Doctor Jose Sanchez is a leading surgeon in his field but like thousands of Filipino medics he has had enough and is leaving the country ... not as a doctor but as a nurse.
In a quiet coffee shop in Manila's Quezon City he contemplates his future with two colleagues in a country where the medical system they say is in terminal decline.
The 50-year-old surgeon with 25 years experience as a lung specialist is just marking time.
Sanchez, not his real name, and two other surgeons agreed to interviews on the condition that they were not named or photographed.
Nursing a cup of black coffee Sanchez says the profession today is not the same as the one he entered in 1980.
"It was different back then. Medicine was a respected profession and money was being spent on health care. But what we have today is a health system in terminal decline," he says.
Of the 40 doctors he graduated with 25 years ago Sanchez says over a third have emigrated.
"I don't know of anyone who is happy. It seems like everyone is leaving and the government for it part doesn't see that it has a problem. We are just another statistic among a growing list of professionals who see no future in this country," he says.
Sanchez says a lack of new recruits is reinforcing the problem.
"When I started it was so difficult getting into medical school. The competition was fierce and the top medical schools set very high standards. Today the standards are still high but the medical schools have difficulty filling places," he says.
"The question people ask me is: why? Why, after all the years of study and 25 years of practice am I leaving, not as a doctor but taking a step back wards and leaving as a nurse. I honestly don't see any future in this country and it is easier to leave as a nurse than as a doctor. The demand for nurses far outweighs the demand for doctors."
He says that three of his colleagues, all surgeons, are now in the US as nurses and one is now the medical director of a hospital in California.
Sanchez said his salary averages around 100,000 pesos (US$1,780) a month. That isn't bad by Filipino standards, but the average salary for a nurse in California is around US$4,000 a month.
Sanchez denies his motivation is money.
"I have just lost faith in the ability of our political elites to run the country and run it efficiently. You don't have to be a rocket scientist to see that this country is just marking time," he says.
"It's going nowhere. Look around the region and our neighbors are leaving us behind. Even Vietnam is starting to overtake us," he says.
One of Sanchez' colleagues, a 39-year-old surgeon, agrees.
Graduating in 1993, many of his classmates have left the country, some as nurses and some as doctors for international aid agencies.
"Our politicians have no interest in the plight of doctors in this country. Successive governments have become complacent to the erosion of the health system," he says.
"Working conditions in the public sector are appalling. It has reached a point where doctors, many doctors, are finding it hard to make a living in the provinces where doctors are leaving in droves because they can no longer afford to stay," he says.
"I am not talking about luxury living, fast cars and big salaries. You have to understand that most of this country's 80 million or so population is poor. I have colleagues who have left the provinces, and I must add reluctantly, as they were mostly working for free.
"Doctors have to eat and educate their children too," he says.
A 35-year-old obstetrician who graduated in 1995 says about half of the 300 doctors she graduated with have left, mostly after retraining as nurses.
"Medicine is my life," she says. "I think you enter this profession wanting to make a difference. But here in the Philippines we just don't have the tools to administer quality health care," she says.
"It's pathetic. Pathetic that we have a system where hospitals are closing simply because they do not have enough doctors. I have worked in both the private and public sectors. In government hospitals a doctor can work 14 hours or more a day. The hospital I work in has a 78-bed maternity ward but only 50 beds and it is not uncommon to see three women share one bed," she says.
"In the private sector it is an eight-hour day, one patient a bed and a room. If you have the money, quality health care is not a problem even in poor countries. But having said that, it is getting more and more difficult to find good specialists. Even they are leaving," she says.
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