MANILA — There was no room on the operating tables this week for 64-year-old Apolonia Ramos. So doctors performed her gastrectomy in the hallway of Manila's Tondo General Hospital.
Tondo General is in the heart of one of Asia's worst slums, two blocks away from Manila's main garbage dump. There are no screens on the windows. Filth, soot and bacteria constantly blow into the hallway where Apolonia Ramos' cancerous stomach lay gaping under the surgeon's knife. And, because of shortages, the disposable surgical gloves that the doctor was wearing had been used and reused after they had been washed and hung up to dry in the same filthy air.
But it hardly mattered. When the surgeon found the tumor in Ramos' stomach Monday morning, he realized that the cancer had spread too far for the woman to be saved.
No Doctors in Barrio
Like most unemployed, lower-class Filipinos, Ramos had not been to a physician in years. There are none in her poverty-stricken barrio. When the pain became unbearable, the only care available was at a government hospital, facilities generally so understaffed and poorly equipped that one American relief worker this week called them "the last step before the grave."
That was true for Apolonia Ramos. The surgeon said she had only a few days to live.
Ramos was merely a single statistic in what is fast becoming one of the world's worst--yet least-known--health and medical crises, a nightmare of needless death and chronic disease caused largely by two decades of manipulation, corruption and neglect under deposed President Ferdinand E. Marcos.
According to statistics gathered from the World Health Organization, the United Nations, Philippine government physicians and health officials and several international relief agencies working in the Philippines, tens of thousands of Filipinos die each year simply because there are too few hospitals, too few doctors, too little medical equipment and medicine and too little money to help the government cure its national disaster.
Declined Under Marcos
For years under Marcos, the nation's health was gradually deteriorating into what has now become a seemingly insoluble crisis; yet the danger signs were not only ignored but deliberately hidden by a government determined to show the world that the nation was healthy and strong.
According to documents obtained by The Times and interviews with present and former political leaders, many of the national and local officials in the Marcos administration routinely diverted huge sums of government health-care funds to favorite or political projects.
"They just juggled the funds and then lied," said Msgr. Antonio Y. Fortich, the bishop of Negros Island, where hundreds of children continue to starve to death each year despite millions of dollars in foreign aid that has been pumped into the island.
"In the Marcos regime," Fortich said, "Marcos was very careful not to release the statistics regarding undernourished children. He (Marcos) told the international relief people, 'Nobody is dying here of hunger, so it is better you send your aid money to other countries.' "
Dr. Rodolfo Maceda, now the director of Tondo General and former vice chairman of a national nutritional council under Marcos, said that four years ago he sent First Lady Imelda Marcos a report showing that 20% of the children whom his council surveyed were severely undernourished.
"The next day, the first lady said, 'No, it is only 2%,' " Maceda recalled this week. "That was a signal that we had to be careful with the real statistics.
"During Marcos, there was censorship of our true health conditions. We were told not to show those things."
Aquino Ordered Increases
Since President Corazon Aquino's rise to power a year ago, though, she personally has lifted the lid on one of the nation's best-kept secrets. Aquino ordered immediate increases in health department budget allocations, and appointed a professional secretary of health who is now struggling with still meager resources to re-equip and retrain the nation's medical service.
In the recently approved national constitution drafted by Aquino's handpicked commission, health is specified for the first time as a basic right of the people, and the government is bound by law to "instill health consciousness among them."
The nation's prognosis has slowly begun to improve. Tondo General, for example, which is built on a landfill and is sinking into the ground beneath it, has just received hundreds of thousands of dollars to relocate. Dozens of district and provincial hospitals nationwide have received money for the same purpose.
Health Problems Listed
But the true picture facing Aquino and her technically bankrupt government in the wake of those 20 years of statistical manipulation remains staggering. Here, based on studies and surveys by international aid agencies, private foundations and Philippine government figures, is just a glimpse of the nation's critical condition: