Acute life-threatening illnesses and accidents can happen anytime, anywhere, and to anyone. Most of the time, these conditions are time-dependent and require immediate life-saving interventions and pre-hospital care given by trained personnel such as the primary survey which can be done to secure a patent airway, stabilize the cervical spine, ensure breathing, control bleeding and ultimately, decrease the probability of morbidity and mortality. Patients should then promptly be transported with continued care preferably by an ambulance to the nearest capable healthcare facility. However, many places in the Philippines, such as several villages in Bansud, Oriental Mindoro, are geographically isolated, and as such, there are no trained healthcare providers that are part of the community. Instead, they have to transport patients by foot in a make-shift hammock attached to a bamboo pole, termed “ambulansiyang-de-paa” then walk for at least 4 hours through a muddy, slippery, and dangerous path. These hours and even days of delay before patients can reach the nearest healthcare provider and/or hospital leave most patients with deformities, disabilities, and worse, death. Many die without seeing a doctor as they do not even attempt to make the travel since they do not have the money to pay for formal care services.
The local government of Bansud acknowledges that there is an alarming health problem in their Mangyan communities. However, I was disappointed to see that their solution to increasing health care access was to build a hospital. This wrongly allocates the already scarce resources as it does not solve the root problem of why it is hard for the Mangyans to access healthcare facilities and services: the distance and dangerous trek to get to local healthcare facilities/providers, and the inability to pay for healthcare services. Theoretically, building primary healthcare facilities with trained personnel, free services, and basic equipment and supplies that are near and accessible to these communities will be better at improving health outcomes than building another solitary, large but inaccessible hospital.
Health is multifactorial. As such, I have come to realize that pre-hospital care is more than just a paramedic and an ambulance. For places that have no formal prehospital system, improving healthcare outcomes relies heavily on the care provided by the community from the scene of disease or accident until the patient reaches a healthcare facility. And it is possible for this community-based prehospital care to be inexpensive but sustainable. Basic strategies can include recruiting, training, and equipping willing members of the community to perform basic first aid techniques, giving culturally-appropriate and acceptable public health lectures to the community to educate them about common illnesses and correct any misconceptions or harmful community health practices, partnering with NGOs and institutions to provide periodic healthcare assessments, preventive strategies, free medicine, and supplies to the community, improving transportation to healthcare facilities by creating safer and shorter designated pathways to the nearest healthcare facilities, and creating direct and two-way communication channels between the Mangyan communities and healthcare providers. These can be possible with strong initiative and support from the government and sustainable coordination with the communities, and private partners.