May we, rephrasing Rizals words, do not
try to have the best thing for ourselves, but try to do the
best thing for others.
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