Cancers are never confined by borders. For most disease types, the ones seen in clinics and institutions throughout the United States are the same found in other first-, second-, and third-world countries. The realities facing cancer, treatments, and patient outcomes are often challenging to address no matter where you live, and it’s one of the many common threads that tie oncology professionals together the world over.

The Philippines, a nation that consists of more than 7,000 different islands, faces challenges and successes unique to their own population, culture, and geography. In November 2017, two ONS members, Susan Weiss Behrend, RN, MSN, AOCN®, and Marlon Saria, RN, PhD, spent time with oncology professionals in Manila, Philippines’ capital city.

They attended an American Society of Clinical Oncology-hosted conference, the Multidisciplinary Cancer Management Course, where they discussed interdisciplinary cancer management techniques and the types of cancers affecting the host country. They also spent time learning from their Philippine colleagues, sharing resources and important educational presentations, and getting to know how the healthcare system works for patients with cancer in the Republic of the Philippines.  

Getting a Firsthand View of the Hospital Systems

Saria and Behrend visited two hospitals during their stay in Manila, one private (St. Luke’s Medical Center) and one public (Philippines General Hospital), and were able to experience the country’s healthcare system at a glance.

“Being from the Philippines originally,” Saria says, “I’m familiar with the country’s healthcare delivery model. One thing that differs from the United States is that there are public and private hospitals. In private hospitals, you can pretty much ask for whatever you want, because you’re paying for it. For public hospitals, unless you’re on a paid ward, there are no appointments. It’s based on a first-come, first-served basis. This includes treatment for patients with cancer.”

Behrend says that the Philippines General Hospital was an older, storied building that was clearly bustling with activity.

“It was apparent that the section of the building where we were presenting was historic in appearance,” she says. “The facility was bustling with staff, patients, and families. We were told that access to care often begins in the early morning hours with patients and families queuing up at 3 am for a clinical slot. This public hospital offers a wide array of clinical services—not limited to just cancer care.”

Behrend and Saria both found that St. Luke’s, the private institution, had a greater availability of resources. They toured several units at St. Luke’s, including the oncology pharmacy, infusion rooms, a women’s health clinic, pain and palliative care department, and an in-patient unit. After visiting both hospitals, Behrend recognized a notable difference in the healthcare delivery of the Philippines compared to her experiences stateside.

“We were informed that very limited or no health insurance exists for Philippine citizens, regardless of economic status,” Behrend says. “All care is given on a fee-for-service basis. In a low-income country such as the Philippines, this can be a major deterrent for access to oncology care. There’s also little semblance of preventive care, and many patients with cancer present with advanced disease.”

Sharing Resources and Education

During their time at the hospitals, both Saria and Behrend gave evidence-based presentations to the oncology staff. Behrend’s presentations, “Caring With Dignity at the End of Life” and “Advanced Practice in Oncology Nursing: A Professional Multidisciplinary Approach,” were well received by her colleagues.

“The audience consisted of nurse generalists, administrators, oncology nurses, and nursing students. My goal was to engage the audience so that they felt comfortable engaging,” Behrend says. “The nurses asked questions that focused particularly on advanced practice roles. The end-of-life talk was pivotal, because many cancer patients in the Philippines present with advanced disease and are taken cared for by families with nursing advice.”

Saria focused his talks on clinical trials, which is still a relatively small field in the Philippines but one he’s hoping will continue to gain support.

“Right now, clinical trial programs aren’t very big in the Philippines, but they do have a good number available,” Saria says. “I could tell by the reactions from staff that awareness of clinical trials is a big issue. Even at St. Luke’s, which offers the most clinical trials comparatively, awareness was low. As a clinical trials nurse, I tried to stress the importance of recruitment, showing how clinical trials are central to getting new drugs to patients. Although trial availability is still relatively small, I think they’re interested in putting an emphasis on these programs in the future.”

Considering the limited availability of resources in the country, Saria emphasized the importance of things like ONS’s Putting Evidence Into Practice resources. The interventions and information therein are free to use and can be implemented quickly. Because patients are on a fee-for-service healthcare model, it’s important to find ways to keep their costs low while also providing the best care possible.

Lobbying for Support and Progress

An old friend of Saria’s helped to schedule a meeting with Eric L. Olivarez, a current congressional representative serving the First District City of Paranque. As former nurse himself, Olivarez is interested in addressing the nursing shortage in the Philippines by supporting better wages for nurses throughout the country.

“The concern in the Philippines is that salaries are so low that nurses seek employment as expatriates in other countries, and therefore the nursing shortage is very palpable,” Behrend says. “Additionally, many nurses remain unemployed and volunteer as nurses while working other jobs, because of low wages and hospitals cutting back on employment.”

During their meeting with the congressman, which was help in a private lounge for political officials, Saria remembers meeting an unexpected guest.

“While we were discussing oncology, nursing, and ONS with Olivarez, the former president of the Philippines entered the room,” Saria remembers. “We were able to briefly speak with her and introduce ourselves. It was very interested to learn about the challenges facing nurses in the Philippines and to meet those who are lobbying for them.”

Join the International Effort

For oncology nurses interested, both Saria and Behrend strongly recommend embarking on international trips like their visit to the Philippines. It’s an educational experience for attendees and their hosts, and it’s a perfect way to recognize the challenges, successes, and overall impact of oncology nurses across the globe. For more information, visit the ONS website to learn how you can be a part of ONS’s international partnerships and programs.

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