“I Too Am a Servant”

It’s a big joke with my family – I didn’t want to move to Manila, 300 miles away, so I got a job in Chicago instead.  But that’s exactly the way it happened.

I was born in Cebu City, on the island of Cebu in the Philippines.  I went to school here, studying nursing.  I got a job in a neighborhood clinic, and later I got a better job at Chong Hua Hospital, one of the best hospitals in the country.  I worked there for fifteen years, while raising my family. I started as a nursing assistant, but after only a short time became an RN.  Within a few years I was moved into Critical Care, and eventually became head nurse of that department. 

Nursing is my career, but it is also what I love.  I believe in my heart that the highest form of expression a person can find is to serve other people.  This is true whether you are a parent, or a farmer, or the president of a country.  Nursing is a wonderful way for me to practice this philosophy. 

The hospital staff always treated me very well.  During the past few years, they knew I was getting bored, and they allowed me to get involved with a number of special projects at the hospital.  A year ago, they even recommended me for a great job at Philippines General Hospital, in Manila. 

I was definitely ready to take on a new challenge – that’s something I need every few years.  And with my mother not well and my daughter approaching the age that she can enter the University, I must also factor in the income potential.  But I could not bear to leave Cebu.  This is our home.

About that same time, a physician from Chicago in the United States was visiting our country, doing volunteer work to help us develop better programs for patients with chronic illness.  We really appreciated his assistance, but it occurred to us during his visit that help can go in both directions. 

His hospital in Chicago had established a chronic care center, with disease management specialists who were assigned to the patients.  As he explained, 75% of all health care expenditures in the United States go toward treatment of chronic medical conditions such as diabetes, asthma, and heart disease.  The chronic care center in Chicago, and others like it around the country, were developing new. more effective ways to help patients with chronic illnesses manage their diseases.

Despite the initial success of the program, it was on the verge of getting cancelled in a round of budget cuts, because the specialists are fairly expensive.  One of our patients here at the hospital, whom the visiting physician met, runs a call center in Cebu. Together, they came up with the idea of locating the disease management specialists right here.  Well, one thing led to another, and I was the first specialist hired in the pilot program.

The goals of disease management are fairly simple: to help people with chronic diseases by providing them with the information, care, advice and encouragement they need as early as possible in the lifecycle of the illness.  Good disease management improves and extends people’s lives, it also lowers costs and it makes the health care networks more efficient and easier to access and use.  In our program, we focus on three diseases:  diabetes, hypertension and congestive heart failure.  My specialty is diabetes, although my cases sometimes include other diseases as well.

One of my patients is Mr. Kowalski, who lives in Oak Park, Illinois, outside of Chicago.  He is 72 years old, and was diagnosed with type two diabetes about four years ago.  He was one of the first patients referred to our program, and the results have been amazing.  One of the interesting – and satisfying – parts of this job comes from the fact that access to proper care is only one part of treating disease.  Mr. Kowalski had total access to the right health care from the start:  his diabetes was diagnosed early and correctly, and the prescribed treatment was perfectly adequate and would have worked well. 

But Mr. Kowalski had some problems that went unnoticed by his health care network.  He didn’t understand, or didn’t want to understand, the seriousness of his disease.  He didn’t maintain the treatment as prescribed.  He had an aversion to needles and rarely checked his blood sugar level, even though the home monitoring equipment he was given is easy to use and virtually painless.

Even in our first session, which was over the telephone, these issues were obvious to me.  I could see that we needed to start with Mr. Kowalski’s attitude and outlook more than his treatment regimen.  But we made rapid progress, and it made such a difference in the way he felt and what he was able to do every day, that within a few weeks he was a model patient.  Now he feels better physically and mentally. He is more in control of his illness and his life.  And, he spends much less of his time worrying about symptoms and monitoring and medication.

Of course, not all of our patients’ stories are that dramatic.  But they all benefit from the personalized care we are able to give them.  And most of them would not have been able to pay for this level of care in any other way.  Plus, the insurance companies and the health care providers are saving money for their organizations at the same time.  So the program is very successful.

The biggest challenge for me in this job is the frustration with not being able to look my patient in the eyes, and feel his pulse, and watch him move.  But I also know that most of these patients could not afford a dedicated specialist at all if it weren’t for a program like this.  And the IT staff are working on better ways of linking us with our patients, so it will be more like actually being with them.  So I am patient, and I do the best I can under the current circumstances.  I have the satisfaction of knowing that I am really helping people who need help badly, and that at the same time I am able to provide for my family.

My salary is a fraction of what the staff in Chicago earns, and yet it is more than I was making before.  The work is not easy, but it is very satisfying and I am happy because I am learning so much every day again.  As our operation grows, I will have the opportunity to broaden my area of specialization and to learn new techniques.  And, because we are a pilot program, they value my input regarding the tools we use and the way the system works.  I am hopeful that the center will expand, and that our success will encourage other similar centers on the island as well.  I know that our government, our business leaders, and even our children are paying more attention than ever to the importance of an educated, motivated population in our country.

Lin, my seventeen-year-old daughter, hopes to enter University next year.  She would like to major in Mathematics, and thinks she would like to teach as a career.  Her cousin majored in physics at the same University and now has a good job tutoring American high school and college students.  Lin thinks she would rather teach in a traditional classroom, but for now she is focused mostly on getting into university.  She is a bright young woman and a good student, and I have high hopes for her if she will stay committed.

My mother, who lives with us, is eighty-two years old.  She has been active all her life, but now struggles with a variety of ailments.  Yet she continues to teach me valuable lessons.  I have learned that although the decline in physical well-being is inevitable, a person’s last years can also be rich and fulfilling, even at times a celebration of a life well-lived. The challenges I see her deal with every day, and her courage and dignity in facing them, provide a perfect role model for me to use with my patients.  And, our experience gives me greater empathy in my work with the families of my patients. 

Well, this is my story: how I avoided moving to Manila by finding work in Chicago, and how I help Mr. Kowalski deal with his diabetes, and how I save up for my daughter, Lin’s tuition, while trying to make life joyful for my mother as her health deteriorates, and to appreciate every day how fortunate I am.  I work very hard, but I know many people who work much harder for much less in return.  So I do feel fortunate.  And I cannot help but feel hopeful for our future:  in Cebu City, in Chicago, and around the world.

I want to finish my story by telling you about a conversation I had with my children’s nanny just last week.  She has been with us for fifteen years, and is the most caring and loyal person you could ever meet.  And yet after all this time, after all she has done for me and for my children, she feels uncomfortable eating a meal with us or attending a party at our home as a guest.

“But Mrs. Rodriguez,” she always protests, “why is it that you treat your servants like family and not like servants?”

Her question puzzles me and disturbs me as well.  I have tried to make her understand:  I too am a servant.  When did that become a bad word?  In the end we’re all servants, it’s just that some of us aren’t very good at it. 

But she just looks at me, and smiles and shakes her head.  She thinks I am naïve, that I don’t understand the way most of the world works.   I do understand that not everyone believes what I believe. Not everyone sees a difference between service and servitude, between submissiveness and submission.  But I do.  And it works for me, and for my household.  It worked on my floor at the hospital.  It works with Mr. Kowalski, and Mrs. Blakely, and Mr. and Mrs. Goldstein.  Maybe it will catch on, maybe it won’t.  In the meantime, my life is richer for living this way, and I will continue to choose this path over any other for as long as I can.

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