SEEKING to establish itself as the Philippines’s foremost university hospital, the 55- year-old University of Santo Tomas Hospital (USTH) is hard-pressed to improve its services despite perceptions that health care in the country is only for those who can afford it.

But the USTH is aiming for total patient care, said Atty. Pilar Almira, USTH’s chief operating officer. She added that the hospital’s renewed focus on service reflects the nature of the hospital as a non-stock, non-profit organization which is “biased for the poor.”

The hospital struggles to make its preferential option for the poor in a set-up that divides the hospital’s services to those who can pay and those who cannot.

At the pay division, walls are painted evenly in light green. The sunlight comes through the Venetian blinds casting a soft glow on one of the private wards spacious enough for a single patient. The room has its own toilet. The table at the right side of the bed is filled with medicine and food. On the other side is a chair for a visitor.

In one of these rooms, five-year-old Nathaniel Paulo Lim lies quietly in his well-made bed. He has dengue fever.

Nathaniel plays with his miniature cars, while his mother, Nancy, is slumped in a chair with a weary look on her face. She has been monitoring her child’s condition for the whole day. The doctor has assured her that Nathaniel is out of danger.

“Magmula nang maliit siya, dito na kami (sa USTH pumupunta). ‘Yung mga pamangkin ko dito (sa UST) nag-aaral kaya alam kong sigurado ako rito,” Nancy says.

“Kaya lang medyo mabigat sa bulsa. Pero compared with other private hospitals, (the rates are) reasonable naman,” she added.

A few rooms away from Nathaniel’s is the room of Jean Kathleen Gonzales, another dengue patient. Her room is just like Nathaniel’s, only hers seems more spirited because of many family members.

Her mother, Solita, talks graciously about how pleased she and her family are of USTH’s services. “Maganda ang serbisyo at reasonable ang expenses,” she said.

She adds that the nurses and doctors are polite and always ready to be of assistance.

“Dito na talaga kami nagpapagamot noon pa kahit nga sa Bulacan kami nakatira. Sa karanasan namin, talagang mahusay (ang USTH). Noong na-stroke ang father ko, dinala namin siya rito. Awa ng Diyos, nabuhay siya,” she explains.

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The picture is different at the Clinical Division, the charity ward of USTH.

Lack of attention

Her lips turning pale, Issa de Vera snuggles close to her grandmother Estelita for life. She is burning with fever. They had arrived at 9:30 a.m., took the necessary medical tests, and received the recommendation of the resident doctor for Issa to be confined at the hospital. Still, they are made to wait for hours due to room unavailability.

“Gabi na, naghihintay pa rin kami kung paano nila kami bibigyan ng kuwarto,” Estelita says in frustration. She is very disappointed at the hospital’s service. “Kahit na ba sabihing nasa charity (ward) ka, sana (asikasuhin naman kami). Nakita na nga nilang may bata,” she says.

Several rows of beds compose the charity ward. There are no dividers separating each bed, making privacy impossible. The ward is not air-conditioned and the rooms are heavily crowded with patients, visitors, and medical staff, aggravating the poor ventilation.

“First time pa naman namin dito (pumunta sa USTH). Ang plano namin i-pull-out na lang siya, tutal nabayaran na namin yung X-ray niya. Uuwi na lang kami,” Estelita says.

Maricris dela Cruz’s case is different. It is also her first time to bring her sick daughter to the hospital. It was through their relatives’ advice that they availed of USTH’s free medical service.

Similarly, they arrived at the hospital at 9 a.m. They underwent the same procedure, as did the other patients. Her daughter, Karen, took the urinalysis test at 11:30 a.m. and they received the results by 3:30 p.m. Then they went back to the pediatrician where an intern asked them for more data while they waited for blood test results.

“Kailangan talagang maghintay sa dami ng mga pasyente. At saka kaya na rin (natagalan) dahil sa hinintay pa namin (ang resulta ng) laboratory,” Maricris says.

She says she had purchased a discount card worth P50. But due to some of the hospital staff’s negligence, the discount card was almost useless.

