But health care cost is seen as a particular barrier to many cleft patient families.
It may not seem much, but the cost is already a huge sum for a family such as Arvie’s, which has a maximum of 1,000 to 1,500 Philippine pesos, or around $20-$30, to spend in a week.
The barriers to surgery
Sustainable Development Goal 3.8 seeks to “achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.” It seeks to ensure everyone, particularly the “most disadvantaged population,” gains access to essential health services while being financially protected from impoverishing out of pocket health expenditures.
One of the first things families often ask of the volunteers is the cost of surgery, which may cost anywhere from $1,200 to as much as $2,500 in private hospitals, said Kimmy Coseteng-Flaviano, area director of Smile Train in Southeast Asia.
These numbers don’t yet factor in other related costs, such as the cost of food and transportation. There are patients who come from Philippine provinces who are not able to take advantage of the free surgery offered at PBM, all because they don’t have transportation money, PBM Medical Director Hector Santos said.
Dr. Hector Santos, PBM’s medical director, explains the progress that’s been made in treating cleft lip and/or palate cases in the Philippines, and the work that remains to be done.
While Baras is located just on the outskirts of Metro Manila, it takes three rides via the jeepney — an iconic public transportation vehicle in the Philippines — from there to the PBM Hospital in Diliman, Quezon City, where cleft surgeries are done free for families with little resources. The journey usually takes about three hours, and costs 120 Philippine pesos, $2.29, per person roundtrip.
They have no regular source of income and are dependent on when Arvie’s father has work as a construction worker, a job that is project-based and seasonal. Arvie’s grandfather lives with them, and the father’s meager earnings feed the growing family of six; Santilices is pregnant with her fourth child.
The family budget needs to stretch to cover basic needs, such as food, electricity, and other unforeseen expenses such as medicine. Marjurie, Arvie’s younger sister, had just completed her treatment for deworming. Meanwhile, Arvie appears to be suffering from stunted growth: at 4-years-old, he has the height and weight of a 2-year-old, according to his doctor, Santilices said, potentially due to poor nutrition and bad diet.
At 23, Santilices had already given birth to three children, but her eldest, Uhrie, died of measles last December. Uhrie’s death and her husband’s imprisonment in the past year — after having been accused of theft — has placed a huge burden on Santilices, forcing her to delay Arvie’s cleft operation.
Arvie Papa undergoes surgery to correct a cleft lip at the PBM hospital. He will still need a second round of surgery to correct his cleft palate and may need speech therapy as well.