Marvin C. Masalunga, a doctor in the Philippines who gave up far more lucrative prospects to serve rural communities, is next up in GHN’s Q&A series highlighting 120 Under 40 leaders. The program, organized by the Bill & Melinda Gates Institute for Population and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health, spotlights the “positive disruptions” made by young family planning champions.
Masalunga currently serves as a deputy municipal health officer in Coron, in the Philippines province of Palawan—an area known as a tourist’s paradise, yet also for its high maternal mortality rate. Masalunga graduated from the University of the Philippines College of Medicine—one of the country’s top programs—yet he chose to work in rural areas, driven by a desire to make population-level change. While caring for patients, he has spearheaded programs for pregnant women, youth development sessions, and counseling for pregnant and postpartum women.
Describe a typical working day in Coron, Palawan, where you are a Doctor to the Barrios.
A typical working day for a doctor to the barrio like me consists of patient consultation and follow ups in the morning. In the afternoon, I usually meet with local government officials and other stakeholders to follow up our programs, which include sanitation, nutrition, and reproductive health. On the days that I am in the field, i.e. far-flung communities, aside from patient consultation, we also do immunizations, prenatal check-ups, and information, education, and communication activities. We also ensure that the communities have enough medical supplies—including modern family planning supplies—to last until our next visit.
What inspired you to work in a rural setting after graduating from the University of the Philippines, and how do you think rural areas could attract more doctors like you?
I was trained in a hospital setting for the entirety of my medical education, and although we get to handle complicated cases, most of the concerns in the rural communities focus on the preventive aspect of health care. The thing about focusing on preventive health care is that we do not just affect individuals, but we make changes at the population level. Admittedly, it is not as lucrative as a hospital-based practice, and what makes it more difficult to fill in the gaps in rural medicine is that most rural doctors are hired by the government—which does not pay much. To entice physicians to work in the rural setting, adequate compensation should be provided, and in areas where safety is a concern, the local government units must ensure the safety of all health care providers.
What are the main reasons behind Coron’s high maternal mortality rate?
A major factor that contributes to the high maternal mortality rate, not just in Coron but in other geographically isolated and disadvantaged areas, is the lack of access to well-equipped facilities and capable health care providers. At times, only 1 general practitioner serves the needs of the entire community. In our case, there are only 2 doctors based in the rural health unit to serve the needs of at least 53,000 people. Another factor is the set of cultural and traditional beliefs that hinder people from seeking modern methods of health care.
What changes did the Reproductive Health and Responsible Parenthood Law bring, and why did it face so much opposition? Is it making a difference?
The Philippines is a predominantly Catholic country. The Church is a very influential force in the affairs of the nation. As the church promotes conservative and pro-life values, the availability of modern birth control methods proved one of the most contentious provisions in the Responsible Parenthood and Reproductive Health Act of 2012 (Republic Act 10354), more popularly known as the RH Law. There is this underlying belief that pills, condoms, and other birth control methods will promote promiscuity among the general population. Another major contributing factor is the misconception that the law promotes abortion, when there is actually no provision in the law that makes abortion legal. The law simply provides that women who have an abortion should not be deprived of adequate medical care.
How do you respond to conservative and religious cultural concerns about family planning in your country; what type of approach do you feel works best?
I find that spending time with families, sitting down and discussing their options, works most effectively in combatting misconceptions. This is the reason why I join as many field visits as possible, because some of our constituents do not even have the means to go to the rural health unit. We may advertise the availability of such services through the local radio station and local bulletin boards, but for as long as their misconceptions remain, they will not avail of such services. It is also an opportunity to provide a holistic approach to health care: by engaging not just the individual but their families and the entire community as well.
This interview has been edited for clarity and length.
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