The struggle for health is a struggle for social justice

By Laravic Flores 

Growing up in a family of activists who survived martial law in the Philippines, learning rally chants such as “Makibaka! Huwag matakot!” was just as normal as learning my ABC’s. Throughout my upbringing, my parents emphasized values of social justice and advocating for the marginalized with a purpose to "Serve the People.” As a medical student currently studying in Cuba, one of the guiding principles we are taught in our medical training is the concept of “solidaridad” and the essence of “ciencia y conciencia” -- that as health professionals, we must not only have a strong basis in science and medicine; but moreover, we must have a social conscience that guides our work in solidarity with poor and disenfranchised communities to use the skills we learn in service of the people most in need. It is with these principles gleaned from both my family rearing and my Cuban medical training that I decided to travel to my homeland this past summer to work with community-based health programs in the Philippines (CBHP’s) and to volunteer with the medical mission relief efforts in response to the floods that affected over 2 million people in the city of Manila. 

Laravic (center, seated), with a family in Barangay Canjulao, Lapu-lapu City.

I was privileged to have had the opportunity to work with Council for Health and Development (CHD) and Visayas Primary Health Care Services, Inc. (VPHCS) who facilitated my itinerary and integration with community-based health programs in the Philippines (CBHPs) both in Manila and Cebu in September 2012. Working with these organizations contributed a great deal to my learning experience and was a valuable addition to my ongoing medical education and development as a future physician dedicated to working with underserved communities. CBHPs and Community Health Workers (CHWs) follow a primary care community empowerment model similar to that which we are taught in Cuba – that health must be viewed from a bio-pyscho-social perspective. As such, in addition to providing medical care, there must also be education and advocacy to address the political, social, and economic factors that affect health. Working with various CBHPs and speaking to CHWs, I gained a better understanding of their experiences promoting health and well-being in their communities through providing free basic health services, and conducting outreach and education that emphasize disease prevention. In addition, participating in political activities that advocate for policies that are pro-people and consider the needs of marginalized communities illustrated the importance of community organizing to overcome past and current struggles. 

Laravic with health workers of the Ermita Fisherfolks Association 

in Barangay Ermita, Cebu City.

From the fisher folk community in Ermita with a more established CBHP spanning almost three decades, to the more recent CBHPs continuing to develop in communities in Mandaue City and Lapu-Lapu City – despite the differences in localities and years of experience, the essence of their work and principles remain the same. CHWs are not only responsible for healing acute physical illnesses in their communities, they are also essential to community building and community organizing in order to address the social ailments endangering their survival and well-being. It was precisely because CHWs were able to organize their fellow neighbors and build strength in numbers that communities in Ermita and Mandaue City have been able to resist threats of demolition from the local government that would have led to massive displacement of already vulnerable communities.

Aside from learning from CBHPs and CHWs about their community experience, my exposure trip also allowed me to see with my own eyes the dire health situation experienced by patients in government health institutions. Walking through the crowded wards in Vicente Sotto Memorial Medical Center, mothers who had just given birth were sitting on the corners of the bed or on chairs nearby. There was no room for them to even lie down because the bed had to be shared by four newborn babies sleeping side-by-side because there were no individual cribs available to them. However, on another floor of the same hospital was another post-partum ward for those with the resources to pay for more comfortable accommodations. These mothers had their own private air-conditioned rooms with amenities that should be provided to every mother and child going through the stress of labor and delivery. Even within the same institution, the disparities due to the privatization of health care were appallingly apparent. Having witnessed this for myself made the forum I attended a few days later on the topic of the corporatization of health that much more relevant.

In the face of the struggles and challenges confronting the marginalized sectors of Philippine society – the rural and urban-poor communities in town centers threatened by demolitions, farmers and indigenous tribes in the mountainside threatened by militarization – the resilience of these communities is a testament to the power of community organizing. And utilizing health as a tool for community organizing speaks volumes to the work of VPHCS and the associated CBHPs and CHWs in implementing this primary care community empowerment model. Integrating with the various CHWs and seeing the passionate work of the VPHCS staff reaffirmed my belief that health must be approached from a holistic perspective. I am very grateful to everyone at VPHCS for hosting me and giving me the privilege to work with them this summer. Through my various experiences, I have seen the dual role of physicians as both healers and as advocates, and I realize the vital role doctors and all those in the health sector have in working towards social change and community upliftment. The struggle for health is a struggle for social justice. Those in the field of health are vital resources in working to achieve that justice.

Laravic Flores was born in the Philippines and later immigrated with her family to the U.S. shortly after the fall of the Marcos dictatorship in 1986. Raised in a family of activist who survived the oppressive years of martial law, her parents shared their deep love for their mother country and the historical socio-political-economic causes of the serious problems still suffered by the majority of people in the Philippines. They instilled values of social justice throughout her upbringing, emphasizing the importance of community organizing and solidarity work with oppressed communities. It is these same guiding principles that led her to study medicine in Cuba and work with CBHP’s in 2012. She is currently studying at the Latin American School of Medicine in Havana, Cuba and is conducting research to explore the topic of “Health and Liberation in Cuba and the Philippines: A Comparative Analysis of Health Care Models from a Historical and Social Justice Perspective.”