She explains Karen’s hospital record was made the day before. When they came back to the hospital the following day, the intern said her daughter’s record was lost. They were then made to pay P30 for the issuance of another record. But the record got lost again and they had to pay another P30 for a new one.

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Maricris says that the person who first attended to their needs was also the one who made the follow-up examinations. But that same person could not locate their records.

Policies

Alita Conde, USTH Director for Nursing says that, notwithstanding the complaints of some patients, the medical staff and employees try to live up to the hospital’s standards and protocol.

“As health care professionals, it is the very essence of our job to help patients. It is an integral part of being a (medical) professional to care for anybody without discrimination on the patient’s status, race, creed, and whether one can pay (medical fees) or not,” Conde said.

The hospital has set a standard for all health care professionals – including doctors, consultants, nurses, and interns – to attend to their patients in the shortest possible time, allowing a maximum of 10 minutes.

However, Conde said that it is common for outpatients to wait because there are times when over 50 patients are in the clinical division. These are, however, non-emergency cases.

On the other hand, in-patients are required to immediately see a doctor in the emergency room. After the initial diagnosis, there would be a series of medical tests. The final diagnosis might come in two hours, depending on laboratory results.

“(‘Yung mga naghintay nang matagal) hindi iyon dahil sa delay in response time kundi dahil sa (wala) silang nakuhang (vacant room). That can happen in a full hospital, and we are a hospital that is gaining patients,” Conde said, regarding the case of Estelita and her granddaughter Issa.

When it came to the work attitude of medical staff, such as rudeness and disregard for patient’s needs, Conde said that the hospital would take proper disciplinary action, depending on the gravity and frequency of the act.

“We take every customer complaint seriously. (But) we do not want to be perceived as a punishing hospital so we more or less give corrective actions,” she said.

According to Conde, the hospital upholds five values: quality health care and excellence in service, service to God, service to men, teamwork, and integrity and honor.

“(Also) the basic thing we have to follow is to respect a patient’s individuality,” Conde said.

She cited that in serious cases where patients are about to die but refuse to undergo resuscitation procedures, the doctor or the Bioethics committee might intervene.

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USTH’s Bioethics committee is headed by Dr. Edna Monzon and is composed of the regent of the Faculty of Medicine, division chairs, nurses, and consultants.

“Doctors and nurses inform the patient (about) his condition and the possible interventions as well as risks lalung-lalo na kapag ito ay mga invasive procedures. Patients have to know because it is their right to make their own decisions,” Conde said.

Patient satisfaction

In the USTH’s Patient Satisfaction Survey conducted last August, most patients complained about improper housekeeping, nasty work attitude, and inefficient billing of payments.

The monthly survey, which has 410 respondents, showed that housekeeping or janitorial services enjoyed a high satisfactory rating of 40.41 percent. Room facilities and utilities, meanwhile, earned a 40.43 percent satisfactory rating.

Most patients complained of the lack of proper maintenance of facilities and inadequate sanitation as evidenced by stained bedpans and dusty beds. They also cited the absence of hot water and limited bathroom space and equipment.

Another major concern was the billing system. Some patients said they were made to pay for medicines and other supplies that they did not consume. The patients suggested that all costs should be itemized and listed specifically in the bill, not just the total amount to be paid. They also suggested that the billing system be fully automated to speed up the process.

When it came to the work attitude of medical staff and other employees, patients emphasized that the hospital staff should be more prompt and sensitive when attending to their needs.

Clerks and interns should be prompt in attending to telephone calls, when transferring patients to their designated rooms, and in admitting patients particularly in the emergency room.

Other complaints included expensive food items and insufficient parking space.

According to the survey, patients prefer USTH for the following reasons: because it is the best equipped hospital (21 percent), due to the attending doctor’s advice (20 percent), due to its standing as the center of the best doctors (12 percent), and its good nursing service, (9.1 percent).

USTH’s goal to provide quality health care and excellent service can be fully realized if the simplest and most fundamental needs of its patients are met. In fulfilling this, USTH must be genuinely service-oriented. Frances Margaret H. Arreza, with reports from Bernardette S. Sto. Domingo

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