A Tale of Excuses

One Sunday morning a friend of my fiancee asked me if I could do a mini-medical mission in her community. She started a daily morning exercise routine for interested individuals in her community. Apparently those who were in attendance were in the age range of 35-80 years of age. When we arrived in the community they had just finished their daily exercise ( which started at 6AM). The participants started lining up for my mini-medical mission. With me were 2 nurses and 1 midwife (one of them was my fiancee which is a nurse) and they started taking the vital signs before I saw each of the participants. I took their history and did physical examination and gave them present medical condition. Most of them were hypetensive, almost half were diabetics. Of the 40 people I saw, only 2-4 persons had adequate medications with good compliance in taking their medicine. Majority of them had uncontrolled hypertension and diabetes. They had previous check ups with doctors and they were given appropriate medications but they were not able to maintain them. Living in our country, the most common reason for poor maintenance of medication was financial constraints above all else. But you'll be surprised about what each of this individuals say when asked why they couldn't take their maintenance medications.

Take Mr. M (not his real name or initials). He is a 50 something male who was diagnosed with hypertension when he had his blood pressure taken when he went to his local health center. His blood pressure was 170/100. He then sought consult with a doctor and he was prescribed Aspirin, amlodipine, ISMN and simvastatin. Apparently during his check up the doctor elicited symptoms of chest pain and when he was worked up he also had high cholesterol. He took the medications religiously everyday for the next 3 months. He checked his blood pressure and saw that it had gone down to 120/80. He started talking to some friends and told them about his condition. One of them asked if he was taking any medications and he told them. The friend went on to tell him that he was taking too many medications. (Mind you, this friend of his has no medical background whatsoever). This friend of his started telling them about this wonderful product that cures whatever disease a person has. A tea, with different neon color and tantalizing designs for separate kind of tea for some disease. At that moment, Mr. M started taking the tea and discontinued his amlodipine, simvastatin and ISMN because he had never felt better than before. (Totally discounting the fact that he has been taking those medications for three months). When I saw him the first time that sunday, he has been experiencing easy fatigability, shortness of breath and chest heaviness and his blood pressure was 170/100. During the course of the interview, I asked him why he stopped his medications. He said, "I don't have enough money to buy the rest of the medication, but I take the aspirin regularly." He said this with confidence that everything will be fine with the tea and aspirin. Be that as it may, I felt the responsibility to give him more information about his condition and the medications he was taking before. A least he would have an informed decision on whether to continue taking his medication or not. Then I started to get the prices of the medications he was taking. At present, the Philippine Pharmaceutical markets have decent, low priced generic medications that are affordable. All in all, the total of all the medications he was taking regularly was about a hundred pesos ( which is around $2.13). That would be around 3000 pesos per day. I told him thats the cost of all his medications every month comparing it if he did not take any medication and he was hospitalized for an acute myocardial infarction (which is a complication of untreated hypertension plus he has been having chest pains). Each day he would be spending more than 3000 pesos each day and he would stay in the hospital for 5-7 days.Then he started pulling something and voila! The beautifully colored tea. He said he has been taking the tea for the last 3 months and he said he feels great when he just tolde me he has been experiencing easy fatigability, shortness of breath and chest pain. I asked him how much it cost. He said 900 pesos for 7 sachets! 900 pesos! Thats 3600 pesos every month with no approved therapeutic claims! The POWER OF MARKETING AND ADVERTISEMENTS ON THE FILIPINO MINDS! Wow, he is willing to spend for something with no therapeutic claims even if he does not have the money to buy medications with evidence based literature for something that celebrities take on televisions.

So........... is financial constraints an excuse? Maybe for some, but definitely not for others.