Stop the Attacks on Health Workers in the Philippines

Dr. Gene Nisperos is an Assistant Professor who teaches Community Medicine at the University of the Philippines (UP) College of Medicine. Dr. Nisperos is also the President of the All UP Academic Employees Union (AUPAEU)-UP Manila Chapter. I (SY) had the honor of learning about community-oriented medical education in the Philippines when I visited Dr. Nisperos at the Philippine General Hospital (PGH) in 2016.

The PGH is the largest training hospital in the Republic of the Philippines. It is state-owned and operated by the UP Manila. Serving more than 600,000 patients annually as the referral center for the entire nation, every day there are crowds of people from far and wide waiting their turn to be seen. The PGH’s 2019 operating budget is 3.2 billion Philippine pesos ($62.5 million), and the Department of Budget and Management has planned to cut this to P2.8 billion ($54.7 M).

Together with the All UP Workers Union (AUPWU)-Manila, Dr. Nisperos spoke out in favor of a P10-billion ($195M) budget to allow the PGH to hire more nurses and other health workers, fund medications for the indigent, and purchase medical equipment. A few days earlier, during a health worker forum on the health care crisis – Dr. Nisperos’ wife, Dr. Julie Caguiat, had suggested a that government officials spend a month in rural community. The couple had themselves formerly practiced in a remote area of Mindanao.

The officials could then experience first-hand the lack of medical care that leads to the majority of Filipinos dying without medical attention. While the Philippines has a robust educational system – low wages and inadequately equipped facilities force health workers to emigrate. The Philippines is the country that contributes the largest number of nurses to the rest of the world.

After Dr. Nisperos had spoken on October 21in favor of an increase in the budget of the PGH, he received an anonymous death threat via text message which read “I know where your condominium is. We will get your family one by one…YOU ARE DEAD BY…including your children and wife…HA HA HA!”

Such threats have become commonplace in the Philippines. Since Duterte became president in June 2016, more than 27,000 individuals have been killed. The majority of these killings have been extrajudicial killings (EJKs) of the poor who have been labeled drug users or drug traffickers. In EJKs, police, military operatives, or unknown persons accost or apprehend individuals on the street or at their homes and shoot them without trial. More recently the regime is targeting human rights advocates, labor organizers, farmers, indigenous people, and persons viewed as opponents.

Between March 2017 and November 2018, nine physicians have been extrajudicially killed across the nation. One of these was Dr. George Repique, a public health classmate of Dr. Nisperos. Such killings lead to further reductions in the number of health workers and contributes to worsening medical care. Budget cuts, threats, and attacks on health workers demonstrates the Duterte government’s disregard for the health of Filipinos.

Dr. Nisperos is a physician and educator who works tirelessly for Health for All. Dr. Nisperos and Dr. Caguiat are targeted for advocating for better health services for the poor. These death threats directed against them constitute violations of human rights, workers’ rights, free speech, and academic freedom. Health workers around the world should stand with Doc Gene and Doc Julie. #StopTheAttacks

Seiji Yamada, MD, MPH is a family physician practicing and teaching in Hawaii.

Arcelita Imasa, MD, is a family medicine resident physician in Hawaiii.