Im an RN who greatly admires the efforts RN and patient advocate organizations are striving for, in addressing inequity and

bringing modern healthcare to one of the most amazing people, I have had the honor to know and learn from. It is great to see RNs creating a voice for the Philippines. This, for the simple reason we, as nurses, are patient-centered, especially when they do not have a voice. I was shocked when I spoke with the clinical physician on March 17th, 2013 at the Barangay Health Center (Rosario Rd, Pugo, La Union) on behalf of my wifes brother Mario, who appears to be dying of end stage liver disease. When I spoke with the Doctor, I wanted to inquire about possible treatment options: Hospice care, treatment, and pain control (end-stage liver disease is a very painful for a patient to die of)- as my sister-in-law shared, her brother was in agony. Within 2 minutes of talking with him, we all realized he was not going to be forthcoming with a consult on care options or even treatment. For my brother-in-laws sake, I was finally able to persuade the Doctor to agree on one lab test, even when we offered to cover all medical expenses. The only feedback beyond this was an impatient ...yes, yeshe is very toxic. So, no pain meds for a Filipino who cant afford a private physician. Maybe just a little lactulose (a common cheap medication) to help flush out the toxic bilirubin from his stomach? Nothing. No, there was one thing. He made a joke to the staff about having to exercise his English, and then walked off. He gave the phone back to my wifes sister who reported the physician told her There is nothing I can do for him. His medical reasoning? He has never seen this type of case. An adult male presents to the clinic in obvious acute distress, barely walking with help, his skin yellow from the toxic bilirubin, a distended hard abdomen from fluid building up because his liver is not working, unbearable pain from his dying liver, along with family reports of him having hallucinations (the toxicity having built up so much, it is collecting in his brain. How does he decide to address this case? he is very toxic and advices the family, there is nothing I can do for him His reasoning? He has never seen this type of case before (a condition any 1st year intern would identify). But here is the injustice part: He refused all requests for medical help, alleviation of suffering, specialist referral, or even a follow-up. He did offer one recommendation: Take him for a walk wherever he wants to go. This is ironic as my brother-in-law was too weak to even walk to the car without assistance, which the physician did not offer to have someone help with that too. My sister-in-law took him home, where he is waiting to die. Hopefully soon.

What is so enraging about this is not the lack of care (though that is no excuse). I understand the Philippines continue to struggle with providing everyone with basic healthcare, and staff are often so overwhelmed and underpaid. It was the fact he could have easily helped by just writing a few orders or have someone make a phone call. And like I said, we told him we would pay for everything. No, he did not just refuse to help. He was making it a point to refuse help. Witnessing this level of unprofessionalism on the part of a Doctor of Medicine, in a clinical setting, left my wife and I- not to mention her sister speechless (not my brotherin-law though, as he was in too much distress to even understand what was going on). He left my brother-in-law, in a state of delirium due to hepatic encephalopathy- at least I think so, as this MD would not even allow anyone the courtesy of a diagnosis- with my sister-in-law and walked away, after making a joke about it. Ive emailed many public health officials and have not received one response. I am doing all that I have left: Sending this email to editorial staff in the hope it will be published and some will read it and respond, either by writing, emailing or calling to help bring pressure on public health officials to give only the most basic of health care, every Filipino should receive above and beyond. He is a good man and does not deserve to die like this just because he is poor. Is it really too much to ask for a Filipino who cannot afford private healthcare to die with a little comfort and dignity? An RN who believes and cares